Health Care Reform, Slowly but Surely

In one of the more eye-rolling legislative press releases I've seen in awhile, Senate Minority Leader Scott Fitzgerald (R-Juneau) swiped at Senate Democrats for not already proposing comprehensive health care reform in the current legislative session.

“The State Senate has now been in session for four days in regular session," Fitzgerald explained.

That's right. Four whole days.

Senate Majority Leader Judy Robson properly shot back her own press release that easily dismissed the minority leader's rhetoric. As Robson explained, the Dems are choosing to take their time getting feedback from the public before moving forward on any single plan.

And if the state GOP's experience with TABOR is any indication, proceeding slowly but surely is a wise move. Rather than creating a three ring circus situation like the one that existed last spring -- where conservative Republicans fell over each other proposing new amendments that would appeal to moderate Republicans only to alienate other conservative Republicans in the process -- any significant reform measure needs to make sure the horse is before the cart from the beginning.

On Monday, for instance, the Marshfield News Herald did a story on a forum held by the Stevens Point League of Women Voters that featured speakers on each of the three health care reform proposals made during previous legislative sessions (the proposals that Fitzgerald and Republicans, then in control of the entire legislature, opted to do nothing about).

As David Riemer -- spokesperson for the Wisconsin Health Plan (WHP) -- pointed out at the event, none of the plans is likely to move through the legislature in its current form. Ultimately, a hybrid proposal is most likely to be put forward.

In light of a recent UPI/Zogby poll on health care reform, this is probably the best route to go. While 9 out of 10 Americans want health care reform, the disagreement is in the details. But the poll did show that a majority believed any reform measure needs to be a combination of public and private solutions.

If the Wisconsin public feels the same as the rest of the country, it suggests that Riemer's WHP is best positioned out of the three existing proposals to appeal to the broadest range of citizens. While the WHP is a combination of public and private solutions through its continuation of private insurance and use of HSAs within a publicly accountable centralized structure, the Wisconsin Health Care Partnership Plan leans more heavily on government regulation and the Wisconsin Health Security Act does so exclusively.

Whichever plan is ultimately pursued by legislative Democrats in the state, it's clear proceeding cautiously is smart. The sheer scope of any significant reform measure is complicated by the fact this is a budget year, and the mix becomes outright volatile when considering all of the ways to spin and attack any proposal that fundamentally alters the way an expensive and complex system is funded.

There's inevitably going to be winners and losers with an undertaking as large as fundamental health care reform. And rather than simply consider whether more winners will exist in the proposed system or whether the extent of losing in the new system is less than the losing that's already taking place in the existing system, the debate can quickly focus on the fact that there will be losers at all.

Therein lies the catch-22 of actually passing fundamental health care reform: There can't be any losing in a reform measure that can't help but create winners and losers. Changing the terms of how reform measures are evaluated is the monumental task, and it's one that takes securing the broadest level of public awareness and support possible before even stepping into the ring.

Those Damn Kids

Just wanted to quick touch on the Wisconsin State Journal article on a new study that claims college students are more egotistical and self-centered today than previous generations. I'm sure the study is based on some fine academic work in the field of psychology, but I can't help but wonder how much of it is typical older people complaints about younger people.

It reminds me a bit of an article Walter Lippmann wrote in the mid-1930s about how the generation that was coming-of-age at the time wasn't worth a damn. Interesting how that assessment turned out.

This isn't to say that younger people are above collective scrutiny. But, rather, it seems to me they often aren't all that different than the rest of society, even if they may express themselves in different ways than older people.

To be sure, individualism has always been a strong facet of American society, although it has manifested itself in different ways throughout US history. And, in the last few decades, individualism has moved from a primarily intrinsic embodiment to an aspect that defines social interactions, as well, making egotistical and self-centered attitudes into logical corollaries.

As historian Christopher Lasch put it at the dawn of the 1980s, ours is a culture of narcissism.

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On another note, I want to put in a plug for the Frontline episode that's set to air tonight at 8:00pm. It's part three in a four-part series on the media. I caught bits and pieces of the previous two episodes on journalists and the First Amendment, and it was very good stuff.

But tonight's episode is that one that will be of most interest to bloggers. Part III, entitled "What's Happening to the News," investigates the growing pressures on traditional broadcast and newspaper media by cable television and the Internet. Should be more good stuff.

UPDATE: In case you missed it, or want to watch it again, you can view Part III of the Frontline series on media here. Especially interesting is the section where LA Times parent company execs explain why the paper's 20 percent profit margin just isn't enough for Wall Street (see clips 21 & 22 for that story).

What Really Worries Wisconsin Businesses

Edward Zore -- the CEO of Milwaukee's largest private employer, Northwestern Mutual Life -- recently took the stage in front of other business leaders and told them that if his company was looking for a place to relocate from another city, Milwaukee would not be high on the list.

Once those lines were uttered, much of the audience was surely thinking: Taxes.

But, as the Journal Sentinel explains, "Unexpectedly for many, Zore repeatedly downplayed Wisconsin's tax burden as one of the impediments." "Taxes for us," Zore told the group, "are not bad."

So what are the impediments? While Zore didn't get into too many details, the relative low number of Milwaukee area residents with college degrees was a point he did stress.

Adding to the answer is a recent survey of 68 biomedical firms in the seven-county Milwaukee area. Top issues on the list were skilled and educated workers, access to university research, health care costs, and access to investment capital. Conspicuously absent from the list is taxes.

This news actually fits well with a similar survey completed by the state's corporate lobby group, Wisconsin Manufacturers and Commerce, last spring. This survey was given to 600 manufacturing CEOs in the state, and when asked about "the top business concern facing your company," the executives responded with the following order:

1. Health care costs (35 percent)
2. Competition (16 percent)
3. Labor shortage (12 percent)
4. Energy (10 percent)
5. Regulation (9 percent)
6. Economic slowdown (9 percent)
7. Taxes (6 percent)
8. Other (2 percent)
9. Lawsuit abuse (1 percent)

While there is little doubt that there are some businesses in the state that would place taxes high on the list of concerns, it's clear from these surveys and comments by executives like Edward Zore that taxes are low on the list of concerns for many.

Surveys of the general Wisconsin public often show taxes higher on the list of concerns, but, depending on who's doing the asking, it's not necessarily the highest. According to the right-wing Wisconsin Policy Research Institute, taxes are at the top of the list with 26 percent followed by health care with 16 percent and education with 14 percent. On the other hand, according to the left-wing One Wisconsin Now, health care tops the list at 45 percent, taxes and the economy/jobs are tied for second at 34 percent, and education is third with 31 percent.

What makes all of this important to note is that, if you listen to the state GOP rhetoric, you'd think there was no more pressing or important issue for any business, individual, or family in the state than taxes -- by a long shot. This rhetoric, in turn, drives public policy attention toward that issue and, subsequently, away from others like education and health care that are actually of more concern to most state businesses and at least as much concern to the rest of the public.

To be sure, during the last legislative session over 14,000 hours were spent lobbying on the so-called Taxpayer Protection Amendment. That's over 6,000 hours more than the second heaviest lobbied bill of the session and 9,000 more than the third.

And one night toward the end of the session, our state Assembly spent the entire night -- literally -- trying to find a version of the amendment that was suitable enough for moderate Republicans to support, only to have that version and the original soundly rejected in the GOP-controlled state Senate.

Around the same time as the TP amendment all-nighter, state Sen. Russ Decker (D-Schofield) and Rep. Terry Musser (R-Black River Falls) announced a comprehensive health care reform package designed specifically with employers and employees in mind.

But while the fledgling TP amendment continued to grab front page headlines and take up time at the Legislative Fiscal Bureau -- which was even able to dedicate an entire section on its website to all of the analyses it did of the amendment -- the Decker/Musser bill touched off articles in only two newspapers in the state, the Capital Times and the Wausau Daily Herald.

None of this is to say that public revenue, in any form, shouldn't garner policy or press attention, but rather the amount of attention it has generated in the past is not on par with the level of concern that exists in the state, at least in relation to other issues that are at least as important.

And much of the attention is being driven by incessant GOP rhetoric that should be, ideally, toned down or, if necessary, neutralized by an equally incessant level of Dem noise on the issues that actually top the list of business concerns and those that share the top of public concerns.

John McCain Might As Well Be Gay?

In terms of his presidential prospects, that is.

To explain, I, like many liberals, wouldn't have any trouble whatsoever voting for an openly gay presidential candidate, but it goes without saying that a good portion of the US population would.

In fact, a recent USA Today/Gallup poll asked Americans what personal attributes would prevent them from voting for a well-qualified candidate from their respective political party.

According to the poll, 43 percent of respondents would not vote for someone for president solely because he or she is gay. The only personal attribute out of those examined by the poll that turned off more people was atheism, which brought out the ire of 53 percent of respondents.

But just a hair above sexual orientation on the list was being 72 years old, which 42 percent of respondents said would cause them not to vote for their party's chosen candidate.

When the general election rolls around in 2008, John McCain will have just turned 72.

Here's a chart of the results for the entire question:

This, of course, is just one poll, and it doesn't mean that McCain couldn't be elected president or that he would face the same level of public scrutiny over his age that openly gay presidential candidates would over their sexual orientation. After all, Ronald Reagan was elected to his first term just a few months under 70 and he ended his two terms as president just shy of 78.

I imagine if the age question was personalized for people by explaining to them, for instance, that Reagan was almost 70 when first elected, the number opposed to a 72 year old presidential candidate would drop. Unfortunately, I don't think any amount of contextualization would make the number drop all that significantly on the gay question.

Still, though, the results are still an interesting, if incomplete, picture of the personal attributes that Americans seem to think a president should have.

Side-Note: It's amazing to me that 5 percent of respondents still think one of those attributes should be white skin, while 11 percent think another should be a penis...as long as it's used only as the God you better believe in intended...though not with three different women whom you pledge before that God to have and to hold 'till death do you part...okay, I'll stop now.

Figuring the Real Cost of the Sick Leave Policy

Before some people get themselves into a tizzy over news that the sick leave policy for elected state officials isn't going anywhere, at least for awhile, can the LAB or the LFB do an audit to find out the actual amount of sick leave time that's converted to pay for retiree health care premiums?

While tabulating the total number of hours that people accumulate is great for an eye-catching story that helps sell papers or a press statement aimed at generating political support, it isn't really all that informative for the policy debate.

As the Recess Supervisor noted back in November: "Just because Chief Justice Shirley Abrahamson has banked half a million in sick leave doesn't mean she's going to come anywhere close to spending all of it. She'd probably have to live another three epochs to do that."

Once we see what the actual cost of the sick leave compensation is to the state, it'll be easier to weigh the possible options for reform.

Perhaps better sick time reporting is all that's needed, as Governor Doyle is proposing. Perhaps sick time should be converted into a dollar amount after each year, rather than at the end of a person's career when the conversion rate is highest, as Bruce Murphy has proposed. Perhaps it's best to do away will the policy altogether, after all.

But we won't really know what needs to be done until we really know the actual cost.

State GOP Gets Budget Message Across

By the time Governor Doyle formally announced his budget proposal, the state GOP was ready.

Press reports dating back a couple of weeks prior to the address alerted conservatives to the places in the budget where Doyle was going to increase revenues; so, come last Tuesday, some selective calculations by Republican legislative leaders had already pegged the total amount of new taxes -- broadly defined to include fees and assessments -- at $1.75 billion over the biennium even before Doyle gave his address.

This imposing sum, along with rhetoric that the increases would hit "every man, woman, and child" in the state was quickly gobbled up by the press that's always eager for an eye-catching story.

The AP grabbed onto the GOP narrative early in the week with an article that opened:

Buying a gun, getting a shirt cleaned, downloading a song off the Internet, driving a car and smoking a cigarette would all cost more under Gov. Jim Doyle's budget. So would getting a license to hunt elk, obtaining a copy of your birth, marriage or divorce certificate, applying to the University of Wisconsin and selling a home. And then there are two other tax increases on hospitals and oil companies that Doyle said won't get passed on to consumers, but critics said they probably will.

This AP piece was picked up by a variety of local news outlets around the state and region, including WISC-TV in Madison, the Janesville Gazette, the Manitowoc Herald Times Reporter, and the Winona Daily News. Even the Dallas, Texas-based National Center for Policy Analysis, a prominent right-wing think tank, ran the AP story in its "Daily Policy Digest."

And while the Journal Sentinel touched on the $1.75 billion figure in its coverage the day after the governor's budget address, the state's biggest daily waited until the widely-read Sunday paper to fully transcribe the narrative that the sum would hit every man, woman, and child in the state in an article titled "Budget Has Many Ways to Pay More."

Tucked away at the end of the JS article, after the jump from the Metro section front page, was the section on tax cuts proposed in the governor's budget.

Completely absent from the JS coverage, however, and just cited at the end of the AP piece was the fact that, due to those new tax deductions, the total size of the governor's budget is not at all out of step with previous state budget proposals, even those under past Republican governors who were praised at the time for their fiscal restraint.

But that -- along with proposals to increase health care coverage to 98 percent, financial aid amounts for college students, assistance to local governments, funds for the state crime lab, money for the state Stewardship Fund, etc. -- was largely trumped by the GOP-crafted narrative that the budget increases certain taxes, fees, and assessments by $1.75 billion for every Wisconsinite.

It seems this effort has put legislative Republicans -- who still control the state Assembly -- in a decent position as budget negotiations kick off this spring.

But the easy part where the GOP gets to talk only about what revenue it doesn't want to raise will eventually come to an end. Soon it'll need to start talking about what programs it wants to cut.

Assessing the Proposed Hospital Assessment

Reading through some of the press coverage of Doyle's budget proposal from around the state, it's pretty clear that the governor is in for a battle over the hospital assessment.

Opposition in the La Crosse Tribune. Opposition in the Manitowoc Herald Times Reporter. Opposition in the Wausau Daily Herald.

Granted, all of the opposition is coming from hospital executives who would be the ones accounting for the assessment. But, the thing is, hospital execs seem to have a bit of an edge over other business execs when it comes to public perception since their facilities provide such an obvious benefit to the public good.

When Exxon Mobil execs complain about a tax, for instance, it isn't going to be looked upon with nearly as much public sympathy as when complaints come from the place that helped grandma get better after her fall or little Timmy after he stuck a pencil in his ear.

And when you add to that recent reports that the Wisconsin Hospital Association was third in lobbyist spending during the last legislative session -- just a hair behind WEAC -- the hill that the governor needs to climb looks even steeper. Indeed, I imagine $1.5 million goes a long way in a single legislative session at the State Capitol.

But at least one health care provider organization in the state is backing the hospital assessment. According to the president of the Wisconsin Federation of Nurses and Health Professionals (WFNHP), "Non-profit hospitals enjoy a special tax status which means they pay no taxes. Governor Doyle’s proposal to require hospitals to pay a small fee based on the number of beds is one way the hospitals can give back to the community."

Makes you wonder about the differences in priorities between those providing the facilities for health care and some of those actually providing the health care. Yet, it may not be too surprising, since it's arguable that the WFNHP simply isn't made up of the people who would be cutting the assessment check, so it follows that the group wouldn't be as concerned about it.

On the other hand, it shouldn't be assumed that the WFNHP doesn't have an interest in the financial viability of the facilities where its 3000 statewide members work. And, the fact remains, most health systems and independent hospitals in the state would be getting more money back, at least in the short run, than they would be putting into the assessment pot due to matching federal dollars.

That's where my concern still lies, however. Tying your hopes to federal dollars is a risky business. Just look at the Wisconsin Shares program. When the feds catch wind that the state has set up a system designed explicitly to generate federal money, a few simple regulation changes could throw a major wrench into the works, which appears to be what happened in Connecticut.

That's why it would be comforting to see some assurances that this proposed set-up is a short term plan, not a system for the long haul -- one biennium, maybe two.

And it would probably also help the plan's chance of passing to establish some sort of mechanism for ensuring that no health systems or individual hospitals loose money on the deal. In other words, everyone would either get more back than they put in or at least break even on their assessment charges. According to this chart of how systems and independent hospitals would fair under the proposed assessment, it would take about $18 million over the biennium to get everyone out of the red.

But I still wonder if it's worth all of the trouble to fight for and establish a system that may only be stable for a few years. And, on the whole, the plan still amounts to just tinkering with our existing broken system.

As I noted last week, if we're tinkering with anything, it should be the fundamental health care reform proposals that currently sit before the legislature, not our fundamentally flawed health care system.

Budget Talk is Cheap

It's very typical for members of the opposite party to attack the governor's budget proposal. It's a large document that can be picked apart from a number of angles using a variety of calculations that suit the attacker.

For instance, while the GOP was glad to quickly estimate the total amount of new taxes and fees that Governor Doyle's budget includes, they are not so quick to consider how the new tax breaks for health care, child care, etc., will offset those increases.

Nevertheless, in spite of how commonplace this is, it's still worth pointing out that it's ridiculous at best and counterproductive at worst.

Taking a trip down memory lane, it's interesting to look at how Governor Doyle's budget proposal, on the whole, compares to the last Republican governor's budget proposal, which would be Scott McCallum in 2001.

That year, McCallum released his budget proposal to the legislature on February 20. The next day, Steve Walters of the Journal Sentinel opened his article titled "Governor Seeks to Curb Spending" with the following:

Republican Gov. Scott McCallum on Tuesday handed lawmakers the smallest budget increase in 30 years -- balanced with $350 million from the one-time sale of future tobacco industry payments -- and asked that future spending be tied to increases in personal income.

Walters followed up by noting that the "smallest budget increase" line was in reference to a 3 percent increase in GPR spending in FY 2001 and a 2.9 percent increase in FY 2002. And, later in the article, then-Assembly Speaker Scott Jensen (R-Brookfield) praised McCallum for "hold[ing] the line on spending and taxes."

Fast-forward to earlier this week, the day after Doyle released his budget proposal to the legislature, Steve Walters, Stacy Forster, and Patrick Marley of the JS wrote in their article titled "Doyle Seeks Tax, Fee Boosts":

The governor proposed $57.7 billion in total spending, including state and federal funds, over the next two years - a 9% increase over the current budget.

And the current Assembly Speaker Mike Huebsch (R-West Salem) added that Doyle "outlined a number of priorities to a lot of different groups tonight, but the one priority he seemed to forget was the taxpayers."

Seems like two completely different budget proposals, right? Well, not so much.

While McCallum's budget proposal did only include a 5.9 percent increase in GPR spending, as Walters noted in his article, the total budget increase -- which was the figure Walters, Forster, and Marley noted in their recent article on Doyle's budget -- was 9.6 percent. That's 0.6 percent more than the increase in Doyle's current budget proposal.

And while Doyle's budget proposal does include a total revenue increase of 9 percent, when only considering the increase in GPR spending -- which was the figure Walters noted in his 2001 article on McCallum's budget -- the increase is only 3.5 percent. That's quite a bit less than the 5.9 percent increase that McCallum proposed in 2001.

Thus, it's fairly clear that Doyle's budget proposal, on the whole, isn't out of step with previous state budget proposals, even the one that came under the last Republican governor who was openly praised for his proposal's fiscal restraint.

So can we move past the attempts to score cheap political points on the budget proposal and get on with using it to craft the actual budget that will get adopted this summer?

Reading the Governor's Budget Proposal

In addition to taking a few minutes to read the press coverage of the governor's budget proposal, consider also taking a few days to read (or at least skim) the actual budget proposal.

That link is to the "Budget in Brief," which is a not-so-brief 114 pages. It's long, but it's also worth the extra time.

It's important to remember this is a Doyle administration document. Nevertheless, it provides a very complete picture of the budget proposal, certainly more complete than any news story or press release, and -- importantly -- it includes the context surrounding the governor's proposals and priorities.

It shouldn't be necessarily the last place you look for information on the budget proposal, nor should it necessarily be the first, but it should be one of the places.

More budget documents are here. And if you just want the numbers, those are here.

Battle Set for Domestic Partner Benefits

When Governor Doyle formally proposes offering domestic partner benefits for state and UW employees in his address tonight, it's going to set into motion one of many budget battles with Republicans in the legislature this spring.

It's unclear whether the constitutional marriage and civil unions ban passed last November will play a role in the outcome of the debate, but what is clear is that the hype around the ban certainly raised the public's awareness of domestic partner benefits as a significant issue.

Republicans in the Assembly are fighting the benefits by claiming the state shouldn't be responsible for picking up the medical costs "for the boyfriends and girlfriends of state employees," as the spokesperson for Assembly Speaker Mike Huebsch (R-West Salem) put it. The implication of that statement being that if domestic partner benefits are allowed, the state will be forced into subsidizing frivolous relationships.

Of course, qualifying for domestic partner benefits would not be as simple as dating a state employee. Just as an example, here are the qualifications for domestic partner benefits in the state of Oregon. Both partners must be at least 18 years old, they must have lived together for at least 6 months, they cannot be blood relatives, they cannot have been married or receiving other domestic partner benefits in the last 6 months, and they must be able to provide multiple documents proving they have joint financial responsibility for basic living expenses.

But if Republicans in the legislature are still concerned that some will be able to game the system, perhaps the most appropriate step would be to dismantle the existing health insurance structure that ties benefits to employment.

After all, considering committed same sex couples cannot opt for a civil union or marriage in Wisconsin, it only seems reasonably fair to afford them some avenue to participate in the same health insurance system that heterosexual couples can access through marriage. If there's no way to make that happen without abuse, then that system needs to go.

It is quite a clever tactic, though, whether or not it was actually intended as one. Eliminating the manners in which same sex couples can demonstrate they are committed -- i.e., civil unions and marriage -- and then claiming those couples also can't share state employment benefits because we'll never know if they're truly committed or just gaming the system.

UPDATE: Fair Wisconsin just released an updated list of employers in the state, public and private, that currently offer domestic partner benefits.

Want to Get Informed?

It's Christmas time for those who wish to be well-informed heading into the upcoming state biennial budget process and beyond.

The nonpartisan Legislative Fiscal Bureau recently released its 2007 informational papers, which cover topics ranging from taxes to charter schools to health care programs to the State Trunk Highway Program.

These papers come out every two years as the budget process kicks into gear, and they're an absolute wealth of information on the fiscal side of the state government, which, of course, drives all of the other sides.

Each paper also includes important background info on the topic being discussed. So if you don't have a clue about a state program, these papers are also a great place to look.

Two Not-So-Good Ideas for Medicaid Reform

Not much time this morning, so this will be a bit brief (at least for how complicated the topic is)...

Governor Doyle's hospital tax proposal doesn't appear to be a good one. The logic is that by increasing revenue for state Medicaid spending -- which goes to hospitals and other providers for Medicaid patients -- the state will be able to leverage more funds from the feds, who give the state 57 cents for every 43 cents it spends in state Medicaid dollars.

If the plan could work like this in reality and over the long haul, hospitals -- at least those that care for a decent number of Medicaid patients -- would get a benefit because the money coming from the feds could more than make up for the amount they were taxed in the first place, hence, helping to close what's been called "the hidden health care tax" driven by low Medicaid reimbursement rates.

But, unfortunately, playing with federal dollars is like playing with fire. Wisconsin should know what that's like from its funding choices for the Wisconsin Shares program in the late 1990s.

The fact is federal dollars aren't stable. Levels can change (or, in the case of Wisconsin Shares, never change), as can requirements regarding how the money can be spent. This year alone, in fact, Bush is proposing a $25 billion cut in Medicaid funding, which comes along with regulatory changes that would cost hospitals in some states tens of millions.

This is not a game Wisconsin wants to play, especially when considering the long term prospects.

But, turning the other direction, the plans on the right aren't any better. The state Senate Republicans released a legislative agenda yesterday that promises to take the burden of low reimbursement rates for Medicaid off hospitals. Sounds fair enough until you read a little further and see they want to shift this burden onto Medicaid patients.

The main mechanism for this shift are what's called Health Opportunity Accounts (HOAs). I covered HOAs more in-depth in a post last fall, so I'll avoid going into the details now.

Essentially, HOAs are HSAs for Medicaid recipients. The federal government is running a HOA pilot program that was passed by the GOP-controlled Congress in December 2005. Ten states will be allowed to participate in the pilot, and it appears Republicans in the state Senate want Wisconsin to be one of them (as Mark Green proposed in his gubernatorial candidacy).

The trouble with HOAs is two-fold. Again, you can see my previous post on the topic for the details, but, briefly, here are those two problems:

1. Deductibles are allowed to surpass the funding of the HOA by 10 percent, leaving Medicaid recipients to foot that portion of the bill on their own, and research shows that out-of-pocket costs are the difference between getting health care and going without it for lower income families. And going without it can quickly make relatively inexpensive preventative care turn into expensive emergency care.
   
2. But since HOAs are voluntary, the GOP argues that the lowest income and least healthy Medicaid recipients don't need to opt for them. This leads to the second problem, which is that, as written in federal law, once recipients become ineligible for Medicaid, rather than forfeit the entire amount left in their publicly-funded HOA, federal law allows them to keep 75 percent of it for a variety of purposes specified by the state. As a result, the nonpartisan Congressional Budget Office has estimated the HOA pilot project will add $261 million over the next decade to the total federal Medicaid bill (see here, page 36), and costs will continue to increase if more states decide to provide HOAs after the pilot period. Considering Bush wants to cut federal Medicaid funding in the upcoming budget, this is an especially troubling prospect.

In the end, the best route for providing universal health care and fixing the low Medicaid reimbursement rates is fundamental health care reform, such as the Wisconsin Health Plan and the Wisconsin Health Care Partnership Plan.

Perhaps neither of these proposals, in their current form, are exactly what the state should adopt, but they are excellent starting points. And if we're tinkering with anything, it should be those fundamental health care reform proposals, not our fundamentally flawed health care system.

The Myth of 4-K as Subsidized Daycare

Earlier this week, a new umbrella organization focusing on early childhood education issues -- called the Wisconsin Early Learning Coalition -- released a press statement announcing some of the group's goals for the upcoming legislative session, which includes expanding access to 4-year old kindergarten in the state.

In response, righty blogger Brian Fraley dismissed the release as a "push for subsidized day care." And Fraley isn't alone in this view of 4-K. In fact, to argue it's just a way for parents to get their child care at taxpayer expense has been a main conservative critique of 4-K.

Two years ago, for instance, when the state was last in the midst of budget talks, members of a GOP-led budget committee looked into suspending state funding for 4-K. One of those backing the option, Rep. Dean Kaufert (R-Neenah), explained: "I just worry about it being subsidized day care for certain children."

To be sure, this line has strong rhetorical value because it plays into the perceptions of people without children and, perhaps to a lesser extent, stay-at-home parents who are led to believe there's a selfish motivation for 4-K that really isn't about benefiting children, communities, or the state as much of the research on the topic makes out.

Hence, the opponents of 4-K aren't just saying that 4-K isn't necessary for some kids, they're also implicitly (or, in some cases, explicitly) making the argument that the only reason 4-K exists for those kids who, they argue, don't need it developmentally is because their parents want it financially.

But this critique of 4-K, to put it bluntly, is a myth.

It comes down to the fact the 4-K programs are not full day affairs. In fact, the DPI sets the standard for 4-K programs at 437 hours of operation per school year, which comes out to 2.5 hours per day in a 175 day school year.

In Whitefish Bay, where I live, the 4-K program runs from 9:15-11:50 in the AM and from 12:40-3:15 in the PM. Parents need to choose one or the other, AM or PM, they can’t have their kids in both.

This leaves a significant portion of the day where there is no care for the children. For working parents -- the ones who, under the conservative argument, are supposedly reaping financial benefits from 4-K -- this means private daycare is still a necessity even if their kids are in the public 4-K program.

So just what is the cost difference between daycare before the 4-K program and daycare with the 4-K program?

The thing with daycare costs is that they decrease as kids get older. The most expensive care is for kids who are 0-2 years old, at least partly because state law requires a higher teacher-child ratio during that time. As the teacher-child ratio requirement decreases, so does the cost, although other factors could also play a role in the drop.

The Whitefish Bay School District partners with a local private daycare – Milestones – to provide care for kids directly in the elementary schools before and after the 4-K program. Younger kids receive care in separate facilities.

The cost of full-time care for 0-2 year olds in Milestones is $265 per week. That cost drops to $220 for 2-3 year olds, a 17 percent decrease. For 3-4 year olds, the cost goes down again to $195 per week, which is an 11.4 percent drop.

When a child enters the 4-K program in the Whitefish Bay schools, Milestones charges $175 per week to provide care before and after the program hours, which is necessary for most parents who both have standard full-time jobs. That’s just a 10.3 percent decrease from the full-time care of the child the year before.

In other words, the 2.5 hour length of the 4-K program essentially does nothing to the cost of private daycare; in fact, at least in the case of Milestones, the drop in cost when the child enters the 4-K program is less than the annual decrease parents see in the previous years.

And it makes sense, too. After all, 2.5 hours of less care per day isn't going to decrease the overall operating costs for the daycare provider in any significant way. The provider still needs to hire full-time staff to care for the kids, even though one group will be elsewhere for a brief stretch in the morning and another group for a brief stretch in the afternoon.

So while opponents can argue all day with the research that points to the benefits of 4-K programs for kids, communities. and the state as a whole, to argue -- explicitly or implicitly -- that parents who push for 4-K programming are just looking for daycare on the public dime is plain wrong.

Doyle Comes Through on Fixing Funding Flaw

It's good to see Governor Doyle offer up a significant solution to the school voucher funding flaw. A couple of weeks ago, the governor was clear that a solution would be included in his budget, but he was unclear about the significance of the solution.

Doyle's plan is still a bit vague, but he did note that the state would cover the entire cost of the voucher expansion agreed upon last January. This means the roughly 15,000 students who were in the program before the expansion still will be part of the funding flaw and, subsequently, continue to cost Milwaukee residents about $15 million per year more than what 15,000 of their MPS counterparts cost to educate.

And it's a tad disingenuous for Mayor Barrett to take a swipe at Doyle's plan, as he did in the JS article this morning, by saying he'd prefer the state cover all voucher students considering Doyle's proposal appears to be a mirror image of the one offered up by Barrett himself last year. I can understand why Barrett may prefer to have all students covered, but he is the one who established covering only expansion students as a reasonable proposal.

It seems likely Doyle's plan will come under attack by some in the state legislature who will frame it as more state handouts for Milwaukee, but, as I've noted before, they won't have a leg to stand on with this argument. The fact is other school districts are making money off the school voucher program -- to the tune of about $3000 per student.

To be sure, if the voucher program was ended last year rather than expanded, the Legislative Fiscal Bureau reports that the property tax levy in Milwaukee would've decreased by $25.6 million while increasing in other districts by a combined $121.4 million.

All Doyle's plan does, it seems, is take $1000 of the $3000 the state saves and use it to even out the score with Milwaukee residents who right now are paying about $1000 more to educate each voucher student than they are to educate each MPS student. The other $2000 the state saves will continue to be logged as savings.

And, again, this is just for the voucher students who enter the program between the old cap of about 15,000 and the new cap of about 22,000.

Let's hope the state legislature doesn't muck up this already very modest and very necessary proposal.

Tax Framing

I can somewhat understand that it's framed in the media as a tax increase when John Edwards calls for not extending the Bush tax cuts for those making over $200,000 a year to help pay for his health care reform plan.

But then how can Bush turn around to propose making those same tax cuts permanent and get media credit for working to "slash taxes by $1.9 trillion" over the next decade?

Where's the mid-point there? Not extending the cuts is an increase, extending the cuts is a decrease.

And, on a related note, considering all of the hubbub in the national lefty blogosphere over Barack Obama's universal health care speech a few weeks back, how about some love for the actual plan to do something about it by Edwards? The words of Obama's speech were eloquent and all, but they really didn't say anything about what he would actually do to address the growing health care crisis.

Ezra Klein, to his credit, did summarize the Edwards plan and how it differs from others offered up to this point. You can read that here.

UPDATE: More from Klein on the media's reaction to the Edwards health care plan, including the revenue proposal (emphasis mine):

But if the problem with the New York Times and Washington Post story was that it failed to clearly or seriously explain the plan's features, much of the media hasn't even bothered to fail at the substantive task. They, instead, have been mainly interested in Edwards' willingness to raise revenues to fund the plan. This, of course, is a no-go, a non-starter, political suicide, evidence of unelectable extremism. On the other hand, all of these reporters would happily tell you, in private, that taxes need to be raised. Most all of them support health reform. They universally loathe the politician's tendency to avoid tough questions like revenue increases. But when a politician steps up, they rush in with the very narratives and reporting style that encourages such irresponsible rhetoric. If the framing were that Edwards was willing to speak the hard truths about how to pay for his, and the country's, expressed priorities, maybe other politicians wouldn't fear honest utterances.

It's stuff like this that's made Klein my favorite voice in the national lefty blogosphere.

Does the Blogosphere Help or Hurt in Wisconsin?

Political blogging is a world of immediacy. It's really a built in feature of blogs -- if you have something to say, you can say it as quickly as you can type and click "Publish Post."

So when a significant political news story appears in a major media source, there is an expectation that bloggers will write on it and write on it fast.

For instance, it's a little after 7:00am as I write this, and I would venture to guess that by noon, at least a handful of bloggers will have commented on Governor Doyle's backing of the proposed rental car tax. By tomorrow, you won't read much about it in the blogosphere, unless it's in the broader context of a post on the budget; the focused commentary on it, for the most part, will be done after today.

At the same time, the political blogosphere puts a premium on analytical commentary. Many bloggers will decry -- and rightfully so -- the posts that do very little except direct someone to a news article.

This may work on the national scene where bloggers are pointing out articles or quotes from obsure publications, pressers, or documents that most people would not otherwise read. But when a Wisconsin blogger, for instance, is merely pointing out a top tier article from a publication like the Journal Sentinel with little more than a couple lines of bland commentary, what's the point?

So the blogosphere has these two forces of immediacy and analysis, and, for the most part, they are very much opposing forces.

How informative, for example, are those commentaries on Doyle's support of the rental car tax going to be after an hour (or probably less) of thinking about it? And actually researching the issue -- who has time for that nonsense?

What this leads to, in my view, is a lot of sloppiness. And there's nothing that eats up sloppy analysis quite like partisanship. Partisanship feeds on half-assed analysis, and in many ways it was born of it.

And the thing is partisanship is popular, too. Readers seem to love it when bloggers of their same mind ra-ra it up with a rant they've probably already heard a thousand times -- nothing new is gained from it except more firmness in the belief that that's the way it is.

Some blogs even take the time to apologize to their readers in advance when a post is going to be "wonky" or involve numbers and such.

So where does this leave the debate? Where does this leave the usefulness of the blogosphere?

It reminds me of when Jon Stewart famously appeared on CNN's Crossfire to tell hosts Tucker Carlson and Paul Begala to "stop, stop, stop, stop hurting America." Carlson and Begala were just two of the talking heads who do nothing to advance the political conversation in the country, but merely further entrench us in partisan debate.

Is the Wisconsin blogsophere any different for the state?

I'd like to think it can be, although I wouldn't say it's the norm, at least right now. And I'm not trying to put myself above the fray. I've displayed rank partisanship on this blog before. It was especially true for me during the election season, and I thought it took a heavily negative toll on my writing during that time.

I feel that some of my best posts are the ones where I eschewed immediacy and actually took a day to think about and look into a topic. And most of the time when I do that, the post I end up writing is dramatically different than the one I envisioned writing when first considering the topic.

Those are also, interestingly, some of the posts that received the least amount of reader attention -- perhaps because they lacked a partisan edge, perhaps because they lacked immediacy (or perhaps because they weren't as good as I thought).

But, that said, I wonder what the blogosphere in Wisconsin would look like if there was a mandatory 24-hour waiting period on posts that involve analytical commentary; that is, the ones that go beyond "Hey, here's a link." It would never happen, nor could it (and maybe nor should it), but I have a hunch the look and feel of the Cheddarsphere would be drastically different if this was the rule (it may also mean less posting for some -- reactive writing is easier than reflective writing).

Some posts may not change even with a 24-hour waiting period, but those who would choose to truly use that time to think about a topic and dig into it beyond the partisan talking points would see, I think, a dramatic change in what they write, at least if they're being honest about what they discovered while waiting.

And I'm not talking about dumping ideology. Ideology -- and the political party that most closely embodies it -- will always play a factor in any political writing.

But there is such a thing as unflinching partisanship, which is the conscious (or maybe subconscious for some) refusal to consider going beyond the surface of an issue, perhaps for fear that what will be discovered will take you away from what you thought you were supposed to believe or defend -- not necessarily to "the other side," but just away from the dramatic edge of your initial reaction.

That's the partisanship that's got to go if the blogosphere has any chance of not hurting and actually helping Wisconsin. And questioning the place of immediacy in writing that fashions itself as analytical may be a good place to start.