Real World Economics: Econ 101 explains district budgeting dilemmas

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Edward Lotterman

The St. Paul Public School District’s need to close a projected $100 million deficit for the coming year, discussed in recent weeks, is not unique.

Similar situations prevail for school districts large and small across the state.

Moreover, the same underlying problem is hitting many other institutions, including churches, scout troops and American Legion posts.

The phenomenon is more than nationwide. Other industrialized countries face it as well, especially in Europe. For economics teachers, it illustrates at least two important introductory principles, plus several others.

One is “age structure of a population.” This deals with how all the persons in specific jurisdictions, from nations to states, cities and school districts, are divided by gender and into various age groups.

The “population pyramid,” a graphic device shaped somewhat like a Christmas tree, is a quick way to convey this demographic situation. It basically is two bar charts, male and female by age, placed back to back vertically. A quick look illustrates when there were large or small birth groups. The wider the bars, the more people there are in the population of that age, the narrower the fewer. An excellent explanation can be found by clicking here.

The second topic, that of “cost curves of the firm,” is foundational to all “production economics” dealing with how goods and services are produced, whether for profit or not.

Now, let’s apply these two principles to real-world situations.

On the first topic, consider that public school districts, congregations, rural clinics, 4H clubs and so forth all struggle with the fact that our population is aging. Even though the populations of our nation and state are higher than ever, the fractions of these populations that are of ages for schooling or for youth activities are smaller, relative to the general population, than they were a generation ago.

Do the math: In 1957, we had 4.3 million births in our nation when the population totaled 172 million. In 2022, 3.67 million babies were born to 334 million inhabitants. Births per 1,000 population were at 25 or above for most of the 1950s but are now under 14. If one excludes births to females who immigrated at any age and their first-generation daughters, that indicator drops significantly more. So as more people age, fewer people are born to replace them.

Secondly, the costs of producing almost anything: cars, corn or educated kids, are complex.

“Fixed costs” must be paid regardless of the number of “units” produced, whether bushels of corn, Sunday school attendees or high school graduates. It costs the same to light and heat a classroom whether it has five students or 40. Readers may be more familiar with it as “overhead.”

Other costs do vary with output. These “variable costs” increase or decrease based on units served or produced. Textbooks, numbers of teachers, cafeteria groceries, fuel for buses, all vary with the number of students, although not necessarily in a smooth linear fashion. Natural gas to heat a school building only becomes a variable cost when there are so few students that the building has to be shuttered. Cafeteria food costs, on the other hand, will vary greatly when more or fewer students eat lunch in a given school year.

For each of such costs, the district may want to know a per-unit-of-product amount. Say a school district needs to spend $1 million on something regardless of number of students. If there are 20,000 students, the “average fixed cost” per student is $50. Drop enrollments to 10,000 and the average fixed cost doubles to $100 per student. With 5,000 kids in the schools, each would represent a $200 share. The same calculations apply to a rural congregation dividing the insurance cost for their building or a pastor’s salary by 300 members versus 75.

Similarly, a district may want to know variable costs on a per-student basis. The number of teachers needed for an 800-student district is less than for an 8,000-student one, but the amount per student is not exactly the same. The per student cost of groceries for a 1,500-student district may be lower than for a 400-student one because of discounts for larger orders.

The problem for school districts and churches is that a high proportion of costs are fixed. One must heat buildings and periodically renew roofs whether there are 50 worshipers or 500, whether there are 800 students or 200. A classroom floor needs cleaning whether 12 kids use it or 28. Nowadays, you need a school nurse or other person qualified to manage kids’ mediations in a building with 200 or 500. Ditto for a custodian, for someone in the office answering phones, accepting deliveries and handling visitors. And you always need someone who can fix glitches with routers, servers and video projector connections.

Some “inputs,” like teachers, are “lumpy.” You can have one biology teacher or three but you cannot have 2.63. Yes, you can have half-time positions. You can have one degreed librarian cover five buildings while less-educated and less costly aides actually help students. You can teach biology every semester but offer geology or physiology only every other year. But it is not a smooth operation like gently easing up on a gas pedal. Considering whether the staffing costs are governed by a collective bargaining agreement adds a new element to the budgeting process.

Another problem is that parents and citizens in general demand certain services. Federal and state laws mandate services for special needs students who would have been shut out when I was a kid. Even in small districts, AP math  or calculus courses are demanded rather than just the algebra-geometry-trig offerings most baby-boomers got.

Yes, staffing and costs at district offices have burgeoned. For some people, including some teachers, “360 Colborne” — the street address of SPPS central administration — has become an epithet used to explain myriad problems. Bureaucracies burgeon easily but resist downsizing. A big part of St. Paul’s budget problems stem from the very predictable ending of large sums of federal funds available under the COVID-era American Rescue Plan Act of 2021. Skeptical conservatives are entirely correct when they say that “temporary” programs funded with temporary dollars inevitably become permanent to some extent because no organization wants to cut back. There always is someone who benefits from a program and doesn’t want it ended.

Don’t blame “bureaucrats” for all problems though. Every district superintendent and finance chief knows that fixed costs can be cut by closing school buildings. They also know that announcing closings of schools that have served neighborhoods for a century always touches off political firestorms. Ditto for tax referendums that could increase school funding.

The final econ idea that is useful in thinking about these challenges is that of “marginal cost,” the change in total costs with a one-unit change, up or down, in some output or input. If we lose one student, how does that change our total costs? If we added another service, how would that increase our total costs? How would it increase total costs to add one section of AP physics? How much would it decrease total costs to cut lacrosse?

Specific situations will change, but demographic changes, especially rapidly dropping birth rates everywhere, will be even more salient in this century than in the last. Knowing how economists explain what’s going on can help understand things.

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St. Paul economist and writer Edward Lotterman can be reached at stpaul@edlotterman.com.

Other voices: Criminal justice reform is alive. Thank conservatives

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Congress eliminated parole from the federal criminal justice system in 1984, but it didn’t completely do away with post-release supervision. About 3 of every 4 people leaving federal prison remain under supervision, often for years, and often for no good reason.

A transition period to ensure successful re-entry into society after prison makes sense. But federal supervised release — a parole-like period of restrictions post-prison — lasts too long and is too expensive. It makes little distinction between those who are at high risk to break the law again and those at negligible risk. And there is mounting evidence that the longer supervision goes on, the greater the chance that the former prisoner will get into trouble again. The extended lack of real freedom interrupts transition to responsible post-prison behavior.

The Safer Supervision Act is a bipartisan bill that would shorten post-prison supervision upon a showing that public safety would not be negatively affected.

It is similar in spirit to the First Step Act, another bipartisan federal criminal justice reform that was signed into law in 2018 by President Trump. The act reduced excessive federal prison sentences while encouraging rehabilitation. It was one of the few truly bipartisan successes in years, a result of efforts by CNN commentator Van Jones and U.S. Sen. Cory Booker, a Democrat from New Jersey.

And, importantly, reform-oriented Republicans.

Liberals could too easily mislead themselves into believing that tough-on-crime conservative lawmakers signed on to the First Step Act six years ago and are signing on to the Safer Supervision Act now as reform newbies. That’s a far cry from the truth.

Criminal justice reform has deep roots in political conservatism. Some of the most meaningful recent sentencing reforms have come from states like Texas, Georgia and South Carolina. The organization Right on Crime and other conservative reform groups draw on religious traditions that stress repentance and forgiveness, plus a deep concern over government expansion and waste — including in public safety and punishment.

Writing in favor of the Safer Supervision Act, former House Speaker Newt Gingrich, a Georgia Republican, emphasized the conservative critique of an expansive carceral system.

“Our nation’s public safety systems are not immune from the bloat, waste, and ineffectiveness that naturally grows in massive government operations,” Gingrich wrote.

You don’t have to be a fan of Gingrich or his politics to appreciate his support for badly needed changes in a criminal justice system with far too large a footprint and too little benefit to show for it.

A decade ago, Gingrich joined with the late Malibu billionaire B. Wayne Hughes Jr., in writing a Los Angeles Times op-ed in favor of Proposition 47, the California reform that right-sizes drug offenses and small property crimes. Hughes, a staunch conservative, founded and ran an organization that assisted crime victims and former offenders. He was one of the biggest donors to the Proposition 47 campaign.

The two noted that Texas reversed prison expansion in 2007, saved billions of dollars and used the savings on drug treatment and mental health services. Texas reset the dividing line between misdemeanor and felony theft at $2,500 (California’s is $950 — well short of Texas levels).

Ohio, Oklahoma, Kentucky, Missouri and Mississippi — all red states, Gingrich and Hughes noted — adopted their own reforms along the lines of Texas’.

“Now voters in California will have a chance to do the same, using costly prison beds for dangerous and hardened criminals,” Gingrich and Hughes wrote. “It is time to stop wasting taxpayer dollars on locking up low-level offenders.”

Today’s election-year posturing has clouded the facts and original politics of criminal justice reform. Some elected Democrats, fearing for their political lives, embrace false connections between smart reforms and periodic spikes in crime. Some elected Republicans– especially in California– betray the conservative reform principles articulated by Gingrich, U.S. Sen. Rand Paul (R-Kentucky) and others to seek backing from law enforcement and other groups that see political gain in embracing fear.

But even law enforcement organizations such as the Major Cities Chiefs Assn. have joined with prosecutors, defense lawyers, religious groups and progressive reformers to embrace the Safer Supervision Act.

Truth be told, the reform doesn’t go far enough. But that’s no reason to reject it. The First Step Act made it clear by its name that more reform steps were needed. But they are to be taken one at a time, as conservatives and liberals, Democrats and Republicans, seek common ground. Passing the Safer Supervision Act is a step that Congress ought to take now.

— The Los Angeles Times editorial board

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Robert Pearl: Why ChatGPT’s ‘memory’ will be a health care game changer

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OpenAI generated massive media interest with the announcement that its signature product, ChatGPT, is gaining memory. The new feature enables the generative artificial intelligence system to “carry what it learns between chats, allowing it to provide more relevant responses,” according to the company.

As Congress holds hearings and regulators rumble with apprehension, the media coverage so far has generally overlooked the biggest part of this announcement, which has direct ties to American health care:

The development of memory-powered AI is a pivotal step toward transforming U.S. medicine.

Although there are many technological and regulatory hurdles to clear — and fears around privacy and security to mitigate — this development has the potential to make health care more personalized, patient-centric and affordable. These improvements — alongside the potential pitfalls of AI-empowered health care — are the subject of my upcoming book, “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.”

Here are three ways generative AI’s improved memory will transform patient care:

More accurate diagnoses

For over a decade, clinicians have wanted to precisely tailor care to each patient’s unique health profile, including their genetic makeup and personal health preferences. But too much has stood in the way.

One major challenge is the sheer volume of knowledge required to customize medical care. The human genome consists of approximately 3 billion base pairs of DNA, which if typed out as letters would fill about 200 New York City phone books. What’s more, medical knowledge doubles every 73 days, making it almost impossible for any human to keep up with all the innovative medical findings and updated guidelines for helping patients.

A third hurdle is technological. With the average patient consulting 19 different doctors throughout their lifetime, an individual’s electronic medical records are often dispersed across numerous medical offices and health systems. The lack of interoperability among EMR systems compounds this issue, preventing clinicians –and, by extension, generative AI — from accessing a patient’s complete medical history.

Currently, ChatGPT’s ” context window” (how many words it can recall before losing its memory), falls well short of the nearly 17,000 words found in the average patient’s medical record.

However, generative AI systems are predicted to become 30 times more powerful within the next five years, dramatically expanding their data retention capabilities and enhancing their reliability. This, combined with OpenAI’s specialized plug-ins (known as GPTs), offers promising opportunities. Initially, generative AI might access a limited set of patient data through platforms like My Chart, which can be used on personal computers or smartphones. Eventually, however, generative AI will enable patients to consolidate their digital medical records from various health care providers.

This will create a comprehensive, personalized health record, serving as a reliable resource for both patients and their health care teams.

With this information stored in an AI’s memory, patients will be able to input their symptoms and receive specific diagnostic and treatment suggestions.

For people who are uncertain about the significance or urgency of new symptoms, the AI will provide reliable advice. And for patients with rare or complex conditions, it will offer invaluable second opinions. Advanced diagnostic ability, alongside comprehensive health care information, will be instrumental in reducing the 400,000 annual deaths attributed to misdiagnoses.

Fewer complications from chronic disease

Chronic diseases like diabetes, hypertension, obesity and asthma affect six in 10 U.S. adults. Complications from these diseases account for 1.7 million deaths each year.

Unlike acute illnesses that appear suddenly and usually are resolved quickly, chronic conditions persist over time, impacting tens of millions of Americans every single day.

Doctors care for these conditions in an episodic fashion, which is far from optimal. Patients with chronic diseases typically see their physician every three to four months, providing doctors with only a snapshot of their health status. As a result, chronic diseases aren’t controlled as well as they should be, which leads to life-threatening, and preventable, complications.

At a national level, hypertension is adequately controlled just 60 percent of the time, and effective blood sugar management in type 2 diabetes is achieved less than half the time. Data from the Centers for Disease Control and Prevention indicate that proper disease prevention and management approaches would reduce the risk of kidney failure, heart attacks and strokes by 30 percent to 50 percent.

Applying these percentages to the U.S. death toll from chronic disease complications, these CDC estimates indicate that more than half a million lives could be saved annually.

Generative AI, once connected to home wearable devices, can update patients about their health status and suggest medication adjustments or lifestyle changes. It can also remind them about necessary screenings and even facilitate testing appointments and transportation, thereby improving disease management, reducing complications and maximizing health outcomes.

Safer hospitals

Generative AI with memory will radically improve inpatient care, as well. Once it’s integrated with bedside monitors and able to remember a patient’s clinical status over time, the AI system will be able to immediately alert professionals when a problem arises, so they can intervene.

Additionally, video monitoring systems powered by AI could oversee the delivery of medical care, pinpointing any departures from established best practices. This real-time oversight would provide immediate alerts to caregivers, preventing medication mishaps and reducing the risk of infection.

These two uses of AI technology would help reduce the staggering 250,000 deaths each year attributed to preventable medical errors.

While ChatGPT and similar technologies hold immense potential, today’s generative AI tools still require clinician supervision. But looking ahead, the exponential growth of generative AI’s capabilities (doubling every year) points to a transformative future for the practice of medicine.

Now is the time for both clinicians and patients to become comfortable using generative AI. And it is an opportunity for regulators and elected officials to advance, not stifle its potential. With memory and GPTs, the doctor’s AI toolkit is quickly filling up.

Robert Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group. He wrote this column for the Fulcrum, a nonprofit, nonpartisan news platform covering efforts to fix our governing systems.

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‘Carefluencers’ are helping older loved ones, and posting about it

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On the east side of San Jose, California, there is an abuela who seems to have more grandchildren than she can count.

Mardonia Galeana holds her grandson Yosimar Reyes hands, in San Jose, Calif., on March 18, 2024. Reyes has cared for his grandmother since the start of the COVID-19 pandemic. (Carolyn Fong/The New York Times)

“A lot of people see me and they hug me,” Mardonia Galeana, 89, said in Spanish. “I don’t even know them, but sometimes they ask me for a blessing on the street and I do the best I can on their forehead.”

Her likeness has been featured in a painting in the San José Museum of Art and in a mural in the city’s mission district. But it’s her online presence that has captivated the thousands of people who have come across the photos and videos posted by her grandson Yosimar Reyes.

“Seeing your Abuela smiling and having a good time truly warms my heart,” one user commented beneath a video of Galeana enjoying herself at a senior center while others danced to a track by merengue singer Elvis Crespo.

Reyes has been chronicling moments in his grandmother’s life on a private Instagram account followed by more than 21,000 people. His posts have shown a trip they took to New Orleans, their strolls with his dog, Chulito, around the San Jose Flea Market, and occasional doctor visits.

Although Reyes calls himself Galeana’s “personal stylist,” he is first and foremost her caregiver — driving her to appointments, managing her medications, making sure she has a roof over her head.

“I take pride in the fact that I care for and dress my grandma,” Reyes, 35, said. “That she’s not going to be out here in a muumuu. Her nails are also poppin’ and it’s a big self-esteem boost for her.”

Francesca Falzarano, an assistant professor at the University of Southern California Leonard Davis School of Gerontology, has a term for the growing number of people like Reyes who share behind-the-scenes looks at the daily realities of providing round-the-clock care for older loved ones.

“In my research lab, we call them ‘carefluencers,’” Falzarano said. “Social media is really the only way a lot of these people are able to access support, education and a sense of belonging.”

Reyes, a poet and artist, was raised by his grandparents and came with them to the United States from Guerrero, Mexico, in the early 1990s. “Even as a kid, I was already a caregiver,” he said. “I had to translate documents and help my grandparents navigate this country because they were older and didn’t speak English.”

Reyes, who was named the 2024 Santa Clara County poet laureate, said he has occasionally found himself overwhelmed since he fully undertook the role of caring for his grandmother during the COVID-19 pandemic.

“I’m trying to build a career as an artist and as a writer, but then I still have to go home and have to take care of somebody,” said Reyes, who has described his experience as a caregiver in poems like “Abuela Gets a Fever.” “Some days, I’m emotionally depleted. And if she’s having a bad day, I have to make sure that I’m not reactionary.”

Mardonia Galeana poses with her grandson, Yosimar Reyes, outside their home in San Jose, Calif., on March 18, 2024. On TikTok and Instagram, people are sharing what it’s like to take care of relatives who have reached their final years. (Carolyn Fong/The New York Times)

As the population ages, Reyes’ experience is likely to become more common. According to the Centers for Disease Control and Prevention, the number of unpaid caregivers in the United States increased to about 53 million in 2020 from 43.5 million in 2015.

Chris Punsalan of Las Vegas, who became a caregiver for his grandmother Anicia Manipon eight years ago, has shared his experiences with her on YouTube, Instagram and TikTok.

“I decided to document us because I felt it was important,” Punsalan, 30, said. “It’s not only for me to be able to look back on, but I also slowly realized that it was very helpful for people who have been through a somewhat similar situation.”

Punsalan, who has over 2 million followers on TikTok, has created content out of tending to his grandmother’s bedsores, cooking her breakfast and sharing the products he uses to tend to her needs. Since Manipon’s death in January, he realized that his social media accounts have done more than provide information and comfort for other family caregivers.

“During her funeral, my cousin said something that really struck a chord with me,” Punsalan recalled. “He said, ‘Whenever I miss my grandmother, I have a library of videos to remember her by.’”

Jacquelyn Revere, an aspiring TV writer in Los Angeles, began posting about her experiences after she became the main caregiver for her mother and grandmother in 2016. She said she found comfort while trying to help others in her position through social media, and the number of people following her on TikTok grew to more than 650,000.

“When I was posting my mom, it’s not like I felt like I had to — it actually became fun,” said Revere, 37. “Social media brought so much validation with people saying, ‘You’re doing such a good job,’ and it became a place of refuge.”

Revere’s grandmother died in 2017; her mother died in 2022.

“Many of my caregiver friends are people who I’ve met on social media,” Revere said. “We’ve really created a community that’s very close knit, because it’s hard to understand the weight of this role if you’ve never had it.”

Mardonia Galeana poses for grandson Yosimar Reyes outside their home in San Jose, Calif., on March 18, 2024. On TikTok and Instagram, people are sharing what it’s like to take care of relatives who have reached their final years. (Carolyn Fong/The New York Times)

While posting a get-ready-with-me-and-Grandma video on TikTok may bring caregivers a sense of community, some viewers can’t shake the feeling that such content might be exploitative. Is a vulnerable older relative in a position to consent to appear in a video, when the person recording it is responsible for administering her medication?

“That is so heartbreaking,” one user commented on a TikTok video of an older woman struggling to eat. “I wish you all would have the dignity to stop posting these messages.”

But according to Falzarano, the benefits of caregivers’ sharing their experiences outweigh the risks. “It’s really contributing to the greater awareness and visibility of chronic illness in caregiving,” she said.

Falzarano, 32, whose research is focused on dementia, family caregiving and technology for older adults, also noted that while there are a variety of resources readily available for expecting parents, the same could not be necessarily said for those grappling with the end of life.

“We all have this universal experience where we’ll need to provide care or need to be cared for at some point,” Falzarano said. “Why not start thinking about it now?”

Galeana, who will turn 90 in December, hasn’t been able to return to the home in Mexico that she and her grandson left behind more than three decades ago. With no clear pathway to U.S. citizenship, the two have built a forever home of sorts online.

“She’s old and she’s been through so much, from poverty in Mexico to all that we’ve experienced in the United States,” Reyes said. “My goal now is to make sure that she’s happy and not always talking about how sad her life was. And people love her here and know her as the abuelita. It’s beautiful.”

Whether it’s being recognized at the market or having flowers or care packages sent to her home by strangers who have encountered her online, she has become a local celebrity.

“As a little girl, I wanted to be an artist,” Galeana said in Spanish. “I would dance and sing and want to be on the movie theater screen. But it never happened.”

But later that week, after Reyes had fixed her hair and done her makeup, she was ready to be the star of a video that would be seen by thousands.

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