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Summer Reading: Health care

by | June 23rd, 2009 | Posted in Blog, Healthcare | Comments (1)

While the arrival of summer has many of us slowing down to a more leisurely pace, in Washington, the debate on health care reform is quickly shifting into overdrive. Several Congressional committees have taken up consideration of health care legislation, with the goal of having completed mark-ups of legislation prior to the July 4th recess. For those  looking for a better handle on some of the key ideas and issues driving the health care debate, here are a few suggested readings to peruse online or download for those quiet hours on the beach:

  • Atul Gawande’s recent New Yorker article, “The Cost Conundrum”, has been widely cited by policy experts and policymakers alike, including President Obama in his major speech to the American Medical Association. Gawande uses the example of  McAlester County, Texas to show that higher spending on health care isn’t correlated with better health outcomes. Gawande makes the case for a system of delivering care in which doctors collaborate to increase prevention and improve the quality of care in a cost-effective manner, as is occurring currently at the Mayo Clinic and several other innovative locations across the country.
  • Gawande and others, notably Obama Budget director Peter Orszag, have been strongly influenced by the Dartmouth study that demonstrates the great variation across regions in Medicare spending and calls for comparative effectiveness research as a major strategy for containing health care costs (see our related blog post on this subject).
  • For a good lay-person’s introduction to the key terms and concepts in the health care reform debate, see the briefs compiled by the Kaiser Family Foundation or the Robert Wood Johnson Foundation.

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Hunger doesn't take a holiday

by | June 22nd, 2009 | Posted in Blog, Poverty & Opportunity | Comments (0)

Recently I had the pleasure of being invited by the Oklahoma Food Security Committee to give a presentation on funding for food and nutrition programs in the stimulus bill.  The meeting featured a superb overview from Liz Tate of the Regional Food Bank of Oklahoma on food insecurity in Oklahoma and the programs that help to supplement the food needs of individuals and families (you can also read the 2007 report of the Oklahoma Task Force on Hunger). Food insecurity – defined as “limited or uncertain unavailability of nutritionally adequate and safe foods” – affected more than one in eight Oklahomans in 2007. Oklahoma’s food insecurity rate of 13.0 percent is significantly above the national average of 11.1 percent.

The economic downturn is creating added pressures on family food budgets and leading to unprecedented demands on both private charities and public programs for food assistance. As we’ve noted in our monthly Numbers You Need bulletins, participation in the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) has increased every month over the past year and has now reached an all-time high, with 450,000 Oklahomans having received SNAP benefits in March 2009. The Committee was reminded that programs like SNAP not only serve a social welfare role, but also have a significant impact on Oklahoma businesses and communities by providing families the resources to buy food at local grocery stores. SNAP payments in Oklahoma exceeded $48 million in the month of March; since then, the stimulus bill provided a 13.5 increase in monthly SNAP benefits.

Children are especially affected by hunger issues, and several programs focus on trying to ensure that children in economically disadvantaged families are adequately fed. The largest is the free and reduced-price school lunch program, which provides meals to children in families with income up to 185 percent of the federal poverty level. Just under 425,000 Oklahoma school children participated in the program in FY 2008, while just under 200,000 participated in the school breakfast program.

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Two stories from the recession

by | June 18th, 2009 | Posted in Blog, Economy | Comments (1)

Sunday’s issue of The Oklahoman featured a compelling report by Paula Burkes on the struggles of several Oklahomans who have unexpectedly found themselves among the ranks of the unemployed, losing long-time jobs and struggling to regain their footing in an extremely unforgiving labor market.  Each of the five profiled unemployed workers are struggling to keep themselves and their families afloat, while hoping that their job prospects improve quickly. In the case of Cindy Mason, who was laid-off four months ago after 29 years working for an Oklahoma City church, the change in circumstance has been abrupt and frightening:

“I’m scared spotless,” Mason, a homeowner, said. Given only two months’ severance, she pulled some money from her retirement account, canceled her YMCA membership and other nonessentials from her budget, is working a temporary job and looking like crazy for employment…

“I don’t want to lose my house, want to pay my bills and keep up my insurance,” she said.

The same day, The New York Times ran an opinion column by Barbara Ehrenreich, the author of the 2001 memoir Nickled and Dimed: On (Not) Getting By in America. Ehrenreich revisits some of the low-wage workers and communities she profiled in her book and finds that, while the media has tended to focus on the emergence of the “nouveau poor” among those who were previously affluent before the recent economic collapse, for the “already poor” and the “always poor”, this recession has been especially tough.  She cites data showing that blue-collar unemployment is increasing three times as quickly as white-collar unemployment, which is pushing many people who were already scraping to get by during the good times right off the cliff of financial stability.

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Hard budget choices remain

by | June 17th, 2009 | Posted in Blog, Budget | Comments (0)

The Tulsa World ran our op-ed laying out the budget challenges that state agencies are now beginning to confront as the new fiscal year approaches:

We won’t know until next June the full impact on public services or our health and well-being, but we can see warning signs. Early indications are that enrollment and usage in the Medicaid program are growing faster in the downturn than the levels provided for in the budget. The Department of Human Services already faces a deficit in the ADvantage program that provides an alternative to nursing home care.

We can expect fewer employees and shorter hours at state parks, museums and other public facilities, and longer waits for driver’s license exams and other services.

You can read our full-length brief on the FY ’10 budget or updated 4-page fact sheet of the main appropriations numbers by clicking here.

Local government mandates–the bad news isn't that bad

by | June 17th, 2009 | Posted in Blog, Capitol Matters | Comments (0)

As we reported last week, the 2009 legislative session was relatively calm for Oklahoma’s local governments. Last week’s post summarized the good news, including some greater control over governance and more land use planning tools. There is bad news, too. Local governments suffered some loss in powers, got new duties without help paying for them, and still hold a big IOU from the state. Other sessions have been worse, though. There is reason for relief in city hall and the courthouse. Here’s the rundown.

Bills that prohibit local governments from acting, also known as preemptions, are among the most serious for local governments, because they can keep the government from responding to demands from citizens. This year’s only example, HB 1473, is a minor one. It exempts agricultural  land 40 acres in size or larger from ordinances restricting land use and building construction when those areas are annexed into a city. This could mean cities can never rezone or restrict buildings on this property, even after it is developed. Here’s the Oklahoma Municipal League’s response, which references an earlier version with an even stricter 10-acre minimum.

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Lottery numbers

by | June 16th, 2009 | Posted in Blog, Budget | Comments (0)

There has been some discussion in recent days about the performance of the Oklahoma State Lottery, including this editorial from The Oklahoman, after the Lottery Commission adopted a budget for FY ’10 that projects $66.6 million in revenues for education for the upcoming fiscal year. This is a slight reduction from previous years, when lottery proceeds have ranged from $69 to $78 million.

Those wishing to understand how lottery proceeds are allocated, track annual revenue collections, and see how lottery revenues have been appropriated in recent budgets, may wish to check out this OK Policy fact sheet [PDF] from last November. It was part of three short briefs [PDF] we produced looking at the new “sin taxes” – the lottery, gaming compacts, and increased tobacco taxes – that Oklahoma voters approved in 2004. The briefs revealed that these three revenue sources raised $286.9 million in FY ’08 for the state dedicated to education and health care: $71.6 million from the lottery, $92.2 million from gaming, and $123.1 million from increased tobacco taxes.

We hope to put out an updated publication once final FY ’09 numbers have been reported.

Guest blog submission: Protecting our natural resources must be a priority

by | June 16th, 2009 | Posted in Blog, Economy | Comments (0)

From time to time, we will use the OK Policy blog to post submissions we receive from Oklahomans who have interesting perspectives on important policy issues for the state. This submission is from Clay Pope, Executive Director of the Oklahoma Association of Conservation Districts and a former member of the Oklahoma House of Representatives.

Isn’t it time we start paying more attention to natural resource issues in Oklahoma?

I know, I know—Many of you are saying, “Why? We pay plenty of attention to natural resources in this state. After all, we are primarily a rural state and agriculture and oil are the two bedrock industries of Oklahoma, so of course we are focused on natural resources.”

Are we really?

Consider this:  In 2007 we had the wettest year on record in Oklahoma history with multiple floods and a freak in-land hurricane that caused hundreds of millions of dollars in damage. The year before that, 2006, was the driest year EVER in Oklahoma history, drier even than the dust bowl years of the 1930’s. Before that, in 2005, we were facing record wildfires, again causing millions of dollars in damage to homes and businesses.

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Child abuse and neglect numbers moving in the right direction

by | June 15th, 2009 | Posted in Blog, Children and Families | Comments (0)

We’re out with our latest Numbers You Need bulletin for June, tracking economic and fiscal trends in Oklahoma and the nation. While the bulletin focuses on monthly and quarterly data on jobs, inflation, work support programs, and the like, each month we present annual data on some indicator of Oklahoma’s general prosperity and well-being. This month we look at the trend in the annual number of confirmed cases of child abuse and neglect in the state. The news is decidedly encouraging.abuseneglect

Last year’s total of 11,714 confirmed cases of abuse and neglect is the lowest this decade. The rate of child abuse and neglect cases – 13.0 per 1,000 children in the population –  is the lowest since FY ’94 and is down 35 percent from the peak rate of 20.0 confirmed cases of abuse and neglect per 1,000 children in FY ’98.

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Behavioral Psychology

by | June 12th, 2009 | Posted in Blog, Financial Security | Comments (1)

Some people might be surprised at the amount of psychology used in our lives. Advertisers have been using the research of psychologists for years. In fact, John Watson, one of the first known successful marketers, actually began his life as a psychologist.

This NPR story is about using the study and findings of psychology and applying them to policy decisions. Rather than using psychology to try and make us buy Fruit of the Loom rather  than BVD, or Pepsi rather than Coke, the research is being used to try and help people save money for the future. Think of the possibilities, psychology used to help make people more financially secure and build net worth instead of used to increase the likelihood of making an impulse buy in the supermarket.

You can listen to or read the complete story through NPR‘s website.

What if we just left health care alone?

by | June 11th, 2009 | Posted in Blog, Healthcare | Comments (0)

Health care reform is in the news. We have the world’s most expensive health care system, but our health care outcomes are not that good and we still leave one-sixth of Americans under age 65 without insurance coverage. President Obama and the Democratic-controlled Congress are making this one of their many top priorities this year.

The possibility of reform raises many troubling questions. Will there be new taxes? Will current employer-provided benefits be taxed? Will government control health care decisions? Will private insurers be run out of the business? Will the federal deficit get even worse?

Whenever we consider significant public policy changes, it is reasonable to ask “What happens if we do nothing?” The Council of Economic Advisers, a White House agency charged with offering objective economic advice to the President, suggests that may be the worst alternative of all. Their new report forecasts the economic effects of health care reform and gives us some insight into the “do nothing” alternative. The Council finds that:

  • Letting costs grow at the present rate stunts economic growth. By 2030, gross domestic product would be eight percent below levels we could expect if we achieve minor–1.5 percent per year–cost controls.
  • Translated into personal terms, a family of four would see about $10,000 less income in 2030 under the current health care system than under one that controls cost growth.
  • Uncontrolled health care costs reduce employment by about 500,000 per year.
  • The current system is inefficient. There is no relationship between cost and health outcomes, and it costs society more to leave people uninsured than it would to insure them. Employer-provided insurance keeps people in jobs when they might have better opportunities elsewhere, and makes it difficult for small businesses to compete with larger ones.

The Council concludes:

The CEA report makes clear that the total benefits of health care reform could be very large if the reform includes a substantial reduction in the growth rate of health care costs. This level of reduction will require hard choices and the cooperation of policymakers, providers, insurers, and the public. While there is no guarantee that the policy process will generate this degree of change, the benefits of achieving successful reform would be substantial to American households, businesses, and the economy as a whole.

Keep in mind that the Council works for a pro-reform president. The report, however, is well-documented and does not advocate any particular reform.

As we learn more about specific reform proposals, most of us will see something we don’t like. Many will vocally and arduously oppose most of the proposals that are offered. As we weigh new options, however, we should never lose track of the risks of leaving the current system alone.