September 6, 2011

Back to blogging

It is a new academic year. After a long break, I thought it would be a good time to re-start my blog. While life is not quite as exciting as it was while I was in Washington, DC, things are still pretty interesting here. In future posts, I'll share information on a variety of topics, including the economics, policy, and politics of the U.S. health care system, as well as teaching and current research.

January 28, 2009

Transition time

When the official transition from Bush to Obama occurred on January 20, it seemed so easy on TV. Deterred by the thought of two million people trying to get to the National Mall, I decided it would be more comfortable to watch it from my living room. Behind the scenes hundreds of individuals have been working long hours to make the transition smooth for the Executive Office of the President.

For those of us working under both Administrations it requires a big shift -- new leadership (Christy Romer, Cecilia Rouse, and Austan Goolsbee), new perspectives and agendas, new processes, and a loss of almost all work from the past six months - email, documents, and computer hard drives.

The final days under the Bush Administration were relatively quiet. I got to meet President Bush on his last Friday in office, which also happened to be the day that the 2009 Economic Report of the President was released. The Oval office is quite impressive. It is bright and sunny. Pictures of Washington and Lincoln face the President's very ornate desk. President Bush welcomed each of us, we got a picture, and then he gave a short talk that covered the economic crisis, reflections on his time in office, and his anticipation of returning to Texas.

Since January 20, it has been a steep learning curve. The new leadership is fresh and energetic. CEA is having to re-define its role and in many cases "educate" others in the EOP about what we bring to the table. There is a new Office of Health Care Reform and I hope that I will be able to connect into that group in the near future. It is unclear at present what health care reform ideas will be pushed given the declining economy. In the immediate term, the stimulus package proposes health IT investment incentives for doctors and hospitals to implement EHRs, financial relief for States facing significant budget pressures given rising demand for Medicaid, and reforms to COBRA which include a premium subisidy program to help workers who have lost their jobs and a "buy-in" for up to a 10 year period for certain groups of workers (e.g., those 55 and older and those who have worked for an employer at least 10 years).

It has been an interesting transition. I expect even more interesting things to come.

December 16, 2008

Holidays at the White House

On Saturday, the family had the chance to tour the White House East wing, which is decorated for the holidays. It was just lovely.

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December 14, 2008

In Transition

It is hard to believe that I have been working in Washington, DC, for almost five months. The position I have requires long hours, and those who are permanent staff assure me that those hours are going to get longer.
I am now used to my daily routine of getting up by 5am to work on my own research, followed by taking care of my daughter Sarah, and then heading out the door by 8:30. The day ends when the deadlines are met or 6pm, whichever comes later. Often it is later.

I commute to and from downtown by metrorail and love it, except of course for the occasional "rider delay," which generally means being standing shoulder to shoulder for 40 minutes or so as the train slowly makes its way through the tunnels. I'm afraid that even though my driving skills are pretty good (thanks to those MN winters), I couldn't stomach having to deal with the stress of driving here during rush hour. I really do love my ability to walk out my apartment building door and head into the metro station entrance.

The past five months have given me an education on how policy is made and the interplay of politics with policy. So much is about interpretation and timing. There is also a lot more spinning than I ever imagined. This week I will be concluding my work on preparing the Economic Report of the President and I am happy about that. It is a long process with several rounds of edits from a long list of agencies. Even though it was a lot of work, I enjoyed having the opportunity to read about topics that are outside my immediate interest areas. I am grateful that I have only health care and entitlement programs to worry about. I am looking forward to seeing the Oval Office and meeting the President when he signs it.

We have now entered the period of transition. Practically speaking, that means that we have to prepare ourselves for the fact that we will have two new Members and a new Chair (Dr. Roemer from Berkeley is Obama's selection). It also means that many of those with whom we work outside of CEA will move to other jobs in government or the private sector, and so new relationships will have to be made. Finally, and perhaps most distressing, everything on our computers (email, documents, etc) and our hard copy files will be archived. In many ways, it is like writing the final paragraphs of a novel and then immediately diving into the next one.

September 27, 2008

A very tough week...

Whether you are on Wall Street or Main Street, this was a very tough week! There is a real sense of urgency here, as though a clock is ticking and the longer this takes to broker a deal, the higher the probability of a worse, longer-term economic slowdown. While some of the Council staff are heavily involved in the "rescue plan" legislative activity, many of us simply learn about the issues via the lunchroom table and the media outlets used by the general public. Of course, probably not too many in the general public have their boss going on CNBC in the morning, as happened earlier in the week.

There have been lots of other tasks keeping us busy, most notably work on helping to formulate the US response to a recent OECD document on the need for health care reform and other matters. There is also some new interest in Health Savings Accounts, and health insurance markets more generally. The Kaiser Family Foundation Survey came out this week. The good news is that businesses continue to offer health insurance at roughly the same rates as last year. The bad news is that premiums continue to rise and so do cost-sharing provisions at the point of utilitization. When you sit down and look at the numbers, it is mind-boggling to think we spend more than 2 trillion dollars per year and that providing health care coverage for a family is over $12,000 per year. We need to be addressing the cost and affordability issues.

Hopefully, next week will be a bit less stressful on everyone.

August 27, 2008

A little surprise in the data

Yesterday the Commerce Department and Census released the latest statistics regarding income, poverty, and health insurance. One statistic caught a lot of folks by surprise --- the number without health insurance declined to 45.7 million from 47.0 million in 2007. Interestingly, the first question asked by the press was "what caused the number to fall?" The answer: increases in public insurance -- Medicare, Medicaid, and Military health insurance. Employer-sponsored insurance declined ever so slightly in the past year, while individual health insurance is at an all time low, covering just 8.9% of the population. It will be interesting to see how this outcome gets spinned as health care reform heats up again in the near future.

As for having some fun in Washington, DC, this past weekend Craig and I visited the Newseum, which is located right behind the National Gallery of Art on the Mall. If you like journalism and current events, this is a fun experience. They even have a 4D short movie experience that combines history and entertainment all in one.

August 16, 2008

A History Lesson

The month of August is fairly quiet in Washington, DC. Congress is in recess and many in the Administration are traveling or on vacation. For me personally, it means that I am more likely to get a seat on the Metro going and coming from work and it also means that the pace is slightly more relaxed. This week I had the chance to learn a little history. On Thursday, I toured the Eisenhower Executive Office Building (EEOB). Located on 17th and Pennsylvania, this structure was built between 1871-1888, and housed the State, War, and Navy Departments originally. While the building is still used extensively by the Executive Office of the President (EOP) for conducting day-to-day business, including many of the meetings in which I participate, there are parts that have been under restoration. This week they opened up the Secretary of War's office suite, which had been under restoration for a number of years. It is magnificent in terms of its decoration -- gold leaf, ceiling stencils, and marble. The ceilings also contain glass jewels or rondels. In the suite, they had many war-related items on display -- from canteens of soldiers in the Mexican-American War to a World War I solider's epilets and helmet. This history tour also included some modern events, such as walking through Nixon's second office during his administration and learning about the bowling alley in the basement. And yes, it is still used today by staff!


August 9, 2008

Routine with Variety

It has been a fairly quiet week, as members of Congress are in their districts or on vacation and many senior leaders in the Executive branch are traveling.

This week was spent researching and writing on two main topics: (1) PEPFAR and (2) Health Information Technology.

PEPFAR is the Administration's global health initiative to combat HIV/AIDS in 14 countries, mostly in Sub-Sarahan Africa. This legislation was first authorized in 2003 and re-authorized a few weeks ago. While small in size relative to domestic programs, it is quite significant in terms of targeted foreign aid to combat a specific health problem. Initial evaluations of PEPFAR have been positive with some concerns regarding how budget allocations were tied to specific approaches for prevention (e.g., the "ABC" approach - Abstinence, Be Faithful, and Correct Condom Use). Overall, the assistance has been effective in providing antiretroviral drugs to those infected and helping to care for children orphaned as the result of their parents dying from the disease.

The other key topic of the week was HIT. We really don't know that much in terms of the magnitude of the savings and/or productivity gains that might result from broad IT implementation in hospitals and physician practices. There is a great CBO report that summarizes what we know and what we don't. It also pokes some big holes in the RAND study that provided politicians with the magic number of $80 billion per year in savings if IT was fully implemented and had interoperability. The key message from that report is that estimates rely on assumptions and that anyone who uses numbers ought to be very careful about interpretation.

July 27, 2008

First Week

The learning curve for any new job is steep, but this one is particularly so. It has been awhile since I have had to walk through security to get to my office, and where I am working, we actually have two sets of security.

On my first day, I was escorted to my office. On my desk was a large stack of supplies, an employee manual, and a large stack of forms to fill out. I was told to please start reading. By noon I had my computer identification and by 2pm that day, I had already been given my first task of reviewing testimony of a high-level official in the Centers for Medicare and Medicaid Services (CMS).

The rest of the week has been somewhat quiet, although I have enjoyed having the time to get "up to speed" on a variety of issues - Medicare Part D, Medicare Advantage, Follow-on biologics, Tobacco regulation, etc. Being effective in this position requires one to not only have breadth but also knowing a lot of detail about how the programs are administered. One has to be able to switch gears very quickly. The pace is much, much faster, and as one outgoing senior staff put it, "you are teaching first principles, not running complicated econometric analyses."

I have now had the opportunity to meet and interact with Eddie Lazear, the Chair of CEA, Donald Marron, the Member, several other senior staff, junior staff, and the permanent office staff. There is a culture of mutual support and teamwork here. The staff eat lunch together and knock on each other's door when there are deadlines to meet. I have found them to be some of the nicest and smartest people.

On the personal front, I'm eagerly awaiting Craig's and Sarah's arrival next Saturday. It will be great to finally be together again and start our DC adventure together.

July 19, 2008

Moving and Getting Settled

A week ago tomorrow, my husband Craig and I left the Twin Cities with a U-Haul and our vehicle to head to DC. We drove 25 hours over two days through Wisconsin, Illinois, Indiana, Ohio, West Virginia, Pennsylvania, Maryland, and Virginia. This was my first long road trip and we were pretty tuckered by the time we stopped in MD on Monday night. Tuesday morning we got our first lesson in driving on the beltway, which makes 35W in rush hour seem like a piece of cake. Of course, we discovered that our fun for that day had only just begun, as the density of motor vehicle and pedestrian traffic by our condo made backing up a 17' truck into a loading dock shared by 3 high-rises a bit of a challenge. I had forgotten how aggressive one has to be in situations such as this. My Minnesota-nice was nowhere to be found by that afternoon. Craig and I worked for four hours unloading our possessions and filling our living room with storage containers and cardboard boxes. By that evening, we just crashed.

Wednesday morning we got ourselves to the local Target -- 3.5 miles away but feeling more like 10. The funniest part had to be taking a ticket to get into their gated parking lot. Spend more than two hours shopping and you get to pay. It was almost comical in some ways. Parking is a real problem here and I am so happy that I will be able to use public transportation this year.

Craig is now back in MN with our daughter, Sarah, who had a thoroughly enjoyable week with her grandparents. Apparently, she now has a few more words in her vocabulary, has tried about ten new foods, and has learned to scale all kinds of furniture. Pretty exciting stuff for a one year old. They will be out in early August and I can't wait until they get here.

This is my weekend to rest up, as I expect the first week on the job to be a pretty steep learning curve.


July 18, 2008

Heading to Washington, DC

In April, my professional life made a sharp turn in a direction that was unexpected. After a few phone calls and an interview, I found myself informing my family, friends, and colleagues that I would be moving to Washington, DC for a year to work as a senior economist on the President's Council of Economic Advisers. What an exciting opportunity!

Those close to me can attest to the fact that this has always been a goal of mine ever since I made the decision to pursue a doctorate in public policy at Carnegie Mellon. Although I worked on Capitol Hill and the Department of Justice, those were short internship positions. I still remember my mentor from undergrad meeting with me after my internship with John McCain in 1994 and telling me that I had caught "Potomac Fever."

DC is an exciting place, but I have a different perspective now relative to 14 years ago. Back then, I was just a naive but confident 20 year old who got giddy each time she saw someone famous and was never afraid to ask tough questions to big names, particularly regarding health care issues. Since that time, I've spent much time gaining expertise on issues of health insurance, costs, and quality, and now am in a position to use that expertise in a way that is very different from my conventional teaching and research roles at the University.

I hope to use this blog to share with others what it is like to spend a year living and working inside the Beltway in a position that affords me the opportunity to participate in the policymaking process and to observe how politics influences outcomes. It should be quite an adventure!


September 20, 2006

Where does the week go?

I have no idea where the days are going. I come to work and try to get tasks crossed off my list, but it seems that as fast as I can get them off, more appear. Urgh. Sometimes this feeling of never catching up gets very frustrating.

The weather pattern has shifted. It feels like Fall here in MN. Here it is the third week of September and I am wearing a sweater and lightweight jacket. I do hope this is not an omen for the type of winter we are going to face. At least I now have my husband, Craig, to share in the fun. He seems to enjoy winter and casts an optimism about the fun that the season can bring. Of course, he is from WI and I grew up in AZ. I wonder if there is a correlation there.

September 18, 2006

Working Weekend

I firmly believe that most academics are work-a-holics. It is not uncommon to see at least a few of my colleagues working in the office on Saturday or Sunday to "catch up" on a few things here or there. I seem to find myself there frequently.

When I first started my career as a professor, I used to tell students that being a junior faculty member is much like being a graduate student in terms of the hours, but that one gets paid a bit more. This type of job is one in which you can carry around a task list and think about all there is to do 24/7. Rarely is there downtime. In fact, if you want downtime, you must consciously make an effort to walk away from your work and relax. For me, exercise seems to be the first thing that I lose when my task list lengthens. Each year, I pledge to do better. So far, the intent has outdone the reality.

Of course, I think a lot of academics love what they do. We may grumble occasionally and look really stressed out as we get buried in the piles of paper, but despite all the multi-tasking, there are very few other types of jobs in which one can have as much opportunity to grow and learn.

September 15, 2006

Crime in the ER

The news headlines have been somewhat startling this week. I just noticed on the web a newstory about an individual who was having symptoms of a heart attack, went to a local emergency room, and the nurse triaged the person as being "semi-emergent." After waiting two hours, the ER staff discovered that the person had died waiting to be seen! Now, the authorities are going to determine whether the hospital (and nurse I presume) is going to be held negligent for that person's death. Talk about poor quality care!

Thankfully, I've only had one trip to the ER, albeit a most unpleasant one. I was attending the American Economic Association meetings in San Diego and I was scheduled to present my research. The day before I went to lunch at a restaurant that seemed acceptable, but apparently was not so. Later that day (roughly 4-6 hours) I started feeling poorly and by the time I found myself at the UCSD emergency room, I was doubled over in two and thought I was going to die. Food poisioning is very serious and not fun!

As sick as I was, it was utterly fascinating to observe what goes on in a waiting room of an ER -- who comes in, how people react. Just like the TV show, there is so much individual diversity -- from the health economist with food poisioning to the uninsured patient who had a respiratory virus, to the the prostitute (yes, that really was the case) who was in need of a psych consult. All on a Saturday afternoon.

September 13, 2006

Life expectancy variation: What drives it?

It is amazing to me just how much variation there is in life expectancy -- variation that depends on geographic residence and race among other factors.

In a recent study by Dr. Murray of Harvard's School of Public Health, he released state rankings on life expectancy. Hawaii ranks first with a life expectancy of 80.0 years, while the District of Columbia ranks lowest with a predicted life expectancy of 72.0 years. That is an enormous difference!

What is likely to explain it? The research community asserts that this variation can be explained by a number of factors including chronic disease prevalence in young and middle age adults, income, infant mortality, violence, drugs, and HIV/AIDs. I would think that other factors include access to care, health insurance coverage, and most importantly, lifestyle behaviors -- overeating, lack of exercise, smoking, and alcohol.

I just love it when articles of this sort come out right before I get to teach. It is fun to bring the news of the day into the classroom and to have students recognize that learning comes not only from the classroom but also the world around them.