Friday, January 18, 2008

O Death, Where Is Thy Certificate Of Need?

Just before the holidays, I went to the doctor's office thinking I had a routine ailment. But while in the waiting room, I had one of those unexpected health scares -- a mortality check so to speak.

As a new patient, I had to fill out several forms. The first, of course, requests that all important personal identification information that consists of an identity thief's bonanza. The next three pages asked me "Have you ever had ... ?" With pen in hand, I checked boxes in the "Yes" and "No" columns.

The next page asked me the reason for my visit. So I wrote: ingrown toenail.

It was page six that explained the doctor's privacy policy in fine print. Though difficult to read -- the copier must have been low on toner that day -- I still had to acknowledge receiving an explanation of the policy with my signature.

At this point, I thought this podiatrist's privacy policy ought to include advice on keeping one's feet covered while in public. I have seen so many sandal-clad, ugly feet that I wish people would learn, once and for all, that Birkenstocks only make their naked feet look mangier. And then there are painted toenails, especially the ones that are half grown out, that really make me cringe.

Then came the killer. Page seven wanted to know if I had a living will and a medical power of attorney. When a podiatrist wants to know this information, then one has to confront the seriousness of any medical condition.

I had been derelict in executing a medical power of attorney because I never felt comfortable with asking someone to end my life. That is such an awesome responsibility to dump on someone else.

But who wants to live Terri Schiavo's life? Nobody wants family and friends to end up in court trying to decipher his or her last wishes.

While sitting in a foot doctor's office, I confronted my dereliction of duty and boldly selected my medical power of attorney-- the West Virginia Health Care Authority.

I didn't even know that the HCA existed until Clarksburg's United Hospital Center decided to move to a new location about five years ago. I live very close to UHC, and I was hoping that the hospital would stay put.

To move, however, UHC had to seek the HCA's approval of a new certificate of need. The process was time consuming and finally had to be decided by the state Supreme Court of Appeals. The court invalidated UHC's certificate of need because the HCA broke its own rules in granting it.

The HCA rules specifically stated that a replacement hospital had to be built within a five-mile radius of the existing facility. UHC's new location was eight miles distant. The HCA has since amended the five-mile rule to accommodate UHC.

Initially, I was mad at the HCA for approving the move. But then a paramedic set me straight. He told me that I lived too close to the hospital to be Life-Flighted. He also said that even five miles was too close to call in the Life-Flight helicopter. But eight miles meant that the chopper could pick me up.

In essence, the paramedic told me the HCA was doing me and everyone else who lived in Clarksburg a favor. I agreed with him and began thinking about the HCA in a positive way.

More recently, the HCA has been involved with deciding who can own and operate CT scanners. It seems that a bunch of greedy doctors want to take that business away from hospitals. Charleston Area Medical Center has said that it makes an annual profit of $45 million from its CT scanning business, which it uses to subsidize money-losing procedures. Doctors, if allowed to own scanners, would just subsidize their already extravagant lifestyles.

I don't know how the CT scanner issue will play out. But I do know this: Only the HCA has the ability and the wisdom to know exactly how many CT scanners we need and, more importantly, where those machines need to be located.

In short, the HCA -- and only the HCA -- knows exactly how much health care each West Virginian needs. This is why I chose the authority to implement my end-of-life directives. The HCA won't keep me alive any longer than I need to be nor will it pull my plug prematurely.

Thursday, December 20, 2007

"Why I Joined": A Soldier’s Story In His Own Words

"And so we watch with detached curiosity, from dry land, to see whether the Iraqis will sink or swim. For shame." -- Christopher Hitchens

Posted by Lt. Mark Daily at MySpace.com.


Christopher Hitchens, writing in the November 2007 issue of Vanity Fair, tells us a heart-rending story about the death of Lt. Mark Daily in Iraq. Hitchens, the liberal who pressed for the overthrow of Saddam Hussein more loudly than any conservative dared to do, was confronted with the consequences of his unequivocal call for regime change when he learned that Lt. Daily took his words to heart and considered them as reason enough to oust Saddam and his Baathist thugs.

Christopher Hitchens is my favorite writer of this age.  His wordsmithing alone qualifies him for that praise.  But what sets him apart from other commentators is his bravery (not bravado) in advancing his views and positions.  Lt. Daily evidently admired Mr. Hitchens as well -- well enough to quote him, and more importantly, to believe in his message.

And so it happened then that when Mr. Hitchens learned of Mark Daily's fate, he felt the pain and anguish of perhaps being partly responsible for this young soldier's death. It is one thing to advocate war from within the safe confines of a typewriter carriage.  But to know that a soldier took the typed page and made it part of his battle creed has to be haunting.

Lt. Daily was killed by a cowardly weapon -- the land mine. In the Iraq war, however, we do not hear the term "land mine" mentioned. In the newspeak of terror war, we refer to these bombs as IEDs -- improvised explosive devices.

Thankfully, IUD was already in use or our soldiers would have to be on the lookout for improvised underground devices.

At his MySpace.com page, Lt. Daily wrote a passionate essay titled "Why I Joined."  He also was kind enough to summarize his reasons for joining the army and going to Iraq by telling his readers to watch the movie "Schindler's List" followed by "Saving Private Ryan."

The young lieutenant was not a hero in the traditional sense of the word, but I would describe him as heroic -- a more fitting word, perhaps.

Oskar Schindler was not a hero, but he was heroic.  Capt. John H. Miller was not a hero, but he was heroic.  And so on.

Lt. Daily went off to fight a war for a noble reason -- that of ridding an oppressed people of their dictator.  He did not go off to war to loot and plunder.  And that is a major difference in the pursuit of warfare that differentiates the American soldier from the hordes of masquerading butchers and thieves who permeate the history books.

Mr. Hitchens article, "A Death in the Family," recounts his meeting Lt. Daily's family.  He wasn't sure at the outset whether he should even make the attempt to contact them.  And if he did so, he had no idea of how to phrase his greeting.

There was no established protocol to guide his introducing himself to this family in mourning.  Nor did Emily Post's provisos lend any advice specific to the situation.  But he felt strongly that, given the circumstance, he needed to make the effort even if the Dailys rejected his condolences out of hand.

We are fortunate that Mr. Hitchens persevered.  The story that he wrote is the final chapter that every soldier's family lives through when bidding adieu to a beloved son or daughter who was killed in combat.

"A Death in the Family" comes to a close on a windswept Oregon beach, the locale where Mark Daily wished his ashes be strewn.  Mr. Hitchens joined the Daily family there for the ceremony, and he read a fitting passage about the death of a soldier from Shakespeare's "Macbeth".

This is all I want to tell you about Mark Daily in this column.  His words are the words you should be reading.  For regardless of your opinion of war, you should avail yourself to hear the soldier's opinion.  You will find it interesting.




Lt. Mark Daily at MySpace.com   http://profile.myspace.com/index.cfm?fuseaction=user.viewprofile&friendid=46348938

"A Death in the Family" can be found at   http://www.vanityfair.com/politics/features/2007/11/hitchens200711?currentPage=1   or   www.hitchensweb.com

Friday, December 7, 2007

David Allen’s Top 10 Predictions for 2008

10. At the request of Agriculture Commissioner Gus Douglas, Al Gore will perform rain dances in drought-stricken Mason County. Commissioner Douglas will have a cameo role in Gore’s next documentary: "An Inconvenient Flash Flood".

9. BrickStreet Insurance loses its monopoly for underwriting workers compensation coverage in July and will face heavy competition from major insurers such as Aetna (dba Cobblestone Street Insurance), The Hartford (dba Elk Crossing Guaranty), Liberty Mutual (dba Blacktopped Boulevard Insurance), and Berkshire Hathaway (Cul-De-Sac LLC). By year end, BrickStreet will have reinvented itself as RoadPavedWithGoodIntentions Insurance Company.

8. For the fifth time, President Bush will visit West Virginia on the 4th of July. When asked what he plans to do in retirement, he will answer, "I wanna work on takin’ the "Duh" out of "Dubya."

7. The Democratic primary outcome will hinge on the gun control issue. Dennis Kucinich, who claims that he has seen UFO’s, will win the WV primary presidential nomination in a romp after promising to defend the right to own and bear ray guns.

6. Come Spring, the "Rachel Ray Show" will discover ramps. Rachel airs live from the Richwood Ramp Festival. Ms. Ray will prepare garlic-fried ramps, gnocchi, and mountain oysters with Marinara sauce.

5. Wal Mart has saturated West Virginia with Super Wal Mart stores. In 2008, the retailer will expand its market share by opening 250 convenience stores and selling cheap, leaded gasoline made in China.

4. The Republican primary results will surprise everybody. Fred Thompson will be nominated for Prosecuting Attorney in all 55 counties.

3. West Virginia will retain its moniker "Judicial Hellhole" as a result of Nitro resident Arthur Treacher suing Long John Silvers for deceptive advertising. Treacher will claim that he is allergic to seafood but that his takeout order of shrimp and lobster didn’t so much as give him a mild case of hives. Long John Silvers will declare bankruptcy after being forced to reveal its food sources. The jury will award Treacher $10 million plus unlimited fries for life.

2. Ang Lee will win the Cannes Film Festival Palm d’Or award for "Brokeback Mountaintop Removal", his touching story of two environmentalists fighting to stop coal mining. Starring Rosie O’Donnell and Paris Hilton. Filmed on location at a Logan County, WV motel. (This film has not yet been rated by the Friends of Coal.)

And the number 1 prediction for 2008: David Allen will overcome his lifelong struggle with dyslexia and win the Pultizer Priez

Friday, November 2, 2007

Bong Hits 4 Jesus and Other Pipe Dreams

This year, I joined the Cato Institute. Technically, I am a sponsor of Cato Institute, and my sponsor's fee qualifies as a tax-deductible donation to a §501(c)(3) educational institute.

It did strike me as odd that I was making a tax-deductible gift to a libertarian think tank. That libertarian intellectuals sought and received special tax status tells me that we have pushed the federal tax code into the Twilight Zone.

This lone, Schedule A deduction got me to thinking about all of the organizations that receive tax-exempt status and, more importantly, asking myself why do we allow tax-deductible contributions in the first place?

We as a nation have a history of convoluted court decisions regarding the separation of church and state. The courts tell us that public school teachers aren't supposed to promote religion with daily prayers. The courts say that churches can't set up Nativity scenes on courthouse plazas if the displays promote religion.

On the other hand, the government allows for parishioners to deduct their contributions to their church. Provided, of course, that the Internal Revenue Service has sanctioned their church.

If you start a church that celebrates the Deity with bong hits for Jesus, then the IRS is likely to say that your church is not a real church. On the other hand, the IRS conveniently looks the other way when politicians make political speeches from the pulpits of Atlanta's Ebenezer Baptist Church and Jerry Falwell's Thomas Road Baptist Church.

I won't pick on the political endeavors of Catholics, Jews, Hindus or Muslims at this time. Lord knows, Christopher Hitchens ("God Is Not Great") has done that dance.

But as for the tax-deductibility of contributions to churches, three things need said.

First, tax-deductibility creates an incentive to give. Second, tax-deductibility for one special group means that all other taxpayers subsidize that donation. And finally, all mainstream churches spend a portion of their domestic contributions conducting missionary work in foreign lands.

Some fair questions exist, then. Is the federal tax code really supposed to be involved in sanctioning contributions to religious entities? Is the IRS within its bounds to define a church or religion? Is it in the best interests of our tax-collection policies to subsidize the Jehovah's Witnesses membership drive in the Amazon rain forest? If religion and state are to be separate, how can the federal tax code allow deductions for contributions to religious entities? After all, these donations promote religion.

Tax-deductible charitable contributions to educational institutions have been allowed for a long time. Everyone agrees that bona fide educational expenses include tuition scholarships, distinguished faculty chairs and the cost of constructing and maintaining academic buildings.

On the other hand, it is a real stretch to say that donations for new Astroturf and a multi-million-dollar scoreboard for the football field fall under the guise of education. Contributions to the athletic fund that are made for the sake of getting good stadium seats aren't exactly educational donations either.

Currently, two Ivy League university foundations are being sued for misspending endowment money. These lawsuits arose because the universities allegedly failed to spend the money in accordance with the donors' directives. If true, should the donors lose their prior tax deductions?

Duke University will pay out millions of dollars to settle the Duke rape case. Most, if not all, of this money will come from Duke's tax-exempt foundation. Should the solicitation of money to shield the school's management from personal liability qualify as a tax-deductible educational contribution?

Tax-deductible contributions of property are rife with overvaluation of the conveyed assets. The IRS should require that donors sell the property at auction and donate the actual sale proceeds. You and I both know that appraisals in these instances drift to the high side.

Millions of lower-income Americans donate "what they can" to a church, or to the Salvation Army, or to the Humane Society. They donate to the Red Cross disaster fund. They buy the flour and sugar for the school bake sale. But these taxpayers seldom get to claim a deduction for their charity as the tax code usually persuades them to opt for the standard deduction.

Thus, a philosophical question needs answered: Does the government (via the IRS) have a guiding philosophy regarding charitable contributions, or is Form 1040 just an arbitrary, and sometimes feel-good, accounting exercise?

If I could revamp the federal tax code, I would eliminate charitable deductions altogether -- even if that means my giving up sponsorship of the Cato Institute.

Friday, October 19, 2007

State of West Virginia Faces a Hidden Highway Problem

My father was a registered professional civil engineer.  He built highways.  When I was learning the trade from him, I asked him for advice about a drainage culvert that was too small to handle the runoff from a storm.

His reply was logical and concise: "The pipe doesn't carry the water.  The hole does.  The pipe just keeps dirt from filling up the hole."

Since then, I have thought about pipes differently.

You probably don't think about roadway drainage, but for every mile of four-lane highway, there's a mile or so of drainage culverts.  Some are as small as 6 inches in diameter -- they drain underground springs or weeps.  Some are as large as 10 feet in diameter -- they allow streams and creeks to flow under highway fills.

The grassy median between divided highway lanes may look scenic to you as you drive.  But the median, with its buried culverts, exists mainly to drain surface water away from the roadway.

When I was a boy, almost all highway drainage culverts were made of reinforced concrete.  I grew up two miles from a concrete pipe plant.  That company's salesman was Earl Brane, a man who once worked for my grandfather as a highway superintendent. I assumed at the time that concrete pipe, and Earl Brane, would be around forever.  But I was disappointed on both counts.

Concrete pipe has a life expectancy of 80 to 100 years.  But it is bulky, requires heavy lifting equipment to install it and it comes in short joints.  The cost of installing concrete pipe eventually led to it being replaced with steel culverts.  Steel is lighter and comes in more manageable sections.

But the tradeoff for steel was not based on comparing apples to apples.  Corrugated steel pipe has a predicted life of 50 years or less -- half that of concrete.

Steel begins to oxidize the moment it is buried.  The industry has used several types of coatings to minimize oxidation, but the laws of physics are what they are.  When you bury steel, you essentially build a battery.

Older steel drainage pipes were most often coated with asphalt.  Epoxy and plastic coatings also are used for certain applications.  Steel pipe also is galvanized or aluminized to slow the oxidation rate.  These various coatings push the life expectancy out to 50 years.

Steel also is attacked by other elements, rainwater being the most corrosive.  Rainfall in West Virginia is acidic on the order of tomato juice.

As water runs off the roadway, it picks up particles of sand and grit that scour culverts over time.  Salt may melt snow and ice in the winter, but the salty meltwater also corrodes steel pipe.

The effects of the elements are insidious.  And like termite damage, the corrosion goes unnoticed until the culvert fails.  The invert, or bottom of the culvert, rusts away first, and then the culvert collapses for lack of structural strength.

The hole that carried the water starts filling up with dirt and debris.

West Virginia's modern highways are approaching the ripe age of 50.  I-81 in the Eastern Panhandle, I-70 in the Northern Panhandle and I-64 between Huntington and Charleston are perhaps the oldest Interstate highway sections.  Then come I-77 and I-79 north of Charleston. 

The newest Interstate sections, the Turnpike and I-64 from Beckley east, are about 20 years old.  Much of the Appalachian system (U.S. 50, I-68, U.S. 460) is more than 30 years old.

In the not too distant future, the then-governor will be looking at a very expensive repair bill for culvert replacement.  And that governor's successors will find themselves facing the same problem.

When a bridge collapses, any governor worth his salt has one thing on his mind -- camera time.  When the replacement bridge is built, that same governor will show up at the opening with ribbons and scissors.  Let's face facts -- bridges make for glamorous photo-ops.

Future governors who cut ribbons at the dedication ceremonies for new culverts obviously will be challenged.  Past is prologue.  And highway engineers will tell you that West Virginians have elected governors who became terribly confused when asked to identify a hole in the ground.

But I digress.

Fifty years ago, steel culverts were chosen to save construction money.  However, replacing these penny-wise pipes will cost a small fortune.  The task ahead will give a whole new meaning to the worn-out phrase "rebuilding the infrastructure."

Friday, September 14, 2007

War On Poverty Gave Us Entitlements (2)

Part two of two parts.

Regardless of all the welfare programs that we have tried, we are no more advanced than the ancient societies that allowed the poor to glean the fields. Like the ancients, we spend on welfare what we feel we can afford at the time.

If our welfare programs had truly attacked the root causes of poverty, then we would have seen some results by now. Head Start schools would be consolidating due to a dearth of students. Child abuse would be fading from view.

But the truth is that Head Start still serves only a portion of the kids who desperately need that respite. And watch the news or read the statistics; child abuse, if not outright child torture, is still all too common in West Virginia.

Welfare spending has done a wonderful job of alleviating the state of being poor. The best example of this comes from elder care.

Millions of the elderly have been spared a life of destitution because of Social Security and Medicare. The social safety net for the aged is broad indeed. An old man may not live out his dying days in a suite at the Ritz, but he is assured a bed in a nursing home.

Unfortunately, this charitable solution is about to end. The aging baby boomers will bust the system.

Had Social Security been used only as a safety net, or had workers been required to save more for their own retirement, then Social Security would be solvent for another century. Instead, Social Security became an entitlement. Whatever surplus the plan ever had has been frittered away.

We no longer see poor people wearing rags. Clothing vouchers and thrift shops have given the poor a contemporary wardrobe that lets them blend in with the crowd.

We no longer see the starving poor. Food stamps have cured undernourishment. But the food stamp program is an entitlement, and the poor have learned nothing from it about nutrition or meal planning.

We have created a class of people, some of whom are third generation, who have mastered the welfare rules. Trust me: They know the eligibility rules better than their case workers.

Because liberals have always viewed poverty as a structural rather than a cultural problem, they desperately needed to develop a spending program that could mask, if not altogether remove, the stigma of poverty. They succeeded (mightily). But in doing so, they also created this class of welfare pros.

This is but a brief summary of forty years of welfare spending. In short, welfare spending has bought us much wallpaper and window dressing. The foundation of the house, however, is what we should have concentrated on.

There are causes of poverty that we will never eliminate. We will always have to take care of the mentally retarded, those with severe birth defects, and those afflicted by a debilitating illness or medical condition.

There are causes of poverty that we will exacerbate. To tease people with dreams of hitting the lottery is most irresponsible. Jack Whitaker won the Powerball jackpot. Ask him what his winning ticket was worth now that he’s spent the money.

We may never cure poverty. However, the day will come when we spend much less ameliorating it. Gone will be the clothing vouchers. Food stamps, the first of which were used to buy baked beans, will possibly return to that role. Gone will be the Social Security largesse. And then the raw images of gripping poverty will again appear in a popular magazine.

The United States is so wealthy now that we cannot image a return to our recent past. But it will happen. And when that day comes, let us hope that some social scientist bothered to save a 1961 dictionary so he can redefine poverty for that era.

In my old neighborhood, we had a running joke about Little Debbie cakes. The joke went like this: "Only people on food stamps buy Little Debbie cakes." To this day, I have never bought them.

Whenever I see a picture of Little Debbie, I remember that joke, and I also think of Marie Antoinette. Though neither of these females cured poverty, their respective cake recipes can teach us a valuable lesson: Timing is everything.

Friday, September 7, 2007

During Past Decades, Nation Has Redefined Poverty (1)

Definition of poverty

Poverty:  The state of being poor or without competent subsistence; need; penury.

Poor:  Lacking means of comfortable subsistence; indigent; needy.

Penury:  Extreme poverty or want.

Funk and Wagnalls, New College Standard Dictionary, 1961

-------------------------------------------------------

Part one of two parts.

In 1960, poverty in West Virginia meant something altogether different than it means today.

In his campaign for the presidency, U. S. Senator John F. Kennedy cast the national spotlight on poverty in our state.  West Virginians warmed to him (and to his pledge to end Appalachian poverty), and we handed him the nomination with our primary vote.  Then came a photo essay about West Virginia’s poverty in the Saturday Evening Post.  The photos shocked the nation.

Whether poverty was the topic of political oratory or sensationalism in the coffee-table magazine graced by Norman Rockwell’s idyllic covers, poverty was a word and an image to be feared.

I looked up "poverty" in my 1961 dictionary and discovered that the word had a much more severe meaning than it does today.  Poverty is now defined by Merriam-Webster dictionary as "the state of one who lacks a usual or socially acceptable amount of money or material possessions."  Poverty, a lifestyle that not so long ago "gripped" its victims, is now an arbitrary measure of spending money.

Daniel Patrick Moynihan served as advisor to President Lyndon B. Johnson in 1965, and he made quite a name for himself when he argued that curing poverty was not a function of spending.  Rather, he argued, poverty was a social problem aggravated by broken familes, a lack of education, and so on.  His analysis infuriated liberals; they had already concluded that monetary benefits would cure poverty.  The only question in their minds for fighting LBJ’s War on Poverty was "How much do we need to spend?"

For the next three decades, the government spent more and more.  Uncle Sam even paid single women to have more children out of wedlock.  Then in 1996, Congressional politics changed, and welfare programs, such as Aid to Families with Dependent Children, were either terminated or radically modified.

In an interesting footnote to the 1996 welfare debate, Mr. Moynihan (then the senior U. S. senator from New York) argued loudly that cutting welfare spending would create chaos.  In his book, Miles To Go, Sen. Moynihan railed that "the national commitment to dependent children'' would be ''eagerly abandoned'' by what he called "welfare repeal."

The boy genius who understood so well the root causes of poverty in 1965 ended his Senate career as a partisan-a liberal general still fighting the last war, a war over spending levels.

Eric Blair, the British author known to us as George Orwell, hoped to learn what it meant to be poor during the years that he experimented with socialism.  In Down and Out in Paris and London, Orwell recounts his life in Paris as a restaurant dishwasher trying to survive on less than a livable wage.  He lived among other poor kitchen workers and waiters. 

Orwell certainly lived in poverty.  At one point he sold his clothes for two hundred francs.  He also skipped out of his boarding house owing rent.  And there were times when he could not afford even bread. 

Parisian bakers sold their loaves whole and charged one franc each.  From this formula, they would not budge.  Orwell could not understand why the baker would not sell him part of a loaf for eighty centimes, all the money that he had to his name in one of his telling chapters.

His comrades, the waiters, for the most part had never known anything but poverty.  When they had less than one franc, they did not eat.  Nor did they trouble themselves with trying to understand the baker’s one-franc rule.  But when the waiters got an unexpected big tip, they splurged.  They bought good wine and fine pastries.  They sated themselves rather than save for hard times.

You have lived Orwell’s scene.  You have passed up Delmonico steaks and instead opted for the meat loaf mix because of your budget.  But when you checked out, the shopper in front of you paid with food stamps.  And topmost on her grocery cart was the shrimp cocktail platter.  Then you realized it was the first of the month.

Whether by Orwell’s observation or your own, you can see that the cause of poverty is better defined in terms of behaviors rather than by levels of disposable income. 

Compared to King Midas, we are all paupers.  In that sense, our poverty can be lessened by his charity.  But to cure the roots of poverty, charity alone has little effect.

In Part Two, I will discuss the future of welfare now that society has accepted poverty as an income problem.