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Posts published in May 2009

Doing its thing

Jeff Kropf

Lost in a lot of the discussion about the merits of the often large-scale pieces of legislation the Oregon Legislature has been working on - and there is some real scale, and a lot of that scale is monetary - is another point: This has been turning into a steadily productive session. Piece by piece, major slices of legislation have been produced, voted on and - in major cases - passed. If you don't like the legislation, this may not be such a good thing. But this has been a productive session, one of the most productive (along with 2007) over the last few decades.

They kicked off with a massive stimulus program (the value of which we have yet to assess, but which was a big effort). And the legislation has kept on coming. A big transportation bill, and a big health care bill (involving tens of thousands of people covered), major change in taxation, all in recent days. And a string of prospectively tricky pieces of legislation (workplace religious freedom, for instance) handled smoothly. You get the impression of a large factory, with few or no production slowdowns.

They're talking in terms of a wrapup by the end of June, which would make it one of the shortest in recent years. (2007 ended on June 28, but you have to go back to 1995 to find an earlier close.) A few years ago, the idea of this level of productivity with so few hangups would have been almost inconceivable. Worth noting.

The other Wyden health bill

While the battle rages over who provides health insurance and how it's funded (check out the dueling ads to the right), the senator caught up in this particular battle - Oregon's Ron Wyden - is also working on another health care bill that may be just as significant but has gotten a lot less attention. We didn't even register it had been introduced until wandering through the Wyden press releases for this month.

This particular measure is the "Empowering Medicare Patient Choices Act" (S 1133), introduced in the Senate (in standard bipartisan fashion) by Wyden and New Hampshire Senator Judd Gregg, and in the House by Oregon Representative Earl Blumenauer. Getting at its significance requires stepping back a moment to consider why health care is so expensive and why so many dollars in our economy are being swallowed by it.

The truth is, there isn't any one reason to account for it. Many of the best-known prospective culprits - the greedy insurance companies, malpractice, high drug costs, archaic paper records - are without doubt real culprits that do add cost, but the biggest problem seems to be more systemic and directly involved in health care itself: Massive overtreatment.

Jeff Kropf

A terrific book we strongly recommend everyone read (seriously, and right now) is Overtreated by Shannon Brownlee, which makes a totally convincing case that "Each year, our medical system delivers an enormous amount of care that does nothing to improve our health or lengthen our lives. Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be." A great piece in the current New Yorker ("The Cost Conundrum," by physician Atul Gawande) makes a similar case and expands on why much of this is happening, and argues: "Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse." And much of this actually can be mapped, because Medicare costs are tracked by county, and in some counties the costs are massively higher than in others, with no improvement (and sometimes diminishment) of outcomes.

Then there's the decades of study at the Dartmouth Atlas of Health Care, which this year reports: "Huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project, published February 26, 2009 in the New England Journal of Medicine. Many experts have blamed the growth in spending on advances in medical technology. But the differences in growth rates across regions show that advancing technology is only part of the explanation. Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas."

The new measure, S. 1133, is aimed most directly just at Medicare, but the principles in it could easily be extended - and might be, with national exposure - through much of the rest of the health care system. (The Dartmouth Atlas people have endorsed it.) What it does, according to Wyden:

"The bill seeks to open up avenues for conversation between physicians and patients so that patients fully understand their treatment options when there is more than one clinically appropriate treatment. Doctors would be reimbursed for the extra time spent counseling patients. . . . The legislation creates a three-step phase-in of patient decision aids which are informational videos and other educational materials about the patient’s treatment options into the Medicare program. Phase I is a three-year period allowing ‘early adopting’ providers to participate in the pilot, providing data and serving as Shared Decision Making Resource Centers. Phase II is a three-year period during which providers will be eligible to receive reimbursement for the use of certified patient decision aids. The final stage requires providers to use patient decision aids for certain conditions as a standard of practice."

Not an ultimate solution, but a thoroughly useful start. One of the most useful things to do with cut medical cost while encouraging beneficial outcomes, which is the prerequisite for doing anything else.

What could go wrong?

One of the tricky parts of legislating is the element of light prognostication it entails: Trying to imagine what the actual effects of a piece of legislation could be, where the land mines might lie.

Congress didn't do that when it passed the Real ID Act in 2005; it contains so many potential problems that not only have 23 states approved anti-RID measures, and not only is there a Homeland Security (please, change the name of that department) secretary in opposition to the measure, but every state has asked for an extension for participating (even though it supposedly went into effect a little over a year ago). (The department's own description is also on line.)

The Oregon Legislature now has passed Senate Bill 536, sponsored by Senator Rick Metsger, D-Welches, that at least would stop the effort until there's money from the federal government to help pay for it.

Some of the best-known provisions relate to the pass of paperwork intended to be associated with drivers licenses. The Oregonian notes Metsger's comments that "Oregon has already taken steps to secure state driver's licenses. But, Metsger says, other Real ID provisions are expensive or threaten Oregonians' privacy. For example, he said, Real ID would allow agencies to electronically scan and share copies of original identity documents - such as birth certificates, passports, and Social Security cards in a shared database."

Oh?

As a commenter to that story pondered: "now what could possibly go wrong here . . ."

Pay and solicitations

Still another suggestion about why high executive pay - even when it doesn't fall into the mega-range you see in so many larger corporations - isn't a good idea.

From Oregon Media Insiders:

I was going to make a contribution to Oregon Public Broadcasting this year, but after reading their tax return I realized that they would use most of the proceeds from the spring radio drive to pay the salary of their CEO.

According to its latest federal tax return (available at opb.org/insideopb), OPB paid its CEO Steve Bass $296,000 with a $34,000 retirement contribution. To compare, according to its most recent tax return NPR paid then CEO Kenneth Stern $354,334 plus an additional $72,723 retirement contribution.

Cranking up on candidate filing

Next week, we see who file for local government offices up for election this year (and legislative spots that need filling). Next week is candidate filing time.

A few points of interest, as Secretary of State Sam Reed's office points out:

For the second time since the U.S. Supreme Court last year upheld the Top 2 Primary system adopted by citizen initiative in 2004, the Declaration of Candidacy form will allow candidates to self-describe their political preference, but this will not mean that the person is nominated by or supported by a party.

The form candidates submit will allow up to 16 characters to provide the name of the party a candidate prefers. Candidates cannot include profanity or imply or state that they are nominated or endorsed by a political party or that a party approves of or associates with them.

The regulations don't rule out candidates trying to wedge in additional information about themselves, such as "Anti-war Dem" or "Pro-life G.O.P", "Evans Republican" or "Jackson Democrat." But Reed, the state's chief elections officer, said he hopes candidates will simply list the actual name of a political party and not try to cram in personal or political information.

Words of candidate wisdom

Learned the hard way.

Scanning a where-is-he-now article (Seattle Times, May 4) about two-time Republican gubernatorial candidate Dino Rossi - the hook was a new job he's taking back in his old field of real estate - a quote jumped out.

Rossi said he's "unplugged" from political activities, and gave indications he's planning to tend to business rather than politics for some time to come. Occasionally, he said, he fields a call or visit from someone (Republicans presumably) thinking of running for office, seeking his counsel.

Rossi: "I try to find out why they're running. I tell them the only reason to run is to be in the right place at the right time to do some public good. I tell them if you want to see your name in the newspaper, I can guarantee you it'll be surrounded by words that you don't like."

Kitzhaber in?

The idea of John Kitzhaber once again seeking the job he once seemed to argue was undoable - governing Oregon - just simply hasn't seemed like a starter. He could have run for the U.S. Senate in 2002 or 2008, but passed; considered a run for governor in 2006 but passed. Why should the idea of a run in 2010 be taken seriously now?

A new piece by the Oregonian's Jeff Mapes suggests the outline of a case for taking it seriously. It says (on occasion of the unveiling of his picture at the Statehouse) that he's thinking about running. Fine; he was thinking about running all those other times, too. But there are a few new factors.

He would likely have a Democratic legislature to work with, rather than the Republican one he fought with the whole time he was governor. He has been pushing his ideas on medical reform, but visibility has been intermittent, and as governor he could go much further to make things happen. His personal circumstances have changed.

What hasn't, probably, is how formidable he would be if he does run. There's no overwhelming favorite in the field right now, and Kitzhaber (whose polling numbers remain excellent and campaign skills remain sterling) would enter as the formidable frontrunner and likely next governor.

But be wary of placing any bets just yet.

Spider to fly

Jan Drago

Jan Drago

You sorta get the feeling that the Greg Nickels forces have been preparing for this. In Crosscut, the headline was, "The Mayor 'welcomes' Jan Drago to the campaign," and you get the sense of a puzzle piece calculatedly falling into place. Even though this means he now actually has not a possible serious opponent, but a real one.

The Seattle mayor should, by rights, be in trouble. His polling borders on horrendous; the Seattle Times reported a couple of weeks ago that Drago is positioned to win by 21 points. Drago is no unknown; she's been on the council since she was first elected in 1993, longer than anyone else now on it.

And there are some structural reasons for thinking Drago might pull it off, including a primary contest which may favor her kind supporters.

But there's also no sense here that Nickles, twice elected (and the first time after two close and tough contests) is on the run. From Crosscut: "It's clear that Mayor Greg Nickels' political Swat team is trying to cut Drago down early in the campaign, before she can get much momentum. There's a press release a day touting Nickels' achievements in his most vulnerable areas: getting stimulus funds, getting favors from Olympia, the pesky snowstorm. The media is peppered with pointed questions to ask Drago: about her absenteeism (code for getting too old), her Nickels-like voting record. Nickels is playing a tough Hillary to Drago's Obama-like message of consensus. It's meant to rattle her (she is eminently rattleable) and to freeze Nickels' supporters from any thought of defection."

A challenger to a veteran incumbent ordinarily has to play one of two cards: Either make the case that a very different policy direction is needed (not useful here, because Nickels and Drago aren't far apart) or hammer the incumbent as too bad to keep in place (which would upend the consensus style Drago likes and which has helped her in the past). She has strategic options available, but they're apt to be unpalatable, and Nickles' people seem to have assessed as much.

Her problem, in other words, seems to be strategic more than anything else. It may be solvable. Should be fascinating to see how she tries to do it.

A mega-OR transport project

Major transportation projects were hard to come by in Idaho this legislative session, but easier in Washington (see Alaskan Way and the 520). And now Oregon seems to be about to set in motion a truly enormous effort of its own. The House today voted 38-22 in favor, enough to win support for the revenue-raising components (which need 60% support in each chamber). Since the odds in favor probably are better in the Senate than they were in the House, and since Governor Ted Kulongoski has backed the plan, it looks close to done.

That doesn't mean there's no controversy, and it comes from both left and right. On the left, there's concern both about the structure of the spending (exact projects and amounts are laid out) and concern that not enough is going for mass transit. On the right, there's concern about the hundreds of millions of dollars involved and the substantial increases in taxes and fees - a six-cent gas tax increase, substantial car registration fee increases and more.

But it seems to be slipping through with less angst than you might think. And less than in either Washington or Idaho. How good a thing that is, may depend on where you sit.

From our point of view . . . we'd be pleased to see the new Newberg-Dundee bypass (on Highway 99) put in place; the new bill funds a third of the expensive effort. That stretch of wine country road, smack between Portland and some of the most popular coast areas, can turn into a parking lot at times. The bypass - bypassing most of the cities of Newberg and Dundee - could help. And turned dirt within the next few years could be considered, locally, as miraculous.

Risch and the Middle East

Sometimes new jobs will throw a different light on people. For a political career going back decades, Idaho's Jim Risch has been involved with state issues, and the international scene just hasn't been part of what we've seen from him, publicly anyway. There wasn't much call.

Now, Risch is in the U.S. Senate and a member of the Foreign Affairs Committee, which might not have seemed the most obvious choice. But he seems to be settling in, and his interchange at a committee meeting with former British Prime Minister Tony Blair shows a grasp of Middle East subtleties and comfort with international politics many Idahoans might not have suspected. (Risch's appearance comes toward the end of this C-SPAN program.)

A hat tip on this to Nathaniel Hoffman of the Boise Weekly, who was in Washington for the meeting (and appears himself, briefly, at the end of the clip), and has a few more comments on Risch's time in D.C.