الأحد، 9 أكتوبر 2011

Lincoln Tribune

Lincoln Tribune

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Time to Repeal Ineffective Certificate of Need

Posted: 09 Oct 2011 03:00 AM PDT

Neal Inman

By Neal Inman | Civitas Institute

A special committee of North Carolina lawmakers met this month to discuss a little-known program, Certificate of Need (CON), which effectively controls large sectors of the health care economy in the state. While lawmakers could simply reform the program to make it more equitable, they can and should decide to repeal this ineffective process altogether.

North Carolina is one of 36 states that retain some form of a CON law which requires healthcare providers to go through a lengthy application process before most healthcare facilities can open, expand or close.  The services regulated range from the acquisition of multimillion dollar equipment to the addition of just one bed in a nursing home.  State agencies issue a limited number of these CONs after a lengthy review process.  Operating without one can result in enormous fines, the loss of medical licenses and a potential end to Medicaid and Medicare spending.

According to the state Department of Health Service regulation, the fundamental premise of the CON law is that increasing health care costs may be controlled by governmental restrictions on the unnecessary duplication of medical facilities.  However, multiple studies have found that the program has largely failed to reduce costs or increase access and mainly exists to protect incumbent healthcare providers.

Proponents of CON claim the process forces hospitals to carefully consider new expansions, keeping healthcare costs down.  Following this rationale, the federal government mandated that each state have some form of CON service in 1974. However, the federal government stopped mandating CON in 1987 due to its complete failure to contain the national growth of healthcare costs.

Congressional testimony indicated that the program was ineffective at best. However, no state has repealed CON since Indiana in 1999.

Since repeal of congressionally mandated CON, several studies have shown that the process has failed to decrease the nation's rapid growth in healthcare spending, including multiple papers published by Duke University researchers Conover and Sloan.

"There is little evidence that CON results in a reduction in costs and some evidence to suggest the opposite," the researchers said in an examination of Michigan's CON program.

The program has been effectively used by hospitals and other incumbent healthcare providers to maintain a monopoly on profitable sectors of the health market. One hospital association member admitted to this rationale in a National Institute for Health Reform study.

"Member hospitals initially had mixed views about the benefits of CON but banded together to support the process after realizing it was a valuable tool to block new physician-owned facilities," said the respondent, who remained anonymous.

Through the CON process, major players in the state's healthcare industry such as Rex Healthcare, Duke, and Novant are able to tie their competitors up in court for years, preventing consumers from accessing quality healthcare.  Navigating the CON regulatory process can take millions of dollars in application and consulting fees. Millions more may be spent as a newcomer's entrenched competitors challenge them in court.  Physician-owned facilities are kept out of the market, whether by regulators or the cost of the CON process itself.

During the recent legislative session, lawmakers from both parties introduced several bills that would help level the CON playing field. While these bills have merit, the General Assembly should repeal most aspects of the current process.

Instead of having the state protect the profit streams of enormous healthcare corporations, let healthcare providers make rational decisions for themselves based on what the market will support.  Consumers will decide which services are needed far better than any bureaucracy in Raleigh.

Neal Inman is an intern at the Civitas Institute in Raleigh (nccivitas.org)

ESC Reports Show No Net Loss in Government Jobs Yet

Posted: 09 Oct 2011 02:58 AM PDT

Perdue’s claims don’t match available data

By Don Carrington | Carolina Journal

Don Carrington

RALEIGH — Gov. Bev. Perdue continues to blame North Carolina's high unemployment rate on a loss of government jobs resulting from budget cuts by the Republican-led General Assembly. Perdue may be right, but the official information provided by the state's Employment Security Commission doesn't back up her claims.

Perdue hinted at large government job losses this spring. At a Democratic fundraiser in April, Perdue suggested that the state budget proposed by GOP leaders would lead to massive layoffs — perhaps 30,000 in all sectors of government and 18,000 in education alone.

Speaking to a group of economic developers Sept. 19 in Charlotte, Perdue claimed that "much" of North Carolina's 10.4 percent unemployment rate was due to job losses in the public sector, according to a WSOC-TV report. At a Greenville-Pitt County Chamber of Commerce lunch the next day, Perdue said a recent jump in the state's unemployment rate occurred because of public sector job losses, the Daily Reflector reported.

But the monthly employment numbers released a few days earlier by the ESC showed a different picture. The seasonally adjusted unemployment rate did "jump" from 10.1 percent in July to 10.4 percent in August. Yet ESC also reported a seasonally adjusted net increase of 13,600 government jobs.

At a minimum, it is premature to make any conclusions about a purported relationship between government job levels, the unemployment rate, and the state budget. Because of quirks in the seasonal adjustment methodology, ESC could report a gain of seasonally adjusted government jobs in September. Such a report would not be an accurate accounting of public employment, but it would place Perdue and others who have been critical of the General Assembly in a rhetorical bind.

Still, despite the lack of reliable numbers at present, Perdue spokesman Mark Johnson maintains that the GOP is to blame for massive job losses in the public sector.

“The Republican legislature’s shortsighted and unnecessary cuts resulted in the loss of thousands of education positions in K-12 and thousands more in the university system," Johnson told Carolina Journal. "Common sense alone tells you that these job losses push up unemployment; if unaddressed, these losses will harm both our ability to sustain a well-trained workforce and to remain competitive in the global marketplace. It’s worth noting that since Jan. 1 the state has seen an increase of approximately 34,000 private sector jobs. Of course, Gov. Perdue won’t be satisfied until every North Carolinian who wants a job has one.”

Adjusting the numbers

ESC serves as the local agent for the federal Bureau of Labor Statistics, which produces the employment estimates. The "seasonal adjustment" factor used by BLS for public education jobs in the summer, for instance, is little more than a guess. It's an estimate based on observations from several recent years of the number of jobs that should exist if all schools remained open year-round and there were no summer break.

A more reliable way to look at public employment is to consider an actual count of jobs, the so-called not seasonally adjusted or unadjusted figure. Since the fiscal year began July 1, the ESC's seasonally adjusted employment estimates show a net gain of 3,600 state and local government jobs. By contrast, the unadjusted jobs figure for local education has plummeted — from 229,100 in May to 132,300 in July. Such drops are typical in the summer when schools are out of session. The unadjusted jobs number rebounded to 189,300 in August and should rise even more when the September report is released Oct. 21.

ESC officials defend their approach. Agency spokesman Larry Parker told CJ that seasonally adjusted estimates are "accurate." In a Sept. 16 interview with Raleigh television station WTVD, Deputy Chairman David Clegg said, "We are using the same methodology that’s been used for decades. We are looking at the same snapshot of North Carolina’s economy each and every month."

ESC has been sharing the data from its monthly employment reports with the governor a day before the report is released to the public.

DPI and UNC report

A survey of the public school systems by the Department of Public Instruction, released in late August, showed 6,300 positions have been eliminated over the past four years — 3,900 of them in previous years when Democrats were in charge of the General Assembly and the governor's office. Slightly more than 2,400 people have been let go since the current fiscal year opened in July.

A similar survey by the University of North Carolina system showed the elimination of 487 full-time filled positions, 2,544 filled part-time positions, and 1,487 unfilled positions. UNC-Charlotte and Elizabeth City State University reported zero reductions in filled full-time positions. UNC–Chapel Hill reported that it had eliminated 95 filled full-time positions.

If these surveys are accurate, education job losses would total roughly 6,000, rather than the 18,000 Perdue predicted.

Still, here's no way of knowing whether these surveys would coincide with ESC data. School systems may count the elimination of unfilled positions in different ways. They may not distinguish between a count of employees and a count of jobs — and whether the jobs are filled or unfilled. ESC also emphasizes seasonally adjusted numbers in its monthly release rather the raw estimates.

The BLS raw count of government jobs in North Carolina drops by as much as 100,000 every summer, because most public school teacher jobs are not counted during the summer break.

ESC's Parker told CJ that most economists would agree a more reliable method of measuring changes in government jobs would be to compare unadjusted employment numbers from September 2011 with those from September 2010.

The employment numbers come from two separate employment statistics programs managed by BLS. The unemployment rate comes from a U.S. Census Bureau national monthly survey for BLS of 60,000 households, with about 1,500 of them in North Carolina.

The count of jobs comes from the Current Employment Statistics program. It is based on a sample of private and government employers.

Don Carrington is executive editor of Carolina Journal.

Man charged in plot to kill Afghan President Karzai had no access to palace

Posted: 08 Oct 2011 06:59 PM PDT

KABUL (BNO NEWS) -- Afghan government officials on Saturday said that a man charged with plotting to assassinate President Hamid Karzai was not a bodyguard and had no access to the presidential palace.

A spokesman for the country's top intelligence agency said on Wednesday that six people had been detained on charges of plotting the assassination of Karzai. Those arrested include four students, a Kabul University professor and a guard near the presidential palace.

But the presidential palace on Saturday denied the spokesman's claim that the sixth man was a presidential bodyguard, saying Mohibullah Ahmadi worked at one of the external gates and was not allowed to enter the palace.

National Directorate of Security spokesman Lotfullah Mashal on Wednesday said the suspects are members of al-Qaeda and the Haqqani Network. He also alleged they have direct ties to the intelligence services of neighboring countries and at least one of them received militant training in Pakistan's North Waziristan tribal region.

The official described the detainees as "a dangerous and educated group" who wanted to assassinate Karzai. It was not immediately clear how the group planned to kill Karzai and how advanced their plot was.

The arrests came less than three weeks after former Afghan President Burhanuddin Rabbani was assassinated during a suicide attack at his residence while meeting with several members of the High Peace Council along with two important members of the Taliban, although the group later denied responsibility.

(Copyright 2011 by BNO News B.V. All rights reserved. Info: sales@bnonews.com.)


Insurgents kill two NATO troops in Afghanistan’s south

Posted: 08 Oct 2011 06:37 PM PDT

KABUL (BNO NEWS) -- Two coalition service members were killed on Saturday as a result of an insurgent attack in southern Afghanistan, the NATO-led International Security Assistance Force (ISAF) said on early Sunday.

ISAF said two of its service members were killed as a result of an insurgent attack in Afghanistan's south. As usual, the multinational force gave no other details about the incident, including the exact location.

The nationalities of the service members were also not immediately disclosed by ISAF. "It is ISAF policy to defer casualty identification procedures to the relevant national authorities," a brief statement said.

Coalition casualties in Afghanistan have been rising sharply in recent years with a total coalition death toll of 709 in 2010, making it the deadliest year for international troops since the war began in response to the Sept. 11, 2001 terrorist attacks on the United States.

There are currently more than 130,000 ISAF troops in Afghanistan, including some 90,000 U.S. troops and more than 9,500 British soldiers. U.S. President Barack Obama previously ordered a drawdown of 10,000 American troops later this year, with another 23,000 U.S. troops to return home next year.

So far this year, at least 475 coalition service members have been killed in Afghanistan. Most troops are American and are killed in the country's south, which is plagued by IED attacks on troops and civilians. The deadliest incident happened in August when a U.S. helicopter crashed in eastern Afghanistan, killing 30 U.S. troops, seven Afghan troops and an Afghan interpreter.

(Copyright 2011 by BNO News B.V. All rights reserved. Info: sales@bnonews.com.)


Ghana church official says poverty, unemployment ’cause’ homosexuality

Posted: 08 Oct 2011 06:18 PM PDT

ACCRA (BNO NEWS) -- A Ghanaian church official on Friday warned local youth about homosexuality and said it is largely 'caused' by poverty and unemployment, local media reported on Saturday.

Reverend Dr. Bugri Nagbo, the Northern Regional Chairman of the Presbyterian Church of Ghana, was addressing youth groups, political parties and chiefs in Tamale, the capital of the Northern Region, during a peace-building seminar organized by the church.

"He said the actors (homosexuals) give their victims fat envelopes of money and assorted gifts to entice them into the act and advised the youth to beware," the state-run Ghana News Agency said in a news report. Nagbo claimed same-sex relations are usually between an older, richer person and a poor young person.

Meanwhile, in the fishing town of Winneba in southern Ghana, psychologist Alhasan Baba Mamudu warned youth to get rid of homosexuality because 'it could destroy their lives' in the future. He also called on parents, Christian and Muslim leaders and the government to intensify their campaign against homosexuality.

The law in Ghana makes consenting homosexual acts a misdemeanor, and lesbian, gay, bisexual and transgenders (LGBT) face widespread discrimination as well as police harassment and extortion attempts. Gay men in prison are often subjected to sexual and other physical abuse.

In late July, Western Region Minister Paul Evans Aidoo ordered the arrest of all homosexuals in the region and tasked security agencies to 'smoke out' all citizens suspected to be engaging in homosexual acts. "All efforts are being made to get rid of these people in the society," he was cited as saying by local radio station Joy FM.

In June 2010, more than 1,000 people protested in the city of Takoradi against reports of gay and lesbian activities in their city. There are no registered LGBT organizations in the African country.

(Copyright 2011 by BNO News B.V. All rights reserved. Info: sales@bnonews.com.)


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