The recent political chatter about “Obamacare” before the Supreme Court of the United States got a great deal of media attention. President Obama added fuel to the fire when he declared, “Ultimately, I am confident the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress.”
For someone who was a law professor those words were absurd. Even if a bill passed unanimously in the house and senate, it could still be overturned – if the law was in violation of the Constitution.
Giving up is not “reform.” County Executive Ed Mangano’s proposal to transfer property assessment from the county to the towns might possibly speed up assessment decisions by replacing one large and overwhelmed bureaucracy with several somewhat smaller ones. It will likely recreate problems that were major motivations in creating our highly centralized county government 75 years ago.
The 1938 county charter merged the town Boards of Assessors and the County Board of Equalization, ending three decades of complaints, lawsuits and hard feelings about the lack of specific, uniform levels of property assessments between the towns. In a tax system screaming out for simplification, clarification and a sense of certainty, spinning off assessments to the towns will reintroduce “equalization” as an annual issue. Tens of thousands of residents are still trying to figure out why their assessment went down but their tax bill still went up. The division of taxes heading up the tax food chain in an equitable manner is the most complex subject in local government, and it’s all going to make people very sad, particularly in villages and school districts that are split between townships.
Manhattan District Attorney (D.A.) Robert Morgenthau was facing a spirited Democratic primary challenge from a former judge in 2005, but his opponent had trouble finding anything substantively negative to say about Morgenthau.
The reason I know this: a city-based tabloid newspaper reporter called me weeks before the election, asking whether it was legal to have a Manhattan driver’s license while at the same time registering and insuring a car in Dutchess County, where auto insurance premiums are much lower. The answer: yes, so long as the insured vehicle is primarily garaged in Dutchess County. I was the director of public affairs for the New York State Insurance Department at the time and knew immediately the question pertained to Morgenthau because he met those criteria.
Written by Robert McMillan Friday, 23 March 2012 00:00
With all the debate over “Obamacare,” Medicare, the economics of healthcare and taxes, take a look with me at some of the issues, which will become front and center over the next five years.
First, examine some of the statistics with me. In the United States – Medicare and private insurance spend some $60 billion each year on hospital bills during the last two months of a dying patient’s life! For example, one day in an intensive care hospital bed costs around $10,000.
The challenge we face is that some of the medical procedures used in the end of life care may very well have no meaningful impact on the life of dying patients. At the same time, some modern day medical treatments do prolong life. Some people are now asking whether prolonging life is too expensive. And that turns into both a moral and economic question, just like whether every American is entitled to health insurance.
With the costs for medical treatment skyrocketing – healthcare expenditures are four times the size of the Department of Defense’s yearly budget. Last year healthcare expenditures in the United States were some $2.6 trillion. All of this reminds me of a comment made by the head of a Florida hospital a few months ago. The hospital administrator was in England and reviewing hospital administration there compared to the United States. As the tour of the English hospital was underway, they came to the intensive care unit. There were only 12 beds. The Florida administrator asked “Why, when you have twice as many regular beds as my hospital, do you have only 12 beds in intensive care?” The English administrator said, “Death is an option.”
With Medicare in deep financial difficulty, and the Administration looking for ways to trim Medicare spending, is “death an option” in the United States?
All of this leads to one area where the new healthcare law is gaining more scrutiny. That is the Payment Advisory Board. There is growing medical opposition to that board, because doctors feel medical decisions should be left to doctors and their patients. Doctors are concerned that government bureaucrats will determine a general standard of care when doctors feel each patient should be dealt with individually.
In the final analysis, as I said before, this all boils down to a moral vs. economic debate. We cannot stop caring for people as they begin to die; yet, the sums of money being spent on end of life care are growing to staggering amounts. Is there any moral middle ground between “dying is an option” and spending is growing out of sight?
Whatever happens in June when the Supreme Court decides Obamacare, we have not heard the end to the issues discussed in this piece. And as more of the nation ages and more spending is at the end of life, the debate could become very fierce.