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Progressive Politics in Minnesota, the Nation, and the World

Q-Comp: Pawlenty's Method of Distraction From Funding Problems

Category: Education
Posted: 02/01/09 10:59

by Dave Mindeman

The Star Tribune has an article talking about the pros and cons of Governor Pawlenty's Q-Comp program. They examined how the program has been implemented in the districts that are using it. The bottom line? The program isn't doing much.

The article explains the programs results:

In 22 school districts whose Q Comp practices were examined by the Star Tribune, more than 99 percent of teachers in the program received merit raises during the most recent school year.

With those kind of statistics, some are starting to question the program's effectiveness. Rep. Mark Buesgens, R-Jordan put it this way:

"Why should we expand it statewide when there is no evidence that it's improving anything?" asked Rep. Mark Buesgens, R-Jordan. Let's quit the charade, let's give every district another $300 per pupil, and quit bluffing."

And Buesgens is a conservative Republican supposedly on Pawlenty's side.

The Governor's goal was to reward good teaching and thus increase student achievement. Even on that score, the program is in trouble:

Test data suggest that, so far, students in school districts in at least their third year of Q Comp have not shown more improvement in reading and math than students in schools not participating in the program.

So what are we to take from this? Well, I have a simple answer....

Teachers are not the problem.

Maybe there are a few teachers who are not doing the best job or are not fully qualified for there position, but I tend to think that the overwhelming majority of teachers are doing a great job with the resources they are given. Pawlenty and other Republicans seem to find it useful to try to link student achievement to teacher competence. But, a truer correlation links student achievement and financial resources of the school.

Instead of teacher evaluation, resources should be assigned based on the type of student population, the economic resources of the geographic location, and the number of special needs students being educated.

Teachers, by and large, are a strongly dedicated group who are truly self motivated to do better. They always look for improved ways to educate.

In a time when resources are scarce, Governor Pawlenty needs to stop hanging onto his pet projects and examine better methods to utilize education dollars.

Teachers aren't the problem -- lack of support is.




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US House GOP Holds "Victory" Retreat?

Category: GOP Politics
Posted: 01/31/09 14:45, Edited: 01/31/09 14:50

by Dave Mindeman

The US House minority GOP caucus had their retreat. And you would think they had just won the lottery. I guess they are convinced that their smaller group has the ability to unify in ways they haven't before. Since most of this group comes from hard core districts, they probably do have a lot in common. But can that bring them back to a House majority?

The election of Michael Steele as RNC chair was probably the better indication that they are coming back. Of all the candidates vying for the position, Steele can probably attract the broadest appeal.

And in a way, it was probably a good sign for Governor Pawlenty's national ambitions. Steele and Pawlenty are closer in broader goals than any of the other RNC candidates.

However, the message is still not changing much. Eric Cantor, the House minority whip, spoke about the recent stimulus vote:

?I know all of you are pumped about the vote the other day,? Virginia Rep. Eric Cantor, the party whip, told lawmakers Friday night, eliciting loud cheers from the roomful of Republicans. ?We?ll have more to come.?

Pumped up about a bill they lost by over 50 votes? Cheers that they all voted to do nothing? I guess victory is in the eye of the beholder.

Maybe I'm missing something, but being negative and obstructionist when the country desperately needs action seems like a wrong headed message to me.

And here's another puzzling symbolic gesture:

Indiana Rep. Mike Pence, the chairman of the Republican Conference whose office organized the three-day retreat, kicked off the final dinner with a clip of George C. Scott as Gen. Patton imploring his troops, ?We?re going to kick the hell out of (the enemy) all the time, and we?re going to go through him like crap through a goose.?

After the drubbing the House Republicans have taking in the last two election cycles, you have to wonder which side they think Scott/Patton is supposed to be referring to.

The voice of reason came from our own Governor Pawlenty, as an invited speaker:

He also warned Republicans away from the divisive politics and infighting that have plagued the party for years. ?We don?t have a big enough party to be throwing people overboard,? the conservative governor said.

Nice thought....but a little late.

I guess the most symbolic distortion of reality came from Cantor:

Cantor had all his deputies sign a magnum of wine to uncork when the GOP wins back the House.

Well, they say wine always gets better with age.
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A Few of the Problems With Our Current Health Care System

Category: Health Care
Posted: 01/31/09 13:34

by Dave Mindeman

The terminology and references to the health care debate always gets lost in assumptions and inaccurate comparisons. As we sink deeper into an economic nightmare, health care should come to the forefront -- because fixing it can speed up our economic recovery.

My perspective comes from two things: I am a pharmacist and see health care issues up close....and my wife has a chronic illness that requires constant insurance involvement. Secondly, I have come to believe strongly in the single payer solution. And as I discuss some of these things, you will see why.

Right now, I want to discuss the daily grind that providers deal with regarding insurance issues. Most of my references are going to involve PBM's (Pharmacy Benefit Managers) -- Doctors and hospitals have more issues but have to deal with PBM's as well.

Several years ago, PBM carriers were touted as an answer to skyrocketing health care costs. They would reduce costs by making claims and benefits more efficient. And at first, they did slow some of the escalating costs. Briefly. But they very quickly reversed that trend as profit motives required more squeezing of providers and patients.

Here are a few of the ways PBM's have complicated health care:

DUR (Drug Utilization Reviews) -- In theory, this should have added to health care quality. What it is supposed to do is examine a drug claim and compare it to recent claims for the same patient to look for drug incompatibilities, overuse, and dosage problems. Pharmacies have their own internal checks but with patients filling prescriptions at multiple locations, it can be hard to keep track of a patient's history. But, although well intended, DUR has ended up adding to costs.

Here is an example: A woman brought me a prescription for a rather high dose of Warfarin -- a blood thinner. The dose was higher than recommended on a normal basis, but this patient had a special situation and the doctor insisted that the dose was correct. The insurance carrier blocked me from filling the presciption citing a DUR violation. After calling the insurance company, they told me the remedy would be a prior authorization application (you will be hearing a lot about prior authorization). In order to obtain an override in this manner, the Doctor (not the pharmacy which had already done the calls and verification) would have to submit a PA request. So, the doctor calls the insurance company and files a form -- a review board decides whether the reason is sufficient and if they agree, they authorize the claim. Notice that the review board...not the doctor... has the final say. One more thing, this woman had obtained a prior authorization for this dosage in 2008; however, her place of employment had changed the plan with this carrier (same insurance company, just a different plan) which invalidated the previous prior authorization and required everyone to go through the whole process again.

Efficient?

Refill Too Soon -- Again, for well intentioned reasons, this method of denying a claim is meant to evaluate whether or not a patient is overusing a medication. Unfortunately, most insurance carriers don't seem to understand that patients do go on vacation, or sometimes lose bottles, drop pills down the sink by mistake, or have changes in dosage by the doctor. So, the pharmacy has to call the insurance company and obtain an override. The request is usually granted -- but the hoops must be jumped through so that the carrier can document such events. Some carriers will "allow" only two such events within a year -- if a third time is required, the patient either pays cash or goes without. In addition, everytime this call is made requires long phone waits on hold with the carrier. Time wasted -- administrative costs added.

Non-Formulary Drug -- Here is another example of care being controlled by the insurance. Doctors often prescribe a specific drug for a course of treatment, but the insurance company has decided that a "less expensive" therapeutic equilavent is the preferred drug. Preferred drugs are put on a "formulary" list. The non-preferred drugs may still be allowed but have to go through a prior authorization process. The Doctor has to provide a reason for using that particular brand. Often, the only reason the insurance carrier prefers one drug over another is that the preferred has a generic alternative which will greatly reduce the cost to the insurance company. One extreme example of this is that I had a patient that needed to use the brand name Zocor for cholesterol. The insurance required that the generic be used, however, this patient had a reaction to the tablet color dyes of any the generics we could get. After several weeks of haggling, the insurance carrier allowed the brand product but reduced the pharmacy reimbursement to the point that we lost money every time this person had the Zocor filled.

These are just some examples of how insurance carriers control health care in America. Doctors, Dentists, and Hospitals have other stories to tell I am sure.

I'll be going over additional problems with the so-called "competitive health care model" in future posts..... as well as why single payer can improve the situation immensely.

Health care is being held hostage by a system that has too many complications and rules. If we are to compete in a global market, one area that we are losing badly in, is health care.

Maybe we can overcome our economic issues -- but without fixing health care, we will only get dragged down again.
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