Published in the Current
I’m 29 years old, I hold a master’s degree, and I live in Maine. The state should pay me to stay here. In November 2001, the State Planning Office issued its “30 and 1000” report, saying that the two keys to improving and stabilizing Maine’s economy, income level and state tax revenue are having 30 percent of adults over age 25 with a four-year degree, and spending$1,000 per worker on research and development into new products and possibilities.
Evan Richert, who was director of the SPO when that report came out, spoke in Cape Elizabeth recently and continued his push toward that goal.
In terms of the 30 percent goal, he said about 23 or 24 percent of adults in Maine now have four-year degrees, up from 19 percent in 2001.
As for research and development money, it can be hard to come by in a state with a big budget crunch. The Maine Technology Institute, which provides seed money for R&D, is losing 10 percent of its funding under Gov. John Baldacci’s proposed spending for 2004-2005.
There is a lot of talk, but little action yet, about spending a few million to retool the state’s technical colleges into community colleges, and the UMaine system is also looking for money to spend on R&D, even as its budget belt tightens.
But there is an easy way to move closer to the “30” benchmark: Help the Mainers who already have four-year degrees. We’re already looking to other states for opportunities, especially those of us who are young. It’s cheaper to live in other states, and incomes are higher too.
Why should we stay in Maine, and why should people move here from elsewhere, when the cost of living is substantially similar, wages are much lower and there are fewer good jobs?
I would like to feel that the state recognizes my presence here as contributing to its economic well-being both now and in the future. Right now, I feel unappreciated by the state that is my home.
The simple solution is money, but how do you allocate it fairly?
One way would be through the state income tax. The state and individuals already use the income tax to exchange money. If I paid too much, the state gives it back; if I didn’t, I write the state a check.
Maine should add a box to the income tax form: “Check here if you are over the age of 25 and have a four-year degree.” Checking that box would permit a taxpayer to add, say, $500 to the standard deduction amount. For single filers, that would bump the amount of money exempt
from taxes up from $7,550 to $8,050. Married filers would go up from $6,775 to $7,275 per person.
If the state wanted to, it could require a photocopy of a college transcript be filed with the return – most of us have one somewhere, and I’d find it if it meant money in my pocket.
The tax rate on taxable earnings after the first $16,950 is 8.5 percent. By offering an increase in the standard deduction, the state would be losing in tax revenue 8.5 percent of that $500, per person with a degree, or $42.50 a head.
If one-fourth of the 1,275,000 people in Maine have a degree, there are just under 320,000 of us. It’s a rough estimate, but that would cost $13.6 million in lost revenue for the state.
That’s far less than the $43 million being allocated for R&D, and less than the $50 million to assist students in paying for higher education. It would be about 1 percent of what the state now collects in income tax – just over $1 billion – and less than 0.2 percent of what the state spends.
That $42.50 wouldn’t hurt the state budget much, or permit me to buy a lot, but it would say Maine’s government was thinking about me and valued my presence here. If Maine is trying to up the number of folks with college degrees, it should look at keeping what it has as a starting point.
Thursday, April 10, 2003
Hospitals struggle to care for patients, selves
Published in the Current
Healthcare costs are so high that one of Greater Portland’s major hospitals is considering dropping its private insurance coverage and setting up its own in-house insurance plan for employees.
Medical service and insurance costs are heading up, primarily because of rising demand for and increasing costs of healthcare, decreasing state and federal payments for Medicaid and Medicare and public demands that all levels of medical services be available everywhere.
Eileen Skinner, president and CEO of Mercy Health System of Maine, which runs Mercy Hospital and other facilities, including a Westbrook primary care center, said her company is considering saving money by self-insuring its staff. Mercy Hospital’s staff already has voted to up health insurance premiums for most of the staff, to keep premiums constant for the lowest-paid employees.
And it’s not alone in looking for ways to deal with the rising costs of care.
“We are struggling, like all hospitals in the state and in the country for that matter,” said Vincent Conti, president and CEO of Maine Medical Center, which has facilities in Scarborough and Portland.
Pressure is coming from a wide range of sources, including rising costs of technology, skyrocketing health insurance, government bioterrorism initiatives and the falling stock market, which is gutting non-profit endowments nationwide.
Medical technology continues to advance, making saving lives more expensive, though more effective. “All this wonderful technology doesn’t come at no price,” Conti said.
Staffing shortages have driven many medical jobs’ salaries higher, too. Nurses, pharmacy technicians and radiology technicians are among those who are seeing wages rise because of hospitals’ competition for employees.
An aging Maine population means more demand on services. With more and more people on Medicare and Medicaid, hospitals are feeling the pinch from state and federal budget cuts. “We get paid less than it costs us” to provide services, Conti said.
For every dollar the hospital bills Medicare and Medicaid – together 70 percent of the hospital’s patients – Maine Med only receives 80 cents. At Mercy, 57 percent of patients are on either Medicare or Medicaid. The difference has to be made up by charging more to people who have private insurance. “We’ve got to make money on that,” Conti said.
They also have to make enough from private payers to cover the costs of government-mandated bioterror initiatives. “Bioterrorism is a national security issue, and one would think that the cost of it should be borne by the general population,” said Mercy’s Skinner.
Higher premiums
This is where insurance companies come in. When HMOs came to Maine, they cut prices to attract customers. Their revenues were not enough to cover their costs, but by attracting more plan members the insurance companies were able to fill the gap temporarily.
Most left the state rather than face increased regulation and declining profits. Now that only Anthem is left, premiums are rising. “Premiums have gone up because health insurance companies are catching up,” Conti said.
Instead of charging discounted rates, they are trying to recoup their costs entirely from premiums, putting businesses and individuals in a financial crunch. The hospitals’ rising charges to private insurers only make that crunch worse.
Because the hospitals are raising prices to make up for shortfalls in government payments, they are effectively “taxing the people who walk through the front doors of the hospital” – the sick and the injured, Conti said.
To limit the impact, Maine Med is trying to cut costs where possible. It works with other hospitals to purchase services and devices in bulk, to keep costs as low as they can. Conti warns against cutting back in services and research.
Changing the system
Skinner, who came to Mercy a year ago from Louisiana, said the system needs to be changed.
“Conceptually, health insurance has become a pre-payment,” Skinner said. The only way people or employers can buy health coverage is to purchase a total plan, rather than the services that are needed at the moment. Employers who can’t afford a complete package don’t buy any coverage for their workers, and people who don’t need medical care now don’t pay for it either.
That leaves large numbers of people uninsured because the initial price point is too high. If there was a way to lower the entry price, many more people would have access to some care, Skinner said.
Each person should have a medical spending account, to which an employer could contribute, without having to shell out the full cost of total insurance. The state could put in some money to help poor people, and individuals could contribute to their own accounts. People who wanted more coverage could then buy a high-deductible insurance plan.
The improved access would reduce long-term costs, though initially more people than ever before would seek medical care they had postponed for lack of funding.
“When you insure a group of underinsured people, the utilization gets very high,” Skinner said. But that only lasts a short time. If, on the other hand, the structure remains the way it is, many people will only seek medical care when it becomes an emergency, at high costs to insurers and hospitals.
Doctors and nurses in emergency rooms are often stuck with an ethical dilemma. When faced with an uninsured person needing care, they either sign the hospital up to lose money or they turn away someone who is sick or injured.
“It’s not really fair for these people to make health care policy decisions on the spot,” Skinner said.
Planning medical services
Some of the long-term thinking could come from planning healthcare facilities intelligently, Conti said.
Though it may at first seem counterintuitive, putting a full range of medical services in every town would still not be the best thing to do.
“The distribution of (services) needs to be clinically appropriate,” Conti said. There is a balance that must be struck between geographic proximity to healthcare, and the cost and quality of that care.
When medical centers are more widely spread across an area, the staff at each location gets less practice, meaning lower quality care for its patients. And each center needs to purchase a certain basic amount of equipment to have on hand, increasing the overhead costs to pass on to patients.
Conti said some services should be widely available, such as first aid and delivering babies. Those will be used enough even in thinly populated areas to keep medical staff at the top of their games.
More specialized services like heart surgery, which is used less frequently than emergency care, should be in centralized facilities for a wider area, Conti said.
Choosing the locations for those centralized facilities should be based on medical needs, but often becomes a political discussion, Conti said. And requiring heart patients from all across Maine to come to Portland is not convenient, but ensures the best quality of care and the best price, Conti said.
Healthcare costs are so high that one of Greater Portland’s major hospitals is considering dropping its private insurance coverage and setting up its own in-house insurance plan for employees.
Medical service and insurance costs are heading up, primarily because of rising demand for and increasing costs of healthcare, decreasing state and federal payments for Medicaid and Medicare and public demands that all levels of medical services be available everywhere.
Eileen Skinner, president and CEO of Mercy Health System of Maine, which runs Mercy Hospital and other facilities, including a Westbrook primary care center, said her company is considering saving money by self-insuring its staff. Mercy Hospital’s staff already has voted to up health insurance premiums for most of the staff, to keep premiums constant for the lowest-paid employees.
And it’s not alone in looking for ways to deal with the rising costs of care.
“We are struggling, like all hospitals in the state and in the country for that matter,” said Vincent Conti, president and CEO of Maine Medical Center, which has facilities in Scarborough and Portland.
Pressure is coming from a wide range of sources, including rising costs of technology, skyrocketing health insurance, government bioterrorism initiatives and the falling stock market, which is gutting non-profit endowments nationwide.
Medical technology continues to advance, making saving lives more expensive, though more effective. “All this wonderful technology doesn’t come at no price,” Conti said.
Staffing shortages have driven many medical jobs’ salaries higher, too. Nurses, pharmacy technicians and radiology technicians are among those who are seeing wages rise because of hospitals’ competition for employees.
An aging Maine population means more demand on services. With more and more people on Medicare and Medicaid, hospitals are feeling the pinch from state and federal budget cuts. “We get paid less than it costs us” to provide services, Conti said.
For every dollar the hospital bills Medicare and Medicaid – together 70 percent of the hospital’s patients – Maine Med only receives 80 cents. At Mercy, 57 percent of patients are on either Medicare or Medicaid. The difference has to be made up by charging more to people who have private insurance. “We’ve got to make money on that,” Conti said.
They also have to make enough from private payers to cover the costs of government-mandated bioterror initiatives. “Bioterrorism is a national security issue, and one would think that the cost of it should be borne by the general population,” said Mercy’s Skinner.
Higher premiums
This is where insurance companies come in. When HMOs came to Maine, they cut prices to attract customers. Their revenues were not enough to cover their costs, but by attracting more plan members the insurance companies were able to fill the gap temporarily.
Most left the state rather than face increased regulation and declining profits. Now that only Anthem is left, premiums are rising. “Premiums have gone up because health insurance companies are catching up,” Conti said.
Instead of charging discounted rates, they are trying to recoup their costs entirely from premiums, putting businesses and individuals in a financial crunch. The hospitals’ rising charges to private insurers only make that crunch worse.
Because the hospitals are raising prices to make up for shortfalls in government payments, they are effectively “taxing the people who walk through the front doors of the hospital” – the sick and the injured, Conti said.
To limit the impact, Maine Med is trying to cut costs where possible. It works with other hospitals to purchase services and devices in bulk, to keep costs as low as they can. Conti warns against cutting back in services and research.
Changing the system
Skinner, who came to Mercy a year ago from Louisiana, said the system needs to be changed.
“Conceptually, health insurance has become a pre-payment,” Skinner said. The only way people or employers can buy health coverage is to purchase a total plan, rather than the services that are needed at the moment. Employers who can’t afford a complete package don’t buy any coverage for their workers, and people who don’t need medical care now don’t pay for it either.
That leaves large numbers of people uninsured because the initial price point is too high. If there was a way to lower the entry price, many more people would have access to some care, Skinner said.
Each person should have a medical spending account, to which an employer could contribute, without having to shell out the full cost of total insurance. The state could put in some money to help poor people, and individuals could contribute to their own accounts. People who wanted more coverage could then buy a high-deductible insurance plan.
The improved access would reduce long-term costs, though initially more people than ever before would seek medical care they had postponed for lack of funding.
“When you insure a group of underinsured people, the utilization gets very high,” Skinner said. But that only lasts a short time. If, on the other hand, the structure remains the way it is, many people will only seek medical care when it becomes an emergency, at high costs to insurers and hospitals.
Doctors and nurses in emergency rooms are often stuck with an ethical dilemma. When faced with an uninsured person needing care, they either sign the hospital up to lose money or they turn away someone who is sick or injured.
“It’s not really fair for these people to make health care policy decisions on the spot,” Skinner said.
Planning medical services
Some of the long-term thinking could come from planning healthcare facilities intelligently, Conti said.
Though it may at first seem counterintuitive, putting a full range of medical services in every town would still not be the best thing to do.
“The distribution of (services) needs to be clinically appropriate,” Conti said. There is a balance that must be struck between geographic proximity to healthcare, and the cost and quality of that care.
When medical centers are more widely spread across an area, the staff at each location gets less practice, meaning lower quality care for its patients. And each center needs to purchase a certain basic amount of equipment to have on hand, increasing the overhead costs to pass on to patients.
Conti said some services should be widely available, such as first aid and delivering babies. Those will be used enough even in thinly populated areas to keep medical staff at the top of their games.
More specialized services like heart surgery, which is used less frequently than emergency care, should be in centralized facilities for a wider area, Conti said.
Choosing the locations for those centralized facilities should be based on medical needs, but often becomes a political discussion, Conti said. And requiring heart patients from all across Maine to come to Portland is not convenient, but ensures the best quality of care and the best price, Conti said.
Board questions Kertes’ commitment
Published in the Current
Cape School Board member Kevin Sweeney questioned the wisdom of appointing longtime teacher and coach Kerry Kertes to serve as eighth-grade softball coach this spring because Kertes has threatened to quit over the firing of hoop Coach Jim Ray.
Sweeney made his comments at Tuesday’s regular School Board meeting, during discussion of proposed spring sports coaches.
Kertes, who also coaches the award-winning swim team, said last week that he would resign from his teaching and coaching jobs if Ray was not reinstated.
Sweeney said that statement called into question Kertes’ status as softball coach this season, because it was unclear whether Ray would be reinstated. “It would be unfair to that team to appoint a coach” who might walk away, Sweeney said.
Board members Jennifer DeSena and George Entwistle III spoke in defense of Kertes. DeSena said, “I would be surprised if he would leave the team
high and dry in the middle of the season.” She expected Kertes would give notice if he did decide to leave.
“This coach is committed to the team,” said Entwistle, who also noted the softball season had already started. Middle School Principal Nancy Hutton said the team’s first meeting was Tuesday.
Board member Susan Steinman agreed with Sweeney, but no other board members did, and Kertes was appointed to the position, along with a slate of other middle school spring-season coaches.
Cape School Board member Kevin Sweeney questioned the wisdom of appointing longtime teacher and coach Kerry Kertes to serve as eighth-grade softball coach this spring because Kertes has threatened to quit over the firing of hoop Coach Jim Ray.
Sweeney made his comments at Tuesday’s regular School Board meeting, during discussion of proposed spring sports coaches.
Kertes, who also coaches the award-winning swim team, said last week that he would resign from his teaching and coaching jobs if Ray was not reinstated.
Sweeney said that statement called into question Kertes’ status as softball coach this season, because it was unclear whether Ray would be reinstated. “It would be unfair to that team to appoint a coach” who might walk away, Sweeney said.
Board members Jennifer DeSena and George Entwistle III spoke in defense of Kertes. DeSena said, “I would be surprised if he would leave the team
high and dry in the middle of the season.” She expected Kertes would give notice if he did decide to leave.
“This coach is committed to the team,” said Entwistle, who also noted the softball season had already started. Middle School Principal Nancy Hutton said the team’s first meeting was Tuesday.
Board member Susan Steinman agreed with Sweeney, but no other board members did, and Kertes was appointed to the position, along with a slate of other middle school spring-season coaches.
Software helps students build skills
Published in the Current
CEHS math teacher Charlotte Hanna is piloting a computer program being eyed by school district officials as a way to help students who need extra help with specific skills in math and language arts.
As many as 15 percent of CEHS students will need additional help to meet the Maine Learning Results required for high school graduation beginning with the class of 2007. Most of those who will need help in math are students who enter high school either in tutorial math or pre-algebra. This year, those two classes are in one group of about 14 students, Hanna said.
She received a grant from the Cape Elizabeth Education Foundation to purchase software and a test-scanning device from the Renaissance Learning Company of Wisconsin.
Rather than being computer-based instruction with students sitting in front of keyboards, the software helps Hanna and special education teacher Ben Raymond, who is also in the classroom, keep track of the students’ individual needs and progress. It also customizes tests and homework.
“It generates individualized sets of problems for the students,” Hanna said. That alone would take hours of human time to create. Grading them is also computerized: A scanner accepts the test forms and gives feedback to students, while simultaneously updating the database with information on what learning objectives each student has mastered.
The problems, while answered on a multiple-choice form, are word problems or regular math problems testing over 200 skills, including place value, multiplication and common factors.
“Everybody’s test is on different stuff,” Hanna said. She can also get a report on every student’s progress, allowing her to work with each student on what he or she needs most. She can see easily if several people need help with the same topic, too. “I can do an individualized (work session) or a small group,” she said.
Students who don’t understand concepts can’t “hide” in her classroom. Each test or homework assignment shows what they know or haven’t yet learned.
The students also like the instant feedback. “When they scan, they get feedback right away,” Hanna said. There was a brief hiccough, after pipes broke in the high school building, soaking the scanner. A replacement took two months to arrive, during which Hanna and Raymond hand-graded and hand-entered the scores.
When they scan their tests, students can see what skills they have mastered, and can track their own progress over time.
It helps these students, some of whom have had trouble staying motivated. “The kids are pretty well focused on their work all the time,” Hanna said.
And beyond the specific skills they are learning, the program’s constant feedback and close monitoring of progress has another payoff. “We’re getting some positive attitudes toward math” in students who have historically ignored the subject, Hanna said.
When students come into the room at the beginning of the class period, they begin asking her questions about their homework, seeking help and wanting to learn. “That’s a wonderful thing,” Hanna said.
Many kids are catching up, getting closer to the proficiency considered normal for their actual grade level. Hanna credits the software for that change, and for some changes in her teaching style.
“I would do a lot more whole-class instruction,” she said. Now, “there’s much more one-on-one and small-group instruction.”
She said the school is planning to purchase additional modules for the software, adding pre-algebra and algebra. The company makes modules from kindergarten level through calculus, she said.
This type of monitoring does not take the instructional role away from a teacher, but offers powerful assistance where teachers are already crunched: test creation and monitoring individual progress.
“This is what the computer is designed to do,” Hanna said.
CEHS math teacher Charlotte Hanna is piloting a computer program being eyed by school district officials as a way to help students who need extra help with specific skills in math and language arts.
As many as 15 percent of CEHS students will need additional help to meet the Maine Learning Results required for high school graduation beginning with the class of 2007. Most of those who will need help in math are students who enter high school either in tutorial math or pre-algebra. This year, those two classes are in one group of about 14 students, Hanna said.
She received a grant from the Cape Elizabeth Education Foundation to purchase software and a test-scanning device from the Renaissance Learning Company of Wisconsin.
Rather than being computer-based instruction with students sitting in front of keyboards, the software helps Hanna and special education teacher Ben Raymond, who is also in the classroom, keep track of the students’ individual needs and progress. It also customizes tests and homework.
“It generates individualized sets of problems for the students,” Hanna said. That alone would take hours of human time to create. Grading them is also computerized: A scanner accepts the test forms and gives feedback to students, while simultaneously updating the database with information on what learning objectives each student has mastered.
The problems, while answered on a multiple-choice form, are word problems or regular math problems testing over 200 skills, including place value, multiplication and common factors.
“Everybody’s test is on different stuff,” Hanna said. She can also get a report on every student’s progress, allowing her to work with each student on what he or she needs most. She can see easily if several people need help with the same topic, too. “I can do an individualized (work session) or a small group,” she said.
Students who don’t understand concepts can’t “hide” in her classroom. Each test or homework assignment shows what they know or haven’t yet learned.
The students also like the instant feedback. “When they scan, they get feedback right away,” Hanna said. There was a brief hiccough, after pipes broke in the high school building, soaking the scanner. A replacement took two months to arrive, during which Hanna and Raymond hand-graded and hand-entered the scores.
When they scan their tests, students can see what skills they have mastered, and can track their own progress over time.
It helps these students, some of whom have had trouble staying motivated. “The kids are pretty well focused on their work all the time,” Hanna said.
And beyond the specific skills they are learning, the program’s constant feedback and close monitoring of progress has another payoff. “We’re getting some positive attitudes toward math” in students who have historically ignored the subject, Hanna said.
When students come into the room at the beginning of the class period, they begin asking her questions about their homework, seeking help and wanting to learn. “That’s a wonderful thing,” Hanna said.
Many kids are catching up, getting closer to the proficiency considered normal for their actual grade level. Hanna credits the software for that change, and for some changes in her teaching style.
“I would do a lot more whole-class instruction,” she said. Now, “there’s much more one-on-one and small-group instruction.”
She said the school is planning to purchase additional modules for the software, adding pre-algebra and algebra. The company makes modules from kindergarten level through calculus, she said.
This type of monitoring does not take the instructional role away from a teacher, but offers powerful assistance where teachers are already crunched: test creation and monitoring individual progress.
“This is what the computer is designed to do,” Hanna said.
Truck spills fuel in South Portland
Published in the Current
A tanker truck carrying 8,000 gallons of fuel flipped over early Monday morning, spilling jet fuel into the street and into storm drains leading to the Fore River and Casco Bay. At least one oil-covered bird has been found dead, and several birds coated with oil have survived, though the full environmental impact remains to be seen.
The truck overturned right outside the South Portland Central Fire Station at the corner of Broadway and Route 77, and closed the Casco Bay Bridge for hours, delaying traffic heading from Portland to South Portland.
Jon Woodard of the state Department of Environmental Protection said the truck was carrying 8,000 gallons. “All of it was released from the truck,” he said. Some was contained on the street and some went into storm drains leading to the water.
“We have collected a lot of it,” Woodard said. The DEP and Clean Harbors, a South Portland-based environmental company handling the cleanup, are using booms to contain the jet fuel that got into the water.
Woodard said the state Department of Marine Resources is sampling the water in the Fore River and Portland harbor to make sure no fuel escaped. He said there have been a few small sheens reported in both of those areas, but does not believe any significant amount escaped.
A spokesman for Clean Harbors said the amount of the spill was “sizeable.” The company said the cleanup is basically complete, but they will continue
to monitor the booms for the next several days.
Woodard said the level of environmental damage remained to be seen. He said the plants “are not really out yet,” and may not suffer much damage, while marine animals and shellfish have different levels of sensitivity to contaminants.
A tanker truck carrying 8,000 gallons of fuel flipped over early Monday morning, spilling jet fuel into the street and into storm drains leading to the Fore River and Casco Bay. At least one oil-covered bird has been found dead, and several birds coated with oil have survived, though the full environmental impact remains to be seen.
The truck overturned right outside the South Portland Central Fire Station at the corner of Broadway and Route 77, and closed the Casco Bay Bridge for hours, delaying traffic heading from Portland to South Portland.
Jon Woodard of the state Department of Environmental Protection said the truck was carrying 8,000 gallons. “All of it was released from the truck,” he said. Some was contained on the street and some went into storm drains leading to the water.
“We have collected a lot of it,” Woodard said. The DEP and Clean Harbors, a South Portland-based environmental company handling the cleanup, are using booms to contain the jet fuel that got into the water.
Woodard said the state Department of Marine Resources is sampling the water in the Fore River and Portland harbor to make sure no fuel escaped. He said there have been a few small sheens reported in both of those areas, but does not believe any significant amount escaped.
A spokesman for Clean Harbors said the amount of the spill was “sizeable.” The company said the cleanup is basically complete, but they will continue
to monitor the booms for the next several days.
Woodard said the level of environmental damage remained to be seen. He said the plants “are not really out yet,” and may not suffer much damage, while marine animals and shellfish have different levels of sensitivity to contaminants.
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