Levees and the era of neglect

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

A column with the word “levees” in the headline probably won’t attract a record number of readers. Unless you live in a floodplain, they’re just big piles of dirt, right?

Well, not really.

The recent floods have drawn attention to Arkansas’ deteriorating levees. Really, “forgotten” is the better word. As reported in the Arkansas Democrat-Gazette Sunday and elsewhere, it turns out that, in many cases, no one’s really in charge of maintaining them, or even caring whether or not they exist. They were built when the need was obvious, such as after the Great Flood of 1927, when the overflowing Mississippi River submerged much of the state. Local boards were set up to maintain them, and legislation was passed to ensure their independence. The board members – those with memories of those floods – grew old and died or for whatever reason stopped paying attention. Those big piles of dirt continued to function fine for decades – until, this past spring, when at least a couple of them didn’t.

A levee is just like anything else in that it becomes less effective over time unless it is maintained. Dirt erodes. Vegetation overgrows. Mankind intrudes. As the Democrat-Gazette reported, one levee nearly failed because someone once dug a hole at its base for a construction project.

This spring was a wake-up call, so legislators are scheduled to hold hearings June 24. It helps that one of them, Sen. Jason Rapert, R-Conway, saw his property submerged under water during the flooding. The issues will be the same as they often are in a democracy: Should someone be in charge, and if so, who? And, where will the money come from?

Were this only about piles of dirt, I probably wouldn’t be writing about it, but Arkansas’ levee situation is part of a larger story – in fact, one of today’s biggest.

For centuries, this was the land of sacrificial investment. Immigrants came here knowing it might take a generation for the family to really enjoy the benefits. Wars were fought where more than just a few contributed. Railroads were laid. Roads and bridges were built. Arkansas taxpayers in the early 20th century paid extra so that’s today’s taxpayers would have an extra sturdy State Capitol to conduct the people’s business.

Contrast that with today, when it’s way too much about the present, and we’ll let our children fend for themselves. The obvious example is the $18 trillion national debt – equivalent to $57,000 for every American man, woman and child – almost all of which has been created since 1980.

But there are other less obvious ways in which we’re passing on the costs of the things we take for granted because of misplaced priorities and waste. For example, the nation isn’t properly maintaining its aging transportation infrastructure, much less making significant improvements. Instead of making tough choices and really addressing the deficiencies, Congress patched a hole in the highway budget this past year partly through an accounting gimmick that borrows from the next 10 years. That money has been spent, future taxpayers will be paying, and yet the Highway Trust Fund is nearly insolvent again. Meanwhile, plumbing systems in many cities are aging. In some cases, they’re more than a century old. Few care as long as it goes away when they flush, but someone will have to fix those pipes eventually.

Americans often assign names and characteristics to generations: the baby boomers, Generation X, the Millennials, but it won’t take long for future Americans to lump us all into one category. We think of the 1700s as the age of exploration and the American Revolution, the 1800s as the era of expansion and the Civil War, and the 1900s as the century of American victory and ascendancy. I fear they’ll someday say ours was the Era of Neglect.

It doesn’t have to be this way. We’re still capable of investing. Maybe this recent scare will result in a renewed emphasis on levee maintenance. Everyone recognizes it costs much less to maintain a big pile of dirt than it does to rebuild a flooded community. Meanwhile, Congress at least recognizes the need to invest in the nation’s transportation infrastructure, even if it hasn’t figured out how. Sometimes those old plumbing pipes actually do get fixed.

I’m struggling to come up with something positive to say about the national debt. How about this? Americans have overcome worse.

Let’s just hope it doesn’t take the equivalent of a flood before we’ll try.

When turkeys attack

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Have you ever thought about what you would do if you were attacked by a turkey? If it happens after Oct. 1, someone will have thought about it for you.

That’s the date the nation’s medical providers – including 38,000 of them in Arkansas – are required by the government to switch from the ICD-9 coding system to ICD-10. The codes are what your doctors transmit to insurance companies and government agencies to get paid.

ICD isn’t just a national standard but a worldwide one. The United States began using ICD-9 in 1979. ICD-10 has been around 25 years, and much of the world has already switched to it.

ICD-10 is “better” in that it’s much more specific. ICD-9 uses 13,000 codes; ICD-10 uses 68,000 – exactly which bone was broken and on which arm, for example. Knowing this information helps payers – insurance companies and the government – detect waste and fraud. It also helps researchers better understand problems and trends.

But ICD-10 takes that specificity to an extreme. According to the fact-checking website Politifact, it has nine separate codes for turkey-related injuries, including one if the patient was struck by a turkey and another if the patient was pecked.

Requiring the nation’s medical coders to switch to that kind of system is not cheap. An American Medical Association study found that, between training costs and software purchases, a small practice will spend between $56,639 and $226,105, with larger practices spending up to $8 million.

That’s a big expense and a lot of trouble, and as a result, the state’s medical providers aren’t prepared for ICD-10. Of the 95 clinics that have responded to an Arkansas Medical Society survey, only 16 percent are ready now, and 30 percent do not expect to be ready by Oct. 1.

The procrastinators are probably hoping the switch will be delayed, as has happened twice. The switch originally was supposed to occur in 2008. But Tami Harlan, deputy director of the state’s Medicaid program, said it’s unlikely the feds will allow another delay. She said her agency is working “feverishly” on the change. On Oct. 1, if a doctor’s office sends Medicaid an ICD-9 code, it will be rejected immediately. The clinic still can be paid by paper check, but that will be costly for it and for the Medicaid program, and the payment will be delayed. So on Oct. 1, expect unprepared clinics across the state to start scrambling.

Is ICD-10 worth it? I don’t know, but we shouldn’t be surprised by all this. This is the system we’ve set up.

American medicine is based on the expectation that most care will feel almost free to the patient as the care is provided. We pay into a big system upfront through insurance and taxes, pizza buffet style, and then expect to pay little afterwards. If we want a $25,000 car, we’ll get a loan because, hey, it’s got a sun roof and we earned it. For a procedure that restores our health or saves our life, we’re outraged if asked to pay almost anything because it’s not fair, and besides, that’s why we have insurance. The system should pay for that.

But if we expect government and insurance bureaucracies to pay the big bills, we should expect them to behave as bureaucracies behave. They want to know how the money is spent. They want to put things into boxes. They want to control, and at some level, they have a fiduciary duty to do so.

I’ve heard more than one well-informed person – specifically, Sen. David Sanders, R-Little Rock, and Cheryl Smith Gardner, executive director of the Arkansas Health Insurance Marketplace – say the health care system inevitably will move in one of two directions: more consumer choice, or more government command and control. They and I would prefer more consumer choice.

That’s difficult in health care. Consumer choice requires consumer responsibility, and it’s not like we can go shopping for the best deal when we’re in the ambulance after an auto accident. But at the very least, for smaller stuff like if turkeys attack, we probably ought to pay for it ourselves, if we can. We probably shouldn’t have been messing with the turkeys in the first place. For the bigger stuff, right or wrong and unless expectations change, we’re probably stuck with something like ICD-9 or ICD-10.

Or ICD-11, which should be ready for whoever wants it by 2017.

Huckabee’s debt approach not serious enough

Uncle Sam hangs on for webBy Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Former Gov. Mike Huckabee made some headlines this past week when it came to light that he had made a joke about transgender people during a February speech. He said that, given the chance in high school, he “would have found my feminine side” so he could take showers with the girls in P.E. This was newsworthy, apparently, because of the attention surrounding Bruce Jenner becoming Caitlyn Jenner.

This column is not about that joke. Let’s instead focus on something Huckabee has been saying when he’s completely serious.

Huckabee has released a pledge in which he makes 17 promises, including to “protect Social Security and Medicare and never rob seniors of the benefits they were promised and forced to pay for.” He has criticized other Republicans for proposing to change those two programs, which together compose 38 percent of all federal spending and are growing.

Huckabee is right that benefits should not be cut for current beneficiaries or for those who are nearing retirement age. They’ve paid into the system their entire lives and planned their retirements based on the rules, with no real say in what those rules were. People a little older than me (I’m 46) and younger, on the other hand, are probably going to have to accept some changes.

But in an interview with Fox News’ Neil Cavuto after speaking in Florida June 2, Huckabee said that the rules shouldn’t be changed for anyone paying into the system, including for those just starting out as teenagers who won’t collect for another 50-something years. He openly told Cavuto that he is differentiating himself from other Republicans who have tiptoed toward this politically hazardous issue.

With the aging of the baby boomers, longer life spans, and increasing health care costs, Social Security and Medicare need some fixes. For example, Social Security’s non-existent “trust fund” is due to become insolvent in 2033. That’s 18 years from now, not 50. If the actuarial tables are correct, whoever is in office that year will be forced to either cut benefits by 23 percent, raise taxes, make deep cuts elsewhere, or borrow from the future. He or she will have to make difficult decisions then because current political leaders won’t make them now.

One honest way to continue paying current Medicare and Social Security benefits is to raise taxes and cut other government programs, including the military. If that’s what America wants to do, I’ll write my check now so my kids don’t have to.

The problem is that Huckabee doesn’t propose anything like that. Among his 17 promises are to “support a balanced budget amendment to the Constitution,” but then he pledges to “secure our borders,” “restore our military infrastructure,” and “end the national disgrace of failing to properly care for our veterans” – all worthy goals individually, but none of them free.

There are not a lot of spending cuts in those 17 promises. He does pledge to deny government benefits for illegal immigrants and to repeal Obamacare. That’s not nearly enough to balance the budget, and besides, the pre-Obamacare health care system was a growing driver of the national debt, too. He did say in his speech that the country should redirect its health care spending toward curing diseases such as cancer and Alzheimer’s. If those efforts were successful, Medicare would be much more sustainable.

Meanwhile, he promises to “oppose and veto any and all efforts to increase taxes” and to replace the current income tax with a national sales tax. He says the new tax system would grow the economy, generate revenue, and be a better way to pay for Social Security and Medicare than cutting spending or raising taxes.

A national sales tax might or might not be a good idea, but it certainly would be a huge experiment. If it raised less revenue than expected, then would Huckabee cut spending?

For decades, Republicans and Democrats have engaged in the same politics: Grow government first, and then worry about paying for it later, or never. At least Huckabee is being honest about the fact that he won’t cut Social Security and Medicare or raise taxes.

But by doing so, he’s contributing to the national misperception that this impossible math is all going to work. Americans haven’t accepted the hard truth that if they want these government programs, they’ll have to pay for them. Leaders must tell them that truth.

Let’s hope Huckabee will use his considerable skills to do so. The national debt is no joke.

Taking stock of third parties, independents

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Three events have occurred the past two weeks that are noteworthy, particularly for the growing number of voters who call themselves independents and the small percentage who actually vote for candidates who are not Republicans or Democrats.

First, on May 29, Gov. Asa Hutchinson signed into law a bill moving Arkansas’ 2016 primary elections from May to March 1. The stated goal was to include Arkansas early with other Southern states in the so-called “SEC primary” so the state would have more of a say in who the Democrats and Republicans nominate for president. It might help Mike Huckabee in his campaign a little by giving him an early state win.

A consequence is that challengers have less time to decide if they want to run against incumbents. That’s particularly the case for independents, who unlike party-affiliated candidates must collect signatures to qualify for the ballot. Under a bill passed in 2013, independents must submit their signatures by the end of the filing period. This election, that would be November, so they must begin collecting signatures in August for an election that won’t occur for another 15 months.

Mark Moore of Pea Ridge, who ran as an independent for the state House of Representatives in 2012, says the 2013 law requiring independents to file so early is unfair and unconstitutional. After all, it gives them the same deadline to qualify for the ballot after collecting signatures that it gives party candidates to merely sign up with their filing fee. When the primary is in May, independents must collect signatures in the dead of winter. The election before the law’s passage, seven independent candidates ran for the state Legislature, including Moore, who won 39 percent of the vote in a two-person race. In 2014 after the law was passed, only one independent ran for that body.

Moore wants a return to the old law, which allowed independents to file first and then collect their signatures. He’s filed a lawsuit and says legal precedents are on his side. His day in court is July 27.

Second, Rep. Nate Bell of Mena, ironically the co-sponsor of the law Moore is suing to end, announced June 2 that he himself is now an independent and no longer a Republican. So now the 135-member Legislature has only 134 Republicans and Democrats.

The third-term legislator, known for being quite outspoken, has not given a reason for his switch other than to say it would enable him to better serve his constituents. He was a strong opponent of moving the primary to March, arguing that it was unfair to candidates and their families.

Finally, just hours after Bell’s announcement, the Libertarian Party of Arkansas submitted 15,709 signatures to the secretary of state’s office, far more than the 10,000 signatures it needed to qualify for the 2016 election as a “new” party. Arkansas law requires it to do so because its candidate for governor did not receive 3 percent of the vote in the last election. Under state law, if the Libertarians’ presidential candidate does not win 3 percent in 2016, they’ll have to collect signatures again for 2018.

Libertarians call themselves the “party of principle,” and that principle is that they want much less government. They would cut all federal government programs significantly if not completely, including Social Security and Medicare, and they also would cut defense spending while legalizing marijuana.

The party’s newly elected chairman, economist Dr. Michael Pakko, points out that every Arkansas voter had at least nine Libertarians on the ballot in 2014, including all congressional races and all state constitutional offices. In the statewide races, no Libertarian candidate won more than 6.4 percent. A numbers guy, Pakko knows the party is not ready to win major elections, but he says the party is growing and will be a viable alternative if enough voters ever decide they’ve had enough of the major parties.

The way the American political system is set up almost guarantees a two-party system, despite the fact that parties are not mentioned in the Constitution and despite George Washington imploring his fellow Founding Fathers not to succumb to party politics.

America’s economic system, meanwhile, is designed to offer unlimited choices. In the cereal aisle I have dozens of viable alternatives.

I don’t want that many choices in the voting booth. But it seems like the political system could learn from the economic system, and give me more than two.

Reforming health care reform

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

During the next two years, the most important number in Arkansas health care may be 1332.

That’s a section of the Affordable Care Act, the one that created Obamacare, that, starting in 2017, may allow Arkansas significant flexibility in implementing the law – potentially even letting it nullify some of its more controversial elements, including the mandate that individuals buy health insurance. Or maybe not.

Legislators serving on two panels these past two weeks heard testimony regarding Section 1332. Cheryl Smith Gardner is directing the state’s changeover from a federal exchange to a state exchange, which is where small businesses and individuals buy insurance. She once was a researcher for the conservative Heritage Foundation. Dr. Lanhee Chan is a Stanford University research fellow who was the chief health advisor for Mitt Romney’s 2012 presidential campaign.

In other words, these are not left-wingers, and both of them indicated Section 1332 offers the potential for major state-based reforms to the Affordable Care Act.

In a nutshell, here’s how it would work. Beginning Jan. 1, 2017, states can receive waivers from the federal government for large sections of the law provided their reforms meet four requirements. A waiver says the law does not apply in a particular situation.

First, health plans – whether provided by insurance companies or the state – must provide coverage that is at least as comprehensive as would be provided otherwise. What does that mean? It’s not clear, but it could mean that plans in Arkansas could have a heavier focus in some areas and a lighter one in others than they currently have.

The other requirements are that out-of-pocket expenses for individuals must be no higher than they are now; coverage must be provided to a comparable number of people as otherwise would be provided; and the changes must not increase the federal budget deficit over a 10-year period.

The section is so open-ended that it appears states can propose almost anything – although one thing they can’t change is the requirement that insurance companies offer coverage regardless of pre-existing conditions. If a state can figure out a way to cover as many people without the individual and employer mandates, it can propose it. Arkansas might be able to move large parts of its population from Medicaid, which is strictly government health care, to the so-called private option, which is more flexible because it’s government-funded health care through private insurance companies. Chan said it might be possible to collectively make changes to all federal health care programs within a state’s boundaries, including Medicare, where states’ roles now are limited.

“My own view is that 1332 has the potential to be a significant step forward for those seeking market-based health care reform,” he told the Health Reform Legislative Task Force May 28. “The challenge, of course, as with any waiver is that the negotiation process has two parties. It has the state, and it has the presidential administration.”

There’s the catch: The waivers have to be approved by the secretary of Health and Human Services and the secretary of the Treasury, which includes the IRS. The skeptical lady sitting beside me was doubtful those officials will approve anything that’s not more generous to beneficiaries than Obamacare already is. Sen. Terry Rice, R-Waldron, wondered if the administration might fail to hold up its end of the bargain if a waiver were approved. When Chan said that would be “unprecedented,” Rice replied, “I appreciate that thought, but I’m one that (feels) like we’ve seen some unprecedented things.”

On the plus side, the Obama administration has proven itself willing to grant health care-related waivers. The private option, in fact, exists because of a waiver. The administration knows that the Affordable Care Act is widely distrusted in red states like Arkansas, so it has an incentive to be flexible. Judging by the questions legislators asked, most seem to be keeping an open mind. Chan’s job in 2012 was to help defeat Obama, and he seems cautiously optimistic about the possibilities.

No state has yet submitted a waiver request, and Arkansas is nowhere near doing so. In fact, most legislators only now are learning much about it. It could create a lot of work that leads nowhere and is a huge disappointment. Or it could let states creatively reform health care reform. We won’t know which will be the case until 2017 is much closer. Until then, remember the number 1332.