Draining debateFederal health care debate drags on, raises more questionsBy Bill Davis, senior editor Part 2 of 2
AUG. 21, 2009 -- Federal health care reform debate in Washington, D.C. has been causing a sickly feeling in Columbia, where fears of further government encroachment and higher costs, or of a compromised reform bill, have increased.
 Members of Congress crisscrossed the state this past week, drumming up support for the fight against President Obama’s supposed health care plan, and beating the bushes for comment in a series of town hall-style meetings held in everywhere from a down-home restaurants to tony private country clubs.
Voices have emerged across the South Carolina political spectrum, both for and against national health care reform, and what it may mean for the state’s health care policy in the coming years and legislative sessions.
Sen. Gerald Malloy (D-Hartsville) stands at the balancing point in the debate over the future of South Carolina’s public health offerings. One on hand, he represents a constituency probably more interested in expanding government health care options than, say, Sullivan’s Island, the ultra-wealthy community where First Lady Jenny Sanford has returned to after leaving her husband.
 But Malloy also serves on the Senate Finance Committee, so he knows more than just the human costs of health care reform. Taking a deep breath, Malloy, the past president of the state’s trial lawyers’ association, said the Statehouse needed to be more focused on “outcomes” than on politics in this matter.
“We’ve got to get more people covered, particularly women, children and seniors,” said Malloy. But, he stressed, a balance had to be struck between what needed to be done for the people of the state and what could be done in a fiscally sound manner.
The first priority, said Malloy, would be to reintroduce a cigarette tax increase when the legislature returns in January. A proposed cig tax increase was scuttled this session due, in part, to concerns over funding issues that could arise from the federal debate.
A warning on what expansion could mean
That may not be enough. Former state Insurance Director Ernie Csiszar warned that health care mandates passed down from the federal government could greatly expand state government budget shortfalls and deficits.
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Far from being an impassioned layman yelling at congressmen at town halls, Csiszar was formerly the CEO of Property and Casualty Insurers of America, the largest property and casualty insurance association in the United States, from 2004 to 2006. He is also currently a professor of risk management at USC.
“How much has the federal senior citizens medicine plan cost us? Ten times its original estimates?” he asked.
State health care programs are already an expensive proposition. In South Carolina, the portion of the state’s General Fund budget going directly into Medicaid this past year was just short of $1 billion. Nationally, states kicked in $218 billion in 2007.
Overall, South Carolina’s residents and businesses spent $21.4 billion on health care in 2004. Considering that the state’s gross domestic product for that same year was $136 billion, that meant one dollar for roughly every six earned went to health care.
Turning up the vitriol
Sen. Lee Bright, a Republican rookie legislator from Spartanburg, is staking out the ground on the far right of the issue. Going beyond labeling health care reform as “socialism,“ Bright said that Obama’s call for reform amounted to nothing more than a federalist grab for power from the states.
 Bright, who had become so strident in his first term on several issues that members of his own party began to criticize him quietly, said there are other free-market ways to reform health care. But, he argued, since those weren’t being discussed on a national level, it laid bare Obama’s actual agenda: a power grab.
Bright’s words echoed the sentiments of the champion of Southern federalism, Robert Goodloe Harper, a former member of the S.C. House of Representatives beginning in the 1790s and eventual U.S. congressman.
Donning the pen-name “Appius,” Harper once wrote: “Great abuses in government, like great rivers, arise from small beginnings. They are easily checked at first, but encreasing [sic] imperceptibly in their progress, they at length become too powerful for opposition.”
The conservative, small-government, lower-tax, think-tank the S.C. Policy Council shared concerns of Appius and Bright.
Free-market alternative?
In a recent position paper, the council held that there was a free-market alternative “that could improve health care access by making insurance more affordable for everyone, without government subsidies and price controls. Absent such reforms, expanding government-run health care will result in higher costs, lower quality care and higher taxes.”
 Csiszar saw reason for concern, too, beyond the erosion of civil liberties. Csiszar saw a possibility of a federal plan, through a proffered public option, driving private companies out of the market. He also saw how the passage of a compromised bill could be the worst thing for the country, one that solved nothing.
Csiszar referenced a state law in Massachusetts that has placed requirements on employers providing health insurance to their employees, but has what he termed a “ridiculously“ low option where business could simply pay a small fine to avoid offering the insurance.
He also argued that the federal government could pass a similar bill, and that members of Congress could withhold or pledge their vote in exchange for more advantageous rates for their constituents.
Crystal ball: Obama is going to get some sort of health care reform bill passed, possibly this year: Democrats in control of the U.S. House and the Senate make that a virtual lock. The question will remain, what reform plan will emerge? And in South Carolina, will the “sacrificial lamb” cigarette tax be enough to cover the potential costs of any federal mandates passed down to Columbia, with or without funds attached?
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Summertime doldrumsThere are scant few state meetings, legislative or otherwise, scheduled for next week. Members from the House and the Senate will meet Thursday at 11 a.m. in 105 Gressette for the Broadband Contract Subcommittee of the Joint Bond Review Committee
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Impeachment ahead?Emboldened by another round of revelations of potential screw-ups, more legislators are considering putting up a measure to impeach Gov. Mark Sanford when the General Assembly returns in January. The talk is still low enough now that it may be unlikely, or, if one is put forward, it may just be for show.
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Sanford’s latest mess
A story broke in recent days that Gov. Mark Sanford may have reimbursed himself for expenses incurred during times he was meeting his Argentine “soul mate."
The governor has reportedly refused to release detailed accounts of how the money was spent. So, on top of abandoning the state for five days to travel to South America to meet with his girlfriend, on top of cheating on his wife, on top of allegations that he may have used the state plane for personal use, and coming on the heels of his attempt to block state acceptance of nearly $800 million in federal stimulus funds meant largely for education, the question has arisen: Is there anything Mark Sanford won’t do to make Andre Bauer governor?
A more important question is, what more will a looming state Ethics Commission investigation uncover?
Getting their man
Critics of the state Employment Security Commission may have gotten their man last week when longtime commission employee and chief officer Ted Halley announced he would step down at the end of this calendar year.
Halley had been at the center of an ongoing political firestorm after the state had to borrow hundreds of millions of dollars to prop up the cash-strapped agency. The federal loans enabled the state to continue sending out weekly unemployment checks.
Critics, including Gov. Mark Sanford, have complained that Halley and other commissioners (read: former legislators) didn’t do an adequate job informing state government about the looming shortfall. Stay tuned: A legislative audit is due around January, when the legislature returns.
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Historical gems must be protectedBy Andy Brack, editor and publisher AUG. 21, 2009 – It’s not every day one gets to see the original Ordinance of Secession of Dec. 20, 1860.
 Or the earliest known copy (1682) of the Fundamental Constitutions, a document that outlined a governmental structure for the colony of South Carolina. Many say it is a foundation of the U.S. Constitution of a century later.
Or signatures on documents by John Locke and Thomas Jefferson. Or a ratified copy of the U.S. Bill of Rights. Or the first petition of the 1949 South Carolina complaint that went on to be part of the landmark Brown v. Board of Education desegregation case.
But it’s all there in Columbia, locked in protected, chilly vaults at the S.C. Department of Archives and History. It’s all the people’s incredibly valuable property.
“Our state archives are a priceless record and historical treasure of South Carolina’s heritage of knowing who we are by knowing who we’ve been and a guide to where we should go,” said noted historian Jack Bass of Charleston. “We need to look back, in part, so we can see where we made mistakes in the past and don’t repeat them.”
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Lesser
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Charles Lesser, senior archivist at the department, said the historical documents and records held in the state’s three vaults, each the size of half a football field, are “the memory of the state. It tells us who we are.”
Important documents, such as the best preserved set of acts of the first U.S. Congress that were signed by Thomas Jefferson, generally are not on public display to protect them from the elements (light, heat and humidity), which can cause them to deteriorate. But they’re all microfilmed or digitally preserved to allow people to learn about the state’s history close-up.
Unfortunately, the Archives and History department is, like many smaller state agencies, showing signs of its own wear and tear due to the up-and-down, drastic budget cuts of the last few years. For example, in 2001, the agency’s state funding was about $5 million and it had 91 state-funded employees. Today, funding is $3.2 million, less than the agency’s budget was more than 20 years ago. Today, there are just 51 state-funded staff members, according to new director Eric Emerson, who started just a week ago after serving as head of the private Charleston Library Society.
A slideshow on the department’s Web site highlights the benefits that South Carolina receives from historic preservation. People, it seems, tend to trust historical sites and museums more than anyplace else as places to learn about history – more than personal accounts, witnesses and teachers.
According to the Travel Industry Association of America, four in five of the 146 million Americans who travel include historical and cultural activities in their trips. And that means money. In 2003, for example, some 1.6 million people visited South Carolina’s historic attractions and spent more than $438 million.
So it makes sense to preserve our history – its documents, its locations and more – for financial reasons, especially with tourism being such a big part of our state’s economy.
But it’s not hard to feel the impact of budget cuts or imagine how more cuts to small agencies could cause them to decline to the point that they’re not able to fulfill their missions in the way required by state law.
At small state agencies like Archives and History, there’s not an available supply of pork or fat that can be cut. That was sliced years ago. Legislators need to realize that more budget cuts will have detrimental impacts beyond causing people to lose their jobs. They will threaten the foundations of our society, such as the very documents that served as policy foundations for what we are today.
Mold, mildew, humidity, temperature and the like destroy historical records. Let’s make sure in the days to come that the financial equivalent doesn’t destroy our past and its lessons for the future.
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Municipal Association of South Carolina The public spiritedness of our underwriters allows us to bring SC Statehouse Report to you at no cost. This week's spotlighted underwriter is the Municipal Association of South Carolina. Formed in 1939, the association represents and serves the state's 270 incorporated municipalities. The Association is dedicated to the principle of its founding members: to offer the services, programs and products that will give municipal officials the knowledge, experience and tools for enabling the most efficient and effective operation of their municipalities in the complex world of municipal government. Learn more: MASC.
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No reform is the scariest choice of allBy Allan Stalvey
Senior vice president, South Carolina Hospital Association
Special to S.C. Statehouse Report
AUG. 21, 2009 -- For years, hospital leaders have been telling policymakers and consumers that the health care system is broken and cannot continue to operate under the status quo much longer. The message has fallen mostly on deaf ears.
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Today Americans are debating the need for health care reform and how best to achieve it. This is a healthy discussion until uninformed people show up at town halls instructed to shut down the debate. Some days, the loudest voices seem to be those who only want to protect the status quo. Their aim is to scare Americans into opposing health care reform. In many cases their arguments are seriously flawed and even dangerous. In truth, doing nothing to reform our health care system is the scariest choice of all.
We have to get the cost of appropriate care down for every patient, and this must be a major goal of reform. According to PricewaterhouseCoopers, more than $1 trillion spent each year on health care in America is wasted. Preventable medical errors, inefficient use of information technology and poor management of chronic diseases are often cited as problems that must be addressed. And they must. However, another target should be a practice known as "defensive medicine" in which doctors order tests to avoid the threat of malpractice lawsuits. Tort reform or changing our malpractice laws could save Americans an estimated $210 billion each year in unnecessary services, including CT scans, MRIs, cardiac testing and hospital admissions.
Choice great when real
We hear a great deal about the need for consumer choice in health care. Consumer choice is great when there truly is a choice in whether and what you purchase. For instance, if you make a half a million a year then you can pretty much buy any car you want. If you make $30,000 a year then you can buy pretty much any car you can afford! But there is no choice for someone with a life threatening condition. When a seriously ill or injured patient arrives at the hospital emergency room, the treatment he receives is determined by his condition, not his wallet. No one is going to ask the patient who is bleeding to death if he prefers to buy surgery or a large band aid. We can't choose health care like we choose a car. Cancer does not discriminate based on one’s ability to pay for treatment. There isn't a Chevy-priced model versus a Cadillac-priced model that will get you where you need to go.
| "Some days, the loudest voices seem to be those who only want to protect the status quo. Their aim is to scare Americans into opposing health care reform." |
And who do you think pays for the care received by someone who can't afford to pay? The hospital? No way. Hospitals must generate revenue from patients to pay all of the costs that they incur. So hospitals have to pass unpaid costs on to those who do pay. And what about Medicare and Medicaid patients? Yes, hospitals get reimbursed for most of the cost of caring for these patients, but not all of it. On average, Medicare pays South Carolina hospitals 14.3 percent less than the actual costs incurred by the hospital. Medicaid pays about 30 percent less than cost of care received by its beneficiaries. Those losses are also passed on to those who have private insurance.
Although Americans continue to debate whether health care is a right, that debate is bogus. Hospitals, and many other healthcare providers, regardless of any legal obligation placed on them, feel a moral obligation to care for any person with a medical emergency, regardless of age, income, race, and even residency status in the United States. This reliance on hospitals as America's safety net is what allows many opponents of reform to claim that everyone in America has access to care. What they don't understand is that the safety net is in jeopardy of splitting in two if we fail to pass meaningful health care reform this time.
Rationing already exists
Opponents say reform will bring rationing. Bad news. Rationing already exists. If you doubt that, call for an appointment with a dermatologist to have a suspicious mole checked out or call a primary care physician's office, as a new patient, to get an appointment. Be prepared to wait months before you can see the doctor. There is a growing shortage of primary care physicians because there is no financial incentive to choose that specialty. Although primary care doctors are the backbone of our medical system, they earn the lowest reimbursement rates of all medical specialties. This is a sad symptom of a system that emphasizes treating serious illness instead of encouraging preventive care and wellness.
Of course, the most interesting of public debates comes from those individuals who benefit from being old enough to qualify for Medicare and cry out against the government taking over healthcare. Enough said on that!!
Finally, there are those more honest protestors who simply say that they are happy with their current coverage and don't want any change that may threaten what they have. Ironically, these are the people with the most to lose if the current system is not reformed. Their sense of security is a false one because if they have employer-based health coverage and lose their jobs, they can quickly go from being a "have" to being a "have not." The annual premium for family coverage is a little more than $12,000, and, on average, workers pay roughly 25 percent of that premium or a little more than $3,000 per year. Without an employer paying a portion of your premium, it will become very difficult to afford the full premium, especially if you have also lost your income.
And if you have a pre-existing condition and lose your coverage . . . good luck. If you can find a company that will insure you, the premium will be even higher. And you don't have to lose your job to lose your coverage. More and more workers are having to fend for themselves as employers, faced with rising premiums and shrinking revenue, are forced to drop employee coverage or raise workers’ premium contributions.
So something must be done to equalize the distribution of financing health care if we are to avoid disaster. If the opponents of reform have any ideas other than doing nothing, they should put them on the table for rational discussion. If they are successful in protecting the status quo, we will see aggressive rationing of care as more and more people become uninsured, and fewer insured Americans are left to pick up the slack. Soon the number of uninsured Americans will swell to a truly unmanageable number. When this happens, the entire system will collapse.
If you'd like to submit a MY TURN commentary of up to 600 words on a state policy or political issue, please send to: feedback@statehousereport.com
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Health care not a rightTo the editor:
I would not confuse the subject by using the word “right” [News, 8/14] at all. Our legal rights are enumerated in the constitution. And many desirable things are not mentioned, such as education, health care, food and shelter. This is the way it should be, since any conferred rights to one group pose an equal (and involuntary) obligation on the part of another.
Enjoy your reporting, although I don’t really agree with your view on most things.
-- Richard A. Saunders, MD, Charleston, S.C.
Great job
To the editor:
Thank you and everyone involved for the great job of keeping us informed on the issues that matter to us.
-- Warren Smith, Charleston, S.C.
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Ups, downs and in the middle
 Coal. Led by a state power cooperative, a plan to buy energy from North Carolina power plants may kill controversial plan to build new Santee Cooper coal-burning facility near Florence. More: The State.
 ACT. State standardized education testing scores may have dropped a tenth of a point from last year, but that may still be a kind of success because scores were expected to drop more because of more students taking the test. (Increasing the pool of test-takers generally causes a statistical shift downward.) More: Post and Courier.
 Jenny. It was Carrie Bradshaw’s job (Sex in the City ) to wear leggy white dresses for a Vogue pictorial and talk about affairs of the heart, not the First Lady’s.
Mark. The governor may have used campaign funds to reimburse himself for costs incurred during times he was meeting with his mistress, according to media reports. Call the hospital to stop the bleeding. More: Aiken Standard.
Deficit. A series of painful mid-year budget cuts in 2008-09 were not deep enough to the save state from a nearly $100 million deficit. More: WYFF-TV.
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