Much will be written following the death of Sen. John S. McCain, the vast bulk of it of with sincere admiration for his personal courage and service to his country. I am among those admirers. His life was undeniably colorful– he was very much human. Equally undeniable was the magnitude of his service to his nation. He knew where his duty lay, and he gave palpably more than any critic to honor that obligation. He knew the difference between patriotism and nationalism or partisanism. Compared to his legislative peers, it is fair to say that few or none have displayed greater loyalty to the common good of our nation as opposed to any political party. In any world– but certainly in today’s political climate– he was a lion among sheep.
What Are CRS Reports?
I interacted with his Senate office one time in 1998 during my Congressional Fellowship and service to the Senate Finance Committee. Senator McCain filed a typically bi-partisan bill that would make most of the reports and issue-briefs prepared by the Congressional Research Service (CRS) available to the public. At the time, I had never heard of these. CRS reports are among those prepared by the Library of Congress, often in response to requests by federal legislators for background information about current or potential legislation. I had hundreds of these available to me at my networked desk in a Senate office building. The resources of the Library are stunning. The academician in me recognized these reports and issue briefs as extraordinarily useful. They are well researched, and clearly written in language that can be understood by non-technical people. Best of all, these reports are as balanced and nonpartisan as anything can possibly be on Capitol Hill. (The worst service a legislative aid can give their member is not to include all sides of an argument in their briefing.) I downloaded and read as many reports related to healthcare matters as I could find, constantly regretting that I had not had them available earlier as I began a second career in health policy research. Continue reading “Honoring Sen. John McCain’s Service by Making CRS Reports Used by Lawmakers Available to the Public”
Revenge of the Aztecs- Part II
Lessons and challenges from the outbreak of Zika virus.
Although it was discovered 69 years ago in the Zika Forest of Uganda, even as a physician I had not previously known of the Zika virus. I first read about it a month ago in the daily two-page news brief on a cruise ship as it left the harbor of San Juan, Puerto Rico – one of the very places we were now warned by pubic health authorities to avoid! Additional concern was generated by the fact that our cruise itinerary included two other islands in the Caribbean where the disease was breaking out.
The Zika virus belongs to the flavivirus family which includes Yellow Fever, West Nile Virus, and Dengue – serious players. It did not help matters that I had lost a friend to hemorrhagic Dengue fever on the Caribbean island of St. Croix a few years earlier. Like its sister viruses, Zika appeared to be transmitted primarily by mosquitoes carrying blood from one bitten person to another – the usual mechanism of arthropod vector transmission.
Where did it come from?
Although the primary infection itself may be asymptomatic, Zika’s usual symptoms are relatively mild and include fever, headache, joint pains, and conjunctivitis (red-eye). The first well documented epidemic of Zika in humans occurred on the Pacific island of Yap in 2007, and then in French Polynesia in 2013. Impressive was the high proportion of individuals infected. On the French islands, a possible connection was made to an increased incidence of the reactive and probably auto-immune Guillain-Barré syndrome which can cause life-threatening paralysis by attacking the nervous system . In 2015, some traveler, perhaps attending a world cup soccer match, probably brought the virus to South America where it exploded to infect over a million individuals so far. Additional millions are expected to become ill as the epidemic runs its course. Public anxiety and my own was amplified by the fact that so little is known about the disease and its natural history. Continue reading “A Herd of Humans – A Murder of Mosquitoes.”
The process of nominating and appointing members of the University of Louisville Board of Trustees has broken down, and– as seems to be the case for some other Kentucky universities– has been out of compliance with Kentucky law for some time. A system designed to prevent politicization of our Board and to foster gender and minority diversity has produced nothing of the kind. A major reassessment of the entire process is in order but it cannot be done behind closed doors in either Frankfort or Louisville.
When it rains on our parade, it pours.
On the same day I wrote about the statutorily impermissible imbalance of membership on the University of Louisville Board of Trustees with regard to sex and race, James McNair of the Kentucky Center for Investigative Journalism published an extensively researched article documenting the major tilt towards registered Democrats on the Boards of UofL, the University of Kentucky, and the Kentucky Community & Technical College System (KCTCS). In a state with 53% registered Democrats, 39% Republicans, and 8% independents or other, the breakdown of appointees at the state’s three largest institutions of higher education are currently as follows:
Dem Rep Other
UofL 12 3 2
UK 12 4 ?
KCTCS 7 1 –
Continue reading “Nomination and Board Appointment Process At UofL Is Broken.”
My cup runneth over with potential issues to explore.
June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so! In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time. The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style. I haven’t even been able to update the Institute’s Facebook and Twitter pages! What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later. These are not necessarily in chronological order or of importance.
The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges. The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA. The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care. Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”
Gov. Beshear used his line-item veto on the state budget passed by the General Assembly to alter two higher-education education items. They relate to the Kentucky Community and Technical College System, and to the University of Louisville.
With regard to the former, the Governor altered language with the intent of giving more leeway to the governance of KCTC to use agency bonds and fees to fund capital projects on their campuses. With regard to the latter, the Governor reduced the University’s role in evaluating its own need for QCCT funding for indigent care or the effect of the reduction in the amounts appropriated. Continue reading “Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.”
Funding of Higher-Education in Kentucky– Death By a Thousand Cuts.
The 2014 Kentucky legislative session is not over yet, but some would say it never really got started. The Governor has time to veto bills that have already passed, including line-item vetoes in the Budget. The House and Senate still have a final day or two to try to pass additional legislation or override any vetoes. Unless there is a miracle on the Ides of April, the budgets of the state Universities are now graven in stone.
What Makes a Good Legislative Session?
Complaints have been voiced that this session was not a fruitful one because so few bills of any significance were passed. That would be a valid observation if the most important function of the General Assembly was to pass good laws. Another school of thought, to which I have some affinity, is that the highest function of legislative bodies is to prevent bad laws from being born– legislative contraception as it were. From that perspective, our Kentucky House and Senate committees with their competitively-adversarial political party structures serve to prevent attachment of many nascent bills to the walls of their respective full chambers. Many bills deserve to be thus aborted.
I spent a good bit of my free time these past few weeks trying to understand what was happening to funding for the Quality Community Care Trust fund (QCCT) that has for some 30 years provided supplemental funding to the University of Louisville Hospital to care for uninsured inpatients. The amounts of funding provided by the city of Louisville and the Commonwealth have been decreasing, the contractual parties have changed several times, and the permitted uses of the money had slowly changed over time in an evolving medical ecosystem. In my opinion, that program is nearing the end of its useful lifetime. I have written about these matters often over the past two years and will continue to do so as I go through the Louisville archive of contracts and correspondence now available to me.
Not a Great Legislative Session for the State Universities.
Our public institutions of higher education are probably more unhappy than most with the outcomes of the session. At a time when they are being urged to enroll and graduate more students, their budget allotments from the general fund continue to shrink. Just as our state retirement systems were systematically underfunded to the point of impending insolvency, so too has funding to renovate or replace our university inventories of aging or inadequate buildings been ignored. What might have been accomplished in small pieces has now become an unmanageable disaster. Money for new educational facilities is largely a gleam in the eyes of university Boards of Trustee members. As I combed through legislative documents this spring, I had occasion to examine the blunt-knife approach to carving up academic budgets, but also to gain insight into the priorities of these institutions and the hoops they must jump through to advance their interests. The initial budgets from the General Assembly called for an across the board cut to the university budgets of 2.5%, and according to some, the 14th year in a row of such cuts. Continue reading “Kentucky’s Universities Fare Poorly in 2014 Legislative Session.”
There are a number of reasons why many individuals and organizations have opposed or had serious concerns about the proposed acquisition of University of Louisville Hospital by Catholic Health Initiatives. The transfer of a state and public asset to a private one, the separation of church and state, the alignment of the entire medical training and clinical operations of a public medical school with a religious organization, transferring a substantial portion of Kentucky’s healthcare system to an out-of-state caretaker, or agreeing to onerous anticompetitive restrictions with other Kentucky health care providers and educational institutions are among them. Any one of these issues provides sufficient grounds for rejecting the proposed business arrangement.
Perhaps the most emotionally controversial of these problems is the agreement by the University of Louisville to subjugate itself to some of the religious teachings and policy of the Roman Catholic Church as the basis for the provision of medical care in its teaching and clinical facilities. The University of Louisville has placed its operations at ground zero of an abortion controversy that has torn asunder the civil fabric of our community. Because it is defined even in the Sponsorship Agreement as an instrumentality of the Commonwealth of Kentucky; the University of Louisville has put Governor Beshear, Attorney General Conway, State Auditor Luallen, Mayor Fischer, and other governmental offices and officials into the most difficult position possible. I do not know what these officials have been told in their private briefings by the business partners, but I heard the hospital system representatives say publicly that medical treatment of women would hardly be affected at all; with the exception of certain procedures the University has contractually agreed not to do. To my and many ears, their protestations and promises changed from day to day and place to place. Requests for the specific contractual language and other relevant agreements were refused in an off-hand manner. To hear the advocates speak, the implications of their business decision on our community and on women’s health care, and the magnitude of the compromise of our institutional academic and medical ethics and independence were a “small thing.” I cannot agree. Continue reading “Analysis of Hospital Acquisition Sponsorship Agreement: Catholic Health Directives.”
There was a little excitement this week in the Louisville Metro Council over whether or not to continue the next installment of the $7 million indigent care payments to University of Louisville Hospital from the QCCT funds. The City of Louisville and Kentucky provide many millions of dollars annually against which University Hospital can bill for eligible indigent patients.
There were a number of issues that caused the Budget Committee to put the brakes on the city’s payments as of January 1. One was that that in the post-Passport scandal era the Hospital had not provided the requested and expected accountability. It is puzzling to me that the Council expressed the same transparency concerns last July but had still not been satisfied. Is the council giving too much deference to the university? The procedural move also signaled that there are deep concerns about the proposed acquisition of University of Louisville Hospital by the hospital chain Catholic Health Initiatives out of Denver. Would the same services be provided, and would it even be legal to give public funds to a private religious organization.
Two days later the Council as a whole voted to release additional installments of the remaining $4.8 million funding until March, pending the apparently delinquent reports by the Hospital. Councilman Downard said that, “the hammer is still there” concerning their demands for information, but I thought the hammer had already been cocked! So much for transparency from this self-declared private institution. Amendments were offered to make the continuation dependent on providing the same range of services after as before any take-over but they were defeated. The protest of the committee hold was overridden, but its point was made. The University of Louisville made some of its documents available publicly the very next day. The University seems to realize that it has lost its public relations war against the citizens of Louisville. I sent the Council an open letter the day of their main meeting. It gives additional details and outlines my thoughts about whether the QCCT mechanism is still an appropriate way to fund indigent care in our city, or whether it has had unexpected and undesirable consequences. What do you think?
Continue reading “Dust-Up Over Disbursement of QCCT Funding to University Hospital”
On Veterans Day, 11-11-11, the Courier-Journal reported on the status of plans to build a new Veterans Hospital for the region of Louisville Kentucky. The community has been waiting with decreasing patience for the results of all the promises and hearings. The update did not, however, announce that a final site had been decided, nor that financing was in hand, nor that a start date was known. Instead, the big news was that the site selection process had decided against leaving the hospital where it is on Zorn Ave, and against moving to the downtown medical center of metropolitan Louisville. Subsequent notice of new road work near the intersection of the Watterson Expressway and Route 42 suggested that the new VA would be located there. On Dec 14, we received further official verification from United States Secretary of Veterans Affairs, Eric Shinseki, that indeed the 4906 Brownsboro Rd address is the first choice for the new medical center. The second choice site is the one Factory Lane near the Gene Snyder Expressway. It was estimated that from the time financing is secured, construction will take a little more than three years. The letter from the Secretary appears to be in response to a request from Sen. McConnell for a realistic timeline for the project. The Veterans’ Day update quoted 5 veterans, 4 of whom expressed disappointment and a preference for staying at Zorn, one of whom was relieved that at least it would not go downtown. Continue reading “New Suburban Veteran’s Hospital for Louisville”
Last week I submitted the following letter to the Governor’s Office.
Governor Steve Beshear
700 Capitol Avenue, Suite 100
Frankfort, Kentucky 40601
Re: Premature approval of hospital acquisition in Louisville.
Dear Governor Beshear,
You have been asked to consider approving a merger/acquisition involving the University of Louisville and University Hospital, Jewish Hospital & St. Mary’s, and the St. Joseph’s Hospital System under the auspices of Catholic Health Initiatives. Individuals and Organizations (including women’s organizations) in the Louisville Community who have written or spoken about this matter are overwhelmingly against this merger, save for employees of the University, or its business partners. The opposition continues unabated despite several public and private briefings. This is in great measure because of the puzzling refusal of the proposal advocates to disclose relevant details supporting the real public or indigent-care need for the merger, or the implementation of its most controversial elements– especially those revolving around church and state issues. Continue reading “Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital”