Bill Hammond wrote this article October 18th in the statesman.com about the awful traffic situation here in Austin. Mr. Hammond makes the very agreeable point that Austin traffic essentially sucks. Anybody who lives in Austin can easily identify with this reality. Mr. Hammond's audience appears to be that of car-owning Austinites who might disagree with toll roads. Being that our infrastructure is primarily centered around automobiles, Mr. Hammond sets us up by metaphorically backing us into a tight spot. Mr. Hammond accurately uses the obvious examples of growth, aging roads, and a "if you think it is bad now, just wait" tactic of emotional agreement to make his stand.
Mr. Hammond happens to be the president and CEO of TAB, the Texas Association of Business (www.txbiz.org). While first glance might make one realize he is a supporter of small business, further examination shows good reason to believe that Mr. Hammond is simply a lobbyist for private transportation-management companies. This is evidenced by a quick Google search revealing that Mr. Hammond is a current registered lobbyist (go figure) for said industry. Mr. Hammond's other resume highlights include a former 8 year stint in the Texas House of Representatives. So, we have an individual with an intimate understanding of the legislative system who is now a lobbyist. Hmm....
So the question begs, what is the aim of this piece? Quite simply, it is to rally support for toll roads. It starts with:
A. We have a big problem that is only going to get worse.
B. It got this way because the current status quo has failed and lastly,
C. We have a magic bullet!
The magic bullet is Mr. Hammond's proposition to support those who have the solution to the status quo failure - no doubt Mr. Hammond's employer. The solution is a lovely, eloquent, win-for-all approach - a "public-private" partnership! Mr. Hammond's solution of a public-private partnership boasts jobs, economic growth, and getting us back on the road to being back on the road! Sounds awesome! Sign me up!
Oh wait, the last time we had a public-private partnership for transportation was the contract with the state of Texas with Central Texas Mobility Regional Authority. CTRMA is a private company but it sounds pretty official. It does say "authority" in it after all. Here is the problem I see: The basic theory in toll roads is the tolls end after the road has paid for itself. So far, not a single toll has been lifted in central Texas. Moreover, how many private property owners had to sell their land for fear of eminent domain?
I hate to sound like a conspiracy theorist, but I would challenge you to prove me wrong. I will save you the time - don't. It is much harder to disprove a negative; what I am saying is just like my argument, Mr. Hammond's argument for toll roads is suspect. At least I can admit my shortcomings.
Why do I say Mr. Hammond's argument is suspect? Let me present certain quantifiable information to enter for consideration. Here is a link to the txbiz.org website. On the bottom of the page it says all the things I feel are the dark underside of Mr. Hammond's plan: initial funding by the tax payer to pay for the road, then management and ultimately, ownership and profiteering by private companies. All the dough with no upfront ownership costs... I mean, there are upfront costs by the ones who use the roads, i.e. the same ones that paid for the road.
Further reading shows TAB's stance on transportation includes local input for "pass-thru financing" and "help fund local needs"; nevermind that, how about the motor fuel tax provision, stipulating future taxes may only be spent on road projects only. This seems like an earmark to guarantee to certainty of funding private corporations on public dollars to me. Lastly, Mr. Hammond expresses increasing vehicle registration by $50 per vehicle. That will be approximately a 40% increase on an already ridiculous tariff. I didn't sell my vehicle to anybody else therefore the registration did not change but I still have to pay it.
While I feel that Mr. Hammond is absolutely on point with the opinion that Austin traffic is atrocious, we should be careful about bedding with the first good-looking, slick-talking thing that comes along. We might just get ourselves into a situation that we have to live with for the rest of our lives - privately-managed road monopolies. I call them road herpes.
Friday, October 19, 2012
Thursday, October 4, 2012
Say "Maybe" To Med School
Don Zimmerman and Roger Falk wrote an editorial commentary called "Say 'no' to a medical school" on the proposed medical school Central Health is pursuing. The article is from September 24, 2012 in the Austin American Statesman. I chose to critique this article as health care is both my career and I am a tax payer in Travis County. Considering the credibility of the authors Zimmerman and Falk leaves something to be desired - credibility. Per the Statesman, Mr. Falk is a retired business owner and musician. Not knowing anything else about Mr. Falk such as education or other life experience, Mr. Falk is certainly entitled to an opinion but caution should be exercised if one would regard him as an expert. Moreover, Mr. Falk's opinion from "Tea Party Solution" (4th entry from top) from Statesman, August 16.2011, shows he is a clear-cut Tea Party advocate and we all know the basic tenet of tea-partyism includes an absolute embargo against increasing taxes. This predisposed latitude of absolute intolerance and disregard for considering all the information and variables makes it difficult to have an open mind as to WHY we might need a medical school. Mr. Zimmerman is shown to have some civic involvement as a treasurer to Travis County's Taxpayer Union Political Action Committee. However, I wonder how often they meet. Mr. Zimmerman is also a software engineer by day. A supposed once-a-month meeting in civics group doesn't carry that much weight but it is better than nothing, especially when we consider how little most people are involved.
The authors state that medical schools historically have been birthed by private charitible donations and have rarely been backed by tax dollars. They state there is already a substantial and quality medical infrastructure, including 30 hospitals, 21 clinics, 6 cancer centers and hundreds of doctors. They cite 8 teaching schools in Texas and A&M has 12 affiliates. Their consolidated first argument is there is an already existing, well-established educational system for doctoral residents in the area. The second argument is two fold: 1. This will increase taxes for the middle class and 2. there are already several goverment subsidized programs citing ACC's health care professional training program and UT's Nursing programs who already run a wellness program. The authors also state the existence of Austin Clinical Education Center and North Central Community Center.
The assumptions made by Mr. Zimmerman and Mr. Folk are that, in my opinion, they think that all these facilities do the same thing. Being that they are not involved in the medical field, I would not expect them to understand the vast, complex, and dynamic galaxy that is modern medicine. From research of hundreds of different diseases (vascular, infectious, toxicology, autoimmune, musculoskeletal, cardiac, and neurological to name a few, all of which have hundreds of their own subcategories), to education, treatment and case management, there are so many aspects to health care.
The authors state 30 different hospitals locally. One must realize that "hospitals" are a loose term. For example, facilities like Summit Hospital and Cornerstone are primarily post-operative rehabilitation facilities for patients, i.e. low acuity and not a whole lot of learning to be done. In Austin, we have 14 hospitals with emergency departments, 2 of which opened in the last 2 years (Westlake and Lakeway Memorial). Of these, 8 are Cardiac Centers of Excellence (places that can actually manage myocardial infarctions with cath labs), 3 are Stroke Centers (Brack, Seton 38th/Lamar, and St. Davids 32nd/IH35). Brackenridge and Round Rock are the only 2 trauma centers, and Round Rock did not receive their level 2 trauma rating until 2010. The point being is there are 2 facilities locally that can handle heart attacks, strokes, and multi-system trauma (which is great for ER residents). The only local teaching facility is UMC Brackenridge through Southwestern University. There may be a lot of "hospitals", but the "teaching hospital" infrastructure is woefully short on a local level.
The author cited there are 8 Liaison Committee on Medical Education accredited medical schools. The fine print that is missing is "in the state". Houston, Dallas, San Antonio, El Paso, and even lil' ol Galveston, Lubbock, and Denton have LCME schools. There are none in Austin. This again proves my point in the above paragraph - only one teaching hospital locally, and it is not a LCME school.
My argument to the second point is while taxes may increase, they are significantly less than what they could be. A hike from 7.9 to 12.4c/$100 value is a 63% increase, it is not a 63% broad-based tax increase. This means that only one category of a property owner's taxes will increase - the health district tax. City, county, ACC and AISD taxes do not increase. The supporting keepaustinhealthy.org website adverstises a ~$9/month increase for the average taxpayer. Yes, I did the math. It is a correct figure. Second, there is a significant up front investment from Seton Healthcare and a substantial long-term contribution from UT. Taxpayers are not being asked to pony up for the whole enchilada, rather 10%. All dollars raised will be matched by the federal government. Mr. Falk's significant right disposition is reared again with his statement of "Central Health's promises of increased federal spending are also irresponsible, considering the credit downgrade of the federal government and more than $16 trillion of debt.". While fiduiary fiscal responsibility needs to be considered, one must realize that the return on investment, especially for 9 clams a month is a substantial ROI. Economic stimulus, jobs, and education is one hell of a ROI, especially in this economic downturn.
Argument 2, subsection 2 of several goverment subsidized programs taxpayers cover is partially correct. The problem is the facilities the author mentioned are in a different environment that what Prop 1 is hoping to facilitate. Austin Clinical Education Center is a prevention-based program. ACC and UT Nursing do not educate doctors. Sure, they train paramedics and nurses, but paramedics and nurses are in fact, not doctors.
The authors made several significantly opinionated statements, including "outrageous tax increases" and "death by a thousand cuts". While dramatic, these opinions detract from another reality-"excellent indigent health care". This is not entirely accurate. The health care available to the indigent is okay at best. Patients in the current system have to wait weeks for appointments for urgent, but not life threatening conditions. They do not have coverage for urgent care clinics such as ProMed or TxMedClinic, nor can they afford the bill. Said clinics are far cheaper than an ER, but still bills are several hundred dollars. The homeless have Caritas, Salvation Army Wellness, and the ARCH health and dental programs but these programs are short on funding and staff. It goes without saying that a homeless person with mental, physical, and/or substance problems isn't going to remember an appointment in 4 days at 230pm. Lastly, there is an abysmal resource for mental health problems, and it has been that way for decades. Relief is coming though - an 85 bed facility that will cater to both adults and some pediatrics is coming to South Austin. Currently, psychiatric patients can go to Psychiatric Emergency Services (56 East Ave, Austin, TX) IF they are sober. Otherwise, they go to an already overburdened emergency room.
Emergency rooms bring me to a point I will make very short. For many, many, many reasons, emergency rooms are NOT the place people should go for non-emergent health care. Both President Bush Jr and Mitt Romney are clearly detached from the 99% for thinking and saying that. The last thing a poor or struggling family needs is a $3000 medical bill because they have no other options. Also, one other HUGE perk to Central Health's facility is insuring/helping to insure hundreds of thousands of uninsured Austinites. How is bankruptcy from a catastrophic medical condition even allowed to happen in today's society?
My resume is this: I have worked on an ambulance for 13 years. Between patient care, observing and being involved in the politics of a municipality in a liberal town, and having a wife who lived the worst case scenarios relevant to this topic, I should know much better than the authors I am contesting. If you want to see for yourself, please come ride out with me. See how your tax dollars are being spent. You just might find out that your tax dollars are being wasted in far more obscene ways and an investment in a teaching hospital might be a much better choice.
My personal opinion is this: I am a patriarch of a single-income, middle-class family barely getting by. I am not in favor of increasing taxes. This last year, my insurance premiums went up, my property taxes went up, my electric bill went up, and gas is $4/gallon. I really can't afford any more increases. However, $9/month to subsidize a medical school that will contribute to bringing much needed doctors to a community lacking doctors is something I can get behind. If the research performed here brings a cure or at least a better management approach to cancer, I would gladly pay $18/month or more. People's lives are worth far more. I'm going to vote yes for Prop 1. The whole point of this was to present you with a different opinion and ask you to consider saying "maybe" to prop 1. I hope I have presented you with enough perspective to make an informed decision.
The authors state that medical schools historically have been birthed by private charitible donations and have rarely been backed by tax dollars. They state there is already a substantial and quality medical infrastructure, including 30 hospitals, 21 clinics, 6 cancer centers and hundreds of doctors. They cite 8 teaching schools in Texas and A&M has 12 affiliates. Their consolidated first argument is there is an already existing, well-established educational system for doctoral residents in the area. The second argument is two fold: 1. This will increase taxes for the middle class and 2. there are already several goverment subsidized programs citing ACC's health care professional training program and UT's Nursing programs who already run a wellness program. The authors also state the existence of Austin Clinical Education Center and North Central Community Center.
The assumptions made by Mr. Zimmerman and Mr. Folk are that, in my opinion, they think that all these facilities do the same thing. Being that they are not involved in the medical field, I would not expect them to understand the vast, complex, and dynamic galaxy that is modern medicine. From research of hundreds of different diseases (vascular, infectious, toxicology, autoimmune, musculoskeletal, cardiac, and neurological to name a few, all of which have hundreds of their own subcategories), to education, treatment and case management, there are so many aspects to health care.
The authors state 30 different hospitals locally. One must realize that "hospitals" are a loose term. For example, facilities like Summit Hospital and Cornerstone are primarily post-operative rehabilitation facilities for patients, i.e. low acuity and not a whole lot of learning to be done. In Austin, we have 14 hospitals with emergency departments, 2 of which opened in the last 2 years (Westlake and Lakeway Memorial). Of these, 8 are Cardiac Centers of Excellence (places that can actually manage myocardial infarctions with cath labs), 3 are Stroke Centers (Brack, Seton 38th/Lamar, and St. Davids 32nd/IH35). Brackenridge and Round Rock are the only 2 trauma centers, and Round Rock did not receive their level 2 trauma rating until 2010. The point being is there are 2 facilities locally that can handle heart attacks, strokes, and multi-system trauma (which is great for ER residents). The only local teaching facility is UMC Brackenridge through Southwestern University. There may be a lot of "hospitals", but the "teaching hospital" infrastructure is woefully short on a local level.
The author cited there are 8 Liaison Committee on Medical Education accredited medical schools. The fine print that is missing is "in the state". Houston, Dallas, San Antonio, El Paso, and even lil' ol Galveston, Lubbock, and Denton have LCME schools. There are none in Austin. This again proves my point in the above paragraph - only one teaching hospital locally, and it is not a LCME school.
My argument to the second point is while taxes may increase, they are significantly less than what they could be. A hike from 7.9 to 12.4c/$100 value is a 63% increase, it is not a 63% broad-based tax increase. This means that only one category of a property owner's taxes will increase - the health district tax. City, county, ACC and AISD taxes do not increase. The supporting keepaustinhealthy.org website adverstises a ~$9/month increase for the average taxpayer. Yes, I did the math. It is a correct figure. Second, there is a significant up front investment from Seton Healthcare and a substantial long-term contribution from UT. Taxpayers are not being asked to pony up for the whole enchilada, rather 10%. All dollars raised will be matched by the federal government. Mr. Falk's significant right disposition is reared again with his statement of "Central Health's promises of increased federal spending are also irresponsible, considering the credit downgrade of the federal government and more than $16 trillion of debt.". While fiduiary fiscal responsibility needs to be considered, one must realize that the return on investment, especially for 9 clams a month is a substantial ROI. Economic stimulus, jobs, and education is one hell of a ROI, especially in this economic downturn.
Argument 2, subsection 2 of several goverment subsidized programs taxpayers cover is partially correct. The problem is the facilities the author mentioned are in a different environment that what Prop 1 is hoping to facilitate. Austin Clinical Education Center is a prevention-based program. ACC and UT Nursing do not educate doctors. Sure, they train paramedics and nurses, but paramedics and nurses are in fact, not doctors.
The authors made several significantly opinionated statements, including "outrageous tax increases" and "death by a thousand cuts". While dramatic, these opinions detract from another reality-"excellent indigent health care". This is not entirely accurate. The health care available to the indigent is okay at best. Patients in the current system have to wait weeks for appointments for urgent, but not life threatening conditions. They do not have coverage for urgent care clinics such as ProMed or TxMedClinic, nor can they afford the bill. Said clinics are far cheaper than an ER, but still bills are several hundred dollars. The homeless have Caritas, Salvation Army Wellness, and the ARCH health and dental programs but these programs are short on funding and staff. It goes without saying that a homeless person with mental, physical, and/or substance problems isn't going to remember an appointment in 4 days at 230pm. Lastly, there is an abysmal resource for mental health problems, and it has been that way for decades. Relief is coming though - an 85 bed facility that will cater to both adults and some pediatrics is coming to South Austin. Currently, psychiatric patients can go to Psychiatric Emergency Services (56 East Ave, Austin, TX) IF they are sober. Otherwise, they go to an already overburdened emergency room.
Emergency rooms bring me to a point I will make very short. For many, many, many reasons, emergency rooms are NOT the place people should go for non-emergent health care. Both President Bush Jr and Mitt Romney are clearly detached from the 99% for thinking and saying that. The last thing a poor or struggling family needs is a $3000 medical bill because they have no other options. Also, one other HUGE perk to Central Health's facility is insuring/helping to insure hundreds of thousands of uninsured Austinites. How is bankruptcy from a catastrophic medical condition even allowed to happen in today's society?
My resume is this: I have worked on an ambulance for 13 years. Between patient care, observing and being involved in the politics of a municipality in a liberal town, and having a wife who lived the worst case scenarios relevant to this topic, I should know much better than the authors I am contesting. If you want to see for yourself, please come ride out with me. See how your tax dollars are being spent. You just might find out that your tax dollars are being wasted in far more obscene ways and an investment in a teaching hospital might be a much better choice.
My personal opinion is this: I am a patriarch of a single-income, middle-class family barely getting by. I am not in favor of increasing taxes. This last year, my insurance premiums went up, my property taxes went up, my electric bill went up, and gas is $4/gallon. I really can't afford any more increases. However, $9/month to subsidize a medical school that will contribute to bringing much needed doctors to a community lacking doctors is something I can get behind. If the research performed here brings a cure or at least a better management approach to cancer, I would gladly pay $18/month or more. People's lives are worth far more. I'm going to vote yes for Prop 1. The whole point of this was to present you with a different opinion and ask you to consider saying "maybe" to prop 1. I hope I have presented you with enough perspective to make an informed decision.
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