Last month, in a first-ever effort by the federal government recipients that received Recovery Act funds had to file a report saying how much they had received, what they had done with it, and how many jobs these funds had saved or created.  The reports were due just 10 days after the end of the federal fiscal year on September 30th, and were posted on Recovery.gov just 20 days later.

More than 130,000 such reports were filed.  You can go to Recovery.gov and look them up by zip code, or search for them on a map.  It’s a “real-time” update on your tax dollars at work that is unmatched by any federal initiative, ever, of this scale.

As part of President Obama’s commitment to transparency and disclosure, it’s been a huge success.  When you consider the sheer number of reports that had to be filed, processed, and posted; the fact that this had never been done before; and the very short time to check reports and make sure they were right – the data collected and posted is very impressive.

Unfortunately, it would be hard to know that by reading some of what’s been written and said about recipient reporting.  The Administration has been criticized for pointing out to the independent Recovery Board some erroneous reports that should not have been posted – and for failing to find all the erroneous reports.  Skeptics have raised doubts about reports that show jobs created with no funds spent (although that is possible, as workers are hired in anticipation of projects starting), or funds spent with no jobs created (when materials are purchased for projects that are not yet underway).

Some filers, working with the new system, punched in the wrong Congressional district, and some just got the data wrong.  And about 10% of those folks who were supposed to file a report haven’t filed it yet.

We fully agree with those who find the mistakes in the data frustrating – and we’ve been working with the Recovery Board to find the mistakes, and fix them.   Just because mistakes are inevitable in any new system – especially one this large, and this new -- doesn’t mean they are acceptable.  We are going through the reports with a fine tooth comb, identifying mistakes, and working with filers to correct them.  That said, three big picture points should not be lost.

First, the mistakes are RELATIVELY few, and don’t change the fundamental conclusions one can draw from the data.   Even if as many as 5-10% of the reports or 5-10% of the totals are wrong (and we don’t think it is that high), that still means the Recovery Act saved or created between 600,000 and 700,000 direct jobs in its first seven months – more than most experts predicted when it passed.  And most leading experts agree that – whatever the recipient reported total should be – the actual number of jobs saved or created is about double that, because the recipient reports don’t include direct payments to individuals, the jobs created by Recovery Act tax cuts, and the jobs created when workers on Recovery Act projects spend their paychecks. 

Second, some of the mistakes are frustrating typos and coding errors that don’t undermine information at the heart of the data.   Yes, it is “silly” that Recovery.gov shows that a project went to the 15th Congressional District in Arizona – when there is no such district.  But a “click” on the project details gives you the address, and a check on the address shows it is in Arizona’s 3rd district.  All this shows is that when people send in 130,000 reports, some will have silly mistakes.  But it doesn’t really undermine the ability of the public to track and follow the data – or the fact that real jobs have been created.

Third, transparency is going to be messy – but it is better than the alternative.   It would be great if every report filed was correct the first time, on time, and contained no errors.  But that’s not realistic when 130,000 reports are being filed in a 10 day period.  It would be great if the reviewers at the federal agencies, could have found all the mistakes in the 20 days they had to do the job, gotten the reports back to the recipients to be fixed, and reposted  – but again, that isn’t realistic.  And so, it’s all out there now for the public to see – because the Recovery Act chose speed and transparency as its watchwords – and the result is some data errors for the critics to pick over.  But think about it this way:  What government program has ever even attempted to provide this sort of information, on this scale, this quickly?  In my over thirty years of government service, I can tell you without hesitation:  something like this has never happened before.  In previous administrations, hundreds of billions of dollars have been spent without anyone being asked what happened to the money, being asked how it was spent, or being asked how many jobs were created – and some of the loudest critics of Recovery Act data today were shockingly silent.  And if these questions were asked, answers would usually take months or years to produce.

Last month, something happened that has never happened before.  Critics – some well intentioned, some who just wanted to discredit the Recovery Act -- have had over two weeks to try to make hay with  the data.   But no criticism has come close to discrediting the larger and most important point:  that the Recovery Act has helped save or create more than 1 million  jobs across America and across various sectors of the economy.   The data will get better and better – but in the noise over counting jobs, we shouldn’t lose sight of the Recovery Act’s progress in creating them.

G. Edward DeSeve is Special Advisor to the President, Assistant to the Vice President and Special Advisor to the OMB Director for Implementation of the Recovery Act

It's no secret that institutions of all stripes focus their communications on certain messages day to day. We thought it would all be a little more open and transparent if we went ahead and published what our focus will be for the day, along with any related articles, documents, or reports.

Supporting article: "Health bill foes solicit funds for economic study," Washington Post, 11/16/09

Supporting report: "Health Care Reform: Creating a Sustainable Health Care Marketplace," Business Roundtable, November 2009 (pdf)

Talking Points: Reform Opponents' Pre-Determined "Study"

• Today's article unmasking their plan to pay a "respected economist" handsomely to produce a "study" with predetermined outcomes is just the latest proof that reform’s opponents will not let the facts get in the way of their efforts to defend to a status quo that has been so profitable for the insurance companies.
• This so-called study would be at least the third intentionally skewed report as part of the last-ditch effort to safeguard the insurance companies' bottom line at the expense of the American people.
  • You may recall that last month, the insurance lobby offered an "analysis" that even the company who produced it said was skewed because that’s what the insurance companies paid for.
  • And just days after that report, another insurance company produced a similarly flawed study.
• The only difference this time is that the insurance industry's defenders were caught red-handed before producing their intentionally misleading "study".
• So whenever we finally see this supposed analysis, we should all take it with a huge grain of salt.
• The reality is that health insurance reform will save jobs and lower costs for American businesses, families, and the country as a whole.
• MIT Economist Jon Gruber reports that reform will save about 80,000 jobs in the small business sector over the next decade and could save a typical family thousands of dollars on health care costs.
• And a recent study from the Business Roundtable confirms that the health care status quo is unsustainable and that reform legislation in Congress is moving in the right direction on cost containment and could reduce premiums by $3,000 over the next decade.

Talking Points: Controlling Costs for Families, Small Businesses, and the Government

• From the beginning of this process, President Obama has been clear that health insurance reform must not only provide security and stability for Americans with insurance and affordable options for uninsured Americans, but also slow the unsustainable cost growth that is burdening families, threatening businesses’ viability, and exploding our national deficit.
• Fortunately, the House and Senate versions of reform share a variety of measures that will reduce the rapid growth in health care costs while also providing Americans with higher quality care including:
  • Changing the way we handle hospitalizations, to prevent mistakes and to prevent unnecessary readmissions.
  • Creating incentives in the payment system to reward quality of care rather than just the quantity of procedures.
  • Giving physicians incentives to collaborate in the coordination of patient care.
  • Investing in research into what works and what doesn't in health care.
  • Reducing hospital-acquired infections and other avoidable health-center acquired conditions through rigorous reporting and transparency.
  • Putting prevention first, rewarding care that focuses on wellness and treating the whole patient in an integrated and coordinated delivery system.
  • Tackling the insurance bureaucracy, streamlining the payment system to save time and money that is now spent processing claims and navigating through the byzantine insurance system.
  • Establishing a health insurance exchange with a public insurance option, where individuals and small businesses can buy lower-cost insurance that will spur competition and put downward pressure on costs.
• These measures build upon the significant down payment we already made in the American Reinvestment and Recovery Act to begin switching from paper records to computerized records; to strengthen preventive care; to invest in patient-centered health research; and to build up the workforce of primary care providers.
• And there are also ideas that will further control cost growth that have been proposed and are being looked at as the legislative process continues, such as:
  • A fee on insurance companies offering high-premium plans — which would create a strong incentive for more efficient plans that would help reduce the growth of premiums.
  • Establishing a Medicare commission — which would develop and submit proposals to Congress aimed at extending the solvency of Medicare, slowing Medicare cost growth, and improving the quality of care delivered to Medicare beneficiaries.

In advance of Wednesday's forum on lending to small business and economic recovery, the White House is happy to welcome SBA Administration Karen Mills today for a live video chat. Tune in at 3:15 EST today.

• Watch here through WhiteHouse.gov/live
• Watch, discuss and engage through Facebook

Administrator Mills explained a little more in-depth in a note last week:

A Message from the SBA Administrator on Helping Small Businesses:

A few weeks ago, President Obama asked the U.S. Small Business Administration and Department of Treasury to convene a forum to discuss how we can best get credit flowing to small businesses to help them make it through this recessions, and put them in a position to grow and create jobs.

We’re hosting the forum next week, and I want to make sure that everyone with a stake in our recovery has their voice heard. 

Which is why I’ll be taking your questions live in advance of the event this Monday, November 16th, at 3:15pm EST in a live video discussion through WhiteHouse.gov/live or through the White House's live-chat application on Facebook.

And whether you can make the chat or not, I'd like to invite you to submit a question ahead of time by emailing us in advance.  We’ll post the full video of the chat afterwards.

I’ll be able to share the concerns of small business owners I hear in the chat with the President and Secretary Geithner, at the Small Business Financing Forum and in our conversations and meetings afterwards. 

The President called for this forum because he knows that small businesses are the backbone of our economy, and that they’re driving our recovery.

We want to open the doors and bring everyone who's involved in this historic effort to the table -- from Administration officials and Congressional leaders to lenders and small business owners like yourself – so we’ll also be streaming the conference at live WhiteHouse.gov/blog, Wednesday, November 18th, starting at 9am EST.

Warm Regards,

Karen Mills

As President Obama spoke in Shanghai to four hundred-plus Chinese youth, many thousands more young (and not so young) people throughout China attended the event virtually in classrooms, coffee houses, living rooms, and at “watch parties” organized by the U.S. Embassy and Consulates.   Some events were hosted by Fulbright professors or Chinese exchange program alumni who had taught or studied in the U.S.  Others were organized by Embassy or Consulate contacts.  The vast majority, however, were simply groups of interested Chinese citizens and netizens who tuned in on their own.

As you've heard in some of our travel updates, there are a lot of things you can do on Air Force One. You can use computers, make phone calls, use the Internet. One thing you can't do is avoid surprise birthday celebrations.

Yesterday, Senior Advisor to the President Valerie Jarrett and Deputy National Security Advisor for Strategic Communications Ben Rhodes had a birthday party thrust upon them unwittingly at about 30,000 feet.

Lured into the conference room with the promise of a security briefing, they were instead treated to cake and good cheer by the President and some of his staff. No one was more surprised than myself, who arrived on the scene with my camera too late to film the event, but just in time for some cake. No one was less surprised than Ben Rhodes, who was unconvinced by POTUS personal aide Reggie Love's clumsy promise of "some sort of briefing."

For several weeks the insurance industry lobby has been releasing alarmist reports about draconian health care premium increases that could result from health reform. Despite being roundly and thoroughly debunked, the insurance lobby continues to release these studies and push their bogus conclusion about cost increases.

Wonder why? Because insurance companies can profit from blocking down reform.  A newly identified report from Goldman Sachs looked at the impact of health reform on major health insurance companies and put it in stark terms – insurance company earnings could be cut by 50% over the next decade if the Senate Finance Committee version of health reform passes. The best thing for insurance companies? Maintain the status quo of skyrocketing premiums, soaring profits and a health system that threatens our economy. But according to the Goldman Sachs analysis, insurance companies will also profit if the bills in the House and Senate are watered down and stripped of the key provisions designed to protect consumers and help drive down long-term costs.  

It may be good for insurance company profits to push alarmist conclusions in an attempt to water down reform, but these provisions are vital to achieving the President’s commitment to bringing down long-term health care costs:

• A recent Business Roundtable report confirms that Congress is moving in the right direction on both fiscal responsibility and cost containment.  The BRT-Hewitt report finds that many of the delivery system reform policies that are currently in health reform legislation will make important contributions to cost reduction, when implemented effectively. As the report explains, "[a] number of the proposed reforms offer real promise, not only to save federal dollars, but also to reduce the rate of increase in private sector spending if adopted and implemented appropriately."
• From the beginning of this process, President Obama has been clear that health insurance reform must not only provide security and stability for Americans with insurance and affordable options for uninsured Americans, but also slow the unsustainable cost growth that is burdening families, threatening businesses' viability, and exploding our national deficit.
• Fortunately, the House and Senate versions of reform share a variety of measures that will reduce the rapid growth in health care costs while also providing Americans with higher quality care including:
  • Changing the way we handle hospitalizations, to prevent mistakes and to prevent unnecessary readmissions.
  • Creating incentives in the payment system to reward quality of care rather than just the quantity of procedures.
  • Giving physicians incentives to collaborate in the coordination of patient care.
  • Investing in research into what works and what doesn't in health care.
  • Reducing hospital-acquired infections and other avoidable health-center acquired conditions through rigorous reporting and transparency.
  • Putting prevention first, rewarding care that focuses on wellness and treating the whole patient in an integrated and coordinated delivery system.
  • Tackling the insurance bureaucracy, streamlining the payment system to save time and money that is now spent processing claims and navigating through the byzantine insurance system.
  • Establishing a health insurance exchange with a public insurance option, where individuals and small businesses can buy lower-cost insurance that will spur competition and put downward pressure on costs.  
• These measures build upon the significant down payment we already made in the American Reinvestment and Recovery Act to begin switching from paper records to computerized records; to strengthen preventive care; to invest in patient-centered health research; and to build up the workforce of primary care providers.
• And there are also ideas that will further control cost growth that have been proposed and are being looked at as the legislative process continues, such as:
  • A fee on insurance companies offering high-premium plans — which would create a strong incentive for more efficient plans that would help reduce the growth of premiums.
  • Establishing a Medicare commission — which would develop and submit proposals to Congress aimed at extending the solvency of Medicare, slowing Medicare cost growth, and improving the quality of care delivered to Medicare beneficiaries.

Nancy-Ann DeParle is the Director of the Office of Health Reform

According to the Centers for Disease Control and Prevention (CDC), over 56,000 Americans become infected with HIV each year. A lot needs to be done to halt the HIV epidemic in the U.S. and, thankfully, we have effective tools at our disposal.

Chief among these tools is HIV testing. CDC estimates that 21% of people living with HIV are unaware of their HIV status.  You might ask how this is related to stopping the HIV epidemic. Well, many studies have found that HIV-positive individuals who know that they are HIV-positive change their behavior to reduce the chance of transmitting the virus to their HIV-negative partners.  People who are infected with HIV but don’t know it are at high risk of unintentionally placing HIV-negative partners at risk for HIV infection.  The result is that a greater number of new HIV transmissions in the U.S. each year stem from people who do not know that they are HIV-positive. If we scale up HIV testing, then we can reduce the number of individuals who are unaware of their HIV infection and possibly also reduce the number of annual HIV transmissions.

We can also do more to help people who are diagnosed with HIV to get connected to appropriate health care services.   Besides prolonging the life of people living with HIV, HIV-positive individuals on antiretroviral therapy (ART) are less likely to transmit HIV to an HIV-negative partner. Increasing the number of people with HIV who receive regular care will help extend their lives, reduce the likelihood of late stage diagnoses (which is especially common among racial/ethnic minorities), and possibly reduce the number of new HIV transmissions.

So, why aren’t people getting tested regularly for HIV or accessing services once diagnosed? There are many complicated personal, financial, and other reasons that affect a person’s decision to get tested for HIV or to access HIV services after diagnosis.  Federal, state and private health insurance policies can also deter people from seeking HIV-related preventive or treatment services. 

The White House Office of National AIDS Policy (ONAP) has commissioned the Institute of Medicine -- the independent health arm of the National Academy of Sciences that provides unbiased and authoritative advice to decision makers and the public -- to examine federal, state, and private health insurance policies that 1) serve as barriers to HIV testing or 2) inhibit entry into clinical care or continuous and sustained care.  We know that providing clinical care for HIV-positive persons is complicated by the fact that fewer providers are choosing to specialize in HIV care.  Even if we get more people tested for HIV or into health care services, it is a problem if there are fewer health care providers available to provide these services for the long-term.  We have also asked the Institute of Medicine to examine policies that may help increase the number of health professionals providing HIV care.

To get the process started, the IOM will select a panel of 15 subject matter experts who will plan a series of workshops that will address questions in each of the following 3 areas:

1. HIV testing and federal, state, and private health insurance policies: Relevant questions include: What current federal and state laws or private health coverage policies impede HIV testing? What has been the impact of opt-out HIV testing?  What effective HIV testing methods can be used to reach at-risk populations?
2. Health care system capacity to administer a greater number of HIV tests and to accommodate new HIV diagnoses: Relevant questions include: Where do HIV-positive patients currently get care? What is the training of most HIV care providers? What capacity is there to absorb newly diagnosed HIV-positives as a result of expanded HIV testing services? What are the impediments for professionals entering into AIDS care and being retained? Are there ways to incentivize HIV/AIDS as a specialty among the health care professions?
3. Federal and state policies that influence entry into clinical care and the provision of sustained care: Relevant questions include: How can federal and state agencies provide more integrated HIV care services? What policies promote clinical care services among agencies at the federal level, state level or between state and federal agencies? What are federal and state agency policies in funding HIV medication adherence programs?

A summary report from the each of the workshops on these three topics will be released in March 2010, May 2010 and September 2010, respectively. Information from the reports will help inform the implementation of the National HIV/AIDS Strategy and will complement ONAP’s other activities. Stay tuned... 

Greg Millett is Senior Policy Advisor in the Office of National AIDS Policy

"And when all is said and done, part of why I believe so strongly in reforming our health care system is because of the difference it will make for these women who gave us life -- so simple -- these women who raised us, these women who supported us through the years" -- so said the First Lady in explaining why she wanted to speak about how health insurance reform will affect older women in America.  She followed several other women who were willing to share their difficult and even tragic stories dealing with the status quo, and thanked them for speaking out.

The First Lady has spoken before about the many ways in which reform will benefit women in particular.  And as for the impact on all Americans as they become seniors and rely on Medicare, the Vice President gave the scare tactics propagated by defenders of the status quo the contempt they deserve.  The First Lady made sure to cover all of that ground again, but also made the point that older woman have their own specific circumstances:

And I don’t think anyone here will be surprised to learn that a recent study found that one-third of all women have either used up savings, taken on debt, or given up basic necessities just to pay their medical bills.  And as many of you know firsthand, these kinds of problems -- the problems of coverage and cost -- only grow worse when you get older, making quality, affordable coverage harder to come by just -- as we’ve seen today and heard today -- just when you need it the most.

In the individual market, people in their early 60s are more than twice as likely to be denied coverage than people in their late 30s.  Older women are more likely than men to face a chronic illness, but they’re less likely to be able to afford the cost of treating that illness.  And in recent years, studies have shown that women over the age of 65 spend about 17 percent of their income on health care.  And that’s just not right.

Our mothers and grandmothers, they have taken care of us all their lives; they’ve made the sacrifices that it takes to get us where we need to be.  And we have an obligation to make sure that we’re taking care of them.  It’s as simple as that.  America has a responsibility to give all seniors the golden years they deserve and the secure, dignified retirement that they worked so hard to achieve.  (Applause.)

While getting ready to do this taping with Jon Favreau, the President’s Chief Speechwriter, my Blackberry was buzzing in my pocket, carrying new instructions for a motorcade movement, pushed up by over 2 hours. What was going to a leisurely stroll to find the perfect location for our Japan update, became a scramble to secure a suitable section of the lobby.