- Associated Press - Wednesday, August 10, 2016

Great Falls Tribune, Aug. 6, on Montana’s health care system:

This country’s health care system is the world’s most expensive, but not all U.S. residents are covered.

Then-first lady Hillary Clinton famously failed in her quest in the 1990s to provide universal health coverage.

President Barack Obama filled some of the coverage gaps during his two terms, but rising premiums for so-called Obamacare health plans have prompted alarm.

Montana’s Legislature in 2015 opted to expand federal Medicaid coverage to lower-income, largely working folks, adding nearly 50,000 people to those receiving Medicaid coverage.

More people have health coverage, but costs are up, and in some places it’s not especially easy to pair those newly covered with doctors, nurses and others who can provide care.

Clearly, it’s a good time to try different approaches to provide good coverage to patients at a price people can afford.

One helpful move in the last decade has been toward federally supported community health care facilities, such as the one in Great Falls. That helped fill some of the gaps for people who lacked health care coverage.

State government, meanwhile, is trying to corral costs a bit through special health coverage for state workers, through contracts with a number of Montana hospitals and clinics.

One approach that is receiving a new try is a two-year pilot program featuring a relationship between the Community Health Care Center in Great Falls and the private group Great Falls Emergency Services, which dispatches ambulances to emergencies. It’s a two-year pilot program, similar to one GFES and the Great Falls Clinic had earlier.

Under the new pilot effort with the center, Great Falls Emergency Services can be sent to an uninsured or underinsured patient’s home or business to check vital signs, living conditions, risk of falling, whether the patient is taking prescription medicine correctly or whether the person’s blood-glucose level is satisfactory.

“It lets us be a good partner with GFES, to use some of their downtime and serve the community in a way that’s meaningful,” said Leslie Southworth, center director.

Jason Grohs, operations manager of GFES, said the program can help prevent unnecessary hospitalizations by handling issues in a person’s home. House calls are not dead, it turns out.

“It’s a win-win-win for everybody,” Grohs said in a story by the Tribune’s Jenn Rowell published Aug. 2.

Grohs said his company is also working with Benefis Health System on mobile integrated health care, and also a program to help children who live out of state care for elderly parents in Great Falls.

Tapping into the skills of emergency workers with down time is not new. Great Falls city firefighters in recent years respond to many emergency calls along with ambulances to help people who are ill.

We think it’s a good idea to try innovative things to try to help our health care system treat more people effectively. Insurance companies and health plans are trying things such as calling a doctor, or calling a nurse, to provide health services that aren’t strictly emergencies.

These new approaches are an admirable part of the effort to control health care expenditures and improve patient health outcomes.

Editorial: https://gftrib.com/2b6Z2kp

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Bozeman Daily Chronicle, Aug. 8, on biking in federally protected wilderness areas:

Advocates for lifting the ban on mountain bikes in federally protected wilderness areas have a steep hill to climb in making a persuasive argument for this move.

U.S. Sens. Mike Lee and Orrin Hatch, both Republicans from Utah, have introduced legislation that would do just that. Some cyclists are enthused about the idea. But the change is opposed by conservation groups who contend bikes would erode wilderness trails more than the hikers or pack stock that are permitted on them today.

That’s one argument wilderness mountain biking advocates will have to respond to. But a more important consideration is the conflicts mountain bikes may have with other wilderness users.

Most people go to the trouble of traveling into wilderness areas because they cherish the solitude and quiet these areas afford. Anyone who has hiked in non-wilderness roadless areas where mountain biking is allowed knows that unexpected meetings between hikers and pack strings with mountain bikers coming downhill at high speeds on narrow winding trails can be startling and potentially dangerous. Permitting cyclists in designated wilderness areas would only create potential for more of these encounters.

This idea will win over support from some cycling enthusiasts right here in Southwest Montana. And on its face, it sounds pretty benign. How much damage can bicycles do? And they certainly wouldn’t be as intrusive as four-wheelers or dirt motorcycles. But making an exception for mountain bikers will only invite other mechanized recreation groups to seek exceptions for their particular sports. And where will that end?

The Wilderness Preservation Act is more than 50 years old and specifically prohibits “mechanical transport” in the areas granted wilderness protection. That has always been interpreted to mean no wheeled vehicles or any form of motorized transportation or tools are allowed.

Outdoor recreation has evolved since the passage of the Wilderness Preservation Act. Mountain biking wasn’t a popular sport back then. But just because recreationists figure out new non-motorized ways to get around in the woods does not mean those activities should be permitted in designated wilderness areas.

Wilderness cycling advocates are invited to make their best case for this change. But it’s likely going to take some convincing to win widespread support for this idea.

Editorial: https://bit.ly/2ayYVxr

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The Missoulian, Aug. 7, on an eminent domain ruling in the Montana Supreme Court:

Proponents of Missoula’s efforts to take over the local water system erupted into celebrations this past week with the news that the Montana Supreme Court had upheld the city’s right to use eminent domain to purchase Mountain Water Company.

The Supreme Court’s 5-2 ruling now leaves the way clear for the city to buy the water company. City leaders were right to celebrate this milestone decision, and understandably eager to begin the utility’s transition to city control as soon as possible.

However, this victory comes at a cost. Missoula taxpayers and Mountain Water ratepayers deserve to know exactly how those costs will be paid - and how much it will end up costing them.

The Carlyle Group, a major global investment firm, bought Mountain Water as part of a package of water companies it acquired when it purchased Park Water Co. for $102 million in late 2011. The city of Missoula lent its official support to that sale with the stipulation that Missoula would have the opportunity to buy its water system at some point in the future. But Missoula’s initial offer to buy Mountain Water for $65 million was rejected - twice. Unsurprisingly, a third and final written offer - for $50 million - was also dismissed.

Thus ensued a complicated, lengthy and costly court battle.

The city formally filed condemnation proceedings in Missoula County District Court in April 2014. Carlyle vowed to give the city a run for its money in court, then within months announced that it had sold Mountain Water, along with two other water utilities in California, to a Canadian utility company for a total of $327 million.

The eminent domain trial in district court ended in the city’s favor with Judge Karen Townsend’s June 2015 order, but that order was appealed and was only one of several issues that needed hashing out.

The tangle of stakeholder parties, court proceedings and legal arguments that led to last week’s ruling could fill a book. Indeed, they could probably fill an entire bookshelf. City leaders and residents can breathe a sigh of relief at having finally entered the final chapter.

But wait: there’s a sequel. The city has announced an intention to file a “bad faith” complaint alleging Carlyle and Mountain Water representatives engaged in unfair dealings and misled the city regarding its intention to sell the water company. For that aspect of the legal proceedings, lawyers have agreed to work on a blended contingency fee basis of reduced rates plus a percentage of costs recouped from the defendant, assuming the city is again victorious. Also assuming the city wins its bad faith case, it may expect to recover a portion of the costs it incurred fighting for control of Mountain Water.

And so the fight continues.

Nevertheless, Missoula’s victory this past week means the war has been won, the legal expenses will soon stop piling up and the city will soon start having to pay down a mountain of debt.

The city is, after all, on the hook to pay not only its own legal fees, but also those of the defense. The defendants have submitted filings requesting reimbursement for more than $7 million in expenses they consider “reasonable and necessary” to making their case in court, although the city disputes that figure and says it is closer to $3.5 million. The city’s own legal expenses have topped $6 million.

Meanwhile, previous legal haggling has pegged the cost of actually buying Mountain Water at $88.6 million.

Missoula intends to transition the water company to city control as quickly as possible, and Mayor John Engen has said that current rates will remain in place for the time being. However, he anticipates that water bills will eventually increase.

But how much - and how quickly - will rates increase? How much of that increase will be reinvested in the water system, which sucks up millions of dollars in maintenance and repairs each year and yet has a leakage rate of nearly 40 percent? How much will be used to pay off legal bills? Operating expenses?

If it hopes to keep its new customers happy, the city of Missoula must take pains to inform its customers about its plan to pay the bills at every step of the way.

Editorial: https://bit.ly/2aKmswH

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