Hospitals and the $963 million question
One percent of Medicare funding (almost a billion dollars) will be based upon a quality index. These include benchmarks such as giving aspirin within twenty four hours to heart attack victims as well as patient satisfaction scores. As often is the case, there is question as to whether this is fair to hospitals treating sicker and poorer patients. (The alternatives are to develop statistical adjustments based upon patient population, or to simply allow a participatory sortition judgment to take this into account.)
An experiment where some hospitals were given bonusses showed no difference with hospitals that were not part of the bonus structure. If there is no change in performance, hospitals will get back of the most payment. There is thus too little downside to incentivize change. Bloomberg Business Week page 35 and 36, September 17 to Sept 23 2012.
White House Petition SiteA federal government web site allows one to post and sign petitions. Here are some of them:
|subject||number of signatures|
|The US should go to the metric system||37089|
|disclose information that the government has been keeping secret about exraterrestrial visits||1947|
|FDA should not regulate electronic cigarettes||18503|
|Legalize online poker||9816|
|recount 2012 president election--alleges 'blatantly obvious' fraud||69610|
|recognize American sign languages||32,457|
Obama organized a conference call between those who petitioned for immigration reform and the people establishing policy.
With 25000 signatures, the White House used to guarantee a response--now it is 100,000 for a guaranteed response..
Sign Here -- Please", page 34, by Michael Scherrer> Time Volume 181 Number Five, 2013
Porto Allegre - participatory democracyEach neighborhood has a full town democracy, but they send delgates to a city wide assembly. However, there have benn dramatic improvements:
- sewer access is now 95% , up from 46%
- tax evasion fell--presumably because people felt the money was spent wisely.
- The poorest 12 percent are a third of participants in the assembly
- One in ten citizen have taken part in at least one of the assemblies.
Participatory budgeting in Venezuela and in United states CitiesAlthough this paper emphasizes the progress Venezuela has made in human development--and I suspect many people would disagree with this piece--but that is beyond the scope of this blog. It does talk about 20,000 "community councils" of 200 to 400 families. Some councils have joined to work on larger poblems. Also article talks about Port Allegre participatory democracy, which I do above, and references Mike Fox's democracy "Beyond Elections: Redefining Democracy in the Americas"
And one ward has particpatory democracy spend its alderman's capital budget of 1.3 million dollars with three other alderpersons following. Participatory democracies tend to have more smaller projects than the conventional budgets.
New York City now has eight council persons doing the same thing. Also, see an article in Epoch Times that said that 42 council members still are not using it. Participants identify and debate infrastructure projects at neighborhood assemblies. Then "budget delegates" do the mechanics to get precise costed out proposals. These are voted on by the community--to determine which get funded. People in the area, whether as an employee, resident or business owner can become budget delgates but only residents get to vote in the final decision. Note that this process only does a small sliver of the 9.5 billion that the city spends each year on capital improvents--and the city expense budget is not involved at all.
Referendum on pay ratesSwitzerland referendum just passed-- share holders have binding say on executive pay. Also bans "golden hellos" and "golden good bye" (golden parachutes). There is controversy whether this will discourage companies from coming to Switzerland, or even if it will attract new investment.