Healthcare: In The Eye Of The Beholder

A fellow Fletcherite and I had an exchange on VPR's Facebook link about the Republican legislative agenda and the caucus' relevance.  Sure he only lives about a half mile away, but our little community doesn't really have a town square so online interaction works nicely, thank you very much.  Anywayz, in light of that and the results of Dr George Till's poll of the VT medical community, I wanted to say a more about healthcare reform in Vermont.  Because that's what I do.

First, I want to quickly get two zombie canards out of the way:

  • Uncertainty – Uncertainty regarding taxes and regulations is always a part of doing business.  Also consider the uncertainty of your fellow Vermonters: will they be able to afford a doctor if they lose their job or want to start a new business themselves?
  • Rushing – we've had literally years to debate and work on HCR.  If you're worried about uncertainty, then move the process forward rather than holding it back: delay only hurts Vermonters.

Even though it won't really change the minds of people who cling to these flimsy excuses for opposing H.202, I think repetition is good.  Speaking of which, let's address another nefarious meme in a little more depth: SOCIALISM!

I am not going to refer to any dictionary definition of socialism.  That's the last refuge of debaters and only invites even more ridiculous parsing–can a community insuring itself really be controlling means of production, wouldn't Employee Stock Ownership Plans be socialism, etc–that only serves to obscure people's true objections.

Besides, the word 'socialism' at this point is a matter of perception and political framing, not any real definitions.  When you strip away the empty rhetoric and misinformation, I think we're just left with usage equals meaning.  And that appears to be “replacing corporate premiums with government taxation to provide a service.”

I don't see any other reason why the socialism label is applied to single-payer health coverage.  Insurance of any stripe socializes risk, as Adam Smith himself observed:

The trade of insurance gives great security to the fortunes of private people, and, by dividing among a great many that loss which would ruin an individual, makes it fall light and easy upon the whole society. 

Heck, we've socialized the risk (though strangely, privatized the profits) of nuclear power, why not healthcare?  All we're talking about is creating a single, large insurance pool to maximize access to medical services, reducing costs through greater efficiency, and administering it through a transparent and accountable entity the People have incorporated for the public good.

And that's the key: healthcare is a public good.  

I hold this truth to be self-evident.  That's why Michigan, for example, explicitly says so in its constitution, as does our Act 128: health care is a public good for all Vermonters.

Other public goods financed through the constitutional power of taxation (as opposed to paying fees or premiums to corporations): the military; police and fire protection; highways and waterways.  Anybody going to call that stuff socialist?  Anybody going to call our state constitution socialist because it establishes a Commonwealth?  Wherein:

That every member of society hath a right to be protected in the enjoyment of life, liberty, and property, and therefore is bound to contribute the member's proportion towards the expense of that protection,…and previous to any law being made to raise a tax, the purpose for which it is to be raised ought to appear evident to the Legislature to be of more service to community than the money would be if not collected.

Free Mark Hero Adam Smith again:

[A] duty of the sovereign or commonwealth, is that of erecting and maintaining those public institutions and those public works, which though they may be in the highest degree advantageous to a great society, are, however, of such a nature, that the profit could never repay the expense to any individual, or small number of individuals; and which it, therefore, cannot be expected that any individual, or small number of individuals, should erect or maintain. The performance of this duty requires, too, very different degrees of expense in the different periods of society.

Like the air we breathe, we take a lot of public goods for granted.  Their benefit and funding is invisible to us, particularly if they were first implemented a long time ago, so most people wouldn't decry them as socialist even as they rely on taxation and help society as a whole.  If I might indulge in a quick aside that pertains directly to me an my neighbors, consider the Rural Electrification Act.

Before the REA, only about 10% of US farms were electrified.  That had serious implications for their sustainability and efficiency, as milk could spoil without refrigeration, creating unsanitary conditions and causing a lot of waste and financial loss.  Add electricity and storage isn't so much a problem, irrigating more lands increases productivity, feeding and milking becomes less labor-intensive, and so on.

Yet bringing power to rural areas in Vermont and elsewhere was cost-prohibitive and profit-driven companies were reluctant to make the necessary investments.  So the Federal government in this case stepped up during the Depression, seeing the need for increased competitiveness and stimulus (agricultural activity has a huge economic multiplier).  As a result, the village of Binghamville (the section of Fletcher my family lives in) was electrified through the Vermont Electric Coop by 1940.

Now in a not-entirely-dissimilar situation, the Feds have done a little bit to deal with our healthcare issues to make sure there's greater access and affordability.  We've eliminated the pre-existing conditions scam, for instance, but there still are corporate death panels since the default position of a profit-driven insurance company is denial of coverage.  It doesn't seem like the folks in DC are going to finish the job any time soon, it's up to us to take the lead at the state level.

Given that we're not going to enjoy more uniform, nationwide reform, some folks have raised the specter of doctors leaving Vermont for friendly states if we implement single-payer.  Democratic Representative Till is the Leg's only doctor and he sent a survey to 1600 licensed physicians in Vermont, 610 of whom answered:

Till noted one response that worries him — the percentage of doctors who said they might leave Vermont is a single-payer system was enacted. Among all doctors, the percentage was 28.4. When looking just at specialists, the percentage rose to 37.

“We could make insurance available to everyone and lose a lot of the access,” Till said, because of a doctor shortage.

I'm not entirely sure where to start unpacking this.  I guess I'll ignore the validity of such a survey and accept it at face value for the sake of argument, and then go for the low-hanging fruit.

First, note that 28.4% of 610 is about 174 doctors who said the MIGHT leave the state.  I'm going to assume that this is a self-selecting survey and that the other 1,000 who didn't respond really don't care either way.  Thus, we have a handful of physicians who are not overly concerned about the communities they serve who might think about going somewhere else to re-establish their practices.  And that's balanced by over 200 doctors who would do the reverse and come to Vermont BECAUSE of our enlightened health insurance system.

Of course this all sounds like people who threatened to move to Canada if Bush won in 2004, or to Galt Gulch if Obama won in 2008, so I don't put a lot of stock in this, glaring issues with the survey method aside.  The problem is that we hear a lot of similar anecdotal evidence about Doctor Flight if Some Very Scary Reform is passed.

In general, we've been hearing about the US losing doctors for, like, ever, and it doesn't appear to be true.  Just another FUD meme so people will defer to whatever physicians want, methinks.

But could such a thing really happen if there's an imbalance in healthcare policies between states?  I have been unable to find any conclusive data on that, though I still believe we can quash the suggestion based on what is available to a simple blogger.

The closest analog we have to Vermont is Massachusetts, both geographically and reform-wise.  Romney's legislation, which is quite similar to the Affordable Care Act, was enacted in 2006.  I've read a variety of material that asserts MA is losing doctors, either to other careers or other states, but they provide nothing to back up their claims.  MA doesn't hit the Wall Street Journal's radar, either.

I looked at Census data, and that doesn't appear to bear out any claims of Doctor Flight either.  The doctor-to-patient ratio in 2005 was 456, 462 in 2006, 469 in 2007 and 468 in 2008 (latest figures I could find).  While there was a slight drop (-0.2%) from 07 to 08, the total number of physicians actually increased a smidge (+0.8%).  Given that the law appears to be quite popular amongst medical professionals in the state, color me unconvinced that the doomsayers are right about MA, which makes me skeptical of any similar warnings in VT.

If you want to rely on anecdote, I find it hard to believe the doctors we see at the Community Health Center would bail on our state.  Sam's pediatrician is heavily involved in homeless healthcare here in Vermont and in her spare time regularly works at clinics in Haiti (she rushed down after the quake, too).  These folks are dedicated to fostering healthy communities and ain't gonna run away when we implement something that helps more people get treatment they need.

We can certainly quibble about some details of H.202–I have some beefs with it myself.  But let's stop with the rhetoric that only serves to scare and confuse people, and rather work constructively to cut our healthcare costs, create jobs and improve the health and competitiveness of our workforce.

ntodd

 

Language matters…

Just a quick kvetch…

This morning on VPR, they were talking to Peter Welch, and he was talking about the looming budget standoff with the GOP, and a few things that are deal breakers for him… defunding the CPR and Planned Parenthood, and defunding Obamacare. Yes, Obamacare.

Perhaps if Mr. Welch, who I’m sure had nothing but good intentions in the interview, plans on using right-wing frames to describe healthcare, at least he could throw us a bone and use the term teabaggers next time he mentions the teahadists? Just for the sake of fairness, if nothing else.

Plagiarism and False Rumors: Statehouse Republicans Embrace Slime

There is honor in being a minority in a democracy. Somebody needs to tell the Vermont GOP that, as they have engaged in decidedly dishonorable behavior in the last week.

First was the anti-health reform speech by Rep. Burditt that invoked “communism” and “radical islam” – and was apparently an act of plagiarism.  According to Hallenbeck, that speech was largely lifted from Association of American Physicians and Surgeons president Lawrence Huntoon:

Burditt said he’s inexperienced at writing speeches and didn’t see anything wrong with using another person’s words. “It’s the same opinion that I have,” he said. “There’s nothing wrong with having the same opinion as anyone else.”

House Assistant Republican Leader Patti Komline, R-Dorset, said Vermont lawmakers are not well-versed in such issues.

Hey, who cares, right? No biggie. Now don’t we have some school funding to go cut somewhere…?

Second was the rumor in full-blown circulation last week that Senator Patrick Leahy was ill and planning to retire next month. It apparently got enough traction that it caused Leahy’s Vermont staff to feel the need to engage and quell the rumors.

All I’ve been able to find out was that the rumor originated with Statehouse Republicans, and since it has no basis in – well, apparently any reality whatsoever – insiders assume it was merely started as an act of mischief. Presumably spreading concerns around the Senators age, health and competence are all they feel they’ve got to undermine him.

Class act, this “loyal opposition.”

Budget fiasco in Washington

President Obama is getting together later day with Congressional leaders in a last ditch attempt to avoid a government shutdown. Meanwhile, the administration is preparing for a possible government shutdown, as was revealed through a memo that was leaked to the Washington Post. If an agreement can’t be reached on continuing funding government activities through the rest of the fiscal year 2011(ending on September 30th), many vital government activities will cease, except those that are vital to national security, etc. I have been following the ongoing drama, and if this can be averted, there are still vital battles ahead on government funding: first, is the debt limit on the amount of money the federal government can borrow, which will be reached at some point this spring and if not increased, will cause at least a partial shutdown of government services and FY 2012 budget, with a first proposal being released today by Rep. Paul Ryan that proposes to phase out and slash Medicare, with the ever-ready voucher system conservatives profess so much love for to take its place.

As a federal employee I am disturbed at the lack of seriousness and dimwitted ideology that the Republican Party has wrapped itself merrily in and I am grateful knowing that at least initially I wouldn’t be seriously affected by the shutdown (working in an agency with its own source of revenue and only a relatively small supplement from Congress makes it easier). Republicans on the national level are pretty happy with a scorched earth policy and to hell with whoever gets caught in the way, as we are all just collateral damage. So far I’ve heard no serious debate on them cutting their own pay and benefits during a shutdown, even as some Congressional Democrats have been pushing for it. They truly know no pain because they don’t even bother to empathize. That’s what willfull ignorance does to you. I’m not very hopeful that President Obama and Congressional Democrats will have the spine to stand up to such nonsense and dare to put the Republicans’ feet to the fire. There will be a price to pay. If Democrats blink, it will be them and there will be more misery in the coming years.

 Know hope!

An Even More Inconvenient Truth

It’s time we had a conversation about “growth.”  



By that, I mean it’s time to challenge the model that shapes contemporary economic assumptions and society as a whole.  I have only a layman’s perspective, but it seems to me that the conventional wisdom that “growth” rather than “sustainability” is the primary goal for human enterprise, is fundamentally unsound.  

Even on the most abstract plane, one can argue that the nature of our visible world is self-limiting and finite; so it stands to reason that economic models and expectations that do not honor that blanket truth represent magic thinking.  

Nature strives perpetually for balance in order to sustain its life-forces; and when uncontrolled growth runs amok in nature, it is a cancer that quickly extinguishes life.  We see this principle demonstrated  all around us every single day, and yet the economic and political assumptions that drive human endeavor remain stubbornly resistant to the lessons being repeated by the natural world since long before mankind learned to count.

Some consideration has been given, from time to time, to population, with all its implications; but we never seem to have extrapolated from that conversation about population to one about the inherent folly of striving for perpetual economic growth.  We’re actually more comfortable talking about the possibility of limiting human population, with all that implies, than we are with the idea of abandoning forever any idea of growing richer…let alone the thought that achieving a truly sustainable world at this point would most likely require that some of us should be somewhat poorer.  

Ironically, nature is pretty good at limiting populations, unaided by human intervention; but as economic models are human constructs, nature can’t apply the brakes.

Wall Street, that pinnacle of magic thinking, has foisted on us the idea that unlimited growth is not only possible but compulsory; so much so that corporations engage in all kinds of financial sleight-of-hand to convince their stock-holders that they are meeting this phantom goal.   And the interests of Wall Street have become firmly wedded with domestic economic policy.  They are almost indistinguishable now.  Those interests almost completely exclude sustainability in order to focus on the next quarter’s bottom line.

In a finite system,  for some to benefit from perpetual growth, perpetual contraction is necessary in an opposing sector.  This is the stuff of expanding income inequities that are rendering thread-bare the very fabric of America.

The politicians and conventional media won’t talk about it, because it flies in the face of the great American myth of upward mobility; so it’s really up to us.  

Pass it on.

The Tea Party Shrugged

 

who is John Gault?

or is it John Gaul?

whatever  Anne Rand (Ann?)

is one of our heroes

we’re going to the movie

the book is too long

and it has big words

but we know no gays

or socialists or Moslams

will be there

we’ll be watching for them

all six of us

this will be our answer

to all those intellec…intelectuals

we have our authors too

we just can’t read them

but we don’t have to

cause we have our candidates

did you know Tom Salmon

is an Objectionist?

and so is Sarah Palin

that’s why she writes

on her hands

you wait til next year

we’re going to take over

then it’ll be your turn to ask

who is John Gaalt?

he’s going to the White House

as in White

we can spell that

and after we take over

nobody will have to spell anyway

why bother spelling

when you can make a sign?

Peter Buknatski

Montpelier, Vt.

(AND–Today is a Bad anniversary day.  43 years ago, in Memphis, they murdered Martin Luther King.

When you remember the courage and eloquence of that man, and what he stood for, the people I’m talking about above don’t seem very amusing after all.
)

You can leave your (corporate) hat on

In a recent report  The politics’ of health care on WCAX  (aka Vermont’s most trusted news source) three people were quoted; a pro,a con and a “political analyst”.

The pro and con, no problem .One a member of the pro single payer Health Care is a Human Right group and the con , executive director and chief fund-raiser of Vermonter’s for Health Care Freedom. The pro, the con, no problem were clearly identified.

Ah, but the third person the “political analyst” Chris Graff who dispensed this wisdom:  

"It's in the specifics; the old devil is in the details. You will see lobbying become more intense,”

   Indeed the lobbying may be underway even as he speaks.

Isn’t it long past over due, after five years as National Life’s Vice President of Corporate Communications & Government Relations Chris Graff  comes out from behind the neutral moniker “political analyst” ?  Especially when quoted in a story about Vermont’s biggest proposed health care /insurance regulation changes ever.  

Women’s Prison Ain’t Broke, So Don’t Fix It

For many local Franklin County folks in politics and law enforcement, moving the state’s women prisoners to NWSCF (Northwest State Correctional Facility) in St. Albans a few years ago made no sense. Among other concerns expressed was the loss of local space to house men being held by local law enforcement for trial and of federal money for housing federal immigration detainees. Now, the proposal to move men back to the St. Albans prison, and the women to the Chittenden Regional Correctional Facility would alleviate those concerns. Further, some argue, more male beds at Northwest means more local corrections jobs.

The diary below provides another point of view, under a pseudonym, because DOC workers are not allowed to speak publicly on DOC issues. ~ NanuqFC

By Concerned Observer

When the new governor was elected partly on a platform of changing the paradigm of criminal justice in this state, many of us who work in this field were optimistic that the time had come for some thoughtful long term planning, to not only save money, but to keep the community safe while changing people’s lives for the better.

The recent proposal from the Shumlin administration to move the women’s prison from the St Albans facility stunned almost everyone who works with this population. This is being called a plan, but in reality there seems to have been virtually no planning involved. None of the DOC staff here at NW were consulted prior to the announcement. Certainly none of the contracted staff were consulted. As far as I can tell, no one involved with this decision stepped foot in either facility before it was announced.

Let’s stop the charade that this is somehow better for the female inmates in Vermont. This will be an enormous step back for them, and to portray it as some kind of wonderful opportunity is disingenuous in the extreme.

  • When the Governor announced this decision a great deal was made of how this would create new opportunities for incarcerated women. Anyone who’s been inside of the Chittenden facility would see this immediately as absurd.
  • We keep hearing that this will enable women to see their children easier. St. Albans is not the end of the world, it’s only 25 min. from Burlington. I don’t believe there are any women who haven’t been able to see their children because of location. In fact, if the underlying issues of substance abuse, mental health, education, employability training aren’t addressed, the sad fact is that most of these kids will be better off not being reunited with their mothers. Children who visit their mothers in jail are many times traumatized by the experience of entering a correctional facility. The proposed family center at CRCF [Chittenden Regional Correctional Facility] is amazingly bleak and depressing.
  • Since  there is no room at CRCF for the type of programming available at NWSCF, the  non-profits are being told they will have to figure out a way to deliver these services outside the facility. This will involve more money, public opposition to siting these type of outside facilities, security issues, etc. The list of obstacles to be overcome is a long one and will take a great deal of planning and money. We are being told we have till July 1, 2011, and there will be very little if any money.
  • The  plan at CRCF is for there to be a wing that can house up to 80 women who will be able, so we’re told, to leave the prison daily for jobs in the community. I can’t imagine where these jobs will come from, since, in the population of around 155 at NWSCF there are nowhere near 80 women who can even keep a job inside the prison. In today’s economy to think that, without any kind of preliminary work, there are jobs for these women seems to be spectacularly  optimistic.
  • PREA:  The Prison Rape Elimination Act was enacted to stop coercive sexual contact in prison populations. One of the reasons for moving the women in 2009 from Windsor and Dale was the high number of PREA incidents mainly due to having 3 or more inmates to a cell. Re-locating women to CRCF will put the women at risk and force the facility to have 3 and 4 inmates to a cell again.
  • The  #1 issue the female population has is substance abuse. At NWSCF Phoenix house  runs a comprehensive, residential treatment program with 6 employees, 5 offices and a conference room. Phoenix house also runs a highly effective, 7-month program for violent offenders in this same space. There is no room at  Chittenden for this type of facility.
  • Many  incarcerated women have a long and tragic history of childhood sexual and physical abuse, and for many that pattern continued into  adulthood. NWSCF has an effective program dealing with these issues. There is no room at Chittenden for this  program.
  • Lack  of education is another piece of the recidivism puzzle. At NWSCF there is a separate building run by the Community High School of Vermont with two dedicated staff members and 2 offices, 2 large classrooms, a well equipped  library, 3 smaller classrooms, a computer resource center where women can write resumes and cover letters and learn job interview skills, and a law library. Women can get a GED or they can get either an Adult High School Diploma or, if they’re under 25 they can, by making up missing credits, get a diploma from the high school they would have graduated from had they not dropped out. At Chittenden, Community High school has 2 small rooms and no library, woefully inadequate.

  • The  type of staff and skills needed is very different for men and women. You don’t just drop a large population into a correctional facility and just pick up where you left off. At NWSCF there was a long and arduous adjustment period, with much of the new staff being hired specifically for their ability to work with women. It’s taken most of the last two years to incorporate all of the  staff into a smooth working system. The NW DOC staff is hard working and very professional, and I have no doubt they can accomplish the switch, but there will be a long and expensive adjustment period, with much training and staff turnover before the facility is up and running. The same goes for the Chittenden facility. This unacknowledged adjustment period will eat up much of the  overly optimistic saving projections.

There is certainly money to be saved in Corrections over the long haul; however, it will require a great deal of planning and collaboration with all parties to make a change to the way we deal with crime in this state. This move, proposed in haste with virtually no thought or planning, will be an enormous step back for everyone involved.  

New Insights Re: Fukushima Daiichi

We are pleased to be able to bring you another segment of expert analysis of the unfolding crisis at Fukushima Daiichi, from Arnie Gundersen of Fairewinds Associates.

Throughout the crisis so far, Arnie’s insights have anticipated new revelations from Tokyo Electric, and explained the underlying science from which he draws his conclusions.

This is an amazing and accessible resource for which we are very grateful.

Newly released TEPCO data provides evidence of periodic chain reaction at Fukushima Unit 1 from Fairewinds Associates on Vimeo.

One more time

There were those who argued that there was no difference between the two major presidential candidates in 2000, and many of them will continue to argue, after the disappointments of the Obama administration, that there is no meaningful difference between the Obama who runs for reelection in 2012 and whatever troglodyte the Republican Party selects as its candidate.

One of the popular memes these last few years is that elections have consequences, and in a presidential election, one of those consequences is that the president gets to nominate justices to the Supreme Court.

The guy selected in 2000 got to appoint John Roberts, the current Chief Justice, and Samuel Alito, one of Roberts’ accomplices. The guy elected in 2008 got to appoint Sonia Sotomayor and Elena Kagan.

Obama’s two appointees and Bush’s two appointees were on opposite sides of a case this week in which the Bush majority decided that a man who was convicted, sentenced to death, and served fourteen years on death row because of a fraudulent conspiracy to conceal exculpatory evidence carried out by prosecutor Harry Connick, Sr., and attorneys working under him, was not entitled to compensation.

Do you think things might have come out a little differently in this case if Bush hadn’t been in the White House to appoint Alito and Roberts?

I sure do.

Thanks, Ralph.