Cliches are where you find them … everywhere

Now, for something completely different.

This past evening we settled down after a lovely repast of leftover Irish-style stew and cornbread to watch a DVD of the 2019 “Downton Abbey” movie. It is about the king and queen visiting the estate and the anticipation of that event for the family and the servants.

Minutes into the flix one of the characters, Merton, asks: “Who were those men measuring on the green as we came past?”

Mary replies: “They’re building the dais for the Queen at the parade.”

Merton: “How exciting.”

Isobel: “It seems rather a waste of money.”

Violet: “Here we go.”

Cora: “Isn’t that what the Monarchy’s for? To brighten the lives of the Nation with stateliness and glamour?”

Then Isobel, quotes Alfred Tennyson’s poem 1842 poem “Lady Clara Vere de Vere,” saying, “Kind hearts are more than coronets, And simple faith than Norman blood.”

To which Violet replies, “Will you have enough clichés to get you through the visit?”

And Isobel smartly counters, “if not, I’ll come to you.”

What makes this a slightly amusing juxtaposition is the fact the next DVD on our shelf is a 1949 flix starring Alec Guinness in several different roles. It is called “Kind Hearts and Coronets.”

Apparently Tennyson is saying that it is one’s character that counts, rather than the nobility of one’s descent.

In the Guinness film, which we’ve yet to watch, apparently one member of the family knocks off those above him in lineage to increase his inheritance and place in line to a title.

So the moral of his story is … none whatsoever. Just a royally odd coincidence to encounter so closely together the same obscure — to me at least — quotation. We are amused, but we are, these days, easily amused. I hope you are, too, whatever your current station in life and lore.

 

Editorial: Nevada should impose work requirement for Medicaid enrollees

Even though Congress could not find a way to repeal the budget-busting, economy-distorting Affordable Care Act, affectionately known as ObamaCare, there are still a few things the states can do to ameliorate its impact.

Chief among these, according to a report prepared for the Nevada Policy Research Institute and the Washington Policy Center by Dr. Roger Stark, is to implement work requirements for able-bodied Medicaid enrollees. The Trump administration announced recently that it is willing to accept waiver requests — known as 1115A waivers — from states that wish to impose a work requirement.

“Applying for a waiver to implement work requirements is a common-sense reform, and it’s one that’s already supported by the administration,” says NPRI policy analyst Daniel Honchariw. “Medicaid should help its able-bodied members who are willing to work, rather than encouraging an unsustainable and demoralizing cycle of dependency.”

Honchariw notes that 60 percent of the Nevadans who gained free Medicaid coverage under ObamaCare’s expansion of the program — approved by Republican Gov. Brian Sandoval, by the way — did not earn a penny of income in all of 2015. Expanded Medicaid now covers 600,000 Nevadans at annual cost of about $5,700 each.

“Such costs are unsustainable over the long-run without dramatic tax increases,” Honchariw states.

According to Dr. Stark, ObamaCare has resulted in only 20 million of the 50 million uninsured people before the law was passed — without a single Republican vote, by the way — to gain health insurance coverage. A large portion of those were handed Medicaid. In Washington state, 80 percent of the newly insured were placed on Medicaid.

“Obamacare has raised insurance premiums for virtually everyone in the country outside of the free Medicaid entitlement. Health care spending was 17 percent of the economy when the ACA became law,” Stark writes. “By 2021, with the ACA in place, estimates show that the country will spend 21 percent of the annual economy on health care.”

He said this past year the cost of Medicaid was $545 billion nationally and is projected to grow to $700 billion by 2020.

Studies have found that the health outcomes for people covered by Medicaid are no better than the uninsured.

We encourage Nevada’s lawmakers to take advantage of the work-requirement waiver and other options to curb the cost to taxpayers and break the cycle of dependency such entitlements foster. —TM

 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.

Court overturns contraceptive mandate as violation of free exercise of religion

The U.S. Circuit Court of Appeals for D.C. on Friday gutted ObamaCare’s mandate that all insurers provide free contraceptive coverage.

In a case involving two Ohio grocers who operate Freshway Foods and Freshway Logistics, the court ruled that the mandate violates the right to free exercise of religion in the First Amendment and as reinforced by the Religious Freedom Restoration Act. Grocer owners/brothers Francis and Philip M. Gilardi are Catholics. They sued to challenge the contraceptive coverage mandate.

The Obama Justice Department made a feeble argument about corporations not being people.  

The court ruled:

The contraceptive mandate demands that owners like the Gilardis meaningfully approve and endorse the inclusion of contraceptive coverage in their companies’ employer provided plans, over whatever objections they may have. Such an endorsement — procured exclusively by regulatory ukase — is a “compel[led] affirmation of a repugnant belief.” That, standing alone, is a cognizable burden on free exercise. And the burden becomes substantial because the government commands compliance by giving the Gilardis a Hobson’s choice. They can either abide by the sacred tenets of their faith, pay a penalty of over $14 million, and cripple the companies they have spent a lifetime building, or they become complicit in a grave moral wrong. If that is not “substantial pressure on an adherent to modify his behavior and to violate his beliefs,” we fail to see how the standard could be met.

The ruling reverses a lower court refusal to grant the brothers a preliminary injunction against enforcement of the law against them.

The ruling was not significant enough to warrant so much as a mention in today’s Las Vegas newspaper.

Nor was the news from Friday that the Bureau of Land Management has opened the comment period for land use plans to protect sage grouse in 16 Nevada counties — an action that could jeopardize mining, oil and gas exploration, grazing, farming, power transmission lines, wind and solar farms and the economic prosperity of Nevada.

Column: ObamaCare doctor shortage coming, especially to rural Nevada

While America, as a result of a number of factors, is about to get slapped with a serious shortage of doctors, rural Nevada may be in for a train wreck. By 2020 the nation will have 90,000 too few physicians, according to the Association of American Medical Colleges. AAMC predicts the doctor shortfall will affect everyone, but will especially impact those who live in areas designated as health professional shortage areas, as reported in this week’s newspaper column, available online at the Elko Daily Free Press and eventually at The Ely Times, when they get their Internet server back up.

Gary Varvel cartoon, July8

According to the University of Nevada School of Medicine, 66.9 percent of Nevada’s rural population already live in a designated Primary Care Health Professional Shortage Area. While there are 182.2 physicians per 100,000 residents in urban areas of Nevada, there are only 76.5 physicians per 100,000 in rural areas — for a statewide ratio that is 48th worst in the nation. Just in time to twist the scalpel in the wound, along comes the Patient Protection and Affordable Care Act, which seeks to provide health insurance to an estimated 30 million Americans. More insured patients. No more doctors. At a recent meeting of the Nevada Republican Men’s Club, I asked Nevada Rep. Joe Heck, himself a former emergency room physician, about the impending doctor shortage. “This bill (ObamaCare) has done nothing to increase access to health care. All it has tried to do is increase access to health insurance. Having insurance does not equate to having health care …” he said. “So what is going to happen is you’re going to get a big influx of people who now have insurance. They’re going to call a doctor and ask for an appointment. And they’re going to be told, ‘We can see you in three to six months.’ And they’re going to say, ‘Wait a minute, I don’t want to wait three to six months. I’ve got insurance now. Hmm, let me go to the emergency department.’” Emergency rooms are already overcrowded, Heck noted. One small glimmer of hope for Nevadans is that the state Legislature passed and Gov. Sandoval signed a bill that as of July 1 allows certain qualified nurse practitioners to practice independently of a doctor. The journal Health Affairs noted “nurse practitioners could fill the growing primary care shortage more quickly than could physicians, since it takes nurses on average 6 years to complete their education and training, including undergraduate and graduate degrees, compared to an average of 11 to 12 years for physicians, including schooling and residency training.”

Dr. Scott W. Lamprecht, president of the Nevada Nurses Association, says the difference is not all that great and will be less so in a couple of years when requirements entry level nurse practitioners are made even more stringent.

Lamprecht explains that currently a nurse practitioner must complete a bachelor’s degree in nursing, which takes four to five years including prerequisites, then a master’s degree in nursing is approximately two years, with an additional one to two years to complete the post-master’s Nurse Practitioner Certificate. This is approximately seven to eight years by the current standards. In 2015, Lamprecht says the entry level nurse practitioner will have to complete a Doctorate in Nursing Practice (DNP) which is approximately an additional two to three years, which raises the overall requirement to eleven to twelve years. Additionally, Board exams are required for both registered nurses and nurse practitioners. “The education content for nurse practitioners is different from that of physicians, but the professional expectations for taking care of patients are the same,” he said. “Nurse practitioners care for patients, manage diseases, perform screenings, order diagnostic tests, write prescriptions, and promote wellness using a holistic philosophy. The goal for all providers should be to provide access to high quality patient care for everyone including rural and urban areas.”

See you in the doctor’s waiting room. Read the entire column at the Elko site and eventually at Ely‘s.