Exploring Opportunities for Collaboration Between Health and Education to Improve Population Health Workshop Summary (2015) / Chapter Skim
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4 How the Nation's Health Care Expenditures Reduce Education Funding
4 How the Nation's Health Care Expenditures Reduce Education Funding
Pages 41-52
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From page 41... ...
While it is not obvious at first, this pattern is another manifestation of the complicated relationship between health and education. According to research that Orszag has conducted with Thomas Kane of the Harvard Graduate School of Education, a major factor in the relative decline in the quality of public universities has been the falling ratio of spending per 41
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From page 42... ...
During recessions, when the share of state budgets devoted to health care spending increases significantly, states ratchet down appro priations to higher education and raise tuition (see Figure 4-2)
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From page 43... ...
One possible solution to this problem would be to try to mitigate the impact of upward pressures on Medicaid expenditures during slowdowns in the economy, but this would only lessen the impact of the rise in health care costs that, without some change, will continue to account for an ever-growing share of state budgets. "Ultimately, the only way to really get at this problem is to slow the growth rate in health care spending, because without that, you are going to be making sandcastles on the beach, and it is not really going to work," Orszag said.
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From page 44... ...
There are difficulties in making conclusions from these data given that there are likely to be differences between a dropout today and a dropout in 1987, and there are likely to be various other selection effects as well, but the fact that so many data sets reveal this same basic phenomenon at least attenuates the concerns that these trends could be driven by selection effects, Orszag said. "It would be a little odd that the selection effect on lifetime earnings was exactly the same kind of thing with regard to education." Orszag added that the net effect of these growing gaps in disparity means "that we are actually starving low-income kids, not only Percentage Completing College FIGURE 4-3 College completion by income status and eighth-grade test scores.
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From page 45... ...
The good news is that health care spending has slowed dramatically over the past 5 to 7 years. There is a raging debate ongoing about how much of the slowdown was structural and how much was the result of the slowdown in the economy, but evidence from Medicare suggests that the slowdown is not being driven only by cyclical forces.
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From page 46... ...
SOURCE: Orszag presentation, June 5, 2014, citing Miech et al., 2011. biggest increases in unemployment or the biggest decreases in housing prices had zero correlation with the states that had the most significant declines in Medicare spending growth rates." Orszag mentioned recent reports in the media that assert that the slowdown in total health care spending has ended.
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From page 47... ...
That in turn would mean that much of the long-term fiscal gap facing the United States would disappear. "If we could simply perpetuate the growth rate in Medicare spending per beneficiary that we have actually experienced over the last 5 years, then everything that you think you know about the nation's long-term fiscal gap would be wrong," Orszag said.
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From page 48... ...
The only sustainable way of slowing the growth rate in health care over time is by slowing utilization growth rates. That appears to be what is happening." Orszag concluded his presentation by saying that there is a need to pay more attention to policies that can reinforce this trend.
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From page 49... ...
"Running an academic medical center is like captaining an aircraft carrier," he said. "You have got to start turning the ship now, so they are practicing for where they think the payment system will be." Given the possibility of the payment system changing soon, the deceleration trend could be reinforced by policies that provide clarity regarding exactly which payment for value policies are likely to take the place of fee-for-service.
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From page 50... ...
Although a deceleration in health care spending would solve this problem, Orszag said that, as with the states, he did not hold out great hope for a massive new federal public investment in education. George Isham of HealthPartners then asked what Orszag thought of a past Institute of Medicine recommendation that the Secretary of Health and Human ervices declare a target for life expectancy, establish S data systems for a permanent health-adjusted life expectancy target, and establish a specific per capita health expenditure target to be achieved by 2030 with the goal of galvanizing the nation to take action, much as John F
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From page 51... ...
"I'm just nervous about setting a goal at the national level for something not fully under our control," he said. "If a policy maker wanted to go do that, I would stand up and cheer.
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