All In a Day's Work

From the AP: "President Bush worked nearly three hours at his Texas ranch on Thursday to design a new U.S. policy in Iraq, then emerged to say that he and his advisers need more time to craft the plan he'll announce in the new year."

Wow. Nearly three whole hours? Including bathroom breaks?

Seriously, the majority of the country has wanted a change in Iraq policy for months, and for many it's been years. It was seven weeks ago that the nation sent a strong message for change in the midterm election, and over three weeks ago the bipartisan Iraq Study Group did the same.

Speaking of responsiveness, after Bush's three hours of work at the ranch, he gave a two minute statement to the press. Upon finishing, he turned and walked away in the middle of a reporter's question.

Bushie, you're doing a heck of a job!

I know this sort of thing is nothing new, and it really shouldn't surprise me. But I can't help but be blown away by the thought that this is the most important position in what is heralded as the greatest democracy in the world.

And that notion is more than just rhetorical. While it may start off that way, it's an ideal that infuses and shapes our nation's policies, particularly foreign, which means, if used, it's an important belief to truly uphold. Either that or we should just drop it altogether.

County Workers Win

The brewing fiasco between Milwaukee County officials and AFSCME Council 48 appears to be over. Just yesterday it looked like the battle would continue in court, but late in the day a tentative deal was struck between the two sides.

While the fight has been going on for two years, it really started to heat up around the time the county formulated the next budget. Scott Walker wanted to privatize the jobs, but the County Board wanted to keep them and put pressure on the union to accept concessions by only funding the positions for three months.

The County Board's tactic won out when it slapped down Walker's ridiculous veto of the budget in its entirety. But instead of accepting rejection, Walker decided to supercede the County Board's negotiation plan by issuing immediate layoffs of the positions in question and proceeding to talk with private contractors about filling them.

The union jumped in at this point and got a temporary court injunction against the layoffs, and before a final ruling on the issue was given, this tentative agreement was reached.

Based on the info provided by the Journal Sentinel, it appears that the union won out on this deal. Most importantly they kept the 100 positions, but, in addition, the concessions they made are ones that they pledged to make, anyway.

And the union also convinced the county to move to a managed health care system that tiers health plans by cost -- if workers want higher cost plans, then they pay more, as opposed to the set-up now that allows them to pay the same for all of the plans. So, in essence, this too was a concession by the union, but one they paradoxically had to fight to get (the tiered system was the idea of Walker's opponent in the 2004 county executive race, Dave Riemer...makes you wonder how much easier this all would've been if things turned out differently that spring).

This is just speculation, but it doesn't seem too unreasonable that the chance Walker and other county officials would be forced to testify under oath in court about their negotiation tactics played a role in this last second turnaround and agreement on a tentative deal.

What's a lot less speculative is the point that all this would be so much easier if Walker and the County Board could just learn how to play nice.

The Packers and Gift Cards

A couple of quickies to mark my return from break...

First on tap is the decision to move the Packers game against the Bears to Sunday night. Last week Packers fans had to deal with the fact that the game against the Vikings only aired on the NFL Network, and now they need to deal with this. Any other Sunday night wouldn't be an issue, but this Sunday night just happens to be New Years Eve.

And if it wasn't enough that it's a Packers-Bears game and possibly Brett Favre's last appearance on the gridiron, the match potentially takes on added importance if the Pack is still alive in the playoff hunt. A variety of scenarios exist to make that happen, but they almost all require a NY Giants loss this Saturday.

So for those fans who only feel the need to alter their New Years plans if there's a shot at the playoffs at stake on Sunday night, the real game to watch this weekend is the Giants-Redskins on Saturday night, which will tell you whether changing plans is really necessary. Of course, you better find yourself a satellite dish, because that game's only on the NFL Network.

In other news, a Dem state legislator from Milwaukee -- Fred Kessler -- is arguing that the state should get the cash from unused gift cards once they expire. Currently, the value from the gift card just goes back to the company that sold it; so, in effect, the company gets paid twice for it. Kessler notes: "I'd rather have people spend the money and use the gift card, but if they aren't, I'd rather the state get the money."

I'm as much a proponent of improving public finance as anyone, but -- at first glance -- this just doesn't make any sense to me. Why should the state get the money? There's no logic to it.

What does make sense is legislation, which has been rejected in the past, to end gift card expiration dates or at least make them more explicit for consumers. Unless Kessler's goal is to create an extreme that, in turn, makes these other proposals seem more palatable, he should just focus on reintroducing the old legislation.

But even if his advocacy is just a rhetorical tool, it seems misguided. Proposals like these are easy fodder for conservatives to claim that Dems are interested in meddling in the free market for no good reason other than to feed the evil tax machine that is our government.

Public finance needs to be improved, but the means for doing so must be at best systemic and at least logically sound. This idea isn't either.

Christmas Blog Break

I've got nothing this morning.

As a state employee, I can't blog from work (the whole using state resources for political speech thing). So I usually spend 6:00am to 7:30am, or so, scrambling around for something to write about before work. If I can't find anything, like today, I usually try to just keep my mouth shut, although I do admit to occasionally regurgitating bland ideas and thoughts just to get something out there.

But not this morning. Since I can find nothing to write about, I'm just going to call today the first day of my Christmas blog break. Barring anything astounding happening later today or tomorrow, I'll be back next Wednesday or so.

As my present to all of you, here's perhaps the greatest monologue in Christmas movie history:

New Proxy for Iraq War Found

According to a hot-off-the-presses DoD report, the new Public Enemy #1 in Iraq is Muqtada Sadr.

That means the White House can start pushing the media to frame the war in terms of confronting Sadr, as opposed to a broader conflict with varying pressures and causes. In other words, we again have a clearly defined enemy and, with it, a clearly defined goal.

And when Sadr is neutralized -- like Hussein and Al-Zarqawi before him -- a much-needed PR victory will be achieved.

Black Student Population Surges 0.7% Under Holistic Admissions

(Warning: Snarky and sarcastic post alert.)

So holistic admissions is back in the news. This time the hubbub is being driven by the formation of a special committee by GOP state legislators "to explore ways to prohibit racial preferences in state contracting and university admissions in Wisconsin."

The committee is going to trundle out Ward Connerly of the American Civil Rights Institute to talk about how we need to strive for a color-blind society, and a key place to start on that is evidently university admissions.

Connerly brings with him a resume that boasts awards from a host of right-wing organizations including the Freedom Alliance, the Conservative Political Action Conference, the California Republican Party, and the Bradley Foundation.

I'm sure the special committee is also going to give time to a scholar like Cornel West, who penned a seminal book on black studies titled Race Matters. After all, a special legislative committee is about gathering as much reliable information and as many respected points of view as possible on an issue of state importance, not merely staging media events to push a partisan agenda, right? (Side-Note: Wrong.)

But clearly there's a need to stop holisitic admissions from running rampant on the racial make-up of our UW campuses. Just look at what holistic admissions has done to African American enrollment at UW-Madison over the past 15 years.

In 1989-1990, just prior to the start of holistic admissions at UW-Madison, the black student population was at 1.8 percent. By 1994-1995, a few years into holistic admissions, it had jumped up to 1.9 percent of the total student headcount. Hold onto your hats, though, because by 2000-2001 it was already up to a full 2 percent. And this past year, 2005-2006, the black student population at UW-Madison reached an all-time high of 2.5 percent.

Cause for alarm and accusations of racial preferences, indeed. I mean, the black population in the state of Wisconsin is only 5.9 percent. Our flagship UW campus is now beyond the halfway point of actually resembling the racial make-up of the state as a whole.

And the only possible explanation for that jump must be holistic admissions. How else could the percentage of black students at UW-Madison increase by 0.7 percent over the past 15 years?

It couldn't be that holistic admissions aims to diversify the overall type of student who's admitted, as opposed to focusing solely or even primarily on the demographic features of applicants; which, in turn, actually maintains much of the look on campus, and really only affects the feel.

It just couldn't be.

I Want My NFL

The Journal Sentinel had an article late last week on the growing controversy between the NFL Network and cable companies.

The article was written in the context of this Thursday’s Packers-Vikings game, which will air on the NFL Network. The issue is that most cable providers – including the two Wisconsin heavyweights Time Warner and Charter Communications – don’t offer the NFL Network as part of their cable package.

Thus, as it stands now, cable and over-the-air viewers in places like Madison and Eau Claire will not see the game. To understand the importance of this, a person only needs to visit the UW-Eau Claire campus this week.

If it’s anything like it was when I was there, the game is going to be the hot topic of conversation heading into Thursday night. I recall after one Vikings victory over the heavily favored Packers – I think it was on a Monday night – a congregation of Vikings fans assembled outside the two Towers dorms to celebrate and taunt the Packers fans.

Needless to say, while all Packers games are big deal in Wisconsin – even when they’re losing – the Packers-Vikings games are a huge deal to many people in the state.

And to toss even more fuel on the flames, this Thursday could very well be Brett Favre's last game at Lambeau (and, not surprisingly, that's exactly how the NFL Network is shrewdly marketing it). I can imagine what foam finger will be displayed by the Packers fans who miss that.

Those of us in the Green Bay and Milwaukee viewing networks – even viewers without cable or satellite, like myself – will see the game because we’re in what’s considered the Packers home market, so our local channels will pick up a feed of the game.

But, still, a good portion of the state is going to miss it.

So what’s the hang up? Well, to put it bluntly, it's cash.

The NFL decided to start featuring select games on its newly formed channel because otherwise only the most die-hard fans would care to tune in if it was just non-stop commentary with a smattering of semi-interesting coverage like the NFL combines and the second day of the NFL draft (I'm using "semi-interesting" loosely).

As for the cable companies, they don’t want to put the NFL Network in the standard line-up – which is what the NFL wants them to do – because they figure they can make more money selling it as part of a premium sports package, thereby forcing people to pay not only for the NFL Network -- which would be the big draw for most -- but also for all of the other sports channels that they many not care to see (and, hence, wouldn't sell very well otherwise).

While it ticks me off that the NFL started this mess by pulling games out of the regular schedule and putting them on its own network (instead of just putting them on an existing cable channel like ESPN or, better yet, one of the existing network channels and simply skimming a portion of the profits from there), I can’t help but side with the NFL now that the controversy exists.

Most of this feeling is driven by the B.S. line from the cable companies that their decision not to put the NFL Network in the standard line-up is about consumer choice. Consumers want to be able to choose if they see the NFL Network, the argument goes, therefore, it should be a part of a premium package – like HBO and Showtime – not the standard cable package.

Putting aside the hilarity of the cable providers claiming they care at all about consumer choice when they are the only show in town for cable in their respective territories, the argument that they make for keeping the NFL Network out of the standard line-up could be made for keeping out every channel that currently exists in that standard line-up.

After all, there isn’t a single channel in the current standard line-up that 100 percent of the cable viewers – or even close to that figure – want to see on a regular or even semi-regular basis. Take C-Span, for instance. I’m about as hooked on politics as anyone; however, I can hardly stand more than 2 to 3 minutes of most programming that comes on C-Span. Who can? Yet, there it is in the standard line-up, and every cable customer is paying for it to be there.

According to the JS article cited above, the cost of getting the NFL Network on the standard cable line-up would be $0.70 (per month, I think, but the article isn't clear on that) for each cable customer (that’s assuming no existing channel would be dropped with its addition). And it’s very true that a portion of people paying that 70 cents wouldn’t care to see the NFL Network at all. But, again, the same could be said for every channel that makes up the standard line-up.

So what makes the NFL Network worthy of inclusion in the standard line-up? The easy answer to that is ratings. Every week during the football season, the primetime NFL games consistently rank near or at the top of the Nielsen ratings for both cable and broadcast rankings.

A couple of weeks ago, for instance, the NBC Sunday Night Football game between Denver and Seattle ranked second in the Nielsen broadcast rankings behind only "CSI." And the ESPN Monday Night Football game between Carolina and Philadelphia ranked first in the Nielsen cable rankings with twice the number of viewers as the second rated show “The Closer.”

Now, the argument could be made that, aside from game time, the NFL Network is not likely to be much of a draw for most viewers. And since the NFL season only takes place during a relatively small portion of the calendar year, does it really make sense to include it in the standard line-up?

While all that is true, the answer must be that it makes at least as much sense as including C-Span 2 and The Golf Channel in the year-round standard line-up.

I mean, really, the legislative process and the PGA Tour can be interesting and all, but can they honestly hold an audience like even the lowliest of NFL games?

Health Care Reform is Alive at the Federal Level

Much of the talk lately about fundamental health care reform has come at the state or even local level. The claim has been that the federal government is in such disarray, at this point, talk of serious reform is all but out of the question for the next couple of years.

But, a couple of days ago, Sen. Ron Wyden managed to get the ball rolling against that thinking with a bold and innovative plan to provide universal coverage to nearly every American while keeping our current system of privatized insurance intact.

Here's the basic idea. Employers would take all of their health care spending for 2007 (or the first year after the plan is enacted) and pay it out as wages to employees. Employees would then use the extra wages to purchase a private health insurance plan from a regional pool that would be created. Plans in these pools would be required to provide coverage at least equal to the coverage currently enjoyed by members of the US House and Senate.

After two years, employers would stop paying out extra wages to employees and start paying into an insurance fund based on annual revenue and their number of FTE employees.

Details of the plan's funding can be found here (other info can be found here). Also, Ezra Klein of The American Prospect has been taking a detailed look at the plan, and his takes thus far can be found here, here, and here.

The bottom line is that this plan would provide coverage for over 99 percent of the US population -- around 45 million more Americans than the existing system -- and it would save the country billions of dollars over the next decade alone, all the while maintaining the privatized insurance industry.

According to the Lewin Group, a top-notch actuarial firm that specializes in health care financing, Wyden's plan -- called the Healthy Americans Act -- would save the country approximately $1.4 trillion over the next 10 years. The first year alone would realize a savings of around $4.5 billion, savings that will directly benefit businesses, families, and state/local governments (see funding citation above).

These savings would result primarily through administrative efficiencies created by pooling the privatized insurance plans into regional groupings and also increasing price competition for the plans involved.

Unfortunately, Wyden's plan doesn't have much chance of becoming law as long as President Bush is in the White House. But now that Dems control Congress, passing a plan like this in late 2007 or 2008 could make it a key issue heading into the 2008 presidential race. If enough Americans get behind it -- and the polls suggest a majority will -- pressure could be put on both major party candidates in the 2008 race to pledge signing the bill if elected.

State and local reform may be the best place to go in the near future, but fundamental reform at the federal level shouldn't be forgotten. And, just as importantly, our elected officials at the federal level shouldn't be allowed to get off the hook on proposing and supporting such reform.

UPDATE: Health policy expert Matthew Holt's take on Wyden's plan is here.

Homophobe Weekly: The Parenting Tips Edition

Ok, it's been a busy week. There's a lot to catch up on, so let's get started.

In probably the biggest news of the week, a writer for the always-reliable World Net Daily told us that eating soy products such as tofu can make males turn gay. Oh, and it makes their penis smaller, too.

"Soy is feminizing," the WND column tells us, "and commonly leads to a decrease in the size of the penis, sexual confusion and homosexuality. That's why most of the medical (not socio-spiritual) blame for today's rise in homosexuality must fall upon the rise in soy formula and other soy products."

I know what you're thinking: "I have a daughter. So if I feed her more soy, she'll for sure be into boys, right?" Well, maybe. But you'll also be setting her on an irreversible path of rapid reproductive system aging.

As the WND explains: "If he is a she, brace yourself for watching her reach menarche as young as seven, robbing her of years of childhood."

Yes, the stakes are high when it comes to soy.

And here's a warning for you vegan parents who still want to push it: "Research [possibly completed in the author's garage] is now showing that when you feed your baby soy formula, you're giving him or her the equivalent of five birth control pills a day. A baby's endocrine system just can't cope with that kind of massive assault, so some damage is inevitable. At the extreme, the damage can be fatal."

Too much to think about? Well, too bad. There's more.

Now researchers at a university in Toronto have discovered that people who can write with both their left and right hands are more likely to be bisexual. So what do you do if you start seeing your child excel with both hands?

If the child is a girl, you could try to give her measured doses of soy products to push her feminine side. Of course, if she starts menstruating in the first grade, well, then you measured wrong.

If the child is a boy...yikes, that's a tough one. Until we have confirmed research that some food product makes someone like the ladies (perhaps beef jerky and chew?), your best bet is to just chop off one of his hands in hope that the shock sets him straight.

That's it for this week. Check back later for more homophobe news you can use.

The Madison-Milwaukee Divide

There's plenty of speculation about why Madison is pulling ahead of Milwaukee in terms median household income in recent years. While the two cities had fairly equal median incomes 15 years ago, Madison pulled ahead during the 1990s and currently has an 80 percent lead over Milwaukee.

Some conservatives have alleged that this disparity is being driven by the fact that Madison has a higher percentage of government jobs than Milwaukee. Thus, they argue, this gap has grown on the back of tax dollars. Unfortunately for this line, the facts just don't seem to be there to support it.

I haven't seen the full report by the Wisconsin Taxpayers Alliance (WTA) because it's not available online, but the group's press release says nothing about government jobs accounting for the growing disparity in median income between Madison and Milwaukee.

After all, the release notes that Dane County is outpacing Milwaukee County even in manufacturing jobs, which used to be the bread and butter of brew-town. Surely not even the staunchest conservative could argue that this change in manufacturing is related to government jobs.

Even beyond that, the difference in percentage of government jobs in the two cities just doesn't warrant a charge that it's a driving force behind the income disparity. According to a recent Journal Sentinel article, 23 percent of Madison's workforce is in the public sector, while the same is true for 11 percent of the workforce in Milwaukee.

Is anyone really going to argue that the 12 percent difference between the two is enough to create -- or even be a significant driving factor behind -- an 80 percent disparity in median incomes over the past 15 years?

Instead, the real factor driving the growing income disparities is the one that has received the most attention thus far, which is the presence of UW-Madison.

There's no question that the knowledge that flows out of the university is driving the creation of industry and, subsequently, good-paying jobs in Madison. This is why the push by Chancellor Santiago to make UW-Milwaukee a major research center, particularly in the area of biotechnology, is so crucial for the Milwaukee metro area.

In this sense, conservatives are on the right track when pointing to the public sector presence in Madison. But they're wrong to think that it's government jobs that are the explicit driving factor behind incomes in Madison. Instead, the public sector creates the fuel that drives the Madison economy -- which is exactly how it should be, and exactly how it could be in Milwaukee.

It seems likely there are other factors that are helping to drive the income disparity between Madison and Milwaukee, factors that have received less attention, thus far.

One is the growth of poverty in Milwaukee. And this is important not only for the obvious reason that it directly drives down the median income of the city, but also because it often leads other factors that hold household income down (which is what the WTA studied) such as a growth in single-earner families.

But what's also a key point to remember is that Milwaukee doesn't only have more poverty than Madison, it also quite likely has more wealth. If you drive through Madison, there is certainly a noticeable difference in terms of wealth in many of the neighborhoods. But it's nothing near the difference you'll see driving from the northeast side of Milwaukee -- around Lake Park, that is -- into the northwest side of the city.

This point leads to some important questions about where the Wisconsin Taxpayer Alliance is getting its income figures. The group's press release vacillates between Madison/Milwaukee and Dane County/Milwaukee County.

If the income disparity figures are from the actual cities of Milwaukee and Madison, much of the gap could be attributed to the fact that most of Milwaukee's wealth has moved to the burbs over the past couple of decades, while Madison has annexed land on its east and west sides to keep much of its wealth within the city limits.

All in all, the WTA report should be a wake up call to the Milwaukee metro area that changes are needed. And it seems clear, at least to the authors of the report and other outside observers, that education must be a central part of those changes.

As WTA researcher Ryan Parsons noted: "But I think what Milwaukee needs to do if it wants to regain some of that balance that was lost in the last 50 years is more of a focus on education and retaining good college graduates. One of the reasons Madison has such an edge over Milwaukee is having people who can fill high-tech science research jobs. A lot of that work force is missing from a city like Milwaukee."

Milwaukee business leader Tim Sheehy seems to agree, stating that the report "bolsters our interest in supporting UWM's ability to grow its research muscle - not in a way to compete with Madison, but in a way to build our economic prospects, our future."

These are words that need to be kept in mind come budget time.

When Oversight Becomes Antagonism

Incoming Assembly Speaker Mike Huebsch (R-West Salem) recently made his committee chair assignments for the coming session.

There are a number of concerning assignments, such as placing Mark Gundrum (R-New Berlin) -- who helped tank the ethics reform bill last session -- in charge of the Judiciary & Ethics committee (though, in fairness, you'd be hardpressed to find a GOPer in the Assembly who did support the ethics bill...at least behind closed doors).

But the appointment that's getting the most attention thus far is Steve Nass (R-Whitewater) as chair of the Colleges & Universities committee. Nass is defending his appointment by saying that being a UW critic is his job as a member of the legislature, which is supposed to provide oversight of state agencies.

He's right, of course. Oversight is necessary and important.

But what makes the appointment of Nass so concerning isn't oversight, but his antagonism toward the UW and its current leadership. This is a point that Dave Diamond noted in a couple of posts yesterday (here and here).

In an August op-ed, Nass even went so far as to essentially state that the current UW leadership -- who he will now need to work with frequently and closely -- should be fired. Other proposals by Nass go beyond mere oversight and into the micromanagement of UW policies ranging from admissions to personnel.

As Dave Diamond noted back in August about Nass' opposition to holistic admissions:

The trouble with Nass is that he believes UW officials can operate the university without being at all responsive to the outside world. To him, it's not a problem if Fortune 500 companies won't recruit at UW-Madison; preparing students for a global economy isn't worth it if it means importing that hippie "diversity" nonsense. It's OK if retention and graduation rates sag, so long as we don't abandon test scores as the almighty determinant of a person's worth.

In short, while it's certainly appropriate for the legislature and the governor to provide oversight of the UW System, taking policies out of context (such as out-of-state tuition reductions) and getting bogged down in incessant specific criticisms of the system's daily undertakings (such as the hiring of one instructor for one class) ultimately transforms oversight into antagonism, which leads to an unproductive outcome for everyone involved -- most notably the state of Wisconsin.

An Economic "Big Bang" or Graduates on Parole?

A state commission charged with upgrading the UW two-year campuses has created a plan to transform the entire system by giving free tuition for UW students who promise to stay and work in Wisconsin for 10 years after graduating.

The idea is that by keeping graduates in Wisconsin, it will help spur economic growth in the state (if you have workers, business will come). And by driving economic growth, the plan would pay for itself (and then some, hopefully) through increased income tax revenue.

Taken separately, the two parts of the idea are very appealing. After all, who wouldn't support free tuition and economic growth?

But there are a couple of tricky aspects to this plan.

For starters, will the supposedly inevitable economic growth actually pay for the plan? If you simply have workers, will businesses come, or will we be hanging many of our students out to dry by limiting their employment options after graduation?

And answering these question requires pinpointing the exact nature of the alleged "brain drain" in Wisconsin, which, in turn, leads to other questions. It seems a good number of UW grads (like myself) leave the state initially after graduation, but then eventually return to settle down. Is this plan going to merely cut out that "in between" time, and subsequently leave the state with a work force that actually looks pretty similar to the one we have?

In other words, will this plan spur enough economic growth to cover the free tuition of those who stayed because of the offer and those who would've stuck around regardless?

Another tricky aspect of the proposal -- and the one that's likely to recieve less attention than the economic side of things -- is that the college experience isn't isolated from post-graduation plans. That is, students often shape their college experiences around the experiences they think they would like to have after graduation. And, likewise, the experiences students have after graduation are driven by those they chose to have while in college.

By altering one end of that spectrum, you inevitably impact the other.

And while an argument could be made that students can always opt to leave the state after graduation and simply pay off their tuition bill retroactively (in one imposing lump sum), the fact is that dangling free tuition in front of most students is going to have an impact on the decisions they make while in college.

Is that really where we want to head with our UW policies? Should public policy be aimed at giving UW students more complicated choices, or just more choices?

Mostly questions at this point, but important ones. And, if nothing else, the plan is useful because it gets us thinking and talking about them.

UPDATE: Although this reform proposal wasn't likely to go anywhere, anyway, Dave Diamond notes how it's as good as dead now that Speaker-elect Mike Huebsch has named Rep. Steve Nass (R-Whitewater) to head the Assembly's Colleges and Universities committee.

As Dave writes: "So ignore any radical ideas about UW reform. There's going to be nothing but gridlock and press releases."

Another Independent Study Rejects Effectiveness of CDHPs

Consumer-driven health plans (CDHPs) are all the craze on the right these days, but they just can't seem to catch a break when it comes to finding an independent study that backs their effectiveness at lowering costs and expanding coverage.

The latest study comes from the Employee Benefits Research Institute (EBRI), a nonpartisan employer group, and the Commonwealth Fund, a nonpartisan research group.

Here are some of the key findings of the study:

• Participants in CDHPs were more likely than people in comprehensive plans to report delaying or skipping necessary medical care because of the cost.
  
• Participants in CDHPs continue to be less satisfied with their health plan than people in comprehensive plans.
  
• Even though federal law states that HSAs can be set up so that preventive care is excluded from the deductible, more than 1/2 of people currently in CDHPs must pay for preventive care out of their deductible (hence, reducing the likelihood that people will receive preventive care).
  
• While participants in CDHPs tend to exhibit more cost-conscious behavior in some areas, they are no more likely to do so in many areas than people in comprehensive health plans.
• Participants in CDHPs were less likely to receive cost and quality care information from their health plans than people enrolled in comprehensive plans.
  
• The uninsured are more likely to enroll in comprehensive health plans than CDHPs.
  
• Those who opt to enroll in CDHPs tend to be healthier, thereby leaving sicker people enrolled in traditional plans, which, in turn, increases the overall cost of the health care system because risk is less decentralized.

These findings come from a September 2006 survey, and they mirror very closely the findings from the same survey conducted in 2005.

An article in Rueters also noted how hospitals are not too fond of CDHPs, thus far. According to the American Hospital Association, people who are coming in for care with CDHPs are not prepared to pay their high deductibles, which is increasing the amount of unpaid medical bills. This, consequently, raises the cost of care for everyone else in the system as expenses are shifted to those who do pay.

As I said earlier in the week, I could care less how the growing health care crisis in Wisconsin and the US is addressed. If consumer-driven care was the answer, then great. But, as independent studies like this one make clear, it's not -- at least not in standalone form.

The Wisconsin Health Plan, which I wrote about in more detail yesterday and back in March, actually includes many aspects of consumer-driven health care, which is what likely gives it the most broad political appeal of all the plans currently before the state legislature (although, evidently, it's still not conservative enough for GOP leaders in the Assembly).

But what gives the WHP a chance a success, while standalone CDHPs have largely failed, is that it does something to alter the structure of the current system -- namely, by introducing a tiered format to the state's health plan set up -- rather than merely latching onto the existing structure that has proven to be inefficient (driving costs up) and unequal (driving coverage down).

And that's the biggest point that needs to be kept in mind as this health care reform debate moves forward in the coming year. Any successful reform needs to be fundamental. Tinkering just won't cut it.

GOP Speaker-Elect Misstates Wisconsin Health Plan Costs

Yesterday, Carrie Lynch picked up on a letter written by Assembly Speaker-elect Mike Huebsch (R-West Salem) to the Wisconsin Farm Bureau upon hearing the Bureau was going to consider supporting the Wisconsin Health Plan (WHP) proposal.

Carrie rightly criticizes Huebsch and other GOP legislators for ignoring the need for fundamental health care reform and instead backing only minor adjustments to the existing system.

But getting into the details of Huebsch’s letter also shows cause for dismay. In the letter, Huebsch writes:

According to the non-partisan Legislative Fiscal Bureau, the WHP can’t pay for itself. According to the Fiscal Bureau, the plan would be short $8.7 billion in the first year alone. The lack of funding can only be addressed in two ways: increasing this new and unprecedented tax on small businesses even higher or dramatically reducing payments to health care providers. Reducing payments would likely lead to physician flight and facility closings, especially from rural areas. The last thing we need as a state is for people in rural areas to have a harder time finding quality care.

Thankfully, Huebsch included a copy of the LFB report with his letter because when the Farm Bureau reads the actual report, they won’t find anything about the plan falling $8.7 billion short in its first year, as Huebsch claims in his letter.

Instead that $8.7 billion figure comes from the difference between total health care expenditures in Wisconsin in 2005 and what actuarial reports projected the total annual cost of the WHP to be in the same year.

Huebsch, amazingly, takes this to mean that the WHP would be $8.7 billion short in its (non-existent) first year of existence.

First off, as the LFB report explains – in a section Huebsch either didn’t read or just plain ignored – the WHP cost estimates do not include out-of-pocket costs paid by people enrolled in the plan (e.g., co-payments, deductibles, etc.) while those costs are included in the total expenditure numbers from 2005.

Based on what Wisconsinites currently pay in out-of-pocket costs, including these payments in the figures would drop the difference to $6.5 billion. And, the LFB report adds, “given that the WHP proposal includes relatively significant levels of cost-sharing in the form of deductibles, coinsurance, and out-of-pocket maximums, out-of-pocket payments could account for an even greater portion of the difference.”

Secondly, the LFB report also notes that estimates for the WHP were done on the cost of Tier 1 plans alone, which are the least expensive for participants. Those opting for the Tier 2 and Tier 3 plans would need to pay more out-of-pocket. As the LFB explains, "The additional payments would further account for the difference between the estimated PHCE [Personal Health Care Expenditures] in Wisconsin in 2005 and the WHP cost estimates."

Lastly, although perhaps most importantly, comparing estimated WHP costs to actual health care expenditures is risky business because it assumes total costs will not change at all under a new structure of health care.

Part of the promise of fundamental health care reform – such as what’s outlined in WHP (to an extent, anyway...more on that below) – is that it streamlines and simplifies the system in a way that increases purchasing power of payers in the system and reduces administrative costs. Hence, to assume the WHP would cost as much as the existing system is like assuming your new Prius should cost you as much in gas as your old Hummer.

And as if Huebsch hadn't already mischaracterized the LFB report enough in his letter to the Farm Bureau, he added this in the paragraph after the one quoted above: "The Fiscal Bureau memo, which I have included with this letter, also outlines a serious concern about the plan. The WHP will likely lead to thousands of employers paying more than they currently are for lesser coverage."

In all 18 pages of the LFB report, this point is never mentioned. What the LFB report does say is that some employers may need to pay above the Tier 1 assessment outlined in the estimated WHP costs "to provide a level of coverage equivalent to that currently provided." This says nothing about those increased payments in relation to what employers currently pay for coverage.

While the LFB report doesn't explicitly reject the possibility that some employers would need to pay more for the same level of coverage under the WHP, there is nothing in the report that defends this statement as fact or even a likely possibility on a small or, as Huebsch makes it seem, large scale.

As I’ve stated before on this blog, it’s my feeling that the WHP doesn’t do enough to realize the savings that could come from fundamental reform, which is why I prefer the plan proposed by Sen. Russ Decker (D-Schofield) and Rep. Terry Musser (R-Black River Falls) called the Wisconsin Health Care Partnership Plan.

By merely funneling the plethora of existing health plans into a tiered system – rather than actually reducing the number of plans – the WHP misses out on the full potential of increasing the purchasing power of payers by pooling as many as possible into a few (or just one) plan. And, actually, the discount rates assumed in the actuarial study of the WHP is a big sticking point highlighted by the LFB, and one that needs more clarification in a future actuarial study (which, apparently, is underway).

But, at the same time, it should be noted that a tiered system for health care plans has been successfully implemented for state employees in Wisconsin, resulting in savings “in excess of $14.5 million” in the first year, according to the administrator of the Division of Insurance Services at the Department of Employee Trust Funds.

Similar savings could be realized through the WHP (on a broader scale, of course). Indeed, one of the main architects behind the revamping of the state employee health plan is the director for the Wisconsin Health Project (which created the WHP), Dave Riemer.

In the end, any way you slice the numbers on WHP, the reality comes nothing close to the grim view presented in Huebsch’s letter to the Farm Bureau. Considering Huebsch is poised to become the top Republican in the legislature, this doesn’t spell good news for those of us looking for, if nothing else, an honest health care reform debate next session.

UPDATE: DHFS Secretary John Leenan already responded directly to Huebsch, and makes points very similar to the ones I do. You can read Leenan's letter here.

Subsidizing Low Wages in Wisconsin

You'll often hear complaints about poor people using social service programs for their livelihoods, which usually alludes to images of welfare kings and queens sitting at home doing nothing but collecting a state check.

But the reality of the situation -- as is the case with most stereotypes -- couldn't be further from the perception.

A recent report by the Center on Wisconsin Strategy (COWS) shows that on average between 2001 and 2004, there were 178,133 working families who received annual aide from at least one of the largest five social service programs in Wisconsin -- health care, food stamps, earned income tax credits, Wisconsin Works, and subsidized child care.

Out of these working families, nearly 80 percent (140,423) had at least one member working full-time for at least 50 weeks out of the year. And 12 percent of those families (16,571) had more than one full-time wage earner.

In total, the 178,133 working families ran up an annual tab of over $837 million on those five state programs on average between 2001 and 2004. The families with full time wage earners accounted for more than $580 million of that total.

The program that accounts for the largest share of the tab is BadgerCare, which provides health care to low income families in Wisconsin. The total average annual cost for BadgerCare between 2001 and 2004 was just over $805 million. Out of that total, working families accounted for over 1/3 of the cost ($315 million).

As the COWS report explains: "Clearly, year-round work is not sufficient to secure employer-provided health insurance and BadgerCare is becoming not only a safety net for the unemployed, but a key support for some year-round working families as well."

And the key word in that is "becoming," since it wasn't always the case in Wisconsin.

According to the COWS report, there has been a significant drop in employer provided health insurance coverage in Wisconsin, just as there has been throughout the nation. While close to 65 percent of private employers in the state provided health insurance to employees between 1985 and the late 1990s, the number began to drop sharply to 57 percent by 2004.

Not surprisingly, this drop in private employer health insurance has coincided with an increase in the number of working families who rely on publicly funded health insurance programs like BadgerCare.

Here's what the COWS report has to say about why:

What is going on? In part, businesses are finding ways to compete in key sectors and provide jobs without the benefits that firms have traditionally offered. These players, carrying lower labor costs, can undercut prices of the other firms. Those providing insurance then have less incentive to do so, and may even need to shed insurance to stay competitive.

Some might say that this is simply the market at work: low costs are winning out. But the firms are not generating these cost savings through efficiency. Rather, they are generating the savings by externalizing the cost of health insurance; by not offering the benefit, they have found a way to pass the cost of health care back to the community. And the community, in fact, picks up this cost -- through our Medicaid budget, through community and public health systems, in food pantries and shelters.

This tells a good portion of the why question, but it actually doesn't get at it all. After all, health care costs are straining employers -- public and private -- who aren't a part of the same type of low cost drive as industries such as retail (which is the second-largest employer of working families on social service programs in Wisconsin, according to the COWS report).

But what the COWS report nails is the point that in addition to fundamental health care reform that lowers costs across the board, an eye also needs to be placed on addressing the low wages that have been a staple of supposedly growing economy.

Indeed, total income in the United States has continued to grow over the past thirty years – 27 percent, in fact, since 1979. But, according to a recent analysis by University of California – Santa Cruz professor G. William Domhoff, the top 1 percent has seen its share of total income increase by over 7 percent since 1982, while the next 19 percent remained fairly steady, and the bottom 80 percent watched its share drop by nearly 7 percent.

Citing a November 2006 study by the New York Times, Dumhoff writes: “Although overall income has grown by 27% since 1979, 33% of the gains went to the top 1%. Meanwhile, the bottom 60% were making less: about 95 cents for each dollar they made in 1979. The next 20% - those between the 60th and 80th rungs of the income ladder -- made $1.02 for each dollar they earned in 1979.”

An even starker telling of the story comes from Dumhoff’s examination of average CEO pay in relation to average manufacturer worker pay over the past 45 years. While the ratio between the two remained fairly steady from 1960 to 1980 at about 50:1, it’s jumped to 411:1 in the last 25 years.

So, it seems clear that the wealth exists in this nation to provide working families living wages that include necessities like affordable access to health care. It’s about time a reasonable distribution of that wealth becomes a matter of not just economics, but also patriotism.

UPDATE: Also recommended is a new COWS report on TIFs. You can read more on that report in One Wisconsin Now's Forward Report from today.

Conservative Bloggers Taken for a Ride

So it turns out it was a Republican legislative aide who stole Senator Mark Miller's (D-Monona) binder and made copies of the Dem election plan that was inside.

These were the copies that were supposedly found by a GOP aide on the copier -- but now the GOP aide admits to making the copies himself.

Here are a couple key quotes from the Journal Sentinel article on the discovery back in October:

Keith Gilkes, executive director of the Committee to Elect a Republican Senate, said Wednesday that an aide to a Republican senator found copies of the political plans in the copier early this summer after duplicates had been made.

...

Gilkes said the aide took copies that already had been made and handed them over to Gilkes in early June - five months before a key election in which Democrats hope to gain three seats to take over the Republican-controlled Senate.

And now that the truth has come out, here's the new line from Gilkes: "Gilkes said Monday that he did not intend to mislead anyone. He said when he talked to O'Brien this summer it seemed clear the copies already had been made."

I mean, really, who clarifies their facts before going to the press these days?

(Side-Note: The fact that the GOP declined to pursue the case that the Dems used state resources for campaign purposes -- which some high ranking Republicans were recently convicted for doing -- suggests that Gilkes and others knew at the time those documents weren't found on a state capitol copier.)

The GOP also tried to claim these documents showed illegal activity beyond simply using state resources for campaign purposes. But it didn't take Elections Board lawyer George Dunst more than a glance to determine that the activities outlined in the document were legal. And it only took the Elections Board as a whole another week to issue the same opinion.

What's most astonishing to me, though, is the way the GOP not only fed the mainstream press a line about this incident, but also fed the same bogus line to its own bloggers.

Indeed, it was the blogosphere, specifically "Boots and Sabers," that first broke the story that the GOP had the documents.

It appears based on Owen's writing that he was being fed the documents and background on them in installments.

At first he writes: "IF this was actually left on a copier in the state capitol, as it was reported to me, then one must ask why the State Senate Dems are using taxpayer equipment for what is clearly campaign related material. If true, that would be a campaign violation for which some have gone to jail."

But in the second update, he clarifies the guilt: "I have a little bit of information on WHY it was left on a copier in the capital. Allegedly, the Dems are running a caucus out of the building again, but they aren’t calling it that. If you go to the south end of the ground floor by Cathy Stepp’s office, there is a door marked 'private.' Behind that door, there are two paid Dem media staffers (I believe on Robson’s payroll) whose job it is to work on media for the Dems. They’ve been there for about a year. Are there any reporters in Madison willing to knock on that door?"

And then in the eighth update, Owen laughs off the possibility that he was being fed a line by the GOP: "Apparently, the Dems are blaming the Republicans. Uh huh. BTW, Miller was the suspect that I mentioned in UPDATE3. I guess it was right since he is now trying to cover his arse."

But, to be honest, I can't blame Owen and others on the right side of the Cheddarsphere for buying into the lines they were being fed on this. After all, if I was sent something from a Dem legislator or legislative aide, I'd be apt to believe it.

My real interest is in why the GOP felt they could mislead their bloggers on this and how the right side of the Cheddarsphere will react (if at all) to being steered in the wrong direction.

Seems to me it's a case of the GOP suckering the bloggers into doing their dirty work. It's one thing when people know they're doing dirty work and still choose to do it. It's a completely other thing when they're tricked into doing it.

How will the right side of the Cheddarsphere respond?

UPDATE: You can read Owen's reaction to the news here, and the reaction from Peter -- who was also suckered by the line back in October -- here. And on the left, here's Jay's thoughts, here's Dave Diamond's thoughts, and here's Carrie Lynch's thoughts.

Solution-Based Health Care Reform

An article in the Journal Sentinel this morning discusses how health care costs are quickly becoming the top problem faced by farmers in the state, which is prompting the Wisconsin Farm Bureau Federation to place health care reform at the top of its legislative agenda this coming year.

This is good news because the more pressure that's put on the legislature to act, the more likely something will get passed this upcoming session. At the very least, the more interest health care reform is receiving at the state capitol, the more it's likely receiving in the state news.

And when people in the state begin to see what's possible with health care reform -- i.e., lower costs and broader access -- they are likely to join the chorus of reformers at the capitol.

But the key ingredient in this is to have voices that are solution-based rather than ideologically-driven.

To explain, I have had a good number of commenters on this blog who have opposed universal health care calls solely because they perceive them to be antithetical to the free market. In their view, universal health care involves government regulation of the health care industry, which never can be good. It's always best, they claim, to let the market do its thing.

My stock response to this is that the health care market is not the same as the market for traditional goods and services. While most people pay a retailer directly for their TV, for instance, most people do not pay their health care provider directly for the care they receive. Instead, the money is channeled through insurance companies, which, in turn, negotiate prices in advance with health care providers.

Due to this principle of negotiation, it's most advantageous for the consumer in the health care market to be a part of as large of a pool as possible to amass the greatest amount of purchasing power. Pooling payers also lowers administrative costs by simplifying the payment system in the market.

In addition, it's also advantageous in the health care market to reduce the number of uninsured because all of the unpaid medical bills aren't simply swallowed by the providers, but instead shifted into the cost of care for those who do have insurance.

So pooling everyone in the state into as few plans as possible has the effect of leveling and reducing system costs while simultaneously providing every citizen with access to affordable health care. But, to the free marketer, it's still tantamount to "socialism" because it doesn't leave the supposed invisible hand untouched.

And that's what's most concerning about the comments I receive -- they're not solution-based, but ideologically-driven.

I, for one, could essentially care less about the ideological manner in which the health care crisis is solved. The concern for me lies with the uninsured and the growing strain rising health care costs are placing on families, businesses, and public finance. If this concern can be alleviated with free market-friendly reforms that tinker around the edges of the existing system -- like so-called consumer driven health care -- then I'd be all for it.

But, the fact is, the evidence just doesn't suggest that tinkering with the existing system is enough. The evidence, on the contrary, points toward the need for fundamental reform.

Thankfully it appears the Farm Bureau is open to investigating all options for reform. Let's hope the investigation is solution-based, not ideologically-driven.

UPDATE: The Recess Supervisor has another great post up, this time on the sick leave issue. At the end, an excellent point is made about health care reform:

However, one cannot address this topic without noting that many of the screamers on this issue have their priorities backwards. A lot of this hue and cry over sick leave conversion is coming from people who likely are just bitter or angry that their own employer doesn't take care of them as well as the state would.

So instead of engaging in a dialogue about how their employers can do better to provide adequate and affordable health care, they simply rag endlessly on people who actually do have good health plans. Instead of fixing the problem, they're content to try and make everyone suffer.

Our time would be spent more constructively by finding ways to help everyone have great health insurance rather than figuring out ways to take it from those who do.

Well put, and right on target.