Posts by Steph Larsen
Politicians vs. Leaders
Published July 22, 2009 @ 02:35PM PT
This week, Steph continues her series on a critical piece of social infrastructure necessary for growing the small-scale farming sector, or any other part of a more localized economy that depends on small businesses: making a public health insurance option available to everyone.
When President Obama was elected, it seemed like everyone was quoting Abraham Lincoln. When I saw this quote today, though, it got me thinking about the current status of the health care reform debate:
A statesman is he who thinks in the future generations, and a politician is he who thinks in the upcoming elections. – Abraham Lincoln
It reminded me of another saying, though I can’t find who said it so maybe I’m making it up – A politician does what is popular, whereas a leader does what’s right.
In either case, the health care debate is separating Congress into statesmen and politicians, with politicians like South Carolina Senator Jim DeMint who is trying to block all health care reform in order to settle mere political quarrels on one side, and leaders like Reps. Ron Kind and Earl Pomeroy fighting to make the lives of their constituents better on the other side.
Both Reps. Kind and Pomeroy are rural Democrats, and yet they were two of the three members of the House Ways and Means Committee (one of the committees that is charged with writing the bill in the House) who voted against party lines and against the bill. Voting against their party is a mighty unpopular thing to do, but it was right to stand up for the rural communities they represent.
Rep. Kind said that he voted against the bill in part because it tied reimbursement rates for the public health insurance option to Medicare rates, which are problematically low in rural areas and providers are reimbursed for the volume of care they provide (which will inevitably be lower in rural areas due to population density). At the same time as he voted against a bill he felt would hurt his constituents, he reiterated his support for a public health insurance option.
Rep. Pomeroy also voted against the bill for similar reasons, saying that tying payment schedules of the public health insurance option to Medicare is a deal breaker for him and that the bill in its current form did not do enough for rural health care.
If you believe the reports that Mr. Obama’s poll numbers on health care are slipping, maybe it is because the President has not been as strong a leader as he could be. Reps. Kind and Pomeroy are standing up for rural America and leading the charge for health reform that works for all of us regardless of geography.
This evening at 8pm Central time, President Obama will discuss health care reform in a prime time news conference. I hope Mr. Obama’s inner statesman – and not his inner politician – is the one who shows up tonight.
Inventing Controversy
Published July 10, 2009 @ 11:34AM PT
There's nothing the media loves more than a good horse race. A little controversy - or a lot of it - sparks readers' interest and drives up sales. In the absence of actual controversy, though, the media sometimes has to invent some.
The debate over health care reform is a great example.
72% of Americans support a public health insurance option that competes with private insurers, according to a recent poll done by New York Times/CBS News. The poll was taken in mid-June and showed that people of all political stripes support health reform that, in the words of President Obama, "keep[s] insurance companies honest." Almost half of people identifying as Republicans supported the idea of a public health insurance option, as well as over 70% of independents and nearly 90% of Democrats.
Another recent survey of small business owners in Nebraska and Iowa found strikingly similar numbers. Done by the Small Business Majority, 69% of Iowa small business owners and 70% of Nebraska small business owners support the choice of a private or public health insurance plan.
I would hardly call this controversy.
It appears that the Democratic leadership in the Senate, where it's likely much of this debate will take place, is beginning to think that those numbers don't really constitute much controversy either. In an article from the newspaper Roll Call, Senate Majority Leader Harry Reid (D-NV) told Finance Chairman Max Baucus (D-MT) that he should stop trying to put forward a bill that doesn't include a public health insurance option or that taxes health benefits, because doing so could lose the votes of 10 to 15 Senate Democrats.
So why, then, is there the appearance of controversy? Ezra Klein puts it well:
Every interview with members of the administration involved in health-care reform goes the same way: A reporter asks if they support the public plan. They do. Then the intrepid reporters asks if it's non-negotiable. And, like everything else in health-care reform "except for success," the public plan turns out to be negotiable. And that's the headline.
In the U.S. Senate, however, there seems to be actual controversy over whether the average American should have the choice of a public health insurance plan. When asked about the New York Times/CBS News poll showing such overwhelming support of a public health insurance option, Senator Kent Conrad (D-ND) quipped, "Poll numbers, as you know, are here today and gone tomorrow. What's going to decide what passes here are votes [of Senators]."
One only needs to follow the money to see where the appearance of controversy in the Senate might be coming from - the $1.4 million dollars per day that the health care industry is spending on lobbying Congress. And it's not enough to have just anyone lobbying for the industry on Capitol Hill - the Washington Post reports:
The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records...Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa)...At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.)
When a legislator is hearing from scores more well-heeled and well-funded lobbyists than constituents, they may start to think that there is controversy where there largely isn't.
That's why your members of Congress need to hear from you. Right now.
You are the expert in the reasons why you need affordable health insurance, your community needs access to quality medical care, and why a public health insurance option creates competition that will help keep the health insurance companies from exploiting the elderly, the sick, and the self-employed.
Even if you've called before, even if your members of Congress have spoken in support of a public health insurance option before, they need to hear it again. We need to remind members of Congress what rural Americans need. Hearing from you helps them do the right thing and stand up against health industry lobbyists.
We may not have millions of dollars, but rural Americans know how to make a racket. Let's remind Congress who they represent and what we need: Health reform that works for all of us.
7 Years, 428 Percent Profits
Published May 29, 2009 @ 08:47AM PT
This week, Steph continues her series on a critical piece of social infrastructure necessary for growing the small-scale farming sector, or any other part of a more localized economy that depends on small businesses: making a public healthcare option available to everyone.
Farmers and ranchers know all too well about the problems that occur when a marketplace has too few competitors. When corporations consolidate, the resulting bigger business squeezes out the smaller businesses that compete against it. With less competition, there is nothing stopping the consolidated business from later raising retail prices for consumers or, in the case of farmers, lowering the price paid to farmers for livestock or grain.
A lack of competition is a problem for a functioning market, regardless of whether you're buying grain, livestock, thing-a-ma-jigs or ... health care (pdf).
With health insurance costs rising much higher than wages, Health Care for America Now! began a study to see whether lack of competition could be one of the reasons. They found that in the past 13 years, there have been more than 400 corporate mergers involving health insurers. These days a small number of companies dominate local markets, but the promises of increased efficiencies and lowered costs have not materialized.
The most staggering statistic for me was that from 2000 to 2007, profits at the top 10 publicly traded health insurance companies rose 428%. Talk about beating the stock market...
This lack of competition is especially bad for small non-profit organizations or people who are self-employed or own small businesses. In a consolidated market, an insurance company can set prices as high as they want, and small groups or individuals don't have the ability to purchase policies "in bulk", so it's like they're paying retail for something larger businesses and organizations can buy wholesale.
Small businesses, entrepreneurs and self-employed workers are the lifeblood of rural communities. Without health reform that works for them, the economies of our rural communities will continue to suffer. Yet our rural states are some of the most consolidated in the country.
In Vermont (pdf) for example, where 62% of the population lives in rural communities, two companies control 90% of the market share of health insurance. Montana's (pdf) rural population is 46% of its total population, and one insurance company has 75% of the market. Iowa (pdf) has 1.1 million people in rural areas, and 80% of the insurance market is controlled by the top 2 insurers.
Of the list of top 10 most consolidated health insurance states, only two - Hawaii and Rhode Island - have a rural population of less than 30% of their total population.
So who needs competition? Clearly it helps us all, but rural states look to be especially hurt by the consolidation of the health insurance industry. The next question must then be: What will you do about it?
Here's something to do: Urge your Senators to stand up for rural voters in your state. If you live in Nebraska, Iowa, Montana, or western Wisconsin click on your state to see where to send a letter. If you don't live in one of those states, click here to find your members of Congress and be sure to send to their offices in your state to avoid security delays. When you write, consider including the following talking points:
- Health care coverage must be affordable, accessible, and available to everyone
- A public plan option - one that consumers can choose if they want to - is necessary to guarantee competition among insurers
- Reform that includes meaningful options for small business and the self-employed will bolster entrepreneurship
- Talk about your own experience with health care, or the importance of health care reform to your community
It's the role of government to protect citizens from abuse by big corporations. It's time we raise our voices and demand equality in health care.
Update: Over at DailyKos, McJoan writes about growing support for a public option in Montana, where the government describes the healthcare market as 'highly concentrated.' - Natasha
Ducks in the Back 40
Published May 04, 2009 @ 01:54PM PT
Cresting one of the many rolling hills in central North Dakota, I came upon yet another large gray lake with the strong wind making waves, ducks near the shore feeding and telephone poles running through the middle.
Wait, double take. Telephone poles? What are they doing in the middle of a lake?
One of several telltale signs that somewhere under several feet of "lake" water is a wheat field that won't be plowed this year or a pasture that won't be grazed.
Like the rest of the country four weeks ago, I heard about the flooding that plagued North Dakota. The media attention focused on the Red River Valley and the cities of Fargo and Grand Forks, and since western parts of the Dakotas tend to be drier, I assumed that the rest of North Dakota wasn't especially wet. Especially not four weeks later.
I was wrong.
Most of the conversations I had while traveling around North Dakota to discuss health care reform started with talk of the floods. The couple who owned one hotel I stayed at said they've had water in their basement for 4 weeks and they had to build a 3 foot dyke of sand and metal behind their hotel to keep it from being inundated.
Valley City, home of Congressman Earl Pomeroy, had to ban flushing toilets when their sewer system overflowed. The city resorted to placing hundreds of portable toilets scattered around town, and business and restaurants shut down due to lack of sanitation. The rumored new crime is people stealing them to put in their garages so they don't have to walk outside to use the loo.
My trip took me to Fargo and Grand Forks, a small town called Northwood west of Grand Forks, then west to Bismarck via Fargo. There was a stretch of road outside of Fargo where the road is literally surrounded on all sides by water - which makes one very conscious about cautious driving. The "shore" was at least a half mile away on either side, and a flock of geese could be seen in the distance. The Red River in Grand Forks is still well outside its banks, to the point where stairway railings simply disappeared into the cloudy water.
The "prairie pothole" region is known for its small wetlands, but even the flattest farm fields looked damp and mucky at the least and at worst had standing water between the plowed rows. As I drove west, there were stretches of drier fields leading me to think that the flooding was over, only to see more as I crested another hill. North Dakota had a wet fall, so much so that in a few places I even saw corn standing in the field. The farmer had clearly hoped that spring would allow him to harvest, but with the heavy snow this winter and the wetness now, that corn is a total loss.
While one wet year cannot make the case that climate change is shifting farmers' ability to grow crops, North Dakota has had a whole lot of flooding in the last dozen years. However, I fear that a wetter North Dakota might be a permanent condition unless we all take some drastic action to reduce the greenhouse gases in our atmosphere. It's just too bad they can't grow rice that far north.
Meanwhile, there's more rain the forecast.
(Photo credit: law_keven on Flickr.)
Past Performance and Future Rural Health
Published April 24, 2009 @ 01:12PM PT
Historians tell us that if we don't learn about history, we're bound to repeat it. So lately I've been delving into old research papers here at the Center for Rural Affairs, hoping past research will inform our current research on health care. What I've found so far is astounding.
My colleagues frequently talk about the profound and prophetic report on vertical integration of hog production, called, Who Will Sit Up With the Corporate Sow? Written in 1975, the title is a play on the act of "sitting up with a sow" if she is having a hard time birthing her piglets, but in this case refers to holding corporations accountable when it comes to unethical business practices that force out family farmers. The report accurately predicted the most onerous impacts that consolidation and vertical integration would have on family farm hog producers over the last 30 years.
Here is a short excerpt:
Overall, the emerging breeding stock industry is a hustle which confinement has made possible. It is significant that a number of confinement units identified here are well outside of traditional hog producing areas. This partly reflects the potential of confinement for accommodating livestock production to environmentally harsh areas...
The combination of breeding stock specialization, large scale production and movement into new areas all point to more loss of producer independence.
Translation - as farmers become more specialized, are further away from truly competitive markets, and expensive technology allows more animals to be crammed into tighter quarters, we will see fewer skilled producers, more investors, and a loss of independence for those producers. While this seems evident to us now in hindsight, it was not at all clear in 1975 that this would be the case.
In the same vein as Who Will Sit Up With the Corporate Sow?, came Wheels of Fortune in 1976. The report examined the impact of center pivot irrigation development on the ownership and control of farmland and water rights.
It found center pivot irrigation to be a more capital intensive form of irrigation, and the popularity of the method was driving concentration of land by non-farm investors. Again, spot on conclusions about what has happened to agriculture in the last 30 years - fewer farmers, larger land holdings, more absentee and corporate control (if not outright ownership) of farming operations.
Then there was the Small Farm Energy Primer, written in 1980 as farmers were struggling to pay the high cost of energy amidst expanding use of energy-intensive farming technology. The complexity and expense of energy-intensive farming make intimidating barriers to young couples trying to get a start in farming.
Thus small family farmers are directly threatened by large-scale mechanization developed in an era of cheap energy. In response, the small family farmer can make use of renewable energy resources, demonstrating that skills and resourcefulness - the human factor - is once again at a premium in agriculture. Again, all obvious conclusions now that were anything but obvious at the time.
Our research lately has been about the dynamics of our current health care system and how reform will effect rural people and communities. We have released two papers so far, with more on the way in the coming months.
In Nutrition, Physical Activity, and Obesity in Rural America, we review the trends indicating that overall obesity is more prevalent for rural adults than urban adults. This is a particular concern since obesity leads to other preventable diseases and is the second leading cause of death in the United States.
Implied in the research is that if we don't take some of the actions this paper discusses to control rural obesity within the upcoming health reform, rural Americans will die more frequently and be sicker as a result.
In our second paper, The Top 10 Rural Issues for Health Care Reform, we investigate the numerous unique health care issues facing rural people and rural places. Any health reform must consider the needs of rural communities and how they differ from our urban counterparts, and this paper explores how these differences necessitate special solutions. This paper is also condensed into a fact sheet.
Is this research as on target as it has been in the past? Not only is our track record good, but we rely on the same principles of research as we always have.
We are committed to rigorous analysis and our research is not guided by the winds of politics. And because we live and work the rural topics we research, we have the experiences of our families, friends and neighbors to corroborate our analysis. As the health care debate grows, you can judge for yourself whether we hit our mark.
What's Your Story?
Published April 17, 2009 @ 09:45AM PT
Do you know who grows your food? If you do, have you asked your farmer what his health insurance situation is?
Every farmer and rural resident I know seems to have a health care disaster story.
Nothing was more clear to me last week as I criss-crossed Iowa holding health care forums with my colleagues at the Iowa Citizen Action Network and the Iowa Farmers' Union.
One farmer talked about getting kicked off his insurance plan because he got diabetes. Another woman, with her 3 children in tow, talked about how far she had to drive to get her kids their shots. Folks opened up about the need for preventative care, more medical professionals in their communities, better access to healthy food, and the need for a public insurance option. One woman even teared up as she described a violent situation in her community that could have been prevented with adequate access to mental health facilities.
Then in my office yesterday, I had another incredible conversation with a 77-year-young farmer from Montana. He told me how medical debt nearly cost him the farm when his wife got cancer.
And this morning, an article in the Nation caught my eye about a woman whose husband was diagnosed with Parkinson's disease and whose daughter was in a horse riding accident that left her paralyzed. The financial strain due to medical expenses has expended the savings of the author, Kate Michelman. I was particularly inspired by this quote:
I do not tell this story because it is unique. On the contrary, the point is precisely that countless people across the country are living it. And millions more are a crisis away from joining them--one lost job, a diagnosis, an accident.
Regardless of how secure your own situation may seem, almost all of us are one crisis away from relying on the mercy of an unforgiving health care system. How certain are you that your insurance will be there when you need it?
Every story I hear touches me, and after I sort through the sadness or disbelief of each story, I am left angry. Anger is good, though. Anger motivates us to search for a solution that doesn't drive people into bankruptcy and other desperate circumstances. Anger helps us realize we are powerful when we are many.
What's your story? Or your farmers' stories? Chances are, hearing them might make us all angry.
Channel that anger towards action and join others in your area demanding affordable health reform.
(Photo credit: José Goulão on Flickr.)
Sowing Poor Rural Health
Published April 03, 2009 @ 07:09AM PT
Still think the health reform debate has little to do with sustainable farming and food?
Think again.
I was struck by two stories on Morning Edition on NPR that drove home the point to me that health reform and healthy food and farming systems are deeply interwoven.
I've said before that if we want sustainable food and farms, farmers need affordable and guaranteed health care options. Unless the farmer has a husband or wife that has a job off the farm that provides health insurance, many farm families find themselves buying expensive health insurance as "individuals", instead of a group plan that shares the costs and risks among many families. As a result, farmers and their families are often stuck with high premiums and deductibles, translating into thousands of dollars of costs if everyone is healthy, and even more if a family member gets sick or injured.
Farmers deserve better than that, and these NPR stories remind me of how broken the system is for people trying to buy health care as individuals.
The first segment I heard featured two women who received cancer diagnoses and thought their respective health insurance plans would be covering the costs. The first woman, Susan Braig, had a "catastrophic policy" covered hospitalization, and Ms. Braig felt sure that it would cover her diagnosis.
