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All Posts, medicaid, taxes

N.C. LEGISLATURE’S HASTE MAKES WASTE

Current events bring to mind two lessons from childhood: “Stop, look and listen.” and “Haste makes waste.” Although they are using different words, those are the messages that I hear Governor McCrory and DHHS Secretary Aldona Wos sending to the North Carolina Legislature.

A hastily proposed bill now in the Legislature would require every facility performing abortions to meet ambulatory surgical center licensing standards. The purported goal is to assure that the procedure is safe for women but the apparent effect is to severely limit the availability of abortion because only one facility in the state could meet the standards. Both the Governor and Secretary Wos have urged the legislature to slow down and to look at the bill and the situation carefully before acting. The governor has even threatened to veto it.

If the bill is about patient safety, the sponsors should be able to present data indicating a problem. What percentage of women have complications after the procedure? What is the evidence that the complications would be reduced in an Ambulatory Surgical Center? The absence of facts is stunning. Many surgical procedures are permitted in physician offices.  Without evidence that safety would be better in a surgical center, the law will be extremely vulnerable to court challenges and we will waste lots of tax money defending it. It seems obvious, that the bill is not about the safety of patients. Instead, it is a dishonest attempt to nearly eliminate abortion services in the state under the guise of patient safety, clearly infringing on women’s rights to make decisions about their own bodies. In their haste to act, the legislators could run us into the street and get all of us hit by an oncoming car – the lawsuits which will inevitably follow passage of the law.

In a similar matter, Governor McCrory is urging caution in the tax reform debate where radical legislators would reduce the state’s revenue so much that major new spending reductions would be required – and they would do that without a plan for which budget items would be cut. They would do it in a state which already ranks 44th among the 50 states in the percent of our economic output that is collected in taxes. The legislators will run into the street without looking and get us hit by a large truck – inability to fund public education, health services, infrastructure, and public safety needs.

It is to the Governor’s credit that he is warning the legislature that haste makes waste but he is far too late in confronting the legislature’s radicals. They have already rejected the return of $15 billion of federal taxes which North Carolina residents will pay for Medicaid expansion through 2019. They also gave back federal money for unemployment benefits at a time when we rank fifth in the nation in unemployment. And they have cut spending on public education in our state which already ranks 44th among the 50 states in per student spending. Yet excellence in public education may be the single most important key to economic vitality.

In November 2012, before the takeover by extremists, Site Selection Magazine ranked North Carolina as the best state in the nation for locating a new business. The magazine cited our “combination of work-force availability and skill sets of interest to employers, proactive business-development agencies, logistics assets and higher education infrastructure” as reasons for the top ranking.   The legislature is taking us backwards. To see how the rest of the nation is viewing us now, you can Google “the decline of North Carolina” and read the opinion of the New York Times Editorial Board. In part, the observation from what may be the most influential newspaper in the country is, “In January, after the election of Pat McCrory as governor, Republicans took control of both the executive and legislative branches for the first time since Reconstruction. Since then, state government has become a demolition derby, tearing down years of progress in public education, tax policy, racial equality in the courtroom and access to the ballot…North Carolina was once considered a beacon of farsightedness in the South, an exception in a region of poor education, intolerance and tightfistedness. In a few short months, Republicans have begun to dismantle a reputation that took years to build.” The growing crowds at demonstrations opposing the legislature’s actions are ample evidence that something is seriously wrong and that many North Carolina Citizens recognize the problem. We ignore these problems at our peril.

When I listen to Republican friends, the ideas that I hear are not the ones that are emerging from the legislature. Instead, I hear thoughtful fiscal conservatives who want to improve efficiency, reduce waste, and limit the scope of government’s role in our lives. While we may disagree on some issues, we share goals of economic growth, excellence in education and efficient use of tax money. We can hope that the Governor is having a change of heart and that public opposition will slow down the march of radical lemmings which is headed for a cliff over which few of us want to fall. On the other hand, maybe the lemmings who walk over the cliff will not be returning to the next session of the legislature. Maybe by letting them go ahead we can improve the legislative gene pool…just a thought…

All Posts, budget, economy, medicaid, poverty, public education, taxes

NORTH CAROLINA TAX REFORM

We create some of our own big problems when we act on our beliefs without checking to see if the beliefs are true. Governor McCrory and the North Carolina Legislature are about to do that as they reform our taxes. They have been cutting spending and now they plan to cut taxes with religious zeal based on two erroneous beliefs. One belief is that cutting taxes will stimulate creation of good jobs and economic growth. The other belief is that North Carolina taxes are too high.

First, let’s look at how much we are actually spending compared to other states. Counting all forms of state taxes including corporate and personal, we collected $2320 per person in 2011. That ranked us 34th highest among the 50 states. Gross State Product measures the total economic output within the state. Our combined state and local government spending as a percent of our Gross State Product ranked 44th among the 50 states. That means that the tax burden on our state economy was lower than all but six states.

Our spending on public K-12 education has been a hot topic. Our per pupil spending in 2011 ranked 44th among the 50 states and the legislature has already cut it below that level. As a percent of GSP, our per pupil spending ranked 46th. The K-12 tax burden on our GSP was 4.8%. Some states with low GSPs are trying to catch up with the rest of the nation. While we go backwards, low wealth states like West Virginia, Mississippi, Alabama, South Carolina and Arkansas are placing a tax burden of 7% to 8.4% on their GSP to support K-12 education.

What about the other reason for cutting taxes – to bring more jobs and economic development? High wage employers will be looking for a highly educated and skilled workforce. That is the reason, for example, that tech industries have concentrated around Seattle, San Francisco and Boston. It is because strong public education K-PhD produces a strong workforce and because those regions provide the quality of life (some of which is tax supported) which attracts and retains highly skilled people. Here in North Carolina, the Research Triangle Park has been a viable competitor for those companies. A few other communities have made some headway, mostly in proximity to universities which help attract the workforce.   A tech company might put a call center or data center in other parts of our state (and that would be a good thing) but the corporate headquarters and the R&D functions which provide the best jobs will be elsewhere.

If our taxes and wages are reduced enough, we may indeed attract some jobs because there are some businesses which consider small differences in tax rates as an important criterion when choosing a location. They are also typically looking for the lowest labor costs. They don’t need a highly educated and skilled workforce and they keep benefit costs low by using as many temporary workers as they can. Those are also the jobs which are most vulnerable to outsourcing and automation. Having a mix of jobs available is a good thing but if we can’t attract our share of the high wage jobs then why will our brightest and most ambitious children return home for their careers? Or will they migrate to other parts of the country (or the world) for better wages and the environment that they want?

My conclusion is that the legislature and the Governor have entered us in a race to the economic bottom and if they continue cutting taxes and spending we are likely to win that race. I hate waste and don’t enjoy paying taxes but I’m very willing to pay for excellence in public education from birth through college. And I’m willing to pay fair wages to public servants who make our lives safer and better, and for parks, arts, and other government programs which promote the general welfare. Business leaders already know, but may require an occasional reminder, that it is a lot easier to earn a profit when your customers have money to spend. For that to happen, we need high wage jobs and a high skill workforce and public education to support both.

Tax reforms to close loopholes, to begin taxing services, and to reduce corporate taxes may indeed be good things but the design of the changes should increase rather than decrease state revenue and the tax burden must not be shifted to the middle class and poor who are least able to bear it.

I am an optimist. I believe in the people of my community and my state – good people who are working hard toward better lives for themselves and their families. We need to see ambition and optimism from our leaders including an understanding of that phrase “promote the general welfare” from the US and North Carolina constitutions. Taxation is not a win-lose game and neither is good government. When we spend our resources wisely on education and enhancements to quality of life, we all win. When wages go up, so does demand for products and services. It is time now for North Carolina to reclaim our dual heritage as a pro-business and progressive state.

All Posts, budget, deficit, economy, justice, poverty, taxes

KEEPING MEDICARE SOLVENT

There is a straightforward way to keep Medicare financially solvent without reducing benefits, changing the retirement age, or raising taxes. Medicare should pay standard rates for each service to all health care providers and let them compete to see who can provide the best combination of cost and quality for that price. The payments should be enough to allow high quality and efficient health care providers to earn a modest profit but should not include special provisions for favored organizations or locations. Right now the rates vary to unjustifiable degrees and patients are not even aware of it.

Here is an example to demonstrate what is currently wrong. In Medicare’s diagnostic classification system, the most frequently occurring inpatient payment is for hip and knee replacement surgery on uncomplicated (otherwise well) patients. There are separate diagnostic categories with higher payment rates for complicated patients. In 2011 Medicare paid for 427,207 of these procedures and the average payment was $14,324. That adds up to over $6 billion. The best paid hospital in the country was the Baylor Surgical Hospital in Fort Worth, Texas which received $38,686 per surgery. The worst paid was Saint John Hospital in Broken Arrow, Oklahoma which received $9,130. Baylor got more than two and a half times the national average and more than four times the price Saint John Hospital would have received for the same service to the same patient. Here in North Carolina, UNC Hospital was paid the most, $20,610 while the North Carolina Specialty Hospital in Durham was paid the least, only $11,058. In the Piedmont Triad, the payments were $18,656 to NC Baptist Hospital, $14,045 to Forsyth Hospital, $13,758 to Moses Cone Hospital, $12,726 to High Point Hospital, and $12,412 to Randolph Hospital. The same pattern exists for other diagnoses and similar variances exist for medical practices.   Readers who want to explore the data in detail can find it at the CMS.gov website or Email me and I will send the link to you.

The hospitals that are paid more do not get better results for their patients. Nor do they have better patient satisfaction. Supposedly the payment variances are because of factors like regional wage differences and costs incurred in educating specialty physicians. That may sound reasonable but the net effect is that Medicare subsidizes high costs at expensive hospitals and penalizes those with lower costs – the exact opposite of a free market economy. The political clout of local congressional delegations has been a huge factor at times, with special rates being set for certain cities or states. Medicare’s proper role is to purchase good health care for beneficiaries regardless of where the patient lives or which health care provider they choose. If we taxpayers are to subsidize medical education (and I believe that we should) then money should be appropriated for that purpose and separate contracts should be established to fund the medical education that taxpayers are purchasing. Educational grants should not be hidden in Medicare.

Medicare pays extraordinarily high prices to a few organizations which often use the surplus to acquire other hospitals or medical practices at the expense of taxpayers and consumers. Then they raise the prices. The UNC system, which also gets preferential rates from the state’s troubled Medicaid system, has used its taxpayer subsidized profits to gain control of large medical practices and other hospitals. With the increased negotiating leverage of the UNC system, prices can then be raised to insurance companies and benefit plans. Private insurance markets, just like Medicare, pay more in large cities and to large hospital systems. The idea that large size brings economies of scale is mostly a myth in health care. If the myth were true, the biggest hospitals would have the lowest costs. They don’t. But they do get paid more just for being big. The American ideal of a free market in health care where high quality and low cost are rewarded can work if we will design our payment system to work that way.

If Medicare rates are set and periodically adjusted to levels that allow good quality hospitals and doctors to make a modest profit, the best hospitals and physicians will thrive. Poor performers will fail financially or be taken over by someone else. That is how competitive marketplaces work. Healthcare resources will be more evenly distributed across the country if payment rates are standardized. We will soon discover that it is less expensive and more convenient to deliver high quality care outside of the bureaucracies of huge medical centers. If payment rates for doctors were the same in extremely rural areas of North Carolina as they are in Raleigh, there would be plenty of doctors in the mountains and down east. The need for the federal agency that operates rural clinics would likely disappear.

 

A free and competitive market will bring more community based health care, less centralization around large medical centers, better quality, better accessibility and lower cost. It will also bring powerful opposition from the organizations now being paid the most.

All Posts, budget, economy, justice, taxes

OBAMACARE 2013

Please take a few minutes to return with me to the basics of whether “ObamaCare” or an alternative universal health coverage program should exist. The underlying question is ethical and philosophical. “Are there circumstances under which a person who is uninsured and lacks money to pay for health care should receive it?” If you answer the question “yes” then we can have an intelligent discussion of who gets care and how to pay for it. If your answer is “no” and if you find yourself uninsured and critically ill, then you have a moral obligation to die without burdening others with the cost of your care.

Today, hospitals are required by law to provide emergency services without regard to a patient’s ability or willingness to pay. Hospitals are also required to force the doctors who have privileges there to serve in on-call rotations for non-paying patients. It is not free. Hospitals and doctors try to cover the cost of serving those who don’t pay by charging more to those who do pay. The system functions exactly like an invisible tax on health services but it doesn’t provide support for preventing serious illness and hospitalization by keeping people well and treating illness early. It doesn’t provide a colonoscopy to prevent colon cancer but if you are bleeding to death from advanced colon cancer, it could get you a transfusion. The law was well intended but it is irrational.

The basic principle of ObamaCare is to strongly encourage everyone to purchase health insurance either through an employer or as an individual. For those who can afford to buy insurance and choose not to, there are tax penalties. Those penalties help pay for services that some who refused to buy insurance will surely need and receive.  For those who can’t afford the full cost of insurance, there is a subsidy to make it more affordable. For those who have incomes below 140% of the federal poverty level there is 100% federal funded expansion of Medicaid. In combination with Medicare and other existing programs, ObamaCare makes a reasonable level of health care available to all Americans. There are incentives built into ObamaCare that are intended to drive the cost of health care down and to improve the quality. It appears that some of them are already having a positive effect in reducing hospital readmissions, for example. And it bans insurance companies from onerous practices like not covering pre-existing conditions.

ObamaCare is not even close to perfect. The President would agree with that statement. It should not be compared to “perfect”. Americans could not even agree on a definition of perfect. Instead, ObamaCare should be compared to what we had before it passed. Those who want to repeal the law would take us back to the exploding costs and inefficiency of a non-system where every year the percentage of the population covered by private insurance went down because fewer employers and employees could afford it.   Many insured employees saw no increase or even reductions in take home pay because the cost of insurance escalated so rapidly. The opponents of ObamaCare have nothing to put in its place except the failed laws of the past.

After nearly a century of debate, going back to Republican President Theodore Roosevelt, we have a start in providing universal access to some level of health care. The best part of the new law is that we finally made that commitment. ObamaCare marks the beginning of the evolution of a uniquely American health care system that emphasizes consumer choice and leaves most of the health care system in the hands of the private sector.

It is time for us to rally around the idea that all of us are going to have at least a basic level of health care.   We will be forced to have the debates that have been held for generations in other democracies about what kinds of care will and will not be covered in taxpayer funded programs. Insurance market regulations will be debated and will need revisions to create health care markets that reward quality and cost, even to the extent of allowing low quality and high cost health care providers to fail financially. That, after all, is the nature of truly free markets.

I hope that attempts to obstruct the law so that it will fail or to repeal it prove futile. I know that they are counterproductive. It is long past time for opponents of universal coverage to acknowledge the end of that debate and to begin proposing their own ideas as ways to improve the law. And it is time for the North Carolina legislature and Governor to back away from their refusal to implement the Medicaid expansion. We will pay the cost of it in federal taxes regardless of what the legislature does but because of their action most of our poorest citizens will receive only emergency care. Refusing the expansion is wasteful of the tax dollars that we are already paying and mean-spirited toward those who with low incomes. It is time to quit fighting the President who finally got something done and to begin making health care better and less expensive for all Americans.

All Posts, budget, deficit, economy, environment, medicaid, poverty, public education, taxes

THE REPUBLICAN PORCH STEP

I had an uncle old enough to be my grandfather who cleared land, cut lumber, and built the home on his Tennessee farm with his own hands. As visitors approached, he warned them not to use the steps on the side of the porch. “Those are Republican steps.” he would say, “They look solid but if you trust them they’ll let you down.” Since handing over the legislature and the governor’s office to Republicans, a lot of North Carolina voters are learning what he meant. Republican candidates said it was time for a change after generations of Democratic control, pointing out numerous scandals and sloppiness in governance by one party. Republicans promised openness in government, less intrusion on personal liberties, lower taxes, improvements in public education and more jobs. Governor McCrory ran a campaign based on economic development and less intrusive government. Sadly, their actions don’t resemble their promises.

The actual Republican agenda appears to have three themes. First and foremost, hold on to power, even if that requires depriving citizens of their rights. The second theme is to financially reward supporters and punish opponents. The third is to impose the social and religious values of their extreme base on all North Carolinians.

Republicans are cementing their grip on power. By gerrymandering our districts they won 69% of North Carolina congressional seats with 49% of the votes. Now they are proposing laws designed to discourage voting by citizens they think are likely to support the opposition. They have proposed laws to:

  • Take away the $2500 per dependent tax credit from parents of college students who vote where they go to college (and live for most of the year).
  • Eliminate early voting on Sundays, which is especially popular among African American churches.
  • Cut back early voting to one week.
  • Restrict the number of early voting locations.
  • End the practice of registering and voting on the same day.
  • Pass a voter ID law, designed to deter voters who don’t have a driver’s license.

Republicans propose to financially reward supporters and penalize opponents. They want to cut corporate taxes, estate taxes, and income tax rates and pay for the cuts by expanding the scope and amount of the sales tax. By taxing food and other necessities then cutting taxes for corporations and those with higher incomes they can redistribute income from the working poor to the Republican base. There are proposed laws to reward generous Republican contributors by legalizing sweepstakes cafe gambling and payday lending (sponsored by our own Senator Tillman).   They passed a law allowing hydraulic fracturing for natural gas while severely limiting the liability of companies for pollution of ground water and land, even if it is caused by intentional violation of safety regulations.

Then they punished the poor – perhaps with the notion that most poor folks either don’t vote or vote for Democrats. They reduced unemployment compensation for the long term unemployed and raised college tuition, making upward mobility for those with low incomes even harder than it was before. Their funding cuts increased financial problems for our public schools. Their solutions include allowing charter schools to hire uncertified teachers without even doing background checks (Senator Tillman again). They rejected $15 billion dollars of federal money to pay for Medicaid expansion through 2019. That punishes the poor who need health care along with the hospitals and doctors who are required by law to provide emergency services whether they are paid or not. The Medicaid expansion would create 25,000 new jobs, mostly in the private sector. Do Republicans think voters won’t miss those jobs or notice that we still have to pay our $15 billion in federal taxes? At one time we were fighting a “war on poverty”. Now it feels like Republican leadership is fighting an undeclared war on the poor.

 

The third element of the Republican agenda has been to impose the social and religious values of their extreme conservative base on the rest of the population.   Randolph County’s own Allen McNeill co-sponsored a bill to exempt North Carolina from the US Constitution and allow government establishment of an official religion. You can find it on the legislature’s website or just Google “HJR 494”. One proposed imposition on personal freedom is a requirement to provide written notice to a spouse two years in advance and attend state approved counseling before filing for divorce – even in cases of domestic violence. There is a bill requiring doctors to get written consent from parents before providing pre-natal care to a pregnant minor or answering questions from minors about STDs or birth control. And one of the first acts of the Republican majority was to encourage a constitutional amendment which prohibits the state from recognizing same-sex marriages or unions – even those performed in states where they are legal. Soon they will be spending our tax dollars to defend that useless amendment in court.

As candidates, Republicans promised less intrusion on personal liberties, lower taxes, improvements in public education and more jobs but they are delivering something quite different. Like my uncle’s porch steps, they looked reliable but they are letting us down.

All Posts, budget, justice, north carolina, public education, taxes

LESSONS ABOUT PUBLIC EDUCATION

We seem to have a consensus that public K-12 education is important and that we want to do better but little agreement beyond that. Presidents Bush and Obama made education reforms key parts of their agendas and now Governor McCrory promises major changes. Public understanding of the issues is meager and our highly partisan atmosphere for legislative discussion is a barrier to good decision making. In this climate, I went looking for the Holy Grail of education: policy answers that would lead to excellence in public education. That search led me to conclude that there is no Holy Grail. There is no one prescription or silver bullet but there are many opportunities for improvement and many possible pathways to excellence.

The most valuable source of information that I found is the Programme for International Student Assessment (PISA) in which 34 developed nations have been cooperating for sixteen years to measure student performance and to identify best practices for improvement. The US is one of the participants and there is a wealth of research at our fingertips. Here is a link to PISA’s work. http://www.oecd.org/pisa/  One PISA research paper “Lessons from PISA for the United States” is the source of most information in this column.

Our performance is about average among developed nations in reading and science but well below average in mathematics. Northeastern states are above average, about like the Netherlands. The Midwest is average, tied with Poland. The Western states perform about like Italy and the Southern states rank lowest, matching Greece. Variability of performance in the US is extreme.

Differences among the nations in spending explain only 9% of the variation in their performance. The US gets sub-par performance while being the number two per-capita spender. We are putting in enough resources to achieve excellence but we may not be putting the resources in the right places. Nor is our mediocre performance explained by a higher than normal proportion of socioeconomically disadvantaged students or students from single parent families. Many of the other nations are similar to us in that regard.

Public school and private school performance are not different. When public and private schools have similar resources and similar socioeconomic mix of students, they produce roughly the same performance.

Here are some attributes that the best performing nations seem to have in common. Teachers are highly respected and have salaries that compare favorably to other top professionals. Best performers allocate resources evenly, based on need.   Because funding is not dependent on the local economy, schools in poor communities get as much money as those in wealthy communities.   Schools and communities with particularly difficult situations may receive additional resources and teachers may be offered additional pay to go there. Only the US, Turkey, and Israel base funding on the local economy.

Best performers use standardized tests to measure performance of students and they use the results to modify curriculum, teaching practices and professional development. They do not use the results punitively against teachers or to de-fund schools.   Most also make test results public and allow families some choice in which schools their children attend. High performing schools expect a lot of their local school principals and grant them the authority to hire, set salaries and remove teachers.

 

I was surprised to see which nations are leaders. Asian and Scandinavian nations, especially Korea and Finland are top performers. Korea, Hong Kong, Singapore and Shanghai score particularly high on “resilience” of their economically disadvantaged populations which perform almost as well as the children of the wealthy.

Canada has a remarkable story and it may be the one from which we can learn the most. Not long ago, their situation was much like the US and education reform became a topic of bitter political debate. Since then, they have improved as quickly as any nation and now Canada is near the top of most performance measures. There appear to be several lessons to learn from Canada. The Provincial (State) school board establishes general curriculum standards but teachers and local schools have a lot of flexibility and opportunity for creativity in how to use the curriculum. Ontario, the largest Canadian Province, attracts many of their best and brightest into careers in public education. Admission to teachers colleges is very competitive and almost all Ontario teachers graduated in the top third of their college classes.

The Ontario funding formula provides a block grant to each district based on the number of students plus categorical grants for specific programs such as special education and rural transportation.

PISA research indicates that selectivity in choosing teachers, professional respect, collegiality, and relatively high teacher salaries are key factors in high performing schools. The Ontario Salaries will shock many Americans. Annual salary for a new teacher, depending on specialty and qualifications, will be between $45,709 and $55,404. With ten or more years of service the salary will be between $76,021 and $94,707. An additional 11% of salary goes to the retirement plan and health insurance is fully paid by the employer. Ontario does this while spending less per student per year than the American average. They have no Federal role in education, more local autonomy, more different kinds of schools and more success for less money. I hope our legislators, news media and voters will study Ontario, PISA and other research before making changes to public education.  We need to get these decisions right!

All Posts, justice, north carolina, race

GERRYMANDERING FOR POWER

Imagine living in a nation where one political party manipulates elections so that it can maintain power over a majority of voters who support a different party. Then imagine that they are so bold as to publicly brag about what they did and raise money to strengthen their grip on power. How do we describe nations like that?

Now you can quit imagining because you do live in that nation. You can go to the website of those who organized the plan and carried it out; and you can read it in their own words. The Republican State Leadership Committee spent more than $30 million over a period of more than three years to control redistricting and assure Republican majorities in the House of Representatives and State Legislatures even when the majority of voters chose Democrats. They named the project REDMAP and created a website to keep supporters up to date. Here it is: http://www.redistrictingmajorityproject.com/  The excerpts below are direct quotes that show how brazen Republicans are about what they have done.

“Drawing new district lines in states with the most redistricting activity presented the opportunity to solidify conservative policymaking at the state level and maintain a Republican stronghold in the U.S. House of Representatives for the next decade.”

“REDMAP’s effect on the 2012 election is plain when analyzing the results: Pennsylvanians cast 83,000 more votes for Democratic U.S. House candidates than their Republican opponents, but elected a 13-5 Republican majority to represent them in Washington; Michiganders cast over 240,000 more votes for Democratic congressional candidates than Republicans, but still elected a 9-5 Republican delegation to Congress.”

“Democratic candidates for the U.S. House won 1.1 million more votes than their Republican opponents.  But the Speaker of the U.S. House of Representatives is a Republican and presides over a 33-seat House Republican majority during the 113th Congress.  How?  One needs to look no farther than four states that voted Democratic on a statewide level in 2012, yet elected a strong Republican delegation to represent them in Congress: Michigan, Ohio, Pennsylvania and Wisconsin.”

“Republicans enjoy a 33-seat margin in the U.S. House seated yesterday in the 113th Congress, having endured Democratic successes atop the ticket and over one million more votes cast for Democratic House candidates than Republicans.”

In those remarks, Republicans are bragging about rigging elections. Their strategy worked. Here in North Carolina, Republicans used massive amounts of untraceable dark money to target Democratic candidates for state legislature before the 2010 election. After taking control of both houses of the legislature, they obtained advice based on computer analysis of the voting history of demographic and geographic groups in the state then used that advice to re-design congressional and state legislative districts. Their strategy worked so well that they won 9 of 13 seats in the US House of Representatives while 51% of the votes cast were for Democrats and only 49% for Republicans. They rigged the system so that they could win 69% of the elections with 49% of the votes while Democrats won 31 % of the elections with 51% of the votes. It was no accident. In North Carolina it was a carefully executed plan that was heavily financed by Art Pope and organizations which he has supported. Now Mr. Pope is the chief advisor to the Governor for development of our budget.

The Redmap strategy has a racial component, heavily concentrating African American voters into a small number of districts which the Republicans “sacrificed” in order to assure their own majorities in other districts. Lawsuits about redistricting are pending but much damage is already done. I could write about the ill-advised actions of right wing legislators in the congress and the state legislature but those are decisions which can be overturned.   The greater damage is the loss of public confidence in our elections and our government caused by this willful sabotage of free and fair elections. Abraham Lincoln, our most cherished Republican President said on the battlefield at Gettysburg, “…we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.” Today, the government of the people is under attack by those who have manipulated elections and overridden the people’s will. Rigging election processes to maintain power subverts the will of the people and overrules the consent of the governed. It is no less subversive and no less treasonous than an act of war.

All Posts, justice

RATIONAL GUN LAWS

According to the Centers for Disease Control and Prevention (CDC), 31,089 people died of gun violence in the US in 2011. The frequency of gun deaths is roughly similar to the frequency of deaths from breast cancer or prostate cancer or motor vehicle accidents. We work hard to reduce deaths from those causes but gun deaths are treated differently.

Most gun deaths were reported only as local news. The Sandy Hook killings captured national attention and brought a call for action but even a diluted gun control bill with limited background checks failed to pass. We respond to each gun-related massacre with a new legislative effort then act surprised when nothing passes. Some say that insanity is doing the same thing again and again but expecting a different result.

More than half of gun deaths are suicides. Most of the rest are homicides by people who know each other.   Having a gun, most often a handgun, nearby when rage or severe depression occur creates opportunities for suicide or murder by people who would not consider such an act under calmer circumstances.   The evidence is clear that nations with strict gun laws experience only a tiny fraction of the gun violence seen in the US.   The CDC is our national public health agency, responsible to recommend ways to improve public health and safety, but the National Rifle Association managed to push a bill through Congress which prohibits the CDC from advocating gun control. It has been safe for legislators to ignore the facts and the wishes of voters because the fire in our hearts burns out quickly and we await the next sensational tragedy while the daily carnage continues. Meanwhile the NRA and its allies consistently find and fund candidates who oppose gun control legislation.

It is challenging to decide exactly what is needed and harder to bring it about but perhaps gun control advocates can organize around some basic principles and stick to them for the long legislative battle. What follows are some thoughts that might guide us.

  1. A background check should be required for every transfer of gun ownership to rule out buyers who are on the terrorist watch list and those with certain criminal convictions, restraining orders or court findings of mental incompetence.
  2. All firearms should be registered to an owner in much the same way that cars are registered.
  3. Concealed carry of loaded firearms on your person should be banned for all except law enforcement personnel. Guns that people carry should be visible.
  4. Except for law enforcement, all firearms should be banned from some locations including bars, areas around schools, government offices, and other sensitive areas.
  5. Private ownership of automatic weapons (machine guns), magazines larger than 10 rounds and ammunition designed to pierce body armor (cop-killer bullets) should be banned.
  6. CDC should explore gun control practices in democracies with low rates of suicide and domestic homicide then recommend similar measures that would be effective in the US.

Banning some firearms and ammunition should not be a constitutional problem. The Second Amendment is about arms generally, not guns specifically.   We can add certain guns and ammunition to current laws banning private ownership of arms like grenades, bombs, and chemical weapons.

Existing concealed carry education and permit programs can be modified to create open-carry permits for carrying firearms in public places. The education should include warnings to avoid handling guns in highly emotional situations. Unfortunately, we seem to be headed in a different direction. On April 24, 2013 the Judiciary Committee of the North Carolina House of Representatives passed a bill that would allow concealed carry of loaded weapons in bars and on college campuses. The full House may vote on the bill before this column is published. It is co-sponsored by Randolph County Representative Allen McNeill. What is this former law enforcement officer thinking? Has he forgotten last year’s rash of bar shootings in Greensboro? Adding loaded guns to bars and college campuses – where inhibitions are often reduced and emotions run high – is a recipe for spur of the moment murders and suicides.

One idea for sustaining public attention is to systematically demonstrate the ridiculousness of what is currently legal. If such demonstrations ever take place, I’d prefer that the guns be obvious fakes and certainly not loaded weapons. Imagine for example, solo demonstrators or small groups of them openly carrying assault rifles and handguns in places where it is legal to do that. That would include sidewalks near banks, schools, and the State Capitol; restaurants where legislators congregate, our residential neighborhoods and other sensitive places. The more unkempt and disreputable the gun carriers look, the more effective their effort might be.

If we want a different result, we need to keep this issue on the minds of legislators and the public so that the debate and the development of reasonable laws can proceed. Conversations among friends and family will help. We also need to let legislators know that we are serious about electing people who will support our positions with their votes.   If voters care and speak up, there will be pro-regulation candidates in both parties. If not, the insane cycle of preventable deaths will continue.

All Posts, environment, justice, public education, religion

PICK UP JOHN WAYNE

One of the reasons that I like folk and country music is the songwriters’ ability to express complex feelings and ideas in just a few words. I’ve heard it said that the main difference between opera and country songs is that the song lasts 3 minutes and the opera goes on for an hour and a half. Here are a few lines that Willie Nelson gave us to ponder.

“The world’s done gone crazy, and it seems to get worse every day. So come on back Jesus, and pick up John Wayne on the way.

While he kicks their butts We’ll just stand there and watch him and pray. Lord the news looked so scary When I glanced at the paper today. So come on back Jesus, And pick up John Wayne on the way”

In biblical history people looked for a John Wayne hero. Israel sought a king to defend against enemies and later a messiah to defeat the Romans.   But the lesson of history and of life is that it is up to the people living in the world to create our own peace and safety and to protect our own children. It may be in our nature to wish for a hero who will put the bad guys in their place then ride off into the sunset; leaving us a safe and peaceful nation. In the real world, a young teacher placed her body between a rampaging killer’s assault rifle and the children in her care. She gave up her life in a heroic attempt to protect them. It remains for us, the survivors, to create a world where children and their teachers are safe from mass murderers. If we accept that responsibility, how will we fulfill it?

Taking rapid fire semi-automatic weapons, large magazines and military style ammunition out of circulation will help. It will take courage to do it because a powerful gun lobby will stand in the way.

Creating a functional mental health system which covers everyone will help. Patients need timely access to competent professionals, counseling, medications, and both outpatient and residential services. The system needs performance standards. It is not acceptable for patients in crisis to wait for days and it is not ok to put them on the street because the hospital beds were closed by the legislature. We would not tolerate a health care system that told someone with a broken leg to wait for several days in an ER until they could be transferred to a hospital with an orthopedic surgeon. Severely mentally ill patients face that every day in North Carolina and across the country. After such ordeals, some who need help the most decide not to seek it again. We also lack well organized outpatient care to prevent illness from becoming an emergency. Many state level mental health systems spend huge amounts of money but have no data to demonstrate which of their services work and which do not. We will have to start at the beginning by understanding the needs of patients; with willingness to pay for things that actually work and the discipline to cut out the waste. It will take courage and willpower to acknowledge that our mental health system has been broken by decades of incompetent tinkering by legislators and budgeteers. Handling the gun lobby will be easy compared to tackling the problems of the mental health system.

Several, but not all of our mass killers had a history of mental illness. At this writing (7 days after the fact), I have heard no confirmation that the Connecticut shooter was diagnosed or treated for any mental illness. Think about the Birmingham Sunday School bombers and those who attacked a Sikh temple in Wisconsin. There is more at work here than mental illness. There is hate. It results in acts of violence based on race, religion, sexual orientation, gang affiliation or other factors. Preventing hate crimes will be every bit as difficult as changing gun laws and improving mental health services.

The next heroes will be the ones who help us take an honest look at America and show us how we need to change. The upcoming test of courage will not challenge the staff of the Sandy Hook School. They have already passed with honors; some with great sacrifice. The next test will determine whether the rest of us measure up to the standard by showing the determination and courage to fix our weapons laws; to build a high quality and responsive mental health system in every part of the US; to eliminate the attitudes that lead to hate crimes and to determine whatever else we need to do. Will that include reducing violence in games and movies? Preventing child abuse that leads to adult violence? I don’t know the answers but I do know that creating this kind of change will require courage. There will be heroes who face criticism and possibly danger for their roles in changing our violent nation. If we pass our test, we can have peace and safety beyond what John Wayne could bring with yet another gun. Neither he nor any other hero will do this for us. To paraphrase another old song, “There ain’t nobody else can walk it for us. We’ve got to walk that lonesome valley by ourselves.” It will be a difficult journey, but we can do it if we will.

All Posts, budget, economy, justice, medicaid, poverty

THOUGHTS ABOUT THE UNINSURED

What should happen when a person with no health insurance and little money needs a major health care service? Let’s imagine it for a fictitious person. Sara is a 61 year old widow who has two part time jobs, one at a restaurant and the other at a dry cleaning establishment. Neither provides health insurance. Her annual income from both jobs is about $28,000. She has little money saved and will have only social security income if she is forced to retire.

Recently Sara has had severe pain when she stands for the extended periods required by her jobs. Her doctor referred her to an orthopedic surgeon. Sara delayed follow-up because of the cost but recently her pain increased enough that she spent money for an office visit. The surgeon determined that Sara needs a hip replacement. The price of the hospital and physician fee is about $40,000 which is well beyond her means. Sara fears she will soon be fired from her jobs because she can’t be on her feet for long periods.

Should Sara be able to get the surgery that would correct her problem? Is “no” an acceptable answer? If the answer is “yes”, who should pay for it? Today, one of two things would happen. Sara might have to do without the surgery. The other possibility is that the doctors and hospital will replace her hip without payment and try to pass the cost along to those who will pay. If there are too many patients like Sara, the hospital will fail financially and many doctors will move to more prosperous communities.

There are 50million uninsured Americans today with little or no ability to pay a large health care bill. http://aspe.hhs.gov/health/reports/2011/cpshealthins2011/ib.shtml Many residents of Randolph and Montgomery Counties fall into that category. As we get ready to vote next month, I hope that Sara and the millions like her will accompany our consciences into the voting booth: a man delaying a hernia repair that he needs, a woman who feels a lump in her breast and hopes it is nothing rather than seeing a doctor today; someone who skips the colonoscopy where a polyp could be removed before it becomes colon cancer. Some of us are the uninsured. Most of us know them personally.

Two Republicans, Teddy Roosevelt and Richard Nixon; and three Democrats, Harry Truman, Bill Clinton, and Barack Obama have pushed for laws to provide health care for all who need it. In a very messy legislative process President Obama finally got a law passed which gets us most of the way there. Republican opposition was absolute and they blocked the legislative process at every turn; preventing the dialogue that could have improved and simplified the bill. From the beginning their stated agenda was to prevent the President’s re-election rather than to collaborate in governing for the benefit of all.

President Obama is praised by some and vilified by others. Critics point out that the law is complicated and imperfect. That is true. Advocates, me included, point out that when the new law is fully implemented it will be a vast improvement over what we have today.   The debate should not be about repealing it; instead we should be deciding how to improve it. In particular, we need initiatives to reduce the cost of health services so that they will be more affordable.

We need today’s Republicans to step up to the responsibility of proposing workable ways to provide more service for less money while covering the uninsured. It IS achievable. Every other developed nation has accomplished it while spending less than we do now. http://www.oecd.org/dataoecd/52/42/49188719.xls  . We can do it too. Those nations set a clear policy of universal coverage and designed economical ways of achieving the goal. Mitt Romney knows that. He is the architect of a Massachusetts program which is nearly a twin to ObamaCare. But he and Renee Ellmers, and the Republican Party have abandoned the humane ideas of Roosevelt and Nixon. While doing that, they also deserted the uninsured, the poor and the middle class.

Did you know that more family bankruptcies are caused by health care bills than by home foreclosures? http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf It is the uninsured middle class and the poor who will bear the burden of a Republican victory this November. Have you heard talk of “class warfare”? Well, this is it. The Republicans want to repeal a law providing health care for the uninsured while cutting taxes for the wealthy. That is economic warfare on the uninsured middle class and the poor. Otherwise, Republicans would have a proposal for how to provide health care. They have also abandoned the doctors and hospitals that are required to provide emergency service with no payment. And in their proposal to “block grant” Medicaid they have deserted the disabled and frail elderly. They pledge to cut federal Medicaid funding. Two thirds of Medicaid spending is for nursing home patients who have depleted their personal resources. Much of the remainder is for childbirth or medical care of sick children.

We can’t afford all things for all people. There will always be two or more levels of care, with the wealthy able to obtain services not available to others. But we can afford to provide most needed and effective services to everyone; and we can find ways to get our costs down. Achieving that will require a national commitment of voters and political parties over a period of many years. It begins with implementing the law that was passed after a century of effort and it should continue with gradual improvement. We are Americans and we are up to the task if we will commit to it.

How will you respond to Sara’s need and to the needs of millions like her? We should take Sara and our consciences along with us when we go to the polls. There, but for the grace of God, go I.