The Bend Bulletin, Aug. 6, on consumers’ involvement in health care reform:
One hope of health care reform is that it will create smart, empowered consumers. They will have the data they need to make good choices about care. And that, in turn, creates incentives for providers and insurers to move to a better health care system.
There’s nothing wrong with that idealized premise, except it has proven very difficult to make it a reality.
Health care reform has created new databases of information. And more and more of that information is being made available to consumers.
Oregon is going to launch a website in the fall of 2016 that will show health care costs by tracking almost all health care billing in the state, as Bulletin reporter Tara Bannow wrote in Wednesday’s paper.
It could be a powerful tool for professional analysis. These so-called all-payer, all-claims databases are appearing across the country. Researchers have already been using them.
An inquiry into similar data by the Dartmouth Atlas Project raised serious questions about the variations in Medicare spending across the country. More spending didn’t correlate with better health care outcomes. That can help inform decisions about how Medicare should be delivered.
It’s, of course, a good thing in theory that consumers will be able to access Oregon’s data. But will it be easy to understand what it means? Will it actually be useful? Most consumers are bound by guard rails in their health care decisions - time, cost, what their health plan covers and their location - to name a few. Will it have unintended consequences that aren’t smart?
Remember the recent release of the data of surgical complication rates by ProPublica? It’s a sort of like a surgeon report card, but imperfect and loaded with limitations. Making a decision about a surgeon based on that alone would not be smart.
Maybe, over the long haul, the new Oregon database or ProPublica’s report card will be refined and improved and better understood by consumers. But for now they don’t create the smart, empowered consumers of health care reform dreams.
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The (Eugene) Register-Guard, Aug. 7, on reforming the state’s foster care system:
It’s usually not good news when a state’s child welfare system is a topic of a committee hearing in the U.S. Senate.
But that wasn’t the case Wednesday when Charles Nyby, a program analyst for the Oregon Department of Human Services, testified before the Senate Finance Committee. Nyby described how the state’s system increasingly is working to keep families united and is using foster care as a last resort. “I’ve seen significant impact on things in child welfare I truly never thought possible,” he said in a hearing on a bill sponsored by Sen. Ron Wyden of Oregon, the ranking Democrat on the committee.
Wyden’s bill would expand a multi-billion dollar federal entitlement program that currently funds only foster care services. The Family Stability and Kinship Care Act would give states the flexibility to use federal funding to make investments in preventive services that have been shown to be effective in stabilizing families and keeping kids out of foster care and either safe at home or placed with relatives.
That’s a smart and necessary move if state child welfare systems in Oregon and other states are going to continue moving away from a foster-care model that for too has long been a source of heartbreak and tragedy.
Current federal law provides states with a federal matching funds for children only after they have been placed in foster care. That restriction on the more than $4 billion that is distributed annually to states serves as a perverse incentive for the unnecessary removal of youths from homes that are troubled - but in many cases, families can be kept intact through well-planned services.
An early draft of Wyden’s bill previewed earlier this year would provide reimbursements for up to a full year of family services. Those services would include counseling, family-skills training and other assistance intended to stabilize a family in crisis and prevent a child’s entry into foster care - or, in some cases, to allow youngsters to safely leave foster care for family placements.
Wyden’s bill has the support of the American Academy of Pediatrics, which praises it for proposing expanded assistance to states and emphasizing “the important role of prevention, including parenting skills training and mental health services.”
Nyby was on target this week in testifying that Oregon’s foster care program has improved over the past decade. Thanks to a federal waiver, Oregon has been able to spend some funds previously restricted for foster care on preventive services for parents and children who are in crisis because of poverty, substance abuse and homelessness.
As a result, the state is serving fewer foster children - and keeping more families together. Oregon’s emphasis on preventive services is similar to the approach that Wyden’s bill would extend nationwide.
But Oregon’s system remains a work in progress. Erinn Kelly-Siel, who in 2008 took the job of leading the state’s troubled child welfare system, recently hammered home that point in a letter announcing her departure as director of the state’s Department of Human Services.
She noted that Oregon’s child-welfare system still falls short of federal and internal benchmarks. The state continues to struggle to fix problems with a new computer and data-tracking system that is essential to gauging how well foster children are being served and how they are faring in the system. The state also has been hit with several lawsuits in recent years alleging that its child welfare system failed to intervene in cases that resulted in serious injuries, sexual abuse or even death. Some of those lawsuits have resulted in judgments that have cost the state millions of dollars.
If Oregon and others states are to do a better job at protecting kids and helping families remain intact, they need more federal funding and greater flexibility in using it. Wyden’s proposal would accomplish both, and deserves enthusiastic bipartisan support in Congress.
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The Oregonian, Aug. 8, on raising the minimum wage:
The debate about raising the minimum wage to $13.50, as an Oregon coalition has proposed, or $15, as several West Coast cities are doing, cuts through a range of complex economic issues. But the most fundamental question that needs to be answered is this one: Who would be helped by a higher government-mandated pay floor?
The short-term macroeconomic impact of a significantly higher minimum wage likely will be minimal, in part because these workers make up a small percentage of the overall economy. But those pushing hardest for higher wages aren’t basing their campaign on economic growth. And, anyway, there are better ways to encourage short-term growth - including infrastructure improvements that neither federal nor state lawmakers seem capable of funding. Before legislators support a big jump in the minimum wage, they need to closely study whether it will deliver on advocates’ primary promise and lift a significant number of workers out of poverty. Here are some of the facts and figures they should consider:
Oregon had 103,500 minimum wage jobs during the first quarter of 2014, according to the Oregon Employment Department’s Characteristics of Minimum Wage Workers report. That was about 6 percent of all jobs in the state. Nationally, only 3.9 percent of jobs in 2014 paid the federal minimum wage, which at $7.25 was almost $2.00 lower than Oregon’s 2014 rate of $9.10.
The majority of Oregonians earning less than $13 an hour work part time, according to Oregon unemployment insurance wage records from the first quarter of 2014.
More than half of low-income working-age Oregonians, defined as adult workers younger than 65 earning less than 200 percent of the federal poverty level, are not the head of their household.
In other words, the number of Oregon full-time workers who head a household and would benefit from a higher minimum wage likely is less than 50,000. Part-time workers would benefit from a raise, too, but if your goals are to reduce poverty and income inequality, you don’t do that through part-time work. And, then there’s the question of how many full-time workers would see their hours cut after a big boost in the minimum wage.
Diving farther into statistics on who works minimum wage jobs produces more questions about the consequences of a big increase. Here’s a look at how Oregon low-wage jobs are distributed by industry and geography, based on information from the Oregon Employment Department.
The leisure and hospitality industry was the largest employer of minimum wage workers in Oregon, with 41,300. Nationally, almost half of minimum wage employees work in food preparation jobs.
Multnomah County had the most minimum wage jobs, 19,389, among counties. But it also had the lowest percentage of workers at the bottom of pay scale, only 4 percent. In contrast, the 1,397 employees earning $9.10 in Malheur County comprised 10.9 percent of the workforce. Two other sparsely populated counties, Wheeler and Harney, also had more than 10 percent of the workforce earning minimum wage. Among counties with more than 32,000 population, Polk County had the highest percentage of minimum wage workers - 8.5 percent.
The geographic employment breakdown presents policymakers with a dilemma. The Portland-area economy probably can support a reasonable increase in the minimum wage, but on a percentage basis it has the fewest workers at the bottom of the pay scale. And because of high living costs, particularly housing, even $13.50 an hour probably isn’t enough to lift families out of poverty. In rural areas, a person working full-time at $13.50 an hour probably can put together a viable household budget, but how many full-time jobs can rural communities support at that wage level?
A look at pay by industry shows why advocates have targeted fast-food restaurants. They and other food and lodging employers employ a significant share of the state’s low-wage workers, and they probably can absorb higher labor costs through a combination of belt-tightening and price increases. But increases could have profound consequences for providers of child and elderly care, who have much smaller profit margins and customers who are more price-sensitive. Will they be able to raise prices, and if not will they be able to stay in business? The demand for their services won’t decrease regardless, which could lead to calls for government subsidies.
The case for a higher minimum wage rests on a strong philosophical argument. People who work full-time should be able to afford necessities. But a close look at who works in the lowest-paying jobs casts doubt on whether raising the minimum wage will accomplish that goal.
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The (Medford) Mail-Tribune, Aug. 9, on reducing carbon emissions:
When Oregon legislators were debating measures designed to reduce carbon emissions in the state, opponents of those bills frequently argued that nothing Oregon does, with a population of just 3 million people, would make any real difference in combating climate change. Solutions, critics said, needed to be national in scope.
Don’t look now, but President Obama announced a plan last week that takes just such a nationwide approach. And, as a result of steps Oregon lawmakers have already taken, this state is well positioned to comply with the president’s Clean Power Plan, if it survives court challenges and is fully implemented.
Oregon is not among the worst offenders among the states when it comes to greenhouse gas emissions. There is only one coal-fired power plant in Oregon, the Portland General Electric facility at Boardman, which is the state’s largest emitter of CO2. PGE already has committed to stop burning coal at that plant by 2020.
But that doesn’t mean Oregon is off the hook. Pacific Power gets approximately 60 percent of its power from coal-fired plants in other states. The utility has pledged to close 10 coal plants by 2029 or convert them to natural gas.
Carbon-reduction goals the state has set for itself are far more stringent than those in the Clean Power Plan, although slashing carbon dioxide outputs may be delayed if coal plant outputs are replaced with natural gas. Gas emits about half the carbon of coal, but methane is a more potent greenhouse gas than carbon dioxide, and leakage of gas into the atmosphere from plants or pipelines can increase the state’s carbon footprint.
Ultimately, replacing fossil fuel power generation with renewable sources such as solar and wind - to the degree that’s possible - will have the greatest impact on carbon emissions, and Oregon already requires its large utilities to get 25 percent of their power from renewables by 2025.
It’s true that Oregon’s efforts, laudable as they are, won’t have much effect on global carbon emissions by themselves. But combined with the other West Coast states and ultimately with the entire country, our state’s contribution will be part of something much larger.
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The (Albany) Democrat-Herald, Aug. 10, on Oregon’s new gun law:
Oregon’s new law requiring background checks for private gun transactions took effect Sunday, so you probably feel a lot safer today.
No? That’s understandable: Even as legislators debated the controversial measure during this year’s session, it never was clear whether it would have much of an effect in the real world.
And it’s still not clear - especially with speculation that the measure, Senate Bill 941, will be widely ignored.
Under the terms of the bill, sales and other firearms transfers between private parties will require a background check (including criminal and mental-health checks) conducted through licensed dealers. These background checks already have been required for sales by licensed dealers at gun shows.
Oregon now is the 12th state requiring these so-called universal background checks for both handguns and long guns.
But how this will play out here remains shrouded in uncertainty: For starters, no one knows for sure how many of these private transactions occur each year in Oregon. The Oregon State Police, which already handles the background checks required by the federal government, has added three temporary workers to be sure that it can absorb any additional demand from the new state law. But because no one knows how many private transactions take place in the state, it will be impossible to gauge the effectiveness of the law.
In addition, even though more than 2,000 Oregonians have the federal firearms licenses required to conduct background checks through the Oregon State Police, it’s not clear how many of them will perform the checks. Already, some stores have signaled that they likely will restrict their background checks to their customers who purchase guns, preferring not to get involved in the checks for a private transfer.
Add to that the fact that many county sheriffs and commissioners have made it clear that they have little interest in enforcing the law (or the necessary resources to do so), and the stage is set for Senate Bill 941 to take its place on that long, long list of well-meaning bills that never made much difference.
And that gets back to our fundamental issue with the bill: Even though its supporters said it would help to keep guns out of the hands of people who shouldn’t have them, it seems extremely unlikely to do that. Someone who’s determined to get his hands on a gun still will be able to do so, and likely won’t be hindered at all by the background check requirement.
In fact, the people who will be most hindered by the requirements of Senate Bill 941 will be law-abiding gun owners who now must endure the extra hassle and cost every time they want to sell or swap a firearm with a friend or neighbor. (At least the bill was amended to exempt sales or transfers between family members.)
But even with that amendment, Senate Bill 941 represents the worst kind of legislation: It allows legislators who support gun control the chance to tell their backers that they took a stand against gun violence, while the bill does no such thing. And the bill constrains our freedoms for an uncertain payoff - a payoff that we won’t ever be able to measure with any certainty.
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