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Ellen Belcher is the Dayton Daily News opinion pages editor. She writes about state government, education, the environment, higher education and all things Dayton.
Martin Gottlieb is an editorial writer and columnist for the Dayton Daily News opinion pages. He focuses on the political process itself and does such national issues as war, the economy, taxes and Social Security, as well as a hodge-podge of local and state issues.Home > Blogs > A Matter of Opinion > Archives > 2009 > September > 10
Thursday, September 10, 2009
Guest column: How can we let anyone be treated this way?
This column was written by Lawrence E. Mieczkowski, of Kettering, an internist who specializes in cardiovascular disease prevention.
“So, doc, what do you think about this health care debate?”
I am usually in the midst of writing a prescription or filling out paperwork when a patient asks. The younger patients don’t usually bring up the subject. They usually are employed and have coverage and generally don’t need a lot of medications.
A few of my wealthy patients ask, assuming I oppose President Barack Obama’s call for universal coverage. They are usually put off by my response that I support a single-payer system.
Sometimes I win over these patients, but, for many of them, this is simply an intellectual debate. They have health care insurance and can’t imagine a scenario under which they wouldn’t.
The most earnest questioning comes from the over-60 crowd; the retirees who took a buyout some years ago and were promised they’d have coverage and now are losing it; and the 30- to 40-year-old guy who is in-between jobs — yet again — and has no coverage.
I see the fear in their eyes, the worry about how they’ll afford the medicine they need, the relief when I tell them that I can give them samples. Their looks are the same when I offer to switch them to a less effective, but cheaper, generic drug, and when I waive their co-pay.
I also tell these patients about Ed, a 70-year-old retired truck driver living on Social Security and a small pension. He pays for the Medicare Part D drug coverage, but his monthly insulin costs alone are more than $300, and he falls into the prescription coverage donut hole within four months of the start of every year.
He calls us every two to three weeks, pleading for a couple of insulin vials. Sometimes he shows up at the check-in window unannounced. How can we refuse his request? I know that he doesn’t take the dose that I prescribe, in order to space out the insulin. We have a first-come-first-served approach to giving out insulin samples. People call to reserve them; we limit the give-aways to a bottle or two. That’s all we have.
Pharmaceutical companies have significantly cut back on samples. Sometime my office only gets five to six vials a week. Most of the time, that’s not enough to meet all of our requests. Ed usually requires five or six bottles monthly.
Then I share Tom’s story. At age 31, he was way too young to have suffered a heart attack, but he did. He wasn’t overweight, and he didn’t smoke. Now 38, Tom inherited a genetic cholesterol problem and then developed diabetes. Because of the diabetes, he then hemorrhaged into the back of his eye and almost went blind.
Still, he kept trying to work. He probably could’ve applied for Social Security disability since he has a bad heart and only one good eye. He’s one of the guys I call the working wounded.
He has had insurance coverage, but he couldn’t afford the co-pays for his diabetes medications, the insulin, the prescription blood thinner, the cholesterol medications, the heart and blood pressure medications, the co-pays for the family doctor, my fees as a specialist, his cardiologist and the two eye specialists. Meanwhile, there are medical expenses for his wife and two children.
There have been times when I have walked Tom out the door with more than $1,000 in medication samples. I’ve told him to send his $15 co-pay when he gets his paycheck at the end of the month. More recently, things have gotten worse since his employer fired him unfairly.
I ask the inquiring patient, not expecting a reply, “Where is Tom to go for help? Is this fair? How can we let this happen?”
These conversations happen sometimes six to seven times a day, week after week. So, yes, I say, repeatedly, forcefully, but respectfully, I favor health care reform.
Permalink | Comments (33) | Post your comment | Categories: Guest Columns, Health Care
Editorial: Business taxes are not what ails Ohio
Your grocery store has been in court — sort of.
Ohio grocers are arguing that they shouldn’t have to pay a certain tax that Ohio imposes on businesses. The grocers say that the Ohio Constitution forbids taxing food, and, therefore, they can’t be taxed on their gross receipts (which is how Ohio’s main business tax now is calculated).
The other side — the governor and the legislature — says that this is a business tax, not a food tax, and that grocers, like others companies, should pay. Even granting that the grocery business is a low-margin business, do you think grocers are looking for a loophole?
The problem for the Strickland administration and the legislature is that if the Ohio Supreme Court agrees with the grocers, Ohio will be short a half-billion dollars (on top of whatever other holes appear because of the economy).
Grocers are set to pay the state $188 million this year; they’d also be due about $355 million in refunds going back to 2005, when the tax was first adopted under a Republican legislature and Republican Gov. Bob Taft.
There’s also another issue relating to the gross receipts tax — known as CAT for short, or the Commercial Activities Tax — that isn’t one for the courts, but for lawmakers. When the tax was first passed, lawmakers guessed at what the rate should be to raise sufficient revenue.
The stated goal was to raise an amount similar to what was being produced by two other business taxes that were being eliminated. The CAT was seen as a fairer and more broad-based levy.
As protection against the state getting a windfall or coming up short, proponents of CAT decided that if revenue projections were off by more than 10 percent — up or down — that would trigger a correction. The tax rate would be adjusted automatically.
In 2007, however, lawmakers and Gov. Ted Strickland changed the rules. They said the trigger would only take effect if the tax brought in more than expected.
This was a “heads I win, tails you lose” proposition if you believe that state government has certain obligations to fulfill. It was a great decision if you think businesses pay too much.
As it has turned out, all the state’s tax sources have gone to heck, including the CAT. That would have been true, too, if the old taxes were still in place.
Still, Gov. Strickland has shown no interest in acknowledging the structural tax problem Ohio has. Some people think he will if he’s re-elected in 2010. Some even believe that whoever is elected — Democrat or Republican — will be confronted with the reality that Ohio can’t afford the services Ohioans expect.
There is this big picture to keep in mind:
The tax burden on businesses in Ohio as compared to individuals has declined a lot. Businesses paid about 40 percent of the burden in 1975; in 2010, one estimate (from Cleveland’s Center for Community Solutions) is that business’ share will fall to 26.5 percent. In 2003, the percentage was 30 percent.
Further, while Ohio’s tax burden once was high relative to other states, it seems to have fixed that. According to 2006 data — the latest available — Ohio’s state and local tax burden ranked 18th.
Other states have changed policies since then, just as Ohio has, but this ranking was calculated before Ohio’s individual tax rates were cut a whopping 21 percent, and before the CAT tax was adopted and two big business taxes were done away with.
The grocers’ beef is a stretch. Other businesses — not just individuals — should find their argument maddening. In truth, businesses in Ohio already are getting a good deal.
Permalink | Comments (11) | Post your comment | Categories: Editorials, Ellen Belcher, Ohio government, Ohio politics
Scott Elliott: STEM school could be the future of choice
Dayton has been a nationally important charter school mecca since the beginning of this decade. We tend to think we know a lot about charter schools and giving families school choice here.
Allow me, for a moment, to challenge what we think we know. A peek back at the intent of the push for charter schools in the United States can teach us something about where the school choice movement should go next in Ohio.
By the late 1990s, when Ohio’s charter school law was written, the national push for school choice had become identified with the right, especially conservatives who hoped charter schools competing with traditional public schools — for kids and cash — might spark reform and innovation in low-performing city schools. But that’s not where it all began.
School choice, at the outset, was not a conservative idea, nor was it a liberal idea. It also did not spring from urban centers, where most charter schools have come to be concentrated. It actually began in the suburbs.
The early concepts that led to the first charter school law, passed in Minnesota in 1991, were not driven by a free market-loving desire to inject competition into education. In fact, the idea was not ideologically driven at all. The Minnesota law would not have happened without support from both Republicans and Democrats, liberals and conservatives.
What that effort was about was helping kids find their niche and learn in an environment that suits them.
This came to mind on the first week of school as I toured the new Dayton Regional STEM School in Beavercreek. Technically not a charter school under state law, the STEM school is a regional center that’s drawing students from any of the 30 districts in Montgomery, Greene and Clark counties.
The school is charter-like in that state funding for its students is redirected from their home districts, and the school also has a specialty theme — high-level instruction in science, technology, engineering and math. It signed up students from 20 districts, including many kids who are making long commutes to try out the new school.
The STEM school is very much in the mold of what the original school choice reformers were seeking in Minnesota.
A couple years ago, I interviewed Ted Kolderie and Joe Nathan about the roots of the charter school movement. Kolderie, a former journalist and public policy expert, and Nathan, a teacher, were both in the room when the plan that eventually led to the first charter school law was sketched out at a retreat held at a lakefront resort near Brainard, Minn., in 1988.
What led to that meeting was a growing interest among a small group of reformers who first came together in the mid-1980s to fight for open enrollment and post-secondary options. Both of those idea eventually spread across the country, including to Ohio.
Open enrollment allows students to break free of the boundaries of school districts set by the state. Nathan told me reformers were worried about underachievers — kids who did not fit in at one school, but who might thrive elsewhere.
The post-secondary option allows kids who do not feel challenged in high school to enroll in college courses. That program was explicitly designed to attract ordinary students — kids who might be smart, but who are bored in school — not just academic stars.
Both programs proved wildly popular, especially to suburban families with kids who didn’t fit in well in traditional schools.
The charter push sought to take school options in Minnesota a step further by allowing educators the freedom to start innovative, independent public schools that would be decidedly different from traditional schools, with the hope of giving offbeat kids more and different options to pick from outside of local school districts.
Open enrollment and the post-secondary option had created demand for alternatives — more schools for kids to choose from if they wanted to leave their local schools. Charters were supposed to provide a better range of unique school choices.
That idea still works. Reform shouldn’t stop at the city limits. Suburban and rural kids — even those in high performing districts — deserve variety, too. More regional specialty schools like the STEM school could be the answer.
Permalink | Comments (4) | Post your comment | Categories: Columns, Education, Scott Elliott, Suburban Communities
