I have been in California for the past week and traveling basically from DC to Chicago, NYC to LA to where I am now in San Francisco since January 14th.
My travels have given me a unique opportunity to compare the dynamics that are happening with the economic realities we are facing from a more intimate local perspective in the cities I have been in.
First off, everyone as expected is concerned about financial realities. It is a part of every conversation and in each business conversation that I have had both healthcare and non-healthcare related, it comes up in context or through more specific content. In each local paper I read, there is some semblance of the economic reality. Hotels are cheaper (good for me) and the appreciation I get for a tip seems to be acknowledged more so than I can recall from past experiences where I have given equal percentages for the service delivered.
Specifically, with my healthcare industry conversations, the over arching theme is the cutting of budgets by hospitals and healthcare systems. In NYC where I visited a hospital in Brooklyn, stretching the dollar for programs related to diversity and cultural competency is not a new thing. However, this particular facility has shown tangible results as far as ROI directly and indirectly through the efforts of its diversity lead; however, the budget to increase initiatives has remained flat and this year has threatened to be cut significantly. What is the rationale?
In Chicago there is a theme of cost cutting as well, but some of the healthcare organizations there are experiencing an increase in Equal Employment Opportunity Commission (EEOC) claims. This is to be expected since the EEOC reports that when the economy is down, discrimination charges go up. A recent Society for Human Resource Management article (January 2009, HR Magazine) quoted The Training Associates marketing director Jeanne Picardi stating that, "Not all senior leaders are familiar with employment law, and may see all training as 'discretionary spending' to be cut. This is a bad idea at any time, and especially in a downturn, because employment law claims increase substantially during a poor economy."
So, while I cannot speak for all of Chicago or all of anywhere for that matter, it is evident that claims will go up and some organizations are taking preventive measures to mitigate the potential circumstances that can result from the current economic reality.
In Los Angeles and in all of California, the talk is on the CA State budget. It is a mess and all Californians are feeling it. From the healthcare industry to retail, jobs are being cut, budgets slashed and consumers are feeling the effects. The effects are coming in decreases in public services (including cuts in public health funding/services), hospital personnel, infrastructure, etc. Not anything different from the rest of the country per se; however, in California there is a conversation in the media that illustrates the dynamics of how the State budget connects to the local economy connects to healthcare that connects to a more profound crisis of deeper, chronic (pun intended) proportions.
Again, I am sure this is happening in most States, but I am not sure about the dialogue being future-oriented given the challenges in the present and the recounting of rationale from the past.
So, where do these chain reactions leave us? First, I think they leave us with a need to turn inward for clarity about what those of us who have the privilege to contemplate the future can do right now to play our role in the collective betterment. This does not exclude concern for our personal and family well-being, but it does require us to look beyond a myopic sentiment of self-interest towards what will create long-term prosperity for many.
Second, we have to stay the course. The money did not "go away". Whatever comes from congress or whatever the banks at some point decide to loan again, we cannot quit moving forward with the focus on growth, not maintenance. Maintenance is death, you grow or you die. If we are maintaining to keep what we have, we will soon see it dwindle. So, whether it be money-wise, health-wise or otherwise, whether we profit, break even, or take a loss, growth has to be at the root of what we do.
If we miss the mark of fiscal profit or better health, we have to sow the seeds and reap profit from our learning about what we missed. If we profit, re-invest in future growth rather than hoard. Gather and store, but let the overflow return to the flow. If it sounds a little Buddhist in nature, so be it. We will see nothing less than the reaping of our labor's fruits of the next 6-12 months. It will seem to arise almost immediately on either continuum. Take note and do what we have to do to not create more suffering from the suffering that we are experiencing individually and collectively right now.
Thirdly, but not last (as I am only sharing snippets) acknowledge that this is temporary and if you act in temporary ways, we will have results based on temporary circumstances. This crisis was created and it can be transformed. It will take the efforts of many to do it. Act based on what you want, not based on what you don't. Either way, we will get what we act upon. Let's act on the greatness that we desire!
Make it a great day!
Showing posts with label California. Show all posts
Showing posts with label California. Show all posts
Wednesday, February 4, 2009
Monday, January 5, 2009
Foundations' role: Drive Change/Policy vs. Fund Research
I found this LA Times article compelling and I think the timing could not be better. Folks, the time for transforming health care is NOW. The window of opportunity has never been wider.
Despite "the finance crisis" and "the credit crunch" the conversation that we can enter into is bolstered by the inclusion of myriad perspectives, participation in the process, and hope that the campaign season created.
Regardless of what political affiliation you subscribe to, we all have a physical body and health affects us all. California is taking the lead we can make mistakes and learn towards new innovation with the most populous and arguably the most diverse state in the Union.
Of course, no one really knows "the solution" but we must do something and we must do something together. . .
Foundations take active role on health policy
January 5, 2009
Reporting from Sacramento — Frustrated that years of financing studies and demonstration projects have not translated into widespread improvement in medicine, California philanthropic foundations and think tanks are shedding their traditionally detached stances to crusade for healthcare reform in the state Capitol and in Congress.
Several of the biggest foundations have established offices in Sacramento and staffed them with experienced former advisors to lawmakers, with the aim of educating legislators to embrace their ideas.
The approach is a notable change in the foundation world, which in the past has maintained an academic distance from the political arena. It is also a delicate endeavor because such nonprofits are barred under Internal Revenue Service rules from lobbying or engaging in partisan politics. With billions of dollars at their disposal, the foundations are seeking to become bigger players.
In November, the California Endowment, a Los Angeles-based foundation with more than $3 billion in assets, announced that it was hiring Daniel Zingale, a senior advisor to Gov. Arnold Schwarzenegger. When he starts later this month, Zingale will encourage policies the endowment favors, including ensuring that all children have health coverage and making doctors and hospitals focus more on disease prevention and the management of chronic ailments.
A onetime AIDS activist and HMO regulator, Zingale led Schwarzenegger's 2007 campaign to expand healthcare to all Californians; that $14.9-billion proposal was rejected by legislators last January.
"We really consider ourselves to be supporting positive change and not just making grants," said Dr. Robert Ross, the endowment's president.
The New America Foundation, a Washington, D.C.-based think tank underwritten by foundations, has crossed even further into policymaking since opening a California office more than four years ago. In 2007, its experts helped Schwarzenegger develop his proposal to expand coverage and promoted it publicly, even appearing at a news conference with the governor. New America's experts can have so much contact with lawmakers that the foundation requires them to keep track of their hours to ensure they do not exceed lobbying limits set on nonprofits.
The California Health Care Foundation, based in Oakland, has taken a less blunt tack since opening its Sacramento office, where it employs a former legislative health expert who helps ensure that the foundation's research topics are relevant to legislative agendas.
"Our view is the Legislature is not facing a shortage of recommendations but a shortage of reliable information," said Dr. Mark Smith, president of the foundation, which has assets of about $640 million.
In 2007, the foundation paid for Jonathan Gruber, an economist at Massachusetts Institute of Technology, to appraise the costs and effects of the healthcare proposals being considered in the Legislature. Lawmakers and their aides relied on those figures in their negotiations.
In an interview, Smith said that the governor and Legislature last year adopted an idea the foundation has supported through grants to ensure that nursing homes and hospitals always know patients' directives about what kind of life-sustaining treatments should be taken when they are seriously or terminally ill.
Sally Pipes, president of the Pacific Research Institute, a conservative think tank based in San Francisco that favors market approaches to healthcare, said foundations risk undermining the credibility of their research by wading into policy deliberations.
"I think that's a bad move for them, because I think they will be really tarred as lobbyists," Pipes said. "I don't think lobbyists have the respect of economists or researchers."
Foundation leaders emphasize they have no interest in direct lobbying and that they promote ideas that are based in evidence, not ideology.
Advocacy is risky for foundations, since most are categorized by the IRS as 501(c) nonprofits, which restricts them from direct lobbying or participation in partisan politics. In the 1990s, Republican senators castigated the New Jersey-based Robert Wood Johnson Foundation, one of the nation's oldest philanthropies, for underwriting a series of forums in which First Lady Hillary Rodham Clinton discussed the Clinton administration's plans for healthcare reform.
But a new generation of healthcare foundations has arisen since then, explicitly charged with advancing more activist missions than those of the older philanthropies started by wealthy families.
"There's been a sea change in thinking," said Leif Wellington Haase, director of New America's California program. "People will realize over time what a big deal that is."
Nationally, 99 new foundations were created when nonprofit healthcare insurers like Blue Cross of California were converted into investor-owned entities, according to the Foundation Center, a New York City-based nonprofit that studies philanthropy. As a condition of regulatory approval, these companies had to set aside a portion of their initial stock sale to endow foundations devoted to improving healthcare.
More than $4 billion in foundation money was devoted to healthcare issues in 2006 by both older and newer philanthropies, according to the Foundation Center
Said Paul Brest, president of the William and Flora Hewlett Foundation in Menlo Park and author of a book on philanthropic strategies: "What I've seen is foundations moving from thinking all we needed to do is support good research in the field and the rest will happen to realizing that unless we are going to support organizations to take the research and try to turn it into policy, then the research is going to sit in the bottom of a pile somewhere."
The California Endowment's entry into Sacramento has been driven by disappointment that many of its pilot projects have shown impressive results yet been ignored by lawmakers, said Ross, its president.
Those include ventures to keep the mentally ill off the streets, extend medical care to children from poor families and help gang members avoid returning to prison.
"We have data and evidence that these programs work," Ross said.
Over the last few years, the endowment has tried to be more sophisticated in how it influences state policy.
Along with four other foundations, including Hewlett, the endowment has financed California Forward, a nonprofit explicitly charged with changing the "outmoded" political structure of the Capitol.
The nonprofit backed Proposition 11, the successful November ballot initiative designed to make legislative elections more competitive and lead to more moderate officeholders.
Now the endowment employs Jason Kinney, a prominent Democratic political strategist, for advice.
In an effort to boost public support for healthcare reform in 2007, the foundation spent more than $10 million on a statewide advertising campaign, community organizing and public forums.
"We are growing weary of experiencing failure on this front," Ross said. He said the employment of people like Zingale "is a trend you'll see more of from our colleagues in the field."
jordan.rau@latimes.com
Despite "the finance crisis" and "the credit crunch" the conversation that we can enter into is bolstered by the inclusion of myriad perspectives, participation in the process, and hope that the campaign season created.
Regardless of what political affiliation you subscribe to, we all have a physical body and health affects us all. California is taking the lead we can make mistakes and learn towards new innovation with the most populous and arguably the most diverse state in the Union.
Of course, no one really knows "the solution" but we must do something and we must do something together. . .
“Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.”
Martin Luther King, Jr.Foundations take active role on health policy
January 5, 2009
Reporting from Sacramento — Frustrated that years of financing studies and demonstration projects have not translated into widespread improvement in medicine, California philanthropic foundations and think tanks are shedding their traditionally detached stances to crusade for healthcare reform in the state Capitol and in Congress.
Several of the biggest foundations have established offices in Sacramento and staffed them with experienced former advisors to lawmakers, with the aim of educating legislators to embrace their ideas.
The approach is a notable change in the foundation world, which in the past has maintained an academic distance from the political arena. It is also a delicate endeavor because such nonprofits are barred under Internal Revenue Service rules from lobbying or engaging in partisan politics. With billions of dollars at their disposal, the foundations are seeking to become bigger players.
In November, the California Endowment, a Los Angeles-based foundation with more than $3 billion in assets, announced that it was hiring Daniel Zingale, a senior advisor to Gov. Arnold Schwarzenegger. When he starts later this month, Zingale will encourage policies the endowment favors, including ensuring that all children have health coverage and making doctors and hospitals focus more on disease prevention and the management of chronic ailments.
A onetime AIDS activist and HMO regulator, Zingale led Schwarzenegger's 2007 campaign to expand healthcare to all Californians; that $14.9-billion proposal was rejected by legislators last January.
"We really consider ourselves to be supporting positive change and not just making grants," said Dr. Robert Ross, the endowment's president.
The New America Foundation, a Washington, D.C.-based think tank underwritten by foundations, has crossed even further into policymaking since opening a California office more than four years ago. In 2007, its experts helped Schwarzenegger develop his proposal to expand coverage and promoted it publicly, even appearing at a news conference with the governor. New America's experts can have so much contact with lawmakers that the foundation requires them to keep track of their hours to ensure they do not exceed lobbying limits set on nonprofits.
The California Health Care Foundation, based in Oakland, has taken a less blunt tack since opening its Sacramento office, where it employs a former legislative health expert who helps ensure that the foundation's research topics are relevant to legislative agendas.
"Our view is the Legislature is not facing a shortage of recommendations but a shortage of reliable information," said Dr. Mark Smith, president of the foundation, which has assets of about $640 million.
In 2007, the foundation paid for Jonathan Gruber, an economist at Massachusetts Institute of Technology, to appraise the costs and effects of the healthcare proposals being considered in the Legislature. Lawmakers and their aides relied on those figures in their negotiations.
In an interview, Smith said that the governor and Legislature last year adopted an idea the foundation has supported through grants to ensure that nursing homes and hospitals always know patients' directives about what kind of life-sustaining treatments should be taken when they are seriously or terminally ill.
Sally Pipes, president of the Pacific Research Institute, a conservative think tank based in San Francisco that favors market approaches to healthcare, said foundations risk undermining the credibility of their research by wading into policy deliberations.
"I think that's a bad move for them, because I think they will be really tarred as lobbyists," Pipes said. "I don't think lobbyists have the respect of economists or researchers."
Foundation leaders emphasize they have no interest in direct lobbying and that they promote ideas that are based in evidence, not ideology.
Advocacy is risky for foundations, since most are categorized by the IRS as 501(c) nonprofits, which restricts them from direct lobbying or participation in partisan politics. In the 1990s, Republican senators castigated the New Jersey-based Robert Wood Johnson Foundation, one of the nation's oldest philanthropies, for underwriting a series of forums in which First Lady Hillary Rodham Clinton discussed the Clinton administration's plans for healthcare reform.
But a new generation of healthcare foundations has arisen since then, explicitly charged with advancing more activist missions than those of the older philanthropies started by wealthy families.
"There's been a sea change in thinking," said Leif Wellington Haase, director of New America's California program. "People will realize over time what a big deal that is."
Nationally, 99 new foundations were created when nonprofit healthcare insurers like Blue Cross of California were converted into investor-owned entities, according to the Foundation Center, a New York City-based nonprofit that studies philanthropy. As a condition of regulatory approval, these companies had to set aside a portion of their initial stock sale to endow foundations devoted to improving healthcare.
More than $4 billion in foundation money was devoted to healthcare issues in 2006 by both older and newer philanthropies, according to the Foundation Center
Said Paul Brest, president of the William and Flora Hewlett Foundation in Menlo Park and author of a book on philanthropic strategies: "What I've seen is foundations moving from thinking all we needed to do is support good research in the field and the rest will happen to realizing that unless we are going to support organizations to take the research and try to turn it into policy, then the research is going to sit in the bottom of a pile somewhere."
The California Endowment's entry into Sacramento has been driven by disappointment that many of its pilot projects have shown impressive results yet been ignored by lawmakers, said Ross, its president.
Those include ventures to keep the mentally ill off the streets, extend medical care to children from poor families and help gang members avoid returning to prison.
"We have data and evidence that these programs work," Ross said.
Over the last few years, the endowment has tried to be more sophisticated in how it influences state policy.
Along with four other foundations, including Hewlett, the endowment has financed California Forward, a nonprofit explicitly charged with changing the "outmoded" political structure of the Capitol.
The nonprofit backed Proposition 11, the successful November ballot initiative designed to make legislative elections more competitive and lead to more moderate officeholders.
Now the endowment employs Jason Kinney, a prominent Democratic political strategist, for advice.
In an effort to boost public support for healthcare reform in 2007, the foundation spent more than $10 million on a statewide advertising campaign, community organizing and public forums.
"We are growing weary of experiencing failure on this front," Ross said. He said the employment of people like Zingale "is a trend you'll see more of from our colleagues in the field."
jordan.rau@latimes.com
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