Thursday, January 31, 2013

Malpractice Insurance, Medicaid Savings, and Health Care for the Poor

What I consider to be one of the most promising idea brought to the Board of the NJ Taxpayers' Association in 2012 was a proposal for the State of New Jersey to offer physicians free medical malpractice insurance in return for volunteering to care for the poor in a deal that would significantly lower the State's annual Medicaid spending tab.

Dr. Alieta Eck, co-founder of the Zarephath Health Center, President of the Association of American Physicians & Surgeons New (AAPS) Jersey Chapter, and highly-rated physician presented this idea. 

Dr. Alieta Eck has testified in Congress about more cost-effective health care delivery. 

Recently, Dr. Eck launched her campaign in the Republican Primary to select candidates to replace the late U.S. Senator Frank Lautenberg of New Jersey. Click here to see her campaign site for details.

When I looked into Dr. Eck's numbers and then researched further for some more facts, such as those listed below, I began to see substantial savings in physician, hospital, and diagnostics payments. 

Much of these savings will be derived from the benefits of more use of primary care physicians for primary care and prevention rather than the emergency rooms for primary care and hospital stays & drugs for late-stage disease & chronic care.

According to the our Dr. Alieta Eck's proposal, New Jersey physicians pay a total of about $300 million annually in medical malpractice insurance premiums.


If all NJ physicians opt in, then NJ State would self-insure (with stop-gap) the equivalent of the $300 million annually. If 10% of NJ physicians opted for the deal, then the State of NJ would self-insure the equivalent of $30 million annually. Of course the actual out-of-pocket costs to the State, likely will be much less.

On the other side of the equation, the state spends a lot on Medicaid and will see substantial savings under this proposal's idea.

According to the Kaiser Family Foundation's "":
-- The State of New Jersey pays 48% of residents' Medicaid spending as of 2009.
-- The state of New Jersey spent $10+ billion annually on Medicaid in 2010,

That's right. The State of New Jersey's 48% share of the statewide Medicaid tab runs about $10+ billion annually. A mere 1% savings on that would be $100 million!

More specifically, of that $10+ billion annually spent by the NJ State on Medicaid, the $6+ billion spent on physicians, hospitals, diagnostics, and drugs (acute care) would see savings immediately in year one and even more savings during the next 10+ years, as the greater use of primary care physicians both reduces emergency room visits and hospital stays. 

The portion of that paid by Medicaid directly to physicians, an estimated $50 million annually, would be slashed immediately because some physicians, perhaps many physicians, will immediately see the value to them of this deal. 

This deal is win-win-win-win. Physicians, patients, Medicaid, and taxpayers all win.

I recommend that my home state of New Jersey, and all states, look at this idea. 

This looks like a good deal to me: More available physicians, greater use of primary care physicians, lower State outlay for Medicaid, and lower medical malpractice premiums for participating physicians.

What do you think?

By Steve Reichenstein

Tuesday, January 29, 2013

North Dakota Oil Patch Shows Capitalism at its worst, 100 years later.

Consumers to buy goods and services form the basis of a successfully growing market economy. Without customers who want and can afford your stuff why make it?

Before employees got weekends off and were paid more of a living wage, they didn't need autos and entertainment stuff. They didn't have occasion to use them. Monday through Saturday at work and Sunday in church didn't leave time. The budget was tight. 

Aside from a few wealthy customers and farmers, Ford wasn't going to sell a lot more cars, even though he figured out how to build a lot more cars at lower prices. That was a key moment in our economy. Ford represented more than 10% of our economy and owned significant assets in nearly all levels of the economy. 

When Ford raised wages and shortened the work week, Ford started selling a lot more cars. Also, people could start affording health care, and that led to medical advances. 

Right now, North Dakota is proving the point that we will get rampant workplace injuries in unregulated, non-union states and either government programs will help or the injured will die or become the mangled homeless. 

Employers prevent or we pay ... or we let people die.

The recent oil boom in North Dakota has turbo charged their economy, even making the state the fastest growing in the U.S. But the oil patch jobs do not provide health insurance and the job sites are not following safety laws or best practices. The hospitals and oil boom workers are suffering as a result.

North Dakota hospitals report facing 2,000% increase in debt, 400% increase in emergency room visits, 59% increase in ambulance calls ... and 200% increase in the number of (reported) traumatic injuries in the oil patch.

North Dakota state government and U.S. Social Security Disability and Medicaid are just have to pick up the tab. 

That's right. Taxes will increase to rebuild hospital finances and build & staff more health care facilities. Social Security and Medicaid will have to support and care for the 200% more traumatically injured employees who lose ability to work. (Women report harassment from the huge migration of single men.)

The injured uninsured workers cannot afford to pay the hospitals. Even finding the workers is difficult because often they are housed in cramped trailers and such. 

Workers' Compensation and injury liability limits in states like North Dakota and flouted workplace safety in states like North Dakota don't go far in helping the mangled bodied victims of the oil patch. 

North Dakota's oil patch is a throwback to the early industrial revolution no rules and no responsibility in the work world and no one picking up the pieces in a consistent community way through our We the People government. 

But now we have government programs the grew directly out of such situations. Now we have labor unions that grew directly out of those situations. But both of these are under attack, especially in states like North Dakota. 

Picture "Biff's world" in the movie "Back to the Future II" when Biff stowaways to go into the future to get the racing results for the prior years and builds up enough winnings to run ... actually, run down ... the town. 

Rather than providing a safer and healthier work environment and health insurance, North Dakota is choosing to build more and more hospitals and medical schools.

Private oil patch industry boom creates oil patch workers and hospitals bust.

These choices made in states like North Dakota don't make sense to me morally or financially. 

By Steven J. Reichenstein

Top-down versus Bottom-up Changes in Municipal Government

The British Crown created counties in the original 13 American states, just as the Crown had done in England, Wales, Scotland, and Ireland, in order to efficiently collect taxes and to watch over their subjects with Crown agents locally based. 

After winning the American Revolutionary War, the new powers that be in New Jersey were the "free holders of land" who originally were the only voters, and these free holders elected the New Jersey counties' "Boards of Chosen Freeholders" to govern. 

New Jersey Counties being considered local made some sense in the 1700's and early 1800's when New Jersey was mostly farmland and mines. But today we are the most densely populated state in the nation and even the suburban Morris County has more than 450,000 residents and nearly 40 municipalities.

I, for one, want access to a government that is closer to home and more likely to care about local families and businesses. I also want to retain my borough's character. 

New Jersey state and municipal governments can legislate; but New Jersey counties cannot. Counties just collect some taxes and provide some services in return. 

I, for one, do not like that we only seem to have the choices of county and municipal as scale of local government. One is too small to be cost-effective and the other too large to be held locally accountable.

What's the point?

On November 29, 2012, the New Jersey Senate passed bill S-2 which allows the State Treasurer's office to decide which towns should share which services with which other towns. If a municipality does not do it, then the NJ State Treasurer will calculate how much money the municipality would have saved with those shared services and will deduct that amount from the municipality's state aid funding. 

That's top-down mandates on We the People's right to establish and operate our own local governments.

Outrageous! That's the final straw in a top-down authoritarian government process that started with the early 1700's British Royal Crown and then was reinforced by the late 1700's free holders of land to rule from above and crush home rule.

Not only does this reek of top-down, power-grabbing authoritarianism ... 


Shared services between 2 municipal administrations creates a constant power struggle between the 2 municipal administration hierarchy over each and every shared service. It's us versus them. Who rules. Local pride versus local pride. 

Merging municipal administrations fully eliminates the multiple administrations for one elected by the combined municipalities' voters. The municipalities retain their local names and pride. Merging municipal administration separates the issues.

Shared services does not cut the tops. It keeps the duplicate expense of operating multiple municipal administrations. If it doesn't cut the top, then where are most of the savings? Big savings really would come out of the field. 

Merging administrations cuts the tops. It saves the duplicate expenses of 2,3, or 4 complete administrations but keeps the service level in the field -- public works, police, parks, etc. -- high, and maybe higher, at lower cost to taxpayers. 

For example, this year Scotch Plains and Fanwood (in Union County) are merging administrations to be elected and accountable to the combined population of voters. But Fanwood will always be referred to as Fanwood and residents will still have that pride and sports competition with Scotch Plains. 

An example which already has been working well for services and taxes is the merged administrations of Hanover, Cedar Knolls, and Whippany (in Morris County). They have one administration as Hanover Township, while each retains it's name, pride, and identity among residents and businesses.

In both merging administrations and shared services have one good thing in common: The  decisions are made from the bottom-up ... at the grassroots level ... by and between the municipalities. That's democracy.

In NJ Senate Bill S-2, the State decides, not the municipalities. (Remember, the Counties do not have  legislative authority; only State and Municipalities do.) What does a State official down in Trenton know about the local identities in every Municipality in every County? Nothing.

NJ Senate Bill S-2 has passed the full Senate already. But its sister bill (this year) is NJ Assembly Bill A-1171 and it remains in committee. Lobby your NJ Assembly representatives. (Each district gets 2 NJ Assembly representatives.) 

Tell you Assemblymen/Assemblywomen to oppose NJ Assembly Bill A1171. Write a letter-to-the-editor. Write your legislators a letter. Stop into their office. Tell them to vote "no" on A-1171.

Let's rebuild the government level that provides local services from the bottom-up. Let each municipality select and negotiate merging with neighboring municipalities. We know our local identities and needs better than NJ State administrators in Trenton.

Let's replace the top-down Crown and Aristocrats mandated County configurations with town-by-town direct negotiation and municipal mergers.

For more information on shared services, municipal mergers, and other related topics, contact Courage-to-Connect. Gina Genovese, the leader of Courage-to-Connect NJ, has a statewide grassroots network that encourages municipalities to merge and helps them with the process. 

Also, download the "Courage-to-Connect NJ Guidebook: The tools for municipal consolidation in New Jersey" at their website.

I, for one, look forward to opposing NJ Assembly Bill A-1171, joining Courage-to-Connect and reading their "Handbook", and ...

... to seeing what municipal merger configurations emerge from a bottom-up, grassroots, democratic reform process.

By Steven J. Reichenstein

Wednesday, January 23, 2013

Direct Popular Election of Presidents and Standardized Voting Method

The Electoral College might be the last bastion of institutional elitism -- the last federal election in which a few can usurp the vote of the many. And it's time to correct that. 

In the beginning of the republic, U.S. Senators were selected by state legislatures. Therefore which ever party controlled the state legislatures effectively controlled the composition of the U.S. Senate. This undemocratic and indirect election of U.S. Senators was changed to statewide popular voting for U.S. Senators in 1913. 

In order to form a more perfect union, it is now our generation's responsibility to change our process for electing U.S. Presidents from an  undemocratic and indirect Electoral College to direct popular vote in Presidential elections.

For some time now We the People have suffered through hanging chads, electronic voting machines pre-loaded with votes and other problems, and, in 2012, ballots packed with dozens of referendum items that confuse issues and slow down voting to a snail's pace. 

Do you recall the electoral process vs. popular vote mess in the 2000 Presidential election when a confusing ballot and inefficient hole-punch ... and the U.S. Supreme Court overturning Florida Supreme Court and stopped recounts ... got in the way of democracy?

Do you remember when a College Elector from North Caroline switched votes in 1968: S/he was committed to Richard Nixon but decided instead to vote for George Wallace? 

Have you heard about Redmap: The Republican gerrymandering plan that configured Republican-dominated states' legislative districts to heavily favor the Republican party to the extent that they lost popular vote but won enough districts in 2012 election to retain control of the House of Representatives for 2013-2014? 

Have you noticed all of the current 2013 plan by Redmap to assign Presidential electors by Congressional district rather than by Statewide vote in states where Republicans control state goernments?  now the It's called Republican "Plan B" scheme to issue electoral college electors by Congressional District

Republican "Redmap Plan B" would remove even the statewide popular vote for U.S. President! 

These cumulative and more frequently occurring outrages have built to a crescendo ... leading us to open the windows ... and to shout ...


It's time to correct the problems by switching nationwide to direct popular voting for President of the United States.

It's time to correct the problems by the Federal government to unify the election process for Federal elective offices by standardizing the voting method. Restore federal democracy. The states should not elect the U.S. President separately, by widely varying voting methods. 

We the People should elect our President directly as a nation. We the People should vote with the same nationwide method for voting!

We the People should demand that our federal government cut out the middlemen of state legislatures scrambling the methods and the middlemen of the various voting machines, especially electric ones that continually have been shown to be tampered.

Voting method for federal office elections falls under the jurisdiction of the federal government. State and local elections fall under the jurisdiction of each state. (Although states have their own jurisdiction, it's likely that the state and local elections will use the same method selected for federal elections rather than require voters to use 2 machines and/or 2 days.)

It's time. The federal government should pay for all federal office elections, restore paper balloting that are read and then retained as receipts for poll challengers to match against machine counts, and cut out the middlemen of the Electoral College so We the People can directly elect our President with direct popular vote ... starting with the 2016 election.

It's time.

By Steven J. Reichenstein

Tuesday, January 22, 2013

Balance of Power in Government, Business, and Sports

Balance of Power is central to the government we formed in our United States Constitution. 

  The Executive, Legislative, and Judiciary Branches of our government form the 3-legged stool that supports our seat of power:The Legislative Branch enacts laws, and in that is its power. The Judiciary Branch determines whether laws are Constitutional, and the Executive Branch enforces laws. Each has one of the three fundamental powers of governing. 

Rarely do they all -- Legislative, Judiciary, and Executive -- completely agree; but, then again, rarely does one sit perfectly centered upon on a chair. Yet, the chair sits firmly upon the floor. 

We are people, neither machines nor static. Our Constitution is a living document in that it must be interpreted and enforced to a meet changing world. Finding an amount of pressure applied, however unevenly, upon the stool legs so that it holds defines our politics. 

So why is it that we insist and revel in a democratic republic for government but not extend this to the marketplace. Why does the floor of an exchange resemble the floor of a legislature? Why is a democratic republic good for outside of our economic lives but not within our economic lives? I often wonder. 


So I have looked around for markets that work and have worked through change. I found sports. Professional sports sits on a 3-legged stool: The team owners, the umpires-referees, and the players. Like the fans, We the People view, attend, and play these games. These are an important, perhaps necessary, part of our lives too.

We the Fans expect, and demand that the sport leagues establish & publish the universal rules, that teams and players follow the rules, and that umpires enforce the rules.

We have seen professional sports leagues establish operating policies upon the teams to ensure competition even off the field by how new players can be drafted & traded, how revenues get shared among the teams, and use collective bargaining to get the best athletes to join the sport and particular teams.

The professional baseball league even imposes a "luxury tax" upon teams that exceed an agreed, league-wide limit on total player payroll. 

When groups of players violate universal rules in conspiracy or by trend, when play inflicts unusual, unnecessary injury, the U.S. Congress holds hearings to investigate -- as they have done over the years with the 1919 Chicago "Black" Sox World Series corruption, use of steroids in baseball, gambling in baseball and, now, head injuries in football.

This model -- the professional sports league model -- seems to embody so much of the functions and values sought in government ... and it works. Let's learn from the sports model.

How do you feel about watching or following a sports game in which there were no universal rules or no one enforcing (neither self-enforcing nor referee-enforcing) the rules equally and effectively. Personally, I wouldn't invest my time, money, or interest.

By Steven J. Reichenstein

Pursuit of Happiness and United States Happiness Rating

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the Pursuit of Happiness." -- United States Declaration of Independence

We have national movements advocating for Life and Liberty but none for Happiness. I believe that we should measure our happiness. 

If we cannot agree on the absolute range of happiness on an incremental scale, then let's report on measurements as compared to other nations of the world.

Forbes Magazine reports that the United States ranks 14th globally (but that's really 16th because there are 2 nations tied at each of 12th and 13th):

6New ZealandAsia633527.6
6Costa RicaAmericas633528.1
14United StatesAmericas574037.3
17United KingdomEurope544427.4
20United Arab EmiratesAsia514817.7
23Puerto RicoAmericas474587.6
30Trinidad and TobagoAmericas445157.9
34El SalvadorAmericas425177.7
40Czech RepublicEurope395196.6
44Dominican RepublicAmericas3554117.3
56South KoreaAsia2861126.9
58Saudi ArabiaAsia276936.7
73South AfricaAfrica217187.3
79Bosnia and HerzegovinaEurope2059206.2
81Hong KongAsia1965167.1
96Palestinian TerritoriesAsia1470155.8
108Central African RepublicAfrica1275136.4
115Sri LankaAsia1066246.9
128Congo (Brazzaville)Africa873206.9
144Ivory CoastAfrica484127.2
144Congo (Kinshasa)Africa485116.4
148Burkina FasoAfrica371266.5
148Sierra LeoneAfrica374236.3
("Happiness: Tables of the World's Happiest Countries" by Francesca Levy,, July 14, 2010)

Outrageous! We score behind the obvious European happy nations and also some, perhaps, unexpected nations like Brazil, Panama, Costa Rica, Israel, and New Zealand. 

Don't get me wrong, I'm very happy that the people of these nations are happy. But I'm an American, so I expect us to be first at all good measures especially each of the 3 "unalienable rights" that we, as Americans, hold up as the most important of many rights: The Pursuit of Happiness!

We follow the financial market measurements daily, we measure the education rates annually, we measure the population at least each 10 years, and so on. 

There are several studies out there, that you'll find in an internet search, such as a measurement of happiness in European nations reported by, a method and way of creating a measurement of subjective happiness reported in Psychology Today, a factors & methods for measuring happiness reported by the Association for Consumer Research, and studies reported by Time Magazine, Yahoo! Finance, the Earth Institute, and the National Science Foundation -- to name a few of the many.

Well, there are studies out there which are easy to find and conducted-reported by a wide range of sources. So why aren't we featuring them on the news? Why isn't this more important and higher-profile in the "National Discussion"?

By Steven J. Reichenstein