Category Archives: Boring But Important

Housing First

An article in The New Yorker looks at a more effective approach to dealing with chronic homelessness:

In 2005, Utah set out to fix a problem that’s often thought of as unfixable: chronic homelessness. The state had almost two thousand chronically homeless people. Most of them had mental-health or substance-abuse issues, or both. At the time, the standard approach was to try to make homeless people “housing ready”: first, you got people into shelters or halfway houses and put them into treatment; only when they made progress could they get a chance at permanent housing. Utah, though, embraced a different strategy, called Housing First: it started by just giving the homeless homes…

…Housing First has saved the government money. Homeless people are not cheap to take care of. The cost of shelters, emergency-room visits, ambulances, police, and so on quickly piles up. Lloyd Pendleton, the director of Utah’s Homeless Task Force, told me of one individual whose care one year cost nearly a million dollars, and said that, with the traditional approach, the average chronically homeless person used to cost Salt Lake City more than twenty thousand dollars a year. Putting someone into permanent housing costs the state just eight thousand dollars, and that’s after you include the cost of the case managers who work with the formerly homeless to help them adjust. The same is true elsewhere. A Colorado study found that the average homeless person cost the state forty-three thousand dollars a year, while housing that person would cost just seventeen thousand dollars.

Here in the Triad the Greensboro-based Partners Ending Homelessness started a Housing First initiative in February, 2014:

Partners Ending Homelessness, a partner agency of United Way of Greater Greensboro, says the “Housing First” initiative it launched in February is providing access to stable housing to 28 formerly homeless households.

The initiative by the agency, a collaborative effort that includes 80 community partners, was funded in 2013 with a $1 million grant from the Phillips Foundation to address the needs of the chronically homeless.

The agency says it needs to secure roughly $2.5 million over the next four years from public and private sources to expand the program.

The effort in Greensboro is already paying dividends:

The early results reflect the experiences of the first five participants in the year before joining the program and in the six months after joining program.

In addition to paying for a consultant who has worked with other communities, the money has been used to develop an Assertive Community Treatment Team for long-term housing support and case management, the highest level of mental health service available short of hospitalization.

“Although $1 million seems like we are spending a lot of money, the statistics are showing we are saving a lot of money,” said the Rev. Mike Aiken of Greensboro Urban Ministry, one of the partners in Ending Homelessness.

“People are being housed and supported. We were absolutely sold on it.”

The number of emergency room visits also dropped, from eight to none. The cost of housing these people dropped from $30,650 in shelters to $8,927 in rent for their new homes. And the number of nights spent in jail dropped from 28 to none.

Corruption Hurts Us All

It's not often you'll find something everyone should read on a blog dedicated to land use  and zoning law, but Tom Terrell has a great post about what the corruption case involving Charlotte's ex-mayor means for us all:

The only thing that has raised my ire in the aftermath of this sad event has been listening to citizens and pundits take partisan political glee in watching an opposing party member take a fall for corrupt behavior. Shame on all of us who reacted this way.  And shame on others who gloat when public corruption arises, as it equally does, from Republican ranks.

The public office that is defiled belongs to all of us, not to any party or party faction.

It’s easy to repeat the worn adage that power corrupts. What we should remember is that power and self-governance also ennoble us, in large ways and small, as we go about the daily and sometimes tedious business of running our democratic institutions for the people.

Unfortunately, those are the acts and decisions that don’t create headlines.

Tax Incentives ≠ Job Creation

David Cay Johnston has written an interesting article that references studies that show tax incentives do NOT lead to job creation. He also explores why, despite the existence of empirical data showing that tax incentives don't work, businesses continue to get them:

The answer, I believe, lies in three areas:

  • A failure by news organizations to aggressively or even adequately explore these deals, which from my experience would never have survived scrutiny in the 1960s when newspapers were still a mass media read by nearly all homeowners.
  • The success of corporate America in implementing the recommendations of the Lewis Powell memorandum from 1971 urging the U.S. Chamber of Commerce to bring news organizations to heel and thwart consumer advocate Ralph Nader and others. The future Supreme Court justice's memo prompted the creation of institutions such as the Heritage Foundation. Powell took aim at news coverage critical of tax incentives for business, writing that those news reports "undermine confidence and confuse the public."
  • The campaign finance system, which increases the power of the well-off to influence who runs for office and who has the money to become known to the public, and ensures access for donors while reducing accountability to the majority.

 This is particularly interesting reading right now as Greensboro and North Carolina consider getting into a bidding war for Boeing's newest project.

Is Lack of Competition Killing Americans’ Pay?

An interesting article in the Wall Street Journal ties fat corporate profits to a lack of competitiveness in American industry which eventually leads to skimpy worker pay:

Never before have American companies seen so much of their sales drift down to the bottom line. In 12 months that ended in the second quarter, U.S. after-tax corporate profits as a share of gross domestic product, a measure of profit margins across the entire economy, came to 10.9%, according to the Commerce Department. That was the highest level according to records going back to 1929. Nor are there signs of erosion: S&P Dow Jones Indices estimates profits at companies in the S&P 500 as a share of sales hit a high in the third quarter…

Why aren't historically wide profit margins getting competed away? One reason may be that there isn't a lot of up-and-coming competition…

To some extent, the dearth of young businesses reflects an environment in which keeping your day job seems wiser than starting something new. But in a lending environment in which funding for newer, smaller businesses is constrained, many would-be entrepreneurs are willing but not able. Facing fewer newcomers, established businesses have one less reason to spend more on wages and equipment; why put effort into building a moat that isn't needed? This is great for profits but not the long-term health of the economy.

C-SPAN Sports

If you're into Robert's Rules of Order and all things parliamentary procedure-y you'll get a kick out of this. The Republican bloc in the House performed some parliamentary gymnastics to make sure they controlled how/if the Senate's continuing resolution made it to the floor and Maryland's Rep. Van Hollen (D) decided to call them on it. Confused? Welcome to the club, but it's crap like this that convinces the vast majority of Americans that Congress is totally screwed up.

NC DHHS’ Software Armageddon

North Carolina's Department of Health and Human Services (DHHS) is responsible for the launch of two new software systems this year that have experienced significant problems, and things likely will get worse before they get better.

The first problem you've probably heard about: DHHS' rollout of the NC FAST system to handle food benefits, aka food stamps, has been problematic around the state and has led to local agencies working with local food banks to make sure people have access to food until their benefit situation can be straightened out. The problem is that NC FAST is supposed to also handle Medicaid claims as of October 1 and it seems highly unlikely it will be able to do so particularly in light of DHHS' other, less well known software snafu.

Earlier this year DHHS rolled out NCTracks which is a new system to process professional Medicaid claims otherwise known as claims from doctors, medical groups, hospitals and other health care providers. That system is so screwed up that some independent practices have already gone out of business. From an article at charlotteobserver.com:

Karimi, 28, had worked for his parents for the past five years. Their company, Right at Home, had provided home health and personal care to the elderly and people with disabilities in Granite Falls. Karimi handled the billing.

But now Karimi is out of a job and his parents are out of business after a decade. The reason? They weren’t being paid for the Medicaid-reimbursed services they delivered in July and August after the state rolled out its new Medicaid payment system, known as NCTracks…

And it’s not just small providers who are having trouble.

In an interview last week, WakeMed CEO Bill Atkinson said his institution was down $1.5 million since July 1 because of NCTracks. He worried that his billers would have to re-submit all of those claims by hand.

It would be easy to blame the current administration for all this  but the reality is that these systems were contracted long before Gov. McCrory was elected and his folks now have the unenviable task of implementing very complex systems that affect a lot of people. If the response to client issues has been as slow or nonexistent as is being claimed by folks interviewed for these stories then the new administration, and by administration I mean Gov. McCrory's appointees at DHHS, needs to take responsibility and do whatever is necessary to get people the help they need. If they don't we'll be looking at a lot of lost jobs in the health care industry, and in particular we could see some small medical practices under severe stress or maybe even folding.
Glitches happen and anyone who's been through a systems upgrade knows they rarely if ever go as planned, but how an organization responds to those glitches is where the "men are separated from the boys" and right now the DHHS folks look like a bunch of little boys at recess the day after Halloween trying to burn off all the sugar they had the night before.

Poorly Educated Poor White Women Dying Young

From a story in The American Prospect:

Everything about Crystal’s life was ordinary, except for her death. She is one of a demographic—white women who don’t graduate from high school—whose life expectancy has declined dramatically over the past 18 years. These women can now expect to die five years earlier than the generation before them. It is an unheard-of drop for a wealthy country in the age of modern medicine. Throughout history, technological and scientific innovation have put death off longer and longer, but the benefits of those advances have not been shared equally, especially across the race and class divides that characterize 21st–century America. Lack of access to education, medical care, good wages, and healthy food isn’t just leaving the worst-off Americans behind. It’s killing them.

The journal Health Affairs reported the five-year drop in August. The article’s lead author, Jay Olshansky, who studies human longevity at the University of Illinois at Chicago, with a team of researchers looked at death rates for different groups from 1990 to 2008. White men without high-school diplomas had lost three years of life expectancy, but it was the decline for women like Crystal that made the study news. Previous studies had shown that the least-educated whites began dying younger in the 2000s, but only by about a year. Olshansky and his colleagues did something the other studies hadn’t: They isolated high-school dropouts and measured their outcomes instead of lumping them in with high-school graduates who did not go to college.

The last time researchers found a change of this magnitude, Russian men had lost seven years after the fall of the Soviet Union, when they began drinking more and taking on other risky behaviors. Although women generally outlive men in the U.S., such a large decline in the average age of death, from almost 79 to a little more than 73, suggests that an increasing number of women are dying in their twenties, thirties, and forties. “We actually don’t know the exact reasons why it’s happened,” Olshansky says. “I wish we did.”…

Researchers have long known that high-school dropouts like Crystal are unlikely to live as long as people who have gone to college. But why would they be slipping behind the generation before them? James Jackson, a public-health researcher at the University of Michigan, believes it’s because life became more difficult for the least-educated in the 1990s and 2000s. Broad-scale shifts in society increasingly isolate those who don’t finish high school from good jobs, marriageable partners, and healthier communities. “Hope is lowered. If you drop out of school, say, in the last 20 years or so, you just had less hope for ever making it and being anything,” Jackson says. “The opportunities available to you are very different than what they were 20 or 30 years ago. What kind of job are you going to get if you drop out at 16? No job.”

If you were to poll folks here in the Piedmont of North Carolina you would find a lot of people who agree with this premise. We're in the midst of a tectonic shift from a manufacturing-based economy to a knowledge-based economy and there are a lot of people who once made a good living with their high school (or less) education who are now struggling to keep their heads above water. Scary, scary stuff.