Health care mandate a volunteer’s dilemma

MY wife and my 20-year-old son were transfixed to the TV as I walked in the door Wednesday night. The evening news was quoting a Supreme Court justice. He was responding to arguments by the U.S. government’s executive and legislative branches why the Affordable Care Act is constitutional.

I was actually shushed. They wanted to hear the debate.

Fascinating. Invigorating. All the ings times 10.

These last few days have been better than any movie as far as showing democracy in action, American style. The third branch of government strutting its stuff. People waiting five days for a seat in the gallery of the Supreme Court. A landmark law and the Constitution pit one against the other.

All I could add was: “Andy, it’s all about the public good.” Meaning, the reason for requiring every adult to have health insurance (the individual mandate) is so everyone pays. Now, the 20-30 percent not covered use hospital emergency rooms, etc., and those of us who pay for insurance pay for their care, too. They get off scot free. The health insurance companies raise the rates for the uncovered about $1,000 a year per family, the government argued, so employees pay more out of their paychecks for health insurance, employers pay higher rates for their group plans, etc. I can’t tell you how many times I’ve sat in editorial boards and heard hospital administrators say they are passing on the cost of the uninsured to those who have insurance. Or, they close their doors to trauma patients.

What is a public good?

My youngest, Andy, 20, a junior studying business in college, quoted from his macro-economics lecturer, answering: “A public good is non-rivaled and non-exclusive.” It’s very good and it’s for everybody, in other words.

But Andy went on. “This is more about the volunteer’s dilemma,” which assumes it costs money to be the volunteer. “If enough people volunteer, than everybody gets the public good. It is only worth it if the benefit gain outweighs the cost,” he said, giving credit to his professor at University of California, Irvine, J.T. Carvalho.

In the health care debate, the insured are the volunteers. And the new law says the public good will outweigh the cost as long as everyone volunteers, so to speak. I realize use of the word “volunteers” may sound misleading here. People will have to buy health insurance but at reduced rates. At least, that’s the way Solicitor General Donald Verrilli Jr. argued it before the justices.

Just a quick glance at the transcripts can be very enlightening. Tuesday’s debate over the individual mandate is apt. Justice Samuel Alito said this is no different than the government “make(ing) people buy broccoli.” He also compared it to requiring everyone to buy burial services, since eventually that is something we will all need.

But Verrilli countered that the law is affecting commerce, the buying and selling of health insurance. That is the way Americans pay for health care. This is way different than other markets (like food and caskets). In Alito’s examples, you don’t have the cost shifting to others, but in health insurance you do.

To me, the better analogy is the state’s requirement for every driver to buy car insurance. Again, it’s so that we all share in the cost of accidents. Some say, well that’s different. One can choose not to drive.

Yes, that’s true. If you don’t drive (you take the bus or ride the train), you are not contributing to the auto insurance market. For health care, you would have to refrain from going to a doctor or emergency room – unless you paid cash. As Verrilli argues, sometimes you can’t make that decision. Sometimes (car accident, stabbing, shooting, hit by lightning, fall off ladder, slip on banana peel, you name it) you will need care and you’ll have to pay big time. Unlike driving, you can’t avoid being in this market. Hence the need for a health insurance mandate.

Unless you rely on herbal remedies and self-surgery. Is that the way the greatest country of the world is heading? I certainly hope not.

Stop starving our state universities

JUST by watching a bit of television the other night I could tell something is afoot in the world of higher education. Slick ads for Capella University, University of Phoenix, Devry Institute, ITT Tech are flooding the prime time airways.
These for-profit colleges have more money for ads than a pro-Romney Super PAC. Well, I don’t really know exactly who has more bucks, but my point is thus: Ads on TV are expensive.

While for-profit colleges are raking in students and profits, our own Cal State Universities are being sucked dry by the state and are closing their doors and windows quicker than a Midwestern homeowner in the path of twister.

If you don’t want to hear bad news, turn the page or click elsewhere. But if you are outraged over the way the state, our Legislature, and our citizenry have turned their collective backs on our Cal State University system, keep reading. Perhaps you can do something about it.

Last week, the CSU Trustees voted to freeze all admissions for next spring semester as a result of the state cutting $750 million in 2009-2010. That means, instead of the getting the usual 16,000 to 18,000 transfer students, they’ll narrow the door to about 2,000 to 3,000. And these are enrolled in a direct community college-to-CSU program started last year under SB 1440. Locally, Cal State Los Angeles and Cal State Fullerton are the only two campuses accepting transfer students in Spring 2013.

That’s the good news.

Schools, including the CSUs, UCs and Community Colleges are counting on voters approving the governor’s tax plan to raise the state sales tax by a quarter cent and also raise income taxes 2 percent on earners making between $300,000 and $500,000 and 3 percent for those earning more than $500,000. The extra revenue would stave off another $200 million cut to the CSUs set to trigger in late November.

If there are more cuts, the CSUs will reduce enrollment in the fall of 2013 by 20,000 to 25,000 students.

In a way parents can understand, that would mean current high school juniors who can’t get into Harvard or a UC and are trying to get into a Cal State would be affected. Up to 25,000 17-year-olds who fill out applications to one of the 23 CSU campuses will be rejected out of hand or put on waiting lists.

Some say the grade point average for a freshman to get into a Cal State Fullerton or Cal State Long Beach will rise to 3.5 (out of 4.0). Most of the adults who graduated from a CSU and are working in their fields wouldn’t get in today.

So sad. It’s a crime, really, that we’re squeezing hard-working middle class kids and families to the breaking point. The students that populate our CSUs today are the ones who later become accountants, teachers, engineers, nurses, writers, scientists and entrepreneurs thanks to the excellent training they receive.

Another tuition hike set to take affect in five months will raise the cost of attending a CSU to about $6,000 a year – just for tuition. Add books, room and board and a family will be paying $20,000 to $25,000 a year for each son or daughter at a CSU.

One of our sister newspapers wrote that many Ivy League schools are so rich with endowments they are reducing tuition, even for families with up to $175,000 in household income. It is becoming cheaper to attend Harvard than Cal State Fullerton.

I don’t think that families of today’s high school juniors realize the predicament they will be in if no new taxes are approved. I’ve heard stories of B or even A- students getting rejection letters from CSUs. Or, they could crash the community colleges, where record enrollment already prevents many students from getting necessary classes to graduate. Mt. SAC has 63,000 students per semester – the largest in the state. Getting classes is only half the battle – the other half is finding a place to park on campus.

And so it goes with our future generation. This is what we’re doing to young people who will be our country’s next leaders. Sure, wealthier kids and the handful who get into Harvard from the San Gabriel Valley will be fine. Some who earn lesser degrees from for-profit schools will be burdened with persistent college debt.

CSU graduates are huge contributors to what’s good in our society. Let’s not lose them. I don’t want to live in a world where the working class kids are left behind.

Another kind of recycling

THE GREEN WAY

Ever since the 1970s, the three R’s of the green movement were Reduce, Reuse and Recycle. It has served the recycling movement well, helping the planet through the recycling of aluminum cans, glass bottles and now, plastic.
A group of preservation minded planners, architects and activists are asking: Why don’t we apply the same green principles to old buildings?

In short, by not tearing down older buildings, that will divert tons of brick and metal from filling up our landfills. Preserving and adapting older buildings for new uses will increase their energy efficiency, reduce their carbon footprint and create jobs.

Just like when we recycle soda bottles and tires.

“We need to reduce, reuse and recycle when it comes to our buildings. Why not apply those three R’s to our built environment?” asks Chris Olson, president of the Alhambra Preservation Group.

For years progress was measured in how many old buildings are torn down and how many shiny new ones erected. This was the modus operandi of American commerce and it infected even architects and city planners. Preservations, on the other hand, have been singing the praises of historic structures but for cultural and aesthetic values. For example, they’d say nobody makes those Greene and Greene fitted beams and wood inlays anymore.

With the release of a documentary last year, “The Greenest Building: The Role of Historic Buildings in Creating a Sustainable Culture,” the preservation

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movement is going green. Screenings across the country, including one in Alhambra Thursday night hosted by Olson’s group, are pumping up the environmental aspects of historic preservation.
More than 74 percent of the commercial buildings in the country were built between 1950 and 2010, according to Ralph DiNola, a green building consultant quoted in the movie. Over the next 20 years, he says, Americans will demolish and rebuild 30 percent of this building stock, he says in the film.

Even replacing them with environmentally friendly buildings may not be necessary, he says. In fact, when the overall environmental cost is counted, a brand new building will cost more in materials mined, energy used, and in the release of pollution and greenhouse gases that raise health risks and cause global climate change.

“We haven’t made that transition when we talk of historic buildings,” he said.

Jane C. Turville, the movie’s writer/producer/director says in her blog that cities must develop environmental stewardship along with building stewardship. One of the topics at Thursday night’s panel discussion featuring Denise Lawrence-Zuniga of Cal Poly Pomona’s John T. Lyle Center for Regenerative Studies; Victoria Deise-Wilson with The Ratkovich Co. and Peyton Hall, managing principal of historic resources with the Gamble House in Pasadena was how to make adaptive reuse more economically feasible.

Turville says laws that preserve historic structures must not be “just another hoop to jump through” for developers. “It should be everyone who values a community’s sense of place.”

Combining environmental stewardship – i.e. preserving our hillsides, our forest, restoring our rivers – with building stewardship – i.e. Old Pasadena, Old Town Monrovia – is what gives the San Gabriel Valley its sense of place.

The SGV’s sense of place, and that of Whittier with its green hills and historic buildings, make for a more liveable space. The quality of life is better here than say, in the San Fernando Valley or in the city of Los Angeles.

Monrovia’s oak tree ordinance and historic preservation laws have raised that city’s property values. Restoring Pasadena’s City Hall dome and Rose Bowl help keep up the Rose City’s unique identity. Olson is trying to get Alhambra to incorporate a historical element into its general plan. That way, property owners can take advantage of federal and state tax breaks when they improve their historic structures.

A greener region, combined with the restoration of historic structures, ratchet up our area’s quality of life, or as Donovan Rypkema calls it in the movie, our “sense of place.”

If preservation of both buildings and open space is not pursued, then we run the risk of losing our sense of place: “For the first time in human history, many of us are locationally indifferent,” Rypkema warns.

Steve Scauzillo covers the environment and the communities along the Puente Hills. He’s the current recipient of the Aldo Leopold Award for Distinguished Editorial Writing from The Wilderness Society. Follow him on Twitter @stevscaz/twitter.com or email him at steve.scauzillo@gmail.com.

New study says diesel exhaust more dangerous

http://www.sgvtribune.com/ci_20146023/new-study-says-diesel-emissions-can-increase-risk?IADID=Search-www.sgvtribune.com-www.sgvtribune.com

A landmark government health study released last week provides evidence that the diesel engine exhaust that pervades California highways could be causing cancer at a greater rate than previously known.
The study says miners exposed to diesel engine exhaust are three times more likely to contract lung cancer and die, and that a similar increased risk applies to people from smoggy, urban areas such as Southern California who live near freeways or commute to work.

The long-term study, carried out by the National Cancer Institute and the National Institute for Occupational Safety and Health, is described by scientists and advocacy groups as the most thorough study on the topic ever released. The study was published in the current edition of the Journal of the National Cancer Institute.

The data will be examined by the International Agency for Research on Cancer, part of the World Health Organization, at the agency’s meeting in June to decide if diesel exhaust should be re-classified as a known carcinogen. Now, exhaust from diesel trucks, buses, portable generators and off-road construction equipment is classified as a “probable carcinogen.”

In California, studies of exposure to diesel exhaust along freeway corridors and inside cars on truck-congested freeways led the California Air Resources Board in 1998 to classify diesel particulate matter as a toxic air contaminant.

The latest ground-breaking study could lead to even tighter regulations

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on buses, trucks, locomotives, ships and other sources of black soot emitted into the air and breathed by 16 million Southern Californians.
“The more we find out about diesel exhaust, the more we are aware of its dangers to the public,” said Dimitri Stanich, a spokesman for CARB in Sacramento.

Martin Schlageter, campaign director for the nonprofit Coalition for Clean Air in Los Angeles, said the findings are frightening.

“This is not a three-fold increase in gray hair. It’s in lung cancer and death,” he said. “Every time a study comes out (on diesel emissions), it is even more toxic than what we thought. But the message is the same: Dirty diesel kills.”

In the San Gabriel Valley and Inland Empire, trucks on freeways are increasing, experts said. The Southern California Association of Governments (SCAG)’s Regional Transportation Plan estimates freight traffic – mostly by diesel trains and diesel trucks – will double in the region by 2032.

“If you live near the 60, or the 710, or the 605, you will have double the truck traffic,” Schlageter said.

SCAG has proposed a double-decker truck lane near the 60 Freeway between the 605 and 57 freeways, but only if the trucks that use it are zero emission. Those trucks would have to run on batteries, hydrogen-powered fuel cells or some type of overhead electrical power like a light-rail trolley, according to the RTP.

The study looked at 20 years of real data on miners exposed to diesel exhaust.

The authors of the study “make the leap” from the 12,000 miners to millions of urban Americans, said Bruce Hill, a scientist studying diesel emissions with the Clean Air Task Force, a group advocating for clean fuels and against coal-fired power plants.

“(The) findings suggest that the risks may extend to other workers exposed to diesel exhaust in the United States and abroad, and to people living in urban areas where diesel exhaust levels are elevated,” said Joseph Fraumeni Jr., director of the National Cancer Institute’s Division of Cancer Epidemiology and Genetics, which conducted the study, in a statement.

The study showed statistically significant increases in the risk of lung cancer mortality among underground workers as the level of diesel exposure increased, especially in those who worked for more than five years.

It concludes that the risk of dying from lung cancer was three times higher for those directly exposed to diesel exhaust than those exposed to lower doses of diesel exhaust, Hill said. Hill estimated those exposed to only 2 to 6 micrograms of diesel pollution over a lifetime – a much lower dose than received by the miners and a possible dose for urban dwellers

Diesel trucks travel the 60 Freeway through Hacienda Heights March 7, 2012. Diesel emissions are more dangerous than previously thought. Some say even commuters riding on the freeway can breathe in diesel exhaust and get exposure levels that cause cancer and premature death. (SGVN/Staff photo by Leo Jarzomb)
- would increase their risk of getting lung cancer by 50 percent.
“In some of the big cities, there may well be levels that reach that,” he said.

Hill’s own studies in Los Angeles County between 2003 and 2009 found that some levels of diesel exhaust exist in varying amounts on and near freeways, whether inside a diesel-powered school bus, a car on the freeway, or in the air in a neighborhood next to a freeway.

Drivers are exposed to higher concentrations than people standing on the sidewalk alongside a freeway due to the “wind tunnel” effect, Stanich said.

“If you are driving in L.A. every day and you are in traffic with diesel exhaust, you will get high exposures to these pollutants,” Hill said.

From his studies of diesel pollution inside cars riding in tunnels in Boston and other cities, he said keeping the car windows up will cut way back on exposure. Also, punching your car’s “recirculate” button will keep out harmful exhaust.

“Some newer cars today come equipped with HEPA filters. That really helps lower exposure,” Hill said.

A HEPA filter in a car traps the fine particles that measure 2.5 microns or smaller. These can lodge deep into the lungs and even enter the blood system, Stanich explained.

Also helping reduce exposure are CARB’s regulatory programs launched in 2000 with the goal of cutting airborne diesel particulate matter by 80 percent by 2020, Stanich said. CARB is supplying grants to help trucking companies replace fleets with newer, cleaner truck models or retrofit them with particulate traps. Also, sulphur has been removed from diesel fuel.

“A diesel truck sold today is more than 90 percent cleaner than one sold 20 years ago,” Stanich said.

Dennis Firestone, president/CEO of KKW Trucking, Inc. in Pomona, said he has been attacking the problem of exposure to diesel in two ways: buying cleaner tractors and reducing fuel use.

The Pomona-based company has about 350 trucks that transport in several western states. The average age of his fleet is 1 1/2 years old, he said, due to an aggressive replacement plan.

Recently, ACE Beverage Co. of Boyle Heights replaced 25 old trucks with brand new ones, with the help of a grant from the South Coast Air Quality Management District. AQMD said the trucks are 96 percent cleaner.

“There has been a significant reduction of emissions over the last decade,” Firestone said. “So the danger is diminishing rapidly. That’s the good news.”

He also reduces fuel used by KKW trucks by prohibiting idling in the truck yard and by participating in a U.S. EPA program that helps trucks yield better mileage through add-on devices such as “belly skirts” that increase aerodynamics.

The NCI study uses 20 years of real data to gauge the risk of diesel exposure on miners, making it extremely valuable to scientists. However, its results were suppressed by mining and diesel-truck manufacturing lobbies since the late 1990s.

The House Committee on Education and the Workforce and the federal courts allowed these industries to review the study results before they could be published. The agencies that performed the study fall under the Department of Health and Human Services (HHS).

Recently, HHS appealed the court order and went ahead and published the study results, according to The Center for Public Integrity, which had pushed for publication.

steve.scauzillo@sgvn.com

626-962-8811, ext. 2237