As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend – counting both public and private money – more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%.
Yet in another decade or so these figures may look small. In 2015 around 14 million Americans needed long-term care. That number is expected to hit 22 million by 2030. There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care.
There are two million home health aides in the U.S. They spend more time with the elderly and disabled than anyone else, and their skills are essential to their clients’ quality of life. Yet these aides are poorly trained, and their national median wage is only a smidgen more than $10 an hour.
The reason? State regulations – in particular, Nurse Practice Acts – require registered nurses to perform even routine home-care tasks like administering eyedrops. That duty might not require a nursing degree, but defenders of the current system say aides lack the proper training. “What if they put in the cat’s eyedrops instead?’ a healthcare consultant asked me. In another conversation, the CEO of a managed-care insurance company wrote off home-care aides as “minimum wage people.”
There is little doubt that the Trump Administration aims to undermine, defund, and repeal much of the progressive agenda. However, progressives have one crucial move they can play to avoid four years of devastating policymaking: using Trump’s own voters against him.
Donald Trump’s Electoral College victory was in no small part due to the support of voters who suffered immensely during the Great Recession and who have still not recovered. Two thirds of all voters thought that their personal financial situation was the same or worse than four years ago and in Wisconsin, where Trump achieved an unexpected victory, the majority of voters believed that the economy was the top issue, despite official indicators of an improving job market.
Trump now faces a paradox. Many of the core elements of his agenda—loosening financial regulation, gutting health care reform, bashing immigrants, attacking unions, undermining the Fair Labor Standards Act—will actually damage the struggling workers and families he pledged to protect. Many of these people voted for Trump in hopes he’d fulfill that promise –even as his policies would do the opposite. So while the Trump Administration may be driven by its ideology to follow through on these proposals, its ultimate success depends on support from voters who would suffer under them.
When people talk about middle managers, certain characterizations inevitably come to mind: gray-suited corporate drones bitter about being relegated to the sidelines of corporate power; middling bosses who don’t particularly care for their subordinates; overlooked paper-pushers eager to clock out at the end of the day.
None of these depictions are flattering; none of them are accurate either. According to my latest research, which involved analyzing over thirty years’ worth of employment data and conducting many interviews with mid-level managers and senior leaders across dozens of companies, middle managers are central, indeed crucial, to an organization’s success. My research shows that middle managers are, for the most part, thoughtful, strategically-minded individuals who have a strong commitment to their jobs, are highly engaged with their colleagues, and gain real pleasure from their day-to-day work.
In the book (and now film) Moneyball, general manager Billy Beane transforms the Oakland Athletics by recognizing that overlooked players contribute value to a team. He overturns conventional wisdom, indeed upends baseball’s domination by wealthier teams,by using data to measure performance. What he learns can also apply to the economic challenges we face today.
When people think and write about what leads to economic success, they too often focus only on the most visible, highly paid players. In the case of the economy, it is the CEOs. The business press is full of praise for celebrity leaders such as Jack Welch and Steve Jobs. But even when the CEO is not movie-star famous, stories about whether a firm will succeed or fail usually focus on the personality and actions of the person at the top.