Washington Passed A Public Option That is NOT a Model For Minnesota

Give leaders in the state of Washington a lot of credit.  Governor Jay Inslee and the Washington Legislature recently passed legislation to create a public health insurance option that will save Washingtonians an estimated 5 percent to 10 percent compared to private health plans.   Starting in 2021, the privately administered “CascadeCare” plan will be available to Washingtonians in the “individual market,” those under age 65 who can’t get insurance through their employers or another public insurance plan.

That’s significant progress, much more progress than Minnesota Governor Walz and the Minnesota Legislature made during the 2019 session when they failed to even seriously consider a plan to give Minnesotans in the individual market the option of buying into MinnesotaCare.  President Trump and his followers are working overtime to sabotage and try to repeal popular Affordable Care Act (ACA) health protections, while Inslee is strengthening the ACA.

We need that kind of leadership in Minnesota.  In the 2020 session, champions of the popular MinnesotaCare buy-in option should hold critics accountable for trying to block an initiative that could save consumers at least 10 percent of their health insurance costs. 

The Fatal Flaw With Washington’s Law

I say “at least 10 percent,” because Washington leaders caved to medical lobbyists in order to get the law enacted. In the process, they sacrificed significant consumer cost-savings.

One of the primary reasons to give consumers a public option is because public health insurance programs with a huge pool of patients are in a relatively strong position to leverage lower medical costs.  You know, like Medicare does. Here’s what a recent Urban Institute study found about Medicare’s ability to control medical costs.

 “…average spending on private health insurance per enrollee grew 4.4% per year between 2006 and 2017—faster than the growth of spending per enrollee in Medicaid and Medicare, and faster than the growth of the gross domestic product per capita, which grew an average 2.4% each year.

Per-enrollee spending in Medicare grew an average 2.4% per year while per-enrollee spending in Medicaid grew 1.6% each year. Holahan said Medicare and Medicaid experienced slower spending growth than private insurance because public programs have more leverage over provider payment rates, helping them to keep costs down. Private payers end up paying higher hospital and physician prices.”

In the face of such findings, what do Washington leaders do?  They guarantee reimbursements at a rate that is much higher than Medicare.  The Seattle Times explains:

The (Washington) law will require health plans to reimburse medical providers and facilities at up to 160% of the federal Medicare rate. That is a higher rate than the original version of the bill, which capped the reimbursement at the Medicare rate.

CascadeCare champions had it right in their original bill.  The reimbursement rate for the MinnesotaCare buy-in option should be set at the Medicare rate to allow savings to be passed on to Minnesotans.  Washington leaders apparently were spooked by lobbyist threats that caregivers would deny care to patients if they got paid Medicare reimbursement rates.

Physicians Can’t Be Sacred Cows

We will never be able to significantly control health care costs until we demand savings from every part of the healthcare system — pharmaceuticals, medical devices, unnecessary procedures, administrative overhead, and, yes, caregiver reimbursements.  American physicians, particularly specialists, are being paid more than physicians around the world, so controlling that cost-driver also must be in the mix.  American doctors can no longer be treated like political sacred cows.

As long as lobbyist-cowed legislators keep carving out these kinds of special interest exceptions, medical inflation will continue to skyrocket and keep Americans from accessing health care.  Minnesota legislators need to pass the MinnesotaCare buy-in option in 2020, and they should do it without caving to any of the interests driving medical costs making health care unaffordable and inaccessible for millions.

.

Garrison Keillor v. Minnesota … “Public” … Radio

As further proof that my cynicism knows no depths, let me assert that based on decades of experience, it is my belief that when it comes to personnel issues, by gargantuan enterprises like NBC/Comcast or merely big ones like Minnesota Public Radio … “It’s Money That Matters” as Randy Newman once sang.

In the matter of its summary execution of Garrison Keillor and the scrubbing of all mention and residue of him from their archives, MPR, Minnesota’s “listener-supported” PUBLIC radio “service” is staying very much in character.

The number of people who have tried to play not just media reporter but media critic in the Twin Cities don’t amount to even a handful. But for years I was one of them, and until the current management of the Star Tribune, no organization in town was more walled off, impenetrable and resistant to potentially negative inquiry than MPR. The joke among those of us who tried over the years was that you were more likely to get a full and forthright comment out of the CIA than MPR.

Despite “Public” being a central part of its name and identity, MPR has always conducted itself as the most private of media entities. By contrast, as I’ve often said, Stanley Hubbard, who truly is a “private” owner of television and radio stations, was routinely willing to take a phone call and offer some kind of an explanation for his internal controversy of the moment. With MPR, at best you were lucky to get a turgid, opaque statement from their PR desk.

(The level of fear that permeated MPR’s newsroom staff was frankly remarkable. MPR laid off a group of people a couple of years ago. Only two of the laid-off responded to requests for an entirely off-the-record, not-for-attribution conversation about what happened … and then only to plead not to ever be contacted again.)

In this Keillor situation what leaps out at me is that the only story of an offense, such as it is, comes from Garrison himself. This is the odd business of his hand slipping up a distraught employee’s bare back. In fairness, MPR may be protecting themselves and Keillor from far … far … more unsavory behavior. But we will never know, unless Keillor decides to lay it all out for his fans and the general public, something at the moment he is saying he doesn’t care to do.

In Sunday’s Star Tribune we had this all too familiar line: “MPR’s director of communications, Angie Andresen, said Friday that her organization would like to share more information, but to do so would be a breach of confidentiality that might deter potential victims or witnesses of abuse from coming forward.”

At that, the treadworn cynic in me screams, “Bullshit.”

Since MPR never shares information about anything with even the most remote potential to injure its reputation and impact its revenue stream, it is fair to conclude that it is MPR not any victimized woman who is enforcing this cone of confidentiality. Other media organizations — CBS with Charlie Rose, NBC with Matt Lauer — have seized on high-profile offenses to encourage other women on the staff and in the culture at large to come forward and speak up. The encouragement to women to tell the sordid stories is at the essence of this moment.

MPR is, as usual, taking the opposite approach. “Public” is for them is a branding scheme with no concurrent obligation to transparency.

I’ve told a few people that I’d be fascinated to get a full picture of MPR’s financial relationship with Keillor prior to this reputational guillotining. Nothing of course could be more horrifying to MPR’s executive offices. This is after all the organization that fought tooth and nail the disclosure of founder/CEO Bill Kling’s salary, firing off letters demanding the firing of reporters reckless enough to ask so basic a question of … a public organization.

With that in mind, it is easy, even logical to believe that MPR seized on the opportunity of some kind of impropriety involving Keillor and a woman/women to invoke a morals clause immediately and completely voiding contract(s) with him. Contracts it has monitored carefully and come to regard as no longer beneficial to their revenue stream.

As the saying goes, “Every crisis is an opportunity.”

I strongly suspect NBC/Comcast executives carefully assessed the financial impact of wiping $20-$35 million of Matt Lauer’s salary off the books and concluded “The Today Show” will survive just fine with Savannah Guthrie and (my bet) Willie Geist on the set fawning over pop stars and offering shopping tips.

As for Keillor, can we all acknowledge he is not an average guy, much less a “normal” human being? A bit like Bob Dylan, Garrison long ago began protecting his talent and productivity by interacting with the quotidian universe solely on his terms, as much as possible. You simply can’t be as productive as people like those two have been and deal hour by hour with the numbing, insipid bullshit of daily life. Hell, Keillor’s even said he’s autistic to some degree. So when he then says he’s remarkably awkward in personal encounters, I believe him.

Could he have had an affair with a staffer? I suppose. But even that seems a stretch. What’s inconceivable though is going all Harvey Weinstein or even pulling a Matt Lauer button-under-the-desk and sex toy routine. But in the absence of actual transparency — from an organization that explicitly demands it of the public subjects of its news gathering — everyone’s imagination is free to run wild.

Personally, I hope Keillor reconsiders his decision not to say more about what’s gone down. As a gifted writer, and just as importantly as a humorist, not mention at age 75 with the bulk of he career behind him, Keillor could help turn this current dialogue down a more nuanced, balanced path.

A path that would include the purely monetary pressures that invariably apply in high-profile matters like this.

 

 

 

Minnesota Reporters Should Heed BBC Call On Climate Change Reporting

Flat_Earth_SocietyThere is a small minority that makes heartfelt arguments that the Earth is flat. Do they deserve half of the news coverage related to global geography?  Two maps in every story?

Likewise, there is a small minority that argues humans with a certain skin pigmentation are superior to people with different pigmentation. Do they deserve half of the news coverage about race-related issues?

There also is a small minority that claims the moon landing was a hoax. Did they deserve half of the coverage of moon landings?

In all of these cases, giving minority viewpoints roughly half of the news coverage would have created a false impression that scientists are roughly evenly split about the shape of the planet, the inferiority of some skin colors and the feasibility of space travel. This kind of reporting would have been promoting things that nearly all scientists have proven to be false.

Which brings us to climate change.  This week, the British Broadcasting Corporation (BBC) Trust recommended that BBC reporters no longer give equal time to the small minority of scientists who contend that climate change is not happening and/or is not impacted by human activity. A BBC Trust report recommends:

 The Trust wishes to emphasise the importance of attempting to establish where the weight of scientific agreement may be found and make that clear to audiences. The BBC has a duty to reflect the weight of scientific agreement but it should also reflect the existence of critical views appropriately. Audiences should be able to understand from the context and clarity of the BBC’s output what weight to give to critical voices.

So, at a time when 97% of climate scientists have found that climate change is happening and is aggravated by human activities, half of the news coverage should not be dedicated to the viewpoint of the 3% of scientists who disagree.

Despite the increasingly lopsided scientific consensus on climate change, a 2013 report done by Media Matters found that half of print news outlets used a false balance approach to climate change reporting.  On Fox News, 69 percent of guests cast doubt on the science. On CBS news, in reporting about a rigorous United Nations scientific report, climate change deniers were given more than six times their representation in the scientific community.

The BBC Trust is politely telling its reporters to knock it off.  It is telling them to make sure their reporting reflects the reality of broad scientific consensus on climate change.

It’s time for Minnesota’s most thoughtful journalism leaders to follow suit.  Star Tribune? MinnPost?  Minnesota Public Radio?

– Loveland

The Bachmann Wannabes: Conservative in the Abstract, But Slippery with Specifics

All four candidates running to succeed U.S. Representative Michele Bachmann in Minnesota’s 6th Congressional District are running on their intent to reverse budget deficits allegedly piled up during the Obama era.  As Minnesota Public Radio’s (MPR) Brett Neely reports:

“So far, there’s little in the way of policy differences that separates the four candidates.  They’re all sticking with the national GOP’s message about what ails Washington.

GOP candidate Rhonda Sivarajah:  “The debt.”

GOP candidate Phil Krinkie:  “Out of control spending.”

GOP candidate Tom Emmer:  “Bureaucrats.”

GOP candidate John Pederson:  “The deficit.”

The same can be said of the Republicans challenging Senator Al Franken, Governor Mark Dayton, and every other DFL incumbent.  This should come as no surprise.  “The national GOP message” is based on public opinion research, and polls show that an overwhelming number of Americans are concerned about the deficit.  For instance, about 90 percent of Americans surveyed in a Bloomberg poll believed that the deficit is getting worse (62 percent) or not improving (28 percent), with only 6 percent saying that the deficit is decreasing.

In other words, the Republican message is selling with Americans.  This bodes well for them in the 2014 mid-term elections.

 The Myth of “Skyrocketing Deficits”

It’s worth noting that 90 percent of Americans are wrong about the state of the deficit.  In an article titled “The Best Kept Secret In American Politics-Federal Budget Deficits Are Actually Shrinking!,” Forbes magazine notes:

Over the first four years of the Obama presidency, the deficit shrunk by a total of $300 billion dollars.  The improvement in the deficit as measured against GDP is the direct result of the deficit falling to $845 billion for fiscal year 2013—a $300 billion improvement over the previous year. And the positive trend is projected to continue though the next fiscal year where the the annual budgetary deficit will fall again to $430 billion.

More recently, the deficit outlook has further stabilized. As CNN Money reported in May 2013:

By 2015, the deficit will fall to its lowest point of the next decade – 2.1% of GDP. And it will remain below 3% until 2019, at which point it will start to increase again. Deficits below 3% are considered sustainable because it means budget shortfalls are not growing faster than the economy.

Still, perception is reality in politics, so conservatives can be expected to milk this inaccurate “the deficit is skyrocketing” myth for all it is worth.

Courting “Progressative” Voters With Generalities

Will_reporters_press_deficit_chicken_hawks_for_specific_cuts_At the same time, don’t look for conservative candidates to provide a detailed list of spending cuts they would make to reduce the deficit and debt more rapidly.  Again, they read polls, so they know that Americans overwhelmingly oppose cutting the largest and fastest growing government programs.  For instance, a Washington Post poll finds that 77% oppose “reducing Medicare benefits,”  82% oppose “reducing Social Security benefits,”  and 51% oppose “reducing military spending.”  Other polls show that opposition to cutting Medicare and Social Security is even more vehement among Americans over 50 years old, who are disproportionately likely to vote, particularly in non-presidential election years such as 2014.

Pew_Research_Poll__May_2013Beyond those enormous spending programs, a Pew poll also finds that a plurality of Americans believes that the funding levels for all 19 major government spending categories they tested should be either increased or maintained.  Though conservatives have spent decades calling for cuts in “government spending,” Americans are steadfastly rejecting specific cuts in all parts of the federal budget.

Therefore, the dilemma for contemporary politicians is this:   Americans support the abstract notion of “cutting government spending,” which sometimes make us appear to be a conservative nation.  At the same time, Americans oppose cutting any of the component parts of “government spending,” which makes us look like a remarkably progressive nation.  Fiscally speaking, Americans are “progressatives,” conservative with our generalized rhetoric, but progressive with our program-by-program choices.

If the past is predictive of the future, most political reporters won’t press conservative candidates for a specific list of spending cuts to support their bluster.  Instead, reporters will allow conservative candidates to rail in a generalized way about “cutting spending,” and in a false way about “skyrocketing deficits.”  And as long as that rhetorical free ride is allowed to continue, the polls show that conservatives’ “cut government spending” mantra is a winning message.

 -Loveland

Note:  This post also was chosen for re-publication in Minnpost and as one of Politics in Minnesota’s Best of the Blogs.

Dayton: Even a Flat Tax Better Than Minnesota’s Current Regressive Tax System

Not so long ago, there was a strong national consensus in favor of progressive taxation.   In the 1980s, conservative Ronald Reagan was running around telling his followers:

 “We’re going to close some of the loopholes that allow some of the wealthy to avoid paying their fair share.  In theory, some of those loopholes were understandable.  But in practice, they sometimes make it possible for millionaires to pay nothing, while a bus driver is paying 10% of his salary, and that’s crazy.

…Do you think the millionaire ought to pay more in taxes than the bus driver or less?

(Crowd:  “More!”)

That was then, but this is now.  Now, conservatives call conservative Reagan’s pro-progressive tax position “socialism” and “anti-American,” a sign of just how radicalized Republicans have gotten in their desperation to pander to conservative talk radio hosts, wealthy donors, and Tea Party primary challengers.

Among the most radical things that Republicans now push is a flat tax.  While a flat tax is attractive at first blush because it is simple compared to the maddeningly complex federal income tax, it is the polar opposite of the progressive income tax that Reagan championed.  While a progressive tax is designed to take a larger percentage from the income of high-income earners than it does from low-income individuals, the flat tax takes the same percentage from everyone, whether you are a bus driver or a billionaire.

As the Founding Father of the modern conservative movement said, “That’s crazy.”

Yesterday in a Minnesota Public Radio interview, Minnesota Governor Dayton made an interesting point on this subject.  When asked what kind of tax reform he favors, Dayton said:

 I still believe in a progressive income tax.  But I sure don’t believe in a regressive income tax, which is what we have now.  …Conservative Senator Rod Grams was always talking about a flat tax.  Well that would be an improvement in Minnesota!  We have less than that now.

Ponder that.  A flat tax – which embodies the radical anti-progressive notion that conservative icon Ronald Reagan not so long ago mocked as “crazy” to the delight of his conservative followers – actually would be an improvement over the regressive tax system that Minnesota currently has on the books today.

Millionaire Mark Dayton is often characterized, by opponents and even by mainstream reporters, as favoring a “soak the rich” ideology.  That’s a silly characterization, because what Dayton actually proposes is not to “soak” the wealthy.  What Dayton recommends is simply a return to the common sense notion of progressive taxation supported by a strong majority of Minnesotans, and even the founder of the modern conservative movement.

 – Loveland