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

Does Trump have GOP nomination sewn up?

NY Times graphic

NY Times graphic

It’s all over but the crying, right?

Donald Trump snatched up at least 89 of the 95 Republican delegates up for grabs in his home state of New York Tuesday, though John Kasich did manage to stick a finger in his eye by winning the three delegates from Trump’s home borough, Manhattan.

Ted Cruz got blanked and faces bleak chances in other New England vicinity states next week — Connecticut, Delaware, Maryland, Pennsylvania and Rhode Island. In fact, Cruz is mathematically now eliminated from any chance of winning the nomination on the first ballot.

Delegate total graphic from R-J today.

Meanwhile, Trump has far more delegates than anyone else and is only 392 from the majority needed to win on the first ballot. But he does not have a majority of the delegates awarded so far. Uncommitted delegates and delegates committed to other candidates total 950, compared to Trump’s 845.

And while Trump continues to whine about the rigged delegate procedures that allow Cruz to take all the delegates in places like Wyoming and Colorado by actually, you know, showing up, it should be noted that the winner-take-all rules are benefiting Trump. In New York he gets 60 percent of the vote but at least 94 percent of the delegates. One person, one vote?

And if Trump doesn’t get to 1,237 by the convention, don’t forget how it turned out in the second Republican National Convention in 1860.

Ramirez cartoon






Trump picked up only 18 more delegates than Cruz on Tuesday

In case you are trying to figure out where the presidential nominating process stands after Tuesday’s voting in neighboring Arizona, Utah and Idaho, you’ll have to look elsewhere than the morning paper which states, “GOP results in Utah and Democratic results in Idaho were not available late Tuesday,” though both were available before midnight.

Both Republicans and Democrats voted in Arizona and Utah, but only Democrats in Idaho.

When the dust cleared, Donald Trump picked up 18 more delegates than Ted Cruz, but Bernie Sanders picked up 16 more delegates than Hillary Clinton.

Here is a New York Times graphic:


New York Times election graphic at

Politico has actual vote counts on its website. In total, Trump picked up 272,000 votes to Cruz’s 250,000. Even though she lost ground in delegates, Clinton got 253,000 votes to Sanders’ 180,000.

According to Politico, Marco Rubio still has 166 delegates, meaning Trump has 739 delegates (yes, that is different from NYT), while all other candidate and uncommitted delegates add up to 798. There are 955 delegates up for grab in upcoming voting. To win the nomination outright requires 1,237 delegates.

The next GOP contest is in Wisconsin on April 5. Its 42 delegates are winner-take-all.









State Department blames poverty for terrorism … what a canard

There they go again. Terrorists are created by the crushing poverty they face in their home countries. So, we need to give them aid instead of killing them, according this State Department mouthpiece.

Never mind that research in 2003 found that 13 percent of Palestinian suicide bombers were from impoverished families, though about a third of the Palestinians are impoverished. In addition, 57 percent of suicide bombers had some education beyond high school, though only 15 percent of the population did.

The poster boy for terrorism, Osama bin Laden, was the son of a billionaire construction company owner.

American Thinker provides this list of poor, poor put upon terrorists:

• Kahlid Sheikh Mohammed was a mechanical engineer

• Mohammed Atta grew up in a middle class household; his father was an attorney.

• Ramzi Binalshibh was a bank clerk.

Son of a billionaire

• Mohammed Atef was an Egyptian police officer.

• Marwan al-Shehhi was a soldier studying in Germany on an Army scholarship.

• Ziad Jarrah came from a wealthy Lebanese family and attended private, Christian schools.

• Abdulaziz Alomari graduated with honors from his Saudi high school and went on to graduate from college.

• Wail M. Alshehri was a Saudi P.E. teacher and university student.

• Waleed M. Alshehri, also a student, was Wail’s brother. Their father was a prominent Saudi tribal leader.

• Zacarias Moussaoui, the “20th hijacker,” had an MA in international business studies.

• Major Malik Nadal Hasan, the Fort Hood shooter, was a psychiatrist.

• Umar Farouk Abdul Mutallab, the underwear bomber, was the son of a bank chairman.

• Hammam Khalil Abu Mulal al-Balawi, who killed eight CIA agents in Afghanistan last month, was a physician.

The more likely crucible from which terrorism arises is lack of civil liberties, as Alan Krueger wrote in The New York Times in 2003.

“The ultimate joke would be if civil liberties are sacrificed in the fight against terrorism, as a lack of civil liberties seems to be a main cause of terrorism around the world. Support for civil liberties should be part of the arsenal in the war against terrorism, both at home and abroad,” Krueger wrote.

But this administration won’t let the facts get the way of their story line.

All the news that’s fit to censor

Reuters photo in today’s R-J.

Today for the first time the Las Vegas newspaper has printed an image of one of the Charlie Hebdo infamous Muhammad cartoons — in this case the cover of the post-attack issue of the French satirical newspaper. The photo is on an inside page.

Elsewhere the issue of whether to publish such “offensive” cartoons continues to roil journalists.

The New York Times’ public editor Margaret Sullivan even questioned her own boss’ decision to not publish any such image, saying the cover of the latest issue was newsworthy.

“I can understand why The Times would not have published ‘the most incendiary images,’ as the executive editor, Dean Baquet, described them last week. He felt those extreme cartoons would not have been necessary to illustrate the story about the terrorist attack that killed eight members of the satirical newspaper’s staff,” Sullivan writes.

But then she concludes:

“Here’s my take: The new cover image of Charlie Hebdo is an important part of a story that has gripped the world’s attention over the past week.

“The cartoon itself, while it may disturb the sensibilities of a small percentage of Times readers, is neither shocking nor gratuitously offensive. And it has, undoubtedly, significant news value.”

Over at NPR this is its position:

“At this time, NPR is not posting images of Charlie Hebdo‘s most controversial cartoons – just as it did not post such images during earlier controversies involving the magazine and a Danish cartoonist’s caricatures of the prophet. The New York Times has taken the same position. The Washington Post‘s editorial board has put one of Charlie Hebdo‘s Prophet Muhammad covers on the print version of its op-ed pages, but not online. News editors at NPR and other organizations continually review their judgments on these types of issues when the materials are potentially offensive because of their religious, racial or sexual content. That review process will continue.”

The Associated Press has stated:

“AP tries hard not to be a conveyor belt for images and actions aimed at mocking or provoking people on the basis of religion, race or sexual orientation. We did not run the ‘Danish cartoons’ mocking Muhammad in 2005, or the Charlie Hebdo cartoons of the same type. While we run many photos that are politically or socially provocative, there are areas verging on hate speech and actions where we feel it is right to be cautious.

“This policy is consistent with our approach to sound bites and text reporting, where we avoid racist, religious and sexual slurs.”

Reuters has posted a few of the Muhammad cartoons. The Las Vegas newspaper did publish one of the so-called Dutch cartoons several years ago under previous management.


Sometimes a ‘sensationalistic fishing expedition’ catches a lot of ‘fish’

Recently both the Reno and Las Vegas newspapers published editorials calling for the Public Employees’ Retirement System of Nevada to release retirees’ names and benefit amounts, information a district court judge and the Nevada Supreme Court both said are public records in a lawsuit brought by the Reno paper.

(The hang up is that PERS has claimed that information is contained only in the individual files of members and those files are not public records by law. The Supreme Court said PERS did not have to create a special report for the Reno paper containing the public records.)

Metro announces the firing of an officer without bothering to mention that officer had already been granted a full disability retirement. (Photo by K.M. Cannon for the R-J)

Predictably, the online comments on both editorials included a few people complaining that releasing names and benefits would be an invasion of privacy.

Beneath the Reno editorial, a commenter asked, “Why do they need employee names?”

Beneath the R-J opinion, a person said, “There is absolutely no reason that the specific identities of pensioners are required to analyze the performance of the system and to identify anomalies that indicate potential fraud.

“The lawsuit to invade pensioners’ privacy is nothing but a sensationalistic fishing expedition.”

And a fish was just caught. Sunday, the R-J reported on how the Metro police made a big show of firing an officer who had shot and killed a mentally disturbed and unarmed Gulf War veteran during a standoff.

Though no one ever mentioned it, of course, Metro could not actually fire Jesus Arevalo, because he had already been granted a full disability retirement by PERS. Arevalo told the paper, “It was stress-related.”

The paper reported Arevalo, 36, will get about 31 percent of his annual pay for the rest of his life — estimated at between $23,000 and $28,000 a year. Estimated, because PERS refused to release actual figures.

How many others are getting such deals is unknown, though the paper mentioned one other cop with such a deal. Lt. Paul Page was granted a full disability retirement by PERS right in the middle of a criminal investigation into allegations he had embezzled funds from the police union. The paper offered no dollar estimates.

It reminds me of a story in The New York Times a couple of years ago. The paper, using public records, discovered:

“Virtually every career employee (of the Long Island Railroad) — as many as 97 percent in one recent year — applies for and gets disability payments soon after retirement, a computer analysis of federal records by The New York Times has found. Since 2000, those records show, about a quarter of a billion dollars in federal disability money has gone to former L.I.R.R. employees, including about 2,000 who retired during that time.”

And that is what one can carch with a sensationalistic fishing expedition.

There was plenty to criticize in Obama speech ending the ‘global war on terror’

In an earlier posting I remarked that Obama’s speech this past week at the National Defense University was basically a unilateral capitulation in the “global war on terror.”

In the 7,000-word speech he said “a perpetual war — through drones or Special Forces or troop deployments — will prove self-defeating, and alter our country in troubling ways,” and he outlined his plan to win the hearts and minds of people who wouldn’t mind cutting out our hearts. We’ve tried the hearts-and-mind strategy and it never ceases to fail.

But I was kind compared to Newt Gingrich, who called the speech “just stunningly, breathtakingly naïve.”

The former Speaker of the House added:

“He says at one point ‘wars have to end.’ Well, [Leon] Trotsky said, ‘you may not care about war, but war cares about you.’ I mean, right after you have somebody beheaded in London, you have a bomb go off in Boston, you have the Iranians … every day trying to penetrate our system with cyber, you have an Iranian nuclear program underway and the president announces cheerfully, ‘the war’s going to end because I’m not happy being a war president.’”

Bret Stephens at The Wall Street Journal called message delivered in the speech Obama’s “Retreat Doctrine:”

“It’s alluring to think that, merely by declaring an end to ‘continual warfare,’ we can end continual warfare; that we can define our problems as we’d like them to be, rather than take them as they are and have them define us in turn.

“Thus the operating assumption of Mr. Obama’s speech, and for that matter his entire presidency: Saying it makes it so.”

Obama at National Defense University capitulating.

Stephens also pointed out the absurdity of Obama’s claim that war has cost us “well over a trillion dollars … exploding our deficits and constraining our ability to nation-build at home,” when the federal government has spent $31.3 trillion since 2002. The war has hardly exploded our deficits. It is the lavish spending from Washington on all those stimulus programs, entitlements, ObamaCare, green energy and so much more that is the problem.

Even the Obama-friendly New York Times pointed out a few incongruities, including the fact this Nobel Peace Prize recipient has a “kill list.”

According to the piece by Peter Baker, Obama is trying to repair his legacy:

“He wanted to be known for healing the rift with the Muslim world, not raining down death from above.

“Over the past year, aides said, Mr. Obama spent more time on the subject than on any other national security issue, including the civil war in Syria. The speech he would eventually deliver at the National Defense University became what one aide called ‘a window into the presidential mind’ as Mr. Obama essentially thought out loud about the trade-offs he sees in confronting national security threats.”

The Times tale ends aptly with a quote from South Carolina Republican Sen. Lindsey Graham, “At the end of the day, this is the most tone-deaf president I ever could imagine, making such a speech at a time when our homeland is trying to be attacked literally every day.”

“But this war, like all wars, must end,” Obama said Thursday. The best way to end a war, like a fistfight, is to win. Just dropping your hands to your side is an invitation for trouble.

It reminds me of a really, really old Aggie joke — with Obama playing the role of the assistant coach from Texas A&M dispatched to Austin  to win the hearts and minds of the Longhorn’s coaching staff and discover the secret as to why the Longhorns kept beating the Aggies in football.

The assistant coach went straight to then coach Darrell Royal (that’s how old the joke is) and asks, “Why do you beat us every year?”

Royal replies, “Because Aggies are stupid.”

The coach asks, “What do you mean?”

“Allow me to demonstrate,” Royal answers and holds his hand up to a brick wall and says, “Hit my hand.”

When the coach obliges, Royal pulls his hand away.

Back at College Station, with his right hand in a cast, the assistant is asked by his head coach what Royal said. He replies, “He said Aggies are stupid.”

“What do you mean?”

“Allow me to demonstrate.” The assistant holds his left hand in front of his face and says, “Hit my hand.”

Ramirez cartoon today

Heller’s sales tax deduction bill tackles the right problem with the wrong solution

Nevada’s junior senator, Dean Heller, this week introduced a bill that would make permanent the federal income tax deductions for state and local sales taxes, rather than having Congress renew the deductions practically every year.

Dean Heller

It addresses a very real problem, but with the wrong solution.

In a press release Heller stated:

“Taxpayers in Nevada benefit greatly from this common sense tax relief. Making the state and local sales tax deduction permanent would help ease some of the stress many middle-class families in the Silver State are feeling every day. This bill would also help encourage economic growth by attracting new business, generating jobs, and promoting investment in local economies. The Senate should move swiftly to pass this legislation so Nevadans can benefit from this much-needed tax relief.”

The state and local sales tax deduction for Nevadans amounted to only $449 million, or less than half a billion dollars. (Wall Street Journal graphic)

Nevada is one of nine states with no state income tax, which has been deductible practically from the start of the federal income tax. The other states that would be affected by Heller’s bill are Texas, Florida, Tennessee, Washington, Wyoming, South Dakota, Alaska and New Hampshire.

Heller argued his bill would help level an uneven playing field by ensuring states like Nevada are afforded the same treatment in the federal tax code as states with an income tax.

Surely Nevadans should not be denied a chance to get our snouts in the deduction trough, you say. That’s only fair.

Actually, there is nothing fair about allowing a deduction from federal income tax for state and local taxes, because the level of taxation the various states heap on their citizens varies wildly. The deduction amounts to a subsidy for high-tax states, which, by the way, happen to be mostly Democrat-controlled.

In 2010, according to a Wall Street Journal analysis of IRS data, five liberal states — California, New York, New Jersey, Maryland and Massachusetts — accounted for half of all deductions allowed for state income taxes.

“The inequity is especially stark if we compare this to states without an income tax,” the Journal editorial continues. “The average state and local income-tax deduction claimed per tax return in 2010 was $4,109 in New York and $3,819 in Connecticut. But the average Texan claimed only about $100, and the average Florida deduction was a mere $219. No wonder New York Senator Chuck Schumer opposes tax reform.”

Using the same 2010 data from the IRS, I found Californians who filed for state and local income tax deductions claimed deductions of $10,700 per return, and almost half of those returns reported earnings in excess of $100,000. Nevadans who filed for the state and local sales tax deduction claimed only $1,430 per return. Calculated on a per capita basis, Californians claimed $2,116 in federal income tax deductions for each and every man, woman, child and illegal immigrant in the state when all state and local tax deductions are included, while Nevadans claimed only $166 each for sales tax deductions.

Heller should introduce a bill eliminating the deduction for all state and local taxes while lowering the income tax rate a commensurate point or two for everyone, including those who don’t qualify for itemized deductions. That would be fair. Perhaps, next to impossible to pass, but fair. It can be argued that the rest of the country is subsidizing that recent huge state income tax hike on “the rich” in California, because many there will simply deduct it from their federal income taxes, leaving those in other states to pick up the slack in federal spending eventually.

Allowing federal income taxpayers to deduct local taxes must be a terrible idea, because The New York Times is for it. The paper said in an editorial in December:

“The theory behind the deduction was that the amount paid to states in taxes is not really part of an individual’s disposable income, because it is obligatory and, therefore, should not be taxed twice. Over time, the deduction has become the equivalent of a subsidy from the federal government to states that believe in a strong and active government. That may infuriate conservatives in low-tax states like Texas, who hate subsidizing states with different views of government’s role, but it’s actually a good thing for the country.

“The deduction is Washington’s way of supporting states that support their most vulnerable citizens and neediest cities. The seven states that account for 90 percent of state and local tax deductions (including sales and property taxes) — New York, New Jersey, California, Pennsylvania, Maryland, Illinois and Massachusetts — generally do a better job of providing for the health and welfare of their citizens, and are more willing to pay for institutions that are good for society as a whole.”

What a bogus argument. It is, as they admitted, a subsidy. It also means the residents of certain states are carrying less than their fair share of the federal tax burden. Also in December a Wall Street Journal editorial explained the problem:

“The state and local tax loophole helps disperse and disguise the real cost of big government. As Mr. Obama likes to say, this is reverse Robin Hood.

“All of which helps to explain what appears to be the ebbing liberal support for a tax reform that reduces rates in return for fewer deductions. Democrats in Congress once supported that kind of reform. But these days they tend to represent states with ever-higher tax rates that prop up state and local governments dominated by public unions that demand ever-higher pay and benefits. The resulting state tax burden would be intolerable if much of it weren’t passed off on Uncle Sam.”

If you want a level playing field, Sen. Heller, file a bill eliminating the deductions for all state and local taxes — income, sales, property, etc. Federal taxes should burden individuals equally, not give a break to those who live in spendthrift states like California and New York.

This sales tax deduction bill provides little more than crumbs while other states are gorging on a five-course meal.

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