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

Editorial: Inaction of Nevada lawmakers highlighted by another campus shooting

A 26-year-old gunman opened fire on a community college campus in Oregon this past week killing nine and wounding nine others before killing himself when confronted by police.

Within hours President Obama was on television declaring, “Well, this is something we should politicize. It is relevant to our common life together, to the body politic. … This is a political choice that we make to allow this to happen every few months in America. We collectively are answerable to those families who lose their loved ones because of our inaction.”

We wholeheartedly agree with the president and turn to our Nevada lawmakers and say: This is something that could have easily happened here on one of our campuses. And ask: What didn’t you do something to prevent this from happening here? How can you explain your inaction?

So, as the president encouraged you to do, ask your Nevada legislators what they did about Assembly Bill 148, commonly called “Amanda’s Law,” which would have allowed holders of concealed carry permits to take their weapons onto college campuses in Nevada and defend themselves and others from attackers.

Amanda Collins

At Umpqua Community College in Roseburg, Ore., the scene of the shooting, no one, not even the security guard, was armed.

“We have a no-guns-on-campus policy,” College President Rita Calvin blithely explained to the press.

This is the current situation on Nevada campuses, because Amanda’s Law failed to pass — not once, but three times.

It passed the Assembly 25-15 this year but died in the Senate, where the Republican majority shrugged and refused to give the bill even a hearing, claiming it didn’t have enough votes to pass. (Former Attorney General Catherine Cortez Masto, who is running for Harry Reid’s Senate seat, testified against the bill.)

The failed law was named for Amanda Collins, holder of a concealed carry permit and a student at the University of Nevada, Reno. In 2007, Collins was brutally raped by an armed man in a university parking garage. She was unarmed because she, unlike her attacker, was following campus rules that prohibit weapons.

Earlier this year, Collins wrote a column for the National Rifle Association about her ordeal.

“Just the other day, I was asked ‘Why do you need a firearm on campus? What’s so threatening about becoming educated?’” she wrote. “Here’s my answer: Eight years ago, during my junior year at the University of Nevada-Reno, I was raped in the parking garage only feet away from the campus police office.”

She noted while being raped with a pistol to her temple, she could see police cruisers parked for the night, and knew no one was coming to help.

Her rapist was caught, tried and convicted for raping her and two other women, including the rape and murder of a California college student who was visiting Reno.

“At the time of my attack, I had obtained my Concealed Carry Weapons (CCW) permit for the personal choice of not wanting to be a defenseless target,” Collins wrote. “In Nevada, permit holders are not allowed to carry firearms on campuses. As a law-abiding citizen, I left my firearm at home, which means that the law that is meant to ensure my safety only guaranteed the criminal an unmatched victim.”

Collins also recounted her story in 2011 before lawmakers in support of a bill that would have allowed weapons on campus for those duly licensed. The bill passed the Senate but it died in the Democrat-dominated Assembly without so much as a hearing.

The law had a similar fate in 2013.

Republicans this year had majorities in both houses of the Legislature and had a Republican governor, but lacked something. Courage?

“This is a political choice that we make to allow this to happen every few months in America,” the president said.

Yes, and there has been inaction for three consecutive sessions. What are our lawmakers waiting for?

A version of this editorial appears this past week in 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.

Amanda Collins testifies in 2013:

Editorial: You too can spot wildfires from the comfort of home

View from fire spotting camera

View from fire spotting camera

The Bureau of Land Management has new eyes to spot wildfires quickly so they can be attacked before they grow into huge acreage gobbling infernos.

Those eyes could be yours.

The BLM has handed the University of Nevada, Reno’s Seismological Laboratory a $250,000 grant to pay for remote cameras atop four central Nevada peaks for five years at some of UNR’s seismic detectors.

The public can see what those cameras see on the Internet at

“These cameras provide fire management personnel in detection and situational awareness,” BLM fire official Paul Petersen was quoted as saying on the UNR website. “For instance, they can be positioned during lightning storms to detect potential ignitions. These are our first steps in building a cutting-edge camera network to protect and conserve forest and sagebrush ecosystems and reduce invasive species that spread after wildland fires.”

Ken Smith, associate director of the Seismological Laboratory, said, “The beauty of this system is that not only can fire service personnel look for indications of fire, but the public interface can be used by anyone, at any time, to look for fires in a crowd-sourcing fashion.”

Wildfire is one of the biggest threats to sage grouse, which could be listed under the Endangered Species Act as early as this fall by the U.S. Fish & Wildlife Service.

The cameras are located on 10,000-foot Jacks Peak between Elko and Owyhee; atop 6500-foot Midas Peak, 40 miles north of Battle Mountain; on 7,500-foot Callaghan Peak north of Austin; and Fairview Peak south of Highway 50 and about 30 miles southeast of Fallon. The cameras are mounted on towers up to 40 feet tall and can be remotely operated, zoom and rotate through a 360-degree sweep of the terrain.

The camera on Midas Peak has already proven its worth. Monitors using the camera spotted a fire 100 miles away in Oregon and another fire between Winnemucca and Elko.

UNR already has seven cameras arrayed around Lake Tahoe. Those can be viewed at

Graham Kent, director of the Seismological Laboratory, said those cameras worked well during a recent series of lightning strikes around the lake.

UNR officials said about 500 citizens are looking at the public site at various times, along with the 12 BLM dispatchers.

In addition to fire spotting, the new locations will allow UNR to expand its seismic detection system and improve earthquake monitoring in rural counties.

This kind of technology could have a real return on investment for our tax dollars.

A version of this editorial appears this past week in some 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.

FIRE shines a light on Nevada universities

FIRE report

Of course, both Nevada major universities are on the naughty list.

The Foundation for Individual Rights in Education studied the policies at at 333 four-year public colleges and universities and at 104 private institutions to find which have the greatest and least freedom of speech and awarded each a red, yellow or green light: “A red light institution is one that has at least one policy that both clearly and substantially restricts freedom of speech …”

Both UNLV and UNR made the red light list. They are in good company, because 55 percent of the institutes of higher indoctrination earned the red light designation.

UNLV, if you recall, is the place that tried to foist on its students and faculty a 14-page speech code a couple of years ago.

It sought to punish bias:

‘Bias Incidents’ refers to verbal, written, or physical acts of intimidation, coercion, interference, frivolous claims, discrimination, and sexual or other harassment motivated, in whole or in part, by bias based on actual or perceived race, ethnicity, color, religion, creed, sex (including gender identity or expression, or a pregnancy related condition), sexual orientation, national origin, military status or military obligations, disability (including veterans with service-connected disabilities), age, marital status, physical appearance, political affiliation, or on the basis of exercise of rights secured by the First Amendment of the United States Constitution.

Got that? A bias incident includes replying to an exercise of rights secured by the Constitution.