Time to Act on Health Care Costs

Source: Peter Orszag, Issues in Science and Technology, Spring 2008

Popular discussions of the long-term fiscal challenges confronting the United States usually misdiagnose the problem. They typically focus on the government expenses related to the aging of the baby boomers, with lower fertility rates and longer life expectancy causing most of the long-term budget problem. In fact, most of the long-term problem will be driven by excess health care cost growth; that is, the rate at which health care costs grow compared to income per capita. In other words, it is the rising cost per beneficiary rather than the number of beneficiaries that explains the bulk of the nation’s long-term fiscal problem.

Full article

The Price of Prevention

Source: Josh Goodman, Governing, April 2008

Woody Allen once described death as “a very effective way of cutting down on your expenses.” In the past decade, states all over the country have gone to great lengths to prove that the comedian was not only morbid but wrong. They have embraced the idea that keeping people healthy is both humane and fiscally smart; if the public is healthier, public spending will decrease. And they seem to agree that the way to keep people healthy is to prevent them from getting sick in the first place. They are investing in healthy-diet promotion and anti-smoking campaigns even as they cope with symptoms of diabetes and other chronic illnesses. “We’re trying to drive people to understand that health status is the goal,” says Marcia Nielsen, of the Kansas Health Policy Authority. “You don’t want more medical care and you don’t want more medical insurance, unless they’re a means to an end.”

To some hardheaded scholars and calculating critics, the problem is that, discouraging as it might seem, Woody Allen had a point. A large body of research suggests that preventive care may help people live longer, healthier lives (no small achievement) but doesn’t actually save money. As a result, governments may be forced to come to grips with the notion that, when it comes to health policy, the right thing to do and the thrifty thing to do are very different.

Full article

In the Shadow of Antilabor Law: Organizing and Collective Bargaining 60 Years after Taft-Hartley

Source: Working USA, March 2008

The essays and commentary in this issue mark six decades since an overwhelming majority of Congressional Republicans and Democrats joined forces to vilify and castigate the specter of “big labor” haunting the postwar economy. In June of 1947, the U.S. had a new labor policy when both houses of Congress handily overrode Harry Truman’s presidential veto to pass the Taft-Hartley Act amending the national Labor Relations Act of 1935. Future amendments to federal labor law have not mitigated the fundamental antilabor impact of Taft-Hartley. Despite tumultuous shifts in the U.S. and world economy and the precipitous decline in private-sector union membership, Taft-Hartley’s amendments to the NLRA remain integral to the legal framework for twenty-first-century labor relations. This regime of antilabor law provides the thematic backdrop for the essays and commentary in this special issue of Working USA.

Articles include:
Labor Law Inside Out by Wilma Liebman
Preemption and Civic Democracy in the Battle Over Wal-Mart by Catherine Fisk and Michael Oswalt
More Democratic Than a Secret Ballot? The Case for Majority Sing-Up by Gordon Lafer
Labor’s New Opening to International Human Rights Standards by Lance Compa
The Employee Free Choice Act and a long-Term Strategy for Winning Workers’ Rights by James Pope, Peter Kellman and Ed Bruno

Collaborative Management: A Positive Approach to Public Sector Employee Relations

Source: Thomas J. Calo, HR News Magazine, April 2008

For the public sector HR professional, the challenge is not, as it may be in the private sector, to actively resist or avoid unions. Rather, because of increasing demands for ensuring accountability in government, good customer service, and government effectiveness, the public sector HR professional is challenged with creating positive employee-management relations with unions and individual employees. Public sector agency and HR managers are well advised and well served to continually explore and implement strategies fro maintaining satisfaction and effectiveness among both unionized and nonunionized employees.

Working with Unions in Tough Fiscal Times: A Guide to Labor-Management Cooperation

Source: M. Scott Milinski, HR News Magazine, April 2008

Many unionized organizations in the private sector have successfully responded to the competitive challenge through labor-management cooperation programs. These programs have also been used effectively in the public sector to reinvent and streamline government, saving taxpayer dollars and jobs. However, many jurisdictions have had poor results with these programs. The reasons are fairly simple; labor-management cooperation initiatives usually fail due to lack of proper support, purpose and structure. This article lays out the critical elements for an effective labor-management initiative. Address these issues, and labor-management efforts will be more successful.

Cities in Crisis: A Special Analytic Report on High School Graduation

Source: America’s Promise Alliance

Graduation rates have become a prominent feature in the landscape of high school reform and within the larger world of educational policy. Studies conducted over the past several years have repeatedly demonstrated that far fewer American students are completing high school with diplomas than had previously been realized. Whereas the conventional wisdom had long placed the graduation rate around 85 percent, a growing consensus has emerged that only about seven in 10 students are actually successfully finishing high school. Graduation rates are even lower among certain student populations, particularly racial and ethnic minorities and males.

That same conventional wisdom also suggests that the type of community in which a student lives and attends school will exert a strong and pervasive influence on a variety of educational outcomes. This connection between place and performance applies to both the experiences of individual students and the collective performance of schools and school systems. Striking differences between schools situated in urban and suburban environments, for instance, have frequently been documented in the area of tested achievement. An analysis by the EPE Research Center also shows that high school graduation rates are 15 percentage points lower in the nation’s urban schools when compared with those located in the suburbs. Despite the acknowledged importance of such contextual factors, apart from attention to broad national-level patterns, there has been limited detailed investigation into the connection between where a young person lives and his or her chances of graduating from high school.

This report takes a geographically-informed approach to the issue of high school completion. Specifically, we examine graduation rates in the school districts serving the nation’s 50 most-populous cities as well as the larger metropolitan areas in which they are situated. Results show that graduation rates are considerably lower in the nation’s largest cities than they are in the average urban locale. Further, extreme disparities emerge in a number of the country’s largest metropolitan areas, where students served by suburban systems may be twice as likely as their urban peers to graduate from high school.

Full report (PDF; 1.8 MB)

AAUP Releases Annual Report on Faculty Salaries

Source: American Association of University Professors

After a short-lived recovery in 2006-07, faculty salaries are lagging behind inflation again this year. Yet the salaries paid to head football coaches, presidents, and other top administrators do not seem to reflect an economic downturn. Over the past three decades, the ranks of contingent faculty, nonfaculty professionals, and administrators have swelled while the number of tenured and tenure-track faculty stagnated. These are the central findings of Where Are the Priorities? The Annual Report on the Economic Status of the Profession, 2007-08, released by the American Association of University Professors (AAUP) today. The AAUP’s annual report has been an authoritative source of data on faculty salaries and compensation for decades.
Here are some of the highlights:
• Overall average salaries for full-time faculty rose 3.8 percent this year, the same as the increase reported last year. But with inflation at 4.1 percent for the year, the purchasing power of faculty salaries has declined for the third time in four years.
• Long-term salary trends also indicate a widening differential between the average salaries of faculty members at private colleges and universities and the average salaries of their colleagues at public institutions. When public institutions struggle to attract (and keep) the best faculty, our nation faces the risk of creating separate but unequal systems of higher education.
• The salaries paid to head football coaches at Division I-A universities are ten times as high as the salaries of senior professors. What does this say about the priorities of these universities?
• The gap between faculty salaries and salaries paid to administrators continues to grow. What does that tell us about institutional priorities? This year’s report builds on previous discussions of presidents’ salaries by including data for other top administrators.
• Over three decades, employment patterns in colleges and universities have been radically transformed. While the number of tenured and tenure-track faculty has grown 17 percent, the ranks of contingent faculty (both part and full time) and full-time nonfaculty professionals have each tripled, and the count of administrators has doubled.

Full Report (PDF; 1.2 MB)
Appendix I State tables (for specific institutions) (PDF; 233 KB)
Appendix II Two-Year Institutions without Academic Ranks (PDF; 52 KB)

USDA Releases School Meals Cost Study

Source: U.S. Department of Agriculture Food and Nutrition Service

From press release:
The study compares the cost of producing school meals in the 2005-2006 school year to the total revenue to schools from Federal reimbursements, state and local contributions, and payments by participating households. That year, the average cost to produce a lunch was $2.28 and the Federal subsidy for a free lunch, including cash and commodity food, was about $2.50. Other key findings include:
• On average, revenue generated from reimbursable lunches exceeded the reported cost of production.
• On average, revenue generated from reimbursable breakfasts and a la carte foods did not cover the reported costs for production. As a result, revenue from reimbursable lunches subsidizes a portion of the cost to produce and serve both breakfasts and a la carte foods.
• On average, school food services operated at a break-even level in 2005-06, with revenues equal to costs.
• While most lunches cost less to produce than the USDA subsidy for a free lunch, not all did. For almost four out of five school districts, the average cost of producing a lunch was less than the free subsidy; in the rest, the average cost exceeded the subsidy.
Reported costs reflect all costs that a school food service must cover with the funds they receive. The study also examined the combination of reported costs and other costs, described as “full costs”. School districts do not always charge some expenses – such as time spent by school staff to support the application process and some overhead costs – to this account. There are many factors that may lead districts not to allocate some costs to that account. Since the last study in 1992-93 school districts are charging a higher proportion of these costs to the food service accounts.

Summary (PDF; 31 KB)
Executive Summary (PDF; 270 KB)
Full Report (PDF; 1.32 MB)

Health-Care-Associated Infections in Hospitals: Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on These Infections

Source: Governmental Accountability Office, March 31, 2008

According to the Centers for Disease Control and Prevention (CDC), health-care-associated infections (HAI) are estimated to be 1 of the top 10 causes of death in the United States. HAIs are infections that patients acquire while receiving treatment for other conditions. GAO was asked to examine (1) CDC’s guidelines for hospitals to reduce or prevent HAIs and what the Department of Health and Human Services (HHS) does to promote their implementation, (2) Centers for Medicare & Medicaid Services’ (CMS) and hospital accrediting organizations’ required standards for hospitals to reduce or prevent HAIs and how compliance is assessed, and (3) HHS programs that collect data related to HAIs and integration of the data across HHS. GAO reviewed documents and interviewed officials from CDC, CMS, the Agency for Healthcare Research and Quality (AHRQ), and accrediting organizations.

Full report

Who Will Pay the Cost of Government Employer Retiree Health Benefits?

Source: Harvey M. Katz, Labor Law Journal, Spring 2008

Who will pay the cost of government employer retiree health benefits? The short answer to that question is that the union worker will pay the cost in the form o decreased benefits, higher contributions, and/or fewer union jobs–unless they act now. This unequivocal statement may seem a bit extreme, however, thirty years of experience as a benefits attorney tells me that it is true. As explained below, my reasons for making such an extreme statement are sound and the cost of ignoring the impending crisis will be enormous.