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A
Ray of Hope for Health Care After All
Well
done article. (See "Why
Not the Best?", November 4, 2003) I am a
graduate of MCV's health administration program and
understand at a small level the complex nature of
our country's health care mess. I think your
article offers many good suggestions and, more
importantly, a ray of hope - which seems to be all
but nonexistent at a federal and state level.
I
recently visited California and stayed with a friend.
She runs the health benefits for all employees of
community colleges in Los Angeles. Given my
background and the fact that her family has
forbidden any more health care discussions within
the household, she engaged me in a good talk about
perverse health care incentives, medical insurance
and universal healthcare. That is a long way to say
that states and people from coast to coast are
struggling with an issue that has become a bit of a
third rail in politics. Few good discussions are
taking place and even fewer action items are being
developed. Thanks for the insights.
P.S.
I agree whole-hog on the COPN and IT suggestions.
They call it progress when you can let go of the
past (COPN) and embrace the future (IT)...
Brian
Jenkins
Richmond
bamjenks@earthlink.net
Maybe
it's Time to Ration Health Care
You're
right, there is a major problem with health care and
the cost of health care insurance. It's a
significant contributor to many Virginia businesses
losing their competitiveness to offshore concerns. I
congratulate you for "entering the fray"
on such a formidable issue. I particularly liked the
way you phrased your challenge for Virginia to be
the leader in this arena, a role we seem not
interested in playing presently.
I
agree with all of the "reforms" you
suggest; they would seemingly improve the rather
woeful productivity record of the health care
industry. However, I question whether they alone are
enough to provide the incentive and reform necessary
for the health care system to generate the kind of
cost reduction (hmmm, that's a new word when talking
about medical expense) needed.
It
is my sense that we as citizens seem incapable of
realizing that our country simply cannot afford an
insatiable appetite for healthcare. The industry
knows no limit to the treatments, tests and costs
that can be rendered in the hope of extending life
or treating a complaint of some dysfunction. I'm no
health care expert, but I'm ready to learn more
about the so-called "Oregon Plan" of a few
years back that attempted to institutionalize the
rationing of healthcare.
Did
I say ration and healthcare in the same sentence?
Absolutely. We ration now; not very well, but the
system rations. Workers comp cases get lots of
medical attention with few bounds on the expenses
incurred, whereas a guy with no insurance is not
likely to get equivalent care. Rationing is a must!
We just need to spend more thought deciding how much
we collectively choose to spend for baseline
healthcare that is accessible to everyone, and then
work to provide that care in the most
cost-effective, productive way imaginable.
Please
continue to address this issue - we need your ideas.
Martin
Lightsey
Specialty
Blades, Inc.
Staunton
martin@specialtyblades.com
Prosecute
Health Care Fraud
Good
op-ed on the health care crisis. This is going to
become a bigger problem in coming sessions.
One
suggestion for controlling costs, you may have
overlooked. Take a look at the billions that the
federal government saves each year through the
inspector generals that exist at each department. In
2002, the IGs collectively reported $64.9 billion in
recommendations that funds be put to better use, $3
billion in questioned costs, and $4.6 billion in
investigative receivables and recoveries. But more
importantly they prosecute the fraudsters and put
them away. Last year, they conducted 10,690
successful criminal prosecutions. Between fiscal
year 99 and fiscal year 02, approximately 28,000
criminals who had been defrauding the government
were convicted.
These
are the type of statistics we never hear from our state
government — no wonder, since we don’t have a
truly independent office that can audit and
investigate all state programs. (I believe they have
an auditing function in the health area, but I
don’t have all the details and if they don’t
have investigative authorities, they are just
spinning their wheels).
I
recently worked on a follow-up audit of the guy in
Henry County that embezzled close to one million
(the actual amount may never be known). Examples
like these are not isolated. Here in Fairfax we’ve
had to county employees embezzle more than $1
million each from different retirement funds.
That’s not small change.
Phillip
Rodokanakis
Oak
Hill
phil@philr.us
HMO
Insurance Explained
Found this on the Internet. Thought it might be
helpful.
Q.
What does HMO stand for?
A. This is actually a variation of the phrase,
"HEY
MOE." Its roots go back to a concept
pioneered
by Moe of the Three Stooges, who discovered
that a patient could be made to
forget
about the pain in his foot if he was poked hard
enough in the eyes.
Q. I
just joined an HMO. How difficult will it be to
choose the doctor I want?
A. Just slightly more difficult than choosing your
parents. Your insurer will provide you with a book
listing all the doctors in the
plan.
These doctors basically fall into two categories --
those who are no longer accepting new patients, and
those who will see you but are no longer
participating in the plan. But don't worry; the
remaining doctor who is still in the plan and
accepting new patients has an office just a
half-day's drive away, and a diploma from a Third
World country.
Q.
Do all diagnostic procedures require
pre-certification?
A. No. Only those you need.
Q. Can I get coverage for my pre-existing
conditions?
A.
Certainly, as long as they don't require any
treatment.
Q. What happens if I want to try alternative forms
of medicine?
A. You'll need to find alternative forms of payment.
Q. My pharmacy plan only covers generic drugs, but I
need the name brand. I tried the Generic Medication,
but it gave me a stomach ache. What should I do?
A. Poke yourself in the eye.
Q. What if I'm away from home and I get sick?
A. You really shouldn't do that.
Q. I think I need to see a specialist, but my doctor
insists he can handle my problem. Can a general
practitioner really perform a heart transplant
right in his office?
A. Hard to say, but considering that all you're
risking is the $20 co-payment, there's no harm in
giving him a shot at it.
Q. Will health care be different in the next
century?
A. No. But if you call right now, you might get an
appointment by then.
Steve
Toler
Richmond
Give
it a Rest, Bacon
In
two essays -- “
Law
Schools
and Baseball Stadiums?”,
October 4, 2003
-- and "Point-
Counterpoint
on The Appalachian School of Law", October
20, 2003 -- I make the case that, instead of
investing in law schools and pharmacy schools,
Southwest Virginia should funnel scarce development
resources into transforming an existing industry,
like the mining-equipment manufacturing sector, into
a knowledge-intensive powerhouse. Obviously, I
didn't persuade Jack White.
The
Tobacco Commission “Economic Summit” yesterday
at UVA-Wise unveils a Chmura report on the
Southwestern Virginia economy. Note the paragraph I
have bolded. Jim, you just blew it in your column a
couple of weeks ago. Why not admit it and move on?
From
the Bristol Herald-Courier: According
to the report, the region still is trying to
recover from the loss of more than half its 13,000
coal-mining jobs over the past decade.
The region also has lost more than 10,000
manufacturing jobs over the past 10 years, mainly
due to the demise of sewing factories and mining
manufacturing plants.
Jackson
S. White, Jr.
The White Law Office
Abingdon, VA
jackwhite@whitelawoffice.com
Nor,
for that matter, did I convince Jack Reasor.
Believe
it or not, the Law School Works!
I
just finished reading your article on the
Appalachian School of Law. I agree with much of what
you have written about spending of federal, state
and local dollars. I generally agree with the
separation of public dollars and private, civic
dollars. I also agree that communities and states
need to think carefully about spending public
dollars on athletic facilities that appear to
primarily benefit team owners.
When
this law school idea received the first light of
day, I represented Grundy and Buchanan County in the
state senate. Del. Jackie Stump, D-Oakwood, and I
were approached early in the process with the
request to fully support this idea and work to get
state funds. Both of us were very, very skeptical.
... I had very serious doubts that the community
could make this work; had significant concerns about
using local government dollars to support such a
private project; was doubtful that the private
parties could raise significant dollars; and was
very concerned that it was not good public policy
for the Commonwealth to invest in such a private,
speculative project.
Being
the "good, public servant", I publicly
supported the county and town efforts while
privately expressing my doubts about the sanity of
this effort and doing little or nothing to get state
dollars. Much to my surprise, Gov. George Allen made
several generous contributions of public funds in
the name of economic development, which I was quick
to privately dismiss as politics as usual.
I
have been pleasantly surprised -- no, shocked -- to
see the community not only take an unsafe, eyesore
in the heart of Grundy and turn it into a beautiful,
fabulous, electronic functioning law school. The
school has been been extremely successful in getting
accredited and seeing enrollment grow by substantial
numbers. (All this in the midst of the terrible
shooting tragedy).
Additionally,
the law school has drawn outstanding support from
sources within the community and across the eastern
U.S. It has given energy and vitality to the
community and has brought people back into the area,
which is something the traditional economic
development efforts have always failed to do. While
not perfect, I believe that by almost every
measurement used, this project has been a huge
success. And I am one of those skeptics who never
thought it would work. (A big side benefit is that a
major goal of the school is also being accomplished:
bringing lawyers to the Appalachian region of the
country dedicated to helping the people of that
region.)
Is
this the way public dollars should be spent? Will
this work as an economic development tool in other
depressed areas? Probably no in both cases. But,
in this one situation, even though I never would
have believed it, this law school has brought
economic benefit to the area, caused people to move into
Buchanan County, brought a sense of pride and
vitality to the region, and was the right thing to
do in this situation, at this time, in this place.
Jack
Reasor
jreasor@odec.com
Silent
Migration from Arlington?
Tim
Wise, president of the Arlington County Taxpayers
Association, forwarded this document to me. The
analysis, prepared by the Arlington County county
manager's office, responds to my column, "The
Silent Migration" (September 8, 2003) in which
I presented IRS migration data suggesting a movement
of wealthier households from the urban core to the
inner suburbs, and then to the outer suburbs. --
Editor
TO: Jay Fisette, Member, Arlington County Board
FROM: Office of the County Manager
SUBJECT: 179572/2120066
Staff in the Department of Management and
Finance and the Department of Community Planning,
Housing and Development provided the information
that follows in response to your inquiry about the
article referenced in the media notes.
Mr. James Bacon, columnist/
analyst, in an
article entitled “The Silent Migration”,
suggests that higher-income residents are leaving
Arlington
County. This
is an isolated statistic and does not represent the
best analysis of demographic change in the County. In fact, the article pointed out that using
data for only one year was not conclusive or
statistically persuasive in forecasting trends.
Staff confirmed that Mr. Bacon used 2001-2002
IRS data and that the numbers he presented are
accurate. There
were approximately 4,600 fewer tax filers and
dependents in Arlington
in 2002 than in 2001, and the median incomes of the
households leaving were higher than the median
incomes of the households entering.
The U.S. Census Bureau also relies on IRS
data to make their County-level population
projections. For
at least the last two years, the County has taken
issue with these data. Using IRS data assumes that when people move
to Arlington
they change their address and that people file tax
returns. Because
there is a group of Arlington’s
population that is relatively transient, there are
likely many who choose not to change their address
officially when they move from another location to Arlington.
Arlington
County
estimates an increase in population between 2001 and
2002 of approximately 4,000 people.
The University
of
Virginia’s
Weldon
Cooper
Center
estimates a 2,200-person increase. The County’s estimates are based on new
construction and assumptions about vacancy rates and
average household sizes. Weldon Cooper uses building permit data in
addition to data from the DMV, birth/death records,
and school records.
Although the numbers Mr. Bacon uses are
correctly reported from the IRS data, staff takes
exception to his conclusion that “higher-income
people are moving towards the urban fringe,
lower-income people are moving towards the urban
core.” While
there may be an element of truth to that, the bigger
driver is household size. It might be fairer to say that, overall,
larger households (i.e., families) are more likely
to be moving out, while smaller households are more
likely to be moving in.
Larger households will automatically have
higher incomes because there are more potential
workers per household.
The IRS data support this point. For each tax return filed among out-migrants,
there are 1.55 people (meaning the filer plus
dependents). For
the in-migrants, the average number of people per
filer is 1.32. The
data suggest that smaller households are moving in.
The data on average sizes of households
reflect the issue of housing choice and housing
cost. Much
of the new supply of housing in Arlington
has been condos or townhouses, or it has been
expensive relative to the region, or both.
Families that want a bigger house with a yard
may be willing to forgo the amenities of being in a
close-in place like Arlington,
and may be willing to face longer commutes, in order
to get a bigger house at a lower price. That makes economic sense to a lot of people
and may be part of what the IRS data show.
Staff further questions that rich people are
moving out of the County and poor people are moving
in. The
2000 Census shows that the average earnings of
workers living in Court House, Crystal
City,
and Ballston were higher than the County average;
these are places new residents are potentially
moving. The
median household incomes in Court House and Crystal
City
are lower, because household sizes are smaller (the
housing units are small). In addition, according to the U.S. Bureau of
Economic Analysis, the per capita income in Arlington
County
has steadily increased every year. For example, the per capita income in Arlington
increased by 3.5% between 2000 and 2001 and by 7.6%
between 1999 and 2000. Data for 2002 and 2003 are not yet available.
Regardless of price, the housing sales market
in
Arlington
is strong. According
to housing sales statistics published in the Sun
Gazette in September, the average sales price of a
single family home surpassed the half-million-dollar
mark in July 2003 and the available inventory is
down nearly 10 percent from a year ago. In addition, the article states that “the
upper bracket continued to perform strongly with 18
homes selling for more than $750,000 in August,
compared to 5 a year before.” This suggests that housing choices may affect
migration more than household income levels or
taxes.
In summary, over the last several years, the
County’s per capita income is rising; luxury,
high-priced housing is being purchased or rented;
assessment growth is strong; and business income is
showing signs of sustained growth.
These trends suggest something other than a
loss of wealth from our community.
The IRS data, however, bear watching over a
more extended time period.
More
Roads or Better Traffic Management?
In
my October 20, 2003 column, "Demand
Side Economics," I profiled Craig Franklin,
CEO of Trichord Incorporated, and suggested that the
state should try investing millions of dollars in
traffic-management technologies before it pumps
billions more into building more roads.
We
do need to use available technology: Moving traffic
efficiently is very important. But I disagree with
the comment about building more roads. You reach a
point when a particular road has reached its
capacity; no matter what you do, you simply cannot
move any more traffic through it. At this point --
or, actually, beforehand -- alternate routes need to
be constructed. I believe [that problems] are more a
lack of foresight on the part of the planners.
Hindsight is 20/20!
R.W.
Kucinski
Traffic
signal tech.
Robert.Kucinski@VirginiaDOT.org
Unfair
Competition from MCI
I
just read the editorial about MCI/Worldcom in
Bacon's Rebellion ("Shoot
MCI/Worldcom?" by Richard Wagner, November
3, 2003), and I think [it is] off the mark.
There
is plenty of competition in the tele-
communications
business today. Just take a look at any of the Baby
Bells' quarterly reports and you will find
reductions in the number of access lines served.
These reductions are caused by competition from
wireless services, cable companies and competitive
local exchange carriers, including companies such as
AT&T. At the same time, the local exchange
carriers that are allowed to offer long distance
telecommunications services are providing plenty of
competition for AT&T, MCI and other long
distance providers. Allowing MCI to go out of
business would not have changed that.
An
important fact you leave out is the number of jobs
lost by competitors of MCI that were, in effect,
competing against a company that was cheating. MCI's
prices were set artificially low, causing their
competitors to have to cut costs by cutting people.
What do you propose to say to those people, that
number in the hundreds of thousands? Why are you so
concerned about a smaller number of MCI employees,
many of which would be absorbed by the companies
that ended up picking up MCI's pieces? Now MCI is
being rewarded with a vast reduction in their debt,
while at the same time being allowed to accumulate a
multi-billion dollar cash hoard.
I
think that MCI/Worldcom being allowed to emerge from
bankruptcy, and in effect rewarded for their past
behavior, is a perversion of the bankruptcy system.
Who is looking out for the shareholders that lost so
much money? Why shouldn't the billions in cash that
MCI now has be distributed to former shareholders?
Why is MCI allowed to pay exorbitant retention
bonuses and salaries to executives in an industry
where there is plenty of management talent out of
work and willing to work for more reasonable sum?
All of this money is coming out of shareholder's
pockets that were picked by MCI when they committed
fraud.
Peter
Cutler
Director
of Marketing
Data
Networks Corporation
Since
Mr. Cutler wrote this letter, the state has awarded
MCI a $250 million, 10-year contract to provide
advanced voice, data and Internet communications for
Commonwealth of Virginia Network, Covanet, the
state's telecommunications backbone. -- Editor
.
--
December 15, 2003
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