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THE BULLETIN • WEDNESDAY, JUNE 6, 2012
E High-deductible health plans must be transparent
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igh-deductible health insurance plans are spreading, and supporters say they could help restrain the growing cost of health care.
The idea is that consumers will make smarter choices about what care they purchase if they must pay a significant amount out of pocket before their insurance kicks in. Such patients are more likely, the thinking goes, to seek lower-cost providers or to question the need for an expensive test. That may sound logical, but the truth is that price-shopping for health care is difficult if not impossible. Even the most determined patient will often be unable to determine in advance what a specific treatment will cost. Judging quality is also challenging. Many large employers are moving to high-deductible plans, according to a recent report from Kaiser Health News, with 70 percent of large companies surveyed planning to offer such plans by 2013, and some saying that’s the only insurance they will offer. Many such plans, with deductibles of $1,000 and up, are combined with savings accounts that allow employees to pay their share with pretax dollars. In some cases, em-
ployers contribute to those savings accounts. Some also include free preventive care. The plans are sometimes called consumer-driven insurance, and analysts believe they may be partly responsible for the recent slowdown in medical spending, according to Kaiser. Surveys suggest half of all workers could be on such plans within the decade. The result is especially troubling for those with chronic illness, who essentially take a large pay reduction when their companies impose such plans. They often have few options to limit their costs. On the positive side, high-deductible plans usually do provide true catastrophic care, unlike more limited plans with low maximum benefits. If these high-deductible plans are to have any chance of influencing patient spending, they must be accompanied by true price transparency from providers. Otherwise, they simply transfer costs to patients.
Disney’s voluntary move on nutrition is smart
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here are right ways and wrong ways to improve nutrition in this country, and just as New York Mayor Michael Bloomberg’s proposed ban on large sweetened drinks is the wrong way, the Walt Disney Co.’s plan announced this week is the right one. The company will approach the problem from several angles, some of which build on previous efforts to improve the nutrition in such things as children’s meals sold in theme parks. Perhaps most visibly, Disney will quit advertising high-sugar, high-fat, high-calorie foods on television and radio programs aimed at children. In addition, Disney will up the nutritional value of food licensed to display the company’s characters and will improve the nutritional value of food aimed at children in its theme parks and elsewhere. Particularly important is this: These changes come not from government pressure or regulation, but because the Walt Disney Co. chose to make them. If you’re a parent, that’s a good
thing. Love the company or hate it, Disney has tremendous influence over what children in this country like and dislike. Its decision to ban advertising of the worst foods will, if past experience holds true, likely be picked up by others, among them Nickelodeon and the Cartoon Network, says The New York Times. While some elements of the program will begin immediately, the advertising ban won’t be fully in effect until 2015, when long-term contracts with current advertisers will expire. More immediately, the company will reduce sodium in its theme park children’s meals and cut sugar in yogurt and flavored milk by 10 percent. And the company will actively promote healthier foods and exercise on its programming, in its parks and on its websites. That’s surely a better approach than a top-down move to forbid large sodas and other sweetened drinks. It’s voluntary, and it’s coming from a company that is not in business to lose money. That’s a powerful message not only to other companies but to the government, should it choose to listen.
My Nickel’s Worth Primary care physicians’ compensation deficient I am a retired internist (primary care doctor of adults), with a response to Monae Johnson’s piece “Doctor shortage should be addressed� printed May 20 in The Bulletin. She is correct regarding a present and increasing shortage of primary care physicians. She is correct regarding the fact that average medical school graduating debt load is huge. She is correct regarding the fact that only a very small percentage of such graduates chooses a career in primary care. What she fails to realize is that compensation is and always has been procedure-favored rather than more equally valuing cognitive work. For example, it is morally wrong to pay a dermatologist $1,000 for spending 15 minutes diagnosing and removing a skin cancer but pay an internist $150 for spending 60 to 90 continuous minutes delivering critical care in an ICU. The American Medical Association has merely given lip service to this compensation disparity, probably because the AMA has historically been dominated by surgical procedure-oriented physicians. The AMA and others (Medicare included) have talked for decades about narrowing this disparity but have responded with only token actions
toward doing so. Until the work ethic and importance of primary care physicians is recognized and rewarded appropriately, interest in primary care careers among newly minted physicians will continue to decline. Ward Buckingham, M.D. Spokane, Wash.
Too much spending on Park & Recreation Consistently, while public safety and enforcement leaders are announcing cutbacks, hiring freezes, lack of funds to house inmates, etc., the Bend Park & Recreation District is continuing on with its rampant, uncontrolled spending along with planning to ask for tens of millions more dollars from strapped taxpayers for a never-ending list of projects. Are more footbridges across the river, hiking trails from Tumalo to Sunriver, athletic facilities competing with private enterprises, more doggie and people parks and on and on, more important than supporting law enforcement, a 911 system, fire protection and other public safety endeavors so these amenities remain safe for use along with public safety in general? The Bend Park & Recreation District has been out of control for quite some time with its rampant spending and constantly asking for more
money. This department has no regard for hardships the economy has placed on the citizens, and it is time for priorities to be reversed. The recreation facilities already in place are more than adequate in our community and just need proper maintenance. In the meantime, a fraction of the funds already going into the recreation money pit would probably be adequate to fund necessities for the law enforcement and public safety departments. Dean Martin Bend
Bulletin lowered its standards Why, oh why, did The Bulletin lower its editorial standards by printing the vitriolic, poorly written In My View column by Alfred Ferguson on May 26? Ferguson wasted your space and every reader’s time with his disorganized, hateful comments. Specific policies Ferguson would support or even specific criticisms of President Barack Obama might have made for an interesting opinion piece. Sadly, Ferguson seemed more interested in spouting invective than informing. Please don’t dignify Ferguson’s style of writing with any more space in your newspaper. Nancy Jolstead Madras
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We welcome your letters. Letters should be limited to one issue, contain no more than 250 words and include the writer’s signature, phone number and address for verification. We edit letters for brevity, grammar, taste and legal reasons. We reject poetry, personal attacks, form letters, letters submitted elsewhere and those appropriate for other sections of The Bulletin. Writers are limited to one letter or Op-Ed piece every 30 days.
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Decades later, Law of the Sea Treaty still an unnecessary risk By Edwin Meese III For The Los Angeles Times
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resident Ronald Reagan so strongly opposed the United Nations Convention on the Law of the Sea that he didn’t just not sign the treaty. He very publicly refused to sign it. He also dismissed the State Department staff that helped negotiate it. And in case anyone didn’t get the message, he sent special envoy Donald Rumsfeld on a globe-trotting mission to explain his opposition and urge other nations to follow suit. How odd, then, to hear proponents of the convention (also known as the Law of the Sea Treaty, or LOST) insist that Reagan would gladly sign on today. To hear them tell it, the Gipper’s reservations were few, minor and subsequently taken care of in a 1994 agreement now incorporated in the treaty. But with the treaty again under consideration by the Senate, it’s important to note that Reagan’s objections to it were anything but trivial. In his view, articulated long before he entered the Oval Office, its fatal flaw was as great as it was simple: LOST posed a direct threat to American sovereignty.
In a 1978 radio address titled “Ocean Mining,� he asserted that “no nat(ional) interest of ours could justify handing sovereign control of two-thirds of the Earth’s surface over to the Third World.� He added: “No one has ruled out the idea of a (Law of the Sea) treaty — one which makes sense — but after long years of fruitless negotiating, it became apparent that the underdeveloped nations who now control the General Assembly were looking for a free ride at our expense, again.� What had begun as an effort to codify certain navigational rights had, during the course of extended negotiations, morphed into a “constitution for the oceans� that would push nations further along the road to a world government. Of particular concern was Part XI of the treaty, which created supra-national executive, legislative and judicial mechanisms to regulate the mineral resources of the world’s oceans. One of these institutions — the International Seabed Authority — is assigned the power to regulate deep seabed mining and development on the extended continental shelf. In re-
turn for “assuring� those rights, the ISA would receive royalties from gas and oil exploration. Those revenues would then be redistributed to poorer countries. Those who claim that the U.S. is out of step with LOST need to know that in 1983, after rejecting the treaty, Reagan issued an “ocean policy statement� affirming the U.S. intent to abide by most of the pact’s provisions, such as navigational rights. After all, most of them merely recapitulate rights established by customary international law. Reagan’s statement also proclaimed that the U.S. had a 200-nautical-mile “exclusive economic zone� in conformity with the treaty. No foreign nation has challenged the existence or breadth of that U.S. zone. The statement specifically took exception to the treaty’s deep seabed mining provisions. Some have claimed those provisions were the only ones that troubled Reagan. But his diary entry of June 29, 1982, makes it clear that the problems went far beyond that: “Decided in (National Security Council) meeting — will not sign ‘Law of the Sea’ treaty even
without seabed mining provisions.� After taking office, the Reagan administration tried for months to negotiate extensive changes in the draft treaty. But the effort failed to produce a document the president could sign. The man who tried to renegotiate the treaty was Ambassador James Malone. In 1984, he explained why Reagan considered LOST to be unacceptable: “The treaty’s provisions were intentionally designed to promote a new world order — a form of global collectivism that seeks ultimately the redistribution of the world’s wealth through a complex system of manipulative central economic planning and bureaucratic coercion.� Eleven years later, Malone declared: “This remains the case today.� Despite the claims that the 1994 agreement “fixed� the offending deep seabed provisions, the “new and improved� pact remained fundamentally objectionable. As senators ponder the treaty yet again, they would do well to consider the question: What, exactly, do we gain by joining LOST? In the most recent Senate hearing, Sen. Chris
Coons, D-Del., asked Gen. Martin Dempsey, chairman of the Joint Chiefs: “Does failure to ratify this treaty in any way compromise the ability of the United States to project force around the world, to support and sustain our allies? Are we at risk as a result of failure to ratify this treaty?� Dempsey’s response boiled down to “no.� “Our ability to project force will not deteriorate,� he said, if we refrain from ratifying the treaty. Why risk sacrificing U.S. sovereignty under the treaty if it makes us no more secure? After all, what initially established and still ensures freedom of navigation under international law is naval power. To secure navigational freedom, territorial rights and all national and international interests addressed in LOST, we must maintain the strength of the U.S. Navy, not look to an anachronistic pact that is intent on advancing a one-world agenda. — Edwin Meese III, U.S. attorney general in the Reagan administration, is chairman of the Center for Legal and Judicial Studies at the Heritage Foundation.