A Medicaid Cost Reduction Idea ...

A tiny Oregon experiment may be showing the way to a more effective way than just covering the costs ... getting people "better" so they don't need the system as often.  At a health system in tiny Bend, Oregon, which has 144 people utilizing the Emergency Room more than 14 times a year under Medicaid, they've provided "behavioral improvement specialists"  (social workers) to work with the 60 % of the 144 willing to be worked with ... and have cut the ER visits in half and saved more than $3,000 per person per year.  It's providing personal attention to help the high users develop better lifestyle/habits that keep them out of the sick care system.

On the Street
•  ALL TEC members I talk with will NOT take advantage of the ObamaCare penalty (paying it and moving employees to the individual exchange).  They feel they have a moral responsibility to continue coverage since they can afford it competitively ... reserving a final judgment until they see the impact of actual exchange costs.
•  I talked recently with a tuned-in local observer who knows of a 65-person employer, with low margins who employees low-wage workforce, will cut employees hours to 29 so that he doesn't have to provide health insurance.  This may be the bigger "unintended consequence"; there have been stories in the media about companies with low margin products and services planning to do this.

Harry Dent Redux (and Mark Parrot)

     Remember Harry Dent's Age/Demographics way of looking at economic growth ... that we are driven by our age/time in our lives to be consuming certain things given our lot in life?  In our 30s and 40s we're major consumers of housing, education and cars.  But beginning about age 50, we switch to saving to pay down debt and save for retirement, spending less on major stuff.  

     The last of the Baby Boomers are now passing age 50 ... so that massive purchasing power isn't any more.  Do you think that is part of our sluggish recovery?  Duh!
 
On Health Insurance/Medicare paperwork:
•  A friend of mine who runs a small independent provider is retiring.  "If the objective of Medicare was to run me out of business with excess paperwork and aggravation, they have succeeded.  I want no more of it.  For every five minutes I spend with a patient, I have to hire someone to spend an hour dealing with the back-and-forth of insurors and Medicare."
•  Another friend, talking with his primary doctor:  "Cost Savings?  I'll tell you about cost savings.  At this location, we have 12 physicians ... and 50 people who deal with the paperwork."

Advance head Fred Monique on our local economic development competitiveness:

No, we're not as good as we think.  Here's the truth:
     1.  Not a Right To Work state, which would attract business expansion.
     2.  Incentives to relocate here are weak, comparatively.  "We lost Bass Pro Shops because we wouldn't provide a tax break."  (It's businesses that create jobs, using last year's profits to fund development of new jobs.  Why are they taxed on their income at all?)_
     3.  Our sites and permitting requirements are less than favorable.
     4.  Our state efforts are "inward-focused," not externally-focused.
     5.  We're not great for Young Professionals ... fast-growing, exciting businesses.
     6.  At home, we need to provide more support for Second Stage companies ... those with $2-to-$50 million, and growing ... strategic alliances, leadership education, etc.
But ...
     We're very good for families ... low cost of living, low housing costs, low crime, good schools.
     Very good for entrepreneurs.
Nationally, we're in the bottom quartile of areas:  Our missing components are Right To Work, investment companies, and a research Institution.

Meanderings ...

•  Legislators, almost by definition, are not leaders.  It's the role of LEADERS to provide the Vision ... and the Guidelines!  Then, legislators can create the programs within those guidelines.

•  High taxes and many, complex regulations are THE major indicators of "Crony Capitalism", a bastardization of the economic system that results in today's distrust.  Regulations always have winners and losers, and taxes take from losers and reward winners (sometimes the general public, oftimes special interests).  These always demoralize and de-energize ... the feeling that the game is stacked against me if I become entrepreneurial and take risks.  Which brings us to this great quote ...

•  "The argument for limited government is really an argument for not overburdening politicians.  Leave as much as possible to the market, to the law of contracts, to the courts.  Don't pile up on politicians more and more impossible choices they have to make on our behalf."  By WSJ columnist Holman Jenkins on March 23.