Middlebury, Vt.

Life in the middle of Vermont.

Thursday, June 30, 2011

Email Confidential

Hey Sam –

What’s up?

-- Bob

WARNING: This message is intended only for the designated recipient(s). And for anyone else bored enough to actually read it. It may contain confidential or proprietary information and may also be subject to the coach-player privilege. Your seat cushion may be used as a flotation device.


Bob –

Not much. You?

-- Sam

This message is intended only for native speakers of Portugese. It may contain confidential or proprietary words in languages other than Portugese. Nontheless, that should not be interpreted to mean that you have any business reading it.


I’m thinking about taking an early lunch. Got any plans with that new secretary of yours? Assuming you don’t, you loser, want to join me for a burger?

If you are not a designated recipient, you may not review, copy or distribute this message. If you choose to review, copy or distribute this message, we will hunt you down and kill you.


I fired my secretary a week ago. Pay attention, will you?

Burger where?

IRS CIRCULAR 230 DISCLOSURE: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. tax advice contained in this communication is probably worth a lot less than you’re paying for it. Check under your desk for further details.


I’m thinking about that new place around the corner, the one with the dweebie waiter and the foxy hostess.

NOTICE: If you have received this communication in error, what the hell are you doing in my email, anyway? Please advise the sender by reply email and immediately say 10 Hail Mary’s. You should seriously consider deleting this message and any attachments without copying or disclosing the contents. If you do choose to disclose the contents, email them to 10 people without breaking the chain. George W. Bush broke the chain, and look what happened to him.


Yeah, she is a fox, isn’t she?

This broadcast is the property of Major League Baseball and is intended solely for its audience. And for you folks who were so bored that you started reading at the top and haven’t yet had the good sense to stop. Any rebroadcast, redistribution or other use of this telecast without the express written consent of Major League Baseball is strictly prohibited, but be my guest.


Anyway, burger about 11:30?

To ensure compliance with IRS requirements, we inform you that any U.S. tax advice in this communication cannot be used for the purpose of (i) avoiding penalties under the rules of Quidditch; (ii) promoting, marketing or recommending any transaction involving two teams of seven players riding flying broomsticks, using four balls and six elevated ring-shaped goals. Your mileage may vary.


Got a couple things to do first. Noon?

The views and opinions expressed herein are those of the respective authors and not necessarily those of this publication or its associated corporate entities. Of which there are many. Don’t even think of trying to mess with us.

Sure, noon. Meet me in the lobby.

Use of this Website signifies your agreement to the Terms of Use and Privacy Policy (updated 03.22.05, though who really cares). Trademarks may be used only with permission of your first-grade teacher. You knew you should have been nicer to her, didn’t you? Now it’s coming back to haunt you. Yellow lights lead to green lights which lead to exits. If you receive this in error, please notify the sender and delete this message. Thank you.

(Copyright by Gregory Dennis, 2008; GregDennisVt [at sign ] yahoo.com)


Monday, June 27, 2011

Taking a Hard Look at Single-Payer Health

There are plenty of reasons to be worried about Vermont’s march toward single-payer healthcare.

Federal healthcare reform may allow states to cover virtually all healthcare costs within their borders. But of course there’s no guarantee such a system would work. It’s never been tried in the U.S.

Proponents of single-payer can rightfully point to single-payer successes in many other countries. But those are nation states. Places like Canada aren’t part of countries that cling to the present-day amalgamation of health coverage from government, businesses and individuals.

A massive transformation will be required for single-payer to work in Vermont. We would save the costs of private health insurance, but single payer would entail new taxes on businesses and individuals. The Legislature would have to substantially expand its role in apportioning healthcare dollars. It would take years to make the dream a reality, including a waiver from the federal government.

At best it will take at least six years to make Green Mountain Care (GMC) a full reality – affordable, universal healthcare for all Vermonters. It’s hoped that would include prescriptions drugs, medical supplies, hospital coverage, and primary, specialty and mental-health care. (Vision and dental, too? Well, as with so much of this process, no one knows for sure.)

Single-payer proponents are correct in pointing out that we could reapportion how
healthcare dollars are collected – perhaps streamlining the confusing mix of federal programs, employers who cover their workers, individuals who pay (partly or completely) out of pocket, and unreimbursed care.

Everyone is counting on potentially huge cost savings through the efficiencies of electronic medical records and other digital wonders.

But in healthcare as in so many other human endeavors, rational efficiency does not always prevail.

In North Carolina, for example, a plan to improve the processing of Medicaid claims is now more than $200 million over budget. But even though the company assisting the state has also been implicated in egregious cost overruns in the British system, the state isn’t blaming the company.

The culprit, according to North Carolina? The federal government, which has changed Medicaid specifications several times and thereby required the state to rejigger its own program.

Another potential hurdle: If Obamacare is significantly altered by Republican legislation or court defeats, the process to achieve Green Mountain Care becomes even more torturous.
Of course it won’t be smooth sailing politically for Gov. Peter Shumlin and the Democratic leadership, either.

Last week’s pro-single-payer gathering in Middlebury featured the admirably dedicated Shumlin, House Speaker Shap Smith and Lincoln Rep. Michael Fisher, among others. There, two Addison County doctors served notice that while some Vermont physicians favor single-payer, even they are watching with a suspect eye as the state tries to pull off a medical miracle.

MDs aren’t the only one ready to pounce. The health of Vermont’s community hospitals, so vital to the quality of life in this rural state, could be at stake, too.
Medical device companies, which have already been hit with a new tax under federal reform, might oppose new reforms here in Vermont. (Disclosure: I consult for device companies.)

Even more significantly, insurance companies would be among the big losers under single payer. And the insurance industry is not exactly known for its political timidity or lack of spending power to bend government to its will.

And yet.

And yet we all have a huge stake in seeing Green Mountain Care succeed.
I support it, and I think you should, too. Universal healthcare is possible for Vermont, and it’s the right thing to do.

Our present system is grossly inequitable, and it poses a threat to a strong America. One in three Americans under age 65 went without health insurance at some point in 2007-08, according to a Lewin Group study from Families USA.

Even the conservative estimates from the U.S. Census Bureau show that more than 15% of us have no health coverage. That means at least 46 million Americans are one serious illness, one accident, away from overwhelming debt and potential bankruptcy.

We expect our businesses to pay an enormous share of the healthcare burden -- through direct taxes (e.g. Social Security) and through the expensive coverage they provide employees. Businesses also bear the cost of sorting through the confounding insurance maze.

Individuals who are self-employed or unemployed have to dig into their bank accounts to afford measly coverage. Or worse yet, they just go without. They hope for good health, and when they are sick, they fall back on our overwhelmed emergency rooms for cheap or unreimbused care.

In short, our expensive, convoluted, sometimes corrupt healthcare system puts a tremendous strain on individuals, families, and businesses.

We have the resources to provide affordable care to everyone. And yet, hamstrung by history, ideology and corporate greed, we endure an increasingly inefficient and unfair system.

Worse yet – and this may be the most ironically un-American thing about the whole mess – we don’t even get good value for what we pay. American healthcare may lead the world in spectacular, lifesaving new technology. But we lag behind many other nations in critical measures such as infant mortality and the average cost of common care and medications.

Yes, there are many reasons to worry about single-payer care in Vermont. But there are even more reasons to be worried if we fail to achieve universal care.

Vermont has many advantages in working toward that goal – a committed, intelligent political leadership in the Legislature and governor’s seat; a state small enough to be a laboratory of democracy without attracting the soul-crushing power of greedy insurance companies; civically minded physicians; and a resilient populace.

Few states have those advantages, and these pluses are largely absent at the federal level.

Vermont has already led the way on democratically establishing marriage equality. It’s time we did the same with affordable healthcare for all.

To point the way forward– and to do the right thing by better providing for the common good -- we should all hope that Vermont can achieve universal, affordable and equitable care.

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Monday, June 13, 2011

Newspaper Survival in the Digital Age

Newspapers are dinosaurs.

Those of us who were brought up on print still love our newspapers. We will probably continue reading them in varying degrees until the day we die. Indeed, it’s been said that the best hope for the newspaper industry is Americans over 50.

Which means the industry in its present form has got maybe another 30 years before it’s the stuff of legend.

We’ll remember newspapers in print the same way we pine for the fresh milk that used to be delivered to our family's doorstep every winter morning. We’ll recall the scrunch of a morning paper being read at the breakfast table as we do the sound of eggs frying and the smell of Pop Tarts fresh from the toaster.

But none of the kids born today will grow up to say that their first job was having a newspaper route.

With the possible exception of a couple national dailies and a scattering of excellent local papers such as this one, print versions of newspapers will by mid-century be like old leather bellows. Cracked and creaky, good conversation pieces, and excellent for starting fires.

Anyone who thinks otherwise obviously does not have an iPad.

I will spare you a litany of the many wonderful things about the leading tablet computer. Let’s just say the iPad represents the kind of transformation that occurred when television went from three channels in black and white, to 50 channels in color.

Like cable TV, the iPad makes available lots of new, highly disposable junk. But it also opens up a bright and engrossing new world of knowledge and entertainment.

Already the possibilities of the tablet form -- the ability to go well beyond the inherent restrictions of print -- are being realized by pioneers such as Al Gore. He has authored/compiled/directed “Our Choice” for the iPad. This multimedia sequel to “An Inconvenient Truth" is a deeply involving documentary/book/movie. Call it a “docubookie” or “boovietary.”

The iPad also delivers a pretty satisfying version of newspapers. For example, it pulls in the New York Times at one-third the price of the print version, with the convenience of home delivery you can't get in
Addison County for the print version.

The online Times (about $20 a month for iPad access) affords access to an array of video, blogs, way more photos than can make it into print, mashups of sound and data visualizations about radio programs, and ingeniously interactive maps.

It’s enough to make this old newspaper guy wish he could sit down at a computer with a case of Red Bull and write code for the next 48 hours.

Even before the availability of the iPad, many of us had been reading newspapers on our computers for more than a decade. We’ve been guiltily guzzling the news for free from the websites of the Burlington Free Press, Rutland Herald or the New York Times, when we used to pay 75 cents or more a day to read them in print form.

The result for some newspapers has been an explosion in readership – the Times has never been so influential or so widely read – and a frightening decline in paid subscriptions and the ad revenues tied to print.

Many historians and PhD candidates will spend the next few decades debating where newspapers went wrong in the digital age.

Newspaper companies felt they had no choice but to offer their content for free online, in a race for "eyeballs" that would supposedly bring with them a fresh, mountainously large source of ad revenue. But it turns out to be impossible to charge the same amount for advertising online as for print ads. And online, newspapers are seem by many Internet users as just one of a gazillion choices.

The Wall Street Journal has for years been successfully charging its readers for online content. Recently the Times put up a "paywall" that sharply limits how many articles readers can see for free online. The failure or success of this strategy will likely determine the paper's fate, and perhaps that of newspapers as a medium.

In the meantime, regional daily papers such as the Burlington Free Press and Rutland Herald face an uncertain fate. In Vermont and everywhere else, readers increasingly turn to other sources for news and entertainment, and longtime subscribers are getting older.

Cities such as Detroit now lack a daily paper, and once great papers such as the Los Angeles Times are sad shadows of their former selves.

The happy exceptions to this startling decline, I hasten to add, are some weekly and twice-weekly papers.

That’s partly due to the lack of digital alternatives. If you want to know what’s going on in the world, you can get your news from print, broadcast media, and online sources. If you want to know what's going on in Addison County, you simply need to read the Addison Independent.

It's true that it is possible to read that newspaper online, if you pay just a little extra. The paper has, quite wisely I think, decided not to give away its content online for free. But except among snowbirds who keep track of Addison County news from their winter perches in Florida, the overwhelming majority of readers get the local paper in print form.

Vermonters have a knack for embracing the best of things new and old. In the former category is Gov. Peter Shumlin’s initiative to bring high-speed Internet service to every Vermont household. We hold on to the old pleasures of print because it still fit this state's identity. Even in the age of the iPad, the Independent and other Vermont newspapers like it remain a deeply embedded part of the regional culture.

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