Denied!

Posted on by John Payne

Supporters of increased government involvement in health care — such as Michael Moore, as seen in his film Sicko — are always keen to show private insurers denying legitimate claims for medical care. That does happen, but it’s less than half the story. As Mary Theroux at the Independent Institute points out, Medicare denies claims at a far higher rate than private insurers:

According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%

In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims—a big improvement, but outpaced better still by the private insurers. The prior year’s high private denier, Aetna, reduced denials to 1.81%—an astounding 75% improvement—with similar declines by all other private insurers, to average only 2.79%.

Maybe there’s something to be said for the need to keep your customers satisfied in order to make that profit after all.

And not only is Medicare more likely to deny claims, it is also driving up health care costs for everyone. Our August policy study on health insurance reform shows that Medicare and other government health care expenditures drive a wedge between consumers and producers that fuels price inflation.

Government interference in health care markets only gives Missourians higher costs while leading to coverage of fewer claims. Effective health care reform must go in the direction of markets, but now that the Senate seems set to vote for cloture on the health care bill, that seems very unlikely in the near future.

Paid Internship Opportunity for the Summer!

Posted on by Caitlin Hartsell

Last summer, I had the privilege of being a Koch Summer Fellow for the Show-Me Institute. It was a terrific experience, and I recommend it to anybody who is interested in public policy and liberty. The Charles G. Koch Summer Fellow Program flew me (and the other 81 fellows) to Washington, D.C., for a week at the beginning and end of the summer, where we listened to lectures about liberty, participated in career workshops, made group policy presentations, and had an overall good time.

For the other eight weeks of the program, I interned at at the Show-Me Institute in St. Louis. As a state-based organization, the Show-Me Institute gave me more opportunities to research and write about policy issues than I would have had at a larger national organization. There were also weekly deadlines for the KSFP program, writing op-eds and letters to the editor, and watching online lectures.

And why should you care about my summer internship experience?

The Koch Summer Fellowship Program (run through the Institute for Humane Studies) is accepting applicants for next summer! Any college or graduate student interested in free-market public policy (whether at the federal or state level) should apply. (Make sure to specify the Show-Me Institute as a preferred destination on your application!)

This 2010 program lasts from June 5, 2010, to August 13, 2010. As a state-based fellow, you receive:

  • A $1,500 stipend for the duration of the fellowship

  • Travel allowance to and from D.C. (for both of the week-long seminars)

  • Housing allowance

    • The deadline for applications is January 31, 2010, and admissions are rolling. APPLY TODAY!

    Missouri Would Be a Good Home for a Charter School Incubator

    Posted on by Sarah Brodsky

    Nashville’s mayor has announced the creation of a charter school incubator to train principals. The center will start out as a nonprofit financed by private donations.

    Supporters hope the incubator will teach school leaders about the features of successful charters:

    Ideas about common traits shared by good charter schools — longer school days, a strong school culture — have become important training tools as the number of schools expands.

    Missouri, with two cities among the top 10 list of cities with highest charter school market share, is home to several charters that principals in training could learn from. Either St. Louis or Kansas City would afford ample opportunities for incubator participants, and would be a good site for an incubator like Nashville’s.

    The diversity of Missouri’s charters could make this an especially attractive place to start an incubator. Future principals who want to learn about charter schools in general, rather than one particular “brand” of charter, would be able to study a wide range of schools. Charters here are a mix of elementary schools, middle schools, and high schools, so participants could observe charter classrooms at any grade level. And the Missouri charter market is not dominated by any particular chain of charters. Some charters belong to national chains and some belong to groups of affiliated schools, but there are also charters that stand alone. And still other charters combine common elements with a unique focus; one such charter that comes to mind is City Garden Montessori. This school employs the same educational approach as other Montessori charters, while concentrating on a small geographic area — which most charters don’t do.

    If a charter school incubator is established in Missouri, I’m sure its proximity to a variety of excellent charters would be a key selling point. But Missouri’s less-successful charters might be instructive examples for participants, too. If a future principal who wanted to study charters came into a market where every charter was applauded, he might conclude that running a charter is always easy and glamorous. He would be in for a rude surprise if, once he had his own charter to manage, he encountered challenges or didn’t see drastic improvements in student achievement.

    Missouri is already in a good position to welcome a charter school incubator, and a few improvements would make it the perfect choice. To be an even more favorable site for an incubator, Missouri could expand charter schooling in these areas:

    • Online charter schools. These would be essential in training anyone who intends to work for a virtual charter, of course. And future principals of brick-and-mortar schools could look to virtual schools for ideas about incorporating technology into the curriculum. They also might want to familiarize themselves with online education in case they eventually decide to expand their schools’ enrollment beyond the classroom walls, like these private schools did.

    • Single-sex charter schools. There are single-sex classrooms within charter schools in Missouri, but no all-girls’ or all-boys’ schools. Single-sex charters are growing more popular in larger markets like New York, and although Missouri probably couldn’t support a dozen of these schools, opening one or two would keep the state on the cutting edge of charter education.

    • Rural and suburban charter schools. Missouri law confines charters to Kansas City and St. Louis. As charters crop up in other states’ suburbs, and as rural districts convert to charters to attract students, educators may expect to find these kinds of schools in a well-rounded market.

    State School Board Votes to Close Wellston

    Posted on by Sarah Brodsky

    The Missouri State School Board voted today to close the Wellston School District. Wellston students will be Normandy students after this school year.

    Normandy is only provisionally accredited; its student MAP scores are better than Wellston’s, but not by much. Normandy has shown admirable willingness to accept new students; however, it hasn’t demonstrated that it can provide a significantly better education than Wellston did.

    If Wellston students were given a choice, some might wish to attend Normandy, and others would probably prefer other schools. It’s too bad that the board assigned everyone to a single district and did not allow the students and their families to make the decision.

    Wellston students are left with one option besides Normandy: They can attend the St. Louis Public Schools’ Virtual School.

    Mayor Slay Overestimates Economic Impact of Up in the Air

    Posted on by Christine Harbin

    In this KMOX article from yesterday, Saint Louis Mayor Francis Slay comments about Missouri’s film tax credit program:

    They (filmmakers) spent a lot of money, had about a $50-$60 million dollar economic impact on the St. Louis area.

    Hold on — $50–$60 million? Where is he getting this figure? Allow me to crunch some numbers and demonstrate that an impact of this magnitude is unrealistic.

    In the comment section of my recent post about film tax credits in Missouri, Econdiva provided an estimate that the producers of Up in the Air spent “just shy of $12 million” in the state. I will grant her estimate for the sake of argument, because she worked on the film and is more likely to know this information.

    For an economic multiplier, I’ll reference a fiscal note from Louisiana regarding the estimated economic and fiscal impacts of film and video tax incentives (emphasis added):

    [T]he current statewide economic multipliers, supplied by the Bureau of Economic Analysis of the U.S. Department of Commerce, for the motion picture and sound recording industries estimate that each dollar of expenditures in those industries generates about 40¢ of earnings throughout the entire economy (a final demand earnings multiplier of 0.3982).

    Using this figure, an expenditure of $12 million for Up in the Air would generate only $4.8 million for Missouri’s economy.

    Even if Mayor Slay used the January 2009 prediction of $30 million in the Saint Louis Business Journal, the amount generated for the state’s economy would only be $12 million.

    Both numbers fall pretty far short of $50–$60 million. This is just wishful thinking.

    Healthy Schools in Missouri and D.C.

    Posted on by Sarah Brodsky

    There’s a bill before the D.C. Council that’s even worse than this one that was proposed during Missouri’s past legislative session. The D.C. bill would mandate 30 or 45 minutes of physical education per day, depending on grade level, and would order schools to buy “minimally-processed” food from local farmers. It would also establish a program to oversee and expand school gardens.

    The Missouri bill was rife with nitty-gritty exercise and food regulations, too, but in some ways it wasn’t so bad. It was aimed solely at public school districts, whereas the D.C. bill would burden both districts and charter schools with new rules. And I can say this for the Missouri bill’s litany of caloric requirements: It stayed on the topic of student nutrition without straying off toward fads like school gardens and local food.

    The sponsoring D.C. Council member takes a different point of view; she says that the local food her bill is preoccupied with should really be the bread and butter of the school day:

    “You don’t work on math scores and say the heck with nutrition,” she said. “It’s not that these are fluff ideas. I don’t see this as something subordinate.”

    It’s another case of a policymaker mistakenly assuming that local food and healthy food are one and the same. If a school says “no thanks” to local food preferences, that’s different from saying “to heck with nutrition.” It just means the school is open to buying nutritious food from wherever it’s grown.

    Filling the Cavities in Missouri’s Dental Care

    Posted on by Caitlin Hartsell

    [Author’s Note: I incorrectly reported that the agreement with the ADA ended Alaska’s program; it is, in fact, still thriving, and the second class graduated this past week. Thanks to Fiona Brosnan of the ANTHC for this correction. — Caitlin Hartsell]

    Oral health is a huge public health issue in Missouri: The state is 47th in the nation for the percentage of the population that visited a dentist last year. The St. Louis Post-Dispatch recently ran an article highlighting the lack of dentists in rural Missouri and its effect upon dental health.

    Alaska had a similar dental problem in the tribal areas, which had the worst rates of oral health in the country. Alaskan dental therapists — trained to do most basic dental work, except for oral surgery — became a much-needed solution to the problem. The New York Times ran a story last year about that program:

    After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities. Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. Johnson’s.

    The American Dental Association (ADA) sued the Alaskan Native Tribal Health Consortium (ANTHC), and they ultimately reached an agreement that essentially ended the program. The ADA argued that dental therapists cannot adequately provide health care. Some groups have argued that there are too many dentists already; this site features a quote from a dentist in Missouri who argues that a dentist is at most an hour from all rural areas.

    But, if dentists are so accessible, why are Missouri’s oral health outcomes so low? Cost and access are both issues; even if a person can get to a dentist, they may deem dental services to be too expensive when money is tight. Dental therapists, because they need only two years of training rather than four post-college, are able to provide comparable care at a more affordable rate. Anyone who needs more than basic drilling and cleaning can then be referred to a professional dentist.

    Dental therapists have been successful in England, Canada, and Australia at providing quality dental care. Dental therapists in Australia are proving their worth beyond just basic oral health care. A recent study found that 95 percent of restorations done by dental therapists were successful, and patients were satisfied.

    Dental therapists provide more than just quality, affordable health care. They also provide jobs, especially in depressed economies in rural areas that have trouble attracting professional dentists on a permanent basis. Unemployment in Missouri, while lower than the national average, is still higher than 9 percent. A change in the law would benefit both those newly employed therapists and their patients, who would have significantly better access to dental care.

    The health care reform debate has focused primarily on health insurance. The majority of people who have health insurance, though, still do not have dental coverage. The best way to improve the dental health of Missourians is to lower the cost in order to improve access. Dental therapists provide an economical way to combat tooth decay, and plans to implement training programs in the United States have already been suggested. The only obstacle to their introduction in Missouri — and to subsequent improvement in the oral health of Missourians — is the regulatory barrier of professional licensing.

    Obstructing the Will of the People

    Posted on by Dave Roland

    Here at Show-Me Daily, we have long documented the efforts of the Missouri Municipal League to prevent this state’s citizens from voting on constitutional amendments that would severely limit abuses of eminent domain in this state. For years now, the league (its leadership is made up of elected officials from across the state) has successfully persuaded cities to use your taxpayer dollars in order to help support their effort. Part of that effort has included litigation that the filers claimed to be an attempt to get a “fair” ballot title — but, in reality, it was intended to keep the measure off the ballot entirely by so delaying the signature-gathering process that it would be impossible to collect the necessary number within the limited time available.

    Up until a few weeks ago, advocates of eminent domain reform had no real proof that the Municipal League’s lawsuits had this suspected insidious purpose. On Nov. 20, however, at a meeting of the Missouri Bar Association’s Eminent Domain Committee, a managing partner in the law firm representing the Municipal League was asked to give an update on the litigation. She had this to say (audio transcript; emphasis added):

    It’s not a real big update, but … um … from the standpoint of the initiative petition, uh, we did partially win, uh, in the … at the trial court level, and it’s on expedited appeal for the western district, um, which will be argued in December, with the main objective being to delay the gathering of signatures and, um, hopefully we’re … we’re accomplishing that.

    Missouri Citizens for Property rights, the group spearheading the petition effort, has asked the court for permission to supplement the record with the audio evidence of the attorney’s statement, and should hear today whether the court will agree. If the court chooses to take her statement seriously, it could assign sanctions against her firm for violating the ethical rules (yes, attorneys are supposed to understand ethics) governing the legal profession.

    The story has started to gain interest nationwide — as it should. It is yet another example of powerful people trying to prevent ordinary citizens from having their own say on important issues. The AP article has so far been run by media outlets in Atlanta, Phoenix, Washington, D.C., Seattle, Miami, Philadelphia, Minneapolis, and Dayton, Ohio. Here in Missouri, the story has been reported in Kansas City, Springfield, Columbia, Jefferson City, Joplin, Cape Girardeau, and St. Louis — although it is interesting to note that the Ost-Pay Ispatch-Day, for some reason, has not yet covered this story.

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