. . . health care provided by the government is socialism but national defense isn’t?
. . . police and fire protection are a right but health care is a privilege?
. . . public health insurance is unfair competition for private insurers, but the Army isn’t unfair competition for Blackwater?
. . . education can be public but health care has to be private?
. . . government-financed health care imposes a bureaucrat between my doctor and me, but private insurance plans are free of bureaucratic intrusion?
. . . the U.S. Postal Service and FedEx can co-exist, but private insurers can’t tolerate a public alternative?
. . . an average salary of $14 million a year for the CEOs of the top eight private health insurance companies doesn’t add more to the cost of health care than the $200,000 a year that top Medicare administrators make?
. . . college professors with 8 years of higher education and 4 years of postdoctoral study get paid a salary regardless of how many students enroll in their classes, while a doctor with 8 years of higher education and 4 years of postdoctoral practice gets paid for each instance of service provided?
. . . the government can build a public post office in every zip code in the nation, but can’t provide a public clinic without threatening the private enterprise system?
. . . members of congress get to choose between a variety of public and private health care plans, but I don’t get the same choices they do?
. . . waiting a few days for elective procedures in a state-run system like Canada’s is an intolerable case of “service denied”, while the failure of the poor to get medical attention at all because they don’t have insurance and can’t pay fee-for-service is not a greater denial of service?
. . . 40% of every health care dollar can go to administration and profits for private insurers, but the 10% administrative costs of Medicare is unacceptable government inefficiency.
. . . the Declaration of Independence says that our inalienable rights include “life, liberty, and the pursuit of happiness” without telling us that life and health are available only on a fee-for-service basis?
Sunday, June 21, 2009
Wednesday, June 17, 2009
Tier 1 for UTEP?
Below is a Letter to the Editor of the El Paso Times that I wrote in response to their editorial advocating Tier 1 status for UTEP last August. It’s a complicated issue that I intend to explore in greater depth in this space soon. For the time being, this gives a preview of my position.
Seeking Tier 1 status while also providing a student-centered education with open-door admissions are both worthy goals for UTEP. Unfortunately, they are mutually exclusive.
There is not a single national model of a Tier 1 university that also focuses on undergraduates with minimal admissions criteria. This is because the scientists and scholars required to be competitive at the Tier 1 level have neither the motivation nor time to concentrate on the classroom, nor can the university divert its resources from research support to educating the masses.
There are certainly models of excellent research universities that value and support undergraduate education while conducting good research on their regional problems and opportunities. UTEP itself has been one of the best such models.
If UTEP’s administrators really think it should become a Tier 1 university, they are right to call for a massive infusion of money and about a decade of time. But undergraduate enrollment will have to be severely curtailed, and those that are admitted will have to be taught mostly by teaching assistants and part-time instructors until their last few semesters, while professors recruited for their research talent devote their time to graduate courses and writing grant proposals.
Seeking Tier 1 status while also providing a student-centered education with open-door admissions are both worthy goals for UTEP. Unfortunately, they are mutually exclusive.
There is not a single national model of a Tier 1 university that also focuses on undergraduates with minimal admissions criteria. This is because the scientists and scholars required to be competitive at the Tier 1 level have neither the motivation nor time to concentrate on the classroom, nor can the university divert its resources from research support to educating the masses.
There are certainly models of excellent research universities that value and support undergraduate education while conducting good research on their regional problems and opportunities. UTEP itself has been one of the best such models.
If UTEP’s administrators really think it should become a Tier 1 university, they are right to call for a massive infusion of money and about a decade of time. But undergraduate enrollment will have to be severely curtailed, and those that are admitted will have to be taught mostly by teaching assistants and part-time instructors until their last few semesters, while professors recruited for their research talent devote their time to graduate courses and writing grant proposals.
Tuesday, June 16, 2009
El Paso Legislators: Response to David K
The following was my response to a critical review of El Paso’s legislative delegation published by David Karlsruher on 3 June 2009. David K claimed that our local representatives accomplished basically nothing in the 81st Legislative session just ended.
Your judgment is too harsh, David K, even if you make a few valid points. Tier One for UTEP was a pipe dream from the start, but progress toward a national research university is a worthy goal that will be helped by the bill that did pass, painting a roadmap for all the contending universities in the state to follow. Eliot Shapleigh authored an earlier version of that legislation (SB1564), and argued vigorously for the framework, if not the final version that he felt (correctly) disadvantaged UTEP. He also authored a bill (SB202) that makes it easier for doctors to get provisional licenses in underserved areas like El Paso, in answer to your question about agenda item 5.
Joe Moody and Marisa Marquez did a lot more than “weather their fists” in their first session. Moody’s rider to appropriate money for a visitors’ center at our state park shouldn’t be trivialized; visitors’ centers greatly amplify the value of our natural resources. Moody passed important bills relating to victims’ rights in cases of domestic violence (HB2236) and making it easier to prosecute street gangs and threats against children (HB2187). Marquez got bills passed to improve the treatment of pregnant inmates (HB3654) and tighten building codes for new construction in colonias (HB2833), on top of her herculean effort in getting the ethics bill (HB2301) passed.
Joe Pickett was noted for his public squabbles and qualified successes as Chair of the House Transportation Committee, but less publicized for his admirable passage of a bill (HB1462, co-authored with Moody) to grant 5 hours of leave per month for state workers to volunteer as advocates for foster children, and his unsuccessful attempt to divert money from the proceeds of “Choose Life” vanity plates to the Department of Protective and Family Services instead of to anti-abortion groups.
Chente Quintanilla’s bill (HB739) to tighten education requirements to peddlers of medicare related products is worthy of more respect than your humorous reference to it accords. Even Norma Chavez, as always, coupled her monumental pettiness with some good legislation, like the addition of job incentive programs (HB2169).
Yes, there was squabbling and embarrassment galore, and the egos of politicians are never too deep beneath the surface. That doesn’t mean they don’t accomplish something. The fact that they were able to get anything done, in a fiscally constrained session largely immobilized by the polarizing pseudo-issue of voter identification, is in fact commendable.
Your judgment is too harsh, David K, even if you make a few valid points. Tier One for UTEP was a pipe dream from the start, but progress toward a national research university is a worthy goal that will be helped by the bill that did pass, painting a roadmap for all the contending universities in the state to follow. Eliot Shapleigh authored an earlier version of that legislation (SB1564), and argued vigorously for the framework, if not the final version that he felt (correctly) disadvantaged UTEP. He also authored a bill (SB202) that makes it easier for doctors to get provisional licenses in underserved areas like El Paso, in answer to your question about agenda item 5.
Joe Moody and Marisa Marquez did a lot more than “weather their fists” in their first session. Moody’s rider to appropriate money for a visitors’ center at our state park shouldn’t be trivialized; visitors’ centers greatly amplify the value of our natural resources. Moody passed important bills relating to victims’ rights in cases of domestic violence (HB2236) and making it easier to prosecute street gangs and threats against children (HB2187). Marquez got bills passed to improve the treatment of pregnant inmates (HB3654) and tighten building codes for new construction in colonias (HB2833), on top of her herculean effort in getting the ethics bill (HB2301) passed.
Joe Pickett was noted for his public squabbles and qualified successes as Chair of the House Transportation Committee, but less publicized for his admirable passage of a bill (HB1462, co-authored with Moody) to grant 5 hours of leave per month for state workers to volunteer as advocates for foster children, and his unsuccessful attempt to divert money from the proceeds of “Choose Life” vanity plates to the Department of Protective and Family Services instead of to anti-abortion groups.
Chente Quintanilla’s bill (HB739) to tighten education requirements to peddlers of medicare related products is worthy of more respect than your humorous reference to it accords. Even Norma Chavez, as always, coupled her monumental pettiness with some good legislation, like the addition of job incentive programs (HB2169).
Yes, there was squabbling and embarrassment galore, and the egos of politicians are never too deep beneath the surface. That doesn’t mean they don’t accomplish something. The fact that they were able to get anything done, in a fiscally constrained session largely immobilized by the polarizing pseudo-issue of voter identification, is in fact commendable.
Monday, June 15, 2009
Texas Needs Public Health Care Clinics
A shorter version of the following appeared as a guest editorial by Louis Irwin in the El Paso Times on May 18, 2008.
Health care inequities across ethnic and economic boundaries exist in this country because we treat the delivery of health care like a consumer commodity instead of a protective service.
Phones, cars, and houses are commodities. We choose them from a large selection to suit our individual tastes and needs. We pay for them one at a time. Competition in the marketplace generates a variety of products, and rightful profit for their producers.
Policemen, firefighters, and the army provide protective services. As everyone is vulnerable to crime, fire, and foreign enemies, we share the risks and pay for protection collectively through our taxes. The role of government is to ensure our basic right to public safety, not to make a profit.
Injury and disease, like threats to public safety, are risks that affect us all. Protection from them should be a basic right. But in this country, pain and suffering are opportunities for profit – from doctors paid a fee-for-service, to hospitals that market aggressively for shareholder profit, to insurance companies that reward agents for denying claims, to lawyers who live off the mistakes of all the above.
The cost of health care is driven mainly by the high technology and drugs on which modern medicine depends; but excessive marketing by drug makers, and advertising by clinics and hospitals that compete for patients to deliver profits to stockholders, inflate that cost. The insurance industry adds a third party payer, whose need to earn a profit for shareholders plus excessive red tape adds another 40% to the health care dollar. To make matters worse, the practice of tying health insurance to employment has made it non-portable for the patient and an economic burden to the employer.
One way to achieve real reform in the delivery of primary health care is to combine the training of personnel with establishment of community-based outpatient clinics staffed by nurse practicioners, physicican’s assistants, and technicians under the supervision of a senior physician. These primary and emergency health care teams across the state would make up a Texas Medical Corps, consisting of health care professionals who would work for one year at a livable but modest salary in exchange for each year of tuition deferment during their training at a public institution.
The community clinics would be placed in existing public facilities, like high school infirmaries or firehouses. Any legal resident would be eligible for minor emergency or outpatient care, and visitors could be treated for a modest fee.
The cost of this community based health care would be lower than the present fee-for-service system, because the clinic facilities would already exist and the health care providers would be paid modest salaries as payback for their state-funded education. Since insurance would play no role in the delivery of health care at community clinics, another third or more of the primary health care expense would be saved.
T
he program would be funded from revenue generated in a manner determined by the Legislature. For instance, employers, now freed of the need to provide health insurance for employees, could pay somewhat more in taxes to support the Texas Medical Corps. Everyone would pay an additional tax to support the program as well, but such a tax should be tied to ability to pay (income) rather than to property, which is already overtaxed in Texas. Whatever the additional cost to the taxpayer, it would be less that the cost of private health insurance (typically a thousand dollars or more a month for family protection).
Health insurance could still play a role, for those willing and able to pay for private policies. These could cover amenities like private hospital rooms, personal physicians, elective surgery, and other optional benefits. But since this type of insurance would not have to be provided by employers, the health care burden would largely be lifted from them, stimulating economic growth and enabling higher wages.
Programs like the La Fe Clinics and the Wainwright Family Resource Center in Northeast El Paso already provide models of community-based health care here. These programs provide valuable out-patient and preventive health care to our large population of citizens who cannot afford the commodity-based health care delivered by profit-driven providers. If such programs were extended to every community, with access to everyone, primary health care would finally become the basic human right that it should be.
Health care inequities across ethnic and economic boundaries exist in this country because we treat the delivery of health care like a consumer commodity instead of a protective service.
Phones, cars, and houses are commodities. We choose them from a large selection to suit our individual tastes and needs. We pay for them one at a time. Competition in the marketplace generates a variety of products, and rightful profit for their producers.
Policemen, firefighters, and the army provide protective services. As everyone is vulnerable to crime, fire, and foreign enemies, we share the risks and pay for protection collectively through our taxes. The role of government is to ensure our basic right to public safety, not to make a profit.
Injury and disease, like threats to public safety, are risks that affect us all. Protection from them should be a basic right. But in this country, pain and suffering are opportunities for profit – from doctors paid a fee-for-service, to hospitals that market aggressively for shareholder profit, to insurance companies that reward agents for denying claims, to lawyers who live off the mistakes of all the above.
The cost of health care is driven mainly by the high technology and drugs on which modern medicine depends; but excessive marketing by drug makers, and advertising by clinics and hospitals that compete for patients to deliver profits to stockholders, inflate that cost. The insurance industry adds a third party payer, whose need to earn a profit for shareholders plus excessive red tape adds another 40% to the health care dollar. To make matters worse, the practice of tying health insurance to employment has made it non-portable for the patient and an economic burden to the employer.
One way to achieve real reform in the delivery of primary health care is to combine the training of personnel with establishment of community-based outpatient clinics staffed by nurse practicioners, physicican’s assistants, and technicians under the supervision of a senior physician. These primary and emergency health care teams across the state would make up a Texas Medical Corps, consisting of health care professionals who would work for one year at a livable but modest salary in exchange for each year of tuition deferment during their training at a public institution.
The community clinics would be placed in existing public facilities, like high school infirmaries or firehouses. Any legal resident would be eligible for minor emergency or outpatient care, and visitors could be treated for a modest fee.
The cost of this community based health care would be lower than the present fee-for-service system, because the clinic facilities would already exist and the health care providers would be paid modest salaries as payback for their state-funded education. Since insurance would play no role in the delivery of health care at community clinics, another third or more of the primary health care expense would be saved.
T
he program would be funded from revenue generated in a manner determined by the Legislature. For instance, employers, now freed of the need to provide health insurance for employees, could pay somewhat more in taxes to support the Texas Medical Corps. Everyone would pay an additional tax to support the program as well, but such a tax should be tied to ability to pay (income) rather than to property, which is already overtaxed in Texas. Whatever the additional cost to the taxpayer, it would be less that the cost of private health insurance (typically a thousand dollars or more a month for family protection).
Health insurance could still play a role, for those willing and able to pay for private policies. These could cover amenities like private hospital rooms, personal physicians, elective surgery, and other optional benefits. But since this type of insurance would not have to be provided by employers, the health care burden would largely be lifted from them, stimulating economic growth and enabling higher wages.
Programs like the La Fe Clinics and the Wainwright Family Resource Center in Northeast El Paso already provide models of community-based health care here. These programs provide valuable out-patient and preventive health care to our large population of citizens who cannot afford the commodity-based health care delivered by profit-driven providers. If such programs were extended to every community, with access to everyone, primary health care would finally become the basic human right that it should be.
WHY I AM DOING THIS
I moved to El Paso in 1991 from Massachusetts, where I had been a college professor of biology and a biomedical researcher in the Boston area, and an elected official in the City of Newton. I was recruited by the University of Texas at El Paso to be chair of Biological Sciences
There were only two doctoral programs at UTEP then, and my major task was to continue UTEP’s momentum toward a nationally-recognized research university by adding a doctoral program in biology. With the help of my colleagues, I did so, and helped created the Border Biomedical Research Center in the process.
After 8 years, I resigned as chair to devote my efforts to teaching and research.
By 2008, I had worked in academia and research for 40 years. The disturbing loss of John Kerry in 2004, spurred largely by fundamentalists with a narrow social agenda in spite of George Bush’s failure to keep us safe and deliver the compassionate conservative society he had promised, aroused my ever-present political interests from sideline observation to activism. Feeling it was time to put my decades of experience as a scientist, educator, and politician to work for the good of society, I decided to run for public office.
I ran for State Representative in the Democratic primary in 2008 but lost. It then occurred to me that all this experience might be of some use to a current office holder. Now retired, I offered my services to several of the political figures I admired – John Kerry, Hillary Clinton, the new senators from Colorado and New Mexico – Mark Udall, Michael Bennett, Tom Udall – the new Congressman from southern New Mexico, Harry Teague, and my own Congressman, Sylvester Reyes. All I aspired to was a lowly staff position, perhaps to help with constituent mail, and I offered to do so as an unpaid volunteer. Mark Udall and Harry Teague acknowledged receipt of my letter, but never followed up. None of the others, including Sylvester Reyes, replied in any way.
Thus spurned by the voters and by members of Congress who had no use for my talents or experience, but still finding myself energized by the issues of the day, I decided the only thing left was to start my own blog. Now cured of the notion that the world is waiting and anxious to hear what I have to say, I have determined that I will say it nonetheless. If anyone reads and reacts to my observations about science, education, the state of our health care, social issues related to crime, drug abuse, punishment, and religion, the wonders of space exploration, the history of our nation, state, and region, or the politics that impinge on all these topics, I will be gratified. But history has taught me not to be overoptimistic about that. I am reconciled to the fact that just writing about it may have to be its own and only reward.
There were only two doctoral programs at UTEP then, and my major task was to continue UTEP’s momentum toward a nationally-recognized research university by adding a doctoral program in biology. With the help of my colleagues, I did so, and helped created the Border Biomedical Research Center in the process.
After 8 years, I resigned as chair to devote my efforts to teaching and research.
By 2008, I had worked in academia and research for 40 years. The disturbing loss of John Kerry in 2004, spurred largely by fundamentalists with a narrow social agenda in spite of George Bush’s failure to keep us safe and deliver the compassionate conservative society he had promised, aroused my ever-present political interests from sideline observation to activism. Feeling it was time to put my decades of experience as a scientist, educator, and politician to work for the good of society, I decided to run for public office.
I ran for State Representative in the Democratic primary in 2008 but lost. It then occurred to me that all this experience might be of some use to a current office holder. Now retired, I offered my services to several of the political figures I admired – John Kerry, Hillary Clinton, the new senators from Colorado and New Mexico – Mark Udall, Michael Bennett, Tom Udall – the new Congressman from southern New Mexico, Harry Teague, and my own Congressman, Sylvester Reyes. All I aspired to was a lowly staff position, perhaps to help with constituent mail, and I offered to do so as an unpaid volunteer. Mark Udall and Harry Teague acknowledged receipt of my letter, but never followed up. None of the others, including Sylvester Reyes, replied in any way.
Thus spurned by the voters and by members of Congress who had no use for my talents or experience, but still finding myself energized by the issues of the day, I decided the only thing left was to start my own blog. Now cured of the notion that the world is waiting and anxious to hear what I have to say, I have determined that I will say it nonetheless. If anyone reads and reacts to my observations about science, education, the state of our health care, social issues related to crime, drug abuse, punishment, and religion, the wonders of space exploration, the history of our nation, state, and region, or the politics that impinge on all these topics, I will be gratified. But history has taught me not to be overoptimistic about that. I am reconciled to the fact that just writing about it may have to be its own and only reward.
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