Sunday, September 27, 2009

Tough Choices Need Courage

We have seen some rapid action lately on some of our most pressing national problems. The stimulus package and energy legislation mandating better gas mileage and emissions controls are examples. The bank bailouts, distasteful as they were, were also necessary to prevent financial petrification and are now starting to be paid back with interest. But when problems are less than immediately catastrophic our current milieu seems to have a great deal of difficulty coming to grips with them. The problem is often lack of courage. Leaders know certain things must be done, but they shrink at asking the people they represent to make the sacrifices necessary to achieve them. The politicians are too often afraid of not getting re-elected. Would that more had a priority of doing what is right and needed rather than what will sell at re-election time.

You certainly have to place a certain amount of blame on the public itself. Too often they demand services but somehow feel they can have all they want without paying for them. Too many office-seekers have been all too eager to make the promises that have encouraged that mindset over the years.

For one example close to home, most of California's water system was put in place when the state's population stood at 18 million. It gives you an idea how well that system was designed 45 years ago when you consider we now have 38 million and most of the state's needs are still being met. Yet, inevitably, we have outgrown it, and increasingly, gaps are appearing. There are effective plans combining conservation with new storage to deliver the quantity now needed. But the legislature is stymied over how to fund it. The Republicans want it all to be by a state bond. The Democrats say the interest on the bond would add another $1 billion a year to an already unbalanced budget. They want to fund it 1/3 by bond and the rest by user fees. While they argue fields lie fallow and the problem grows more acute. You just can't get around the fact that with the state budget the way it is, the money to build this project that both sides agree is necessary will have to entail some form of making those who use the water pay for it. But wedded to their no-tax pledges, the Republicans will not face reality.

The same kinds of dynamics are at work with problems like the coming shortfalls in Social Security. It really isn't rocket science. One or some combination of three things will have to happen: Either the payroll deductions for employees and employers will have to be raised, the retirement age will have to be raised or benefits will have to be cut. If neither of the first two are done, benefits will need to be cut to 73% of what they are now. So, why don't they act? Because nobody wants to tell the people the truth, that's why. They "kick the can down the road," and hope for a miracle, or at least put things off for someone else to have to deal with later--presumably after present congressmen and women are no longer in office.

We'll see how it pays out with health care, too. There are actually two main problems that need to be solved. One is the 47 million people are not covered. That has to be fixed. The other is that costs keep going up faster than economic growth and inflation, the rendering the system unsustainable and guaranteed to lead to a crash like the housing-banking-derivatives crash we have just been through when the economy can no longer support the price structure. Those two are the bedrock needs that have to be faced. Instead, too much of the debate has been stuck on outlandish fears and gotcha points. I happen to feel a "public option" would help a great deal to keep prices in line. But there are other paths to that goal, such as really stringent price controls that could accomplish the same purpose, though they would make government much more directly intrusive in the economics of the system. If leaders actually want to solve the problem, they will have to decide. But that would, like the other problems mentioned, take some honesty and courage.

This is an important enough issue it would be very noble for members of congress to truly solve the problem, even if it would lead to their defeat next time around. There is something to be said for being able to look one's self in the eye in the mirror and say, "I saved thousands of lives," or, "I helped keep the U.S. economy competitive." It would be nice to see that kind of courage and integrity in evidence in our own day a little more.

Monday, September 21, 2009

Some Common Sense on Health Care

I went to a public forum on health care last week. There were representatives of five groups: Republican, Democrat, "Tea Party Patriot" (tends libertarian), Health Care for All (advocates single-payer) and the Chief Financial Officer of our local hospital. The forum was well-moderated by Paul Hurley, the op-ed editor of our local paper, the Visalia Times-Delta, the participants were mannerly and the audience of over 200 was well-behaved. It was quite a relief not to be subjected to some of the boorish behavior we have all seen on the news lately.

I want to focus on the remarks of the hospital CFO. They are particularly telling to me because it was rather predictable what the others were all going to say. I couldn't tell what to expect from him. Gary Herbst had quite a few interesting things to say from the perspective of the provider. Keep in mind that our hospital, Kaweah Delta Hospital (KDH), is a non-profit with a board elected by the community. Its take on things thus has more weight to me than an operation motivated largely by profit. Kaweah Delta wants to make enough to stay in business and provide the services the people of the community need. Visalia is a city of about 125,000 in Central California, an area that is primarily rural. By volume of farm sales, for instance, Tulare County is typically number two in the nation, right behind neighboring Fresno County.

Gary started out by saying how much in agreement he and the hospital are with most facets of what President Obama's plan and HR 3200 want to do. He described KDH as "non-profit and pro-reform." They agree with the industry working to save $155 billion over ten years. They like the bill's expansion of primary care physicians and nurses and increasing the supply of physicians in general. He likes the expansion of "community-based health and prevention" efforts. He feels private insurance definitely needs competition and must be prevented from dropping people who get sick. He agrees care providers should not get paid again for "readmissions and errors," says the current system impedes doctor-hospital cooperation by inserting insurance questions into the middle of everything, and very much likes the prospect of a standardized system of notification and billing. He says it will save big money. A large operation like Kaweah Delta employs a lot of people who have to spend too much time dealing with all the various requirements of a myriad of insurers. He and KDH are in favor of the "public option."

He is concerned primarily with two things: that the cost of insuring everyone regardless of pre-existing conditions is accurately assessed and that the "reimbursements" paid to institutions such as his are realistic. He believes that the bill would lower reimbursements to the medicare level. That is a concern because of the statistics he presented. He said that 70% of their business in Medicare or Medical. They lose $10 million a year on Medicare patients, who constitute 47% of their admissions. 20% of KDH patients have private insurance, on which the hospital made a "profit" of $20 million. That allowed it to operate in the black by $9 million last year and add some modern equipment. If everything is reduced to the Medicare level, he fears KDH will not be able to make it. As he says, "I support reform and the public option, but it must reimburse real costs.

So that is the take of the business manager of a non-profit hospital. If some of the other savings he foresees materialize as Gary expects, that may mitigate the reimbursement levels currently contemplated. But if not, they would be a good way for the foes of reform to scuttle the reform effort. It is certainly essential that all Americans are covered so they can go to the doctor when they are ill, and that rising costs are contained before they, like the housing bubble, crash and disastrously affect the economy. In the meantime, of course, it is necessary that congress take realistic figures into account about what things will actually cost and how much will be needed to keep the system running.

I left pleased at the acceptance this non-profit hospital executive had of the need for reform and his confidence in most of the measures proposed for accomplishing it. It seemed to assure, from one who would be entrusted with carrying it out, that if amassing large profits was not your primary goal you could operate the system sensibly in the manner being contemplated by the reformers.

Friday, September 18, 2009

Who Owns a Gene?

You might be surprised to learn that it is legal to patent a human gene. I was. It is estimated that approximately 20% of the roughly 24,000 genes in the human DNA sequence have been patented. This has touched off a bioethics issue and spawned a lawsuit designed to test whether a natural substance such as a gene can be patented for protected private use. You can read a CNN article on it here.

The American Civil Liberties Union has brought suit on behalf of breast cancer survivor Lisbeth Ceriani against the Patent and Trade Office and Myriad Genetics over patents on two genes: BRCA1 and BRCA2. These genes are known to increase the risk of breast and ovarian cancers. Now Ceriani is contemplating whether to have her ovaries removed, and intends to if she has either of the telltale genes. But since the PTO granted Myriad a patent on these genes, Ceriani (and others) cannot get a diagnosis on whether she has them without the permission of the company--a privilege for which Myriad charges $3,000 for the use of its "intellectual property."

The ACLU contends that, "patenting a gene is as wrong as patenting a basic element like gold or a basic law of nature like gravity. When it patents a gene, the U.S. Patent and trade office (PTO) is really patenting knowledge, which violates freedom of scientific inquiry." According to the ACLU Journal Civil Liberties, "Patents were designed to protect human inventions, and you can't invent a gene."

As an outgrowth of this practice, other researchers are barred from looking into someone's patented gene. According to Wired, Myriad Genetics has "issued a cease-and-desist order to Yale University scientists researching the genes." The ACLU suit thus asks the federal judiciary to rule against the patenting practice on grounds of infringing on freedom of speech and scientific inquiry as well as on establishing favored and protected monopolies on natural substances. In short, the whole concept of patenting a human gene will come under argument and be subject to legal review.

The decision, when it comes, will have far-reaching effects. Currently, about 63% of patents on genes are held by companies and 37% by universities. Is it right for anyone to own a patent on a naturally occurring substance or component of the human body? Is it right to grant such an entity sole discretion on whether a person can get a test to determine if the substance may give them a disease or how much they must pay for the rights to have that test done? Is it legitimate to allow them to bar medical researchers from looking into the gene, natural substance or body component and thus to curtail any potentially life-saving medical investigation into it for the life of the patent? How many lives might such theories ultimately cost?

Sunday, September 13, 2009

Encyclopedia of Life

Imagine an online site where you could look up all the important biological information for every species on earth. It is becoming reality right now. I invite you to take a look at an amazing project currently underway, the Enclyclopedia of Life. You can also read a four-page article on the project in the magazine On Earth.

The 2003 brainchild of Harvard biologist E. O. Wilson, EOL got $12.5 million in foundation grants and debuted in February, 2008 with 30,000 species. It got 5 million hits the first day and crashed! It now has 170,000 species, about ten percent of the known and catalogued global taxonomy of approximately 1.8 million species. To continue work for the next ten years it may well take $100 million overall. The thing is, there are thought to be at least ten times that number of species (18 million) and when they finally get around to discovering and differentiating all the species of bacteria, some estimates are that the species list will run into the hundreds of millions.

The scale and scope of the EOL project are awe-inspiring. The system uses the Wikipedia model, but there is little reason to worry about hoax information on it. There are only some 6,000 qualified taxonomists in the world with the credentials to be allowed to submit data to the project. Yet people are currently scanning all the articles on biodiversity written before 1923. This is thought to amount to about 500 million pages of research.

The pages themselves are attractive, though. The basic pages include a picture of the species, its basic description, its Latin classification from kingdom down to species and links to the more specialized information you might be interested in. What is its geographic distribution? What does it eat and what eats it? Its ecological niche? Morphology? References in scientific literature? What current research projects are being done on it? It's a treasure trove for biologists and ecologists and students, for sure, but is interesting for regular lay people to peruse, too.

The Encyclopedia of Life is certainly the kind of project visionaries had in mind when they touted prospective uses for the new technology of the Internet. Take a look for yourself and wring your hands thinking about what we would have had to do find this kind of information for our high school or college term papers!

Wednesday, September 9, 2009

Obama's Health Care Address

President Obama continued to seek middle ground in his speech tonight to a joint session of congress. In trying to incorporate ideas from figures all the way from John McCain to Ted Kennedy and in talking of allowing four years to phase in his health Exchange, Obama marked himself as a conciliator still eager either to win Republican votes or at least give the appearance he tried. On the other hand, he seemed full of fight when it comes to getting something done, dispelling the distortions that opponents of reform have been spreading and making the case that humane action on health coverage is a moral imperative.

This administration drew some fateful conclusions from the failed Clinton-era effort at health reform. The most important seems to have been that by delivering a fully-formed bill to congress in 1993 Bill and Hillary stepped on too many Capitol Hill toes and that is what led to defeat. As a result the Obama team has up to now sketched merely the broad outlines of what he wants and left most of the bill-drafting heavy lifting to Congress. On the positive side, this has resulted in three bills passing from committee in the House and one in the Senate. By contrast, none made it out of committee sixteen years ago. But on the negative side, the President's reticence has allowed his political enemies to command the initiative and control the debate for the past month. The result has been a slide in support for the health bill and for Obama's popularity too.

Obama walked a fine line. He made clear he wants any final product to accomplish three things: reform and regulate insurance practices, cover just about all the American people and rein in costs. He made a good case for a "public option" to be part of the mix. He sounded quite committed to it. But he also said his "door is always open" to discuss constructive ideas for accomplishing the three principal components of the reform he wants.

He spoke angrily about the distortions that have been spread, such as "death panels," funding for abortions, cutting medicare coverage, or funding services for illegal aliens. He said if people continued to spread untruths about his plan he would, "call them out."

And there also seemed to be a catch in his voice near the end as he spoke about his feelings about why this is all necessary. He gave examples of people who had been cut off from their coverage and died. He spoke of not wanting anyone to have to say to a loved one, "There is something that could make you better but I just can't afford it." He summed up with a quote from Ted Kennedy that, "What we face is a moral principle of social justice and the character of our country."

The president made an effort to present many more specifics than he had in recent speeches up to now. There are too many for a short blog, but you can go to his website for an outline here. Some are that everyone would have to get coverage or pay fees, and large companies would have to cover their workers or pay fees. 95% of small businesses could be exempt. There would be "tax credits" for those of limited income to afford something. An "Exchange" would provide a menu of choices to select from. A not for profit public option would be one of them. It would not receive subsidies from the government. Insurers would be required to insure all comers, could not decline for pre-existing conditions, could not discontinue someone if they got sick, and would have to cover preventive care and routine checkups. Out of pocket expenses would be limited by law.

Although the Republican response delivered by Rep. Charles Boustany (R-La), an MD, called for delay, there is every chance that something will pass this year. Democrats are not all on the same page, but they are aware that failure to get anything passed would destroy their claim to effective governance and likely position the GOP for big gains in the 2010 congressional election. So the Democrats will pass something this fall. Exactly what that is will depend on the compromises necessary to get the more conservative Democrats on board in the Senate. But at a minimum, expect it to include the requirements and regulations mentioned in the preceding paragraph. On those matters the Republicans stood and joined the Democrats in their applause this evening. There will be improvement in health care in America in the near future. It may not be as much as fervent progressives want, but it will nevertheless be at the very least the most extensive overhaul since Medicare in 1964. Given the wealth and power of the insurance, pharmaceutical, medical and HMO interest groups, that will be an accomplishment for Barack Obama and his party to be proud of.

Sunday, September 6, 2009

The New Scramble for Africa

In George Orwell's 1984 three great totalitarian empires rule their respective parts of the world. They reserve Africa as the site of their interminable wars against one another, part of a psychological strategy to keep their publics unquestioningly obedient by agitating them into a perpetual state of patriotic war hysteria.

Africa has long been one of the world's chief whipping boys. For four hundred years it served as the source of the New World's slave labor. For centuries before that it filled the same role in the Islamic world. Once they had achieved unrivaled technological primacy, the nations of Europe met in 1878 at the Congress of Berlin to draw up the ground rules for the coming partition of Africa. This first "Scramble for Africa" colonialized the continent for the better part of 80 years.

Direct empire and colonial rule are a bit out of fashion these days, but informal empire for resource and commodity exploitation most decidedly are not. So it is that once again, outside powers are moving in to gain title to the continent's material goods while denying them to Africa's resident population. As the French like to say, "The more things change the more they stay the same." This time the target is farmland--millions of acres of it.

The Fall 2009 edition of "On Earth," the Journal of the Natural Resources Defense Council, the article "Africa on the Auction Block" by Bruce Stutz provides a glimpse into what has been happening lately. Motivated by the doubling of world grain prices between 2007 and 2008, "wealthy nations with growing populations dependent on agricultural imports stepped up their search for alternatives to secure their own food supplies." Chief among the buyers of some 50 million acres, "equal to all the farmland in France" have been such nations as, "the Gulf states, India and South Korea. "

The land has been bought in desperately poor and hungry countries such as Madagascar, Mozambique, Sudan and Ethiopia. Often it has taken place with little or no oversight, or with collusion and dubious motives on the part of African officials. Stutz frames the issue well: "Will the quest for food security or profit bring much-needed investments in these poor host nations? Will it bring jobs, schools, roads, hospitals, irrigation, technology, port facilities and revenue from export duties? Or will these vast 'land grabs' as some have called them mark the beginning of a new era of agricultural colonialism, in which local farmers and herders are forced off their land and left to labor on foreign-owed plantations producing food for export?"

Uganda's parliament stepped in to halt a deal when it found out it envisioned leasing 2 million acres to an Egyptian consortium. Madagascar's president had "unilaterally agreed to grant the South Korean company Daewoo Logistics a 99-year lease on 3.2 million acres--nearly half the country's arable land--to raise corn for export." Public protests and the president's ouster in a military coup followed. But more deals are in the works, including Saudi Arabia's lease of 1.2 million acres in Tanzania and South Africa's interest in 25 million acres in the Republic of Congo. It is not hard to envision a future where hunger gets even worse for Africans as foreigners buy up the region's land and ship the produce overseas.

As the article concludes, it must not be forgotten that this prospect raises "not only a land rights issue. It's also a human rights issue."

Friday, September 4, 2009

Henry T. Perea

I went to an interesting sit down with California 31st Assembly District candidate Henry T. Perea last night. The Tulare County Democratic Women's Club invited Henry to the Methodist Church in the town of Dinuba (population 21,006). The setting was intimate. Eleven of us sat around a table with Henry, who told us about himself and his ideas for serving our Central Valley area and California as a whole and answered questions for about an hour and a half. It was pretty remarkable that a fellow running for such an important position would spend so much time with such a small number of people. He left a very good impression.

Like many area Latinos, his family started out working in agriculture. His grandmother was in the bracero program in World War II canning peaches. She instilled an ethic of service into her children, and Henry was brought up in a political family. His father was the first Latino on the Fresno City Board of Education and the Fresno County Board of Supervisors. His mother was a union negotiator.

While a student at Fresno State Henry interned in the office of Democratic Congressman Cal Dooley. He ran for the Fresno City Council at the age of only 23 and won an upset victory over a wealthy and well connected Republican opponent mainly by sheer determination and hard work. The opponent was endorsed by the Fresno Bee and practically the entire establishment of power people. But he was lazy. For Henry's part, he found an issue, the lack of equal infrastructure in his south area of the city (many streets didn't even have gutters and sidewalks). Henry outworked the opposition, personally knocking on every door in his district an amazing five times. Finally, unlike his competitor, he showed up extremely well-prepared for the debate. He won the seat and has been a Fresno City Council for 7 1/2 years. As for the infrastructure issue, he is proud to report that it was completed under budget and a year ahead of schedule. Last year he lost a hard-fought campaign for Fresno mayor.

Now Henry is endorsed by most of the movers and shakers, including, almost all the district's mayors, the termed-out incumbent and State Senator Dean Florez, a local power and a leading candidate for lieutenant governor. The 31st AD is an interesting mix of a district. It is 51% Fresno city urban and 49% rural. For those who are unaware, Fresno is hardly small potatoes. It has an estimated 2009 population of 500,017, making it number 36 in the nation. But the composition of the district makes it essential to be responsive to issues of both types. This Henry certainly is. He is intelligent, personable, still young at 31, and well-spoken. He is not afraid to state his views, but is considerate and listens well to the concerns people brought up. He had some interesting and attractive takes on the issues.

Major area issues to him include water, transportation and air quality. He is for conservation and environmental protection, but feels we simply must build new dams in the nearby Sierras and a peripheral canal for more water for the valley. He said he sat down with the Sierra Club the day before and knew they weren't going to like that but he told them anyway. Any candidate in this area must be for developing more water sources. I am a Sierra Club member myself and agree with Henry on this! We have the second worst air quality in the nation and suffer high childhood asthma rates as a result. He is for extending Fresno's banning of wood burning fireplaces in new homes area wide, the commencement of two new solar energy projects and the state high-speed rail system through the valley to cut down on car traffic. As a side benefit, he'll fight for the construction of its primary maintenance facility to be located in the Valley near its midpoint. That could mean 1,000 jobs to this badly depressed economy.

Speaking of the economy, he understands the importance of diversifying the region from its traditional over-reliance on the ups and downs of agriculture. Both vocational and degree-producing educational opportunities must be greatly expanded in the valley to remediate its chronically high unemployment, now standing at upwards of 15%. A better qualified workforce will encourage more employers to locate here, he reasonably maintains. He feels the way to begin making serious headway against gangs is with job training and creation. I couldn't agree more.

In terms of California's well-known governmental dysfunction, Henry has come to the point where he favors some of the ideas of California Forward, including holding a state constitutional convention, limited to prescribed issues. He thinks we absolutely has to get rid of the two-thirds requirement to pass a budget but favors keeping that 2/3 threshold for increasing taxes. He feels that as the recently-passed redistricting proposition takes effect beginning in 2012, there will be more competitive legislative and congressional races, but the sharpest dividing line will be less Republican versus Democrat than urban versus rural. I'm not so sure about that, but time will tell.

I was quite impressed with his characterization of public service. He said those who put down politicians and say, "Get a real job!" have no idea how hard you have to work. The most work isn't done on the floor in session, it is behind the scenes reading mountains of reports and bills and meeting with allies and opponents, frequently long after regular work hours to craft solutions and forge common ground enough to move improvements forward. That is, of course, in addition to all the time one has to put in to get and keep the job itself.

There is no doubt you have to be incredibly committed and energetic to do what he is doing. On service, he also quoted the late Senator Ted Kennedy, "We believe in public service as an honorable path, to be a voice for those who have none." If the people of the 31st Assembly District, which leans Democratic, elect Henry T. Perea to represent them, they will have done themselves a favor. He is a moderate progressive, suited for the area. Most of all, he will be a sincere and dedicated public servant.