St. Cloud Times, Feb. 19
Congress must allow USPS cuts
For years, U.S. Postal Service officials have sent an SOS riddled with financial woes to Congress. Not surprisingly, lawmakers have continued to let the government-run but not government-funded service capsize.
On Feb. 6, USPS leaders stopped waiting for a response from lawmakers and announced the decision to cut mail delivery, but maintain package delivery, on Saturdays beginning in August.
The mail service estimates the move will save $2 billion a year.
It's a long overdue and much needed move. The agency's decision has produced little uproar, further solidifying it is the right call and Congress should not intervene — unless to modify legislation in the agency's favor — with the change.
But axing Saturday service only chips away at the Postal Service's deeper financial problems. Though the agency consolidated hundreds of facilities and made tens of thousands more cutbacks in its workforce, the agency still reported a loss of nearly $16 billion last year.
That's more than triple the $5.1 billion loss the previous year. The deficits can be attributed to a combination of the ailing economy, the Internet and obligatory pre-funding of retiree health benefits.
Last year, rather than file bankruptcy, the agency defaulted on $11.1 billion in payments to cover future retiree health care costs. That's a huge chunk of the $16 billion total, and without that and other labor-related expenses, the agency would have had an operating loss of $2.4 billion lower than in 2011, according to a Feb. 6 USA Today report.
Still, benefits and retirement funds are just part of the underlying problem. Raising a first-class stamp by a measly penny is not the answer, either.
As stamp prices slowly rise and the Internet becomes more prevalent, there's an increase in consumers who are paying their bills online. And the move to digital will only continue to increase over time.
Like all successful businesses, the Postal Service needs a plan that guarantees it will make money and stay out of debt. American Postal Workers Union President Cliff Guffrey is calling for a solution from Congress.
Congress can start by repealing the 2006 federal law that limits rate increases to the pace of inflation.
Postmaster General Patrick Donahue said he's continuing to press for legislation that will provide greater flexibility to control costs and make new revenues. He expects an increase in package delivery as e-commerce grows.
Congress has yet to commit to the change or any legislation, and already failed to pass a postal bill last year. As we've seen before, taxpayers end up footing the bill when Congress can't agree on a solution.
Donahue said the agency does not want and will not take any tax dollars.
It's a wise decision on his part.
The Free Press of Mankato, Feb. 18
Medical devices shouldn't get tax break
In a rare instance of cooperation, Minnesota Republicans and Democrats in Congress have united to try to repeal a new medical device tax.
In this case, the bipartisanship is being used in a misplaced effort.
The reason for the camaraderie by Republican Rep. Erik Paulsen and Democratic Sens. Amy Klobuchar and Al Franken is simple to understand — Minnesota has a big and powerful medical device industry, including Medtronic and St. Jude Medical, that doesn't like paying the tax.
The tax was part of the legislation to fund health care reform and put most all Americans on some kind of health insurance. The medical device industry already won a major concession when it got the proposed tax cut in half to 2.3 percent, which will raise about $2.9 billion a year when it kicks in next year.
The medical device industry is not being singled out. All industries tied to health care, from insurance companies to drug companies, knew they'd have to help pay for some of the cost of health care reform.
And the industry's stark warnings of job cuts and a reduction in innovative new discoveries are at best overstated.
A Bloomberg Government analysis done last year concluded the medical industry's claims of massive job cuts that would be triggered by the tax were "not credible."
When a push was made last session to repeal the device tax, proponents suggested replacing the lost revenue by trimming insurance subsidies for low- and middle-income workers under the health care law. That's a callous proposal that would undermine health reform and put more burden on the working poor so as to give a tax break to corporations.
The only reason this issue is still alive is because of the extraordinary influence of special interests like the medical device industry.
And it is another example of why carving so many loopholes into tax law in the first place is a bad idea. Every exemption from taxes given to some favored industry means everyone else — particularly those with less influence and means — end up paying more.
St. Paul Pioneer Press, Feb. 16
Nurse ratios are for hospitals, not legislators, to decide
They couldn't make headway on hospital staffing standards at the bargaining table, so Minnesota nurses again are taking their cause to the Legislature.
With all due respect to these dedicated health professionals, that's misguided. What do legislators know about running a hospital and caring for patients? Generally speaking, nothing.
A bill that ultimately would set staffing levels for nurses in hospitals across the state was introduced last week, with support from the Minnesota Nurses Association, the state's largest union for registered nurses, representing about 20,000 professionals.
Staffing legislation was introduced last year but didn't advance under Republican majorities. This time, the bill does not specify particular nurse-to-patient ratios, but would instead direct medical centers to implement staffing standards set by professional societies or a committee appointed by the state health commissioner.
Such a committee would have 12 members, two from the public and one representing hospital management, but nine who are nurses. Calling the arrangement "lopsided," as a Minnesota Hospital Association representative did, is an understatement.
Staffing ratios were a key issue in a lengthy contract dispute in 2010 involving the union and six Twin Cities health systems with 14 hospitals. Nurses didn't win the staffing language they sought, but they made clear they would ask the government to force hospitals to bend to their will in a fight that has persisted since the 1990s.
Commitments to work on staffing issues were among fence-mending statements after 2010 contract deal. "Hospitals agreed to work with us" on staffing issues, said Carol Diemert, nursing practice specialist with the union. "There has been little progress."
The parties should find a way -- away from the Capitol -- to seek solutions that will protect patients, yet control costs. Legislators are ill-prepared to run hospitals, and ill-advised if they try to do so.
For now, however, the differences run deep:
Nurses "honestly believe patients are at risk," Diemert told us. "The safety net is stretched too thin." According to a survey last year of MNA members, almost two-thirds of registered nurses worked more than two shifts a month with insufficient staffing.
Understaffing is "chronic, rather than episodic," Diemert said. The problem is, nurses are doing more in less time."
What's more, the Minnesota Health Department's annual report on "adverse events" in health care is "only the tip of the iceberg from the patient's point of view," Diemert said. It doesn't reflect the "near misses under the radar screen" that are prevented by dedicated nurses.
The Minnesota Hospital Association cites the excellence of Minnesota's health care system and the state's national leadership in patient safety. Among the stats: Together, Minneapolis and St. Paul have the safest hospitals in the nation among metro areas with at least 1 million residents.
Hospitals also express concern that restrictive, mandated staffing ratios would affect their ability to meet community needs at critical times -- for example, during the recent flu epidemic, in which one local emergency room was treating more than 260 patients in a day, about 35 to 40 patients above average.
In such situations, mandated nursing ratios might mean diverting patients to other hospitals, which might also be overwhelmed, with the patient in an ambulance, rather than the ICU.
And the cost: Potentially hundreds of millions of dollars statewide, according to Lawrence Massa, president and CEO of the Minnesota Hospital Association.
Mandated staffing also puts at risk "the equilibrium of the team approach to health care" that involves therapists, nursing assistants and others, said Sara Criger, president of Mercy Hospital in Coon Rapids and senior vice president of Allina Health.
The hospital association says a requirement to hire more nurses could mean layoffs or reduced hiring of other health care workers.
Only one state, California, has mandatory staffing ratios, which were introduced in 2004.
We couldn't think of another field that's regulated quite the way the bill would mandate operations in state hospitals.
"I can't either," Criger told us.
Student-teacher ratios aren't analogous, said Mary Pynn, chief nursing quality officer for HealthEast. By comparison, "a classroom is a stable environment with a defined number of students" and clear content objectives for what is to be accomplished. In a hospital, "patient care needs shift every hour." And even if it were an apt comparison, there's no one-size-fits-all agreement about student-teacher ratios, either.
The MNA's Diemert, however, points to government regulation in other industries from airlines to nuclear power, to trucking industry limits on hours in the cab and staff-to-child ratios in day-care centers.
As we've reflected on these pages, a good nurse is the best advocate a patient can have. Generally, nurses' concern for patient safety is real and sincere. But so are the cost pressures in health care. In an environment that will continue to change rapidly as technology advances, today's models won't be tomorrow's. Hospitals will need more flexibility, not less. The place for hospital staffing decisions is in the hospital, not the Capitol.