Health reform taking root

Forget repeal. Health reform is taking root in Colorado and forcing doctors and insurers to face the facts of their new existence. 

Take, for example, the complaint of nurse practitioner Mary Lou Hendrix in yesterday's Denver Post. In a story by Nancy Lofholm, Hendrix described the difficulties she has encountered trying to be "credentialed" by health insurers whose pregnant customers want to use Hendrix's skills without her being supervised by a doctor.

"Credentialed" means the insurer agrees to pay Hendrix for her services when their customers make a claim through her for payment. According to Lofholm, a 2008 state law allows Hendrix to operate without supervision, at the same rates as physicians. After working for doctors for years,  Hendrix opened her own practice last spring.

In late September, Gov. Bill Ritter officially notified Medicare that Colorado is opting out of a federal rule that nurse anesthetists also must be supervised by a doctor, a full-fledged anesthesiologist. The next day, the Colorado Society of Anesthesiologists and the Colorado Medical Society, representing doctors, sued the state to block Ritter's decision. The lawsuit is pending.

Both developments reflect progress and resistance toward enactment of health reform meant to improve the lives of Coloradans. Nurse practitioners and nurse anesthetists can make competent health care available to more people across the state, expanding the market for their services and providing a measure of competition to doctors. Perhaps even driving down some prices.

For nurse anesthetists, the argument for their not needing a doctor's supervision is more than two decades old. I dated a nurse anesthetist in Texas, before coming to Colorado, who had to leave Austin for Idaho in order to practice her skill in a market unfettered by rules protecting the livelihood and wealth of doctors.

But when Ritter opted Colorado out of the Medicare rule this year, only 15 other states had done the same, showing how long it takes some reforms to take root. Hendrix's continuing problems with insurers illustrates the same slow creep of progress.

Following Ritter's decision and the filing of the lawsuit, the Colorado Society of Anesthesiologists posted on its website a call for members to register their displeasure with Ritter by calling or e-mailing his office. Lorez Meinhold said the office has received one complaint since the Sept. 28 announcement; that e-mail came in on Nov. 1. 

Health care in these United States can hardly be called a revolution, despite the Tea Party's Revolutionary War custumes during the last election campaign. Evolution occurs with each dying dinosaur's extinction. One day in Colorado, the evolution of a 21st century health-care system will be complete.

In the Chemo Room: I'm back ... !

Yes, I'm back in the Chemo Room, just as my oncologist suspected I would be, and I had hoped I would not.

But the only way to keep cancer from killing you is to keep fighting it.

So I am back in the Chemo Room fighting my cancer with the same two chemicals that got a "profound"  response from my body during my last round of chemo: Erbitux, that expensive cell-starving biologic, and Ironotecan, a cell-killing juice you really don't want to try.

My latest treatment was last week on Thursday, and I spent most of Friday and part of Saturday and Sunday trying to get over the hump of it. Sunday's Broncos' thumping of Kansas City helped.

I feel better now, so I'm back at my computer to tell you again about where I've been in my fight against this disease.

Before the latest treatment, I was telling people I felt I had come back to nearly 100 percent of my work energy before ever being diagnosed. That was the result of a seven-month break from the chemicals: my hair grew back; the neuropathy in my hands, feet and legs continued to dissipate, making me feel like my nerves were growing back; I was writing and posting these blogs (about other subjects) more frequently, writing on http://www.examiner.com/ about Colorado poetry more often, finishing my book about Denver oil man Timothy Marquez, and even writing about other literary topics on my poetry website, http://www.robertschwabpoet.com/.

I also underwent six weeks of radiation therapy trying to kill the one cancer-cell production center -- a lymph gland in my chest -- spotted in the March 17, 2010 pet scan I received following the end of the first Erbitux round of chemo.

The side effects of that treatment were minimal except for the fact that Anthem Blue Cross Blue Shield initially denied paying for the treatment and sent me a statement indicating a debt of more than $70,000. I believe that claim is now being worked out. When you don't make much money, you have to treat such claims casually and just seek to have them resolved between your doctors, the hospital and your insurer.

Five-year survival rates for colo-rectal cancer starting with a tumor in the rectum are about 59 percent, according to a 2006 post on About.com.

My doctor, Thomas Kenney, believes my cancer had already metastasized to my lung before the September 2007 surgery to remove my tumor, so my odds of living with the disease for five years probably have been considerably lower, but my luck on the Erbitux and Irinotecan gives me a chance to boost my odds of survival even past the five-year mark.

I was taking flax-seed oil during the whole last round, and I believe (with no proof) it might have helped me, too, since long-ago research that was ignored by the medical community claimed flax oil acted as an anti-cancer agent. The latest anti-cancer agent to acquire blooming Internet demand is something called Lypo-Spheric Vicamin C, but you won't find many doctors swearing by it (again no proof).

My docs don't like me taking extra Vitamin C because they claim it interferes with the chemo. Kenney has told me to investigate my own alternative treatments to the cancer, and during the seven months I have been off his chemicals I have found that diet is probably the most logical alternative or supplemental treatment besides flax that I might undetake.

That's a difficult choice. You pretty much have to stop eating red meat, and if you don't eat vegetables raw, you should cook them from a raw state to have the most impact. The idea is the foods naturally boost your immune system, and your immune system is the best cancer-fighting agent there is. Chemo essentially destroys your immune system.

But with a new Whole Foods store and a Vitamin Cottage nearby, I might just give the food route a try. Many of you who know me well, know that I have never lost my appetite during this fight. Not for the fight, nor for a good dinner, cocktail and dessert on most evenings.    

Fees Colorado Republicans won't oppose

The most interesting story in Sunday's Denver Post was given banner (top-headline), front-page treatment and it concerned the real attack against the middle class: increased prices charged by utilities and other public agencies that provide necessary services to the rich, the poor, and the middle class.

These are price leaders -- for water, sewage, electricity, public transportation, telephone, postage, and you could even include Internet connections -- that drive up costs for small businesses, drive down consumer spending on products and services that small businesses provide, drive up shipping costs for both employers and all consumers who still use the mails, and the cost of holding a job (by adding to the cost of getting to work) or sending your kid to school (also because of higher fuel costs).

The Post's Colleen O'Connor quoted Ethan Pollack, from the nonpartisan Economic Policy Institute, who said such price increases act the same as taxes on the middle class and the poor, holding back both consumer spending and economic recovery.

Yet you won't hear Republicans, Tea Party activists, the business community including some Democrats, even Tom Tancredo or John Andrews going after these price hikes like they rail against taxes.

These price hikes have the cover of supposed good business practice. They may drive more people into poverty, but the authors of such cost-of-living increases bear no responsibility to the public. You could say they are the inevitable result of free markets and unrestrained capitalism.

Or you could hold their authors accountable. Admit such business practice is just as accountable for the destruction of the middle class as Wall Street shenanagans, the marginalizing of labor unions and outsourcing. 

That's my kind of accountability. Happy Monday!

Post-election: Optimism vs. cynicism

Following all the hoopla of the campaign, the vote on Election Day and the delayed declarations of winners in Colorado and elsewhere, perhaps a new bipartisan spirit is abroad in the land, despite Mitch McConnell.

God knows we need some, even if McConnell doesn't seem to get it.

Republicans across the land staged a comeback in Congress, but the wave splashed pretty harmlessly across Colorado. Michael Bennet beat Ken Buck and will take his business-friendly Democratic philosophy back to the state's junior Senate seat for the next six years.

Gov. Hick promises a new attitude from a different Democratic administration at the statehouse.

A one-vote majority of Republicans in the state House isn't promising to restore all the business tax exemptions Gov. Ritter took from them in 2010, but Hickenlooper is willing, like Obama, to give a listen.

The Denver mayor also is probably smart enough to try to restore a state helping hand to the natural-gas industry to get it off Colorado government's back. Gas is a clean fuel after all; and although it's available enmasse all over the country right now (keeping its price low), perhaps incenting local drilling to serve local natural-gas powered electric plants will actually revive Colorado's gas-producers.

Hick's probably smart enough to ensure a continued coal-producing industry as well. Our coal is cleaner-burning than most coal dug farther east, and there will be no wholesale conversion of old plants across the Mississippi, so despite transportation costs, that market will remain available to Colorado for years to come.

Perhaps, just perhaps, our new governor also will be smart enough to get the railroads to join a venture to improve transportation lanes in and out of the state, reducing shipping costs for coal and other products made here. There's lots a smart governor can do.  

And there's certainly lots to do. On the Sunday before the election, the Metro Denver Economic Development Corp., which is the jobs-recruiting arm of the local Chamber of Commerce, weighed in on the challenges Hickenlooper will face as the new governor.

In the metro chamber's 2010 study, "Toward a More Competitive Colorado," education funding, multimodal transportation and health care for all Coloradans are cited as eroding pillars of the state's economy that must be fixed NOW!

Colorado labor has already been whipped into shape by Ritter to not expect much from a state leadership that is required to appease every whine that emanates from the business community.

And what labor really wants most right now is a job -- almost on any terms.

So what's left to be cynical about?

Only, perhaps, that even Republican victories, a restoration of balance to our legislatures both in Washingon and Denver, will not be able to insure that our political machinery is now well-oiled enough to actually produce something for its people.

Gridlock still threatens, and only politicians with "the People" truly in their hearts will make things happen in this the greatest democracy, the greatest model of capitalism, on the planet.

First, inspired business performance; then, Obama fires up Dems for Bennet

Tom Mauro's big splash for Colorado Performance Excellence is next week. He hands out 2010 Timberline Awards to Elevations Credit Union in Boulder and the VA Health Administration Center, Denver, for continous performance improvement in 2010.

Also four Foothills-level awards for beginners in the CPEx program to AlloSource in Centennial, Avista Adventist Hospital in Louisville, the Poudre Fire Authority in Fort Collins, and the S.M. Stoller Legacy Management Program in Broomfield.

The awards mark the work done by participants in the statewide CPEx program which uses Baldrige National Quality Award criteria to improve business performance of an organization.

The all-day program at the Marriott South at Park Meadows, just west of Interstate 25 and Lincoln Avenue in South metro Denver, costs $275 per person for attendees from profit-making firms, and $250 per person for nonprofits. The speeches and seminar tracks explain how Baldrige criteria measure business excellence  and improvement.

Mauro's organziation has been spending the year trying to develop ways for more Colorado small businesses to become a part of the Baldrige Quality Award competition. He will announce the results of that effort during this ninth annual CPEx Quest for Excellence event.

*** 

President Barack Obama fired up Sen. Michael Bennet's troops in a telephone town hall Thursday night, telling Bennet volunteers: "There couldn't be a better cause right now because obviously this is a tough election.

"We've got a lot of headwinds ... the economy is still tough in Colorado and around the country.... We inherited, both Michael and me, the worst economic crisis since the Great Depression.

But working together, you know we have been able to stop the size of job losses, stabilize the economy, get small bsuiness its financing, get our economy growing again.

"And Michael has been a critical part of that work in the Senate each and every day.!"

I was invited to listen because I contributed a small amount to Bennet's campaign. It was fascinating hearing the president of the United States speak over the phone. And Obama spoke with the same cadence and pronunciation that are mimicked so well on Saturday Night Live each week. You had to laugh.

Of course, you could push a button on your phone to volunteer your own boots on the ground during these last few days of Bennet's close race. I pushed the button, but am still waiting a call from the campaign to get my own feet out there walking for him.

Its hard to run a government or a campaign like a Baldrige-quality business.

But I think at least this government keeps trying.

Stop the pain at 8.5 percent unemployed

I read in the news today that charitable giving was down nationwide by 11 percent in 2009 compared with 2008, and that the lingering end of the Great Recession might have had something to do with the decline.

The recession officially ended during the early part of last year, and yet most news stories that mentioned it also point out a stubbornly high, 9.5 percent national unemployment rate and anecdotal evidence from most everyone that they don't feel like they've recovered from the economic shock of the past three years.

Maybe we should redefine a recession, which currently is described by sustained negative economic growth over a period of time. Any sustained positive growth, no matter how small, officially ends the recession.

Maybe we should automatically consider the United States in recession as long as the national unemployment rate is at or above 8.5 percent. That way public pressure could be maintained on both business and government leaders to create jobs that increase consumer spending.

Consumer spending has been regarded as the only true savior of American workers and owners during all of the recessions and near recessions during my life.

When consumers spend their money, workers and owners, managers and employees, even government officials prosper. Fewer children remain in poverty. Fewer food stamps are distributed to feed the hungry.

Some might say 8.5 percent is a bit high. But during my lifetime, full-employment for the nation was once described at a 5 percent unemployment rate, until, during boom years and after welfare mothers were forced to go to work, even lower unemployment rates were accomplished in many states of the union.

Lots of people are working and tons of money is being made when the national unemployment rate dips below 5 percent. But real pain starts to be felt among middle- and lower-income people at around a 6 percent rate.

Yet pain has never been a signal to the rich in this country that middle- and lower-income people deserve some economic relief. When someone else is feeling economic pain, our American-Calvinistic work ethic kicks in, and we blame joblessness on a lack of character among the poor and uneducated.

So 8.5 percent, though high, seems an appropriate level to consider the workforce automatically worthy of a little bit of aid from the nation's pool of wealth.

It doesn't seem unreasonable at that point to increase taxes on the top 1 percent of earners in the country, as well as on those who earn money purely from their invested assets. We could hold those taxes in place at least until enough jobs are created to allow the middle class and working-class poor to regain the economic footing necessary to boost consumer spending again.

Middle-class spending will, as usual, give the economic engine of the country enough momentum to warrant pulling back again on any extraordinanry taxing of the rich.

That's a 63-three-year-old non-economist's perspective of the world on this Monday morning.

Let me know what you think.

Middle-class consultant, worthy of a tax break

Eric Marburger is one of my croquet buddies, a part-time human resources expert working with the Mountain States Employers Council, and an entrepreneur HR consultant with private clients.

Marburger started his business, ESM Consulting Services, twelve years ago to supplement his and his wife Helen's income after the couple arrived in Colorado in 1998.

It was a good gig. Helen's position came with medical-insurance benefits, so Eric's tiny business and the Mountain States part-time work gave him the schedule flexibility he wanted in his work life. Together the couple made a good middle-class living.

"I don't want to work 60 hours a week," Marburger told me. Or "try to make as much money as possible."

Then came the Great Recession. Helen lost her job in February, but the couple continued their health-insurance through COBRA, the safety net that allows you to keep coverage provided by your employer's health plan as long as you can pay the full premium for the insurance.

As a human-resources expert for hire, Eric has had to know the ins and outs of health-insurance coverage, employee compensation, employee retention and terminations, other benefits and the whole range of HR chores within a company. His specific expertise is compensation, and you can tell he knows the subject well when he discusses problems employers regularly encounter in a down economy:

"There's only so much money organizations have for their employees," he said. "I tend to work with firms and organizations where personnel services might be 80- to 85 percent of the total expenditures for the company. Well, if health insurance is going up, let's say 12 percent, which is probably what it's averaged over the last few years, there's not a lot of money left over for pay increases or for any other additional benefits that might be wanted by the employees or even by the management of the company."

In other words, Eric Marburger knows the crossroads of operating a business profitably where rising health-insurance costs, declining sales, employee demands amid reduced numbers of workers (layoffs), and government regulation pull a business owner in multiple directions. As a sole-proprietor of his own consulting service, Marburger also makes a good example of a businessman dealing with all the push-and-pull that 21st century business entails nowadays. And this is a man who doesn't want to work 60 hours a week.

But Eric has been busy lately. We don't see him on the croquet court as often as we once did. His part-time work as a business consultant for Mountain States (about 20 hours a week or more) and the revenue he generates from his small consulting business (about $30,000 a year) is far more important to his family income now than it was before the recession. And like any good entrepreneur he is broadening the spectrum of services he can offer a client.

"I've tried to diversify my areas of expertise a little bit," he said, "just kind of make myself a little more valuable generally."

Making himself more valuable to the family, as well. For example, with Helen's layoff after 12 years at her employer, Marburger knew his family could qualify for a reduced health-insurance premium through a subsidy created by the economic stimulus package passed by Congress in 2009.

"We're paying $460 a month for probably a $1,400 insurance plan," he said, but the subsidy runs out next spring, as does his wife's COBRA coverage, so the couple is going to have to figure out a way to pick up new health insurance on their own, perhaps with a new insurer.

That's why learning the changes businesses face with the onset of national health-care reform becomes a large part of Eric's effort to make himself more valuable. He can help himself, his clients and his family all at the same time. And maybe even make more money.

Nevertheless, Marburger never expects to be one of those small-business owners with family incomes above $250,000 who might be taxed more heavily if Bush-era tax cuts for the wealthy are allowed to expire in December. Republicans and some Democrats (I betcha they're the wealthy ones!) want to renew the tax cuts for the rich, but the Obama administration wants to limit the renewals to the middle classs.

President Obama's opponents on the issue argue that small-business owners who pay taxes on their profits through their personal income-tax filing will bear the brunt of the increased taxes on the wealthy, and, therefore, limit their ability to hire new workers at their small businesses.

To be quite frank, and since I'm a blogger and can use more colorful language than I could in a newspaper or a magazine, that argument is pure bullshit.

Small-business owners who include business profits on their personal-income tax forms are more often sole-proprietors like Eric Marburger, and they fall far short of the $250,000 income level that would be subject to restored higher taxes.

Marburger is a compensation expert. He agrees with me that the small-business owner who makes enough money to be be placed in the $250,000-or-higher tax bracket is a rare bird, indeed.

"I've certainly worked with folks that earn $250,000, but they're not small-business owners," Marburger told me. "They're executives of larger organizations. I've worked with a lot of health-care companies, hospitals and corporations, ... [and] the executives are the ones earning over $250,000 a year. I don't know that I've worked with any small-business owners that would fall into that category."

He also said his own income from private clients for the past few years amounts to about 30 percent of his annual take-home pay, which falls far below the $250,000 level. "Not even close," Eric said and laughs. "Not even close."

While I was a full-time business reporter and writer, I avoided doing profiles of business consultants because I considered them less than substantive parts of Colorado's economy. Self-employed contractors who don't employ others usually have little influence on the economy and, therefore, are often ignored by business journalists.

Now that I'm a self-employed journalist and wannabe consultant, I have a different perspective.

It's still true that small businesses with employees are the job-creators national, state and local governments are trying to stimulate nowadays to hurry up the nation's economic recovery.

But it is also true that the self-employed contractor -- a carpenter, electrician, even a business consultant -- is among those who suffer the effects of a business downturn, much like the unemployed who get laid off from small companies and larger ones as well.

The self-employed also add to the recovery when they get work as an economy improves. As Obama says over and over, we're all in this together. The rich people who made money during most of the Bush era leading up to the nation's latest economic downturn may have to give back a little of it to put a bunch of middle-class business consultants, construction workers and professionals back on the job.

Furthermore, if you've been making $250,000 a year through the downturn, it seems like a small price to pay for the privilege.