Grassroot Perspective – March 26, 2003-Tide of Red Ink; Freedom or Free Socks?; Cool Criminals; Drugged Out; Revolution Needed to Save Our Long-term Care System from Collapse

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“Dick Rowland Image”

”Shoots (News, Views and Quotes)”


– Tide of Red Ink

States across the country are entering the silly season of budget
gamesmanship. If they have huge deficits, they’re automatically planning
huge tax hikes. The spending binges of the 1990s are but a memory now,
but sooner or later lawmakers will have to admit they went a little
crazy. You’d think.

The handful of states that didn’t take the revenue windfalls of the ’90s
and promptly shovel them out the door do not have budget woes now. No
surprise there. Slow and steady Wyoming, without a personal income tax
to capture capital gains from a booming stock market, never got around
to expanding its budget by double digits every year. Hence, it is still
in the black.

Wyoming does get revenue from its sizable mineral resources, something
not every state can do. Even so, other states with mineral resources
also find themselves in a mess. Residents of Nevada just had their
governor propose a $1.1 billion tax hike. The new revenue would come
from increased sin taxes, higher property taxes, and a kind of
state-wide value-added tax on business income. Hefty and unsustainable
wage promises to public sector workers have helped put the state in the
red, a common theme in state capitals this season.

Once again, California leads the pack in how not to do things. The
state, which faces a $26 billion shortfall, is just now starting to
rethink some $8 billion in special tax breaks and credits created over
the last decade. Adopted as part of push to make California
“competitive” with other states — i.e., to bribe companies not to leave
— the breaks are an early warning sign of failure.

The best taxes, in terms of both fairness and predictability, are low
and universal instead of high and selective.


– Freedom or Free Socks?

What price liberty? New tube socks? It is a start. Recognition that the
multiple levels of security (also known as “hoops”) one must traverse to
get on an airplane really are a big pain might get us back to the day
when passengers are viewed as paying customers first and potential
terrorists second.

The Tri-Cities Regional Airport in Blountville, Tennessee, is giving
away free socks to passengers whose shoes are inspected by airport
security. The idea is to show that the whole shoes-off routine is at the
very least inconvenient, if not embarrassing.

The socks are locally made and come with a gift box. No word if they
come with note, “Sorry. What with shoe-bombers and all. Your friends at
the Transportation Security Administration.”

Perhaps we’ll see more airports adopt this clothing-for-dignity
approach, with variations based on the level of inspection. For the
popular belt-buckle turnout and inspection, how about new underwear —
flyers’ choice, boxers or briefs. For a full-body wanding, which always
draws gawks and whispers, a nice reverse-weave sweatshirt is in order.
The gift shops have plenty.

For a more ominous experience — the utterly random yank out of the
line, followed by a total suitcase toss and El Al-style destination
interrogation — we’ll get one of those snazzy, shiny track suits.
They’re great for travel anyway, and a couple of sizes fit just about
anyone. TSA could even stick their logo on them for some free PR.

Democracy is all about compromise.


– Cool Criminals

The U.S. banned freon in 1996. Mexico didn’t. Americans still want freon
for their air conditioners. Mexicans are happy to sell it to them.
Presto, an illegal freon trade is thriving.


– Drugged Out

That noted pro-drug outfit, the White House’s Office of Management and
Budget, observes that the Drug Enforcement Administration “is unable to
demonstrate progress in reducing the availability of illegal drugs in
the United States.” OMB also found that the DEA lacks sufficient
budgetary controls and that its managers are not held responsible when
they fail to fix problems.


”Roots (Food for Thought)”

– Revolution Needed to Save Our Long-term Care System from Collapse

By Jerry Reilly, Public Policy Consultant Former state Medicaid director in
New Jersey and Washington Past executive director Washington Health Care

It is time for a revolution if we are to save our long-term care system.
We must take strong and dramatic action to reform the way long-term care
services are financed in this country, and in each state.

Without such change, we are already on the verge of the collapse of our
long-term care system. When we start to experience the elder population
wave anticipated over the next 20 years or so, the crisis will be

But the truth is simply coming up with a new approach is not enough. We
cannot count on elected officials to take an idea – no matter how good –
and implement it.

The only way anything will change is if we take action ourselves.

We must develop our own specific proposal . . . get it introduced as
legislation . . . guide it through the legislative process . . .
generate public awareness and influence public opinion . . . and
persuade lawmakers to adopt the reforms we propose.

That’s the revolution that is desperately needed. And we must be the
ones to make it happen.

Throughout my long career dealing with long-term care and government
medical assistance programs, we have seen the treadmill of increased
reliance upon diminishing public financing take the long-term care
system to the brink of collapse.

The government can no longer pay adequate reimbursement rates. Providers
can no longer meet regulatory or consumer expectations. Access to
services and the quality of care are increasingly jeopardized. Our
publicly-financed long-term care system is faltering, but few Americans
have prepared by saving or insuring to pay privately for their own
long-term care needs.

Fortunately, there is another path we can take. But, it won’t happen
unless we take action and stop waiting for government to solve the

Instead of the bleak picture we see today, imagine a long-term care
system in which one-third of the participants are supported by Medicaid,
one-third are paying their own way through guaranteed loans secured by
their estates, and one-third are supported by insurance payments from
policies which they had the foresight and incentive to purchase.

This is the future that will flow from the ideas offered by the Center
for Long-term Care Financing for a restructuring of the financial
foundation of long-term care. (For a detailed description and analysis
of the long-term care problem and the “LTC Choice” solution, visit .)

It is a future based upon the original premise that Medicaid needs to be
a program for the genuinely indigent. The rest of us should be expected
to pay our own way by means of insurance coverage or use of our personal

Most recognize that Medicaid has become the de facto, taxpayer-financed,
social insurance system for the large majority of people receiving
residential long-term care services, especially in nursing homes. Many
recognize that growth of a private insurance market to cover long-term
care risk has been very slow partly because of competition from an
essentially “free” public program, which despite continuing attempts to
tighten eligibility, makes it possible for almost anyone to gain entry.

I have been frustrated by the apparent lack of interest or political
will to take up the powerful ideas embodied in the “Long-Term Care
Choice” program advocated by the Center. One of the key factors in this
lack of progress is that there has been no focused public policy
campaign, at the grassroots political level, to implement the vision of
“LTC Choice” in any state.

With the long-term care crisis growing worse day by day, we can no
longer sit by and wait for somebody else to start the revolution.

That’s why we are organizing a Coalition to Reform Long-Term Care
Finance. The Coalition will campaign to enact the concepts of “LTC
Choice” in Washington state. Once this campaign gains momentum in
Washington, we expect it to generate substantial interest in other
states facing the same issues. Our objective is to establish model
legislation and a campaign framework in Washington that can translate
into success throughout the country.

Washington is identified as the initial target because the state
currently faces a $2 billion shortfall in building its state budget for
the next two years. The state now finances the cost of care for about
12,000 nursing home patients and about 3,000 assisted living residents
through its existing Medicaid program. All of this costs about $1
billion each biennium, with the federal government providing roughly
half of the funds. In addition to the magnitude of the state’s budget
crisis, Washington is a logical target because it has created a Medicaid
system that is more generous than most. This combination has made the
fiscal burden of Medicaid greater than in most other states.

In short, legislators in Washington are facing an especially difficult
budget situation and view Medicaid, including long-term care, as a
particular problem area. This should make lawmakers in Washington very
open to reform proposals.

If the elements of the “LTC Choice” program were now in effect, it is
likely that between 30 and 50 percent of the Medicaid-supported
long-term care recipients would be financed privately. This would reduce
total public expenditures for long-term care in Washington by up to $500
million per biennium.

Clearly, the kind of restructuring required could not be completed in a
single two-year period. However, the financial problems faced by
Washington, as well as most other states, will exist for the foreseeable
future and substantial long-term reductions in public funding can be
achieved in a relatively short time — but only if we begin the
transition as soon as possible.

Because of this stark budget situation, Washington, and other states as
well, may now be ready to look at the ideas contained in the “LTC
Choice” proposal.

Yet it will only happen if we succeed in putting together a broad
coalition of people who care about improving long-term care financing
and long-term care services.

Implementation of the “LTC Choice” program as our “future” will have
many benefits.

Long-term care consumers will have more choices and better access to the
services they want as more of them enter the market as private buyers.

Long-term care insurers will find a much larger market for their

Long-term care providers will see their costs met and be able to meet
changing consumer preferences in a market that is two-thirds private.

State budget writers will experience a significant drop in demand for
scarce public resources.

Medicaid-sponsored residents will receive better care because government
payers will be able to pay on a more adequate basis since they will
responsible for fewer eligible people.

Long-term caregivers and other employees will benefit by higher wages
that providers will be able to pay as they become less dependent on
public funds.

Recipients, providers and caregivers will all benefit from enhanced
quality of care when greater reliance on private financing provides the
resources necessary to improve staffing.

Taxpayers will benefit because they will no longer be required to
subsidize the care for people who can afford to pay their own way.

No matter how reasonable, rational and beneficial “Choice” reforms may
be . . . the only way anything will change is if we decide to take
action and create our own revolution.

We are striving to create a coalition that will take specific action to
wage and win this fight:

Preparing a legislative proposal for introduction in the Washington
Legislature during the 2003 session.
Lobbying this measure, seeking hearings and encouraging action in 2003,
if possible . . . laying the groundwork to win passage over the next few
years, if necessary.

Planning and implementing a media relations campaign to increase public
awareness and generate support for the “choice” approach.
Developing a grassroots campaign of LTC stakeholders to persuade
legislators and the governor to support long-term care finance reforms.
Using this proposal as “model legislation” that can be shared with other
state Legislatures and promoted through national organizations, such as
the National Conference of State Legislatures and the American
Legislative Exchange Council.

If you are willing to participate in this coalition, please contact me
(e-mail would be best at or phone at 360-561-4212).

Above article is quoted from Center for Long Term Care Financing, LTC
Bullets November 8, 2003

”Evergreen (Today’s Quote)”

“If going upward and reaching for excellence is where success gets
tricky, going onward by putting yourself second and others first is
where success really gets tough. Most books on success tell you that you
have really ‘arrive’ when you win the race. That’s wrong. Truly
successful people are the ones who help others cross the finish line.”
— Dave Thomas

”’Edited by Richard O. Rowland, president of Grassroot Institute of Hawaii. He can be reached at (808) 487-4959 or by email at:”’ ”’For more information, see its Web site at:”’