A procurement and systems analyst perspective on single-payer

One of the key reasons US manufacturing declines is that it has to compete with manufacturing in countries who don't tie health insurance to employment, relieving their employers of a huge cost burden. Image via Wikipedia

A friend whose father was a highly successful systems analyst and procurement expert for top socialist organizations (IBM and the Pentagon) took a look at health care from a systems perspective and came up with single-payer as the answer.

Top Ten Reasons Why We Absolutely Need Single Payer Healthcare

1. It will be much easier to get everyone covered without people being shuttled around seeking coverage and falling through the cracks, or suffering delayed approval and care when they become expensively sick. The dollar savings from eliminating this wasted time and effort will be significant in and of itself.

2. It will allow doctors to concentrate on patients, not their billing and collection problems as currently driven by multiple insurance providers with different requirements and paperwork.

3. It will make it possible, through compensation adjustments, to rebalance the number of medical practitioners by area of specialization to better meet the needs of the patient base. It also facilitates payment based on quality (outcomes), not just quantity of care.

4. It will facilitate, through payment incentives, improvement in the availability of health care services in currently underserved areas.

5. Because of the enhanced auditing capability inherent in a single payer system, it allows the day to day billing and collection process to be run on a presumption of integrity and honesty, thereby greatly simplifying procedures and paperwork for all involved.

6. It will create an environment where the pharmaceutical companies and medical equipment suppliers will be forced to deal with a very competent customer, instead of a group of disorganized ones.

7. It will create a situation where common accounting standards, utilizing direct costing principles and practices, can be implemented at hospitals, thereby linking costs and billing with services provided.

8. Once the payment process is centralized, it will facilitate meaningful analysis to identify cost drivers in all areas so effort can be concentrated on fixing them.

9. It will converts the twenty to twenty-five cents of every premium dollar currently expended by private insurers on excessive salaries, administration, advertising and profit into payment for healthcare services. This goes a long way toward paying for the fifty million people to be covered.

10. All of the above subjects are or should be part of a real health care reform effort, in fact, they are vital components. However, none of them have been or realistically can be accomplished (have a snowballs chance in hell) utilizing a process with private insurers as its backbone.

Hello, City of Salem! Walkable Neighborhoods Increases Home Values

You can find old houses that were once beautiful throughout poorer sections of Salem, nearly always abutting high speed roads that have destroyed the homes along the streets that ferry the well-to-do to their neighborhoods across town. Image by McMorr via Flickr

And that increases property tax revenues. This isn't hard, people -- the value of homes are inversely proportional to the average speeds on the streets they front.

Most of what city officials do these days in the name of "planning" consists of figuring out ways to cater to the automobiles of people in well-off neighborhoods at the expense of people in less-well-off neighborhoods, imposing "mobility standards" that essentially offer up the neighborhoods of the poor and minority areas as high-speed sacrifice zones for the richer people to drive through (with monstrous "improvements" naturally slated for these areas, where the people are too poor to fight back).

Look at any decrepit section of a residential area where there are once-beautiful homes oddly close to the roads -- you will find that these were once grand homes but, when the road got wider, they became rentals and then meth dens and now sit as reproachful monuments to our "Auto Uber Alles" idea of city planning.

Shameful. And stupid.

UPDATE: Hat tip to RR for this:

"UGB expansions involve big stakes. Expansions can cost taxpayers hundreds of millions in new infrastructure and services, reduce quality of life, damage natural areas and increase global warming. But developers and land speculators can cash in on a sometimes 10-fold increase in land values." --- John Platt, Helvetia Winery

From Planning for Sprawl: Staff study betrays bias for unbridled development, by Alan Pittman Eugene Weekly.

Imagine Minto's Ag Acreage as the Super Farm-to-School Lunch Site

This is the kind of food kids need, and that kids love if they get to help grow it. Image via Wikipedia

There's widespread recognition that the school lunch program reflects the worst of our country's agricultural policies, which are firmly in control of Big Agribusiness and operate to the detriment of all eaters, especially the most vulnerable ones, children. Schools are used as a dumping ground for surplus goods more than as a place where children might learn healthy eating habits.

Lost in the rush to grab a tiny few stimulus dollars under an "emergency flood control" easement by locking away 200 acres of rich, prime farmland in Minto Brown Island Park is any effort to see the possibilities for addressing numerous social ills by keeping the land as agricultural land. Not least among these is the chance to convert that acreage into community gardens and even into a unique opportunity to promote better nutrition in schoolchildren by giving over as much acreage as needed to growing food for school breakfast/lunch programs year-round (especially in summer when many poor children suffer a huge drop in nutrition).

The ag land on Minto can become the centerpiece of a revitalized curriculum that teaches kids (and the adults who care for them) not only about the benefits of good food but also how to grow that food in a way that preserves and protects the environment, while building up kids' sense of themselves as people who have a purpose and who contribute to the wellbeing of their families. The loss of useful chores -- tending the kitchen gardens, caring for hens -- is one of the saddest things about childhood today, where children are trapped in an auto-dominated world that imprisons them in their cul-de-sacs with nothing useful to do. Sure, there's make work chores, but they don't build a sense of agency and responsibility the way meaningful contributions do.

UPDATE: A must-read book is available from the Salem Public Library and our local booksellers: "This Organic Life: Confessions of a Suburban Homesteader" by Joan Dye Gussow. (Chelsea Green Press). This is outstanding, wily writing, with lots of tempting recipes, leading the reader gently, painlessly, but inexorably into thinking deeply about food and where it is grown and the costs of our obliviousness to those things. Blurb by Barbara Kingsolver, whom many consider a Goddess of Food Writing:

The most important book I've read in a long while. Full of hope, kindness, and arresting wisdom, it iwill serve as a valuable guide to anyone who wants to live more thoughtfully on the only planet that feeds us.

Bad Precedent Rising: Still time to speak out

This is an old Oregon plat map. One of the very first and most important acts of government in North America has been platting land and defending those boundaries. Image by Beaverton Historical Society via Flickr

Sometimes it seems that there's simply no idea so bad that some body of elected officials won't embrace it heartily, despite its gross defects.

Take rewarding people who poach public park land, for instance. One of the first and oldest principles in law is that you cannot obtain title to government land by adverse possession. This reflects a deep and historically unbroken recognition that public land is a special form of public trust. That is, it's not just that the land is valuable, the way cash is valuable. It's more that public lands are irreplaceable, and public officials are simply trustees for that land for the rest of us, caretakers in other words; it is not theirs to give away to their friends, campaign contributors, or even sympathetic but careless homeowners who encroach on it.

The Marion County Commissioners appear determined to make the worst caricatures of politicians come to life as they, against all reason and advice, try to create a terrible precedent by giving away something that is not theirs to give, stealing it from the rest of us and violating their oaths of office to do so:

Problems arise when squatters claim public land. Squatting is like stealing because it is taking possession of something that doesn’t belong to you.

In spite of that basic truth, Marion County Commissioners are considering giving public land to property owners who have no claim to it.

The hearing on this case is called: PLA/FP/Greenway Case No. 09-017

And it is taking place Wednesday, August 19 (tomorrow), at 4PM, at the County Building; 555 Court Street, Main Floor.

Here’s the background:

Property owners bought property next to Spong’s Landing (a county park) and fenced off some of the park land.

In May 2008, Marion County Public Works wrote to the property owners ordering them to remove the sections of their fence that enclosed a part the park. The property owners appealed and asked the County to give them title to the enclosed park land.

This required a hearing where NO ONE testified in favor of yielding the park land. In spite of the public outcry, the commissioners voted to sell the land to the property owners for $5000.

Concerned citizens put up the money and filed an appeal with the Land Use Board of Appeals (LUBA). LUBA agreed with the citizens and told the commissioners to find another solution.

Now the commissioners are simply redrawing the Spong’s Landing property line and giving the park land to the property owners.

Giving park land away like this is extremely unusual. There are no provisions for it in the Comprehensive Plan and the Marion County Parks Commission objects to it. It doesn’t serve the public interest, and it ignores the unanimous will of the people.

The Commissioners could have followed the rules and supported staff’s legal notice ordering the property owners to vacate the park land. Instead they have let the matter drag on for several months and consume thousands of dollars of public funds.

The Commissioners should stick to the rules.

Please attend or testify that the property line adjustment be DENIED.

Testifying is one way you can claim standing if there needs to be another appeal.

For more information contact: Aileen Kaye, 503-743-4567

While we were busy obsessing about the terror of urban hens . . .

This is the type of portal by which tons of toxic-bacteria-loaded fecal wastes from dogs and cats enter our waterways. Image via Wikipedia

. . . dogs and cats -- whose waste is toxic, rather than an outstanding soil amendment -- run and do their business all everywhere, degrading our water, killing songbirds by the millions (cats), contract and spreading rabies, causing car accidents, and occasionally mauling or even killing people (dogs).

Public hearing at City Hall at 5:30 p.m. tonight (8/18) so the Planning Commission can decide whether to recommend taking pet hens out of the definition of prohibited "livestock" in Salem's land use ordinances. This would allow the City Council to devise a city ordinance on hens without having to treat everything having to do with hens as a land use issue (which requires involving the Planning Commission). So whether you're for or against urban hens, you should be for this proposal, so that the decision on hens goes to the right place (the electeds rather than an unelected land use board). If keeping hens is a land use issue, then keeping dogs and cats with all their attendant problems should be a land use issue too, and should require much more stringent controls and enforcement.

A mission for dog owners: Pet waste contaminates water supply

An average dog generates about one-half pound of waste per day, which translates into about 12 tons of untreated waste per day, according to Mary Middleton, a research biologist with the Pacific Shellfish Institutes in Olympia.

In addition, one gram of dog waste, which weighs the equivalent of a business card, contains 23 million fecal coliform, almost twice as much as human waste.

All it takes is a hard rain to wash pet waste off streets, sidewalks and lawns into storm drains that empty into lakes, streams and Puget Sound. Once in the water, the bacterial contamination can lead to swimming area and shellfish harvesting closures.

"Pet waste is a concern to shellfish growers," Middleton said. "It's even more of an issue when you have a lot of concrete and impervious surfaces."

In 2000-01, the Thurston County Department of Environmental Health studied sources of bacterial pollution in Henderson Inlet. Failing septic tanks and pet waste turned out to be the main culprits. . . . For years, the message to dog owners has been to either seal their dog's waste in plastic bags and put them in the trash, or flush the waste down the toilet, if you're on a sewer system.

But the . . . the region's sewer utility, recently recommended against customers adding dog and cat waste to the wastewater load.

Pet waste is dry, and hard to move through the sewer system, said LOTT spokeswoman Lisa Dennis-Perez. Also, it contains different bacteria and pathogens than human waste, which could make it harder and more expensive to treat.

"It's not that we've had a problem," Dennis-Perez said. "But that's a huge volume of waste, if everyone started flushing it down the toilet."

Capitol Chess Club makes first move @ the Ike Box

Image by betsythedevine via Flickr

Fifty years from now, a small handful of middle-aged guys and maybe even a few hale really oldsters will be able to say that they were there when a chess club started back up in downtown Salem, as the Capitol Chess Club got launched today with a smallish but pleasant turnout at the IKE BOX. The club will meet every Monday night at 6 p.m. and play until close (8 p.m. through Labor Day, 10 p.m. thereafter). Join us!

TIP FOR PARENTS: Introducing your child to chess is one of the best gifts you can give. Check out this amazing site, Chess Magnet School, where you can find a carefully constructed set of chess lessons that start with absolute beginners and take them gradually through progressively-harder chess lessons that are truly wondrous. In chess as in languages, young people are like thirsty sponges -- they soak it up effortlessly, quickly mastering skills that us old folks struggle to master. There's a 30-day free trial (with full features) there, and it's very inexpensive to continue after that. Many of us old codgers are jealous of tools like this, imagining how much better we'd be at chess if we had such good instruction available to us. Check it out!

P.S. Chess Magnet School is not just for kids -- adults who know how to play but were never very good at it can get much better quickly too!

Join Friends of Salem Saturday Market and get great, behind the scenes access to delicious local food!

Why join Friends of Salem Saturday Market?

Well, in addition to being cool, and some neat trinkets for members at higher donation levels (BPA-free water bottles, cool little nylon stuffsack market bags, etc.), all members also get to meet the growers on their home turf. We've already enjoyed a wonderful tour of Oak Villa Farm with local fruit, vegetable and egg man Dan Rosado of Dallas, Oregon. Next up, a members-only tour that's even MORE local -- Salem's own Minto Island Growers!

For those of you who are members, SAVE THE DATE! Elizabeth Miller and Chris Jenkins of Minto Island Growers are graciously hosting a Farm Tour for Friends of Salem Saturday Market members on the last Saturday in September, Sept. 26th, at 5 p.m. Sounds like they will be overwhelmed with tomatoes, corn and squash — plus lots of other yummy things will be seen on the tour. We’re still in the planning stages about the food that will be served to members, but rest assured, it will be delicious (and directly from the ground!)

For those of you who aren’t members yet… sign up now! Only members of the Friends of Salem Saturday Market (those who paid $10, $25 or $50) are invited on the tour. Find a membership form on our Web site or stop by our booth on Saturdays.

This is your opportunity to meet local farmers, find out how they grow your food, and find out more about what’s in season at the end of September.

From the Capitol Fountain to Union Street please!

Awesome:

From Planning Magazine: A new USDA

We can grow an abundance of premium vegetables for health and flavor right here in Salem! Image by agelakis via Flickr

Great interview with a new USDA Deputy Secretary suggesting that Salem could have an ally in the US Department of Agriculture for efforts to expand community gardening (such as in Minto Brown Park) and to make Salem's unique and wonderful farmland a centerpiece of the local efforts to live more sustainably and to provide more food and food security to ourselves. Excerpts from the interview:

Kathleen Merrigan was deputy secretary of agriculture for only a month when she sat for an interview with Kimberley Hodgson, manager of APA's Planning and Community Health Research Center. Before signing on with the federal government, Merrigan taught at Tufts University and was director of the Agriculture, Food and Environment program at the university's Friedman School of Nutrition Science and Policy. She holds a doctorate in environmental planning from MIT

Q In light of your background, what specific steps do you suggest that planners take to improve the US. food system?

A: Planners have a large role to play. [Here is the context.] I've just been given the challenge by the president and the secretary of agriculture, Tom Vilsack, to lead USDA's local and regional food systems initiative, which we're calling Know Your Farmer, Know Your Food. There's a lot of enthusiasm for this initiative. There are a lot people who are excited again about agriculture; food policy councils are starting up all over the country. That's great, but when I sit at my big desk here on the Mall, I am struck by the complexity of the challenge before me. Reinvigorating local food systems is a structural challenge of great magnitude.

So where do planners come in? The planning profession [encourages] people to grapple with those complexities, to see how the interconnected parts fit together. I hope that planners across the country embrace the public fervor for local food and help communities figure out what can be done. Given the unique needs and the various characteristics of a community, there is no one-size-fits-all solution. My job here in Washington is to figure out what barriers might be in place, some of them government-constructed barriers, and figure out how to tear them down.

Q In honor of Earth Day 2009, Vilsack declared the entire grounds at the USDA Jamie L. Whitten Building as the "People's Garden" and unveiled plans to create a sustainable landscape on the grounds. In what tangible ways will the USDA support urban agriculture for commercial and noncommercial purposes nationwide?

A The inauguration of the People's Garden was my first public appearance. . . . We thought it was a great opportunity to take the little bit of land we have left here at USDA headquarters and set up a demonstration garden for people to see fruits and vegetables being grown, to talk about healthy eating, to talk about organic agriculture. And we are going to expand what's there now to use the entire area for ecological landscaping. We are [also] challenging all USDA facilities both in the US. and at our various overseas operations to come up with their own versions of the People's Garden.

That's just one thing, though. We are trying to bring kids back into agriculture because there is evidence that children do better in science and have greater ecological sensibilities because of gardening experiences-and they consume greater quantities of fruits and vegetables.

Q Do you think there is a role for urban agriculture in our urban centers?

A: Absolutely. It's a great opportunity not only for healthy diets, but to strengthen communities. In some cases urban agriculture has helped fight crime, reconnect people through common activity, and bring families together.

Q How will the USDA support urban agriculture?

A: I don't think we received a complete road map during my first month on the job, but we can engage people in the conversation about seasonal variety and supply, and we should understand more about markets. If I'm an urban consumer, is it better to drive 20 miles to pick up my share of produce at a CSA [Community Supported Agriculture] farm, or is it better to go to the Stop and Shop only two miles away? [Or is it even better to preserve precious farmland WITHIN the city limits? --- LOVESalem]

Sometimes these issues are reduced to very simplistic equations like food miles. Food miles have been a great way to bring people to the conversation, but if we really want to do something about [sustainable food systems],we have to embrace the complexity. Again, complexity is the key to all of this.

Q President Obama has emphasized the need to improve the health care system. What new farm or food initiatives (and funding) may emerge as part of that focus?

A: The president and Mrs. Obama are clearly very interested in healthy eating and very concerned about the childhood obesity epidemic. The first lady has her own garden on the lawn of the White House, which is prominently displayed for everyone to see. They even have a beehive. . . .

From where I sit as deputy secretary (and it's lovely to have this chair because I have the opportunity to think about reprogramming, reallocating, reprioritizing), I would be very uncomfortable going to Congress and asking for some big new money. I first have to convince myself that we've done everything we can with what we have. Just today, I sent out a memorandum to all USDA agencies to help me better understand the inventory of programs that are already facilitating local and regional food systems. And I'm establishing an interagency task force (that I'll chair) on the Know Your Farmer, Know Your Food initiative. What we want to do is think out of the box, be strategic, and think across all 26 of the USDA agencies.

Q: Assuming you agree that the U.S. food system should be fair, healthy, and sustainable, what is your vision for getting there?

A: I guess if had to pick one word, it would be diversity. Diversity in terms of the kinds of foods. (Our genetic stock is becoming too uniform, and that makes me nervous. And it means that we are missing out on lovely, traditional heirloom crops.) Diversity of farm types and farm sizes. I want farms in all regions. (I've long been a champion of organic farmers, but I don't see the world going 100 percent organic. It's not the right fit for everyone.)

Diversity in the voices at the table when key agricultural decisions are made. [Like the proposal to lock agriculture out of rich river bottom land that has been farmed for 150 years is being considered. -- LOVESalem] That's what's so exciting about this resurgence of interest in agriculture. That's what's always drawn me to agriculture-trying to get some of the important voices amplified.

The Bill

Watch.