Category: Featured

Tom Milne’s Response To Tom Seltz’s Featured Post

Webb,

In my opinion,the MD’s response is understandable and probably typical. In most instances,pharmacies add a professional fee to the cost of the drug dispensed, so there is little or no incentive to dispense the more expensive brand name drug. What this case shows is a profound lack of communication, a lack of understanding about the safety and efficacy of generics among consumers, and a lack of thoughtfulness on the parts of the MD and pharmacist.

I worked with a legislator in Oregon in 1974 to get a generic law passed. The law requires that every pharmacy post in a conspicuous place a placard that says (may not be quite exact words) “This pharmacy may be able to substitute a less costly but therapeutically equivalent generic drug in place of that which your physician prescribed.”

Something like that, and it might have made a difference in this case.

Watch For Revisions

On our one year anniversary of broad casting from North Carolina, the primary author is taking a week to recharge and to update our format and topics. Please take this opportunity to Post, and watch for new posts from yours truly beginning October 24,2011. W.

Health Care Consumer… or Recipient?

A True Sad Story of A Woman and Her Drug

Written by Tom Seltz

A few years ago, an employee of a small group client of mine contacted me to discuss her situation. She was of very modest means, married with two kids, and although her very rich health benefits were 100% employer-paid, she still was stuck paying over $200 per month for a single prescription drug. Other than food and rent, this was one of her biggest expenses, and the impact of this extra monthly cost was affecting her lifestyle and happiness. Going out to eat at a proper restaurant, movies for the whole family in the first-run theater and other small pleasures in life were entirely out of the question, directly due to this prescription.

Although her employer’s health plan had a very generous $10 generic / $35 preferred / $50 non-preferred Rx copay plan, her cost was over $200 a month because of a “Generic Substitution Penalty”. For the uninitiated, this is a very common provision which says that if you go with a non-preferred brand name instead of its generic equivalent, you will be stuck paying the difference. Often the whole thing. I explained this to her, but she was still confused: it was her firm understanding that there was no generic available, yet she was being forced to cover the extra anyway.
A 10-second Google search confirmed that there was a generic equivalent after all. I spelled its 15-letter name for her (not even attempting to pronounce it), but she was skeptical it was really the same thing. I assured her that indeed there may be cases where the generic is not suitable – for example when the non-coated generic version irritates the lining of the patient’s stomach. But she was sure she would have remembered that and was confident no such trial occurred.
So why was she paying $211 a month for a drug that was available to her in another version for only $10 a month?
I advised her to speak with her doctor, and to get back to me with the answer. Maybe there was something more to it, that only he or she could explain?
When she called me a week later, she was audibly shaken. She explained that she had just come from her follow-up appointment where she asked her doctor why she wasn’t taking the generic version of her drug. She said her doctor seemed puzzled, then replied, “I don’t know… why aren’t you? You can if you want; they are made of the same active ingredients.” Her doctor went on to explain that he cannot remember the generic drugs’ names or how to spell them, so instead he just writes out the easy-to-remember brand name. “In fact,” he added, “it’s the pharmacist’s job to dispense the generic equivalent.”
According to the woman, she burst into tears upon hearing this while her doctor just stood there staring at her dumbly, seemingly confused as to what the big deal was. He even asked, while trying to console her, “But don’t you have insurance?” as if having insurance made the whole issue irrelevant.

The doctor failed to grasp that she had been needlessly spending $200 per month for over two years, to the tune of over $4,800, (after taxes, no less). He and her pharmacist inadvertently conspired to help her flush her well-earned money away because the doctor never wondered what the cost was to her, let alone asked, and the pharmacy, surprise surprise, was not motivated to inform her that they were selling her a more expensive drug than she needed.
Was it the doctors’ fault? Was it the pharmacy’s fault? Or the patient’s fault? Was it a conspiracy or simple human error; a momentary miscommunication with lasting effects, or something broken that is larger, more systemic?
I have thought a lot about that woman and her situation over the years, and I have come to the conclusion that the true problem was, and is, cultural. It is well known that Americans by and large do not spend on healthcare as carefully as they spend on other goods and services. The same young man who will drive three blocks out of his way to save three cents a gallon to fill up his tank with gas will book an expensive and risky back surgery that physical therapy would have addressed just as effectively (and with less disruption to his health and income); the same woman who happily clips coupons on basic grocery items will buy brand new crutches as her ankle heals instead of finding a gently used set at a fraction of the price. The examples are endless.

Due to my profession, I have learned slowly how to act like the true consumer of health care that I am, instead of just a recipient… but it hasn’t been easy.

What’s the difference?

A consumer asks, “What does this cost, and do I really need it?” when a recipient would ask, “Will it hurt?” A consumer asks, “Are there any alternatives, just as good or even almost as good, which may be a better value for my money?” when a recipient would ask, “How soon can it be done?”

As my four-year old son goes in for his allergy and breathing issues, I must admit that I still catch myself some days, asking the wrong questions. The temptation… no, the instinct to follow the doctor’s plan A without question is undeniable. But I’m getting better at it.
The next time you consume health care I encourage you to take a moment and ask yourself how you would handle the situation differently if it were another type of good or service that you were buying. Look at each new expense with healthy skepticism, worthy of investigation, and you may be surprised how often there are many good options to be considered.

Tom Seltz is an insurance broker focusing primarily on group health, life and disability insurance for unions, non-profits and small businesses. Tom is currently a member of the DC Health Insurance Exchange Subcommittee of the Mayor’s Health Reform Implementation Committee, tasked with providing analysis and recommendations to the Mayor on the set-up and implementation of the District of Columbia’s Health Benefits Exchange. Tom is an active member of the National Association of Health Underwriters, the Greater Washington Association of Health Underwriters, and the Society for Human Resource Management. In addition, Tom is a produced playwright, screenwriting hobbyist, and avid film buff.

Mandated Mail Order Drugs

by Webb Hubbell

As more and more employers are finding ways to lower premiums on their employee’s health care coverage we see a stronger and stronger move toward prescription drug coverage mandating the use of mail order pharmacies who negotiate better prices for the health insurance companies, but not necessarily lower costs to the employees in the way of lower co-pays. Will this lead to the end of corner pharmacies and personal service? If it hasn’t already. More importantly where will the responsibility attach for drug interaction detection and individualized problems such as lost medication, immediate needs, use of generics? In the past a local pharmacist was an integral part of our health care system. Will they quickly become part of our memories of the good old days? Will our older population end up paying tremendous amounts more for drugs, because mail-order and telephone computers are too confusing? Will this further enhance a two-tier health care system in our country? One for the rich, and one for the poor. Are there solutions? Let everyone hear from you.

Editors Note:

As part of our series on public health we turn our attention to trends in that part of our Public Health System that deals with the cost of medical care. I recognize there is a large looming cloud over all of this discussion called the recently enacted Health Care reform legislation. Please feel free to comment on how you see the new legislation affecting this discussion. I personally believe the U.S. Supreme court next June will announce that the mandated coverage section of the legislation is unconstitutional which will effectively put everything back to square one or further behind in coming to a system ordinary citizens can afford, but we will have to see. In the meantime, we must deal with the everyday issues faced by individuals. Our team of experts is prepared to help work you through the maze, so please comment and send in your questions. We will have a new category on the site to host articles on Public health, but most will also be found at Featured Articles and/or Webb’s Daily Post. Finally, my webmaster insists I remind everyone that in order to defray his costs we do accept contributions. Please go to the Donate button and click on your mouse. There I did it maybe he’ll leave me alone for a brief while. W.

America Invents Act — Who does it Protect?

EDITORIAL NOTE – This post is written Philip Furgang, a noted New York patent law practitioner. Philip is the author of the forthcoming book, “Patent Prosecution” (Oxford University Press.) The views expressed are his own and do not necessarily reflect the views of the creator of this site.It is here to promote thought, discussion, and research rather than just trust our representatives to protect our interests.

The future of America lies in its ability to be creative — to “out think” the rest of the world. Come up with a great idea and you can become rich. You can build a business that will create many jobs. And there is a system in place to protect inventors, the patent system. Think of those who have done it: Thomas Edison, Henry Ford, Steve Jobs, Bill Gates, the Wright Brothers, and many, many more. That system, the system which made it all possible for the US to lead the world, a system in place since 1789, the system is about to be changed to discourage creativity, and to hobble the independent inventor. Large corporations have mounted a large lobbying campaign, spending huge sums of money, to get the so-called “America Invents Act” through Congress. They must be stopped. [More . . ]

Zach Carter observed in the Huffington Post:

Today, the patent bill looks like a scorecard tallying points for powerful corporations: a win for pharmaceutical companies whose monopolies are driving up Medicare costs; a win for Wall Street’s battle against check-processing patents . . . .
Left out of the tally is the public, even as the economic landscape for American families grows darker. Historian Richard Hofstadter famously observed that Congress during the Gilded Age busied itself with dividing the nation’s spoils among the rich and powerful. But as the current patent struggle suggests, the spoilsmen are back and Washington is once again an arbiter of who lands the lucre.

Here is just part of what the so-called “American Invents Act” will do if it becomes law and what you can do to stop it.

What the Proposed Bill Does:

Imagine this: you have a dispute with a large corporation and decide to sue. Then you find out that the winner of the law suit will be decided by, of all things, a race. Whoever wins the race to the courthouse steps wins the law suit. Sound ridiculous and farfetched. Think again.
Under the present system, the one who invents first gets the patent. What this means is that an inventor can’t be stopped because a huge corporation can beat the inventor to the door of the Patent Office. Under the so-called “reform” it will be whoever wins the race to the steps of the Patent Office will get the patent!

The repercussions are much broader than the obviously dishonest idea of giving a patent to someone who wins a race to the door of the Patent Office. To develop inventions takes time, effort, and money. By awarding patents to first inventors, the current system encourages development. Going to a first to file system, as called for in the proposed law, will discourage developments. More than that, it would increase the likelihood that patent applications would be defective because they would be filed too early in the development stage. But this is precisely the barrier to independent inventors that large corporations, who oppose startup competition, crave. Given such a situation, it would be no surprise that investors will be disinclined to support startups.

The current Patent Act encourages inventors by providing a grace period for filing a patent application. During this period small companies can go to the marketplace, seek financing, find manufacturing and marketing partners, or decide whether or not to file a patent application.
Under the proposed act, the grace period would be eliminated. Go out and promote your invention and you lose the right to file. This means that small businesses will have to file first and then find out if they should commercialize an invention afterwards. The proposed act would cause small businesses to incur additional and unnecessary expense, and thereby discourage innovation, development and job creation.

Under the present system, if a new method of doing business (say, a great way of delivering music on the Internet) is created, it can be patented.

The new act, if it passes, eliminates business method patents. There is not a single other industry that has a special patent provision to protect it, not one.

The present law gives competitors the right to have the Patent Office review an issued patent. The proposed law would give competitors more weapons to have patents reviewed and re-reviewed, in order to delay inventions and innovations and upwardly spiral an inventor’s costs. So to the cost of patenting an invention add the cost of defending it again and again and again. This ups the price and the risk for small companies and puts them into expensive (very expensive) litigation, litigation they might not want, may not be able to afford and may not be ready for. The mere existence of these procedures will be another way of closing out the small inventor and small businesses.

Under current law, a company must file a patent within one year of putting the invention into commercial use, whether or not the public is aware. The new act would changes the rules. A company will be able to use an invention in secret for years and then file a patent application years later. This undermines one of the major objectives of patent law – to bring the benefits of innovation to the public as quickly as possible. After all, the Constitution provides Congress the power to enact laws that “promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.”

Today, it’s one patent for one invention. The new act permits the filing of multiple applications for the same invention. Issue multiple patents for the same invention and thereby create a legal thicket which will be used to block startups and competition.

This one’s a beaut. Today an inventor must disclose the best method of making the invention. Under the proposed act, a large company can keep the best method secret so long as they can show some other way of practicing the invention. The whole idea of the patent system is to require the inventor to provide for the public benefit the best way of making the invention so that when the patent ends, everyone can make the invention. Now, large businesses can hold the best methods and processes secret, thus the defeating the purpose of our patent system.

No Social Security Checks Affects More Than The Elderly. Only Accountants Benefit.

by Webb Hubbell

President Obama tried to get Congress off the dime by saying come August the government may not be able to issue Social Security checks. Now I don’t believe this will ever happen. My bet is still a stop-gap solution with everyone pointing fingers and continuing to push the issue down the road. However, risk managers are paid to worry about such possibilities. So let’s just take one example, one the President has told the American people is a possibility, and run with it.

First, one month without checks would bring our economy to a halt. For the most part, recipients of SS checks spend the money as soon as the money hits the bank. If the money isn’t there grocers, landlords, and care takers don’t get paid. A huge monthly influx into the economy is shut down. Let’s look at one minor example go further. Millions of people receive SS Disability checks. What most people don’t understand is that almost all private disability policies provide that if the recipient receives SS the monthly private benefit is reduces by the amount of the SS payment. If SS Disability stops for even a month then for every individual who recieves both SS Disability and private insurance dollars the insurance companies are on the hook to their disabled customers for the monthly amount again. That means millions of dollars in cash must be used to pay policyholders who were off the books so to speak, causing cash flow problems for the insurance companies, restatement of balance sheets, and losses to shareholders.

This is just one possible repercution. Every major company in the country will be scrambling to put a number to the effect on their company our failure to pay the bills as they come due, will have. This is not just for the short term, if we default for one day, then every company, insurance company, bank, and business will forever have to footnote their balance sheet to compensate for future defaults. Once it floods, a piece of land is forever in the 100 year flood plain. Once the U.S. defaults it will forever be in the record book of once being in default, and individuals and countries will have to factor the likliehood again.

Look at the bright side of all this, one day of default will make the accounting industry’s year.

Why Writers Belong Behind Bars

Why Writers Belong Behind Bars

By Webb On July 25, 2011 · Leave a Comment [Edit]
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By TONY PERROTTET

Published: July 22, 2011

While researching the Marquis de Sade several years ago, I came across an intriguing biographical tidbit: that crazed French libertine, whose string of luridly violent works gave rise to the term “sadism,” actually began his literary career as a travel writer. In 1775, Sade embarked on a yearlong grand tour of Italy, and wrote an enormous (and enormously tedious) manuscript about the journey entitled “Voyage d’Italie.” The rambling opus, filled with ruminations on Florentine museums and Neapolitan customs, was never completed. Sade’s attention wandered to more carnal pleasures, and in 1777, he was arrested for a long list of unsavory imbroglios, including one that historians call the Little Girls Episode. Sade was thrown into the prison of Vincennes, and would spend most of his remaining life incarcerated. “Voyage d’Italie” soon joined a range of half-finished manuscripts from his youth, scraps of verse and staid dramatic pieces, none of which Sade ever had the discipline to complete.

From a strictly literary point of view, prison was the best thing that ever happened to the marquis. It was only behind bars that Sade was able to knuckle down and compose the imaginative works upon which his enduring, if peculiar, reputation lies.

Sade’s most impressive stint began after 1784, when he was transferred to the Bastille, which effectively operated as a literary colony on a par with Yaddo today. From a suite decorated with his own furniture and 600-book library (and tended by his valet), the marquis entered a mind-boggling frenzy of writing, cranking out thousands of manuscript pages at breakneck speed. As Francine du Plessix Gray describes in her classic biography “At Home With the Marquis de Sade,” he completed the first draft of his pornographic novel “Justine” in a single two-week-long burst, and knocked out the final 250,000-word draft of “The 120 Days of Sodom” in 37 days, transcribing minuscule letters on five-inch-wide pages glued into a roll nearly 50 feet long. By 1788, after only 11 years behind bars, Sade had churned out 8 novels and story collections, 16 historical novellas, 2 volumes of essays, a diary and some 20 plays. Whatever you make of Sade’s oeuvre, you have to envy his productivity.

Literary distraction seems a very modern problem. These days, distracted writers tend to blame the Internet, whose constant temptations shred our attention spans, fragment every minute and reduce us to a permanent state of anxiety, checking e-mail every 30 seconds — “like masturbating monkeys,” a writer friend once put it, a phrase of which Sade himself might have approved. But history is filled with writers who, like the marquis, could function only in extreme — and involuntary — isolation.

“A prison is indeed one of the best workshops,” Colette declared. She wasn’t speaking metaphorically. In the early 1900s, by her own account, her caddish first husband had stashed her in a tiny room for four hours a day, refusing to let her out until she had finished a requisite number of pages — a drastic measure, but one that resulted in a novel a year for six years. “What I chiefly learned was how to enjoy, between four walls, almost every secret flight,” she later recalled, sounding almost sentimental.

The peripatetic Marco Polo got around to recording his classic travels through China only because he was captured in 1298 during a naval battle with Genoa and held in a lavish palazzo. Five hundred years later, the playboy Giacomo Casanova found time for his renowned erotic autobiography only after he had run out of money (and libido) and retreated to Castle Dux in Bohemia, where he accepted a sinecure as a librarian. Napoleon Bonaparte dictated his multivolume memoir — one of the great best sellers of 19th-century France — thanks only to his long exile on St. Helena. Even the harsh public jails could induce results. In 1897, Oscar Wilde wrote the philosophical essay “De Profundis” while locked up in Reading Gaol on charges of “unnatural acts.” And in 1942, Jean Genet wrote his first novel, “Our Lady of the Flowers,” while in Fresnes prison, near Paris, for petty theft, scrawling on scraps of paper.

Of course, few writers seriously dream of a stay in a latter-day Bastille, though until recently it still seemed relatively easy to recreate a kind of makeshift solitary confinement. In 1992, in “The Writing Life,” Annie Dillard described pushing her desk away from the windows in her tool shed study on Cape Cod, which looked out on lovely pine forests, to face a blank wall. (“Appealing workplaces are to be avoided. One wants a room with no view, so imagination can meet memory in the dark.”) John Cheever preferred his New York apartment building’s dark and dismal basement, and the Algonquin Round Table wit Edna Ferber recommended facing the “blank brick wall of a cold-storage warehouse.”

Today, however, being chained to the desk, as the expression goes, is no longer a guarantee of productivity. Who can stick with the blank page when the click of a mouse opens up a cocktail party of chattering friends, a world-class library, an endless shopping mall, a game center, a music festival and even a multiplex? At once-remote literary colonies, writers can now be spotted wandering the fields with their smartphones, searching for reception so they can shoot off a quick Facebook update. These days, Walden Pond would have Wi-Fi, and Thoreau might spend his days watching cute wildlife videos on YouTube. And God knows what X-rated Web sites the Marquis de Sade would have unearthed.

It’s wonderful that writers can access medieval manuscripts, Swahili dictionaries and collections of 19th-­century daguerreotypes at any moment. But the downside is that it’s almost impossible to finish a sentence without interruption. I confess that even those last 15 words were stalled by a detour, via Wikipedia, to various health Web sites, where I learned that concern was aroused last year by a report that Wi-Fi radiation was causing trees to shed their bark in a Dutch town, and that our excessive Web browsing and e-mailing may also be having ill effects on bees and British children. After an hour of this, I concluded that perhaps an equally urgent scientific study might be conducted on the devastation Wi-Fi has caused to world literature. The damage is surely incalculable.

Although everyone I know acknowledges the problem of digital distraction, there is surprisingly little resistance. In New York literary circles, anyone who doesn’t have a Twitter account qualifies as a radical Luddite. But some have made gestures toward enforced self-denial. The novelist Jonathan Lethem has said he owns two computers, one of which he had Internet-disabled to use for his fiction writing. Dave Eggers, Nora Ephron and others have extolled the computer program Freedom, which cuts off your computer’s Internet access for up to eight hours. Jonathan Franzen wrote “The Corrections” in a dark room wearing earplugs, earmuffs and a blindfold, and confessed to blocking his Ethernet port with Super Glue while working on “Freedom” (not named, apparently, for the software program).

Of course, there are even simpler solutions. Another of France’s wildly prolific authors, Honoré de Balzac, felt that the most effective spur to productivity was abject poverty. As a best-selling writer in his early 30s, Balzac looked back fondly upon his younger days as a bohemian, living in a garret and gnawing on a diet of bread, nuts, fruit and water. (“I loved my prison,” he wrote, “for I had chosen it myself.”) Even when successful, he would wake at midnight, symbolically don the habit of a medieval monk, and write for eight hours straight, fueled by pots of coffee. His biographer Graham Robb suggests that Balzac went so far as to deliberately run up debts to force himself to churn out the pages. Given the dwindling amounts writers are paid these days, the fear of bankruptcy — the modern debtor’s prison — remains an inspiration to us all.

Tony Perrottet’s latest book is “The Sinner’s Grand Tour: A Journey Through the Historical Underbelly of Europe.”

A version of this article appeared in print on July 24, 2011, on page BR27 of the Sunday Book Review with the headline: Serving the Sentence.

Fast Bytes and Slow Food: Chattanooga’s New Formula

Editor’s note: The following article is offered in continuation of our series of articles on Public Health.

By Neal Peirce
Washington Post Writers Group

Posted: Friday, Jul. 08, 2011

CHATTANOOGA, Tenn. A handsomely made, people-friendly Riverwalk runs along the Tennessee River, tied to the old Walnut Street Bridge that’s been painted a deep happy blue and is now reserved for walkers and bikers. The Tennessee Aquarium features freshwater fish. Electric, fare-free buses run up and down Broad Street. There’s lots of art, outdoor sculpture included.

From a smoke-clogged industrial disaster a generation ago, Chattanooga has come a stunning distance, spurred on by organized citizen action and generous local foundations. It recently garnered national attention by attracting Volkswagen’s new $1 billion LEED-aggressive assembly plant.

But all is not well. The downtown has an empty feel – in fact 1 million square feet of vacant office space. Relations remain strained between the city and the rural Tennessee, Georgia and Alabama counties that surround it. Education levels still lag seriously.

So what’s next? It’s a mix of bytes and bites, or put another way, fast gigabytes and slow food. That’s the fascinating mix for this decade that Chattanooga political and business leaders had to tell a meeting of the Citistates Group, which I chair, in Chattanooga late last month.

Leading the byte breakthrough is the city-owned Chattanooga Electric Power Board, which services 170,000 customers across nine Tennessee and Georgia counties. Winning a highly competitive $111.5 million matching grant under the 2009 Recovery Act, it’s installing a fiber optics network capable of providing one gigabit-per-second Internet service. Among the fastest in the world, it’s 200 times faster than the average national download speed today.

Receptors in the system will make it possible to create a “smart grid” to warn communities of oncoming weather disasters, to monitor sewage – averting any overflows into the river – and to fight crime. The utility’s latest goal is to connect every streetlight to the grid, making it possible to turn up the lighting at any location to intense, high levels when a crime incident is suspected.

The reliability of the grid’s electric power supply is also rising – proved this April when the utility was able to perform a rapid restoration when a tornado ripped through the region, cutting off many customers’ power. Plus, consumers will have new power to monitor their electricity use.

The Chattanoogians’ next challenge is how to build a new economy around the rapid smart grid service – and before other regions catch up. New companies may be attracted, for example, by virtually instantaneous videoconference capability that might attract footloose young entrepreneurs in search of short commutes, mountain trails and other smaller city amenities. There is some question about how well the region supports startup firms, but an “angel” venture capital fund – Chattanooga Renaissance – fills some of the gap.

Chattanooga’s other ambitious new agenda is promotion of locally grown foods – tasty, healthy, fresh, and produced from city backyards out to the 13-county surrounding area. The food initiative is being pushed by the locally based Benwood Foundation, committing $1.65 million to a three-year “Gaining Ground” initiative.

In one way, it is a throwback to the past, when local farmers could sell their produce, poultry and meats to local wholesalers. But the nation’s move to gigantic national processing chains and factory farms has shredded the local system. Today, says Jeff Pfitzer, leader of the Chattanooga region’s new local food movement, less than one-tenth of 1 percent of the region’s food spending goes to area farms. Raising the figure to 5 percent, he calculates, would represent $100 million in economic development.

There are basic health issues too, including food “deserts,” both in the low-income Chattanooga neighborhoods and county areas suffering high poverty levels.

But Gaining Ground seems ready to take on the broad challenges, from providing people with skills on how to grow their own food to creating new regionwide sales channels for local produce. It’s launched “Chattanooga Grown” – a “Harvested Here” branding that highlights 80 quality-checked local farms that already sell directly to consumers or through grocery stores and restaurants.

“The strategic value of this initiative means it should be treated as a major economic issue,” notes David Crockett, director of Chattanooga’s Office of Sustainability and a former city council chair. “It links all parts of our community. It responds to the threat to our national security posed by long supply lines. It protects farmland from subdivisions. And it poses a real intergovernmental challenge, spanning a three-state area.”

The point is intriguing: If a human and economic need as basic as food can’t reconnect city and county, making allies of longtime competitors, then what can? And if not Chattanooga, with its track record as a successful risk-taker, then what other American city?

Neal Peirce is a columnist for Washington Post Writers Group. Write him at nrp@citistates.com.

Read more: http://www.charlotteobserver.com/2011/07/08/2436344/fast-bytes-and-slow-food-chattanoogas.html#ixzz1RWUSXcoB

Time For a Little Game of “Hot Potato.”

By Webb Hubbell

Ever play the game as a child of “hot potato?” A small group of people get in a circle and toss a potato around. If you drop the potato or hold it too long you “get burned.” You are out until the remaining two are hitting the potato back and forth as fast as they can, until the last person drops or holds on to the potato. Congress and the President play “hot potato” with issues all the time with the American people the “always loser.” It is always someone else’s problem, fault, idea, or “potato.”

Today let’s play hot potato with a few news stories. You take a minute and comment or respond on the following:

1. Roger Clemon’s trial begins today. He is accused of lying to Congress. Many sports commentators in the past few days have commented, “Congress lies to us all the time, why are they accusing Clemons?” Does Congress have any business hauling athletes before a committee and forcing them to testify? Should our prosecutors spend millions of dollars going after Roger Clemons and Lance Armstrong?

2. Will the President and Congress come up with a long term solution to our “debt crisis,” or come August will they pass the “potato” down the road? Want to take bets on this one based on past performance.

3. Casey Anthony is not guilty of committing murder? True or False. This is a trick question, of course she is not guilty. Better question do you believe Criminal trials should not be equated with a search for the truth? They are merely a process for the testing of evidence: Can the state prove the charges against a defendant by proof beyond a reasonable doubt? If you think we should change the system ask yourself, if I was being charged with murder you did not commit, what would you want the standard of proof to be?

The “potato” is now heading in your direction. Let’s see what you do with it.

Happy July 4th

by Webb Hubbell.

Enjoy the day. Have a cold beer and a polish dog, and celebrate the progress we have made toward freedom, and the work still left to do. Listen to Ray Charles sing America the Beautiful and Jimmi Hendrix play The Star Bangled Banner. Remember those who gave their life for our experiment in Liberty, and say a silent prayer for those who battle in the trenches everyday to fight for the civil liberites that we take too much for granted and are under attack by those who believe that criticism should be silenced and patriotism means my country right or wrong, or that the inalienable rights are reserved for those who possess wealth and/or power. Read the Declaration of Independence again today and enjoy the celebration of a beginning not an end.

All Hands Off Weiner

By Bill Press

Tribune Media Services

The reasons for him to resign were loud and strong. And we remember them well…

We expect better from our elected officials. It’s a matter of character. He’s a bad role model for our children. If he can’t be trusted to keep his wedding vows, what else can he be trusted with? He lied. He betrayed those who voted for him. And the Democratic Party will never get anything done as long as he’s in office.

Sound familiar? They should. Because those were the arguments shouted out by Republicans, and some Democrats, for Bill Clinton to resign as soon as the Monica Lewinsky scandal broke, back in January 1998. And they’re the very same arguments we hear today, demanding the resignation of Congressman Anthony Weiner.

They’re loud. They’re strong. And they’re wrong. Wrong then, and wrong now. Clinton was right not to resign. And today he’s more effective, and more highly respected, than ever before.

Which is not to defend Weiner’s sexting and sending lewd or nude photos over the Internet to six different women he’d only met online. It’s everything you want to call it: inappropriate, disgusting, immature, bizarre, and shockingly stupid for so smart a man. But one thing it was not. Unlike Clinton’s lying under oath, or David Vitter’s hiring of prostitutes, or John Ensign’s lining up lobbyists for his lover’s husband, Weiner’s transgressions were not illegal. Phone sex may be a strange hobby for a married man — why not just go bowling? — but it’s not against the law.

Until the congressional ethics investigation, immediately demanded by Democratic Leader Nancy Pelosi, is completed, we also won’t know whether Weiner used a government BlackBerry or computer to reach his online girlfriends or made calls from his office phone. Even so, the result would be an official reprimand or fine, not expulsion from the House.

Weiner’s not the first, of course. He’s but the latest in a long line of politically powerful men — notice, only men! — brought down by a sex scandal. Think John Edwards and Chris Lee. And he validates the feminists’ theory that all men think with their penis instead of their brain. That’s especially true of men in political, sports, celebrity, or corporate power — think Tiger Woods, Arnold Schwarzenegger and Dominique Strauss-Kahn — who believe they can do anything and get away with it by lying.

The wall-to-wall coverage of Weiner’s Internet compulsion also underscores the media’s neurotic obsession with sex. If Weiner were caught taking a million-dollar bribe from an insurance company, it would have been a one-day story at best. Yet, unlike Europe or Asia, America’s media pay little attention to financial misdeeds, yet can never get enough of sexual hanky-panky.

Meanwhile, reaction to “Weinergate” by members of both parties has been both predictable and disappointing. Republicans, of course — ecstatic that, for once, it’s not one of their own caught with his pants down — have responded with transparent indignation. They demand that Weiner step down immediately: a punishment they somehow never deemed necessary for Henry Hyde, Dan Burton, Newt Gingrich, John Ensign, Larry Craig, Mark Sanford, or David Vitter.

At the same time, Democrats — fearful that Weiner makes all liberals look uncontrollably horny — have been too quick to throw him under the bus. They make the mistake of thinking that average Americans care as much about this issue as cable television producers. When, in fact, most people are more interested in saving or finding a job than whatever Weiner did while his wife wasn’t looking.

Leaders of both parties forget that, in the end, they have nothing to do with whether Weiner stays or goes. His constituents are the ones who sent him to Washington — and they’ll be the ones who ultimately decide whether he keeps his job or not. In the end, as the New York Post so appropriately put it, “Erections Have Consequences.”

In Brooklyn and Queens, November 2012, voters will once again be offered a choice: between a man who fights for all the issues they care about, but happens to have a zipper problem; and a man who’s pure as the driven snow, but willingly wallows in bed with oil and tobacco lobbyists.

The choice is clear. Whatever his personal failings, Anthony Weiner has been one of the bravest, strongest, and most effective members of Congress ever. If he runs for re-election, he’ll be easily re-elected.

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Bill Press is host of a nationally syndicated radio show and author of a new book, “Toxic Talk,” available in bookstores now. You can hear “The Bill Press Show” at his Web site: billpressshow.com. His email address is: bill@billpress.com.

(c) 2011 Tribune Media Services, Inc.

Locked Up, Locked Out

The social costs of incarceration

by Bruce Western from the July 2011 issue of Reason

Do prisons make us safer? By taking would-be offenders off the streets, prisons clearly have reduced crime in the short run. In the long run, though, imprisonment erodes the bonds of work, family, and community that help preserve public safety.

Three effects are fundamental. First, former prisoners do worse economically than if they had never been incarcerated. We can see some evidence in a study I conducted in 2004 with the Princeton sociologist Devah Pager. We ran an audit experiment that sent trained testers to apply for more than 1,000 entry-level jobs throughout New York City. The fake job applicants were dressed similarly, gave similar answers, and provided résumés with identical education and work experience. At each job interview, however, one randomly chosen tester would tick the application box indicating a criminal record and submit a résumé that mentioned a prison and provided a parole officer as a reference.

White testers who were assigned a criminal record received call-backs or job offers from employers only half as often as testers with clean records. For African Americans, a criminal record reduced employment opportunities by two-thirds. Labor force data from the National Longitudinal Survey of Youth paint a similar picture of incarceration’s negative effects: Wages fall by about 15 percent after prison, yearly earnings are reduced by about 40 percent, and the pay of former prisoners (unlike compensation for the rest of the labor force) remains stagnant as they get older.

The second important effect of imprisonment falls not on ex-inmates but on their families. About half of all prison and jail inmates are parents with children under 18. By 2008 about 2.6 million children had a parent in prison or jail. By age 17, one in four African-American youth has a father who has been sent to prison.

Because of their poor job prospects, formerly incarcerated fathers are less able to contribute financially to their families. Because incarceration strains marital relations, those fathers are also less involved as parents. Compared to otherwise similar kids whose parents haven’t been behind bars, the children of incarcerated parents are more likely to be depressed, behave aggressively, and drop out of high school. These problems appear to be more common for boys than girls. Incarceration, it seems, is weakening the bonds between fathers and sons.

The third important effect of incarceration is cultural, shaping how the institutions of law and order are viewed in high-crime/high-incarceration neighborhoods. The prison population is drawn overwhelmingly from low-income inner-city areas whose residents come to associate police and the courts with the surrounding social problems of violence and poverty. Police are viewed as unhelpful, and often unaccountable, contributing to what the Harvard sociologist Robert Sampson calls “legal cynicism” in troubled, crime-ridden neighborhoods.

Part of the power of punishment as a deterrent to crime is the shame and stigma of a criminal record. Where incarceration has become commonplace, as it has in poor African-American communities, the righteousness of the police is no longer assumed and a prison record is not distinctive. The authority of the criminal justice system has been turned upside down, and the institutions charged with maintaining safety become objects of suspicion.

The negative effects of incarceration reduce the penal system’s capacity to control crime. Drug dealing and other illegal activities are more attractive to people with prison records, who have few legitimate prospects. Children of incarcerated parents, without a secure and predictable home life, are at risk of delinquency and school failure. And a community, soured on a capricious and unaccountable police force, is less likely to call for help or assist in investigations.

Because of the mounting social costs of incarceration, the benefits of prison have reached a point of diminishing returns. Sixty percent of state inmates are re-arrested within three years of being released from prison. Recidivism rates have not fallen despite a fourfold increase in incarceration rates since the 1970s.

We may care little about the job prospects of ex-cons. We may not even care much about their children or neighborhoods. But if the social costs of imprisonment grow without limit along with the prison population, mass incarceration becomes a self-defeating strategy for crime control.

Reducing these social costs is an urgent priority. Successful programs now offer transitional jobs to released prisoners, support the children of incarcerated parents, cultivate police-community relations, and send fewer people to prison in the first place. Measures like these reduce the social damage of mass incarceration and promise a sustainable public safety.

Bruce Western (Bruce_Western@harvard.edu) is a professor of sociology and director of the Program in Inequality and Social Policy at Harvard University.

1099 Provision Repeal Signed Into Law

by Tom Seltz / Marvin A. Address and Associates, Inc. (4/15/2011)

Yesterday, President Barack Obama signed into law the “Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011”. In short, this law affectively repealed the Patient Protection and Affordable Care Act’s “1099 provision”, which had required organizations to submit 1099 forms on all payments for goods of $600 or more annually to other businesses beginning January 1, 2011. It also altered some of the upcoming rules pertaining to Exchange Overpayments, which will not come into play until January 1, 2014.

More can be read about this new Act at http://www.washingtonpost.com/blogs/2chambers/post/obama-signs-repeal-of-health-care-laws-1099-tax-reporting-rule/2011/04/14/AFRhYjeD_blog.html.

Please note that there are still many parts of the Patient Protection and Affordable Care Act that are not yet enforceable because Health and Human Services and/or the Department of Labor have not released regulations, even though the deadlines have passed. This includes the new non-discrimination rules for all group health plans (described in the law only as “to be similar to the Section 501(h) rules”), the new health Plan Summary requirements, and the CLASS ACT (a federal long term care program) that was to have begun January 1, 2011. We will keep you updated as those requirements become more clearly defined over the next several months, and will advise you when they become enforceable.

As always, if you have any questions regarding the slowly evolving Affordable Care Act or how it affects you or your organization, please do not hesitate to contact me directly. I will be happy to answer whatever questions I can. Additional information may be available through your attorney, tax consultant or healthcare.gov, as appropriate.

Tom Seltz is an insurance broker focusing primarily on group health, life and disability insurance for unions, non-profits and small businesses. Tom is currently a member of the DC Health Insurance Exchange Subcommittee of the Mayor’s Health Reform Implementation Committee, tasked with providing analysis and recommendations to the Mayor on the set-up and implementation of the District of Columbia’s Health Benefits Exchange. In addition, Tom is a produced playwright, screenwriting hobbyist, part-time film script consultant and avid film buff.

Transparency – Seeing Behind the Curtain

by Carlye Christianson

For a nonprofit, transparency is one of those ubiquitous concepts about which we hear, but one that we cannot quite understand what it means or how to achieve it. Transparency is an essential aspect of sound governance. It builds trust; it enables donors, service recipients and other constituents to make better decisions; and transparency encourages charitable giving.

Shortly after the passage of the Sarbanes Oxley Act of 2002, the discussion of transparency in nonprofits focused on addressing information concerning
• financial accountability and
• the cost and effectiveness of the mission and programs.

Increased interest in process has expanded the standards of transparency to include disseminating information as to
• how decisions are made and
• how information is communicated.

But the question remains: How to evaluate the quality of your communications for transparency. In large measure there are few objective measurements. One approach is to look at the information your organization provides on its website and in marketing materials to determine if you are:
• presenting all relevant information, and
• presenting the information in a way so that a donor can feel confident that all knowable and relevant information has been provided.

Posting the Form 990 and audited financial statements seems to be a minimum. But making the information accessible also must be supported by making the information understandable. Many people may need, or the information contained in the reports may dictate, a narrative of some aspect of the financials. This is especially true if there has been a significant change in revenues or expenses or reserves. So, if reserves were significantly diminished because of reconstruction in office space, add a paragraph. If revenues decreased by more than an expected level, explain what was taken into consideration in budgeting anticipated revenues. If fundraising expenses increased because of a capital campaign, address the issue. If space is being rented from a board member explain the process undertaken to ensure the rent being paid is appropriate.

Including brief biographic information on board members and senior staff leadership opens the door to donors or other constituents to know the people who are involved in the decision making processes.

Identifying the standards – objective or otherwise – used to determine whether a program is successful is an important piece of transparency. If your nonprofit provides services for the homeless and success is measured in the number of beds available, that information should be highlighted. If the success though is measured in terms of the number of people or families transitioned to permanent housing, that measure should be highlighted as well. Look at you website and your marketing material to ensure adequate information is provided so the reader knows the impact of your efforts.

In its March, 2011 publication, the Chronicle of Philanthropy printed an article by Bob Carlson of the Missouri Attorney General’s office. His office deals with complaints regarding nonprofits. He noted that lack of transparency, failure to disclose information and other related topics are at the source of more complaints than almost any other issue. The complaints are not a result of unmet expectations, but rather as a result of the absence of information. The vacuum created with a lack of information creates distrust.
“Transparency sheds light on an organization’s practices, and that enhances incentives for ethical, efficient and effective operations and facilitates oversight by the public and others.”

Interest in what is happening behind the scenes has never been greater than it is now. Take care in letting people see what’s behind the curtain.

Editors Note: Carlye Christianson is a leading expert in discrimination law and risk management for non-profit organizations. She writes, lectures, consults and trains nationwide. She is headquartered in the DC area. We are fortunate to have her as a new contributor and affiliated with our site. Look for more of her analysis in week’s to come. Carlye can be reached at carlye.cb@cox.net.

Health Care Reform — Things To Consider, Health Status Predictors

by Tom and Casey Milne.

In the context of the health status dialogue, we thought your readers would be interested in taking a look at how health status predictors vary by state. Folks can go to http://www.countyhealthrankings.org/ and then click on their state (or any state of interest). Data is given across several dimensions of health-related factors – smoking, education, income, etc., for the entire state. Further, folks can click on their county and see how it compares with state-wide data or national data. The maps identify the healthiest and the least healthy counties by state and compare some of the relevant factors. The rankings were published by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.

The table below compares the healthiest county in Oregon (Benton) against the least healthy (Jefferson). We’ve just included a few of the factors to make a point: Both populations enjoy approximately the same access to health care as each other. But health status varies significantly because of choices of personal behavior (smoking, violence), education, income, etc.

Health Factor Benton County Jefferson County
Low Birth-weight babies (per 1000 births) 5.1 7.1
Adults who are smokers 12% 19%
Adults who rate health poor or fair 10% 18%
Violent Crime Rate (per 100,000) 143 229
High school graduation rate 80% 70%
Uninsured adults 26% 26%

The point that we are making here is that factors such as education, income, personal behavior, and environmental issues are actually of greater importance collectively to how healthy a population is than the importance of access to medical care. Medical care is certainly important and it does save lives. But when a country spends as much as we do (approaching 18% of GNP yearly) and gets the outcomes we do (average ranking among first and second world countries in the world is about 35th), one has to think that outcomes can be improved if we just place more focus on education, housing, nutrition and the other health predictors. Food for thought.

Tom and Casey
Contact Tom and Casey at www.milneassociates.com