Op-Ed: Make Obamacare Work by Carol Voyles

“Rammed through Congress” after a year and a half of deliberations and seventy-nine congressional hearings, the Affordable Care Act has covered millions more of us. Now, after sixty knowingly futile attempts to repeal it, no viable replacement yet in sight, and just one hearing, we are being asked to believe promises to cover everyone at less cost will be kept.

This will likely take more time. Very few of us agree with Paul Ryan that 24 million losing coverage to save $300 billion over a decade “exceeds expectations.” Conservative Wall Street Journal columnist Peggy Noonan has surprised us. She has had enough and has recommended that Medicare be made available to many, many more of us.

We have made progress, though. Millions more of us have coverage, for now; and some health care costs are down; but there is clearly work to be done as long as better outcomes are delivered in other nations at less cost.

The National Academy of Medicine and Health has suggested that unnecessary care may account for up to half of our costs. We do know that no other nation performs surgical procedures at our rate. Cardiac bypass surgery also costs twice as much here as in Canada, although our clinical outcomes are virtually identical. Life expectancies are longer in Canada, too.

In 2009 our nation’s highest per capita Medicare costs were found in Miami, Fla. The population of second-place McAllen, Texas, better reflected our demographic average, and yet McAllen was spending double our nation’s average. Litigation was suggested as a cause, but a law limiting awards for medical damages had been passed, and lawsuits for malpractice had become nearly nonexistent in Texas.

They were doing more, but primary care was being overlooked. By 2011 the Affordable Care Act was encouraging any physician’s group with more than 5,000 Medicare patients to become an Accountable Care Organization, prioritize patient outcomes, and receive bonuses for the savings they produced.

Focusing more upon primary care and patient education, McAllen moved in a positive direction. By 2014 its ACOs had saved $26 million, 60 percent of which went back to the participants.
Health care insurance premiums were growing at slower rates than during the Bush administration, too, until it became clear that insurance doesn’t work efficiently when purchased only by those who need it.

Repealing the individual mandate is on the agenda now, and we have been advised that we might have “more skin in the game.” Our health care already costs us more, though, and prices aren’t likely to go down as long as we are driving farther to see fewer doctors less frequently. NationMaster finds proportionately more physicians in 51 other nations, and they are seeing their patients more often.

Having choices and a level playing field helps control prices, but when it comes to health care we may not only find ourselves with limited choices, we may not be up to the task of shopping around. In such cases oversight may be required. This is the role of government, and it’s up to us to make it work.

Concerning the repeal or reform of the ACA, President Obama has stated clearly, “If it works, I’m for it.” As long as patient outcomes are prioritized and more of us are covered at less cost, he welcomes change. We might let our representatives know that we would like them to move beyond ideology, work together, and do what works. Becoming a healthier nation at less cost is in all of our best interests.

Looking beyond our borders to see how things might work may be a leap, but hundreds of thousands of us are going abroad for more affordable care. Too bad we aren’t permitted to buy our medications abroad. That would bring our costs down, too.

Lower administrative costs would also be helpful, and for that we need look no further than our very own single payer base with private options. We love our Medicare. Allowing more of us to choose it would be a start.

Carol Voyles of Sherwood is treasurer of the Talbot County Democratic Central Committee and a board member of the Talbot County Democratic Forum.

Op-ed: Marijuana legalization Shouldn’t be Held Hostage to Drugged Driving Concerns by Paul Armentano

Maryland lawmakers are once again considering legislation to regulate the adult use and sale of marijuana to those age 21 or older. Nearly six in 10 residents support this reform, according to a February Goucher poll. But opponents charge that doing so could pose a risk to traffic safety.

Such concerns are not all together unfounded, but deserve to be placed in proper context.

First, it should be stressed that driving under the influence of marijuana is already a criminal offense in Maryland. Nothing in the language of Maryland’s proposed adult use laws changes this reality.

Second, scientific studies consistently find that marijuana-positive drivers possess a comparatively nominal accident risk, particularly when compared with alcohol-positive drivers. In fact, the largest ever controlled trial assessing marijuana use and motor vehicle accidents, published in 2015 by the U.S. National Highway Traffic Safety Administration, reports that marijuana positive drivers possess virtually no statistically significant crash risk compared to drug-free drivers after controlling for age and gender.

By contrast, drivers with detectable levels of alcohol in their blood at legal limits possess nearly a four-fold risk of accident, even after adjusting for age and gender.

This finding is consistent with prior meta-analyses of crash risk data. For example, a review of 66 separate crash culpability studies published in the journal Accident Analysis and Prevention reported that THC-positive drivers possessed a crash risk on par with drivers testing positive for penicillin (Odds Ratio: 1.10 for cannabis versus Odds Ratio: 1.12 for penicillin) This risk is far below that associated with driving with two or more passengers (OR=2.2) and is comparable to the difference between driving during the day versus driving at night.

Further, data from states that have liberalized marijuana’s legal status show no uptick in motor vehicle crashes. Writing in December in the American Journal of Public Health, investigators at Columbia University reported, “[O]n average, medical marijuana law states had lower traffic fatality rates than non-MML states. …. Medical marijuana laws are associated with reductions in traffic fatalities, particularly pronounced among those aged 25 to 44 years. … It is possible that this is related to lower alcohol-impaired driving behavior in MML-states.”

A review of federal FARS data (Fatal Analysis Reporting Systems) further finds that trends in motor vehicle accidents in Colorado and Washington post-legalization are no different than crash trends in non-legalization states over this same period of time.

Nevertheless, the use of marijuana prior to driving ought to be discouraged and better efforts ought to be made to identify drivers who may be under the its influence. These include greater funding for the training of Drug Recognition Evaluators, the use of modified roadside field sobriety tests, and potentially the provisional use of roadside marijuana-sensitive detection technology, such as saliva test or breath test technology.

These efforts should not include the imposition of per se thresholds for THC or its metabolites, as such limits are not scientifically correlated with driver impairment.

Efforts should also be made to better educate the public with regard to the existing traffic safety laws, as well as to the evidence surrounding marijuana’s potential influence on driving. In particular, this messaging should stress that combining marijuana and alcohol greatly impacts driving behavior and is associated with far greater risk of accident than the use of either substance alone.

Such an educational campaign was implemented nationwide in Canada by the Canadian Public Health Association and could readily be replicated in the United States and promoted by groups like the American Automobile Association.

In addition to increasing public safety, implementing these steps would help assuage concerns that regulating the adult use of marijuana could potentially lead to an increase in incidences of drugged driving or limit the state’s ability to successfully identify and prosecute such behavior.

Adults’ consumption of and demand for marijuana is here to stay. It is time for Maryland lawmakers to acknowledge this reality. It is time to stop ceding control of the marijuana market to untaxed criminal enterprises and to regulate its adult use and sale accordingly.

Paul Armentano is the deputy director of the National Organization for the Reform of Marijuana Laws (NORML) and is the co-author of the book “Marijuana Is Safer: So Why Are We Driving People to Drink.”

Op-Ed: The Case for a Fracking Ban by Paul Roberts and Mike Tidwell

Next week, on Feb. 28, the Health, Education and Environmental Affairs Committee in the Maryland Senate will take up legislation dealing with shale-gas drilling (fracking). For public safety, economic, and environmental reasons, we believe the technology should not be allowed in Maryland.

Nearly three out of four senators have indicated a willingness to extend the current fracking moratorium, set to expire in October. This suggests they recognize that gas-drilling will not be the economic bonanza that supporters have claimed since 2011, when the mountains above Marcellus Shale deposits in Western Maryland were first targeted.

Two bills are pending. one bans fracking altogether, while the other extends the moratorium for two years—though it departs from the current moratorium by permitting fracking in counties that approve it by referendum. On the ban bill, 23 of the Senate’s 33 Democrats are co-sponsors; the moratorium bill has 24 co-sponsors, including several Republicans.

In the House of Delegates, leadership declared long ago that a frack-free Maryland was its preference. A ban bill is advancing, and there is no moratorium bill. After committee hearings, legislation may go to the floor of each chamber for further debate. If the House and Senate don’t pass the same bill, some sort of compromise is required before any legislation can be approved and sent to the governor for his consideration.

About three-fourths of Marylanders already live in a place where local elected officials have created anti-fracking laws or resolutions. But fracking is regulated by the state. So, for those who’ve worked for six legislative sessions on the issue, the “heavy lift” is in the Maryland Senate.

Unlike neighboring Pennsylvania and West Virginia, Maryland did not rush into fracking. Successive administrations studied the technology, then overhauled outdated regulations. Meanwhile, energy prices continued to fall. The industry allowed nearly all of its original sub-surface mineral leases purchased last decade to lapse.

Furthermore, Maryland lacks large-scale deposits, the pipeline and processing infrastructure, or interest from industry (in the form of leased mineral rights) to make large-scale fracking financially feasible today. Yet we can’t rule out a change of circumstances that drives up fossil fuel prices—setting set off a new round of leasing that leads to fracking in years ahead.

Meanwhile, mounting problems elsewhere show the technology cannot be effectively regulated. In Pennsylvania recently, investigators from Public Herald, an investigative journalism nonprofit, dug up previously undisclosed citizen complaints about water contamination from fracking. Their work took years. Far from regulators’ 280-odd citations against industry, Public Herald found some 4,100 complaint filings—all told, one official complaint for nearly every well drilled. There’s more. It appears that the vast majority were never investigated. Then unresolved original complaints were shredded. Hundreds of state law violations were documented, and Flint, Mich.-style government criminality is a possibility.

In recent weeks in Western Maryland, many residents were infuriated by the Senate president’s public remarks that “there are no jobs whatsoever” in that part of the state. In fact, the unemployment rate in Western Maryland in 2016 was almost identical to the state average, and lower than some counties. Long gone are the days that Mountain Maryland depended overly on extractive energy and assembly line work.

Tourism and vacation real estate provide about half of all jobs and two-thirds of Garrett County’s tax base. Some of the highest-value rural real estate in the eastern United States lines the shores of Deep Creek Lake—second only to Ocean City as a vacation destination for Marylanders. Generations have visited and created the magical memories that many families cherish forever.

To state the obvious, nowhere in the world do fracking and world-class tourism mix. That’s why in Florida right now, with Republicans in charge, the legislature is considering a fracking ban. Florida’s economy is Deep Creek’s, writ large.

Additionally, fracking is “anti-business”: While a few short-term jobs may be created, most Western Marylanders—like others in a state where the solar industry grew 40 percent in 2015—prefer small-business ownership, with sustainable economic investments in tourism, agriculture, and green energy.

Mountainside solar installations are burgeoning. Indeed, Western Marylanders want the same future as the rest of the state. Most polls show that a strong majority of Garrett and Allegany county residents want the fracking ban that Marylanders as a whole support.

Is this another “jobs versus environment” debate? Not at all. Nationally, less than 10 percent of jobs on a well-pad are unionized. Along with embalmers and theater projectionists, zero petroleum engineers belong to unions.

The Laborers International Union recently came out in support of fracking and staged a rally in Annapolis. In a union with a proud tradition of training workers in emerging industries, wouldn’t organizing solar-industry installers sustain and grow its membership?

Finally, there’s the matter of fracking’s effect on global climate change. Farmers statewide are already feeling the effects of erratic precipitation, unpredictable freezes and bigger storms. This year, the annual “Winterfest” festival in Oakland, Md. (the state’s “snowiest” town) was postponed due to spring-like weather.

Scientists agree that fossil fuel combustion is driving planetary warming. And new scientific analysis confirms that fracked gas is nearly as bad as coal for the atmosphere. That’s because, before it is burned at distant power plants or on your stovetop, natural gas (mostly methane) is constantly leaking from wellheads, pipelines and compressor stations. Estimates of leakage vary from about 2 percent of production to more than 10 percent. Overall, carbon dioxide is a more potent greenhouse gas, but in the short-term—measured in 20-year periods—methane is orders of magnitude more detrimental. So the life-cycle warming impact of gas rivals coal. To save our climate, we have to steadily move off of gas, not increase its use through reckless fracking.

For Maryland’s economy, health and environment, we need to ban fracking once and for all. This drilling method will never be safe. We have all of the data we need on that. Now we just need the political will of our leaders in Annapolis to finally do the right thing.

Paul Roberts served as a state commissioner on a special fracking study panel under former Gov. O’Malley, and is the board president of Citizen Shale in Western Maryland. Mike Tidwell is director of the Chesapeake Climate Action Network.

Op-Ed: Death with Dignity Debate by Robert Bjork

In a recent Spy op-ed, Michael Collins suggested that we need to debate this issue because the proponents of the bill provide personal stories (he calls them tales) that rely on raw emotion to promote these acts and should make us pause before enacting them. In his article he then goes on an emotional journey of his own by using loaded words suicide, killing, and euthanasia to describe this bill and with his own tales of abuse in the Netherlands.

His first sentence in an attempt to explain this act contains the following “….to obtain lethal doses of drugs with which to kill themselves”. A person in this position is not killing themselves they are already going to die very soon. They are choosing to end their lives when, where, and with whom they love. Throughout his article he continuously refers to death with dignity as suicide and even euthanasia.

Medical aid in dying is fundamentally different from suicide:

A person seeking medical aid in dying wants to live but not with the physical or emotional pain that living would require. The person considering suicide has no terminal illness buts want to die.

A person seeking medical aid in dying, is suffering life-ending illness and understand that further treatment is inappropriate and there is no hope for a better outcome. Those considering suicide see no hope but do not recognize their problems are treatable.

People seeking medical aid in dying are deliberate in their request and will often include family in their discussions with their physicians. The act of suicide is secretive and often impulsive without involvement of family, friends, and healthcare professionals.

Equating medical aid in dying with euthanasia is hypocritical. Euthanasia is commonly a lethal injection given by a third party. It is frequently done without the consent or approval of the patient. The bill in the Maryland General Assembly does not allow euthanasia.

Mr. Collins also talks about Doctors violating the Hippocratic Oath. I assume he means the often quoted “do no harm”. Are Doctors doing no harm when they make decisions about treatment based on their expertise alone followed by pushing patients into dangerous treatments that have no hope of improving a person’s life or even prolonging their life? I believe doctors need to obtain a sense of the patients own priorities before discussing treatment options.

Doctors should not be the final arbitrator in this decision it should be up to the person to make that choice.

One of the major components of this bill is that before a Doctor can prescribe a lethal dose of medicine the Doctor must provide the patient with a complete picture of all their end of life options including pain and symptom management, hospice, Voluntarily stopping eating and drinking, declining or stopping life-sustaining treatment, palliative sedation, as well as medical aid in dying.

I don’t disagree with Mr. Collins in that the end of life medical treatment provided in this country needs to be fully debated and thought about. This includes reexamining what medical professionals are taught in medical school.

Mr. Collins should look at Oregon and not the Netherlands for understanding how this law works. This law has been in effect in Oregon since 1997 and in that time End-Of-Life care has improved due in large due to the dialogue encouraged by the law between people and their doctors. Hospice use is high as is other use of palliative care. Some hospice programs reported a 20% increase in referrals since the law went into effect. The in-hospital death rates are the lowest in the nation, in-home death rates are the highest, and violent suicide among hospice patients has virtually disappeared.

Op-Ed: The View of an Oyster Sanctuary from CBF’s Perspective by Tom Zolper

The fate of Maryland’s oyster population is being worked out in a church basement in Annapolis.

That’s where the state Oyster Advisory Commission (OAC) meets the second Monday of each month. This is the group appointed by Governor Hogan to review the state’s oyster management system, and to recommend changes, if necessary.  

This past Monday night was perhaps the most important OAC meet so far. The Department of Natural Resources (DNR) presented a proposal to open up about 970 acres of ‘sanctuary’ oyster reefs to harvest.

As I have on several occasions, I sat in on the OAC meeting. But it was difficult to sit still.

The makeup of the OAC is controversial, filled mostly with watermen and those who sympathize with their views. The direction the OAC is taking also is controversial.  

The controversy brings out the crowds. The OAC meetings used to take place in a meeting room at the DNR headquarters right next door. So many people began showing up, DNR had to move the meeting to the fellowship hall of the Calvary United Methodist Church on Rowe Blvd. Now even that room is often jammed.

Watermen feel the state has cheated them. Under prior governor Martin O’Malley the state increased the acres of productive oyster reefs set aside as sanctuaries—those areas that can’t be harvested. O’Malley himself was guided by scientists’ warnings that so few oysters remained in the Chesapeake that the status quo was no longer viable.

With input from everyone involved with oysters, the harvest industry included, O’Malley increased from nine percent to 24 percent the portion of oyster bars protected as sanctuaries. Three-quarters of reefs were to remain open to harvest. He also relaxed decades-old regulations to give watermen more opportunities to farm oysters rather than harvest them in the wild. In Virginia oyster aquaculture is a booming business, but at the time of O’Malley’s new plan it was negligible in Maryland. The idea was to boost watermen’s earnings, and simultaneously to take out an insurance plan for the future of oysters in the Bay.

There’s no doubt short term watermen took a hit. They had fewer places to harvest, although fortunately for them Mother Nature provided strong oyster reproduction for several years, resulting in strong harvests.  

Scientists and groups such as the Chesapeake Bay Foundation (CBF) where I work sympathized with the watermen. But we believed someone had to take the long view before oysters were wiped out completely.

CBF, along with a host of western and Eastern Shore groups such as the Midshore River Conservancy, St. Mary’s River Watershed Association, and others, believe the OAC proposal to shrink the sanctuaries is ill-advised. At a minimum, the state must wait till DNR finishes a stock assessment of the oyster population. You wouldn’t start spending more money without knowing what’s in your bank account. That’s exactly what the proposal would do.

It would open up 1277 acres of sanctuaries for harvest in the following rivers and Bay segments: Upper Chester, Miles, Wye, Upper Choptank, Hooper Strait, Upper Patuxent and Tangier Sound. It would expand sanctuaries by 300 acres in: Mill Hill/Prospect Bay, Eastern Bay, Lower Choptank and Nanticoke River. The net result would be 977 fewer acres in sanctuaries, an 11 percent reduction in those sanctuary acres.

It’s only 11 percent, you might say. But it’s 11 percent of the most productive, healthy sanctuary bars in the Bay. And it is giving away these protected areas before we have any idea the true size of the oyster population. That’s not scientific. That’s not sound judgment. Harvesting oysters on those 977 previously protected acres could do irreversible damage to the fragile population.

A bill in the Maryland General Assembly, HB 924, would freeze any alterations in the sanctuaries till after the stock assessment. Oyster harvesting is the only major fishery in Maryland that isn’t managed with a science-based plan. It pays us to wait till we have the science before we implement a major change such as OAC is considering.

The bill will be heard this Friday, Feb. 24, at 1 pm in the House Environment and Transportation Committee. We urge people concerned about the proposal to shrink sanctuaries to make their voice heard.

Tom Zolper is Assistant Director of Media Relations at the Chesapeake Bay Foundation. For more information about CBF please go here.

 

  

Op-Ed: Legislating Death with Dignity needs Debate with Dignity by Michael Collins

The introduction again of legislation that would allow people with terminal illnesses to obtain lethal doses of drugs with which to kill themselves has reignited the debate about assisted suicide in Maryland.

The attraction of the “Richard E. Israel and Roger “Pip” Moyer Death End-of-Life Option Act,” HB370 and SB354, is understandable. Who has seen people in the last stages of a terminal illness and not thought, “What can we do to ease their suffering?” Whose heart has not gone out to families whose loved ones endure often intense pain as they die?

I’m sure many people have thought, “If I am ever in that condition, I don’t know how long I’d want to hang on.”

These laws’ advocates often use intensely personal tales, such as that of former Annapolis Alderman Dick Israel, who succumbed to Parkinson’s disease, and, Brittany Maynard, a 29-year-old California woman with terminal brain cancer, who moved to Oregon to take advantage of that state’s assisted-suicide law.

Yet, that the passage of these laws relies so heavily on their raw emotional appeal should make us pause. We need to ask some hard questions about these issues and think just as hard about their potentially ugly answers.

Have we exhausted all options related to palliative care? If there are laws and regulations that onerously restrict physicians from prescribing the painkillers that can alleviate a terminal patient’s suffering, shouldn’t we change them first?

If enacted, this law will establish the principle that people in Maryland have a right to “death with dignity,” as the legislation was called when first introduced two years ago. With that accomplished, what is there to prevent the law from expanding to allow physician-administered suicide?

Slippery slope

In the Netherlands, where euthanasia has been legal since 2002, physicians are helping people with treatable mental illnesses—like depression—commit suicide. And, numerous doctors have become “angels of death,” euthanizing terminally ill patients without their consent.

A 2012 paper by J. Pereira in Current Oncology, found that despite safeguards built into so-called “death with dignity” laws, most safeguards are ignored.

For example, in 2005, more than 540 people in Holland were euthanized without providing explicit consent. In the Flemish part of Belgium, 208 people were euthanized without consent because they were in a coma.

Pereira’s study concluded that in 30 years, the Netherlands has slowly moved from euthanasia for terminal illnesses to euthanasia for psychological distress. That point was driven home last year in a widely reported case where a woman in her 20s—who did not have a terminal illness—was euthanized in Holland. She had been a victim of sexual trauma and her psychiatrist determined that she had untreatable Posttraumatic Stress Disorder.

Lawsuits

Proponents of so-called “death with dignity” argue a patient should have the right to self-administer a lethal dose of prescription drugs. But what about people with disabilities? Such a law is one lawsuit from being an Americans With Disabilities Act (ADA) violation for those who cannot self-administer.

Opponents of capital punishment point to the Hippocratic Oath to keep doctors from assisting in legal executions. They have also attacked drug companies for providing the lethal cocktails for executions. And they have pointed to botched executions as reason to end all executions.

Would doctors who prescribe lethal doses of drugs be violating their Hippocratic Oath? Could they be subject to professional sanctions?
Will drug companies have an incentive to create more powerful poisons so a patient does not have to swallow 100 capsules?
If even medically supervised executions can be botched, what can we assume about patient suicide? If not supervised, what happens? Could a patient be in a permanent vegetative state requiring life support? If supervised, would more active measures be required?
Proponents of such abortion-inducing drugs as Plan-B have sued pharmacists who refuse to dispense abortificients because it violates their conscience. Will pharmacists be liable to lawsuits if they refuse to prescribe life-ending drugs?

Conscience

The introduction of euthanasia will place Maryland’s health-care professionals on a collision course with numerous ethical and moral dilemmas. Anti-capital punishment activists argue that the Hippocratic Oath prohibits doctors from assisting with legal executions. Can it be made to square with euthanasia?

What about those with religious objections? Will a Muslim doctor be able to refuse to write a prescription for lethal drugs based on his religious beliefs? Will a pharmacist who is an evangelical Protestant be able to refuse to fill such a prescription on the same grounds?

Grim efficiency?

In 2008, Barbara Wagner and Randy Stroop were denied further cancer treatments by Oregon’s state-run Medicaid program because their cancers were in advanced stages. They were informed, however, that it would pay for their assisted suicide drugs.

Opponents of Oregon’s assisted suicide have noted potential conflicts of interest between doctors who approve assisted suicide and their employment with health maintenance organizations (HMOs).

Will Maryland’s Medicaid provide suicide drugs? What about insurance policies purchased through Maryland’s health exchange? Will we create a two-tier system where the wealthy with private insurance get their expensive cancer treatment while the poor on Medicaid get offered suicide drugs?

I fear that many of the people now holding out the promise of “death with dignity” are exploiting our compassion, anxieties, and fears in order to move us—incrementally, at first—toward a truly nightmarish future in which human life will be easily and callously disposed of in service to some amorphous “greater good.” Will we soon have ambulatory “dignity” clinics, like the dystopian future presented in the 1970s film “Soylent Green?” Recall how the Edward G. Robinson character “went home,” a euphemism for assisted suicide.

Before we pass the “End-of-Life Option Act” law, we need a debate with dignity, that strips away the euphemisms, asks the hard questions and gets the unvarnished answers.

Michael Collins can be reached at michael.collins.capital@gmail.com.

Charity and Prudence on Immigration by David Montgomery

How to deal with the threat of enemies infiltrating the United States under the guise of refugees is a question without easy answers. It is a classic case of reconciling the virtues of charity and prudence. No one would give a stranger a key to their house and let them live in their spare bedroom without checking them out, nor is there any Christian doctrine that demands that naïveté. Of saints and martyrs, perhaps, but not of ordinary men and women. Yet we are also instructed: “Do not neglect to show hospitality to strangers, for thereby some have entertained angels unawares.” (Heb 13:2) A satisfactory resolution is to ask questions first and to keep the guests in a safe place while they dine.

The state has a primary duty to assure the wellbeing of its people, and has authority to do things that individuals may not. That does not mean ignoring the needs of others, but it gives prudence and practical judgment an even higher priority. In a fallen world, no good deed necessarily results in good outcomes, and this is particularly true when nations fail to exercise prudence in their relations with the rest of the world. For my part, I could not devise a materially better way to reconcile prudence and charity in light of the threat of Islamic terrorism.

Depicting the Executive Order on immigration as closing the borders of the United States is preposterous. It is selective, time-limited, based on facts and an assessment of a clear and present threat, includes waiver authority, and is directed at potential enemies who could exploit our good intentions to do us harm. It even sets out what would make entry from any country possible in the future.

Nor is it true, as some critics seem to imply, that the United States left its doors wide open until January 27, 2017. Exactly 100 years ago, Congress passed the first broadly restrictive immigration act, and entry into the US has been limited and based on criteria ever since. FDR failed miserably by every test of morality and statesmanship when he and Churchill refused to bring in Jewish refugees from the Holocaust. The Immigration Act of 1965 replaced national quotas with preference for family reunification. It shifted origins from Europe to Asia and Latin America and reduced quotas for a large number of countries to near zero. President Obama himself suspended entry from the same list of countries for six months and then limited the number of refugees after re-vetting applicants.

The text of the order matters. Here are some actual statements in the order that have been misrepresented or ignored in most press reports and editorials:

The order states that:

… the United States should not admit those who engage in acts of bigotry or hatred (including “honor” killings, other forms of violence against women, or the persecution of those who practice religions different from their own) or those who would oppress Americans of any race, gender, or sexual orientation.

How could anyone fail to applaud this policy statement? Indeed, it explicitly protects the LGBT and feminist factions that are constantly accusing the President of discrimination. It is about time we labeled bigotry, hatred and persecution practiced in other countries and by religions outside the Judeo-Christian tradition as what they are.

The order also provides that individuals will be allowed to enter only if it is possible to obtain sufficient information to determine whether or not they would be a threat. This seems to me to be a fully justified act of prudence. Thus there will be

… a review to determine the information needed from any country … to determine that the individual … is who the individual claims to be and is not a security or public-safety threat.

The order then proceeds to discuss how “… countries that do not provide adequate information” will be identified. Nowhere does the order announce a ban on Moslem immigrants nor does it name any country except Syria. Instead it makes reference to a list compiled under President Obama of countries that represent exceptional security risks. A list to which no one objected before President Trump acted on it.

The much-maligned temporary ban on entry from hotbeds of Islamic radicalism is intended to give time to determine which countries provide adequate information, and in the confident conclusion that those seven do not. Moreover, it provides that visas may be issued “on a case-by-case basis, and when in the national interest” to individuals from those countries seeking entry.

And in the case of refugees, it remedies the inexplicable discrimination against Christian refugees carried out under President Obama. The welcome words of the order are

“…admit individuals to the United States as refugees on a case-by-case basis, … but only so long as they determine that the admission of such individuals as refugees is in the national interest — including when the person is a religious minority in his country of nationality facing religious persecution.”

Facts also matter. First, no word in the order instructs anyone to ignore or violate any law. Instead, it instructs all officials to enforce immigration laws vigorously, thus reversing the order of President Obama that the law be ignored. Second, Europe has faced increased crime, antisocial behavior, and terrorist attacks from immigrants from the same countries subject to the order. A high proportion of refugees now moving into and through Europe are military age males, especially in the cohort from Syria, and both ISIS and Iran have announced that they are infiltrating soldiers and terrorists with the refugees. And we need to worry about the numbers of immigrants from the breeding grounds for Islamic fundamentalism and how they can be assimilated. This we must do to avoid creating zones like those in France where police cannot go and Sharia law is enforced, remembering that Sharia law itself justifies violence against women, gays, and Moslems who convert to another religion.

There are some issues that could have been handled better. I believe that if someone is in danger because of aiding our military overseas, we owe them refuge. But even there prudence demands we make sure about their loyalties. From reports of returning soldiers, this kind of justice for people who helped them was slow and inconsistent under President Obama. President Trump could make it better, by giving the Secretary of Defense full authority over such cases.

There are good reasons why an order like this one needs to go into effect immediately, to avoid a rush of those who will no longer qualify to enter, but it could have been less disruptive if the procedures for waivers had been set out in advance and delegated as far as possible. That would have eliminated the flap about visitors in transit and green card holders that has led to so many false tears. The urgency might not have been as great had President Obama not expunged the existing list of suspected terrorists as a parting gift to the nation.

So I would challenge those who are demonstrating and otherwise expressing outrage at this order. If you are advocating open borders so that anyone can enter and live in the United States without review or hindrance, then say so. If you are opposed to the President, then state why and don’t use this Order as an excuse to condemn him. If you believe it arises from some ill-will toward Muslims, check out the similar order issued by President Obama in 2015. If you have a different solution to the dilemma of generosity versus security, then state it and defend it with facts and logic. I look forward to a discussion with you.

David Montgomery was formerly Senior Vice President of NERA Economic Consulting. He also served as assistant director of the US Congressional Budget Office and deputy assistant secretary for policy in the US Department of Energy. He taught economics at the California Institute of Technology and Stanford University and was a senior fellow at Resources for the Future.

Gray Shore: Looking at the ACA in the Era of Trump by Memo Diriker

November 2016 has come and gone. Now, we have a new President and a new faces in the U.S. Congress. The Republicans may have won it all but now, they are facing the daunting task of delivering on their various (costly) promises while simultaneously respecting the conservative values they hold dear. No GOP promise has been repeated as often and as loudly as the one to repeal the Affordable Care Act (ACA), otherwise known as “Obamacare.”

Not surprisingly, Republicans in both the House and Senate have moved rapidly to set in motion the process for repealing the ACA but they seem to have not much of an idea with what to replace it. Every option available to them seems to have a different booby trap attached to it. While the senior leaders of the Republican Party are unanimous in their desire to repeal the ACA, they are most definitely not unified as to what will take its place. Whatever they solution they might be able to craft, they are assured of vigorous opposition from Democrats in Congress and from a very wide range of stakeholder groups throughout the nation.

To make the process even more complicated, the policy direction the new White House wishes to take with the replacement part of Repeal and Replace is not very clear. We are now finding out that some of the staunchest supporters of the new President were not aware that the “Obamacare” they so loudly opposed was the same as the Affordable Care Act that they seem to like quite a bit. The choices are not very good:

Should coverage be denied due to pre-existing conditions? Most Americans oppose this.
Should children over 18 be excluded from policies? Most families like this benefit.
Should the individual tax mandate be removed? Budgetary implications of this are phenomenal.
Should coverage amounts and categories be reduced? Seems to be a No-Win solution.
Should the high risk-pools replace the current policies? This is a bad solution with high costs.
Are Health Savings Accounts the answer? Not for millions who do not earn enough.

Another aspect of the replacement process is that Republicans can only repeal parts of Obamacare that have to do with budget measures. They will need at least eight Democrats in the Senate for replacing part of all of the ACA. The likelihood of Democrats collaborating in the replacement of their signature achievement has got to be pretty low.

Earlier, some GOP senators introduced a bill that would allow states to keep the ACA if they so choose but most Democrats are opposed to this bill that they label “Chaos.” Based on early indications, it is clear that the head winds against replacement will come from all corners, including within the GOP itself. Yes, Republicans want to get rid of the Affordable Care Act, but not all of them are ready to accept the consequences hurting people or adding to the deficit.

Finally, none of the current talk about repealing and replacing the ACA includes the need to reform the way we do healthcare here in the United States. At over $3.3 trillion a year or over $10,000 for each man, woman, and child in this country, we spend at least 50% more on healthcare than the next highest spending country (France) as a percentage of our GDP. Are our health outcomes 50% better? The answer is NO! Among the top 10 industrialized nations, we are dead last in healthcare outcomes. These outcomes include: Quality, Access, Efficiency, Equity, and Wellness. So, what is the one big difference between us and the other nine? Universal healthcare!

Dr. Memo Diriker is the Founding Director of the Business, Economic, and Community Outreach Network (BEACON). BEACON is the premier business and economic research and consulting unit of the Franklin P. Perdue School of Business at Salisbury University. BEACON is home to the award winning Community Visioning, ShoreTRENDS, GraySHORE, ShoreENERGY, GNAppWorks, and Bienvenidos a Delmarva initiatives and a proud partner of the GeoDASH initiative.

Out and About (Sort of): 90 Days Matter by Howard Freedlander

Some years ago, former Congressman Bob Bauman, a Talbot County resident who once represented the First Congressional District, quipped that the American people were always in trouble when Congress was in session. The sharp-tongued United States representative used self-deprecation to describe democracy and the oft-criticized actions of our 535 federal legislators.

Rep. Bauman used humor to portray himself as a fiscal conservative who might not be as dangerous in budgetary matters as his associates.
I’ve often thought about Bauman’s crowd-pleasing comment when the Maryland General Assembly meets for its annual 90-day session. The 2017 session began last Wednesday, Jan. 11 and adjourns at midnight on Monday, April 10. Then, the 188 state legislators leave their “mischief” and return home.

Having worked with our state legislature for a large part of my career, I view our delegates and senators as public servants seriously conscientious about enacting legislation helpful to their constituents. I well understand that some disagree with me and question the value and motives of our state legislators.

I don’t. In fact, I would urge all citizens to watch what happens in Annapolis for three months.

Why do 90 days matter in our state capital?

Budget decisions affect the money going to our public school system. That’s critically important. New school construction and renovations only happen with state funds.

Non-profit capital projects in Talbot County and the Mid-Shore receive dollars due to the largesse of state legislators and the governor.

Money for new roads and bridges result from budget decisions made in Annapolis.

In this session, the General Assembly will decide whether to fund a study of a third Chesapeake Bay span. That’s unquestionably important decision for those who favor as well oppose expansion.

New rules and regulations concerning environmental matters and the health of the Chesapeake Bay are directly tied to legislative actions.

Funding for Program Open Space affects the preservation of farms and forests on the Eastern Shore.

There are so many issues that I haven’t mentioned, such as law enforcement, economic development, health care, higher education and workplace conditions, that fall under the purview of the Maryland General Assembly.

Does politics, both local, regional and state, play a role in the final products of an often divisive legislative session? Of course it does. It always has and always will. It’s the nature of the process.

Though our national epidemic of political polarization has infected deliberations in Annapolis, I believe it’s a little less pronounced, a little less poisonous. That’s my take, perhaps a bit naively.

We are now in the third year of the Hogan Administration. Typically, the Republicans and Democrats begin to position themselves for the 2018 gubernatorial and legislative elections. At times, deliberations over bills and policies resemble a slugfest.

The political environment will likely become toxic at times. Gov. Hogan will face off against Senate President Mike Miller and House of Delegates Speaker Mike Busch. The public will watch either with interest and glee or despair and disgust.

Your perspective depends on your political bent.

I recommend that citizens closely observe the machinations of our General Assembly. Bills passed and killed all have impact. They matter to individual and interest groups.

This column is not intended to be a clarion call for civic engagement. It’s meant to inform readers that the 90-days session has significant implications for all of us.

Notwithstanding former Congressman Bauman’s admonition, I recommend vigilance—and participation. Even a dash of admiration.

Columnist Howard Freedlander retired in 2011 as Deputy State Treasurer of the State of Maryland. Previously, he was the executive officer of the Maryland National Guard. He also served as community editor for Chesapeake Publishing, lastly at the Queen Anne’s Record-Observer. In retirement, Howard serves on the boards of several non-profits on the Eastern Shore, Annapolis and Philadelphia.

Op-Ed: Maryland’s Demeaning ‘Begathon’ Continues by Barry Rascovar

Here we go again. In a few weeks, school superintendents will trek, en masse, to the second floor of the Maryland State House to grovel before the Board of Public Works for additional school construction funds.

It is a demeaning “begathon” that long ago outlived its usefulness and turned into a political circus allowing the governor and comptroller to praise and reward their friends in the counties and humiliate their enemies.

This time, the target for Gov. Larry Hogan, Jr. and Comptroller Peter Franchot is Baltimore County Executive Kevin Kamenetz – a man who has signaled a desire to run for statewide office next year.

Anything Hogan and Franchot can do to undercut Kamenetz’ credibility helps their reelection chances.

That explains the consistent animosity by this tag-team tandem toward Kamenetz’ requests.

Comptroller’s crusade

Franchot has conducted a consistent crusade to force the county to install portable, temporary air-conditioners in all schools lacking central cooling units.

Former Baltimore County executives bear the brunt of the blame for leaving too many school kids in overheated classrooms during the early fall and early summer.

Kamenetz, on the other hand, has been making up for lost time with a $1.3 billion program to get students into air-conditioned schools. But his expensive plan is phased in due to fiscal constraints.

Franchot has persisted in pummeling Baltimore County’s leader for not following his insistence that Kamenetz buy window A/C units.

Each has a point: Kids should not swelter on extremely hot days, yet it makes little sense to spend millions for a short-term fix when a long-term fix is in the works.

The ideal solution is for the state to forward-fund the money Baltimore County needs to finish the job ASAP through a combination of costly upgrades and replacement buildings.

Embarrass Kamenetz

However, neither Franchot nor Hogan has lifted a finger to support the county’s efforts. They could have designated a pot of school construction money for jurisdictions needing window-unit air-conditioners. Instead, they remained silent.

Their goal is to publicly embarrass Kamenetz. Thus, the dynamic duo voted last May to punish Baltimore County (and its school kids) by withholding $10 million in state funds for county school construction – thus delaying portions of the work on air-conditioning classrooms.

The two also withheld $5 million in badly needed construction dollars from Baltimore City, which also is in the process of getting all schools air-conditioned.

They demanded that the two jurisdictions air-condition all classrooms in a matter of months – an impossibility for any number of legal and practical reasons.

The two Annapolis politicos apparently think the city and county can simply wave a wand and, voila! they’ll reverse a situation that’s been festering for two decades.

The reality is that it will take a number of years – and billions – to correct this situation.

Political favoritism

When the “begathon” parade shamelessly takes place on Jan. 25, it is likely Hogan in particular will look kindly upon Baltimore City’s requests, including the withheld $5 million, as a goodwill gesture toward the city’s new mayor, Catherine Pugh.

He and Franchot will save their contempt for Baltimore County School Superintendent Dallas Dance and, indirectly, Kamenetz. There could well be “plants” in the room to demonstrate Hogan and Franchot are supported by county residents in their harsh criticisms.

It’s all part of the set-piece melodrama the “begathon” has become.

In most cases, conservative, Republican-leaning counties will be treated with kid-gloves by the Republican governor while Democratic strongholds get a cold reception.

It’s quite a distasteful scene, one that is as unbecoming for the governor and comptroller as it is for the school chiefs forced to grovel before them.

Barry Rascovar’s blog is www.politicalmaryland.com. He can be reached at brascovar@hotmail.com.