Posts filed under 'Better Government'
Tante grazie to Paul Levy for the nice things he opens with, but he has a less than sanguine reply to my op-ed in the Globe today on the viability of the health care reform act without further some level of reduction in the supplemental payments made to the Boston Medical Center and the Cambridge Health Alliance.
AdamG of the Universal Hub piles on citing Paul.
So, let’s start with niceties. Paul is one of our best public managers. Note BID, note that MWRA. You want Paul on your side. I want Paul on my side, but you can’t always get what you want. I also find a touch too much political spin in the fastball Paul throws my way in suggesting that I am in the long line of “attacks” on BMC and CHA.
On this one, quite simply my math differs from Paul’s:
· I don’t disagree that the expected costs of Chapter 58 are due to costs being underestimated at the start, but that does suggest that the legislation was, while not ill conceived, at least structured poorly. We should be willing to touch up the math so it works – we should not put the reform at risk.
· Paul cites the law’s purpose as providing “greater insured access to health care.” That is only half of the reform. The other half was how to get there—and, again, the reform was a move from supporting institutions to supporting individuals. Prior to the reform, I would not quibble with the extra support needed for BMC and CHA. I would not even quibble with some level of support even today being needed for these institutions. I just don’t think it is close to the $180 million it currently stands at.
· Paul cites insurers and taxpayers as needing to foot more of the bill. I appreciate Paul’s pushing this off to the insurers, but it would be constructive to hear what they can do besides provide affordable plans. I’ll wait to hear more on this. As far as the taxpayers are concerned, they are tapped out on health care: The proportion of the budget dedicated to health and human services is burying all other core services. As far as businesses are concerned, they are tapped out on health care and the recent increases in fees and other levees under Governors Romney and Patrick.
· As Rick Lord of AIM was quoted in the Lowell Sun over the weekend, “What we’ve failed to do in a serious way is address the cost of health insurance and unless we do that health care reform won’t be sustainable in the long term.” There are other things we can and must do over the long term, including some flexibility on mandates and providing clarity on outcome and pricing data to consumers (in an easy to understand way). But in the short term, there is little else we can do to get this waiver through.
· Finally, and most importantly, while I agree with Paul that there is a mouse going through the proverbial snake in terms of pent-up demand for services like mammograms by individuals heretofore uninsured, it is also true that there are more people signed up at this point than the crafters of the legislation foresaw. That should mean that there are fewer people accessing hospitals without insurance. Shouldn’t that mean that the overall costs to the hospitals of providing this care (which they had been providing to “free riders”) should be more predictable and less expensive for the BMC and CHA? Doesn’t that raise the question of whether we should reduce (I never said cut completely) the extra payments to these institutions? The reasonable answer is yes.
July 22nd, 2008
As you may already be aware, the latest scandal to embroil Boston’s Fire Department involves an inspector who was videotaped at a bodybuilding contest just six weeks after handing in to the department a doctor’s certification that he is permanently disabled due to a work-related back injury.
The inspector, Albert Arroyo, has been ordered back to work. My question is: Really? Back to work? He gets to keep his job after attempting to defraud the department and taxpayers out of potentially hundreds of thousands of dollars?
Um, shouldn’t he be fired?
July 19th, 2008
Right now, the economy is struggling. Home prices are down, gas prices are up and credit markets seem to be in almost daily convulsion. It has, however, not been bad news for everyone in Massachusetts. As the Globe reported yesterday, it’s been a banner year thus far for the lobbying industry. This is at least partially due to the fight on Beacon Hill over casino gambling, but I can’t help wondering whether there isn’t an actual causal link between the struggling economy and its thriving lobbying sector.
My thesis - and it is only that, a thesis - is this: In strong economic periods, different firms and industry sectors don’t require government largess to help turn a profit, but, when the economy sours, they go, hat in hand, looking for the tax credits and other goodies that government too often hands out in the name of job creation. Thus, increased revenue for lobbyists.
I suppose there’s also a thesis to be offered to explain the concurrent boom in Lottery ticket sales, but I will leave that for some other armchair social scientist.
July 18th, 2008
One of the great frustrations for bus riders everywhere is the unpredictability of service. Some systems have addressed this, in part, by setting up systems that allow passengers to know when the next bus will arrive. The Washington DC Metro system allows bus riders to call a number, enter a stop-specific code, and get an estimated arrival time for the next bus.
Leafing through a copy of “Leveraging ITS Data for Transit Market Research: A Practitioner’s Guidebook” (don’t ask; but see pg. 59 for the example) reveals the utility of that approach. The Chicago Transit Authority tested arrival time notification by setting a stop with a notification system and using a stop with similar volumes but no system as a control.
Riders who were aware of arrival times registered a 27% improvement in wait times, yet there was no actual change in wait times.
What does this tell us? Technology can be a low cost way to improve the customer experience and increase satisfaction.
July 18th, 2008
From the Freedom Foundation of Minnesota: it seems that, of the 42 municipal golf courses in the land of lakes, only 5 did not lose money in 2006, the most recent year for which data is available. Collectively, the 37 courses that bled red lost a total of $2.3 million.
Of course, the easy (and I would argue obvious) solution would be to lease the courses losing money to private operators, as the Commonwealth sensibly decided to do (and our own Steve Poftak urged right here on this blog) at Ponkapoag. There is ample evidence that such solutions work.
For example, in 2006 Pioneer undertook a study of the 26 ice skating rinks in Massachusetts operated by private vendors under long-term leases from the state and determined that the rinks remained open longer, were used by more people, had benefited from significantly more capital investment and, here’s the kicker, were cheaper than the remaining rinks still operated directly by the state.
July 17th, 2008
In June Mike Rebell, an experienced litigator with expertise in taking on states in funding “adequacy” lawsuits, held an advocacy conference in D.C. It was called the 7th Annual Quality Education Conference, and one of the speakers on the program was Justice John Greaney of the Massachusetts Supreme Judicial Court. Justice Greaney gave what to many will seem a shocking presentation.
The document gives remarkable insight into what the good Judge would have done in taking over the state’s education business, had his side prevailed in the Hancock v. Driscoll (2005) case.
Greaney’s June presentation is striking for, as a friend as put it,
Its breathtaking arrogance and the Judge’s elevated view of the court’s “special skills,” independence from special interests — all of whom he says he would then invite to participate in the remedy! — and ability at “truth finding.”
At the same time, he dismisses the majority opinion in Hancock as “utterly unpersuasive” (evidently they don’t have the same ability at “truth finding” that he possesses), and attributes the decision to “what can happen when membership on the court changes.” So perhaps he’s saying that the court membership is not so independent after all?
He seems pretty upset by the fact that his colleagues on the court had the wisdom to see the quagmire they faced. As Scot Lehigh of the Boston Globe, in a piece published the day after the Hancock decision in February 2005 noted:
[T]he high court dealt a stunning loss to those who had hoped to sidestep the political process to achieve court-ordered remedies. That includes the Massachusetts Teachers Association and the Massachusetts Federation of Teachers, two unions that had provided most of the funding for the so-called Hancock lawsuit alleging serious underfunding.
Lehigh was spot on in noting that “the high court actually ended its long-running role in monitoring the state’s educational efforts.”
He was also right to note that “[i]n arriving at its decision, the SJC ignored the recommendations of [then] Superior Court Judge Margot Botsford, whom it had appointed to make a finding of fact on the case.”
The problem is that Judge Botsford now sits on the state’s Supreme Judicial Court, appointed by Governor Deval Patrick. With the membership of the court changed, and with Botsford now sitting on the bench beside Greaney, the MTA knows that it is one seat away from clear sailing…
The implication of this presentation is crystal clear: As court membership changes, Judge Greaney and the MTA are all for court control of the schools.
July 15th, 2008
In Japan, Bud is hardly known. It was a flash in the pan in the late nineties but never really caught on. Stella Artois and other InBev beverages have a stronger toehold, but really only a toehold. That is especially true outside of Tokyo and Osaka. For the most part, the market is locked up by Suntory and other Japanese manufacturers. (Full disclosure: I have a special dislike for how locked up it is, as the liquor importation laws, now amended, prevented me in 1992 from expanding a small exporting business to Japan. The laws are amended, but this is still Japan.)
I am sure back home the news of the InBev buyout of Bud has lessened sales, as bar hounds realize, as Drudge put it, “This Bud is … for EU.” What I found interesting was the willingness in a down market for InBev to take on so much debt to fund the $52 billion buyout of Anheuser-Busch. Perhaps this nugget from the Wall Street Journal helped convince InBev that it was a good idea:
InBev’s willingness to take on so much debt may be partly explained by Anheuser’s corporate tax rate, which at 40% was more than twice InBev’s last year. The new company may be able to offset some of Anheuser’s taxes with interest payments on the new debt.
So, tonight, raise a pint of InBev products to your federal government.
Sounds so familiar, doesn’t it?
July 14th, 2008
Limited, but interesting post on Red Mass Group. (I’ve plugged Blue Mass Group on here in the past and figure, as a non-profit, we should also be non-partisan.)
It seems that, despite a population roughly half of Pennsylvania’s and a geographic area less than a quarter of our fellow Commonwealth’s, our state budgets are almost identical in size - $28.3b as opposed to our $28.2b - which means Governor Patrick’s government will spend just about twice as much per capita in fiscal year 2009 as Governor Ed Rendell’s government.
Now, without having seen any breakdowns, I assume Massachusetts spends significantly more as a state for public education, which is just one of the reasons why we have the best public schools in the country, and the costs associated with health care reform were much higher than most people anticipated.
We can and should debate the state’s appropriate role in both education and health care - particularly whether it should be the purview of the state to guarantee access to health insurance; even more particularly, whether the state should be mandating insurance coverage. We should also be asking ourselves whether the slew of recent legislation passed and proposals floated is worth the various price tags.
Maybe, as voters, we do decide that universal proficiency, universal health care, expanded commuter rail service, targeted tax credits for biotech and film companies, infrastructure repair and everything else on offer by the Governor and Legislature are what we want. But we should be having a public and spirited debate over spending priorities.
And a simple, but stark statistic such as this one might be a good place to start.
July 11th, 2008
[I]f there is a state budget problem, it is not the result of increased enrollment in Commonwealth Care but rather of the state failing to fully comply with the basic waiver agreement to shift subsidies from health care providers to individuals needing assistance in buying health insurance.
That’s a clear indictment from Greg D’Angelo and Edmund F. Haislmaier of the Heritage Foundation in the just released policy piece entitled Health Care Reform in Massachusetts: Medicaid Waiver Renewal Will Set a Precedent.
The Health Care Reform Act However included hold harmless payments for the Boston Medical Center and Cambridge Health Alliance (so-called Section 122 payments). The payments “were authorized for three years starting at $200 million for FY 2007, declining by $20 million each year.” D’Angelo and Haislmaier note that:
Had initial enrollment in Commonwealth Care come in at or below projected levels, these Section 122 payments would likely not have created a financing issue. But with enrollment running higher than expected, the state has already obligated elsewhere hundreds of millions of dollars that it should otherwise have available to meet the added cost of providing subsidized coverage to more individuals. In FY 2008, Section 122 payments come to $180 million, while Commonwealth Care overruns are $153 million.
D & H finally note that
State payments for uncompensated care do not seem to have decreased as much as these trends suggest they should have. One explanation may be that some hospitals are attempting to compensate for providing less uncompensated care by charging the state higher rates for the uncompensated care they still provide.
Interesting work — and the timing is impeccable given the waiver discussions.
July 11th, 2008
I have referenced the Stephen Moore-Arthur Laffer report on Rich States, Poor States, and its overall message that tax policy does matter for people and business locational decisions. I know the question of business creation and population growth is more nuanced than that, but as I was reading Stephanie Ebbert’s piece in the Sunday Globe about the hundreds of thousands of dollars we are spending to boost our Census numbers, I wondered if we aren’t as usual on trying to manage the message rather than addressing the underlying problem.
So, a friend from Mississippi emails the Moore-Laffer report and notes that we are soon to have the political oomph of the Mockingbird and magnolia state. Check out table 1 on page 15 of the RS/PS report, which suggests that Massachusetts is among the bottom 10 in the nation in terms of cumulative domestic migration. Huh? It means that we lost 330K people over 10 years (1997-2006). Connecticut lost 110K, and at the very bottom of the list is California at -1.3 million and New York at -1.96 million.
At the top (winners) is Florida at +1.6 million, Arizona at 770K, and even colder states like Washington (+218K). Folks, can we, uh, start acting like adults and figure this out?
July 11th, 2008
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