Well, I finally managed to get back into my blog after months of trying. For some reason I just couldn't remember my password and instead of simply utilizing the password assitance technology offered by Google, I was sure I would be able to evenutally remember it. Now after 4 months, I finally gave up and used the technology assitance.
Needless to say I have months of commentaries backlogged, so I will post them over the next few weeks.
Tuesday, November 24, 2009
Friday, August 28, 2009
Wanted: Health Care Finance Reform
During a recent town hall-style meeting in Colorado to bolster support for his health care initiative, President Obama was asked why he had changed his rhetoric from using the term “health care reform” to the term “health insurance reform.” In my opinion, it was a smartly-asked question that required a more thoughtful answer than the president provided. For if I were to lay my cards out on the table, I would admit that for me it’s never been about health care reform but rather it’s about health care finance reform.
Whether we realize it or not, here in Minnesota and throughout the entire upper Midwest region we are blessed with the best health care delivery system in the nation. We are fortunate to have some of the most talented physicians, nurses and health care practitioners, working in state-of-the-art hospitals, clinics and health care facilities. A large percentage of our care is delivered through large multi-specialty clinics and integrated health care systems that lead the nation in quality; achieving efficiencies that other parts of the nation can only dream about. When we talk about our health care systems up here names like Mayo, Fairview, Allina, Avera, Sandford, Altru, Meritcare, Gunderson and Marshfield are all recognized for their quality, efficiency and effectiveness. Simply put, we don’t need to nor want to change our health care delivery system.
On the other hand, the way we finance and pay for all this great care is a total mess. This is just as true for our public payers as it is for our private payers. It’s too expensive, excludes more than 40 million Americans and is financially unsustainable. Here are some simply examples of the illogic of the current financing system:
· A physician working in a highly efficient, multi-specialty clinic in Minnesota who sees a patient for a routine office visit; or a hospital in North Dakota that admits and elderly patient with a simple uncomplicated case of pneumonia, will receive a much lower Medicare reimbursement than a physician or hospital treating a similar patient in Dade County, Florida. In other words, Midwest providers get penalized for their efficiency, while physicians and hospitals in other regions of the country get rewarded for their uncoordinated and inefficient care.
· An uninsured patient who enters an emergency room with a deep gash to their leg will receive a significantly higher bill for services in the E.R., than a similar patient whose insurance company has negotiated deep discounts with the hospital for their enrollees. In other words, those who can afford it the least get charged the most.
· A 24-year old patient with a serious chronic disease is virtually uninsurable in the health insurance marketplace, when he/she leaves their parent’s family insurance plan upon their 25th birthday. In other words, health insurance often is unavailable to those who need it the most.
· More than 14,000 Americans lost their health insurance each day during 2009 due to being laid off by their employer. For you see, we are the only industrialized country where if you lose your job, you lose your health insurance.
So when the president was asked about this change in his rhetoric, I wish he would have plainly told the questioner that the reason he now uses the term health insurance reform is because that’s where the problem lies. That we want a health insurance market that doesn’t deny you coverage if you have high blood pressure, diabetes, or other pre-existing conditions. That if you lose your job you sure as heck have enough to worry about; and keeping your health insurance shouldn’t be one of them. For you see, unemployed people get sick too.
Unfortunately, those who try to characterize this as a government takeover of “health care” are just trying to scare you. For you see, the most universal federal health care finance program we have is Medicare, which covers millions and millions of elderly Americans. So if this is the socialistic takeover of health care where are the Medicare-employed doctors and nurses? Where are the Medicare hospitals and clinics? Where is the federal takeover? Well, as we all know, this is all political hyperbole. Medicare beneficiaries get to choose their doctor or change their doctor just like you and me. They use the same private clinics we do; and the same private hospitals we do. Medicare is simply a publicly funded insurance program; nor more … no less.
So let’s dial down the rhetoric and scare tactics and let’s dial up some of our best ideas. Whether we need a “public option” or not is certainly open to an honest debate. But wouldn’t it be great if we ended up with a decent basic health plan that all Americans would have equal access to (let’s call it the Basic American Plan) that all insurance companies would sell for the same price. If insurance companies want competition, well let them compete on quality and service; but not by cherry-picking the healthiest among us, and denying coverage to those who need it the most. Now wouldn’t that be something!
Sunday, August 9, 2009
Is it ever really all or nothing?
As a member of the Minnesota Hi-Speed Broadband Task Force I have spent the past few months listening to a variety of public officials and others who have provided comment and testimony regarding broadband deployment throughout the state. And through this process it’s become clear that for a growing number of Minnesotans, ubiquitous access and universal adoption of broadband is a significant goal. But when you really think about it, this notion of universalism increasingly permeates much of our public policy today. Within the current public debate about health care reform, universal coverage is a goal that both Democrats and Republicans publicly seem to embrace; and in our national discussion about public education we want to ensure that absolutely no child is left behind.
It’s interesting that in a capitalist culture that focuses on competition, product differentiation and market share that we seem to be romancing the values of universalism. For example, for many years economists defined the term “full employment” to actually mean an unemployment rate of 5 percent or less. I simply don’t ever recall back in the 1990s seeing public officials at the state or federal level wringing their hands over the 3-5 percent of the work force that were jobless. And public schools with a 90 percent graduation rate used to be a source of pride and held up nationally as an example of what is right with our public school system. Sure, we aspire to100 percent graduation rates, but there just seemed to be an understanding that while no one wants to leave a child behind, that reality often trumps aspiration.
Returning universal adoption, I am reminded that virtually all former innovative technologies still have yet to reach the goal of universal adoption. This is true for even some of our most mundane technologies. For example, we have yet to achieve universal adoption of a telephone in every home, a microwave in every kitchen, or a car in every garage. For the simple reality is that there are a variety of factor that help explain why people choose to adopt some technologies and take a pass on others. Age, income, culture, tradition, religion, education and awareness all come into play.
The late Everett Rogers wrote the seminal book on the adoption and diffusion of innovative technologies. Rogers was an Iowa farm boy who earned his doctorate in the 1950’s trying to understand why some farmers adopted some obviously beneficial technologies while others did not. A decade earlier when agriculture was transitioning from planting varietal seed corn to hybrid seed corn researchers understood that both the yield and the drought-resistant characteristics of the hybrid seed made it far superior. Yet it took many years for farmers to adopt this new technology. From these and other studies, Rogers argued that the adoption of any new technology actually occurs in a series of predictable stages which culminates in an “S-shaped” curve, where the adoption of a new innovation starts out very slowly until it reaches a critical mass; at which point the adoption rate soars, only to tail off and stabilize. Most importantly however, was that Rogers never suggested that any technology will achieve a 100 percent adoption rate. In other words, regardless of the benefits of the innovation there will always be some non-adopters. A good example is the recognition that even today; some parents choose not to immunize their children against a variety of serious and contagious diseases.
So how do we rationally address this increasing attention to universalism in policy when all the evidence suggests that such universalism is unreasonable and unattainable? Well, first we need to recognize that defining anything less than 100 percent as failure makes a fine aspirational goal, but it makes poor public policy. Whether defined as a zero-tolerance drug policy, universal adoption, or no child left behind; policy is always best implemented when it is guided by rational discretion over aspirational ideology.
It’s interesting that in a capitalist culture that focuses on competition, product differentiation and market share that we seem to be romancing the values of universalism. For example, for many years economists defined the term “full employment” to actually mean an unemployment rate of 5 percent or less. I simply don’t ever recall back in the 1990s seeing public officials at the state or federal level wringing their hands over the 3-5 percent of the work force that were jobless. And public schools with a 90 percent graduation rate used to be a source of pride and held up nationally as an example of what is right with our public school system. Sure, we aspire to100 percent graduation rates, but there just seemed to be an understanding that while no one wants to leave a child behind, that reality often trumps aspiration.
Returning universal adoption, I am reminded that virtually all former innovative technologies still have yet to reach the goal of universal adoption. This is true for even some of our most mundane technologies. For example, we have yet to achieve universal adoption of a telephone in every home, a microwave in every kitchen, or a car in every garage. For the simple reality is that there are a variety of factor that help explain why people choose to adopt some technologies and take a pass on others. Age, income, culture, tradition, religion, education and awareness all come into play.
The late Everett Rogers wrote the seminal book on the adoption and diffusion of innovative technologies. Rogers was an Iowa farm boy who earned his doctorate in the 1950’s trying to understand why some farmers adopted some obviously beneficial technologies while others did not. A decade earlier when agriculture was transitioning from planting varietal seed corn to hybrid seed corn researchers understood that both the yield and the drought-resistant characteristics of the hybrid seed made it far superior. Yet it took many years for farmers to adopt this new technology. From these and other studies, Rogers argued that the adoption of any new technology actually occurs in a series of predictable stages which culminates in an “S-shaped” curve, where the adoption of a new innovation starts out very slowly until it reaches a critical mass; at which point the adoption rate soars, only to tail off and stabilize. Most importantly however, was that Rogers never suggested that any technology will achieve a 100 percent adoption rate. In other words, regardless of the benefits of the innovation there will always be some non-adopters. A good example is the recognition that even today; some parents choose not to immunize their children against a variety of serious and contagious diseases.
So how do we rationally address this increasing attention to universalism in policy when all the evidence suggests that such universalism is unreasonable and unattainable? Well, first we need to recognize that defining anything less than 100 percent as failure makes a fine aspirational goal, but it makes poor public policy. Whether defined as a zero-tolerance drug policy, universal adoption, or no child left behind; policy is always best implemented when it is guided by rational discretion over aspirational ideology.
Friday, June 26, 2009
Horses & Broadband on my Mind
Today I'm in Winona, Minnesota at the Minnesota Equestrian Center watching my daughter compete at a regional horse show. If you've ever been to a large regional or national horse show, you truly know the meaning of the phrase "hurray up and wait!" We started the day at 5:30am and it is now around 4:30pm and we're still waiting for the first riding class. I'm figuring that the riding classes might be completed around midnight - but we're used to it. So I bring the laptop and a broadband card and spend much of the day working and writing in the trailer.I've mentioned in an earlier post that I serve on the Governor's Broadband Task Force, which is good as broadband has been a longstanding research interest of mine. And coincidentally, I've just completed a study of 689 businesses throughout rural Minnesota, examining their adoption and utilization of the Internet in their business. So I'm sitting in the trailer writing up the findings and getting it ready for publication and release in a few weeks. I will release the final report through the EDA Center website at www.umcedacenter.org
But until then, let me give you a short sneak preview of a couple of the more salient findings:
- 89.7% of rural businesses are now online. This compares to 65.5% in 2004.
- 96% of rural businesses online connect with a broadband connection. Again, this compares to 61% back in 2004.
- The median price paid for a broadband connection was $50; not much more than a residential connection. That's likely because the majority of rural businesses are very small businesses with fewer than 10 employees.
- And as a result 71% of businesses characterized the price they pay for broadband as "very affordable" or "priced about right."
- 85% of businesses reported that their current Internet connection speed is adequate for their business needs; however, only 37% had confidence that their current connection speed would meet their needs 24 months from now.
Better get back to the horses ...
Monday, June 22, 2009
What's Wrong with Socialized Medicine?
This week aside from the protests in Iran, the news and Sunday political shows were filled with a variety of opinions on Obama's desire for a national public health care plan. While the advantages of such a plan are simple; i.e. universal access and coverage, opponents suggest that the disadvantages are too numerous to mention. However their primary concerns are (1) keeping government out of health care; and (2) arguing that no one wants or needs socialized medicine.
For quite a while I bought into these arguments as my natural inclinations are capitalistic. But after following this issue for a while I have made a 180 degree turn; and my logic is rather simple.
First, for those who want the government out of health care, the reality is that ship sailed more than 40 years ago. If you simply add up Medicare, Medicaid, Indian Health Service, Veterans Administration and Railroad Retirement expenditures, you will discover that the government already pays more than 45% of the entire U.S. health care bill. Do we really want government to bail out of these programs? I don't think so.
But what about socialized medicine? We certainly don't want that, right? Well, I'm not so sure about that. What exactly is socialized medicine?
From my perspective, socialism is when the government controls industrial resources, or what Marx called the "means of production." So back in the 1970's we laughed at the Soviet Union's inefficient government-run agricultural cooperatives, where production was low and there were no incentives to increase production or efficiencies. Through examples such as these, we came to conclude that government was incompetent and couldn't organize a two-car funeral procession!
But clearly, there are many other services we want our government to control; right? When we call 911 do we want an emergency dispatch operator to first ask us whether we have "police insurance" and if so, what our policy number is? Heck no ... get the cops here right now!
But then why is it OK for such an exchange to occur in the hospital emergency room, but not on a 911 call? Does this suggest that we actually want socialized police protection, socialized fire protection, socialized national defense and socialized roads and bridges, but not ... socialized medicine? And if so why?
Well the answer seems to be simple. While the free markets are optimal for the exchange of most goods and services, they don't really work well for society's essential services. Services such as police and fire protection, clean water, roads and bridges and national defense are so central to our collective well-being, that we decided to exempt these services from the marketplace. Rather, we prefer to collectively tax ourselves to ensure that we all have access to these important services regardless of our ability to pay.
So the real question here is when will enough Americans come to the conclusion that access to health care is an essential service? And when we arrive at that point we just may begin to wonder ... So what's so wrong with socialized medicine?
For quite a while I bought into these arguments as my natural inclinations are capitalistic. But after following this issue for a while I have made a 180 degree turn; and my logic is rather simple.
First, for those who want the government out of health care, the reality is that ship sailed more than 40 years ago. If you simply add up Medicare, Medicaid, Indian Health Service, Veterans Administration and Railroad Retirement expenditures, you will discover that the government already pays more than 45% of the entire U.S. health care bill. Do we really want government to bail out of these programs? I don't think so.
But what about socialized medicine? We certainly don't want that, right? Well, I'm not so sure about that. What exactly is socialized medicine?
From my perspective, socialism is when the government controls industrial resources, or what Marx called the "means of production." So back in the 1970's we laughed at the Soviet Union's inefficient government-run agricultural cooperatives, where production was low and there were no incentives to increase production or efficiencies. Through examples such as these, we came to conclude that government was incompetent and couldn't organize a two-car funeral procession!
But clearly, there are many other services we want our government to control; right? When we call 911 do we want an emergency dispatch operator to first ask us whether we have "police insurance" and if so, what our policy number is? Heck no ... get the cops here right now!
But then why is it OK for such an exchange to occur in the hospital emergency room, but not on a 911 call? Does this suggest that we actually want socialized police protection, socialized fire protection, socialized national defense and socialized roads and bridges, but not ... socialized medicine? And if so why?
Well the answer seems to be simple. While the free markets are optimal for the exchange of most goods and services, they don't really work well for society's essential services. Services such as police and fire protection, clean water, roads and bridges and national defense are so central to our collective well-being, that we decided to exempt these services from the marketplace. Rather, we prefer to collectively tax ourselves to ensure that we all have access to these important services regardless of our ability to pay.
So the real question here is when will enough Americans come to the conclusion that access to health care is an essential service? And when we arrive at that point we just may begin to wonder ... So what's so wrong with socialized medicine?
Wednesday, June 17, 2009
The Midwest Rural Assembly
I received an email from Eleonore Wesserle from the Institute for Agriculture and Trade Policy in Minneapolis with further information about the upcoming Midwest Rural Assembly, August 10-11 in Sioux Falls. It appears that slowly but surely they are putting together the agenda for this first ever event.
Click here to view the preliminary agenda. It is my understanding that they plan to fill in the blanks in the agenda as they go along. So viist their website regularly to see who's coming and what will be happening in Sioux Falls.
For further information contact about the Midwest Rural Assembly contact Elenore at ewesserle@iatp.org
Click here to view the preliminary agenda. It is my understanding that they plan to fill in the blanks in the agenda as they go along. So viist their website regularly to see who's coming and what will be happening in Sioux Falls.
For further information contact about the Midwest Rural Assembly contact Elenore at ewesserle@iatp.org
Monday, June 15, 2009
The Rural Policy Forum
Today I moderated a legislative panel of 4 legislators at the Minnesota Rural Health Conference here in Duluth. The day turned out to be outstanding with bright sunshine all day, which clearly brightened everyone's mood. The 4 legislators in attendance were Rep. Tom Huntley (D-Duluth); Rep. Mary Ellen Otremba (D-Long Prairie); Rep. Steve Gottwalt (R-St. Cloud); and Sen Yvonne Prettner Solon (D-Duluth).There were few partisan fireworks to report from up here. Rather, there was a sense (or hope) by many that this was the year meaningful health care reform was going to occur at the federal level. While they were all quite hopeful, it was equally clear that they all have a great deal of faith in President Obama's ability to deliver. We'll see ....
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