Thirty years ago, the United States and other developed countries such as Australia, Canada and France had similar traffic death rates of about 25 per 100,000 persons. That toll has been reduced over time thanks to safer cars, safer roads and other factors, but by a significantly lesser margin in our country.

A new study co-authored by researchers at the National Center for Injury Prevention and Control attributes the difference to tougher traffic safety laws abroad, especially regarding seat belts, child restraints, drunken driving and cycle helmets. Minnesota and the United States as a whole have been slow or still unwilling to adopt such measures, which are common and effective elsewhere.

Although traffic fatality rates in the United States have fallen 35 percent since the 1980s, they are double those in comparable developed nations. U.S. crash costs, borne mostly by society as a whole, also far exceed those in other countries — 2 to 2.3 percent of gross national product here, compared with 0.5 percent in Great Britain and 0.9 percent in Sweden.

That translates to real money. The new study found a direct medical and lost productivity cost of $99 billion in 2005 due to 3.7 million deaths and injuries from U.S. crashes — a per driver “lax road rules tax” of nearly $500. Add in indirect costs such as higher insurance premiums, travel delays and increased government expenses and the annual financial toll reaches $230 billion, three-quarters of it not paid by the crashing motorists.

Conservatives often warn of “creeping socialism” in the United States while upholding the insidious kind that already exists — maximizing the liberty to take foolish risks on public roads while socializing their inevitable costs. This kind of lax regulation and enforcement was the recipe for the nation’s economic meltdown, and it’s just as stupid as conservative transportation policy. If we are ever to seriously address a national traffic toll that kills nearly the same number of people as the 9/11 massacre every month, our traffic laws and enforcement have to get tougher.

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When last we checked in on Westbrook, Minn., city leaders were puzzling over how to repave the crumbling streets of the Cottonwood County town of 700. They were staring at a daunting estimate of $2.5 million, five times the city’s annual budget.

Now the project is a go, thanks to a surprisingly low bid of $1.4 million. The apparent bargain reflects declining asphalt prices and economies of scale for the winning contractor, Knife River Corp. of Sauk Rapids, Minn., which has several other road projects in the same area of southwestern Minnesota.

“We pushed to get the job done this year because we knew the price would be better than the estimate,” said Mayor Rocky Kolar. “I feel everyone in town is going to benefit.”

Everyone in town will have to sacrifice as well. With no access to state or federal user fee money, special assessments and an overall property tax increase will cover the cost. The owner of an average-value home on a repaved street will pay around $150 more a year for the next 20 years. Those living on county roads in town with no property abutting the city project will pay about $100 a year.

This will be a stretch in a place where the median household income is barely half the state average and the poverty rate is nearly twice the state average. But the job had to be done, Kolar said. Since the last major street project in Westbrook in 1983, patching potholes had become an exercise in diminishing returns. Now, by the end of October the town will have a half-mile of new curbs and gutters and 22,000 tons of fresh asphalt spread over 11 miles of streets, vital infrastructure to last another generation.

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An economist friend once told me about a conversation with a businessman who was railing against U.S. government socialism. “Does that mean you’d get rid of the Federal Aviation Administration?” my friend asked. “Hell, no,” said the man. “I don’t want the plane I’m on colliding with another one.”

The FAA promotes airline safety via air-traffic control, pilot training standards and other regulations that conservatives regularly denounce as socialistic oppression. When right-wingers held sway in Washington, they stood in the way of updating the rules under a misguided philosophy that the airlines, not the traveling public, were the FAA’s “customers.”

Now, more than 16 years after a Northwest Airlink commuter jet crashed in Hibbing, killing all 18 aboard, Congress has finally enacted new FAA regs that hold regional pilots to the same training standards as those for major carriers. Until now, the former could fly commercial jets with one-sixth the flight hours required of the latter. In addition, the legislation directs the FAA to update flight and duty time rules for pilots consistent with scientific findings on pilot fatigue and to require that pilots are trained to recover from midair stalls.

“When you buy a ticket from Duluth to Chicago or New York, you have the right to know that the pilot flying the Duluth leg has the same qualifications and training as the pilot flying out of Minneapolis,” said Minnesota U.S. Rep. Jim Oberstar, who began pushing for the changes in 1994.

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Governor Pawlenty’s conservative legacy of disinvestment in our state – particularly in our education system – has left Minnesotans with large gaps to fill. A recent report from the College Board Advocacy & Policy Center reiterates how education in the US is lagging far behind other industrialized nations. With the need for advanced education in the workforce on the rise, quality investment in education – and the future of our state – becomes ever more crucial.

How do you see the way forward? What will it take for Minnesota to recover from Pawlenty’s disinvestment in education?

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How’s this for a man bites dog story? The Rochester Post-Bulletin reports that Olmsted County is transferring $749,000 from its employee health plan to increased resurfacing of county roads. Lower than expected claims last year produced a surplus in the self-insured health plan; commissioners already used some of it to waive premiums in January.

This runs counter to a long history of steep increases in health coverage costs and belt-tightening for transportation. But it’s also more proof that the user fees of fuel and vehicle registration taxes are no longer up to the job of keeping Minnesotans moving.

Across the state, property taxes are the main source of revenue for most of what local government does — from health care to roads and bridges to any number of other services. In Washington, policymakers are turning more and more to general funds raised mostly from income taxes to plug holes in highway accounts due to an obsolete federal gasoline tax that hasn’t been raised to keep up with inflation since 1993.

All this shows further erosion of the user-pays principle that built America’s extensive system of roads and bridges. As that principle has faded from public policy, so has the condition of the highway network. I’ll have more on this important subject next week at www.mn2020.org.

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As the federal health care reforms start rolling out, Governor Pawlenty might have already put Minnesota at a disadvantage. His recent decision to turn down $1.4 billion in federal Medicaid matching funds could cost Minnesota 22,000 jobs, $2.7 billion in business activity, and $984 million in salaries and wages, at least for now, according to the Minnesota State House 2010 Session Summary.

A press release from the governor’s office explaining his decision not to sign Minnesota onto an early expansion of Medicaid stated that it would “add another $430 million in costs to the bottom line.”

Not exactly. The transfer of many Minnesotans from state programs (like MinnesotaCare) to Medicaid would save Minnesota $242 million in the health care access fund from 2010-2013. Here’s the math: $430 million – $242 million = $188 million net cost. Not $430 million.

In addition to saving $242 million in the health care access fund, early expansion would also decrease uncompensated care costs, reducing a massive hidden tax on Minnesota’s citizens. Uncompensated care costs are incurred when the uninsured can’t pay out-of-pocket for emergency care and hospitals are stuck with the bill. The uninsured can only cover an average of 37% out of pocket, while government programs and charities pay 26%. The remaining 37% is paid for by a hidden tax on American families and businesses in the form of higher insurance premiums. In 2008, this hidden tax was estimated at $1,017 per family per year.

By not opting into early Medicaid expansion, Minnesota would face increased uncompensated care costs — which totaled $268 million in 2008 — as the number of uninsured in Minnesota and health care costs continue to rise. Recently, the Minnesota Department of Health ­­­­­­­­­­­­­­­estimated that by 2014, Minnesota will spend 52% more on health care in 2014 than in 2008. As this spending skyrockets, so will the hidden tax on the insured.

Pawlenty has already vetoed the expansion but a newly elected governor will have until January 15^th to approve the opt-in.

Expanding Medicaid early would:

• Decrease the uncompensated care totals that impose a hidden tax on Minnesota’s insured
• Provide better care for some of our most impoverished citizens (those who make 75% or less of the federal poverty line, or up to $8123 for an individual)
• Increase the productivity of 43,791 adults who would be newly covered by the expansion by reducing lost work time in sick days and promoting better health in the work force
• Infuse $1.4 billion dollars — about a $7 to $1 match — of federal money into our health care industry, thus stimulating our economy and creating jobs
• Generate thousands of new jobs, produce billions in business activity, and generate nearly $1 billion in salaries and wages for Minnesota’s labor force

I don’t disagree that we need to spend carefully; with a massive budget deficit on the horizon, we need to prioritize spending on programs that give us the biggest bang for our buck. This is one of them.

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From Pawlenty’s Daily Show appearance prompting more than 100 comments to the BP has Gone Loony post, Hindsight’s June discussions were lively and varied.  Articles on Race to the Top and classroom size also sparked intense debate. Great insight, Hindsight readers! As we roll ahead into July, keep the comments and discussions coming – together we’ll move Minnesota’s policy debate forward.

Here’s a recap – the best of June at Hindsight:

1. The Strange World of Emmer Math
2. Schools Are Not the State’s Piggy Bank
3. Why We Should Extend Unemployment Insurance
4. Why Cut out the Classroom?
5. Another Reason Why Race to the Top is a Sham
6. Local Cheese Company Finds Success in Midst of Recession
7. BP has gone Loony
8. The First Page in an Ugly Chapter in Minnesota Health Care
9. New Bike Laws Help All Commuters
10. A Refund from your Health Insurance Company?

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Not only are Minnesota’s rural hospitals fighting to attract and retain physicians some are fighting to stay in business. The recent state budget was balanced on the back of many vital services, among the biggest losers was health care. Rural hospitals are struggling to meet the costs incurred by treating the state’s neediest residents, while receiving below-cost reimbursement rates. The recent GAMC compromise added insult to injury, leaving rural hospitals with few places to turn when it is time to pay the bill for GAMC patients coming through the emergency room.

For many small hospitals the lack of funding means they are unable to update their systems and buy state of the art equipment. The lower patient population, means that those who are privately insured and thus come with higher reimbursement rates, may choose to go elsewhere to receive top-of-the-line care. With low revenue and outdated equipment, the struggle to attain quality providers becomes increasingly more challenging.

More than a quarter of Minnesotans live in rural areas, yet the state continues to fail in ensuring that they too have access to quality care, further exacerbating the problem by cutting funding at a time when Minnesota’s aging population needs wider access to health care. The hospitals are forced to cut where there is “nothing” left to cut, which for many hospitals means cutting nursing homes and staff. This in turn leaves the community with more unemployment, poorer care for the elderly, and even more people turning to poorly reimbursed public programs. Without proper investment in all of Minnesota, our rural communities will no longer be able to sustain vital health care services to those who need it.

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In an examination of 255 hospitals, Minnesota’s Fairview and Mayo made the top ten list, while three other hospitals in the state ranked in the top 20 percent, putting us with Ohio as a top medical provider.

The Thomson Reuters index used several key outcome measurements to rank the hospitals,  such as rate of mortality, rate of complications, patient safety, and post-30 day readmission.  Hospitals in the top 10 had:

• 12.3% lower rate of mortality;
• 13.2 % lower rate of complications;
• 5.4% adverse patient safety events;
• lower 30-day mortality rates and lower 30-day readmission rates;
• 4.7 versus 5.3 days average length of stay.

These accomplishments come despite the fact that the top 10 hospitals also tended to treat sicker patients.

This is mixed news for Minnesota.  We’re among the best in a low-rated pool compared to other developed nations.  A recent Commonwealth Foundation study found that the U.S. is the biggest health care spender, with the lowest outcomes compared with Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. As far as effective care, safe care, coordinated care, and patient-centered care, the U.S. never ranks higher than fourth out of these seven.

The other part that Minnesota must pay close attention to is access. What good is being a leading health care provider if fewer and fewer of our citizens can afford this quality care. Cuts to MA and GAMC  limit access to the preventative  care that’s at the backbone of our system.  Cuts to schools that provide nurse training programs and the University of Minnesota Medical School, further erode the brain power that puts our system among the nation’s top.  Our goal shouldn’t be best in the nation, it should be best in the world.

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On Sunday, July 4, our nation will commemorate the adoption of the Declaration of Independence, a monumental document that has helped shape the fabric of our nation. In honor, Minnesota 2020 is declaring independence from conservative public policy. We want to be free from the policies that have led to severe underfunding of our schools, contributed to the deterioration of our roads, cut thousands off of health care and resulted in a regressive property tax system.
We’d like to hear your declarations.

From which conservative public policies are you declaring your independence? How are you moving forward to a more progressive Minnesota?

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