Jerry Knirk: We all need access to health care

A lively discussion of what type of healthcare system people would like to have occurred at my town hall meeting in Tamworth on June 7 and in this week’s Tele-Talk. In Tele-Talk there was a broad range of responses, some thoughtful and some ideological.

A basic question that should underlie any discussion about health care is: What is the responsibility of society to help those in need?

We are a species that cares for our fellow beings. If we find a person hit by a car lying along the side of the road, we do not leave them to become roadkill. We take them to the hospital and treat them, even if they do not have insurance.

It is critical to understand what happens to the costs that are generated by that uncompensated care. There is no magic fairy that pays the bill. Those costs are shifted either to those with insurance or to the government.

A similar problem occurs when an uninsured person walks in to an emergency room in a medical crisis, perhaps due to untreated chronic illness such as diabetes or asthma.  When people do not have access to healthcare, chronic diseases are not managed in the appropriate setting in a cost-effective fashion and instead are treated in an expensive location like an emergency room.

It is not a matter of if we cover health care costs, but it is a matter of how we cover them. The costs of health care do not go away by leaving people uninsured. The only way to make health-care costs disappear completely is to choose to let people go bankrupt, suffer and die. If we do not accept that choice, then we need to move away from ideology and explore the actual data regarding currently successful systems in other countries.

The only way to prevent cost shifting of uncompensated care is to ensure that everyone is covered in some way. There are different ways to achieve that, ranging from compulsory, highly regulated insurance provided by non-profits, giving uniform basic benefits that do not discriminate due to health status or age or gender, with government subsidies capping the individual contribution at about 8 percent of income, such as in Germany and Switzerland, to publicly funded systems such as in Canada and the United Kingdom.

One response in Tele-Talk stated that our health care should remain with the private enterprise system — which “has worked fine.” Unfortunately, our current system of private insurance has not worked fine.

Many people blame Obamacare for our rising health-care costs, but a critical look at the data shows that health-care costs have been rising for decades.  Our non-system of multiple, private, for-profit payers and fee-for-service compensation — which rewards excessive intervention and testing, under-values primary care, promotes fragmented, poorly coordinated health care, and lacks universal coverage — have led our system to be twice as expensive as other developed countries with the worst outcomes.

The current proposals being considered in Washington do not really reform health care. They do not provide universal coverage, address fundamental cost drivers (especially the fee-for-service system), nor address our fragmented and inefficient health-care system. These bills fulfill an ideological pledge to repeal Obamacare by stripping health-care access from the working poor in order to give tax cuts to the wealthy.

At times it feels hopeless trying to get real reform in this country.

Massive amounts of lobbying money goes to our legislators in Washington to perpetuate our broken system by those who benefit from it: pharmaceutical companies, medical device manufacturers, the for-profit health insurance industry, some hospitals and even many providers. They do not wish to dismantle a health-care system from which they have profited well.

It is our duty to continue to demand real health-care reform. People must continue to educate themselves on the issues and advocate for reform.

In the fall, I will be holding further town halls on health-care reform in our area and around the state.

There are some aspects of health care financing which we can try to address at the state level. New Hampshire does control Medicaid and health insurance for state employees, state retirees and university employees. Rep. Ed Butler and I are working with four other representatives to address improvements that we might be able to make at the state level, including transparency in pharmaceutical pricing, reform of payments to providers and a more rational approach to the overall health of our citizens.

Much of our discussion of health care revolves around financing. In Tele-Talk, a few respondents did bring up the importance of individual responsibility that transcends our payment system. Our health status is affected greatly by poor lifestyle choices such as a poor diet, obesity, smoking and lack of exercise. To this list we should also add environmental toxins and emerging contaminants in the environment which impact our health.

It is still important to realize that even if we make all the right choices, accidents and illness can affect any of us. We have an economic and societal responsibility for everyone to have access to a health-care system with universal coverage and effective cost controls. The question is how to do it.

Jerry Knirk is a freshman representative from Carroll County District 3: Tamworth, Madison, Freedom and Albany. He lives in Freedom.

Susan Bruce: Grade A bunkum

By the time you read this, New  Hampshire may have a budget for fiscal years 2018 and 2019. It’s also possible that we may not.

The budget process begins with the governor, who presents his budget to the House and Senate. It contains his priorities, the things he would like to see funded in the next biennium. The House Finance Committee then uses the governor’s budget as a blueprint for the budget they design. There are hearings where every government agency lists its needs, and public hearings where residents can express their budget priorities. Eventually they finish it and it comes out of committee and goes to the full House for a vote. After passing, it goes to the Senate Finance Committee, where they tinker with it. The House flies blindly, without revenue projections, but the projections are in by the time it gets to the Senate. When they finish tinkering, the bill comes out of committee and goes before the full Senate. If it passes, it goes back to the House, where it is sent to a Committee of Conference, where members of the House and Senate work out their differences, agree to concur, the budget is voted on by both bodies, and then prances off to the governor’s desk.

This year, the budget process has been a disaster from the very beginning. For the first time in recorded history, the House failed to pass a budget. The creation of a budget became the responsibility of the Senate. The Senate Finance Committee had the same hearings with various government agencies, interested parties and a public hearing for voters. Once they finished, the committee voted it ought to pass, and then it went to the full Senate for a vote. The Republican Party has control of the Senate, so the votes fell along party lines. The budget went back to the House for concurrence but there was no concurrence to be had, so a Committee of Conference was put together so that both bodies could work out an agreement. They have. The only Democrat on the Committee of Conference was removed when she refused to sign off on the CoC report. The House and the Senate will each have voted on this budget by the time you read this column.

Opinion pieces by the majority party are springing up like mushrooms (and you know what mushrooms grow in) in newspapers around the state. There is much chest thumping about “living within our means,” “business tax cuts” and “job creating.” The writers assume you won’t put two and two together. If the last round of business tax cuts was such a tearing success, why are we running the state as if it were impoverished? They claim the tax cuts will allow businesses to hire more and keep young people here. That’s pure grade A bunkum they’re selling.

The state fails to invest in higher education, infrastructure and affordable housing. Even if young people wanted to stay in a state so unwilling to invest in itself, there isn’t any place for them to live. This week there are four and a half pages of help wanted ads in The Conway Daily Sun and six apartments for rent. It’s the same all over the state. Rather than wake up and smell the future, thanks to The Pledge, we continue to elect people who perpetuate the foolishness that it’s still 1975. The business tax cuts just mean that the burden will continue to be shifted to the homeowner in the form of property tax.

Attaching keno to the full-day kindergarten funding is being touted as a “compromise” instead of the poison pill that it really is. The education of our children should not be attached to uncertain gambling revenues, and, again, if those business tax cuts are working so well, why is this necessary? A cynical person might wonder if this weren’t the plan all along. Our Trump supporting governor made himself sound human on the campaign trail by touting support for full-day kindergarten. If the kenogarten bill fails, he can blame Democrats AND not have to cough up state money for education, something Republicans in this state are profoundly opposed to. It’s a win-win for him.

The Republican Party is fighting an internal war, between the regular old right wing and the far extremist right wing of the party. The self-styled Freedom Caucus thinks the regular right wing is spending too much money and doesn’t hurt enough people. The Democrats don’t think the budget spent enough money. The regular right wing probably could have negotiated with the Democrats, to pass a budget, but they didn’t want to because this isn’t about what’s best for the state. This is about ideological purity and party loyalty. To negotiate with the Democrats would be seen as weak. They’d be called RINOs. They’d be primaried in their next elections for not being hard core enough. The Republican Party has abdicated its responsibility to New Hampshire voters and chosen ideology over New Hampshire.

Susan Bruce is a writer and talk radio personality on “The Attitude with Arnie Arnesen”  on WNHN-FM. She lives in Concord. Visit her blog at susanthebruce.blogspot.com or find the broadcast at www.wnhnfm.org.

National Perspective: July 1 reminder of strong U.S.-Canada relationship

 

By David M. Shribman

MONTREAL — When the United States celebrated its 150th birthday, Calvin Coolidge was president, Al Capone's gangsters were running wild in Chicago, NBC was just being formed and Gene Tunney was girding to defeat Jack Dempsey. Generally, it was a quiet, contented country, not all that important in world affairs, not all that worried about war or depression.

This coming Saturday, Canada turns 150 in a different world, more quiet and contented than its neighbor to the south, about as influential in world affairs as the United States was in 1926, indeed very much like America was then: on the rise, admired globally, a little self-conscious but overall a relatively uncontroversial force for good worldwide.

The United States has many natural advantages, but none so great as being planted beside Canada. In a landmark speech in Parliament in Ottawa during his first trip abroad, President John F. Kennedy delivered remarks that are revered here. "Geography has made us neighbors," he said. "History has made us friends."

That was a bookend to a speech Winston Churchill delivered 22 years earlier, in London remarks in honor of former Canadian Prime Minister R.B. Bennett: "That long frontier from the Atlantic to the Pacific oceans, guarded only by neighborly respect and honorable obligations, is an example to every country and a pattern for the future of the world."

Today Kennedy's words are carved into the walls of the U.S. embassy in Ottawa and are a hardy perennial in U.S.-Canadian relations. They were cited by former prime ministers Pierre Trudeau in 1981 and Brian Mulroney in 1984 and by President Bill Clinton in Ottawa in 1995 and again in Washington two years later.

And the Churchill remarks are so vital to the Canadian psyche that when I spoke the other morning with Mulroney, who was the country's prime minister from 1984 to 1993 and helped create NAFTA, he quoted them word for word, with unerring accuracy. He went on:

"The relationship between Canada and the United States is a model for the world, and that is why I worked on it for so long," Mulroney said. "It's very important that as we begin the NAFTA negotiations in the next few months, the parties realize how vital and beneficial that relationship has been. It is the most productive and peaceful relationship between any two neighbors in world history. Both sides should celebrate that, and resist any attempt to diminish it."

The country's birthday — up here it is called Canada Day, and it precedes the United States' Independence Day by three days — is being marked by the sale of Canada Day body jewelry, all manner of T-shirts, a splendid two-CD salute to songs written by Canadians and books.

Plus, celebrations galore. The "Proud to Be a Canadian" event in Dorchester, New Brunswick. The "150 Years Strong" celebration in Whycocomagh, Nova Scotia. The "All Day, All Night Canada Day" festivities in Ilderton, Ontario. The "Birthday Bash 2017" in Whitewood, Saskatchewan. The "Tomahawk Canada Day Celebrations" in Tomahawk, Alberta.

But perhaps the most unusual commemoration is occurring 300 miles south of here, in Milton, Massachusetts, where the 41st president of the United States was born at 173 Adams St. in 1924. The selectmen of that town recently proclaimed July 1 "George Herbert Walker Bush—Right Honorable Brian Mulroney-Canada Day."

Like Franklin Delano Roosevelt, who had a summertime retreat at Campobello, New Brunswick, Bush has a special affinity for Canada. "Can you imagine waking up every morning worried that your neighbors might invade at any minute? Or might send raiding parties? Or spies into your midst?" Bush wrote in an email for this column. "Too many countries have lived with that fear off and on in their long histories. With Canada, that has never been the case. We trust each other. We work together. We root for each other. We breathe the same air, and share the same values."

The son of a Montreal mother and a Massachusetts father, I am quite literally the product of the Canadian-American relationship. And, like any marriage, that relationship can be perplexing, in part because Canada, with its two languages, is a far more complex nation than Americans generally realize.

"(Canada) is what it is because we built it together," Andre Pratte, a Canadian senator and author, wrote in his introduction to "Legacy: How French Canadians Shaped North America," published here last year, "and it will keep on growing in relative harmony ... only if we continue on our journey hand in hand, reaching out with those hands to the new Canadians joining us every day, and drawing on the knowledge and wisdom of the First Nations."

Then there are the challenges in the Canadian-American relationship itself. Lyndon Johnson once manhandled Lester Pearson after the prime minister criticized the American role in Vietnam — pinning Pearson against an outdoor railing at Camp David, twisting his shirt collar, even lifting him into the air before telling the 1957 Nobel Peace Prize winner, "You pissed on my rug!"

The two countries still are engaged in a dispute over softwood lumber that only lawyers understand and over which only lawyers profit, and this spring the two countries sparred over milk prices.

"We had a few disagreements, although at age 93, I can't remember them," Bush said of Canada and Mulroney in his email. "But I could always trust he had my back. I think our friendship is symbolic of the friendship between our countries. We have each other's back."

We do have each other's back, both in French and in English, and we also have that long, undefended border. Sometimes only the first two sentences of Kennedy's remarks in Ottawa are remembered and quoted. Perhaps as we approach Canada Day, we might recall the three sentences that follow:

"Economics has made us partners. And necessity has made us allies. Those whom nature hath so joined together, let no man put asunder."

David M. Shribman is executive editor of the Pittsburgh Post-Gazette. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it., or follow him on Twitter at ShribmanPG. The Pulitzer Prize-winning journalist has a vacation home in Kearsarge.

 

Tom McLaughlin: Lacking common sense

The young woman looked nervous as she knocked on the window of my classroom door. “Excuse me, class,” I said as I stepped out to speak. She was a former student and substituting in the next classroom.

“A boy is throwing things at other students. He won’t stop, and he refuses to go to the principal’s office. Can you help me?”

“Sure,” I said. The boy wouldn’t make eye contact when I entered the room. Every other student did though, waiting to see what would happen.

“Bobby,” I said (not his real name). “Miss Fellows told you to go to the principal’s office and now I’m telling you.” He just sat there, still not making eye contact. “Bobby,” I repeated, “Maine law says that if a student is a danger to others and refuses to leave the classroom, the teacher can use the necessary force to remove him. Now, I’m telling you again to go down to the principal’s office.”

That got no response either.

“I’m going to count to three. If you’re not moving at three, I’ll move you. One, two, th…”

He got up, went out the door and headed for the stairs. I picked up the wall phone and called down to say Bobby was on his way. “Thank you,” said Miss Fellows.

“You’re welcome,” I said, then returned to my classroom and forgot about it.

The following Monday, Jim Underwood, the principal, came into my room during my free period. I liked Jim. He was a very effective administrator. “Tell me what happened with Bobby,” he said, because he’d been out of town when I dealt with Bobby and appointed another teacher as acting principal. I filled him in.

“If you had removed him,” Jim said, “I would not have backed you up.”

That surprised me. Like I said, Jim was a good principal, one of the best I ever worked with. “Jim,” I said. “That is state law. I have a copy in my briefcase.”

“I know it is,” he said, “but the courts are interpreting it differently now.”

“So, if I wasn’t to remove him, what was I supposed to do?”

“Call the police.”

“You’re kidding,” I said.

“Nope.”

“That’s crazy. I’m supposed to leave two classrooms full of students sitting on their hands and wait for the cops because of one disruptive student?”

“Yup. That’s what they’re telling us now.”

Bobby went to the office on his own because he knew I wasn’t bluffing. Calling the police would ruin half a day for about 50 students and at least two teachers. Clearly, things were getting much too complicated, and I wondered how much longer I could continue in the teaching profession.

In July of last year, a similar case came before our newest Supreme Court Justice, Neil Gorsuch, when he was on the 10th Circuit Court of Appeals. A middle school boy in New Mexico had disrupted class by generating fake burps. He wouldn’t stop and was sent into the hall, but he kept opening the door to “let out a giggling belch” as the Daily Signal described it. Then:

“A school resource police officer placed the student under arrest ‘for interfering with the educational process.’ The 13-year-old then spent approximately one hour locked in a juvenile detention facility before he was released to the custody of his mother. He was never charged for his misbehavior.”

The boy’s mother filed suit claiming her son’s civil rights had been violated. This was an even less serious case than the one I dealt with because there was no danger from flying objects, yet the student had been arrested and incarcerated, however briefly. Ten years had passed and the teaching profession had continued its decline. A minor incident became a federal case and made it to a high court, which, in a 94-page ruling decided in the school’s favor. Gorsuch wrote only four pages in dissent. According to the Daily Signal again: “Gorsuch ... explain(ed) that a reasonable police officer should have understood that arresting a ‘class clown for burping was going a step too far.’”

Indeed.

Gorsuch concluded that: “The statutory language on which the officer relied for the arrest in this case does not criminalize ‘noise(s) or diversion(s)’ that merely ‘disturb the peace or good order’ of individual classes.”

Referring to his colleagues on the 10th Circuit, he said: “Often enough the law can be ‘a ass — a idiot,’” quoting Charles Dickens, “and there is little we judges can do about it, for it is (or should be) emphatically our job to apply, not rewrite, the law enacted by the people’s representatives. In this particular case, I don’t believe the law happens to be quite as much of a ass as they do.”

Ouch.

Common sense is often a misnomer when applied to educational and judicial practice these days, and it’s refreshing to have a Supreme Court justice willing to point that out.

Tom McLaughlin lives in Lovell, Maine.  He can be reached on his website at tommclaughlin.blogspot.com.