Newspaper column: Democratic candidates could hurt rural health care

As Democratic presidential candidates sweep across the state in advance of Saturday’s caucus rural voters should pay close attention — as if your life depends on it, because it does — to what they say about their plans for changing how Americans pay for health care.

Two of them — Sens. Bernie Sanders and Elizabeth Warren — are advocating what has been dubbed “Medicare for All,” which would basically outlaw private health insurance, such as that offered by employers and unions, and replace it with a taxpayer-funded single payer plan.

The rest have called for creation of a public option that would compete with private insurers and saddle taxpayers with the cost.

One problem is that Medicare reimbursements are estimated to be on average 40 percent less than private insurance. According to a New York Times article from a year ago, Medicare typically pays a hospital $17,000 for a knee replacement, while the same hospital would get about $37,000 for the same surgery on a patient with private insurance. Also, a hospital could get about $4,200 from Medicare for removing a gallbladder, but $7,400 from a private insurer.

This has been exacerbated by Medicare’s method of reimbursement, which is based on wage indexing.

In November the administrator for the Centers for Medicare & Medicaid Services wrote that, for example, prior to some adjustments this fiscal year, a hospital in a low-wage rural community could receive a Medicare payment of about $4,000 for treating pneumonia, while a hospital in a high-wage urban area could receive a Medicare payment of nearly $6,000 for the same case.

Because of such payments schedules and other factors, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, 166 rural hospitals have closed since 2005, including in 2015 the Nye Regional Medical Center in Tonopah. That closure left residents 100 miles from the nearest hospital and 200 miles from the nearest level one trauma center, though some local clinics now provide some urgent care. Four rural hospitals have closed so far this year.

The Medicare administrator noted that nearly 60 million rural Americans — often living in areas with higher rates of poverty and having difficulty traveling long distances to a hospital or doctor’s office — face higher risks. Recent Centers for Disease Control data found 57 percent of deaths from chronic lower respiratory disease in rural areas were preventable, compared with only 13 percent preventable deaths for people with the same condition in urban areas.

A study this past August for the Partnership for America’s Health Care Future conducted by Navigant Consulting looked at what the impact on rural health care might be at different levels of federal takeover of health care reimbursements.

Under the least intrusive option in which everyone covered by an employer-based insurance program kept that plan while others were swept into the public option, the study estimated that 28 percent of rural hospitals would be at high risk of closure, including three in Nevada.

Under the Medicare for All option, the study estimated that 55 percent of rural hospitals or more than 1,000 could be at high risk for closure, including eight in Nevada.

Even Sen. Warren has recognized that the plan she and Sanders have been backing could have an adverse impact on rural hospitals. A posting on her campaign website says, “Medicare for All will mean access to primary care and lower health costs for patients — and less uncompensated care for rural hospitals, helping them stay afloat. Elizabeth will create a new Medicare designation for rural hospitals that reimburses them at a higher rate and offers flexibility of services to meet the needs of their communities. Elizabeth will also strengthen antitrust protections to fight hospital mergers that increase costs, lower quality, and close rural facilities.”

How it will be paid for is not mentioned.

For his part Sanders blithely states online, “Rural people in particular have suffered the negative consequences that result from a lack of access to affordable, quality health care. Access to health care is a top issue for farmers and have some of the highest uninsured rate, in fact 41% of dairy farmers lack health insurance. With Medicare-for-All, small business owners, including farmers, will no longer have to worry about providing health care to their families or employees.”

Who will worry about paying for it?

According to the University of Nevada, Reno School of Medicine, Nevada already ranks 45th in the nation for active physicians per 100,000 population, 48th for primary care physicians and 50th for general surgeons.

A version of this column appeared this week in many of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel and the Lincoln County Record — and the Elko Daily Free Press.

Ramirez cartoon

When the morning paper agrees with Harry … something freezes over

My backup topic for items in this week’s rural newspapers turned out to be today’s editorial in the Las Vegas newspaper.

Though I settled on other topics, I had made a note that retired Nevada Sen. Harry Reid should get a tip o’ the hat for warning Democratic presidential candidates that Medicare for All and open borders are stances too radical for voters to accept. As my ol’ Pappy used to say: “Great minds travel in he same plane, but fools just think alike.”

The lede on today’s editorial reads:

If the Democratic Party keeps embracing the fringe left, Harry Reid might have to re-register as a Republican.

In a recent interview with Vice, the former Senate majority leader urged Democrats not to support “Medicare for All” and decriminalizing illegal border crossings. As recently as two years ago, those two radical ideas would have been seen as extreme among mainstream Democrats. Not now. Many of the party’s top presidential candidates have embraced both proposals.

Mr. Reid said “of course” pushing Medicare for All would make it more difficult for a Democrat to defeat President Donald Trump.

Though Reid has championed many liberal propositions over his lengthy stay in D. of C. — including the lamentable Obamacare — even he recognizes his party is listing too far to the left.

When was the last time Harry and the Las Vegas newspaper agreed on anything?

R-J file photo of Harry Reid.

 

Editorial: State budget could use some belt tightening

The members of the Nevada Economic Forum met earlier this month and came up with a forecast for how much the total state general fund revenues will be for the next two years.

The Economic Forum was created by lawmakers in 1993. It is responsible for providing forecasts of revenues for each upcoming biennial budget period. The figures are binding on the governor and the Legislature in crafting a budget, so they don’t wildly overestimate potential revenue and cause a budget crisis when funds come up short.

The forum members reported that the past two-year’s revenues turned out to be $8.244 billion and the coming two-year period should generate 7.2 percent more funds or $8.835 billion, after application of all applicable tax credits, of which there are a number.

Outgoing Republican Gov. Brain Sandoval has already drafted a budget for the next biennium, which will be handed over to incoming Democratic Gov. Steve Sisolak and the majority Democratic lawmakers, who take office in January. Of course, they all appear to anticipate spending every last dime of that $591 million windfall even though current inflation is running only 2.5 percent.

Much of the anticipated money is being targeted for expanded Medicaid under ObamaCare and various education spending schemes.

After the Economic Forum issued its forecast, Sisolak gave a statement to the press saying, “I am encouraged by how the state is performing. I look forward to reviewing the final forecast released by the Economic Forum and creating a roadmap to implement the priorities that matter to Nevadans. I am committed to building a bright future for our state and that starts with building a budget that funds the initiatives that will get us there.”

May we be so brazen as to suggest that taxpayers might appreciate an “initiative” that lets them keep a bit more of their paychecks. Or at the very least pour more of that anticipated-but-not-guaranteed revenue into the rainy day savings account for that time in the future when the outlook is not so rosy, because everyone knows that once government spends a certain amount of money it expects to continue to do so in perpetuity.

For the record, from 2011 to 2017 the state general fund budget grew by 32.3 percent, while inflation amounted to 7.9 percent.

Though we know we are whistling in the Democratic wind, we also suggest that the burdensome commerce tax passed in 2015 as part of Sandoval’s $1.5 billion tax hike be repealed. The tax was imposed even though the voters in November 2014 rejected a commerce tax at the ballot box by 79 percent to 21 percent. The commerce tax is expected to generate only $445 million in the coming biennium and could be covered by that extra $591 million in the projection.

Every Nevada business must file a commerce tax form with the state, even if the business owes no tax. For many, compliance costs exceed the taxes owed. That is a hidden tax on the state economy and retards job growth.

Lawmakers should think about the burden on taxpayers as well as the beneficiaries of their customarily spendthrift ways.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

Newspaper column: Whither renewable power after wind farm rejected?

Wee Thump Joshua Tree Wilderness Area, with Crescent Peak in the background. (Basin and Range Watch pix)

The Bureau of Land Management has rejected a bid by a Swedish firm to construct a mammoth wind turbine project on the Nevada side of the border with California near Searchlight.

The Crescent Peak Wind Project was to have covered 32,000 acres of public land with as many as 220 wind turbines standing 400 to 600 feet tall and generating 500 megawatts of power. The proposed site is adjacent to the Mojave National Preserve and the Castle Mountain National Monument in California and the Wee Thump Joshua Tree Wilderness and the South McCullough Wilderness in Nevada.

While the vast majority of the arguments against the project were based on probable environmental and ecosystem damages, some of the reasons given by the Nevada office of the BLM for denial were actually ones about economics and, perhaps most importantly, air traffic safety.

While the land agency said the project did not conform with the area resource management plan, it also cited other concerns. “These issues include that access to the turbines would potentially affect the development of more than 300 mining claims; the turbines could interfere with radar at two regional air facilities — one military and one civilian; and impacts to the visual landscape,” said Nevada BLM in a statement obtained by Basin and Range Watch.

Such air facilities include McCarran International Airport, a gateway to Clark County’s profitable, job-generating gambling resorts, and Nellis Air Force Base, a key element in the nation’s air defense training that includes air combat and bombing practice ranges that cover a vast swath of central Nevada.

The original denial letter, from the assistant secretary of the Interior Department, also obtained by Basin and Range, mentioned the potential for “a significant threat to military operations” at China Lake Naval Air base 150 miles away in California.

If such turbines can’t be located within 150 miles of such air facilities, where in Nevada, with all its commercial and military aircraft activity, can they be sited?

Dr. Donald Deever of Searchlight warned of just this problem in his 43-page public comment submitted to the BLM in June. He wrote: “As further proof of the devastating frequencies emitted by industrial wind turbines, something that isn’t common knowledge is that in the early years of the first term of President Obama, a feasibility study was commissioned to look into the possibility of transforming the Nevada Testing Site into the world’s largest photovoltaic solar energy plant. Unfortunately, the proposed project was diverted by Senator Harry Reid, who replaced the idea of solar panels with industrial wind turbines. Although Congress approved the project, it was immediately shut down when government engineers and researchers at Area 51 let the President and Pentagon know that the frequencies emitted by industrial wind turbines would completely interfere with America’s advanced stealth technology tests. If the frequencies of industrial wind turbines could overwhelm the circuitry of our country’s most modern stealth circuitry, one can only imagine how much damage it can do to the even more delicate biological systems of all migrating birds, whom scientists now know rely on magnetic fields to accomplish their annual migrations.”

Such limitations on the siting of wind farms near air traffic corridors might have an impact on the implementation of Question 6, should voters approve the proposition again in two years. In November, 59 percent of the Nevada voters approved a change in the state law that currently requires 25 percent of the state’s electric power to come from renewable generation sources such as wind and solar by 2025. Question 6 upped the ratio to 50 percent by 2030, no matter the cost and practicality or whether carbon emissions are actually reduced.

It should be noted that Question 6 passed in only three counties — Clark, Washoe and Mineral. It failed in every other county by wide margins.

Wind and solar eyesores gobble huge tracts of land and the most likely candidates for such projects are generally cheap federal public land, primarily found in rural counties.

Only 22 percent of voters in Lincoln County approved of Question 6, only 26 percent in Eureka, 29 percent in White Pine and Esmeralda and 32 percent in Elko, for example.

Clark County, the site of the rejected Crescent Peak Wind Project, saw 64 percent voter approval.

It will be hard to generate 50 percent of the state’s electricity with solar power, since the sun shines only half the day.

A version of this column appeared this week in many of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel and the Lincoln County Record — and the Elko Daily Free Press.

 

Newspaper column: These are the best choices to send to Washington

It is vital for rural Nevada that we send representatives to Washington who will defend us from the encroachment of the federal bureaucracies.

When it comes to the race for the Senate seat, the choice is obvious. Republican Sen. Dean Heller knows rural Nevada and what its residents need to survive and prosper.

His opponent — one-term Democratic representative Jacky Rosen — would modify the Trump tax cuts, block the nomination of conservative judges and justices, bar the use of public lands, push socialized medicine, big government spending and generally side with the radical left that is so entrenched in Washington.

Heller would continue to work to create jobs and improve the economy.

“As a lifelong Nevadan and rancher, I am fighting hard to ensure that Nevadans have access to our public lands for multiple-use purposes such as grazing, economic development, and recreation,” Heller says on his campaign website. “Without a doubt, the federal government owns too much land in the West. Because 87 percent of Nevada’s land is managed by the federal government, I believe Congress should transfer some of our lands to the state and local governments.”

Heller also promises to work to responsibly develop energy resources on public lands to keep fuel prices low.

He also opposes the government takeover of health care, saying, “Now, Obamacare is costing jobs, stifling economic growth in our nation, and the cost of care has increased.”

The Republican senator also has a track record of pushing for border security and immigration reform.

“Big government is not the answer to fixing our economy,” Heller warns. “Congress needs to control wasteful spending and shrink the size of government. Adopting pro-growth policies that expand tax relief across the board and allow Americans to keep more of what they earn will lead to job creation and economic prosperity in the future. Capitalism is the foundation of America’s prosperity. We should embrace these principles, not run from them.”

As for the candidates for the House of Representatives for rural Nevada, Republicans Mark Amodei and Cresent Hardy are the clear choices.

Amodei has represented the 2nd Congressional District in northern Nevada since 2011.

His Democratic opponent Clint Koble opposes selling public land and advocates reinstating ObamaCare and expanding Medicaid. Koble bemoans what he calls a wealth gap and claims the tax cuts have not benefited workers and “its worst provisions should be reversed.” He also favors instant background checks of all gun sales and promotes expensive renewable energy boondoggles.

Amodei is a strong defender of the right to keep and bear arms. He has sponsored bills that encourage economic development in rural counties.

“A significant issue for Nevadans, which dovetails with economic growth, is public land management. I believe that it is possible to leverage our natural resources in an economically and environmentally responsible way,” Amodei relates on his campaign website. “As a member of the House Interior Appropriations Subcommittee, I am advancing legislation to strengthen local control over the federal lands, which compromise more than 85 percent of the state. I think that local communities should be able to decide for themselves the best uses for public lands to spur economic growth.”

The congressman was a strong supporter of the tax cuts bill and advocates legislation to undo the worst problems with ObamaCare.

Republican Cresent Hardy is seeking a return to southern Nevada’s 4th Congressional District seat, which he won in 2014 by defeating incumbent Democrat Steven Horsford but lost in 2016 to Democrat Ruben Kihuen, who is not running for re-election after being accused of sexual harassment. Horsford is the Democrat nominee again this year.

Hardy is the clear choice for southern Nevada.

One of the starkest differences between Hardy and Horsford is on health care. Horsford backs ObamaCare and has said he favors transitioning to the socialized medicine proposal known as Medicare-for-all being pushed by socialist Sen. Bernie Sanders.

“Management of healthcare policy at the state level would help to mitigate fraud and abuse, while ensuring that each state develops programs that best suit the needs of their residents,” Hardy says on his campaign website. “A one-size-fits-all approach does not work on an issue as complex as healthcare coverage. Reform is needed. However, the ACA (Affordable Care Act or ObamaCare) is far over-reaching, expensive, and detrimental to our fragile economy.”

Horsford supports raising the minimum wage to $15 an hour, while Hardy opposes it as harmful to small businesses and to younger unskilled workers.

Hardy favors state and local control of public lands, while Horsford opposes this.

A version of this column appeared this week in many of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel and the Lincoln County Record — and the Elko Daily Free Press.

Editorial: Democrats pushing for socialized health care

In a speech in Illinois this past week former President Obama called “Medicare for all” a “good new idea.”

He said, “It’s harder for young people to save for a rainy day, let alone retirement. So Democrats aren’t just running on good old ideas like a higher minimum wage, they’re running on good new ideas like Medicare for all, giving workers seats on corporate boards, reversing the most egregious corporate tax cuts to make sure college students graduate debt-free.”

Sen. Bernie Sanders actually has such a bill pending that would nationalize and socialize the U.S. health care system and claims he has 16 Democratic senators supporting it. Sanders has argued that the United States spends almost three times as much on health care per capita as the British, who have a socialized system.

Nevada Democratic Sen. Catherine Cortez Masto said in August she supports an eventual move to a “Medicare-for-All” but that it is not immediately plausible.

“I applaud the concept, I understand what they’re trying to do at the end of the day, which is get us to the day where we have health care that everybody has and they can afford,” she said in an interview with the online news site The Nevada Independent. “And what it looks like, you can call it whatever you want, but we’ve got to take incremental steps along the way and bring everybody along.”

Nevada Republican Sen. Dean Heller meanwhile is said to be leaning toward supporting a move by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, who would take money spent under the Affordable Care Act and give it to states in the form of block grants.

As for Medicare for all, a recent George Mason University’s Mercatus Center study found Sanders’ plan would add $32.6 trillion to federal spending in its first 10 years and costs would steadily rise from there. Doubling corporate and individual income taxes wouldn’t cover the costs.

The proposal also would amount to a roughly 40 percent cut across the board in payments to doctors and hospitals, a devastating blow to the economy. With rural hospitals already going out of business, image how many more would have to close and how many doctors would retire or change professions.

As if the costs were not enough, that aforementioned British socialized health system earlier this year was forced to cancel 50,000 non-emergency surgeries due to hospital overcrowding. Emergency room waits were said to be as long as 12 hours.

You don’t have to pay as much for something you don’t get.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

Obama calls for Medicare for all. (Getty Images pix)

 

Editorial: ObamaCare costs keep soaring

Premiums for ObamaCare-eligible health insurance plans are soaring this year, according to an analysis by the Urban Institute.

The study, sponsored by the Robert Wood Johnson Foundation, found that the lowest priced of the so-called gold plans that cover 80 percent of medical expenses for a 40-year-old non-smoker increased 19 percent nationally this year and 25 percent in Nevada. The lowest cost silver plans for that individual, which covers 70 percent of medical costs, went up 32 percent nationally and 45.6 percent in Nevada. The second lowest priced silver plans jumped 34.3 percent nationally and 48.3 percent in Nevada.

But not to worry, the Nevada Appeal newspaper in Carson City reports that more than 85 percent of the nearly 100,000 Nevadans who are covered by such plans through the Silver State Health Insurance Exchange will not pay much if any of that premium increase because they receive federal subsidies. Guess who pays those federal subsidies? All of us.

The Appeal reports that, according to a recent report by the Congressional Budget Office, the nationwide increase in premiums will cost the taxpayers $10 billion more in subsidies this year.

Of course, a state health exchange executive blamed the premium spikes on “instability in the health insurance market — much of it caused by tactics designed to undermine the Affordable Care Act. That includes the decision to stop paying insurance companies for the Cost Sharing Reduction subsidies mandated by the ACA for consumers making between 138 and 250 percent of the poverty level,” the Appeal explained.

The taxpayers get stuck with the bill either way — subsidize the insurer or subsidize the rate payer. Six of one, a half dozen of the other.

During the debate this past year over those Cost Sharing Reduction subsidies, The Wall Street Journal reported, “In an ironic twist, stopping the subsidies would also wind up costing the federal government more in the end, the (Congressional Budget Office) report said. Higher premiums for mid-priced plans would require the government to pay larger tax credits to consumers to help offset coverage costs. The federal deficit would increase by $194 billion through 2026, the report said.” Instead of paying $7 billion in subsidies to insurers, we are paying $10 billion to ratepayers.

Pay no heed to the fact ObamaCare premiums have been rising sharply since the law was passed in 2010 without a single Republican vote and using dirty tricks devised by Nevada’s own Sen. Harry Reid. According to the website eHealth, from 2013, the year before ObamaCare went into effect, through 2017, health insurance premiums had already increased 140 percent. Forget repeal and replace, just repeal. Remember at the ballot box this fall just who brought us this expensive boondoggle and would vote to keep it.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.