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Douglas House 
Member since Sep 27, 2014

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Colonel, Retired, US Army Attorney at Law State Representative, District 40 Arkansas House of Representatives

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Recent Comments

Re: “Walton public school attack continues for Massachusetts charters and Arkansas vouchers

The writer "Sound Policy" asked an honest question, "Did you consider that most parents (to paraphrase, won't know how to select a school?)" Yes, we did, at length, and we wrote it in the law that parents must have their child in an Arkansas Public School (except for military families) for a year before becoming eligible. That puts those parents in contact with special ed teachers and administrators who do have that expertise and can bring facts and insight and resources to bear. I cited one child in a school who will probably never be removed by her parents because of the wonderful care at at tremendous expense. But not all schools have the expertise or resources to do this. True, most parents also do not know how to treat a medical condition or select a lawyer, much less pick a special needs school. So I'd say most parents of severely disabled children know if their public school is not working for their disabled child. They ask people who also have disabled children, they check with schools that cater to special needs kids, but most importantly, they must notify the school that they are going to bail their child out. That brings them into contact with the best experts available, the teachers. I have faith that the special ed teachers will tell them the truth, whether a private or public setting is best for their child. Its not perfect but it seems to be working in 25 other states. If anybody has any better ideas, my cell phone is 501-590-1055.

Posted by Douglas House on 09/30/2016 at 3:27 AM

Re: “Joint Public Health discusses Government Accountability Office report on private option

I could not let it pass. So here I am, a digital subscriber. I always enjoy the printed edition to this grandchild of Jefferson's National Gazette. It is like reading the enemy's order of battle. Just a few facts to keep the record straight.
1. There were four federal laws, (I don't have time to look the names up again) that took $2.2 Billion of Medicare money over ten years away from Arkansas hospitals. Two made up the Affordable Care Act, one was the bill passed with the Bush Tax Cuts and the other one was the bill that addressed Fiscal Cliff fiasco, what was it, three years ago now? That $2.2 B was money our local hospitals used to cover the cost of 250,000 uninsured poor people going to the emergency rooms, and to defray the costs of in-patient admissions for which they could not pay.
2. Our hospitals went into a death spiral. I did not just take the Arkansas Hospital Association's word for it. I went to several of central Arkansas hospital CEOs and CFO's and said, "show me your books." I also started reading their IRS Forms 990, the tax returns for not-for-profits. Everybody ought to read their own local non-profits' tax returns. I refuse to donate to some because of what they do with the money, but I digress. Some hospitals had less than a year to live, some of the bigger ones could survive by cutting expenses and people, merging, and changing the way they do business. But to survive, they needed three years or so in time, and time means money.
3. Obamacare gave us two, then later three options. Expand the traditional Medicaid program (dead on arrival as far as we, 100% of the GOP, were concerned) do-nothing, and buy insurance with the money. The reasons Medicaid was DOA include (a) Doctors won't take it anymore, unless they work for some subsidized institution that absorbs the 30-70% loss on every service they deliver, and (b) you must expand government costs to administer it. Oregon had expanded their Medicaid program at the time. I called the folks who run the OR program. They told me that they had already raised their reimbursement rates to doctors and hospitals in order to make Medicaid patients attractive. I have talked to folks in Kentucky and West VA. They have told me that they had to expand their government force when they expanded their Medicaid. Expanding Medicaid in Arkansas was money down a rat hole. Without raising reimbursement rates private physicians (what the GAO didn't check) we were still back to the emergency rooms for care. Get folks out of the ERs, get folks to primary care doctors, registered nurses, physician assistants, pharmacists, chiropractors, optometrists, heck, even certified nursing assistants can check blood pressure and blood sugar.
4. I am not an economist but I play one in real life. Folks throw around the word "costs" like they know what they are talking about. Usually they refer to only one component, what comes out of their own pocket, or their field, or stash. When you talk about taxpayer money, folks tend to ignore the labor, capitol, and raw material that constitutes the cost of DELIVERY. The cost of delivery of a dollar of goods and services in a family is nothing, or pretty close to it. Mom gives you a dollar (maybe she earned it, got it from Dad, etc.) for lunch, the cost of delivery is next to nothing. Generally, Several things I have read over the years convinces me that it "costs" the taxpayers of the federal government about $4.00 (on average) to deliver $1.00 in goods and services. Think of all of the overhead, from Congress passing a law, to collecting taxes, to creating a bureaucracy, to cutting a check, to auditing after the fact. For taxpayers of the State government, some have said (ABOUT) $3, for local government it is $2, for private businesses it is $1, and for charities, about 25 cents. What's the point? It costs less to deliver payment for medical care using private businesses (called insurance companies) than it does to deliver those services through a government. The price of a band-aid is the same no matter who pays for it. That price is based on supply and demand. But who pays and how affects the costs to the taxpayer? I checked with Arkansas Department of Human Services. We have already eliminated seven medical programs that were government run under Traditional Medicaid. The services are still being provided, better, faster, cheaper, more account-ably through health insurance, rather than through a team of government employees.
5. Keeping our hospitals open until 2017 is my legislative objective. Everybody, rich, poor, with or without insurance depends on them. Hospitals in the states that did not take the Obamacare medicine are closing. We will survive. My district includes Mayflower and 12 miles of tornado destruction. We had 140 people taken to Conway Regional that night. Some would not have survived a ride to Little Rock. But Conway Regional took a big financial Medicare hit thanks to the current presidential administration. And Conway Regional management knows it must adapt to a new paradigm. So do other small hospitals. Baptist has adapted and is expanding to Conway. St. Vincent's is expanding too through mergers. Cut overhead, become more efficient, economy of scale, etc. But if you lose the community hospital, you lose the community, and you lose lives. One of my friends said, "Oh, yeah, what about West Memphis?" Right. The one that caught fire, was turned into a petri dish for mold and antibiotic resistant strep/staphylococcal by fire department hoses, and is within ten miles from a half-dozen, and 20 miles from eighteen or so world class Memphis medical facilities. Folks will have to cross a river, which they were doing anyway, and why a tiny hospital is West Memphis was doomed. I am saddened, but not surprised. But Private Insurance for 180,000 non-payer users, at last count, gives the hospitals some breathing room to adapt. If the state portion is 10% in a couple of years, it is still less than the $200 Million we are going to have to find to keep hospitals open. And get over it, nobody hates poor people. We hate waste.

So comparisons of Medicaid versus private insurance don't interest me unless you factor in all of the overall costs to the taxpayers. We are going to spend $650,000,000 for insurance when we could have taken half of that amount in block grants to open clinics, pay doctors and staff, subsidize the hospitals for uncompensated care, and serve the poor. That is the GOP formula, one that the feds will not let us follow.

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Posted by Douglas House on 09/27/2014 at 5:52 AM

 

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