Archive for October, 2007
Ever get that feeling that you were doing just that, without really paying attention to the world around you? Apparently the Legislature sometimes has the same problem:
…lawmakers, meeting in an informal House session, recited the Pledge of Allegiance. Halfway through, they realized that the flag they were pledging to, normally propped up above the rostrum in the rear of the chamber, had been taken down…
From State House News Service (sub. req.).
October 31st, 2007
But fewer younger, healthier people are joining the state’s workforce to defray the costs incurred by the older, sicker population.
Thus spake the Boston Globe this morning and their assessment is correct. The Commonwealth’s population is stagnant. We are losing young workers even as we gain dependents. Their focus, however, is another matter.
We must begin with the fundamental question, which in this case is: Why are so many young workers leaving the state? The easiest answer to that question is the high cost of living. And, yes, double digit increases in health insurance premiums are part of the problem. Its crux, however, is not health insurance; it’s housing. We should be focused on ways to reduce the cost of housing in Massachusetts. Only in that way will we be able to entice the young and the healthy to stay here.
Which brings me to the title of my post this morning. What is a dependency ratio? It’s simply the ratio between the number of people in a given pool who are of working age and those who are not - children and the elderly. A dependency ratio can be calculated for a country, a company or, in this case, a Commonwealth. Last year in the New Yorker, Malcolm Gladwell explored the implications of dependency ratios for companies such as Bethlehem Steel and GM. Despite enormous increases in productivity - GM makes more cars today with 1/3 the workforce than it did at its supposed height in the early 60s - GM is being eaten alive by its dependency ratio. The lessons for the economy of a state whose dependency ratio is fast approaching GM’s are not happy ones. We need to sit up and take notice before we become GM to North Carolina’s or Texas’ Toyota.
October 31st, 2007
Mr. Robert Goulet, the pride of Lawrence, died yesterday. You may be more familiar with his work in Camelot and Man of La Mancha, but for those of us weaned on ESPN, he will always be remembered for the series of faux-lounge college basketball commercials he made during the 90s. Pure genius.
October 31st, 2007
Ever heard of the “Heart Law“? It says that certain public safety officers who develop hypertension or heart disease shall be assumed to have developed said condition in the line of duty and puts the burden of proof on the employer to demonstrate otherwise.
There is currently legislation wending its way through the Legislature, in informal session, with no debate or roll call votes, that will extend this law to county corrections officers.
I don’t know if its a good law or a bad law. But our 2006 report on pension costs prompts me to ask the following questions:
1) How much will this bill add to the pension liability? and
2) Who will pay for it?
Wait, I think I know the answer to number two.
October 30th, 2007
A recent op-ed in the LA Times calls for certain medications to be prescribed by pharmacists. This suggestion is on a continuum with a few other ideas that move select portions of medical practice from its traditional delivery mode to more convenient and cost-effective (but still clinically rigorous) modes. Increasing the practice rights of nurse practitioners and allowing Minute Clinics are ideas along these lines.
The gist of the idea is that for certain medications, it is a appropriate for a pharmacist to prescribe directly to customers who come in and complain of specific symptoms. This should be familiar to anyone whose ever gotten mildly ill in Europe — where the practice is widespread.
Although this seems like common sense, you can sure that the various state medical associations will vigorous protect the existing system.
October 30th, 2007
The prospect for dynamic reform on Beacon Hill seemed slight a week ago. New initiatives seemed to be breaking down in a familiar pattern — Governor proposes ‘bold, new’ (expensive) initiative, Legislature promises ‘careful, in-depth’ review (and plenty of revisions.
Then, Senate President Murray gave her speech at Wednesday’s Greater Boston Chamber of Commerce meeting. She proposed the following:
1) Public hearings to document the causes of premium increases above 7 percent
2) Realigning of payment methodologies to encourage quality and efficiency, not just the volume of services provided.
3) Increased recruitment of primary care providers
4) Allowing nurse practitioners to serve as PCPs for some patients
5) Permit “limited service clinics” proposed by the Department of Public Health.
6) Expanding the certificate of need process to include all medical care facilities
Now, Pioneer is not necessarily in favor of all of these (although 2,4, and 5 are particularly attractive). But we salute the Senate President for her willingness to break through the guardrails of the polite debate (Better healthcare at lower cost? Sign me up!) and gore the ox of pretty much every stakeholder with these ideas.
Thus far, the reaction seems pretty good. Charlie Baker of Harvard Pilgrim appears to approve. As does Paul Levy of BIDMC and the folks at Healthcare for All.
October 25th, 2007
The Governor has frequently talked about his openness to lifting the cap on charter schools, but only with a financing fix, which certainly means reducing the funding to charters below the average per-pupil expenditures within the district school system. Say community X spends $10K per student in the traditional district schools, the new formula would halve that amount for parents of kids in the district who choose to go to a charter school.
That’s what the Massachusetts Association of School Superintendents and Mass Association of School Committees want. The Governor has shown openness to this view, which of course makes charters financially unviable.
I’ve often wondered about this proposal given all the court cases out there pushing for equitable funding of schools (and more recently discussions around “adequacy”).
Shouldn’t charters have equitable funding? What about vocational-technical schools, and other types of schools where parents opt-in?
Hello? Maryland calling Massachusetts. Anybody home?
Over the summer the Maryland Court of Appeals settled an instructive matter on just this topic. According to WTOP News,
Last academic year, the Baltimore school system’s budget contained the equivalent of more than $13,000 per child for public school students, though not all of that was spent directly on children. Charter schools received $5,859 per child in cash and the rest in services.
Sounds like the MASS and MASC view of the world. In a 5-2 majority vote, the MD CoA determined that MD’s charter schools students are “entitled” to the same level of funding as district schools.
So, going forward, Baltimore district schools will get $13K per student and so will charters.
Someone tell me, why do we keep reverting to ugly conversations–conversations reminiscent of a terrible history when we accepted unequal rights, when that was thought OK?
Anybody want to bring a lawsuit on this, if the “fix” is in, in Massachusetts? If there is a move to shortchange charter students, I’ll guarantee you there will be one and the MD CoA decision will be a very interesting part of the discussion.
We’ll win.
October 23rd, 2007
As much of the Sun Belt dries up, we may have to revise our tally of regional economic advantages.
For generations we’ve been told to flee the Northeast for some air-conditioned car-ported open-shop Elysium. Today, though, the Quabbin Reservoir is making me feel like an early-’70s Alaskan. If we get our water-policy act together, the Commonwealth’s natural resources may, for the first time since the whale-oil days, actually give us a competitive edge.
Please, though: no pipelines.
October 22nd, 2007
support the Massachusetts Health Care Reform?
We get the question all the time, especially from other think tanks and national press outlets trying to figure out what this all means as the presidential election starts to show signs of life. (When presumed frontrunners of each party start hammering on each other, you know the line-up is soon to winnow down.)
At the end of the day, Pioneer supports whatever will lead to better health care outcomes and contain the rising cost of care. It’s an empirical question, or to put it more colloquially, the proof is in the pudding. And anyone who’s been an in-patient knows it’s hard to be patient with what passes for dessert in the hospital. (Do you think the quality of care can be correlated to the quality of the food?)
Increasingly, I am concerned about the “mandate.” Especially as 2008 approaches, whereafter the moratorium on mandates is lifted.
Look, mandates means you have to define what it is you’re mandating–the so-called minimum benefits package. Over time, because of political pressure and the fact that there is only a diffuse constituency to play opposition to new mandates (taxpayers), that minimum package will grow and the mandates will become a huge cost-driver. From my conversations with advocates, this could happen fast.
Just imagine the lobbyists lining up to ensure that obesity pharmaceuticals, lasik surgery and hair transplants are among the mandates. Folks, I’m kidding (kind of), but you get the picture, and it’s not a pretty one.
I can see the next gubernatorial debates coming to a head when a major party candidate known for his bare pate removes his toupee to show, yes, a mane every bit as full as Gene Shalit’s.
“Together we can have a bad hair day!” will be the mantra suffused with empathy for others. Uh, no thank you.
October 22nd, 2007
Brunch in Boston - or anywhere really - is a time to get caught up and let the conversation meander. No policy or politics this morning. Just some thoughts on kids, grey hair and Engelbert Humperdink.
My brunch partner has an issue with America and its cultural decline. I know this is a broad and ugly topic, and it has gotten to the point where some blame our cultural loss for the Islamic Fundamentalist movement’s fire.
Guys, I don’t get it. I mean, my sausage, yogurt and fruit (not a traditional mix, I know) was accompanied by Tom Jones over the wire. First we got the oldies-but-goodies like “What’s new pussycat?” with its deep refrain of
Pussycat, pussycat, I love you.
Yes, I do, you and your pussycat eyes.
What’s new pussycat, whoa-whoa-whoa.
Then came “my, my, my, Delilah” blaring its faux Mariachi horns. Then Tom’s, uh, delightful cover of a Talking Heads song. Now, Tom was my mother’s favorite, or maybe second favorite right after Engelbert Humperdink. As a first-generation Syrian, she was a lousy speller but could spell EH’s name — and that was a mouthful. (Perhaps a good MCAS question?) And the Talking Heads were a favorite of mine. (I like big suits and can’t sing.)
For the first time I was jealous of my daughters’ generation — and hopeful for the future. They’ve got to be able to come up with something better than Tom Jones, EH, and the Talking Heads. How can we talk about a decline? I have great confidence in my kiddos to do better.
If you are hungering for Humperdink, please do not hold yourself back. Click here where you can “Link to Humperdink,” as his official site proudly urges. Oh, yeah, why doesn’t he have grey hair?
October 20th, 2007
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