As someone who has been deeply involved in New Hampshire health care delivery and financing for more than a quarter century, I have personally observed the health consequences and crushing financial strain of patients without health insurance coverage. People may forgo needed preventative care and treatment, go without needed medications, and often end up in emergency departments, the most expensive place to receive treatment. An established primary care relationship would have avoided any needless morbidity or mortality, all of which sap the strength of our families and the economic vitality of our communities. It is with this perspective that I 'd like to impress upon those pursuing a legislative solution to increased access to health insurance, how important it is to both craft the access and sustainable financing to ensure that an initial achievement remains a sustainable one.
In crafting the New Hampshire plan for expanded health insurance coverage, the saying that comes to mind is "measure twice and cut once." This saying also describes the challenge for the New Hampshire Legislature. We have only one opportunity to achieve this in a responsible and sustainable way, thus maximizing benefits for our state while minimizing any risks. It is vitally important to all of our fellow citizens that we get this right.
There appears to be a growing political consensus that expanded health insurance coverage represents the fundamental building block for improving health care for the citizenry. However, the benefits of such an expansion alone will prove illusory without a sustainable financing plan behind it.
As an individual citizen, I call upon our elected state leaders to expand health insurance coverage through a New Hampshire solution that adds to the New Hampshire Advantage. Other states have crafted state-centric plans and have sought and obtained the necessary waivers from the federal government on a speedy basis. From my perspective, the key elements of such a plan would include:
1. Strengthening New Hampshire's private insurance market for those currently with and without coverage, through use of private insurance to cover newly eligible (and those currently eligible where there is the flexibility and capacity to do so). We as a state are relatively small from a population standpoint, which makes it hard to support options in insurance coverage. Retaining individuals in the private market helps us contend with that challenge versus adding to it.
2. Promote the highest level of coverage continuity (i.e. avoid "churning") to promote health and the cost to individuals and the state. It is sensible to have continuity with your provider and insurer so that investments in health promotion can be more readily sustained.
3. Improve budget predictability for the state by financing premiums versus services. In financing premiums versus services, the state will have the benefit of fixed unit costs in the coverage it supports.
4. Ensure protection to the state from any potential financing changes from the federal level. Arguably, the more coverage that comes from tax credits and private coverage reduces future exposure to the state should federal policy shift.
5. Secure a federal match to finance this expanded coverage that is competitive with other neighboring states. Our state is in optimal position now to negotiate the parameters of expanded coverage that will drive the fed's and state's effective participation to support sustainable implementation.
The aforementioned saying expresses something considered to be a general truth. The truth of expanding coverage is that it represents a one-time opportunity to do it right to ensure a sustainable system that protects patients and taxpayers. We can and should come together to achieve a plan with these elements. Moreover, we should allow a relatively short-time, in the scheme of things, to secure the available beneficial waivers from the federal government, as some other states have recently done. That will prove the key "measurement" in the future level of success we get from expanded coverage as individuals and for the generations to follow.
My appreciation is extended to all of those in Concord who are working towards increasing access to health insurance for my home town and the state as a whole.
(Henry D. Lipman is senior vice president for Financial Strategy and External Relations at LRGHealthcare in Laconia. He also represents Ward 3 on the Laconia City Council.)
Last Updated on Tuesday, 29 October 2013 10:20
Danvers, Mass., is two towns away from where I grew up. I used to shop at the mall there. When I was much younger and stronger, I'd ride my bike that far. We played Danvers in football. I went to camp in Danvers.
If you'd asked me yesterday or the day before whether Danvers was a scary town, I would have laughed. Danvers? I live in Los Angeles. In Danvers, kids still ride their bikes at night.
Danvers should be safe. And I always thought it was — until I read about the murder of math teacher Colleen Ritzer, originally from Andover, one more town away, and only a year older than my daughter.
The alleged murderer was arraigned in the First District Court of Essex County. When I was a kid, my first job was at the Essex County Registry of Deeds, right next door to the courthouse, and for "fun" (would-be lawyer that I was), I used to go over at lunch and sit in on the trials. There was one family murder, but I never sat in on a case like this. Things like this didn't happen in Salem or Danvers or Andover.
Until they did.
Why does a 14-year-old murder a well-liked, dedicated, beautiful and talented math teacher just 10 years older than him? I'm sure his lawyers will come up with some excuse, mental illness or an abuse excuse, family troubles, diminished capacity, one of the long list of defenses and excuses I used to teach.
Is it wrong to say I couldn't care less what his excuse is? Is it wrong to say that if 14 is old enough to kill — and it is — then it's old enough to be responsible and to be punished as an adult?
Maybe I've lost my empathy. Or maybe I've just become very clear about who does and does not deserve empathy Not the alleged killer. The victim and her family.
Ritzer is the second teacher to be killed this week by a student (allegedly, of course). Two days earlier, in Sparks, Nev., another math teacher — this time a man, a former Marine and National Guardsman — was shot at school by a 12-year-old who also shot two other students before killing himself.
You can try to find a pattern. But really, what could it be? That teaching math is life threatening? Ridiculous. I'm pretty sure the gun-control laws in Massachusetts are tougher than in Nevada. So the 14-year-old used a box cutter, allegedly. The kid in Nevada reportedly got his gun from home. Some people are describing the kid in Danvers as "soft-spoken," whatever that means (like the "baby-faced" Marathon bomber, who was no baby-face), and others are speculating that he was infatuated with his math teacher. If every teacher of an infatuated student were vulnerable to murder, well, there would be no profession.
In all of my years living on the North Shore of Boston, as a student and as an adult, I never heard of a student killing a teacher. I certainly would remember. It just didn't happen.
So why now?
It's the sort of thing we need to talk about thoughtfully, not screaming at one another about gun control, but listening respectfully, trying to figure out what's gone wrong and what we can do about it. But we don't have those kinds of conversations anymore — about anything. There is no discourse. It's all just ideological prattle, screaming back and forth, talking heads competing to be outrageous enough to get their own shows. Meanwhile, decent people shake their heads, and parents and families mourn losses that are just unfathomable.
Two math teachers in one week. So wrong.
(Susan Estrich is a professor of Law and Political Science at the University of Southern California Law Center. A best-selling author, lawyer and politician, as well as a teacher, she first gained national prominence as national campaign manager for Dukakis for President in 1988.)
Last Updated on Wednesday, 31 December 1969 07:00
September was another strong month for residential home sales in the twelve communities covered by this report. There were 104 transactions at an average sales price of $406,327 for the month compared to 91 sales at $316,816 last September. Last month's average sales price was pumped up by eight sales over $1 million with one sale coming in at $7 million. For the first three quarters of the year there have been 784 sales at an average price of $302,663 compared to 676 sales at an average of $299,060 for the same period in 2012. That's a 15 percent increase in the total number of sales. That's almost as scary as Halloween!
And, as Halloween approaches, I felt it is my civic duty to provide homebuyers with some tips on determining whether a home could be haunted or not. After all, some people are more sensitive to otherworldly phenomenon than others and don't want to live in a house with some unseen previous owners still there. It is kind of the same way some people get worked up about radon. You can't see radon either, but it scares the bejeesus out of some folks.
Anyway, it is worth a discussion because many times a great home is ruled out and not purchased because of something strange going on during a showing. As a realtor, I have a duty to set the record straight and clarify some of these "occurrences." Realtors have had to take continuing education paranormal courses and can help you determine whether the unsettling event you just experienced was a haunting, your imagination, or just part of buying a home. Buying a home without a realtor can be pretty scary.
The most common sign that a place is haunted will be that you will feel like you just walked through a cold spot or that the room suddenly drops in temperature. This could very well mean that you just walked through dear departed Uncle Josiah because he just couldn't get out of the way in time. When you look at houses, try not to move too quickly and barge into rooms. This will give those souls still living there time to get out of your way. Taking your time also allows you to observe more of the home you are considering buying. It might also help you to determine if that sudden chill comes from a broken window or drafty door.
Another common sign that you have an unwanted guest in the house is unexplained noises. Usually, these noises occur in the middle of the night in the pitch black, so if you hear them in broad daylight during the showing you can be assured things are going to get worse. That scurrying and scratching sound could be a squirrel in the ceiling...or maybe not. That banging sound could just be air in the heating pipes, but then you realize the house has forced hot air heat. Did that door just slam shut because Josiah is mad that you are here or is it because of sudden drop in air pressure in the house? Now, you are beginning to see why you need a realtor who can set you straight on these things.
Sometimes on showings you hear hushed, faint whispers when you are in a room by yourself. That can be pretty unnerving, especially when you realize that they whispering about you. Was it your realtor talking to the listing agent? Perhaps not, the listing agent was outside... What about that uneasy feeling that you are being watched? If the homeowner didn't leave during the showing it is can be very uncomfortable and that's why we always try to insist they are not there. But what if Josiah didn't leave either and it feels like he is up on the corner of the ceiling? Makes the hair stand up on your neck, doesn't it? Buying a house on your own can be a scary thing.
It is well documented that strange animal behavior is another indicator that there is an unknown presence in a room. Animals have sharper senses than humans and their psychic abilities are much more finely tuned. I have been on many showings where the owner's beloved pet was in his crate barking his lungs out when we came in to look at the house. That's normal for a dog. Not so much for a cat. Could it be a sign that something else is going on?
Many times on showings you may be unsettled by a shadow that you catch out of the corner of your eye. You might also be startled when you glance in the bathroom mirror and see someone lurking behind you. Then, with great relief, you realize it is your realtor. And behind him is Josiah. But that doesn't scare you, because even though your realtor is pretty scary looking too, you have him between you and the unknown...
Please feel free to visit www.lakesregionhome.com to learn more about the Lakes Region real estate market and comment on this article and others. Data was compiled using the Northern New England Real Estate MLS System as of 10/23/13. Roy Sanborn is a realtor at Four Seasons Sotheby's International Realty and can be reached at 603-455-0335.
Last Updated on Friday, 25 October 2013 07:19
Dr. Nicholas DiNubile, a Philadelphia orthopedic surgeon, has a timely reminder for everyone encountering the federal health care exchange meltdown: "If you think signing up for Obamacare is a nightmare, ask your doctor how the EMR mandate is going."
The White House finally acknowledged the spectacular public disaster of Obamacare's Internet exchange infrastructure during Monday's Rose Garden infomercial. But President Shamwow and his sales team are AWOL on the bureaucratic ravages of the federal electronic medical records mandate. Modernized data collection is a worthy goal, of course. But distracted doctors are seeing "more pixels than patients," Dr. DiNubile observes, and the EMR edict is foisting "dangerous user-unfriendly technology" on physicians and patients.
Instead of concentrating on care, doctors face exhausting regulatory battles over the definition of "meaningful use" of technology, skyrocketing costs and unwarranted Big Brother intrusions on the practice of medicine.
As I reported last year, Obamacare's top-down, tax-subsidized, job-killing, privacy-undermining electronic record-sharing scheme has been a big fat bust. More than $4 billion in "incentives" has been doled out to force doctors and hospitals to convert and upgrade by 2015. But favored EMR vendors, including Obama bundler Judy Faulkner's Epic Systems, have undermined rather than enhanced interoperability. Oversight remains lax. And after hyping the alleged benefits for nearly a decade, the RAND Corporation finally 'fessed up that its cost-savings predictions of $81 billion a year — used repeatedly to support the Obama EMR mandate — were (like every other Obamacare promise) vastly overstated.
In June, the Annals of Emergency Medicine published a study warning that the "rush to capitalize on the huge federal investment of $30 billion for the adoption of electronic medical records led to some unfortunate and unintended consequences" tied to "communication failure, poor data display, wrong order/wrong patient errors and alert fatigue." Also this summer, Massachusetts reported that 60 percent of doctors could not meet the EMR mandate and face potential loss of their licenses in 2015. And a few weeks ago, the American College of Physicians pleaded with the feds to delay the mandate's data collection, certification and reporting requirements.
Dr. Hayward K. Zwerling, an internal medicine physician in Massachusetts who is also president of ComChart Medical Software, blasted the Obamacare EMR mandate in a recent open letter: "As the developer of an EMR, I sincerely believe that a well-designed EMR is a useful tool for many practices. However, the federal and state government's misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship." Zwerling's call to arms appealed to fellow doctors to pressure the feds to repeal the mandate. "It is past time that physicians reclaim control of their offices, if not the practice of medicine."
As I've mentioned previously, my own primary care physician in Colorado Springs quit her regular practice and converted to "concierge care" because of the EMR imposition. Dr. Henry Smith, a Pennsylvania pulmonary doctor, also walked away. "Faced with the implementation costs and skyrocketing overhead in general," he told me, "I finally threw in the towel and closed my practice." He said, "As EMRs proliferate, and increased Medicare scrutiny looms, medical documentation is evolving from its original goal of recording what actually was going on with a patient, and what the provider was actually thinking, to sterile boilerplate documents designed to justify the highest billing codes."
Dr. Michael Laidlaw of Rocklin, Calif., told EHR Practice Consultants that he abandoned the Obamacare EMR "incentive" program "when I realized that I spent the first two to five minutes of each visit endlessly clicking a bunch of garbage to make all the green lights show up on the (meaningful use) meter. I said to myself: 'I'm not wasting precious seconds of my life and my patients' time to ensure some database gets filled with data. I didn't go into medicine for this. It is not benefiting my patients or me. I hate it.' I actually refused to take the $10K-plus this year. I have even accepted that I would rather be penalized in the future. What is worth the most to me is AUTONOMY."
Let me underscore that again: Doctors face steep penalties if they can't meet the radical technology goals imposed by the very same glitch-plagued Obamacare bureaucrats who now need an emergency "tech surge" to fix their own failed info-tech Titanic. The Obamacare wrecking ball has only just begun.
(Syndicated columnist Michelle Malkin is the daughter of Filipino Immigrants. She was born in Philadelphia, raised in southern New Jersey and now lives with her husband and daughter in Colorado. Her weekly column is carried by more than 100 newspapers.)
Last Updated on Thursday, 24 October 2013 08:37
Ever notice how some government programs draw the ire of almost everyone? Conservatives, liberals, environmentalists, libertarians, business, labor, consumers and grouchy taxpayers are all opposed. Yet these programs go on as though directed by an unstoppable particle beam from a neighboring galaxy. The public rarely sees who in Washington keeps the outrage in motion, and that's how "they" get away with it.
The sugar support program is one such curiosity. We will get into the "who" and "how," but first an explanation of why almost everyone hates it.
Americans pay about three times the world price of sugar because of a complex farm program designed to greatly enrich U.S. sugar growers and processors, in actuality a handful of families. Among other things, it limits imports of far cheaper sugar from impoverished Caribbean countries. It provides taxpayer-backed loans: If prices slip, the borrowers repay their loans with sugar, which taxpayers must sell at a loss or store at their own expense.
In sum, the policy provides a government-guaranteed income to cane sugar producers in Florida and sugar beet growers in Minnesota and Michigan. Who pays? American consumers, for starters. The manipulated price of sugar amounts to a tax estimated at $3 billion a year.
The domestic sugar industry argues that 142,000 jobs would be lost if the sugar program ended. But the Commerce Department reported in 2006 that inflated sugar prices kill three manufacturing jobs for every sugar-growing and -processing job saved. Many U.S. candy-makers have seen no choice but to move factories and their jobs to countries with normal sugar prices. Among the examples:
— Atkinson Candy Co., of Lufkin, Texas, recently sent most of its peppermint candy production to Guatemala. "It's a damn shame," company President Eric Atkinson told The Wall Street Journal, he had to move 60 jobs to Central America that should have stayed here.
— Jelly Belly Candy Co., based in Fairfield, Calif., has again expanded its factory in Thailand. Sugar makes up half the cost of the product, Jelly Belly President Bob Simpson said. High U.S. sugar costs have forced him to raise his prices several times over the past 10 years.
Reluctant to take their small family-owned businesses to other countries, domestic candy-makers had been reducing the amount of sugar in their product. It is no accident that from 2002 to 2012, imported candy contained 33 percent more sugar.
As Congress debated last spring whether to continue the program, Big Sugar's lobbying force, the American Sugar Alliance, ran an ad in The Washington Post, hotly headlined "Big Candy's Greed." The candy-makers, the ad charged, were trying "to boost their already bloated profits."
In Florida, meanwhile, the giant sugar plantations — propped up by taxpayers and abused consumers — dump fertilizer runoff into the Everglades, threatening the state's precious water sources.
It should surprise no one that the American Sugar Alliance greatly out-spent the confectioners to win the affections of our elected representatives. Thus, in a recent close vote, the House again saved the program. Followers of partisan politics will be intrigued to see so-called liberals combining with so-called conservatives to preserve this travesty.
On the Democratic side, Florida Reps. Debbie Wasserman Schultz and Alcee Hastings both voted for the program. On the Republican side, House Speaker John Boehner and Rep. Frank Lucas, of Oklahoma and chair of the House Agriculture Committee, also voted in favor. As he backed the government shutdown, Lucas was speechifying for a budget "that reduces spending and eliminates waste and abuse in government programs."
How the politicians get away with this is simple: The voters aren't paying attention. Only when they do will this absurdity stop.
(A member of the Providence Journal editorial board, Froma Harrop writes a nationally syndicated column from that city. She has written for such diverse publications as The New York Times, Harper's Bazaar and Institutional Investor.)
Last Updated on Wednesday, 31 December 1969 07:00