Category Archives: Health care

The Ultrasound Abortion

By Peter Galuszka

Abortion is always a very unpleasant topic just as it must be horrendous for a woman to be in a position to make such as choice. Still, it is her constitutional right, the law of the land.

So, after years of trying, Virginia’s conservative legislators are on the verge of putting themselves, and the power of the state, in between a pregnant woman and her doctor with a measure that would require that an ultrasound examination be performed before the abortion takes place. In six other states that have such a provision, the mother would be “offered”  a chance to see the result although not  required to do so, according to Guttmacher Institute.

Experts agree that there’s no medical reason for an ultrasound in the first trimester of a pregnancy. Rather, such a requirement is a naked psychological ploy to assault the mother with feelings of guilt and play on her emotions to not go through the procedure. Even though abortion is legal within limits, this extra requirement would be both medieval and insulting. Not to mention sexist: men don’t have to endure such state-sanctionned manipulation.

In Virginia, however, women may soon have to. By an 8-7 vote, the Republican-controlled Education and Health Committee has endorsed the ultrasound requirement and have sent it to the full Senate, which, thanks to the GOP’s refusal to share power, it is likely to pass, given the 20-20 imbalance of power and Republican Lt. Gov. Bill Bolling holding the deciding vote. Ultrasound bills are being pushed by Sen. Jill Vogel, R-Fauquier County and Sen. Ralph Smith, R-Roanoke County.

What’s so utterly hypocritical of many conservatives is how they pick and chose their fights. Most of the time, they are lecturing us that we need to get government and its regulations away from people’s everyday lives. We need smaller government and should leave as much as possible to personal choice.

But not when it comes to one of the most painful and personal decisions a woman makes. Swollen with their moral authority, they want to be there, dressed in a blue hospital gown beside the doctor, laying on a profound guilt trip to an experience that is most times already wracked with grief. They are assuming that women (not men) are too stupid to understand what abortion is despite their right to one that is bound by the U.S. Supreme Court.

The General Assembly needs to keep its nose out of the doctors’ offices. It needs to respect the intelligence of women to make a choice that is legally theirs to make.

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More Hypocrisy from Philip Morris USA

By Peter Galuszka

Tobacco has always been a powerful industry in Virginia since the days of the Jamestown colony. It is no less influential today as Henrico County-based Philip Morris USA and its parent firm, Altria,  constantly play shell games about the hazards of their products.

Just before Christmas, and right in time for the 2012 election year, Altria trotted out a new Website called “Citizens for Tobacco Rights” that seems designed to tap some of the anti-government, anti-regulation fervor of the Tea Party movement to boost its top line.

The company says that it is offering the Website so that smokers know their rights. It has a virtual smorgasbord of information about taxation, local and state laws limiting smoking and other government efforts to somehow restrict tobacco use, which is one of the largest health issues in the U.S. and kills a about 400,000 every year.

Yet what makes this new Website peculiar is that it goes against Altria’s low-profile public image that the firm has been trying hard to invent since it was one of four cigarette makers dunned for $206 billion by 46 states in 1998 because of health risks.

Philip Morris, consequently, started including health warnings about its products in four-color paper flyers and also on its Web page. In 2008, the firm split itself into two parts. Philip Morris International, based on Lausanne, Switzerland, was free to make cigarettes with several times the addictive nicotine and tar content as ones made in the U.S. and market them vigorously in the Third World where people might not understand the link between cancer, lung disease and other ailments and smoking.

Philip Morris USA, on the other hand,  took a far more benign approach, and from its new headquarters in Richmond, clung to a gradually diminishing base of smokers while telling them they really shouldn’t smoke. As it states on its Website: “PM USA agrees with the overwhelming medical and scientific consensus that cigarette smoking cause lung cancer, heart disease, emphysema and other serious diseases in smokers. Smokers are far more likely to develop serious diseases, like lung cancer, than non-smokers. There is no safe cigarette.”

The statement is on one part of the corporate Website. For an entirely different view, click on the new “Citizens for Tobacco Rights” page on the same site.  You get the impression that ordinary cigarette users are having their God-given rights trampled upon by nefarious do-gooders and government regulators. Let’s wave the “Don’t Tread on Me” flag. Invite Sarah Palin to speak.

One can only speculate on why Altria is trying this gambit at this particular moment. The obvious reason is that the firm’s propagandists want to tap the Tea Party sentiment to boost sales. In 2010, Altria Group reported net revenues of $24.3 billon, a 3.4 percent increase over the previous year.

The firm complains that it has been under heavy pressure since federal excise taxes were boosted in the late 1990s and many states and localities have banned cigarette smoking in public places. One is New York City, where city officials and not easily impressed with corporate money and from which Altria retreated its headquarters to Richmond. Another reason for the Web page could be that it’s been a long time since the 1998 health settlement and people tend to forget.

In Virginia, Altria is considered a sacred cow. It employs about 6,000 people and is one of the leading donors to universities, the arts and research. Its impact is especially strong in Richmond, where it operates its last large cigarette manufacturing plant in the country and funds everything from chairs at Virginia Commonwealth University to the Richmond Symphony.

Don’t think that the largesse doesn’t come without strings. When an artist wanted 400,000 cigarettes for a piece of artwork that was to be displayed at the Virginia Museum of Fine Art, Philip Morris said no even though it is a major sponsor of the museum. VMFA public relations people were careful to play that one down.

The new Website underlines, once again, the hypocrisy and contradictions of Philip Morris USA and Altria. Its ploys to encourage people to stand up for their rights while warning them its products kill are beyond routine cynicism. As it has since 1609, Virginia just plays along.

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New Studies, Reports and Inanity…

Motor Vehicle Dealer Internet Access Study
Report to the General Assembly

In 2011 the General Assembly adopted legislation requiring all newly licensed automobile dealers to have an Internet connection and email address. The Motor Vehicle Dealer Board even engaged the Point Management Group to conduct a study, which proceeded to document that all MVDB dealers already have Internet access. But that didn’t stop Point Management from recommending that all new dealers — just in case someone laying thousands, even millions, of dollars on the line to open a new dealership was too friggin’ stupid to think of setting up an email address and Internet connection — should be required to do so as well.

Why stop there?  Why not write a regulation requiring every auto dealer to have a phone? Why not spell out in detail how they must stock their offices with desks, chairs, copying machines and free coffee. Grrr. Makes me so mad. Hey, Gov. McDonnell, while you’re consolidating and closing all those useless state boards and commissions, here’s idea. Add the friggin’ Motor Vehicle Dealer Board to the list!!

Status Report: Regulations Establishing Nutritional Guidelines For Competitive Foods Sold in the Public Schools
Report to the General Assembly

The General Assembly is rightfully concerned about increasing obesity rates among Virginia’s youth, and legislators have rightfully honed in on the volume of junk food that school kids consume from vending machines, snack bars and a la carte items in the cafeteria. This draft report contains numerous recommendations on how to regulate these sources of empty calories. Snack items shall contain no more than 200 calories per portion, derive no more than 35% of calories from fat of sugar, or have a sodium content exceeding 200 mg, blah, blah, woof, woof. But, oh, the regulation shall not apply to beverages.

Really? Is that it? Did it occur to the geniuses drafting the regulations that restricting calories per snack might encourage kids to…. buy more than one snack? And what’s this about exempting soft drinks? Did the General Assembly cave in to the soft drink bottling industry?

Let me make this real simple. Ban all vending machines and shut down all snack bars in public schools. When kids got thirsty back in my school days, they drank — can you imagine this? — water from the friggin’ water fountain! When we wanted snacks, we had to wait until we got home and raid the cookie jar. As far as I’m concerned, purveyors of junk food should be allowed to sell whatever they want to whomever they want, but not where they want. They have no more right to peddle their garbage in schools any more than they have to set up a vending machine in my pantry. Board of Education, get a friggin’ spine!

What kind of monument are we talking about anyway? One like this...

First Annual Executive Summary Commemorative Commission to Honor the Contributions of the Women of Virginia
Report to the General Assembly

You could make the case in a state that once practiced slavery and then oppressed blacks through decades of Jim Crow laws that there is justice in erecting a monument to Civil Rights heroes. Unfortunately, the General Assembly followed up that laudatory effort to establish a commemorative commission to honor the contributions of the women of Virginia.

… or one like this?

The rationale seems less than clear. Judging from this report, the commission devoted its proceedings over the past year bloviating in banalities about the contributions of the fairer sex and hosting a series of eight “community conversations” across the state. Public attendance appears to have been sparse. In the Richmond meeting, “the Commission heard from a group of students from St. Catherine’s School and two members of the public.”

Having gleaned valuable public input, the commission then moved on to more important matters, like voting to hire a consultant.

Evaluation of Camera Use to Prevent Crime in Commuter Parking Facilities: A Randomized Controlled Trial
Urban Institute

Before 2003, half of all crimes on METRO property took place in commuter parking lots. Metro Transit Police teamed up with the Urban Institute to see if prominently placed video cameras would discourage car thefts and break-ins. Due to budget limitations, only one-third of the cameras were live, rendering the intervention of limited use for investigative purposes. The findings? “The cameras had no discernible impact on crime.” Oh, well, it was worth a try.

Just remember to take the darn things down.

– JAB

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The Wonk Salon, November 15, 2011

What Do We Do With Violent Sexual Predators When They Leave Prison?
Joint Legislative Audit and Review Commission
Virginia’s methodology for assessing the risk posed by violent sexual predators when they leave prison is flawed, leaving it vulnerable to using out-of-date actuarial science and limiting input from qualified professionals.

Challenges to Growth of Virginia’s Bioeconomy
Southeast Agriculture & Forestry Energy Resources Alliance
In Virginia the “bioeconomy” of biopower, biofuels and bio-based consumer products is limited mainly to biomass burned in industrial boilers and to biodiesel.

Revitalizing Georgia’s Forestry Sector
Southeast Agriculture & Forestry Energy Resources Alliance
Georgia does wood like Iowa does corn. Trouble is, wood is dependent upon the housing sector, which is in the dumps. So the state is hoping to spark innovation and new markets by putting industry, academic and government player together.

Reforming Primary Care
National Academy for State Health Policy
As Obamacare is implemented nationally, states are wrestling with how to create new, integrated models of primary care. State budget cuts aren’t making the job any easier.

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The Wonk Salon, November 10, 2011

Teacher Evaluations: No More “Culture of Nice
American Enterprise Institute
Something’s wrong with teacher evaluation systems that rate 97% of all teachers satisfactory or good. It’s time to find ways to rate the quality of the teaching, not the quality of the teacher.

How to Recruit More Minority Teachers
Center for American Progress
Minority students comprise 40.7% of all students in the classroom but only 14.6% of all teachers. Because teachers can be positive role models for students, school systems should expend greater effort recruiting and retaining minorities.

Florida’s Patient-Centered Medicaid Reform Saves Millions
Heritage Foundation
If Florida’s patient-centered Medicaid reforms were replicated nationally, Medicaid programs could save up to $28.6 billion annually. The secret: Increase patient choice of health plans.

More Strife Inevitable with Public Employee Unions
Manhattan Institute
The interests of taxpayers, public employee unions and welfare state beneficiaries are fundamentally opposed. There are three broad options to dealing with the conflict: (1) restructure union pay and benefits, (2)  cut spending, or (3) raise taxes. Take your pick.

Stronger Fathers, Stronger Families
Urban Institute
The New York “Strengthening Families Through Stronger Fathers initiative program focused on creating better employment opportunities for non-custodial fathers. The result: Participants increased earnings by 22% and child support payments by 38%.

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The Wonk Salon, November 9, 2011

Linking Databases to Spur Educational Reform
Education Sector
By linking school, college and workforce databases, the federal Statewide Longitudinal Data Systems initiative has awarded $515 million to help states divine how well schools are preparing graduates for college and the workforce.

Income Tax as Tool of Crony Capitalism
John Locke Foundation
North Carolina’s corporate tax stands at 6.9% but it’s riddled with loopholes. Politicians grant exemptions to subsidize favored or politically correct businesses. The system is “hidden, dishonest and inconsistent with informed decision making in a free and democratic society.”

Pension Liabilities Bury Rhode Island in Deep Kimchi
Mercatus Center
Rhodes Island’s state and municipal debt is a lot worse than official figures indicate. Using more realistic assumptions about the rate of return on investment on pension assets, unfunded liabilities climb from $9.3 billion to $18 billion.

New Priorities for Public Health
Urban Institute
With its emphasis on preventive medicine, the Patient Protection and Affordable Care Act can provide a big boost to public health care.

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The Wonk Salon, November 5, 2011

Health Exchanges Violate State Sovereignty
Goldwater Institute
Obamacare promises to give states flexibility in implementing state health exchanges. In reality, the feds control the providers who get to participate, control the plans and benefits and force states to enforce the individual mandate.

Report on the World’s First Social Investment Bonds
Rand Corporation
The United Kingdom has launched the world’s first experiment in Social Investment Bonds (SIBs).  A private financier pays the upfront cost of reforming prison inmates and pockets a share of the reduced cost to government if the programs are more effective than the alternative.

Kids Beware, Longer Schools Days May Be Coming
Wallace Foundation
Six hours a day and 180 days a year is not enough time to provide the education that American children, especially disadvantaged children, need to learn what they need to learn.

Education in an Age of Austerity
American Enterprise Institute
After decades of spending growth, educators had better get used to the idea of doing more with less. Federal stimulus spending is ending, state budgets are under  pressure and property tax revenues are down. Innovation and reform is the path ahead.

Information Sharing and Child Development
National Academy for State Health Policy
The Better Child Care Health and Development learning collaborative supports healthy child development through care coordination and linkages among medical providers and community services programs.

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The Wonk Salon, November 2, 2011

Thirty-four Referenda this Year
National Association of State Budget Officers
It’s an off-year for elections so there are only 34 ballot measures in nine states this year, down from 160 last year. The referenda range from voting on slot machines in Maine to approving/rejecting an Ohio law limiting collective bargaining.

Implementing Common Core State Standards
National Governors Association
Forty-four states serving 80% of the nation’s K-12 school population have adopted new common core standards in English/language arts and mathematics. But policy makers can do more.

How States Can Support Creativity and Innovation
Southern Growth Policies Board
Innovation is the only way to climb out of the current economic malaise. States can stimulate innovation by establishing venture funds, hiring world-class researchers, establishing R&D tax credits, promoting STEM teaching careers and undertaking other measures.

Healthy Americans, Health Economy
Trust for America’s Health
Healthy Americans are more productive at work. States and communities around the country are partnering with business to encourage employees and their families to make healthier choices.

Best Start LA off to a Slow Start
Urban Institute
Best Start LA is designed to strength the capacity of families to raise children and the capacity of communities to support families. In other words, it takes a village. But this program seems to be having trouble getting off the ground.

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Uh, Oh, the Percentage of Insured Virginians Is Falling

The decline in workplace coverage. (Click on graph for more legible image.)

by James A. Bacon

The percentage of Virginians with  employer-provided health care has reached the lowest point in almost 20 years. While a higher percentage of  Virginians receive health care coverage in the Old Dominion than workers do nationally, that percentage is declining. And the percentage of premiums paid by employees is going up. So finds the Commonwealth Institute in its latest research report, “Unaffordable, Unavailable, Uncovered.”

The problem is particularly acute among businesses with fewer than 50 employees. Only 40% of businesses with fewer than 50 employees offered health insurance in Virginia in 2010 — compared t0 97% of businesses with more than 50 employees who did.

The Commonwealth Institute documents a real problem. The medical insurance system in the United States is broken.

The authors, John McInerney and Michael Cassidy, suggest that the Affordable Care Act will help. The ACA provides tax credits for businesses with fewer than 25 employees and average wages less than $50,000 up to 235% of the premiums paid. The authors don’t see many new businesses signing up to take the credit, but they hope that it might prevent some businesses from dropping coverage. Another reform is the creation of a purchasing pool that will allow small businesses to access and purchase health insurance coverage for their workers, the Small Business Health Option Program.

We’ll see how those insurance reforms work out. In the meantime, as documented previously in this blog, Obamacare has made life more difficult for small-company insurers by requiring all insurance plans to pay at least 80% of their premiums in benefits, driving at least one start-up insurer out of business  and making the space less attractive to others. (See “How Obamacare Helps the Working Class (Not)“). Furthermore, the federal government will impose minimum coverage standards, eliminating the option of providing bare-bones plans for those who can’t afford the gold-plated plans.

So, color me skeptical. The way to fix the broken market for health insurance is not through more regulation, mandates and cross-subsidies. With the exception of education, health care is already the most highly government-dominated industry in the US. It’s no coincidence that it’s also one of the most dysfunctional. I laid out the path forward in “Boomergeddon.” The first place to start is eliminating the tax preference for employment-based health insurance. Putting the employer in the mix creates an entitlement mentality on the part of workers, divorcing them from the costs of their lifestyle and medical decisions. Also, it makes insurers compete for business by packaging plans that appeal to employers, not to patients. Obamacare only reinforces this insanity.

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The Wonk Salon, October 25, 2011

States Must Do More to Improve the Quality of Teachers
Center for American Progress
Principals account for a quarter of a school’s total impact on student learning. States can do a better job of ensuring the quality of their schools’ principals.

No Price Transparency in Health Care
Government Accountability Office
Try asking your doctor for the price of a diabetes screening. The answer will be, “It depends”…. assuming he can legally provide that information at all. Without price transparency,  the market for medical services cannot function properly.

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