Wednesday, September 13, 2006


Social Security Administration Analyst Susan Bussman gave members of the National Conference of State Legislatures' Labor and Workforce Development Committee a low-key but dramatic warning yesterday afternoon: President Bush has somewhat revised his Social Security "reform" plan, has the strong support of Social Security Subcommittee Chair Jim McCrery (R-Louisiana), and plans to bring it up for consideration again in 2007.
I was at the meeting representing the Pennsylvania legislature in the Committee's deliberations. Although my subsequent internet search revealed that this is a known fact among those who closely follow this issue (see a thorough analysis of the politics of 2007 Social Security schemes at, it is a fact that is too new to be widely known.)

August 15, 2006


Today, I was the leadoff the speaker at a Harrisburg state capitol rally against suicide. There are now about 50% more suicides each year (about 30,000) than homicides (about 20,000), and there are about 650,000 suicide attempts a year.

The high number of suicides is only slightly off the all-time record. Suicide usually results in large part from the physical weaknesses and chemical imbalances that cause mental illness, but the number of people who could attempt suicide is far higher than who do. Those who actually commit suicide--complete suicide according to the current language--are disproportionately the most vulnerable: gays, blacks, drug users, seriously mentally ill, those under pressure from either pressure to reduce dependency (those 15 through 24) or to increase dependency (those 75 or over). The Bush Administration record on suicide prevention is mixed. It has supported the doubling of suicide prevention funding passed by Congress in the wake of the recent suicide of the son Sen. Slade Gorton (R-Washington) and the the suicide three decades ago of the son of Democratic Leader Harry Reid.

The proliferation of grassoots groups around the nation in the past decade pushing suicide prevention has obviously been felt in the Bush Administration and in the Republican Congress. Bush has accepted the Clinton Adminstration's Suicide Prevention Initiative as a guide for his administration's policies, but his administration has threatened to shut down a suicide prevention hotline used disproportionately by gays.

The vast difference in resources between suicide prevention and crime prevention is jarring. I obtained $100,000 for suicide prevention awareness in this year's Pennsylvania budget, and this was hailed as a major achievement by Pennsylvania's suicide prevention community. But Pennsylvania spends about $1.5 billion a year in state prisons alone to fight crime.
I favor focus on suicide as a separate distinct problem. Completers (committers) of suicide that I have known include an uncle, a legislative staff member, the spouse of another legislative staff member, and a Philadelphia city councilman. I am sure that other deaths of people I know have been suicides even when family shame prevented them from being announced as such.
But it is obvious to me that suicide disproportionately affects those who are left behind by today's cruel and callous public policies. A society that valued all human lives, that had a safety net of services for the disadvantaged far greater than we have today, would have far less suicides.

I said at the rally that facing problems can give us the courage the solve them. That is true whether one looks at the increased incidence suicide over time as a problem in itself or as a symptom of broader societal disfunction. It is both, and we must deal with it on both levels.
It is outrageous, for instance, that Medicare pays 80% if the cost of treating physical illness, but only 50% of the cost of treating mental illness. It is shortsighted and tragic that families of murder victims are usually treated by society as victims themselves, even if the murder victim was criminally involved, while the families of suicide victims tend to be critically evaluated as possible causes of the suicide.

Every suicide, no less than every murder, is an example of a tragedy that should not have happened. As individuals and as a society, we can and should work to make suicide in the future as rare as the old prevalent of dueling to settle slights or insults is today.

September 12, 2006


There was a time when Americans looked to the White House to lead in solving urgent national problems. That time is over. If urgent national problems are to be solved today, Americans must lead; state and local governments must follow; pressure must be built up on Washington so huge that no amount of campaign contributions or lobbyhist machinations can get in the way.
At the annual meeting of the National Caucus of Environmental Legislators, which I attended representing Pennsylvania as part of the annual National Conference of State Legislatures, the American Nurses Association presented a panel designed to demonstrate a commitment to taking the lead on urgent national problems.

The promise was made that state affiliates would educated in these issues, and that a truly national effort would be made.

August 16, 2006


All professional associations and all business advocacy groups would love to totally ban all suits against their members, which would save them a lot of money.That is totally unrealistic, of course, so they try to come as close to that as possible. It is totally unrealistic because without liabilty, all the financial incentives in health would be to cut corners and take risks with people's lives. Financial incentives are not the only factor determining people's behavior, but they are a major factor.Pennsylvania's subsidy enables most doctors to get the high incomes--often over $200,000 per year--they feel their hard work and extensive educational preparation entitles them to, while preserving the rights of those persons who are seriously injured by medical errors to sue.The whole problem with health insurance is that the vast majority of the time, many people do not need it; but the vast majority of people need it sooner or later. Most day to day medical care is affordable, but serious illnesses or conditions can be extremely expensive and financially disastrous to all but the wealthiest of people.Medical savings accounts are OK, but they are most useful for doctors bills or outpatient medical procedures. Spending a week in a hospital without health insurance would wipe out the balance of almost all medical savings accounts.

August 10, 2006


Pennsylvania for the past few years Pennsylvania has been subsidizing medical malpractice insurance with cigarette tax revenues. I have supported this policy.At some time in the future, Pennsylvania's malpractice insurance should become more affordable because the state has made various changes requested by the Medical Society and because there is now competition for medical insurance business which should drive down prices.Until there is agreement that the malpractice insurance has reached a level of affordability, I favor continuing the malpractice insurance subsidy.

August 9, 2006


Massachusetts--one half the population of Pennsylvania--has enacted a comprehensive and extremely complicated plan to ensure every person there. It contains the unique idea of taxing every individual for a health care insurance premium of roughly $300, and is feasible on paper (there are widespread doubts about actual implementation) in part because Massachusetts already spends much more than most other states do on health care.Both Vermont and Maine also have passed less ambitious and comprehensive health care plans. I and other legislators--along with interest groups ranging from the Hospital Association, the Chamber of Business and Industry, and the AFL-CIO, and Pennsylvania's pioneering and widely acclaimed Health Care Cost Containment Council, which I helped establish in 1986---are looking at these New England plans to see what we can support for here in Pennsylvania.In addition, Governor Rendell has set up a task force on health care financing reform, which began meeting long before the New England plans were finalized. Rendell's task force should be reporting within a month or so, and it's report will have the benefit of both in depth study and the New England plans.Based on the thoroughness of Rendell's preparation of past plans, I think that whatever his team comes up with will be taken extremely seriously in Harrisburg.I would not at all be surprised if there was kind of pool set up for small businesses and individuals to purchase health care more cheaply than at present.Getting more people covered is key to getting the financing necessary to provide more health care. Governor Romney said his "key insight" was that everybody now gets expensive and often too late health care through emergency rooms; what we need is cheaper, earlier and more useful health care in doctors' offices.

August 9, 2006