Category Archives: National Politics

How the US Postal Service Could Possibly Save Itself

Just last week the United States Postal Service announced another $1.9 billion loss in just one quarter, with the warning that without substantial changes the losses would continue to mount.  Something has to give.

Retired from the Postal Service, I have some ideas on what needs to be done to save this Constitutionally provided institution, and a new line of clothing, mentioned several months ago, does not even make my list, nor do I think elimination of Saturday delivery alone would be sufficient.   During my career I carried mail, worked inside a large postal plant, and collected data for a year.

It was that year of collecting data that foretold today’s inevitable crisis.  The year was 2000, and at that time as I remember, first class mail was less than half the letter mail volume but more than half total postal revenue.  The problem was that, of that first class mail, somewhere around 70% consisted of bill presentment and payment.  The writing was on the wall.  Much less bill presentment, bill payment volume has evaporated to the internet and will continue even more.  This was one major straw that broke the back of a camel already straining under what the postal service failed to recognize early on, that the business was becoming about the delivery of things rather than information.  Other substantial problems contributed to the current situation, but the loss of quality volume sufficient to sustain delivery to every delivery point six days a week was an inevitable result of new information technology and beyond the post office’s control.  Simply cutting the workforce and utilizing a heavy application of sorting automation, in many ways commendable, could not keep up with the deteriorating situation.

Political considerations put cutting several known sources of waste beyond reach that could have delayed, but only delayed, the current crisis.  One example, but certainly not isolated, happened near where I live.  Two small towns that appear as one are separated only by a railroad track.  Each had its own post office with its own postmaster and staff, and unfortunately still does.  One town outgrew its office.  Since the two towns together are smaller than many single towns, the opportunity was perfect to build one new office large enough to accommodate both.  I’m not sure if this was even suggested, but am confident, if tried, the local congressman would have been besieged with calls from one of these adjacent towns about losing its identity or the hardship of having to travel perhaps a half mile further to reach the new combined office.

Another common well-known waste that politics preserves occurs in suburban neighborhoods that originally had mail delivered to a box attached to the house or through a slot in the front door, rather than a box at the curb.  In such situations the carrier drives to the area, parks and walks to each house, then moves the vehicle to the next area, over and over.  Yet by all appearance such neighborhoods are identical to others where curbside boxes were required from the start, and delivery from the vehicle is several times more efficient.  Private businesses looking at the current postal challenges would quickly change this, but under the political connection no one dares to even try.

Unions are another obstacle to efficient operation in ways other than wages that exceed the skill level.  Removal for poor performance or abuse of leave is extremely  difficult.  The workplace is fractured into crafts, each represented by its own union, so employees of one craft may not touch the equally low skilled work of another.  At one time this could work, simply not today.  One would think when workers at some plants, willing to work many hours of available overtime, can earn in excess of six figures, there would be concessions to overall efficiency and responsibility to secure the remaining jobs of all.

That brings us to today with the postal service looking to cut Saturday delivery to keep itself afloat.  This is attempting to put a band-aid on a gaping wound, and will be difficult to manage as well, as every Monday will follow two non delivery days and will be like the current volume anomaly of Tuesdays after Monday holidays.  Of course there will still be Monday holidays and those Tuesdays will now be after three consecutive non delivery days, what I can only imagine as a volume-overload management nightmare.

With that we get to the only possible solution I can conceive, the immediate move to three-day M-W-F delivery.  While each delivery day volume would increase, it would be more manageable by being more consistent day-to-day.  Such a move would mean adding carriers as some routes would have to be cut slightly (but not nearly by half) to get the job done.  Savings would be attained by cutting the use of delivery vehicles substantially.  The other significant savings would require a major change of workplace rules where carriers not delivering express mail and priority parcels on Tu-Th-Sa would be working in plant preparing mail for delivery, replacing work being done by clerks and mail handlers now, eliminating many of those positions.  Consideration would have to be made to occasionally deliver on Tu-Th-Sa in working around holidays.

Proposed plans are to continue delivering parcels six days a week and I would assume express mail also.  Most offices could do this job with one of every three or four current carriers, leaving the others to work in plant.  Limiting six-day parcel delivery to priority rate parcels would encourage greater use of the higher priority rate.  For letters considered urgent there already is a flat rate express letter option that does not require a time-consuming signature.  Out of the box thinking and a willingness to be flexible with current workplace rules and a decidedly more radical approach is necessary to potentially continue the US Postal Service as a self-sustaining entity in the twenty-first century.

Note: This post shared to WatchdogWire-Pennsylvania

The Insidious Non-Optional Medicaid Expansion That Further Clouds the Future for States

So much about Obamacare has been “by any means necessary”, from the legislative gymnastics to get the bill through Congress to the current mandatory expansion of Medicaid that is here now even though largely unnoticed.  Here now?  But wasn’t Medicaid expansion optional?  Some yes and some no as it turns out.  This almost unknown stealth expansion was required of the states and imposed on them despite the Supreme Court ruling because it is being funded 100% by the Federal Government, but only for two years 2013 and 2014, after which, funding abruptly ends.  Because a strong constituency is being created (or bought) that will demand this expansion be continued past 2014, and no one can predict the outcome of those likely demands, further possible complications and risks arise for those states that decide to embrace the optional Medicaid expansion.  Allow me to explain.

Because of current constraints to participation by medical professionals both by low reimbursement rates, 1800+ pages of cumbersome rules, and audits that go beyond financial fraud to interfere in actual treatment decisions, there are at present not enough willing doctors to adequately serve those now eligible for Medicaid benefits.  Realizing this, and attempting to avoid making the optional expansion to 133% of poverty and influx of new eligibles a disaster, “any means necessary” was once again deployed.

On November 6, 2012 (surprisingly not a Friday) CMS published a Final Rule to go forward.  146 primary care Medicaid services identified by the ACA would, by regulatory proclamation, be compensated at the higher Medicare rate, starting with 2013 but only for two years.  Since Medicaid reimbursement rates relative to Medicare reimbursements vary tremendously from state to state, the percentage increase covered by Federal funding varies accordingly.  At one extreme are two states that surprisingly pay higher Medicaid fees for the covered services than they do for Medicare.  These states will receive no additional Federal funding.  At the other extreme is Rhode Island, where Medicaid fees will increase 198%.  Five other states will receive boosts of over 100%.  Pennsylvania is number seven on the list and doctors will be compensated an additional 96% to equal the higher Medicare rates.  On average across the nation Medicaid fees for the ACA primary care services will rise 73% at an estimated cost of $11.9 billion, all in an attempt to keep willing physicians on board, expand their willingness, and attract newcomers.

The problem, of course is what happens after 2014.  It is unimaginable that doctors enjoying the higher reimbursements for two years will do anything but lobby stridently to extend the increases and indeed have them made permanent.  Realizing, otherwise, the carrot to participation would no longer exist, this outcome can be considered probable.  The mystery is who would then pay?  Would the increase be included in the ultimate 10% state funding under optional expansion to 133% of poverty or even some formula that would require states to pay more? Would the increases fall to each individual state or be averaged over all the states?  The point is that today no one knows.  While perhaps not being the main reason to avoid the optional Medicaid expansion, especially those states with the greatest percentage “temporary” increases need to consider the possibility of very serious consequences in the aftermath of this two year attempt by the Federal government to buy a loyal constituency for implementation and avoidance of massive failure.  It is also interesting that the current reimbursement increases were only applied for two years, as estimates for the cost of Obamacare have been made over a ten year period, allowing more, for now, to remain hidden from view.

The two main sources used for this post were a policy brief from the Henry J. Kaiser Family Foundation and an article in American Medical News published by the American Medical Association.  More details can be found at these two locations.  Also used was a recent article written by the President of the Texas Medical Association.

Note: This post was shared to WatchdogWire-Pennsylvania on Sep 24, 2013.

Every State Not Expanding Medicaid (and those that do) Needs to Do THIS — ASAP!

Pennsylvania is fortunate to have a governor who has made bold choices in opposition to Obamacare by both declining state insurance exchanges and the more difficult, but entirely correct, refusal to expand Medicaid, but it can’t stop there.  Governor Corbett and all non-expansion states need to explain why their decision was correct and promote alternative solutions asap, or lose the battle for public perception as Democrats are painting the Governor and the GOP as standing against the poor and caring only about the rich, despite it not being true.

Last week on PCN-TV, a Pennsylvania version of C-span,  State Senator Vincent Hughs was practicing his art of indignation by trashing the Governor on Medicaid expansion and demanding to see the figures on Governor Corbett’s fiscal concerns.  He also posted a response on his website.  Senator Hughes seems to have the idea that adding more free stuff from others better off can never go wrong, and because we would in the end retain 90% Federal funding, that Federal money somehow materializes from thin air, rather than from the pockets of people in the states, including Pennsylvanians.

For the benefit of Senator Hughes, and to his credit, we should look at numbers, and outcomes and realities as well, being sure to consider everything we know and leaving indignation, hubris, and emotion at the door.  If Senator Hughes would approach the debate in such fashion and the GOP would learn to articulate their message and promote detailed solutions and alternatives to Medicaid expansion we may find places where we can agree, and even discover ways to provide better care for the poor at less cost to the taxpayer.

Without too much detail, Medicaid is a mess.  Low reimbursement rates that don’t cover costs keep many physicians from participation entirely and must limit the number of eligible patients seen for those who do.  For others a different cost is too great, best summed up in this quote from an article written by the President of the Texas Medical Association, Dr. Michael E Speer :

“Texas physicians are also discouraged from accepting new Medicaid patients because of the program’s 1,802-page rulebook and exasperating, irreconcilable red tape. We need to return to treating the patient, not the administering bureaucrat.”

These constraints to participation create rationing by waiting time, length of visits, and lack of availability to care that result in the much higher cost of seeing non-emergency cases at hospital emergency rooms.  After all it’s better to wait 6 hours to see someone than 6 days or 6 weeks, and those facing such choices cannot be blamed for doing what they perceive is in their best interest.

All this has numbers attached too that Senator Hughes and those deriding the Governor’s decision should be equally interested in seeing as well.  Ask any doctor.  Medicaid patients often fare worse than patients without any insurance.  Expansion of eligibility will do nothing but increase the waiting times of those already attempting to find access from too few professionals who can afford to offer it.  Coverage clearly does not equate to care.  Also, expansion to 133% of poverty forces more people into Medicaid because only  those over 133% will be eligible for subsidies in exchanges.  Many additional people toward the upper end of the 133% will be be forced to drop private insurance they now have to join the ranks of the current overextended Medicaid mess.  Senator Hughes and others, is this what YOU want?

We must look to better ways to provide for our poor, not extend a system of failure.  Various alternatives to providing for the poor have been tried, some with much success and satisfaction.  Successful innovations have been tried in Indiana, Florida, and Rhode Island.  These involve empowering the poor with ownership via their own special accounts or insurance policies that have incentives to choose services wisely.

Perhaps the single best idea I’ve seen comes as a bill that has been introduced in the New Jersey Senate that uniquely looks at a partnership between state government and private charity.  Senate No. 2231, also known as the “Volunteer Medical Professional Health Care Act”, is a brilliant idea that should cross party and partisan lines with appeal to anyone who seriously wants to provide better access at lower cost along with less government involvement and control.

Very simply, New Jersey Senate No. 2231 would grant any physician (primary care or specialist) or any dentist who agrees to volunteer at least 4 hrs per week in a non-government free clinic, immunity from civil liability through the entirety of their medical or dental practice in the state.  These physicians would not need to purchase malpractice insurance and be freed from oppressive Medicaid regulations and scrutiny, creating an almost irresistible incentive for many more physicians to participate than are willing to commit to Medicaid.  Medicaid would never be involved or ever billed for any of this service.  The New Jersey chapter of the Association of American Physicians and Surgeons (AAPS), who inspired the legislation has estimated New Jersey could expect to save $2 billion of a $10.2 billion Medicaid budget or close to 20%, while offering more timely and much better care for those they see.   AAPS itself was inspired by the vision of two members, Drs. Alieta and John Eck, who responded to the needs of the poor and their concerns over the pitfalls of Medicaid by starting a free clinic in their hometown, Zarephath, NJ,  in September of 2003, thus will enjoy their 10th anniversary this year.

Governor Corbett in Pennsylvania and other Governors who courageously declined to expand Medicaid made the right choice and need to stick to it.  Opponents need to open their eyes to existing realities, and all need to come together to find better solutions such as S-2231 in New Jersey as well as others.  AAPS has informed me that similar legislation may soon be introduced in UT and AZ.  It is not enough to decline Medicaid expansion and then do nothing, while being falsely painted as uncaring by those with insufficient understanding.

Before Sending Drones Against Americans Abroad

Much has been said lately critical of killing Americans without the benefit of due process.  While it can be tempting to disregard the rights of those who have turned on their country and/or acted in consort with an enemy, there should be a process, a due process, to clear the way for what may also be regarded as the justified assassination of turncoat citizens plotting against us and posing threats from beyond our borders in places also beyond the possibility of extradition.

One way to do this may be a process to bring charges of Treason in Absentia against those on whom we have sufficient evidence of treasonous activity abroad.  Those so indicted by a Federal grand jury would be given a clear choice.  Either return to United States territory within 30 days and surrender to authorities to then face treason charges here, or immediately be stripped of all rights and citizenship.  Those who then willingly fail to face charges here, having surrendered all rights could, at that time, be put on a kill list and treated as any enemy.

I present this as a solution where an executive order is clearly not sufficient yet hesitation to act on a situation is not either.  Citizens must know there are severe consequences to tying themselves to a foreign enemy abroad, and such actions can and will jeopardize their rights, citizenship, Constitutional protections, and even their life.