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September 21, 2017
Golden Valley News
Page 3
N. D. Matters
By Lloyd Omdahl
Hello,
I know we have all been con-
cerned with the fires that roared
across Montana and other western
states.
I had the opportunity to witness
some of the devastation first hand
on Friday. While driving in the rain.
On Friday morning, in a nice
rain, I drove down to Bowman and
met a friend to go to a horse sale in
Great Falls. It was raining nice at
home. And from here to Bowman
and then northwest to Great Falls,
we never shut the wipers off! 525
miles with the wipers on in western
North Dakota and eastern Montana.
That may happen only once in a
lifetime. When I was young, it
would have been a nail-straighten-
ing day.
We drove to Miles City and then
north to Jordan. In a wonderful rain,
we drove by the 300,000 acres that
had burned west of Jordan. You' see
still pictures of it. You probably saw
pictures posted on social media.
They do not do justice to the actual
burned acreage. Mile after mile after
mile, with nothing but burnt pas-
tureland. No cattle. No wildlife. No
birds. Just blackened ground and
ash. That fire was a while ago, but
there was not a hint of green. It
brought tears to my eyes. But this
rain was bringing more than mois-
ture. It was bringing hope.
At Great Falls, we went to sup-
per with a young couple that was
hosting the sale. Their ranch had
been in the middle of a devastating
Hat Tips
By Dean Meyer
fire in the Bear Paw Mountains. I
had seen pictures posted. But to hear
their stories was riveting.
The men had been up in the
mountains on the fire line. For three
days. Without coming home. The
wind switched and the fire started
advancing on one of the prettiest
ranches in the world. The young
housewife was there alone. With no
cell phone service to call for help.
She went on facebook and asked for
assistance. She asked people to
share her plea. In a matter of hours
she had 200 people in her yard.
Many with pickups and trailers to
evacuate horses and livestock
penned at the yard. For three days,
they fed 200 people 3 meals a day
in their ranch yard. That's cowboy.
The father told of watching a
dozer go over a steep incline and
down into a canyon. Three men.
And as he watched, the canyon ex-
ploded into fire and the men were
surrounded. He was forced from his
vantage point and knew deep down
inside that those three men were
doomed. He went back to camp and
didn't inform the wives that he was
certain those men had perished in
the inferno. Someone else who had
witnessed the canyon explosion was
not so delicate. He came in and said
he was certain they were gone. Dev-
astating.
Hours later they learned what
N.D. licensing boards d
If complaints are a fair measure of
happened. The men were trapped, performance, the North Dakota
Encircled by a raging fire. The boards that license 45 professions
dozer operator made a few circles and occupations have been doing a
around the firefighters, and they grade "A" job.
huddled in the middle of their small With 44 of 45 boards responding
clearing. A pilot in a spotter plane to a survey, we found that boards li-
could see their plight. As the fire ad- cense 80,502 professionals and over
vanced toward them, he radioed for the last fiscal year received only 633
a helicopter. The helicopter, minutes complaints. That is a mere fraction of
before the fire reached the doomed one percent.
men, arrived with a load of water As expected, the boards with the
and dropped it directly on the fire- largest constituencies received the
fighters. They escaped, most complaints. The State Board of
One rancher told of hauling five Nursing had 19,751 certified nurses
horses out and dollying down the and received 134 complaints. The
trailer and going back for another Board of EducatiOn and Practice had
two-horse trailer and two more 10,000 licensed educators and re-
horses. The pickup was loaded with ceived 75 complaints .Cosmetology
what things they could throw in the had 8,447 licensees and had 25 corn-
trailer in a moments notice as the plaints.
fire advanced on their home. Thirteen boards received no com-
The last thing he loaded was two plaints.
blue heeler dogs. He threw them in The issue of board performance
underneath the horses. Blue heelers came to the fore when the U. S.
are tough. He got them out of harms Supreme Court agreed with the Fed-
way and dollied that trailer down eral Trade Commission that state li-
and headed back to fight fire. censing boards could claim
A day and a half later, he got immunity from federal trade laws
back to that trailer and opened the only if they were strictly supervised
end gate to unload the horses and by the state.
dogs. He said those dogs were di- One point made by the FTC was
rectly under those horse's bellies that most of the licensing boards
and wouldn't wiggle. They had been were dominated by the professionals
stomped on enough, they knew bet- being licensed, indirectly suggesting
ter than to even flinch. Those horses that this was questionable arrange-
had done something I've never been ment.
able to do. Make a blue heeler mind. Fourteen North Dakota boards
After hearing their stories, I have no consumer representatives;
won't complain about a little the remaining boards have nominal
drought, representation. Of the 275 members
Later, Dean
serving on 45 licensing boards, only
58 are consumer representatives.
So what would more consumer
representation on boards achieve that
is not now being accomplished?
Another question: Would con-
sumers be effective on licensing
boards?
In some cases, perhaps. The work
of some licensees, such as barbers
and cosmetologists, are generally un-
derstood by the public at large. How-
ever, an ordinary citizen could hardly
offer serious input on the specialized
professions, such as the boards on
optometry, real estate appraising, re-
flexology or medical imaging
Jim Abbott, executive director of
the Board of Accountancy, pointed
out that his board had to include rep-
resentation for a variety of special-
ized accounting skills. To satisfy the
FTC, six consumer members would
have to be appointed to place profes-
sional accountants in a minority. That
would be an interesting Board of Ac-
countancy.
Not only would such a board be
too large to function effectively but it
would also require an in-house train-
ing program for the consumers. That
would also be true about most other
boards.
So who is watching the conduct of
the licensing boards? Among the
complainants cited in the survey
! !
an
were consumers, businesses, agen-
cies, other licensees and employers.
Apparently, a variety of entities and
citizens are watching and reporting
on the boards.
When asked to explain the small
number of complaints, respondents
suggested that the licensing proce-
dure and standards weeded out un-
principled practitioners; some
credited regular communications of
professional standards to licensees;
another suggestion was high con-
sumer satisfaction with the quality of
practice by licensees.
Another suggestion that should be
added is North Dakotans patience.
Most complaints never get to the
boards but are resolved between cus-
tomers and providers, e.g. a com-
plaint about improper plumbing goes
to the plumbing business and is re-
solved peaceably at the local level.
Another possibility is that boards
are somewhat removed from the pub-
lic eye and consumers may not know
how to press a complaint. Raising the
visibility of boards may be helpful.
The last session of the Legislature
authorized an interim study with the
goal of minimizing "the risk of its oc-
cupational and professional licensing
boards being subject to antitrust
laws." So there is very likely to be a
remedial proposal in the next session.
In any case; we now have figures
to quantify satisfaction with licens-
ing boards and it seems that they
function effectively with or without
more consumer representation, with
or without more state supervision.
Hospitals may get accredited even withpoor care
Spotlight on
Economics
By Siew Hoon Lim
Associate Professor
NDSU Agribusiness
and Applied
Economics Department
Earlier this year an Illinois
woman sent an email telling me of
the poor care her husband received
at a large Chicago hospital. After six
weeks of fighting for his life, he
died.
"I wish you could see his records
and all the infections and surgeries
he had," she told me. "I've been
wanting to do something about the
care he got and just didn't know who
Thinking
about health
By Trudy Lieberman
Rural Health News
Service
2015 cost on average $18,000.
to go to." The Joint Commission awards a
I return to this topic from time ioI: "G01d Seal of Yq:/pftJ'~aF' fO~ those faL
time becaUSe everyone is vulnerable ~- cifi'.fie'~ ~th'at~"'~t~ee~ ~ ~ its,'' st, aOda.ixls.,
to hospital mistakes. Mostpeople~ Maybe you've seen them when
think of hospitals as safe, loving
places that advertise their miracle
cures on TV and build new wings to
house the latest technology. How can
things go wrong? But they do, and
readers of this column have been
eager to share their experiences.
Increasingly, it's becoming clear
there are few places patients and
their families can turn for help in
avoiding bad care and equally im-
portant there's almost no guidance
from state or the federal regulators.
When news outlets try to write about
unsafe hospitals, they run into a "veil
of secrecy that protects the industry"
as one reporter in Michigan put it.
The Wall Street Journal has just
published a fine story that begins to
lift that veil.
Not many Americans know that
the federal government has turned
over the task of accrediting most of
the nation's hospitals to a private or-
ganization called the Joint Commis-
sion, which is funded by hospitals
and governed by a board of directors
some of whom are executives in the
health systems it accredits.
Medicare requires hospitals to
comply with safety standards, and
they can use state inspections or hire
a government-approved accrediting
body to show they are in compliance.
Most have chosen the latter.
Hospitals have a lot of skin in this
game paying the Commission an an-
nual fee between $1,500 and
$37,000 depending on how big they
are, the Journal reported. They also
pay for the inspections, which in
Rechlin graduates
from BSC
Please
support your
local merchants!
BISMARCK - Alexander Rech-
lin, Medora, graduated from Bis-
marck State College with an a
ssociate in applied science in p
aramedic technology degee this sum-
mer.
you've visited ah0spitai. It encoUr:
ages hospitals to use those accredita-
tions in their marketing activities,
even providing them with a public-
ity kit. The Commission has also
created a patient brochure with this
reassuring message, "Whenever and
wherever you receive health care,
look for The Joint Commission Gold
Seal of Approval."
However, the Journal found that
those seals of approval can be mis-
leading. Using information from in-
spection records, reporters found that
in 2014 some 350 hospitals had Joint
Commission accreditation even
though they were in violation of
Medicare safety requirements, and
60 percent of them had safety viola-
tions in the preceding three years.
It seems that most patients facing
an operation or a hospital stay would
want to know that. Dr. Mark Chas-
sin, president and chief executive of
the Joint Commission, told the Jour-
nal that his organization doesn't rou-
tinely withdraw accreditation of
hospitals with safety problems be-
cause its focus is less on regulating
or penalizing and more on prevent-
ing problems.
And this brings us back to that
age-old problem: Should a govern-
ment regulate business, including
hospitals which have become very
big businesses - or should it provide
information so buyers, or in this case
Puf Your Money
Where Your House Is~
,c, c3! :n~ecenoe~t A~ stce~,gthen 9u!
L~usmesses are ~ com~unit/
patients, can compare the offerings
and make decent choices? Oppo-
nents of regulation argue that pro-
viding information is best.
In the case of hospitals, though,
patients have neither regulation nor
information. The Journal's reporting
shows that the Joint Commission's
inspection process often lets hospi-
tals keep their accreditation even as
they deliver poor care. At the same
time, the Joint Commission has con-
tinually refused to make .its hospital
inspection reports public. So if pa-
tients are;supposed to do their home-
work before undergoing health
procedures, it's a fair question to ask:
How should they do that?
Earlier this year the Centers for
Medicare & Medicaid Services pro-
posed a rule that would have re-
quired the Joint Commission to
make its inspection records public.
The agency cited serious concerns
about the Commission's ability to
identify safety problems. The Com-
mission opposed the regulation, ar-
guing it would make its work harder.
Hospitals opposed it, too.
CMS heard their pleas and with-
drew the proposal leaving patients in
the same information vacuum they
were in before.
Earlier this year Ashish Jha, a
professor of health policy at the T. H.
Chan School of Public Health at
Harvard, told me he had no idea
which hospital in New York City had
the lowest risk of safety problems. At
best he could only make a rough
guess. He told the Journal its find-
ings show "accreditation is basically
meaningless - it doesn't mean a hos-
pital is safe."
( What kind of information would
you like to see about safety and qual-
ity of care at your local hospital?
Write to Trudy at trudy.lieber-
man@ gmail.com. )
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Do casinos have positive effect on economic growth?
Casino legalization is controver-
sial because, historically, gambling is
perceived by some as immoral, fool-
ish and irrational, and unlike other
entertainment businesses, gambling
creates social and economic costs
that must be borne by gamblers and
nongamblers.
But morality arguments and reli-
gious influences against casino garfi-
bling have dissipated in many
communities through the years, and
the genera! public in the U.S. has be-
cgme inCr-easingl~ rd~epib)e'to b~isi'
ffds. Acc0rding tb 'tlie AmeriCari
Gambling Association (AGA), most
American voters believe casinos help
strengthen their communities and im-
prove local economies.
But does casino development nec-
essarily lead to economic growth? A
large number of studies on this sub-
ject in the past three decades have
reached mixed results.
First of all, whether casinos have
a counter-cyclical effect on an econ-
omy remains ambiguous. Even if
casinos may contribute economi-
cally, the AGA reckons that they are
not immune to external macroeco-:
nomic conditions.
Economic uncertainty, consumer
confidence and consumer spending
also have considerable impacts on
casino visitation and revenues, and
consumers cut back on gambling
during recessions. If the casino in-
dustry is not recession-proof, then the
presence of casinos will contribute
little to alleviate a state's fiscal stress
during a recession.
Additionally, casino expansion
can reach a saturation point and re-
sult in intra-industry and intorstate
competitions that could lead to the
disappearance of a casino's positive
economic impact, if any, on the local
community in the long run.
In a recent study my colleague Lei
Zhang and I examined the relation-
ship between casino establishments
and economic growth of counties, in
the 48 contiguous U.S. states from
2003 to 20121 We examined the
short-term (three-year) and long-term
(lO-year) county-level economic
growth rates.
Specifically, we compared the ef-
fects on real per-capita personal in-
come and job growth rates of the
counties with and without casinos.
We found that the effects of casinos
on economic growth to be positive
but relatively small.
Casino expansion was estimated
to have increased the short-term per-
capita income growth rate by 0.4 per-
centage point and the long-term
per-capita income growth rate by 0.5
percentage point in 2003-2012. But
after controlling for spatial o[ neigh-
boring-county correlation effects, the
effect of casinos on the long-term in-
come growth disappeared.
On the job side, casino expansion
was estimated to have increase the
10-year salary job growth rate by
Van or Bus Service
Billings County
Golden Valley County
Distance of 160 Miles
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first Tuesday of each month at
701 S. Central Ave., Beach.
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0.71 percentage point during the
2003-2012 period, and its effect re-
mained but only at 0.67 percentage
point after controlling for inter-
county spatial effects.
Our study did not examine the
negative externalities of casinos. The
negatives of casino gambling are
well documented. Those negatives
include not only behavioral problems
associated with gambling, but also
other individual, family, social and
economic problems,
Gambling avai!abilitylis associ-
ated with increased problem and
pathological gambling ~,behaviors
among individuals in the casino
neighborhood. Also, casinos lead to
higher crime rates, but those rates de-
crease with distance, and the prox-
imity of casino gambling is found to
be associated with higher bankruptcy
rates.
Policymakers and community
leaders/developers must bear in mind
that the social costs of gambling re-
main an important issue in the casino
debate. If the economic benefits are
short term and small, but the harm to
society is long term and potentially
irreversible, rather than focusing on
the temporary gains, one must weigh
the benefits and costs in a compre-
hensive, holistic manner.
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submitted copy
and stories and
all ad orders is
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Call 872-3755
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