Marion Michael Rounds's weekend press is the usual blap of vague policy pronouncements and wishful thinking: South Dakota common sense, national debt, EPA bad, go broke and die if you aren't working—

—wait, what's that last one?

[Rounds] wants to fix the problems with the Affordable Care Act by replacing it with a product he says is not dependent on promising people their health care will be paid whether they’re working or not [Roger Larsen, "Rounds: S.D.’s common sense needed: U.S. Senate candidate speaks at Huron Rotary Club," Huron Plainsman, 2014.04.05].

Hmm... as I've been working with the health insurance exchanges, I must have missed the call script that said, "Press 2 for free health insurance so you can quit your job."

As usual, Rounds gives us no concrete policy proposal, just words meant to enflame voters. But what is he saying? If you don't have a job, no one pays for your health care? That flies in the face of half of the health care model our country follows. Retirees get Medicare. Veterans get VA benefits, whether they have jobs or not. Children get CHIP. Rounds seems to be saying people only deserve help if they don't need help, which is offensive to morality and simple logic.


Jonathan Ellis shines a harsh light on the culture of secrecy with which state medical boards and hospitals shield doctors from facing the consequences of their malpractice. Focusing on the "trail of pain" left by surgeon Allen Sossan, Ellis shows that Nebraska and South Dakota boards that review doctors' performance seem more concerned about protecting doctors' privacy than protecting patients' lives.

Ellis's report includes stories of patients who were paralyzed or killed by Sossan's shoddy and unnecessary surgeries. Complaints to the Nebraska licensing board did not result in action against Sossan's license. When Sossan came to practice in Yankton, Avera Sacred Heart Hospital allowed him in, despite the grim stories that attached to his name:

They delayed granting him privileges, but after about a year, Sossan threatened to sue. Matt Michels, a lawyer for Avera Sacred Heart, told the executive committee that Sossan probably would prevail in court under laws that bar organizations from restraining trade. The problem for the executive committee was this: Nebraska’s licensing board had not taken action against Sossan’s license, and Faith Regional had not reported adverse activity, so Avera didn’t have grounds to reject his request for credentials [Jonathan Ellis, "Secrecy Protects Surgeon's Trail of Pain," that Sioux Falls paper, 2014.03.23].

Yes, that Matt Michels. Now Lieutenant Governor Matt Michels.

But don't blame him; blame the licensing system and the medical culture that insulates doctors from punishment and bad press and ties the hands of administrators and institutions would try to protect patients from bad doctors.

*   *   *
By the way, one lawyer who successfully sued Sossan for killing a patient with unnecessary surgeries has managed to pierce the institutional veil of secrecy and discover that Sossan's entire career may be based on cheating on a test:

Tim James, a Yankton lawyer who represented Bockholt’s children and who is representing other clients against Sossan, uncovered records showing that Sossan — who then went by the name Alan Soosan — was arrested while in college in the early 1980s for felony grand theft and burglary. Sossan was arrested in Florida, according to a police report, for breaking into the biology department and stealing a test. “What made it really interesting was that it was a core requirement to get into medical school,” James said. “It’s not like he was stealing a French test” [Ellis, 2014.03.23].

As a French teacher, I object to the characterization of my work products as trivial.


When President Obama and Democrats pass a law forcing insurance companies to cover individuals and procedures that they don't consider profitable, Republicans cry bloody constitutional and economic murder. When Republicans pass a law forcing insurance companies to cover individuals and procedures that they don't consider profitable, it's a great day in South Dakota.

Republican blogger Pat Powers rejoices over the South Dakota House's approval of House Bill 1257, a bill to require health plans to cover "screening, diagnosis, and treatment of autism spectrum disorder." "It's been a long time in coming," says Powers, who is the parent of a child with autism. Powers says HB 1257 is pro-family and pro-taxpayer, since it transfers $3.2 million in average lifetime costs of caring for each autistic child from society's shoulders to insurance companies (which get their money from policyholders, who are members of society...).

The wicked Affordable Care Act forced insurers to stop excluding children with autism and to cover autism screenings. But it left states the authority to define the "essential benefits" that insurers must cover. HB 1257 avoids calling applied behavior analysis, the main autism therapy under discussion, an "essential benefit," thus sparing the state from having to pick up any costs.

An insurance lobbyist noted that Medicare and Medicaid don't cover applied behavior analysis. HB 1257 goes farther than the wicked federal government in controlling the health care marketplace.

But no matter. When we strip away abstract, arcane arguments about political philosophy, when we put real faces, real children, real families, and real medical needs on the front page, the health care debate becomes very different. Ask a parent with an autistic child if laws to help that child get medical help without bankrupting the family is a good idea, and that parent suddenly becomes a big-government liberal... which is fine with me.


Jana and I are quite happy to see the Affordable Care Act working just the way we expected to end job lock. We are dismayed to see the media working as we have come to expect, getting the story wrong in the urge to spin the ACA as killing jobs.

The Congressional Budget Office released its 2014–2024 Budget and Economic Outlook Tuesday. The CBO's analysis includes an estimate that the Affordable Care Act will reduce the number of hours people work by 2.0 million full-time equivalent positions by 2017 and 2.5 million FTE by 2024.

My conservative friends are quick to conclude that Obamacare is putting people out of work. My conservative friends are wrong. The Affordable Care Act is making possible what almost every one of you working stiffs will be wishing today around 3:30 p.m. (or tomorrow when you get up for the early shift at 3:30 a.m.): that you didn't have to spend so much time working.

The Affordable Care Act is not taking jobs away from people. It is reducing Americans' need to do crappy jobs:

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall economy will be proportionally smaller than the reduction in hours worked [Congressional Budget Office, "The Budget and Economic Outlook: 2014 to 2024," February 2014, p. 117].

Thanks to the Affordable Care Act, millions of Americans won't have to take that second part-time job to cover their health insurance premiums. Americans hoping to start their own businesses will feel a little freer to let go of a job they do for someone else just to hang onto a health insurance policy. Folks approaching retirement won't be quite as stuck doing unsatisfying jobs just for the sake of keeping health coverage until they qualify for Medicare.

Yes, yes, work is noble. Work builds character. Work gives us purpose. But work also wears us down. Work makes us miss our kids' dance recitals and track meets. Work subjects us to the will of other people and corporate policy manuals. Work makes us say and do things that we would not do if we did have to take orders from the boss.

By allowing millions of people to choose to work less without risking their families' physical and fiscal health, the Affordable Care Act expands liberty. By reducing the labor supply without equal reductions in labor demand, the Affordable Care Act creates more opportunities for folks who do want to work extra hours.

Think about when you feel the greatest liberty. It's probably not when you're in the office, hurrying to finish the report the boss wants by the end of the day. It's probably Friday night when you don't have to set the alarm, or maybe Saturday when you wake up to enjoy a leisurely breakfast with your kids, or that one day a week when neither job calls you in and you can walk around town in your jeans, knowing you've paid your bills for the month and can afford to buy a book or a new toolbox. Or maybe it's that one blessed day when you can finally show your pain-in-the-neck boss your backside and leave for a job you really want.

The Affordable Care Act makes more days like that possible. The ACA doesn't kill jobs. It doesn't promote laziness. It promotes liberty—daily, practical liberty.


In the Facebook conversation on my post on pro-discrimination Senate Bill 67, my crazy cousin Aaron (not to be confused with my sane wife Erin) maintains that government is a greater threat to liberty than the free market.

If you can think of a more backwards line in political philosophy, let me know.

All human institutions err. But the free market has a really poor track record of providing the basic preconditions of liberty in a civil society, like education, public safety, and, as we see in Thursday's New York Times, health care:

Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors.

Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital [Julie Creswell and Reed Abelson, "Hospital Chain Said to Scheme to Inflate Bills," New York Times, 2014.01.23].

The free market is bringing us corporate control of hospitals, and corporate control brings us managers looking at stock charts, not patient charts. Corporate execs and lucky investors may enjoy more liberty to jet to Bermuda, but patients subjected to unnecessary medical treatments will enjoy less liberty as hospitals driven by the free market take us all for a ride.


Some folks get awfully sensitive when authorities in their own pew disagree with them.

John T. Porter, CEO of the Catholic Avera Health, takes to the opinion pages to join most moral and practical South Dakotans in exhorting our Legislature to expand Medicaid. Mr. Porter cites the familiar arguments:

  • Provide health coverage for 48,000 more South Dakotans.
  • Invest $1.6 million in state funds, get $649 million in federal funds that would act as economic stimulus.
  • Help thousands of working neighbors live better lives.

Working together to use our vast national wealth to help our neighbors seems like a good idea from a Catholic perspective. It seems like a good idea from a practical problem-solving perspective. It seems like a good idea from almost every perspective other than the "Oh my goodness—that Medicaid expansion is another one of Barack Obama's ideas, and Barack Obama is eee-viiiilll!!!" perspective.

Cue Pat Powers, Catholic blogger and Barackophobiac. First the personal attack:

You know, I’m sure Mr Porter is a nice man, but I’d bet dollars to donuts that Mr Porter makes far, far more on a yearly basis than I do despite my best efforts. And for that matter, I’d wager his hospital system does as well [Pat Powers, "Avera CEO Asking for {Me to Write Another Long Headline Demonstrating I Don't Have the Journalistic Skill to Condense My Thesis into One Concise Statement}," Dakota War College, 2014.01.15].

Notice how Powers has no problem playing the class envy card when it suits his purposes.

Then the disingenuous political attack:

So, why is he asking me to pay for all this subsidized medicine through my taxes? Especially because that bill is going to go up in an explosive manner when, yet again, the federal government fails to honor another promise to state government (see Missouri River Dams, aspects of education funding, etc) [Powers, 2014.01.15].

Ah, yes, the false flag of a failing federal government. The single greatest risk of someone turning off the federal funding spigot seems to come from Powers's own Republicans, who make great sport of shutting down the federal government and threatening to default on our financial obligations. Republicans like Powers have yet to extend this "What if Uncle Sam leaves us?" argument to say we should stop paving I-29. And I have yet to hear any coherent explanation of how a federal government withdrawal of Medicaid funding would legally obligate South Dakota to pick up the slack instead of just shutting down the program.

Finally, Powers reaches for Porter's wallet:

If providing “primary care and health screenings” is that important, might I suggest Mr Porter give all that health care away?

I mean, why not? He’s wanting to pass the expense on to us, including me. As a show of commitment to what he’s advocating, shouldn’t he lead by example? Aren’t they supposed to be non-profit? So, give health care away for free! [Powers, 2014.01.15]

Powers completely misrepresents Porter's position. Powers is asking Porter to pay for this social program entirely with his own resources. Porter is not making the same claim on Powers. Porter is asking that all of his, Porter and Powers, Catholics and agnostics, chip in to pay for this social program.

Basically, Porter is saying, let's all work together to help each other. Powers is saying let's all isolate ourselves on our own islands of selfishness and let our neighbors and our state economy suffer, just to make a tired political point.

Porter vs. Powers—choose your pews, Catholics!


South Dakota state law currently caps increases in state funding for K-12 education at 3% or the annual percentage change in the consumer price index, whichever is lower. (House Bill 1003 would amend that law to set a minimum annual increase of 2%.)

So if the state can cap increased funding for a vital public service like education at the going rate of inflation, could the state cap cost increases in another vital public service? That's what Maryland is doing with health care:

...[T]he state took another big step forward on Friday with the announcement that the federal government will allow the state to tie increases in hospital spending to economic growth—a bold challenge for a sector of the economy that has typically far outpaced the broader economy.

After a decade in which hospital spending in Maryland grew twice as fast as the state’s economy, Maryland will hold all of its hospitals to a growth rate of 3.58 percent, the state’s per-capita rate of economic growth. The state is also required to capture $330 million in Medicare savings over a five-year test period, reduce hospital readmissions, prevent hospital infections and file annual reports on population-health benchmarks. The new agreement with the Centers for Medicare and Medicaid Services upends the practice of paying doctors for each individual transaction, instead transitioning to “global payments,” which offer bulk sums for an entire population and encourage providers to reduce unneeded procedures and improve care to hold onto as much of the money as possible [Chris Kardish, "Maryland Becomes First State to Cap Hospital Spending," Governing, 2014.01.10].

If South Dakota can expect schools to run on a funding increases tied to economic factors, we should be able to impose the same expectations on hospitals, right?


From the Bizarro Department, the penny-pinching, smaller-government Obama Administration continues to look into saving money by closing the Veterans Administration facility in Hot Springs:

...the VA is moving forward with an environmental impact study on closing the century-old historic Hot Springs facility — a medical treatment and rehabilitation center with inpatient and nursing home units — and rebuilding in Rapid City.

...The VA says an economic analysis has shown that restructuring its facilities in western South Dakota would be cheaper and more efficient than trying to fix the aging facilities in Hot Springs. The environmental impact study is required by law to look at the plan's environmental, social and economic effects ["VA to Do Study on Closing Hot Springs Facility," AP via Black Hills Pioneer, 2014.01.08].

The closing appears unrelated to the federal facility's outburst of secessionism last spring. Rather, the VA seeks to improve access to services:

The VA’s Black Hills Health Care System proposal, the Veterans Department said, was to enhance the delivery of high-quality, safe and accessible care closer to veterans in parts of four states [Christopher Doering, "VA ADvances Closure of Hot Springs Facility," that Sioux Falls paper, 2014.01.08].

South Dakota's liberal Congressional delegation is outraged at this move toward more efficient service provision and demands bigger federal spending in health care:

"I am deeply disappointed that the VA is now looking to move forward on a plan that many South Dakota veterans are adamantly opposed to and that could jeopardize the care those who have fought for our country need and deserve," [Congresswoman Kristi] Noem said in a statement [AP, 2013.01.08].

In defense of the Hot Springs VA facility, local government-run health care activist Patrick Russell launched this broadside against private sector health care:

Russell noted that closing the Hot Springs facility will mean “veterans will travel farther to wait in longer lines to receive their care. Or they will be forced to obtain their care in private sector facilities that do not have the capacity to care for more patients or the knowledge, skills and abilities to diagnose or treat illness and injury common to wounded warriors” ["VA Opts to Move Forward with 2011 Plan," Rapid City Journal, 2014.01.08].

Expect Noem to face tough questions from her 2014 election challenger about her defense of costly, inefficient government-run health care.


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