- Associated Press - Monday, July 20, 2015

The Oregonian, July 15, on Uber and Lyft in Portland:

It was impossible to know just what sort of chaos would ensue when the Portland City Council decided to throw open the doors to competition and encourage a transportation free-for-all with ridesharing companies Uber and Lyft and the city’s taxicab companies.

Would drivers for Uber and Lyft, which allow customers to hail their ride service through a smartphone app, steal away taxi companies’ business? Would Uber once again serve as its own worst enemy and trigger customer backlash with some cataclysmic faux pas? Would there be a taxi-versus-Uber showdown at the airport?

So far, based on a status report presented to Portland City Council on Wednesday afternoon, the reality of a 120-day pilot program has not been chaotic at all. Information based on the first full month of service leads to this primary conclusion: People are getting rides to and from various destinations with the vast majority of people waiting less than 10 minutes for a pickup. In Portland, which for years restricted the number of allowable cabs to a miserly 460 and forced residents and visitors into long waits or long walks when public transit closes up shop, that is a dramatic statement. The city that works is, at least for now in this respect, living up to its motto.

Taxi companies, of course, aren’t so happy with the arrangement, but they should devote their attention to helping shape the future. A city task force is now working on recommendations for a more permanent regulatory framework to govern taxis and the “transportation network companies,” or TNCs as Uber and Lyft are called.

Here are a few findings worth highlighting as the task force develops its proposals for City Commissioner Steve Novick to consider in August.

The city needs to recognize that TNCs are here to stay. Uber and Lyft are fulfilling a need that has gone ignored for too long. Bryan Hockaday, a policy adviser to Novick, notes that for the month of May, taxis and the TNCs collectively provided 230,000 trips. That does not include taxi rides from hotels or hailed off the street. While there are no year-over-year data, transportation officials believe traffic easily exceeds the business cabs handled in May 2014. How? Unmet demand is finally being met.

The pilot program has directed long overdue attention to the transportation needs of people with disabilities. Nickole Cheron, the disability coordinator for the city who also uses a wheelchair, recalls a time several years ago when she needed to arrange for a taxi to get her to the Kennedy School in Northeast Portland for a work event. She reserved the taxi the previous night for an 8:30 a.m. pickup. It arrived at 9:15 a.m.

That appears to be shifting with Uber and Lyft, according to the report, although the TNCs handled less than a third of the calls for wheelchair accessible vehicles as traditional taxis. But customers calling Uber and Lyft had average wait times of 10 minutes, according to the status update, while nearly half of the taxi customers waited 30 minutes.

Previously, the city mandated that taxi companies’ fleets include a minimum percentage of wheelchair-accessible vehicles. But companies often did not meet those minimums, and the city did little to address the problem. Other solutions similarly fell short. Now, disability advocates want the city to consider how well companies meet performance targets, such as waiting times, rather than just dictate a minimum number of vehicles.

Help taxi companies adopt the same technology or business practices that make transportation convenient for customers. Many already use the Curb app that allows people to hail cabs. But the taxi industry complains that they are not allowed to take credit card information in advance, unlike TNCs, which require it.

Insurance remains a murky area that may need further attention. Steve Entler of Radio Cab says one of his taxi drivers was injured in a crash with an Uber driver on his way to pick up a customer. But the driver’s personal insurance carrier is challenging whether it should have to pay because the Uber driver, in the carrier’s view, was on the clock doing business, he said.

Uber did not have details of the incident and Entler declined to provide the driver’s name to The Oregonian. But Uber said it provides primary insurance coverage for drivers from the time they open the Uber app with a limit of up to $1 million for drivers once they have accepted a ride request. As the insurance market starts offering new policies that address this emerging market, the city should work with the TNCs to ensure that the policies provide sufficient coverage.

One month of data - and incomplete data at that - is not enough to predict with certainty how this industry will develop and what regulations will ensure fair and vigorous competition. And perhaps that is the biggest takeaway that the city should keep in mind as it structures the new framework: Periodic evaluations and adjustments are necessary to keep Portlanders moving and preventing the kind of years-long buildup of frustration that the city allowed to fester.


The (Corvallis) Gazette-Times, July 15, on childhood vaccinations

You can be sure that many of the issues that got hashed out in the 2015 Oregon Legislature will stage return engagements during future legislative sessions.

Among them likely will be the issue of childhood vaccinations, an issue that prompted some passionate (and sometimes ugly) debate during the course of the 2015 session. The opposition was enough to persuade Sen. Elizabeth Steiner Hayward, a Democrat from Beaverton, to drop a proposal to remove all nonmedical exemptions for vaccines.

Instead, Steiner Hayward, a physician, wound up promoting Senate Bill 895, which requires schools to publish available immunization data. The bill (which also applies to other facilities that serve children) would require the information to be posted on school websites and also included as part of the school performance reports that are sent to parents and guardians.

That bill passed the Legislature, largely (but not completely) on party-line votes. It awaits the signature of Gov. Kate Brown, who hasn’t given any indication that she plans to veto the bill, which is good: Senate Bill 895 makes sense and should be signed into law.

Steiner Hayward is clear about her motivation for the legislation: She wants to find ways to improve the state’s rate of vaccination for children, which is too low. As that rate drops, it jeopardizes the herd immunity that helps to protect even people who aren’t vaccinated.

Naturally, Senate Bill 895 attracted some of the same opponents who fought against eliminating the nonmedical exemptions. Some opponents of the bill claimed that the requirement to share the information could set the stage for a “social bullying atmosphere” at schools. “We’re going to create gossip,” said one opponent.

The argument struck us as a hollow one then, and it still seems that way. For starters, the information does not identify individual children, just overall vaccination rates. And this information already is publicly available through health authorities.

Another argument against the bill - that it provides only an incomplete picture of vaccination rates at any individual school - has somewhat more merit, but still is outweighed by the benefits of the measure. In some cases, parents elect to stretch out vaccination schedules to minimize any potential risk, no matter how slight; that would tend to depress a school’s vaccination rate. Parents would need to take that into account as they analyze the numbers.

But all of the other measures included on a school’s performance report are, by nature, incomplete: None of them tells the whole story about a school. They do, however, suggest areas where parents can start to ask questions about a particular school.

We understand why the vaccination issue tends to be emotional. And while our position on the issue is that parents should vaccinate their children, we are uncomfortable with the idea that government should force parents to vaccinate.

Senate Bill 895 doesn’t do that. But it still has merit in offering another tool parents can use to help guide their informed decisions.


The (Albany) Democrat-Herald, July 16, on Medicare’s end-of-life policy

Last week, when Medicare officials finally got around to announcing that the program would cover costs of voluntary end-of-life counseling, the response was quiet.

Gone were the shrill (and silly) denunciations that such counseling would lead to “death panels” that would be empowered to make the decision about whether it was time to “pull the plug on grandma,” in the memorable and misguided words of U.S. Sen. Charles Grassley.

In fact, the furor over the proposal, initially launched by U.S. Rep. Earl Blumenauer of Oregon, threatened to stall President Barack Obama’s health care proposal in Congress back in 2009 and 2010.

To his credit, Blumenauer has been quietly pushing the idea ever since. But he wasn’t taking credit last week for Medicare’s decision. Instead, he recognizes that the nation has moved toward a greater understanding of how important these end-of-life discussions are - and the federal government has taken note of that shift, small as it may be.

“There was a time when the federal government could have been a leader on this, but now it’s basically responding to where the rest of America is going,” Blumenauer said.

The Medicare policy change, to take effect Jan. 1, was tucked into a massive regulation on payments for doctors released last week. Counseling would be entirely voluntary for patients.

But it’s still potentially a huge deal, especially considering that Medicare serves 55 million beneficiaries and is the largest insurer at the end of life.

Some doctors already have these conversations with their patients without billing extra. Some private insurers have begun offering reimbursement as well.

Those are signs of real progress, but we have more work ahead of us: A landmark report from the Institute of Medicine last year concluded that far too many people fail to make their end-of-life wishes known to their doctors or to other family members.

As a result, these vital decisions often fall to people who simply don’t have the information they need to make these decisions about life and death. So it’s no wonder that so many deaths are filled with breathing machines, feeding tubes, powerful drugs and other treatments that fail to extend life significantly and dramatically reduce the quality of life over those final days and weeks. And it’s no wonder that people who say they’d much rather prefer to die at home still die in the hospital. (Although this is a secondary concern, these additional layers of treatment also drive up the costs of our health care system.)

Patients here already have tools in place to help with these decisions: For example, Oregon is among the states that allow patients to specify their preferences with doctors via a document known as Physician Orders for Life-Sustaining Treatment, better known by the acronym POLST. The orders, which are signed by a doctor, allow patients to specify their preferences in cases when they might not be able to speak for themselves.

The orders, however, require candid and open conversations about the end of life with doctors, patients and loved ones. This change in Medicare policy helps to pave the way for those discussions.

But it’s still up to us to start the conversation.


The Bend Bulletin, July 17, on expanding telemedicine to rural areas

If you live in rural Oregon, you can call a physician on a video-conferencing system if you have medical problems. Now, thanks to a change in the law approved by the 2015 Legislature, people all over the state will be able to do the same thing.

Senate Bill 144 changed the law covering telemedicine in Oregon, making it available to Oregonians in urban as well as rural areas and including teachers and other public employees. It also expanded the circumstances in which telemedicine can be used.

Equally important, the bill requires insurance providers to cover use of the system. It also removes a provision of the law that barred the use of telemedicine if it duplicated or replaced services that were available in person.

That means, if the physician’s office is equipped to do so, you might be able to call and have your pediatrician diagnose a sick child without having to leave home.

The bill also should dramatically expand mental health services in communities that don’t have that to offer today. Psychiatrists in Portland will be able to set up weekly appointments with patients in Heppner or Madras if they wish, and the patients will not have to spend hours on the road to keep those appointments.

Those kinds of hidden costs - time, gasoline, perhaps even a night in a motel - seldom show up when the rising cost of medicine is under discussion, but they’re very real, nonetheless. Telemedicine offers a quicker and less expensive way to get the same sort of care that’s available to residents of much larger communities.

Telemedicine doesn’t now and won’t anytime soon replace all visits to the doctor’s office, to be sure. Even the most souped-up teleconferencing system cannot set a broken bone or provide other hands-on treatment.

At the same time, SB 144 will put Oregonians in touch with a service that makes some medical care easier to reach, less expensive and less time consuming than it has been before. That’s nothing to sneeze at.


The (Eugene) Register-Guard, July 20, on minimum wage legislation

With labor activists moving ahead at full speed with plans to get a $15 minimum wage initiative on the 2016 statewide ballot, it’s puzzling why Oregon House Speaker Tina Kotek, D-Portland, continues to say she intends to re-introduce in next year’s short legislative session her controversial proposal to raise the statewide minimum to $13 over three years and to repeal the state’s pre-emption on local wage increases.

“That proposal, from my perspective, is ready to roll - I just haven’t had a chance to get all the votes for it,” Kotek told The Oregonian’s editorial board late last week.

Kotek should reconsider before forging ahead with her plan.

Democrats had enough votes in the recently concluded session to pass Kotek’s proposal, or any of nearly a dozen other minimum wage bills introduced by lawmakers, without any Republican support. But some Democrats, both in the House in the Senate, were rightly concerned about overburdening state businesses in the same session that also lawmakers approved a bill requiring mandatory paid sick leave and several other workplace-related bills.

When the 2016 session convenes, it’s doubtful those concerns will have been allayed. Some lawmakers, including more than a few Democrats, might reasonably question the wisdom of Kotek’s push for an increase of nearly $4 in light of Oregon’s national leadership on the wage front in recent years. Since state voters in 2002 approved Measure 25, which raised the minimum to $6.90 an hour and provided for annual increases indexed to the rate of inflation, Oregon’s wage base has risen to one of the highest in the country. Currently at $9.25, it is a full $2 higher than the federal minimum and will be even higher after next year’s index bump.

The contentious 2015 session took a heavy toll on lawmakers, and by the date of adjournment Kotek’s relationship with Senate President Peter Courtney, D-Salem, was, to put it mildly, less than collegial. Courtney adamantly opposed increasing the minimum in the 2015 session, and it’s questionable Kotek will have his necessary support in 2016.

The 2016 session promises to have a packed agenda that is likely to include transportation, affordable housing, campaign finance and other pressing issues. Meanwhile, the labor activist group Oregonians for 15 already has gathered, and secured the necessary verification from the Secretary of State’s Office, the signatures necessary to qualify for a measure title for the 2016 ballot.

With a minimum wage initiative likely to end up on the 2016 ballot, Kotek should seriously consider backing off her plan to introduce legislation on a new state minimum. Better to let Oregon voters have the final word on this vitally important issue - just as they did in 2002.

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