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Sun report ignored real driver of Medicaid reimbursement rates

To The Daily Sun,

After the Jan. 20 Belknap County Commission meeting, I handed a paper which summarized the effects of state policy in nursing home reimbursement for Medicaid patients to Roger Amsden. The ratio of Medicaid patients to "all payers" is what drives the per diem rate for Medicaid reimbursement and that is the primary reason for a decrease in state payments.

Ignoring what I documented on Jan. 20, Mr. Amsden reported on Jan. 23 that it is the lack of electronic medical reporting which accounts for the decreased payment from the Department of Health and Human Services. The illogic of blaming the lack of EMR for the change in reimbursement is the reason I decided to investigate how the state sets Medicaid rates. It is what the state refers to as Case Mix Index, and our higher proportion of Medicare patients and private patients in 2015 accounts for the loss of about $180,000.

The other glaring error in Mr. Amsden's article is his reporting that it was the former nursing home director who was responsible for our nursing home not having a receptionist. Firstly, Mr. Logue was here for two years, and the nursing home has not had a receptionist for seven years. Secondly, it was the responsibility of prior commissions to prepare a budget and there is no evidence that they requested money for a receptionist. Indeed, the nursing home was a favorite whipping boy of past commissions.

For Mr. Amsden to report that a former nursing home administrator was responsible for the lack of a receptionist shows a peculiar lack of interest in analyzing what he is told by people in administrative support.

Dick Burchell
Belknap County Commissioner, District 2


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GOP needs a true conservative with broad appeal to all voters

To The Daily Sun,

I fear for our country.

The absentee ballots are in the mail for our first-in-the-nation presidential primary to be held on Feb. 9. Seldom in our country's history has who is to be the nominee been more important.

The late famous conservative thinker and writer William F. Buckley once wrote what later became known as the "Buckley Rule," which said something to the effect that a conservative should vote for the most conservative candidate in a primary who can actually win in a general election. That has never been more true than at this time.

There is seldom, if ever, an election in which one is able to find a candidate with whom the voter and the candidate agree on every issue. It is usually a matter of voting for the lesser of the evils.

We have an "open" primary in which voters who have registered as undeclared as to political party can request a primary ballot for either party. Thus, the wise political strategy in this election cycle is for supporters of Hillary Clinton to register as undeclared, request a Republican primary ballot, and vote for the Republican candidate who is least likely to beat Hillary.

If the Republican nominee is unable to beat Hillary Rodham Clinton in the general election in November, imagine what her presidency will be like:

She will be able to appoint (for life) several justices to the U.S. Supreme Court, for several of the existing justices are ill and old. Imagine whom she will appoint: how about that well-known constitutional law professor, Barack Hussein Obama? How about one or more of her closest confidants and advisers, Huma Mahmood Abedin (wife of the infamous ex-congressman and serial sexter Anthony Weiner), or Sidney Blumenthal? How about John Kerry or even William Jefferson Clinton (a disbarment should not stand in his way)?

What would her cabinet look like? Take some guesses. No matter how improbable, you will probably be fairly close to what would actually happen.

These are only some of the issues that cause me great fear and should concern every American.

Although Donald Trump may have touched several chords by voicing a number of statements that reflect what many typical Americans actually think and feel, his nomination as the Republican nominee to run against Clinton will ensure a victory for her.

Trump was a Democrat before he was a Republican, and he espouses numerous viewpoints that are at odds with conservative and/or libertarian American values. For example, he has, on national television, said that he "loves eminent domain," which is when the government takes your private property, supposedly for public use, but sometimes to turn over the property to private real estate developers, like Trump, for private for-profit development.

No matter how much Trump supporters might fantasize about a Trump win, in reality Trump simply cannot win in a general election, because to win the candidate must have sufficiently broad appeal to attract votes from the so-called middle-of-the-road voters, who are neither doctrinaire Democrats nor Republicans. Trump has the highest negatives of any candidates, meaning that he has the highest number of people answering polls who say that could never vote for him.

Thus, I urge my fellow Republicans, declared or undeclared, and my fellow Americans who would not like to see another Clinton administration and what it would do to our great country, to refrain from selecting Trump as the Republican nominee, and pick a candidate who is a true conservative with the personality and temperament to have broad appeal to all voters.

My candidate is my former law partner and friend, Marco Rubio. He is not a bully. He is not a reality show star. He does not take great pleasure in shouting out to someone on national TV that they are fired. Not only is he a true conservative but he plays well with others.

Norman J. Silber

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