In 2009, the Minnesota legislature passed the Toxic Free Kids Act. With this bill, the Minnesota Department of Health and Pollution Control Agency are required to make a list of chemicals used in manufacturing that are of high-health concern. Included in this list are some pretty common toxic materials: lead, a few phthalates, formaldehyde, and BPA.
This year, the Toxic Free Kids Act of 2013 was introduced to build on the prior law. The 2013 version requires all manufacturers to publish any of their chemicals included on the list. Furthermore, the state would have the authority to require gradual phase-out of these chemicals. Moreover, the Formaldehyde in Children’s Personal Care Products Act and the BPA in Children’s Food Packaging Act require manufacturers to halt use of formaldehyde and BPA in products or food packages for children under 12 within a year.
As a college student, it doesn’t seem that I would have any interest in these bills. I don’t have a child, and I’m over the age of 12. No connection. However, I feel I do. As a citizen, it’s important that I feel compelled to remove such dangerous chemicals from products for innocent children.
Take formaldehyde as an example. In 2011, the National Toxicology Program’s 12th Report on Carcinogens named formaldehyde as a carcinogen—along the same lines as cancer-causing carcinogens found in cigarettes or pesticides.
Or, maybe look at lead. In 1978, we banned the use of lead in paint. Lead can cause nervous-system damage, kidney damage, and stunted growth in children in during their early stages of development. Therefore, it was logical to ban lead’s use in products that developing children would be using.
I know many other products still include these products: jewelry; ceramic tiles; and, for formaldehyde, solutions used in the preservation of biological specimens. I know, with how immense the production sector is in this era, we can’t remove all of these products.
However, this is a start. It will help keep developing children—who need it most—healthier and safer, and it’s one less thing we can worry about in our busy lives. That is a no-brainer.
Medical expenses are on everybody’s mind these days, and for good reason. There’s talk about Medicare spending in almost every deficit discussion. There’s Steven Brill’s tremendous cover story in Time Magazine about the insanity behind medical expenses (it may take an hour to read in its entirety, but it really is worth it). There’s also some talk about how nurse practitioners (NPs) could be a shortcut to lowering healthcare costs and expanding access to care.
The theory is that if NPs – nurses who have received a graduate-level education in nursing – could diagnose patients and write prescriptions, then patients with relatively routine needs would be able to avoid the higher charges of seeing a doctor. Many states, especially rural ones, allow this to happen. The best part of this arrangement: Study after study shows that the level of care received in this situation is similar.
Minnesota does not allow NPs to diagnose or write prescriptions, in a strict sense. According to Minnesota statute, NPs may only write prescriptions if they have a written agreement with their doctor. That agreement must also comply with the standards of the Minnesota Nurses Association and the Minnesota Medical Association – which presumably limits the types of situations when NPs can exercise this responsibility.
ER and primary care doctors are becoming scarcer, especially in rural areas. They are are not as high-paying or glamorous as orthopedic surgeons or cardiologists. This means the supply of ER and primary care doctors is going down at the same time that the demand for their services is going up.
It makes sense that NPs should be able to diagnose and prescribe medication for relatively routine cases across the board – not dependent on a prior agreement with their doctors. It will mean less wait time for patients, better access for rural residents where doctors are the most scarce, and (best of all) it should lower cost of care.
In December, I fractured my thumb playing dodgeball. At first, I didn’t know if it had been broken or sprained. Either way, I knew what would happen: I’d get an x-ray and a splint. If I had been able to have the entirety of my care done by an NP, I might have saved time and quite a bit of money. But, Minnesota hasn’t taken the step that 18 states (including Hawaii) have taken to ease a pressure point in the medical process. Even if Minnesotans wants to take a measured approach and start by allowing NPs authority on certain types of cases, that’s a start. Quality and cost of care are going to remain areas of concern for decades to come, so it’s important to pick the low-hanging fruit now to bend the cost curve downward as early as possible.
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As baby boomers age, Minnesota faces a massive shortage in workers qualified to assist them with daily living demands. In the next decade, Minnesota needs roughly 50,000 new home care workers, according to Minnesota Department of Employment and Economic Development projections.
These workers play a critical role in keeping aging Minnesotans and people with disabilities independent and living in their homes, carrying out a number of household and minor medical tasks. Some home care workers are family members who've had to leave their full-time jobs to care for aging loved ones or family members with disabilities.
Unfortunately, both family and non-family care workers aren't well compensated, with many struggling to stay above the poverty line, and relying on public assistance to cover health care needs. Recently introduced legislation would allow these workers to decide whether or not to join a union, which would help provide them with a fairer wage, benefits, and better medical training. Making the job more attractive and raising professional standards through organizing will help avoid a dangerous shortage of qualified workers to care for those with disabilities.
By now, you've at lease heard that Minnesota is setting up an on-line market place for folks to buy health insurance, as directed by Obamacare. But how will it work? It's a simple questions with a complex set of answers. Over the coming months, Minnesota 2020 will help break down how this complex policy might impact you and your family.
For now, here's a fun video from the state introducing how the exchange works. You can also visit the Minnesota Health Insurance Exchange website for some basic information.
Statistics abound. We know there are people in every community who are hungry. We think of children going to bed hungry, or unable to learn because they have had no breakfast, or not growing strong bodies because of poor nutrition. We think of elderly persons who have to choose between food and meds, or who have no transportation to get to the grocery story or the food shelf. We think of parents working two and three shifts to feed their families.
Many of us do lots to end hunger. We support the local food shelf, volunteer for Meals-on-Wheels, or Walk to End Hunger. We know in our hearts that hunger is one social issue that can be solved; but how? It’s not a lack of political will, but of political complexity.
President Obama put a name on some of the entanglements: “For me, the people understand that our country cannot succeed when a shrinking few do very well and a growing many barely make it.”
He spoke, too, of charities’ limits: “We remember the lessons of our past, when twilight years were spent in poverty and parents of a child with a disability had nowhere to turn… We recognize that no matter how responsibly we live our lives, any one of us at any time may face a job loss or a sudden illness or a home swept away in a terrible storm.”
He spoke of living wages, “We know that America thrives when every person can find independence and pride in their work, when the wages of honest labor will liberate families from the brink of hardship.”
The President sets a tone that is emphatic and bold. It’s up to an informed public, advocacy groups and elected officials to break that down into doable programs.
At the top of my list, as usual, is the imperative of transparency. The main reason we don’t understand the symbiotic relationship between the Farm Bill (which allocates funding for Food Stamps, now know as SNAP) and hungry Americans is that we can’t fathom the depths of the legalese.
If we know more about the use of public funds, we'll better understand the many tools we have to cope with hunger. Of course we need to take care of people in need today, but we should not allow ourselves to stop digging deeper into knowing more – not just how many people are hungry, but why?
- What is our food and nutrition research agenda?
- Who is speaking to Congress and State Legislatures?
- How much of our food dollar goes for advertising/lobbying?
- Why are elderly Minnesotans going hungry – lack of transportation to food sources, poverty, or poor allocation of SNAP funds?
- To what extent is hunger a “women’s issue?
Bottom line, hunger in this nation of plenty is one of the most complex issues on our endless banquet of solvable problems. Thinking systemically about hunger is a powerful mental exercise that requires access to information that is current, accurate, impartial and understandable. The conversation about hunger in America must reflect the perspectives of many forces – a challenge in a nation divided.
Still, it is only informed systemic thinking, putting hunger and the right to food in context, that we as a nation or a community will solve what is, in the end, a solvable problem.
The constant drone underlying the rhetoric at the legislature on our state's economy always gets back to jobs. The legislature wants to help job creation. Progressives and conservatives have different ideas on how to do that, and for each party's approach a direct correlation is difficult to prove.
Progressives push bonding projects with construction jobs, building infrastructure for long term economic growth. But immediate effects are hard to calculate and economic cycles can come and go in the long term, negating known effects from the past.
Conservatives continue their dubious job creator tax cut strategy which simply has not worked. Corporations have pocketed the savings and told their shareholders that they have a bigger bottom line margin.
Gov. Pawlenty promoted JOBZ which by most accounts was a failure for Minnesota's economy. Any success it had simply moved jobs from one region to another -- forcing communities to compete with each other with no net gains for the state.
We took the dubious initiative to try and save Northwest Airlines with low interest loans during a period of extreme pressure on the airlines. The loans were meant to keep Minnesota-based NWA and its jobs. Then came deep pocketed Delta who merged with NWA and moved many of the jobs to Georgia.
In 2007, the Mall of America came looking for the state to help with its $2 billion expansion. The legislature balked at the direct intervention and the project has been delayed for the last 5 years. It looks like it still may proceed but in smaller incremental steps.
As you can see, the interaction between the legislature and economic activity has been a very mixed bag. There are no guarantees. Business responses are chaotic as well. They want financial help from the state but not the meddling. We are supposed to give them to loans or tax breaks and shut up.
Here is why I bring all this up. Mayo Clinic.
Mayo Clinic wants to invest $5 to $6 billion in an expansion project but would like the state to invest half a billion in infrastructure investments to coincide with it.
The reaction? Mixed. A key member of the House, Ann Lencewski, the Chair of the Tax Committee is very skeptical. She has consistently opposed these public-private investment projects. She was a key opponent of the Mall of America expansion; even though she represented the MOA district. Gov. Dayton supports it with reservations. The House and Senate leaders are open to it but need to see more. Mayo is pushing for an answer during this session.
Frankly, I think this is worth serious consideration. And here are my reasons why.
1) Economic Activity: A major Mayo clinic expansion will push a host of investment activity in the Rochester area. Rochester is a key growth area for the state and the city would see a host of business activity to follow the increase in people and money that will almost assuredly result from this type of push. Hotels, restaurants, recreational opportunities will develop. All of which would increase state revenues.
2) Deep Pockets: If Mayo wants to invest this type of money, they can do it. Unlike the Mall of America which would depend on investors and debt service, Mayo can provide very stable revenue streams, with actual cash or investment confidence. Once the go-ahead is given, this will happen.
3) Infrastructure Control: The question has to be asked: If Mayo has such deep pockets, why do they need state funding? They probably could do it without the state, but like any wise investor they will want to reduce direct exposure in any area they can. But there is also something else to consider. The state is the ultimate responsible party for infrastructure and if $500 million is going to be earmarked for Rochester projects, then shouldn't MnDOT want to be the controlling interest? If Mayo is the sole payer, wouldn't you assume that they will want these projects to be for their own benefit? If the state has that big a stake, then MnDOT has the opportunity to work these projects to mesh with the rest of the area infrastructure in a more coordinated manner.
4) Real jobs: With this kind of investment, real jobs (not potential) will result. From construction to related retail to business opportunities, it all fits in with REAL job creation. Unlike the Mall of America proposal which would have given us temporary construction and long term low wage retail, the Mayo Clinic project should bring in a variety of income groups.
I understand the hesitation about going with this proposal. But let's give it a full examination. The Clinic proposal should certainly have some negotiating room. There is a lot of money on the table here and high level potential.
If the Twins and Vikings are deemed essential for state investment, how can we not take world class health care seriously as well?
Photo credit: Mayo Clinic, creative commons
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A hallmark of a rational tax system is that similar products are treated similarly. For this reason, “little cigars” should be taxed liked cigarettes, because that is essentially what they are.
According to ClearWay Minnesota, an advocacy group that works to “reduce tobacco use and smoke exposure through research, action and collaboration,” both “little cigars” and cigarettes are filtered, come in packs of 20, are of similar weight and size, and—most importantly—contain the same cancer-causing chemicals. To see the two products side by side, you would conclude that they are nearly identical and you’d be right.
The only difference is that “little cigars” are wrapped in paper that contains more tobacco pulp and thus are brown in color, as opposed to the standard white cigarette. This creates a loophole that allows “little cigars” to avoid many of the taxes and fees that apply to cigarettes. As a result, a pack of “little cigars” can retail for less than half the cost of a conventional cigarette pack. According to a recent Star Tribune editorial, a price check at a local convenience store revealed that “little cigars” sold for $1.99 per pack, compared to $5.70 for cigarettes.
The cheaper price of “little cigars” gives them additional appeal to cost-conscious teens looking for a cheaper alternative to cigarettes. To add to their appeal to young customers, “little cigars” are often marketed in various candy and fruit flavors, including chocolate, vanilla, strawberry, and grape.
Given the well-documented health consequences of these tobacco products and the long-term societal costs in terms of increased private medical insurance premiums, higher Medicare and Medicaid costs, and lost productivity, there is no reason to give “little cigars” an unfair tax advantage relative to cigarettes. An increase in the price of tobacco products is known to reduce the rate of consumption—something that economists refer to as “elastic demand.”
An added benefit of closing the little cigar tax loophole is that it will generate an additional $10 million in state revenue during the current biennium even after the reduction in consumption is factored in, according to the Minnesota Department of Revenue estimates.
During the current era of partisan rancor, it is good to see that folks in both parties' caucuses are uniting to close the “little cigar” tax loophole. During a January 30 Senate Tax Committee meeting, Senators Kari Dziedzic (DFL-Minneapolis) and Carla Nelson (R-Rochester) presented similar bills (Senate File 134 and Senate File 135) that would eliminate the tax disparity between “little cigars” and cigarettes. If common sense prevails, this legislation will become law during the 2013 session.
Smoking is bad for you. Really bad. Accumulating research continues to reveal the countless ways that smoking diminishes quality of life, creates significant financial burdens on individuals and families, and facilitates long-term public health cost shifting to communities. Despite this, tobacco smoking persists.
Nicotine, through cigarettes delivering the drug, is one persistent addiction.
A research study published by the New England Journal of Medicine finds a clear, silver-lined path within a mountain of grim findings. Smoking cessation has an immediate, positive impact on health and longevity. Quit now and you’ll live longer than if you don’t quit smoking, even if you’ve smoked for years.
According to the study, using data drawn from several hundred thousand smokers, gathered between 1997-2004 in smoking and smoking-cessation studies, smoking’s life-shortening impact is clear and unequivocal. Smokers, age 25-79, are three times more likely to die than similarly aged people who’ve never smoked. The smoking-related deaths were caused by vascular, respiratory, neoplastic and other diseases already commonly associated with smoking’s health effects.
Here’s the take-away. Smoking shortens your life even if it doesn’t seem like its shortening your life. Stopping smoking increases the probability of extending your life regardless of how long you’ve smoked. While never smoking creates the greatest probability for experiencing a long life, smoking cessation improves on a smoking life’s diminished projected life span.
Smoking is perceived—not to mention marketed—as a relatively low-risk activity. It’s not. Analyzed from both personal health and public health perspectives, smoking carries significant, life-defining, long-term costs. Dying early is only one those but even dying early isn’t perceived as a long-term cost, particularly among younger smokers.
The New England Journal of Medicine’s research study is another important step in building the public case for smoking cessation efforts. Clearly, however, the barriers to complete smoking elimination remain formidable. A clear public path forward is elusive despite mounting research data.
Let me make a highly personal suggestion. No matter how irascible, no matter how defensively entrenched you are in your smoking as identity, and no matter how much of a pain-in-the-ass you might be as a result, I’d rather have you around for another year or ten than not. Even though quitting saves you, personally, a lot of cash and reduces Minnesota’s public health burden, life is about playing the probabilities. You’ll likely live longer if you stop smoking. The data bear it out.
The Mayo Clinic has announced a plan, in addition to the already-existing “Destination Medical Center,” to improve, renovate, and add its clinics. Over the next 20 years, it will invest $3.5 billion dollars in a wide range of projects: medical care, lab space, clinical sites, and other resources. Along with this plan, Mayo is asking for help from the state of Minnesota and the city of Rochester.
Mayo is asking for $585 million from Minnesota, and they request legislative approval to create a “special taxing district” around the Mayo Clinic in Rochester. It is also seeking tax-increment financing.
With the budget problems Minnesota is facing, many would assume there would be no way we could finance and support a $585-million. Others would say that the Mayo could wait. However, there seems to be great incentive to start this endeavor.
Jobs. According to the Rochester Post-Bulletin there were roughly 32,000 personnel and students working at the Mayo Clinic in 2010. An increase in space, undoubtedly, would add employment opportunities to Minnesota—from the construction workers and contractors to the nurses, support-staff, and doctors to work in the new areas. This would make Minnesota an even greater place for work and research in the health field, attracting more top-notch health experts
Revenue. According to projections, this effort would raise up to $3 billion in tax revenue for the state—not to mention all the businesses and facilities throughout Mayo that would benefit from an increase in patients and staff. Many struggling, small businesses would find hope, all while supporting a vital and prosperous center for world health.
Patient Experience. Certainly, patient experience is a crucial part to any industry. With the aid granted, the Mayo Clinic can build more places for parking, add more rooms, and increase family waiting center. Thus, they would reduce congestion, while increasing the patients’ care and experience when being treated at one of the most prestigious hospitals and research centers in Minnesota—and the world.
With all this being said, it’s necessary that we support and promote this enterprise. With a growing health field, this is not the time to stop. With a continuation in the right direction like this, we will better prepare Rochester—and Minnesota—for the future.
Photo credit: Chad Johnson, creative commons
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Recently introduced Legislation should ensure Minnesota implements a health insurance exchange that custom fits our needs. Once it's up and running, it will serve as an online gateway, helping about 1.2 million Minnesotans find affordable health insurance.
The online marketplace will require insurance companies to compete for the business of Minnesota’s families and small businesses in a clear and concise way so that people can make their own individual choices about their healthcare coverage. When implemented, the exchange will provide subsidies and tax credits to middle-class families and small businesses; individual consumers should see a 23% decrease in the premiums they will pay using the exchange and it will help an estimated 200,000 small business employees purchase health insurance. By 2016, 300,000 previously uninsured Minnesotans will be covered.
Minnesota has already received $70.3 million in federal aid to set up the online marketplace and has applied for $39 million more. Once the online system is in place, it will be funded by a 3.5% surcharge that will be added to the premiums purchased through the exchange. While some legislators like Sen. Tony Lourey, author of the Senate health exchange version, are ready to implement the bill, others like Senate Minority Leader David Hann, remain in opposition. Roughly 30 conservative-lead states are blocking exchanges.
At the federal level, leaders like Minnesota's Sen. Al Franken keep working to move the Affordable Care Act forward, trying to work out the details of federal insurance options, which states might want to use, that fall between Medicaid income eligibility and private insurance affordability, according to the Star Tribune.
Early reports indicate that Minnesota's exchange efforts so far are among the nation's best, let's hope this continues, so that the state will uphold its position as an incredible health care leader. Implementing an exchange that ensures all Minnesotans can access a wide range of medical services without going broke or foregoing necessary care will do that.
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