NewGeography.com blogs

While much of the media coverage on the ongoing healthcare reform debate has focused on partisan division, a less mentioned point of conflict exists between rural and urban healthcare interests.

Rural healthcare providers have long received lower Medicare reimbursement rates than their urban counterparts. Such geographic disparities are set by complex formulas that take into account (among other things) prevailing wage rates and assume higher costs of care provision in urban areas. Rural providers have argued that while wage rates may be lower in their communities, they face challenges in providing care not seen in urban environments, and are less able to take advantage of economies of scale potentially available in higher volume urban settings.

Rural concern over reimbursement rates has now become a point of contention in the heated healhcare reform debate. At issue is a proposal to have the so-called 'public option' "pay health care providers at reimbursement rates used by Medicare". Rep. Earl Pomeroy (D-North Dakota), a member of the House Ways and Means Committee, voted against what he stated was "a very urban bill." Another Democrat, Ron Kind of Wisconsin's 3rd District, also voted against the reform bill in committee, arguing that the proposed reimbursement rates were unfair, and that he didn't "want to lock our providers into a system where they continue to be penalized".

Perhaps sensing a growing threat to their healthcare agenda, the Obama administration appears to be making conciliatory moves to placate rural Democrats. On Tuesday, House "Blue Dog" Democrats, representing the more conservative wing of the Democratic Caucus, met with President Obama to discuss their concerns. On the table were proposed changes to the legislation focused on "protecting rural areas and small businesses."

Upon leaving the White House, Rep. Mike Ross (D-Arkansas) expressed hope that the meeting had yielded progress towards creation of an "independent Medicare advisory council". Such a council would, reports the Wall Street Journal, be empowered to "to make binding recommendations on how Medicare pays doctors and hospitals." This would appear to be a concrete step towards addressing rural concerns over potential geographic disparities under the public option. However, it remains to be seen if the proposed changes will be acceptable with representatives from more urban districts.

Unemployment in the construction sector increased by 79,000 in June, according to a report The Associated General Contractors of America released earlier this month. Over the past year, that number has grown to 992,000.

Even more alarming is the disparity between the construction worker unemployment rate, over 17.4 percent, and the national average for all sectors, around 9.7. Construction employment is crumbling before our eyes.

The current economic climate has not proven friendly to construction on the whole as state and local revenue continues to decline and little demand for commercial or retail facilities, as well as shrinking orders for new facilities, puts construction in a perilous zone.

Though as recent as last November, President-elect Obama had conjured up a program to rebuild the nation’s infrastructure.

The $787 billion American Recovery and Reinvestment Act would modernize roads, bridges, schools, and public transportation – among other things – and reinvigorate the floundering construction and manufacturing industries.

However, this “shovel ready” stimulus plan did not sit well with women’s groups who wanted nothing to do with a stimulus package that only created jobs for “burly men.”

These women’s groups seemed to misjudge the president-elects original plan designed to “stop the hemorrhaging in construction and manufacturing while investing in physical infrastructure that is indispensable for long-term economic growth” and instead turned the stimulus into an issue of gender politics. But from the first complaint, onward, the construction and manufacturing industries stood no chance.

Obama changed his plan, adding health, education, and “other human infrastructure components” to his proposal.

A report entitled “The Job Impact of the American Recovery and Reinvestment Plan” released on January 10, estimated that the number of jobs created that were likely to go to women was around 42%, a non-too disheartening figure when women “held only 20 percent of the jobs lost in the recession.” The report concluded that the stimulus package would now “skew job creation somewhat towards women.”

The act was signed into law on February 17 and over the past four and a half months some unfortunate figures have appeared. As noted previously, the construction industry is in a downfall, while there is a growing discrepancy between female unemployment rate (8 percent) and male unemployment rate (10.5 percent) – the highest male-female jobless rate gap in the history of the BLS [Labor Department] data back to 1948.

All this data, however, has pushed the issue of gender-politics above the issue of human need. Now which group of people should make their voices heard? Let’s hear from women in the construction industry.

I want to pass along this Wall Street Journal op-ed on some of crazy transportation goals starting to get traction in Congress. The main excerpt:

Messrs. Rockefeller and Lautenberg aim to "reduce per capita motor vehicle miles traveled on an annual basis." Mr. Oberstar wants to establish a federal "Office of Livability" to ensure that "States and metropolitan areas achieve progress towards national transportation-related greenhouse gas emissions reduction goals."

What does this mean? Most travel is not for its own sake. So reducing the total miles traveled -- whether the length or number of trips -- means people would have to reduce the activities they want and need to do. People would be "coerced," in effect, to live in less desirable places or work in less desirable jobs; shop in fewer and closer stores; see their doctor less frequently; visit fewer family members and friends.

There are three likely ways this could work. The cost of travel could be increased by raising the prices of vehicles or fuel; travel time could be increased by not expanding the highway system; or superior alternatives to the private car could be developed. The most likely way to increase the cost of travel would be by increasing fuel taxes perhaps to as much as $4 per gallon, as some have suggested.

Allowing congestion to increase travel times would be politically easier. In the name of "multimodal planning," for example, road-use taxes could be diverted, as Messrs. Rockefeller and Lautenberg suggest, to "increase the total usage of public transportation." But public transportation (where it's available) typically takes twice as long as automobile travel, so it's not practical for many Americans.

Moreover, public transportation (passenger rail services, subways, buses, light rail) requires heavy subsidies, while roads mostly pay for themselves through fuel taxes. Our roads would be even more self-sustaining if 20% of the federal fuel tax were not already diverted to public transit from the federal Highway Trust Fund. Messrs. Rockefeller, Lautenberg and Oberstar want to grab even more money from the trust fund.

Americans have always valued their independence and mobility. One way to reassert their rights would be to abolish the misnamed Highway Trust Fund, which finances highway construction and maintenance. Let the states decide what roads they need and how to finance them. The present system expires on Sept. 30 unless Congress reauthorizes it. Let it die.

Sen. Kay Bailey Hutchison (R., Texas) has in this regard introduced the "Highway Fairness and Reform Act of 2009," which would explicitly allow states to opt out of the federal financing system. A companion bill has been introduced in the House.

If a significant number of states opted out of the federal system, it would collapse and responsibility for roads would revert to the states. The vast majority of road users would benefit from such a change. And, if "livability" standards were deemed desirable, local preferences would determine them, rather than federal "greenhouse gas emissions reduction goals."

You go, Kay. As I've said before, the personal vehicle is now a permanent part of our culture, but the engine technology will evolve to meet climate or energy needs. Transit is not a realistic answer for the vast majority. But beyond that, the Feds really shouldn't be in the transportation game any more. They built the interstate system - now leave local transportation decisions and funding to the states. That includes high-speed rail, which can be done by consortiums of states if they really want it. But, as Reason recently pointed out, inter-city buses make far more sense:

As I've said many times before, I am a life-long rail fan who has ridden trains on four continents. As a transportation professional, however, it's incumbent on me to advocate meeting transportation needs in cost-effective ways. Before we spent tens of billions of taxpayer dollars on inter-city passenger rail, I think it behooves us to take a closer look at the potential of inter-city bus travel.

...

Besides considerably lower fares than Amtrak, much wider geographic coverage, and a much smaller carbon footprint, inter-city bus service has something else going for it: negligible cost to taxpayers. The Nathan study puts the federal subsidy per passenger mile (averaged over the 10 years from 1996 to 2005) at 0.1 cents. Amtrak's figure is 19.2 cents. Those numbers are consistent with federal subsidy figures in the 2005 U.S. DOT Bureau of Transportation Statistics report "Federal Subsidies to Passenger Transportation."

I rest my case.

He even mentioned some of the luxury bus services with wifi popping up around the country - especially in the northeast - that appeal to a different demographic from Greyhound. How come we can't get one of those for the Texas Triangle?

This post is cross posted at Houston Strategies

A recent USA Today analysis of government disclosure and accounting records has revealed that counties that supported Obama last year have reaped more of the benefits of the stimulus package than those counties that supported Senator John McCain.

That federal aid, which amounts to around $17 billion, has been the first piece of the Obama administration’s stimulus package that can be tracked locally. The USA Today findings showed that Obama-counties received an average of $69 per person while McCain-counties received around $34.

While the disparity between the two looks bad on paper, it is not all that uncommon. As USA Today writes, “much of [the aid] has followed a well-worn path to places that regularly collect a bigger share of federal grants and contracts, guided by formulas that…leave little room for manipulation.”

The aid has gone to repairs for military bases, improvements in public housing and helping students to pay for college – all areas that eclipse political party lines. Additionally, about a third of the $17 billion allocated towards projects such as runway repaving and nuclear waste clean up has gone to counties that supported McCain.

It is far too soon to be drawing conclusions about a stimulus effort that favors Obama’s constituents. While we can keep an eye out for “political favoritism,” ensuring that the stimulus aid lands where it’s most needed (regardless of county) should be our first priority.

If you think that Wall Street’s vapor traders helped house the nation’s people then you are probably eagerly looking forward to how they will keep our environment clean. Under current “free-market” cap and trade proposals the same people who brought you the housing bubble and have contributed to wild swings in energy prices are eagerly anticipating their next vaporous bonanza. Senator Byron Dorgan of North Dakota, one of the few elected officials vigilant enough years ago to foresee the effects of financial deregulation, believes there is a better way. And his proposed solutions will reduce carbon emissions without leaving the future our environment in the hands of speculators – wizards though they may be. Let’s hope, as The Who was once proclaimed, we won’t get fooled again.