The Carlisle Mosquito Online

Friday, March 14, 2008

Opinions

Getting to know the candidates (no, not Hillary, Obama or McCain)

For readers of this newspaper, it has become clear that Carlisle is facing a serious budget crunch in the year ahead and beyond. Having to juggle the needs and requests of town departments, the Carlisle Schools and the Concord-Carlisle High School, as well as concerns of Carlisle taxpayers, town officials are deliberating long hours at meetings in the run-up to the May 5 Town Meeting. Many of the town’s long-term capital investments have been put on hold. The DPW’s request for a $110,000 dump truck to replace one almost 30 years old and a side mower for $75,000 are good examples of deferred needs. Over $1 million in requests this year have been put aside.

Turning to thoughts on the citizens who volunteer unbelievable amounts of time and energy to running our town, I was pleased to see the results of the Town Caucus, which was held on March 3. This year there will be three contested races – three candidates running for two openings on the Board of Selectmen, three candidates for two openings on the School Committee, and two candidates for one opening on the Board of Trustees of the Library. Unfortunately, only one candidate has been nominated for two positions on the Planning Board and there is one position to be filled on the Housing Authority. [The Mosquito has learned that Susan Stamps has obtained the necessary signatures on a petition to appear on the ballot for the one opening on the Housing Authority.] Still, there is time for other citizens to run for these (or any other) offices if they obtain a petition from the Town Clerk and have it signed and returned by March 25, or run as write-in candidates.

Running for the Board of Selectmen this year are two incumbents, Bill Tice and John Williams, and a challenger, Cindy Nock, formerly a member of the Zoning Board of Appeals and the School Committee. In the race for two openings on the School Committee are William Fink, Donald Rober and Louis Salemy. Vying for the one opening on the Board of Trustees of the Gleason Public Library are Ann Rosas and Vera Tice.

In this year of deadly constricting budgets, as well as the usual array of issues facing the town, such as 40Bs, wind turbines and a decision on the fate of the Highland Building, it is especially important for townspeople to get to know these candidates running for office. One way to do this is to attend the League of Women Voters Candidates Forum on Sunday, May 4, in the Clark Room at Town Hall. Another is to look for the candidate write-ups in the Mosquito in April.

With the May 15 Town Election two months away, that should give us plenty of time to meet the candidates and hear their thoughts on how they would handle these important issues. For the voter in town, this is the only way to cast an educated ballot.

Our healthcare crisis?

  I believe nearly everyone would agree that our healthcare system is in crisis. We are constantly told that:

A. There are 30+ million uninsured in this country;

B. the newly-minted Massachusetts Health Plan is $200 million in the red and failing;

C. the drug manufacturers and the insurance companies are running roughshod over us;

D. the Canadians have it all figured out.

  Does anyone dare to dispute this? It ís no wonder that healthcare is near the top of the issues in this Presidential election cycle. We’re in crisis!

  I have been implementing accounting systems in hospitals and doctors’ offices since before Medicare was enacted in 1965, and my perspective on the topic is somewhat different. My views have been shaped by how I have seen the healthcare system respond to federal government programs. The federal government, via Medicare, has been the largest single purchaser of healthcare over the past 40 years.  It has been a classic case of “unintended consequences.” 

In its first 20 years, Medicare paid hospitals whatever it cost them to deliver services. Buoyed with this new source of funding, hospitals went on a buying frenzy of technology and brick and mortar the likes of which had never, ever been seen before. The cost of healthcare in the U.S. rose from <5% of GNP before Medicare to >12% of a much larger GNP by 1985. Then the Fed decided it needed to put on the brakes, and Medicare started paying fixed costs for each procedure. Suddenly, hospitals were losing money on Medicare patients, so they did the logical thing; they raised the prices they charged to Blue Cross and commercial insurance companies to make up for the losses. Thus insurance premiums have been escalating at double digit rates.  

As to items A; B; C; & D above:

  A. The Robert Woods Johnson Foundation studied the make-up of the 30 million uninsured and found that when you took out those who had just changed jobs and technically had a gap in coverage; took out those who could afford it but risked not buying it; removed illegals from the rolls; and adjusted for other factors, there may have been around 6-8 million people without insurance. It is also important to note that no one in this country is refused treatment if they cannot afford to pay for it. They may have to seek it in the ER of a hospital, but they are never turned away.

  B. It is also important to note that an individual could purchase “premium level” healthcare insurance in Massachusetts for about $350 a month. Yes, the start-up costs of the new plan have placed it in the red, but that is to be expected during the phase of enrolling new members prior to the positive cash flow of premium revenues.

  C. It is quite easy and convenient to blame drug companies and insurance companies for the high cost of healthcare, yet the facts tell a different story. Doctors and hospitals account for 52% of total healthcare costs, prescription drugs for 10%, yet they have contributed enormously to our quality of life and longevity. Insurance company administration, marketing, and profits make up only 12% of their premium costs. The long and short of it is that, since 1970, hospital costs have risen by  >$600 billion; doctors fees have increased by  >$400 billion; prescription drug costs have risen by $200 billion; and private insurance costs have risen by $150 billion.

D. I am a “snowbird” in Florida in the winter, and my Canadian friends that I see daily say they are disenchanted with waiting three months to see a doctor, six months for an MRI, a year for a hip replacement, and a ten-month waiting list for the maternity ward. As one person told me, “I can always go to the ER if I need care urgently.” Wow. And to think that they get all this for a tax burden of 37% of GDP vs. 27% in the U.S., and they pay a pittance for defense. It is very enlightening that, whereas America’s founders wrote of “life, liberty, and the pursuit of happiness,” the equivalent phrase at Canada’s founding was “peace, order and good government.”

  The conventional wisdom may hold that our health-care system is in crisis, and the only solution is for the government to save us from ourselves. I believe that facts speak to just the opposite. There is a saying in healthcare that there should be three components to it: (low) cost, (high) quality, and (easy) access. You can pick any two, but you can’t have all three. Our current system offers easy access and high quality, but at a relatively high cost. A government-run system will certainly assure higher cost and more control over access, and it is anybody’s guess at what will happen to quality.

 

 

 

 

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