Sandoval confirms increased doctor shortages coming for Nevada's current Medicaid patients
There are a lot of reasons that expanding Medicaid, like Gov. Brian Sandoval announced he was going to do yesterday, is a terrible idea. As NPRI has pointed out, one of the most unfortunate is that expanding Medicaid to healthy adults above the poverty line will increase doctor shortages for the most needy, including children and disabled.
And that diagnosis has been confirmed by none other than Sandoval himself. Via Steve Sebelius:
Sandoval acknowledged one problem with the expansion — there likely won’t be enough doctors to treat all the new patients who will be seeking primary care. He said he would seek to expand scope of practice rules and enhance medical license reciprocity with other states to immediately allow more doctors to practice in the Silver State. “We definitely have identified that [reciprocity] as a method,” he said.
This is not just a theoretical argument either.
The case of 12-year-old Deamonte Driver speaks volumes about the impact of health-care rationing on Medicaid patients.
Driver, a beneficiary in Maryland, developed a toothache. It should have meant only an $80 extraction.
However, because only 900 of Maryland's 5,500 dental care providers were accepting Medicaid, and these providers faced a backlog of patients, the Driver family — after calling more than 20 providers — was unable to get a timely appointment for Deamonte.
Soon, the youth's tooth infection abscessed and the infection spread to his brain. Deamonte, after complaining of a headache, was rushed to the hospital. He received two brain surgeries, but tragically died less than a month later.
Why does anyone think subsidizing healthy adults above the poverty line is a good idea?
Read moreAmerica's unsustainable spending in three charts
If a picture is worth a thousand words, these three charts shouldclearly show how unsustainable federal spending is.
Your Money
As you know, NPRI is a 501(c)(3) organization that neither seeks nor accepts any government funding, meaning we rely solely on the generosity of freedom-loving Nevadans like you to fund our work.
But even though we don't accept money from the government, that doesn't mean that the government doesn't affect our funding. Changes at the federal level on tax deductibility for charitable gifts can play a role in our donors' decisions to give — and changes are likely coming.
I'd like to share with you a portion of an email I received from Chris Askin, president and CEO of the Community Foundation of Western Nevada. Chris wrote:
Simply put, most professional advisors whose clients are high income earners suggest now is the time to make a large charitable contribution. We now know who will be President for the next term and we know his position on the tax deductibility for charitable gifts.
President Obama's proposal includes a provision to limit all tax deductions, including giving to charity, to 28 percent. Even though he is proposing raising overall income tax rates, anyone in a tax bracket higher than 28% will not receive a charitable deduction for the full amount of their gift. For the highest-bracket taxpayers this is a potential decline from 35% this year to 28% in 2013, a 20% decrease.
Taxpayers in brackets below the highest 35% marginal rate also may receive less benefit when giving to charity. Under the proposed Obama plan, there will be a haircut to the charitable deduction of 20% for tax brackets above 28%. (Emphasis added.)
Advisors across the state and the nation are telling their clients that now is the time to make their charitable gifts in order to lock in the current benefits.
I hope that as 2012 comes to a close, you'll consider a year-end gift to NPRI.
For those of you who'd like to make a lasting gift, please consider joining our Legacy Society. Information about the Legacy Society at NPRI may be found here: http://www.npri.org/join/legacy-society.
Investing in NPRI is a great way to build a free and prosperous future for our great state. For more than 21 years, we have advanced sound public policy solutions that improve the lives of all Nevadans. Elections, campaigns and politicians come and go, but NPRI's commitment to free-market principles will always remain.
I am grateful for every single one of NPRI's supporters. Without your generosity, the Institute would not exist, and the cause we serve would suffer.
Thank you, most sincerely, for your generosity.
While there may be a lack of certainty regarding charitable-gift deduction in future years, we do have certainty through the end of this year. I hope that during this holiday season, you'll be able to make donations to all the organizations and causes that you value. And I hope you'll consider a year-end gift to NPRI.
Take care,
Andy Matthews
NPRI President
Denis: Nevada Legislature is like "high school"
Great news. Just in case you thought it was good idea to give our legislators more power, consider what Senate Majority Leader Mo Denis told freshmen lawmakers recently.
Denis said: “Don’t buy into the gossip. You’ll hear a lot of that, too. In some ways, it reminds you of college or high school up here during session.”
Gossip runs rampant at the Legislature. And not the just the smutty kind that sometimes, but definitely not always, has a kernel of truth from the above-mentioned nightlife in Carson City.
Policy can be affected by such rumors as who is or isn’t supporting a bill, what the governor will or will not do on the budget, and what sneaky plan a lobbyist might have for hijacking certain legislation.
Any smart lawmaker will keep an ear to the rumor mill but verify before taking action. (Emphasis added.)
Is there a way to avoid this entirely? Probably not, because you can't change human nature.
But there is a way to limit it? Absolutely. Limit the length and frequency of legislative sessions, which fortunately Nevada already does.
Now some, like liberal pundit Jon Ralston, think it would be great for Nevada's legislative "high school" to meet on a full-time basis. Here's what he said last week on Ralston Reports.
Oh, I know: Few people agree with me.
Imagine what Mark Twain, whose 177th birthday was Friday, would have said. Maybe what he said about a century and a half ago: “No man's life, liberty, or property are safe while the legislature is in session."
Twain would be appalled at giving people he considered thieves more time to steal the public’s business. But these are territorial days no more – and Nevada is long overdue to modernize its legislative process.
It’s not just that we get what we pay for. It’s that the term limits gutting of experience and talent has exacerbated an endemic problem. Offer people a good salary. Give them well-paid staff. And have them meet every year so it’s not like throwing darts at a faraway dartboard to project what will happen in the state and what Nevada’s needs might be. (Emphasis added.)
So would high salaries for full-time legislators and full-time staffers lead to better results?
We don't have to speculate on the answer in the vacuum, because our neighbor, California, has a full-time legislature and pays its legislators over $90,000 a year plus $140 per session day in per diem. Lawmakers also have huge legislative staffs, including 93 staffers making over $100,000 a year in salary.
How's that working out for them? Hmmm.
Or how about Congress? House and Senate representatives make$174,000 a year plus benefits and have huge staffs.
How's that working out for us? Hmmm.
Government isn't designed to solve problems; it's intended to protect freedom and provide core services (more at the state and local than federal level).
When you give legislators more power and more time in session, they tend to "solve" problems that aren't any of their business by taking away the liberty they should be there to protect in the first place.
Unemployed teens highlight problem with minimum-wage laws
Ideas have consequences. And for kids like Jacqueline Duarte, the consequences of minimum wage laws (both state and federal) are to price her right out of employment.
It comes as no shock to Jacqueline Duarte that the employment rate among youths is the lowest since World War II.
The 17-year-old Valley High School senior, who earns A's and B's, has applied at McDonald's, El Pollo Loco, Target and just about every entry-level job source she can find, to no avail.
"I'm competing with adults now," she said, concluding that her grades don't matter because other applicants have experience.
That is a conclusion researchers also have reached in explaining why the number of working 16- to 24-year-olds in the United States has been cut nearly in half since 2000. About 6.5 million youths in that age group were both out of school and out of work in 2011, according to the Annie E. Casey Foundation's youth and work report.
That list of 6.5 million doesn't include Duarte, who is still in school. But if she can't land a job to start saving money for college, she may join those who are out of school and jobless. She also wants to help her mom with the bills.
As Milton Friedman noted many years ago, minimum wage laws harm the very people they're intended to help.
Former Clark County manager outlines need for PERS reform
Thom Reilly, former Clark County manager, had a great op-ed in the Review-Journal yesterday, which details exactly why pension reform is so urgently needed.
Nevada's pension system is one of the most generous public employee retirement plans in the nation.
Nevada PERS caps benefits at 75 percent of the average of retiring employees' three consecutive highest-earning years - 90 percent for those hired before July, 1, 1985. The system has no minimum retirement age, as long as the retiree has 30 years of service, and has few employees who are required to actually contribute to their own retirement. PERS has one of the highest formula multipliers used to calculate benefits - either 2.5 percent or 2.67 percent per year of service, depending on employment dates, while the national average is 1.95 percent - while Nevada governments provide some of the highest average salaries in the nation.
Also, Nevada PERS has one of the highest employer contribution rates in the nation. While higher contribution rates are typical of plans that do not include Social Security coverage in addition to a pension - like Nevada's - the state ranks as one of the highest among plans that do not include Social Security coverage for both regular employees and for police and fire. At the same time, Nevada ranks in the bottom fifth of states with regard to the percent of funded pension liabilities. It is generally assumed that pensions funded at 80 percent or less have a serious problem. Nevada's is 71 percent funded.
The only disagreement I'd have with Reilly here is that PERS is actually only 34 percent funded, not 71 percent. To get to 71 percent, PERS officials currently assume a risk-free 8 percent rate of return.
So what should we do about this growing problem?
Reilly's piece has several good suggestions, but the ultimate solution is moving public employees to a defined-contribution orhybrid (combining elements of a defined-contribution and defined-benefit) retirement system. From NPRI's PERS study:
Shifting PERS to a defined-contribution, 401(k)-type structure would not make these unfunded liabilities go away. However, it would ensure that benefit obligations are fully funded going forward, ensuring that lawmakers, taxpayers and public employees are clear regarding the pensions promises the government has made and its ability to fulfill them.
While a defined-contribution (DC) approach is not perfect, experience with reformed 401(k) plans and the Thrift Savings Plan for federal government employees shows that a DC pension plan can be managed cost-effectively for employees and taxpayers alike.
Ignoring Nevada's unfunded pension liability will only make the problem worse. And, as we've seen in California, ignoring these problems can lead to bankruptcy.
Liberalism is like eating your seed corn
Imagine you're a farmer facing a long winter. You had a rough harvest. You and your family will be able to make it through the winter, but food will be tight and appetites won't always be fully satisfied. You also have a large barrel of seed corn to plant in the spring that will provide food for you next year.
Do you eat the seed corn this winter?
If you answered no, you're probably a fiscal conservative, because you understand that many times you need to delay gratification in the present in order to create a better future.
In contrast, many liberal policies benefit some in the short term while increasing the risk of suffering in the long term.
A great example is socialized medicine. To hear a liberal describe it, you'd get universal health care by making all medicine "free" to the consumer, since it's paid for by the government.
Now, the immediate reaction might be to think that this sounds good — just as it might sound good to your family when they're told they can eat the seed corn in the winter. But in each case, the consequences of that decision — while not immediately apparent — would be devastating.
In the case of government-run health care, this decision would not simply be unwise. It would also be immoral. That's because the process involves the government taking money from someone for purposes beyond what is necessary to defend life, liberty and property. Governments are created to protect rights, not to redistribute property, and the mere fact that government confiscation of wealth may be legal — and deemed by some to be "for the common good" — doesn't make it legitimate or morally justifiable.
But let's focus on the practical consequences of government-run medicine. One result is that it exacerbates shortages of medical care. Scarcity is a reality in any economic system, but the beauty of the free market (which we don't currently have in American health care) is two-fold.
One, prices tell people how scarce something is, which allows individuals to reduce demand for care by comparing it to their next best alternative — "Do I have to go to the ER, or would an urgent-care option work?" Also, high prices encourage more individuals to become doctors and nurses, while also spurring innovation. While demand for medical care will always outstrip supply (scarcity), individuals in a free-market society will create ever more supply, which increases access by lowering prices.
Contrast this with a system of government-run health care. When you make something free, you greatly increase the demand for it, as a basic supply-and-demand chart shows. And unlike in a free-market system, government control deprives doctors of major financial and other incentives, like being able to set their own hours, which leads to "brain drain." The inevitable inefficiencies of government also decrease supply.
Finally, because of skyrocketing demand and diminishing supply, government-run medicine leads to rationing.
This is inevitable. Consuming the wealth of a nation through the taxing or borrowing that government-run medicine requires — akin to eating your seed corn — may delay this for a time. But ultimately it will happen. And in the case of government medicine, rationing can take the form of extensive waiting lists, denial of treatment or "helping" sick patients die faster.
Great Britain, which has had socialized medicine for decades, does all three.
Under optimal conditions, British heart-disease and cancer patients wait more than five-and-a-half months for treatment. British "health" officials have rejected the use of a life-saving liver- cancer drug because it cost too much. British doctors use a "death pathway" — removing food and hydration — to kill 130,000 elderly patients per year. Tragically, this practice is nowbeing used to kill children and disabled infants.
One doctor described the impact of depriving a child of food and water as "the unique horror of witnessing a child become smaller and shrunken."
Once a society eats its seed corn, it eats is children.
May America — by understanding the morality and functionality of free markets — wake up in time.
Take care,
Andy Matthews
NPRI President
Socialized Medicine at work
Sick babies starved/dehydrated in Britain
Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’.
Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults.
But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.
One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.
Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ‘smaller and shrunken’.
The LCP – on which 130,000 elderly and terminally-ill adult patients die each year – is now the subject of an independent inquiry ordered by ministers.
The investigation, which will include child patients, will look at whether cash payments to hospitals to hit death pathway targets have influenced doctors’ decisions.
Medical critics of the LCP insist it is impossible to say when a patient will die and as a result the LCP death becomes a self-fulfilling prophecy. They say it is a form of euthanasia, used to clear hospital beds and save the NHS money.
I urge you to read the doctor's letter at the bottom of the story to get a glimpse of how grotesque dehydrating a child to death is. Here's just a small snippet.
I know, as they cannot, the unique horror of witnessing a child become smaller and shrunken, as the only route out of a life that has become excruciating to the patient or to the parents who love their baby.
I hope this story serves as a gut check for liberals who support socialized medicine.
Ideas have consequences. And when you implement flawed ideas like socialized medicine, the consequences can be deadly.
Cartoon: "Let's be like those guys!"
Both Sen. Harry Reid and Sen. Dick Durbin have said that entitlement reform shouldn't be part of any fiscal cliff deal.
Eric Allie sums that attitude up perfectly in this cartoon.
Why support for education doesn't mean support for more education funding
Assemblywoman Lucy Flores had another interesting tidbit in her interview yesterday with the Las Vegas Sun that I want to examine.
Everyone always talks about how they are for education. You don't ever find anyone who is against education. So what I tell people is the question should not be: Do you support education? The question should be: Do you support funding education? Because at the end of the day, that's where the parties diverge. That's where you're either for education in action or you're just about education in words. I think for a very long time we've been about education in words.Now this is a very common argument in education policy, but it's also one that misses the point, which you can see clearly by examining the same argument in a different context. The article notes that Flores has completed multiple marathons so let's apply her argument to running.
Just like education, nearly everyone supports running. There are also certain costs to running, including running shorts, shirts and shoes, and food items like bananas, energy bars or Gatorade.
Do you care about running less if you buy Gatorade for 69 cents a quart instead of $1.19? Do you support running less if your bananas cost 33 cents per pound instead of 56 cents? Does running matter less to you if you wait for New Balance shoes to go on sale before buying them?
Of course not. It's ridiculous to even suggest this, because it's so obvious that the goal is completing your run and that spending money on food or clothing is just a means to that end.
You're not "for" running if you pay more for supplies or "against" it if you seek out the best deal, but that's exactly the argument Flores is making about education.
Do you see the error in that argument and way of thinking?
The goal must be student achievement.
And since the goal is student achievement, let's examine ways to increase student achievement. We've tried spending more money, and Nevada has nearly tripled inflation-adjusted per-pupil spending in the last 50 years. With the lowest graduation rate in the country, however, spending more hasn't worked. Spending more hasn't worked nationally either.
Fortunately for the children you know, we know what does work. School choice has the biggest impact on increasing student achievement. Twenty-seven random-assignment studies have found that school choice increases achievement for either students who use school choice programs or remain in public schools. No random assignment study has found a negative impact for either group.
In 1998, Florida enacted a series of reforms, including school choice, that produced these results.
We should all run to embrace proven education reforms.
