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Posts published in June 2011

Tim Woodward (no r.i.p. for you)

Often when these posts have a name at the top, it means they've died. Tim Woodwood, a writer for 40 years at the Idaho Statesman, has - happily - not died. But with today's final set of columns in the Statesman, he has retired, taking from the paper its leading writing icon. His columns have been regular reading from here for, oh, well over 30 of those 40 years. They have been a tonic: After absorbing the regular bulk of ugliness and strangeness in Idaho public affairs, Woodward's columns were a corrective, a reminder of older Idaho, of human Idaho, of the good things so often otherwise untold.

Not often told is Woodward's help in launching the sequence of activities that led to, among other things, Ridenbaugh Press and this blog.

In 1987, I was at the Idaho Statesman covering politics, and was weighing the idea of writing and publishing a book on that subject. The politics I knew something about; about writing and publishing a book, virtually nothing. Fortunately, my office desk was only a few feet away from someone who had done just that, with some success: Woodward, who had published several collections of his columns (and was at work on the Vardis Fisher biography Tiger on the Road for Caxton Printers, 1989). Woodward was one of the first people (there would be others, too) to offer both encouragement and highly practical information and advice. He was one of the people without whom that book, Paradox Politics, might not have seen light. And after it came Ridenbaugh Press and a string of other publications, one of which you're reading now.

So from Ridenbaugh Press: Have a happy retirement, but keep those words of enjoyment, advice and tonic coming.

Ryan, district by district

The budget proposal by U.S. Representative Paul Ryan - especially, his proposal for Medicare and Medicaid - is bound to continue to be a centerpiece of political discussion nationally. At least, it will if Democrats have anything to say about it.

Some of the shape of that may emerge through some online documents developed by the Democratic caucus on the House Energy & Commerce Committee. These are reports outlining the effect of the Ryan plan congressional district by district.

They're accessible on a map page.

Here's sample, a small slice of the report from Oregon's 1st district:

The Republican proposal would have adverse impacts on seniors and disabled individuals in the district who are currently enrolled in Medicare. It would:

• Increase prescription drug costs for 8,500 Medicare beneficiaries in the district who enter the Part D donut hole, forcing them to pay an extra $84 million for drugs over the next decade.
• Eliminate new preventive care benefits for 97,000 Medicare beneficiaries in the district.

The Republican proposal would have even greater impacts on individuals in the district age 54 and younger who are not currently enrolled in Medicare. It would:

• Deny 620,000 individuals age 54 and younger in the district access to Medicare’s guaranteed benefits.
• Increase the out-of-pocket costs of health coverage by over $6,000 per year in 2022 and by almost $12,000 per year in 2032 for the 128,000 individuals in the district who are between the ages of 44 and 54.
• Require the 128,000 individuals in the district between the ages of 44 and 54 to save an additional $29.9 billion for their retirement – an average of $182,000 to $287,000 per individual – to pay for the increased cost of health coverage over their lifetimes. Younger residents of the district will have to save even higher amounts to cover their additional medical costs.
• Raise the Medicare eligibility age by at least one year to age 66 or more for 71,000 individuals in the district who are age 44 to 49 and by two years to age 67 for 496,000 individuals in the district who are age 43 or younger.

One of the many health answers

It's long been our contention that no one silver bullet will solve the health care fiscal crisis (and we do so define it). But the hail of a million smaller bullets can bring it under control.

Just after the Regence hearing in Portland, we walked over a few plugs to an unrelated meeting were some actual health care cost solutions emerged.

This was at the Portland Linux Users Group, which focuses on linux and open source software. Here was tonight's subject: "Introduction to OpenEMR, maybe the most downloaded open source Electronic Health Records system in the world." Open source means, among other things, that the cost is going to massively less than you'd see from most commercial software providers.

The recent federal health care law requires more extensive and meaningful use of software to track health care provision and costs, and new kinds of software will be needed. Tony McCormick, a project leader for this effort, which spelled out is "open electronic medical records," said that number of downloads has increased drastically in the last couple of years.

The whole medical field has had very little by way of open source software - most of what has been and will be in that area is apt to be riotously expensive. Sounds of a piece of the industry ... but it doesn't have to be that way. McCormick would be happy to talk about it.

Regence hearing: More questions than answers

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Regence hearing at University Place in Portland/Stapilus

The public hearing this afternoon on the 22.2% rate increase request by Regence Blue Shield of Oregon should have been commonplace rather than something new and unusual - an open discussion of the cost of health care. An editorial note: We should have been doing this for a generation. There should be much more, with every rate increase and cost increase proposed, in every state and even in every county. (There is legislation afoot at Salem to accomplish that.)

Large pieces of the costs were spotlit, laid out, examined, analyzed. We all could surely use more of that.

It gives the insurer, who was on the hot seat in this unusual proceeding (usually only paperwork, much of it out of public view, is involved), a change to make their case. And for the first hour of this presentation, out of the scheduled two and a half, Regence aggressively did just that.

The state Insurance Division presenters said that no rate proceedings have ever drawn as many public comments (maybe in part because few have gotten nearly the media attention - even local TV showed up for this.) About 250 people showed up, and the speakers appeared heavily oriented against the increase. They were calm, patient and well behaved. But, you got the clear sense, not happy. (Only anti-rate increase speakers drew applause.)

Regence argued both on statistics and otherwise - a tad too slick and defensive both. They spoke of "people like Kathy and Michael." And one other (name lost in notes here), referenced regularly, each of whom received hundreds of thousands of dollars a year. The premiums paid by them (whether per month or per year was unclear) were noted as $3,400, $7,370 and $1,850. If annual, what kind of terrific deal were they getting? If monthly, they - the first two anyway - were paying a hell of a lot in premiums.

A state questioner noted that this is an increase request higher than most competitors - and Regence acknowledged that customers are using less health care." The reply noted that percentages can be misleading," minutes after - and without a tracy of irony - a presentation loaded with percentages.

Some of its points were sounder. One Regence speaker remarked that better cost transparency is needed, that better analysis of effective treatments be developed. And "It's going to require we change the economics of health not to reimbursing hospital on ho many times I show up in their office but when I get better."

Like any insurer, a Regence speaker said, it has to collect enough in premiums to pay out for medical costs, and they need to collect enough (this was in response to a question about whether higher prices will continue driving people away from insurance). "If we pick wrong, who will pay?" A pertinent question, but maybe one constituting a better argument for something like single payer.

Laura Etherton, The speaker for OSPIRG Foundation - a nonprofit that has been working on medical costs - said the increase "will likely drive more Regence customers (to either drop out or move toward more high-deductible policies ("benefit buydown," in the lingo), further destabilizing the health insurance market. Regence has increased insurance rates by double digits every year of the last decade, while enrollment dropped. (Regence downplayed the dropout effect of a rate increase and suggested enrollment should remain stable; OSPRIG said that 43,000 customers have dropped out over the last decade or so, from a peak of more than 100,000.

(Start here for more of the OSPIRG's research, which is extensive, here.)

Because of the tendency of insurers to avoid non-health people, "If you're sick (with pre-existing condition) you're pretty much stuck here" while healthier employees would be more able to move - or opt out of insurance. Among other things, that will make the Regence clientele progressively "sicker" - more expensive too. (And presumably an ever higher rate increase next time around.) (more…)

Carlson: Rebuild or not?

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Chris Carlson
Carlson Chronicles

Thirty-five years ago this week the Teton Dam in eastern Idaho catastrophically collapsed on June 5, 1976, causing the deaths of 11 people, millions of dollars in damages as well as displacing hundreds from their homes and ruining thousands of acres of productive cropland.

Governor Cecil D. Andrus flew to Rexburg, jumped in a National Guard helicopter for an inspection flight and was simply stunned by the destruction the collapse had wrought.

The chopper returned and landed near the Administration Building of what was then known as Ricks College and today is Brigham Young University-Idaho. A group of newspaper reporters and television anchors with camera men spotted him getting out of the chopper and came charging at him across the lawn.

The first one to reach the Governor was from KSL-TV in Salt Lake City. He breathlessly threw out the first question: “Governor, are you going to rebuild the dam?” Andrus’ eyes flashed in anger at the insensitivity and the impropriety of the question.

Using some words, which can’t be repeated in a family newspaper, the Governor proceeded to dress down the reporter for the insensitive, and inane question.

The question was premature by about 35 years. Yes, it is still a controversial question with strong feelings on both sides of the matter in the Upper Snake River Valley. According to a late winter article by Sven Berg in the Idaho Falls Post-Register the issue is being vigorously debated in homes and coffee shops.

Surprisingly, the anti-dam building lobbying group, American Rivers, sponsored a survey of 300 folks living in eastern Idaho. They were astute enough to use Moore Information, a Portland-based political/public affairs polling firm that has worked on the campaigns of almost all major Republican office holders in Idaho, including Governor Butch Otter, Second District Congressman Mike Simpson and Senator James Risch.

Moore’s polling showed the region was still sharply divided and memories still fresh. His poll showed 45 percent in favor of rebuilding and 34 percent opposed. As Moore noted to the reporter: “There isn’t a huge groundswell of opinion behind rebuilding that thing.”

Though recognizing the need for more water storage throughout the Snake River basin, Governor Andrus has always been skeptical about the site. Before heading off to Washington, D.C., to serve in the cabinet of President Jimmy Carter some seven months later, Andrus ordered the Idaho Department of Water Resources to conduct its own review of what went wrong.

Thus, when the Interior Department Solicitor, Leo Krulitz (yes, he is related to all the Krulitzes residing in Shoshone County) came by a couple years later to ask what I thought Secretary Andrus’ reaction would be if Interior sued the dam contractor, the huge Boise-based construction firm of Morrison-Knudsen, I was able to tell him “that dog won’t hunt.” (more…)