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Albert Paschall

Somedays:

The Case of the Baffling Budget

by Albert Paschall,
Senior Commentator, Lincoln Institute

As it was with Holmes off on a much needed vacation on the Continent I was posted in our London rooms at 221-B Baker Street to review the day's rash of emails. "Blasted emails," Sherlock would say every day, "so uncivilized." Nevertheless they were there from people seeking our help from all over the world. Not inclined to really review them all, at my age I don't really want to grow more hair, but a few that that seemed urgent would get daily attention.

One in particular that arrived really drew my eye as it was posted from ed@thepennsylvaniagoverner.com. "My dear Holmes," it opened, "I'm in quite a quandary here in Harrisburg trying to get a budget passed. The one I put out is full of good things but I just don't know how I can get it passed by the legislature. Please help. Your admirer, Ed R. in Harrisburg"

Of course! Ed Rendell, the Governor of Pennsylvania, a good friend. Last time Holmes and I visited the States he was quite hospitable, though I'm not sure I'll ever be an aficionado of things called cheese steaks or Buffalo wings.

I immediately replied to the Governor that while Holmes was away I was holding down the fort as it were and would do my best to bring my humble talents to bear if it were to help. I closed my email with: "To save time Governor, with a deadline rapidly approaching, summarize your problems and I will try to be of service." 

The Governor responded within minutes. "Doctor Watson, my good fellow, it is probably better that it is you at my side. A lot of the problem is about health care and as a physician you will undoubtedly have great insight. Thanks! Ed R." Flattering as the Governor was I knew the legends of the bloodiness of Pennsylvania politics and wanted to be cautious. "What is troubling about health care in the Commonwealth, Governor?" I wrote back.

Rendell replied immediately: "Not enough of it! I can get health care for 800,000 uninsured people if I tax every business that does not pay for health care benefits equal to 3% of their payroll a year."

I had recalled that on our visit with the Governor that he had mentioned this plan to Holmes and me. Sherlock was quite diplomatic at the time but later confided to me that he thought the plan to be flawed. I chose my response carefully so as not to offend such a good friend. "Governor" I wrote, "if it is true that it can cost an employer as much as 25% of payroll for health care insurance for its employees, if they can get off the hook by paying just 3% won't they do that? And, if they do, will it flood the system with more uninsured people?"

It was quite a lengthy wait, perhaps an hour more, before I heard from the Governor again. Finally he sent: "Well, Watson, I have another idea, I am going to expand the role of nurse practitioners in the state, save costs and get more help to people." It was no secret even at the London Medical Society that you did not practice medicine in Pennsylvania unless you wanted to work for six months out of the year to pay for liability insurance. Thousands of doctors have left the state and I knew that an unkind response related to my own profession would be well, not taken. After all, the Governor had been a lawyer once.

Carefully crafting my email I sent: "My dear Governor while nurse practitioners are marvelous people who serve well, perhaps if we made the physicians' lives easier with some form of relief from nuisance lawsuits medical costs might go down and more people could afford it?"

Well, dear readers someday soon we will have an answer to what I call the Case of the Baffling Budget. I wish I could give you the ending now but I've heard from Holmes about some kind of mad dog and must meet him in a place called Baskerville. I thought the jovial Governor would have sent me some resolution to his dilemmas by now but you see after that day of furious emailing I haven't heard nary another word.

Albert Paschall
Senior Fellow
The Lincoln Institute of Public Opinion Research, Inc.


Taking the Pulse of Pennsylvania