Rural Iowans’ wish list

San Francisco 49ers quarterback, Brock Purdy, got the challenge—which means opportunity—of a lifetime. His first professional football start was against arguably the greatest of all time. Tom Brady and his Tampa Bay Buccaneers were in town. “Mr. Irrelevant,” the last pick of the 2022 NFL draft, didn’t request this script. He was ready, though, to flip it. Purdy, and a great supporting team, defeated Tampa Bay 35 – 7.   

Turns out Purdy was never irrelevant. Just someone who was given a chance and then did something with it.

Rural communities in Iowa have challenges, too. Despite that, they want the ball and the opportunity to show what they can do with it. Give them a fair chance. They’ll take it from there.   

Fairness, though, isn’t always a given. Rural Iowans know when the playing field isn’t level.

Start with Iowa roadways.

According to 2020 census data, about half of Iowa’s population live in 90 counties that are primarily or moderately rural. It’s not unusual for those living in rural communities to travel 20, 40, 60 miles or more, round trip, to get to their job, the grocery store or the doctor. That’s a lot of trips to the gas pump, and gas taxes are what pays for roads. Good roads are also necessary for economic development in small towns. It’s almost impossible to lure an industry, and the jobs it brings with it, without good infrastructure. Without jobs, small towns die.

According to the Iowa Department of Transportation, it plans to build or improve about 1,250 miles of roadways from 2022 – 2026. Most of these improvements are planned in or around metro areas with limited road projects going to rural counties. For example, the 10-county rural region of Northeast Iowa is slated to receive about 65 miles of road improvements or about five percent of budgeted projects.

Rural Iowans pay for a lot of roads with long-commute gas taxes. They just have to drive to metro areas to enjoy them.

Secondly, many small towns in Iowa didn’t have access to high-speed, fiber optic internet services until recently. Small towns—just like cities—depend on technology to grow businesses and compete efficiently. The Empower Rural Iowa Broadband Grant Program helped deliver needed broadband services to finally make that happen. These businesses aren’t guaranteed success, but at least they now have a fairer chance to compete. 

But while connectivity is improving in small towns, there are still many rural residences without access to high-speed internet. It’s a quality-of-life issue, especially for younger generations. The countryside will continue to empty out without it.  

Lastly, rural counties and local communities are struggling to provide adequate emergency health care and ambulance services.

A greater percentage of the elderly live in rural communities compared to urban areas, and they are primary consumers of health care. The Iowa Department of Public Health projected that by year 2030, 22% of the state’s total population will be over the age of 65 and living in rural areas. Needs will grow. Services may not be able to grow with it.

A few states provide some type of supplemental financial assistance to emergency medical and ambulance services. Iowa is not one of them.

There are only so many taxpayer dollars to go around. But the harder it is to obtain ambulance services, the more rural Iowans will question wasteful spending by the state. When allocating resources, every legislator should be asking the question, “Is this more important than leaving rural communities without access to ambulance services?”  

Rural Iowans pay a ton of gas taxes. They’re still waiting for more blanketed broadband coverage. And they have higher elderly populations that require access to emergency health care and ambulance services.

But they’re also like every other community in Iowa, whether it’s rural, urban or suburban. They just want a chance to succeed and to show that they’re not irrelevant.

Allocate resources fairly, and rural Iowans will put up the points.

Early retirees, with advanced degrees, can assist in education

Three sets of statistics are converging to form either a perfect storm or a perfect solution. The outcome is up to us.

And the stakes could not be higher. It’s about the education of our youth and offering them the same opportunity that every generation before them had—a chance to improve their standard of living through a quality education.   

The issues in play are: student learning loss from the pandemic, underpaid teachers, and rising early retirements in the general population from individuals with advanced degrees.

According to the Government Accountability Office (GAO), about half of teachers had more students start the 2020-21 school year behind compared to a typical school year. Nearly two-thirds of teachers had more students make less academic progress. And 45% of teachers reported that at least half of their students ended the year behind grade level.

COVID was deadly for many, especially the elderly. But our youth suffered, too, through a disruption in learning.

It hasn’t been easy on teachers, either.

The GAO reports there were fewer public school teachers in 2021 than in 2019, and many teachers are considering leaving their job earlier than anticipated. It draws upon a National Education Association survey that puts that number as high as 55%.

Throughout the country, states and schools have struggled to provide salaries to teachers that are adequate. Iowa Code 284.15 sets a minimum public school teacher salary at $33,500. Minimum and what the market bears are two, different things. Still, posts that Iowa teachers with one year of experience can expect to make just $38,000 on average.

The spin on these numbers is that the cost of living in Iowa is less than in other parts of the country. That may be true, but the argument isn’t good enough. Teachers are finding other jobs paying more, without moving, and continuing to enjoy a lower cost of living.  

Teachers need a pay raise.

And then we step into the completely different world of individuals, with advanced degrees, choosing early retirement.

The Pew Research Center found that retirement among those 55 and older, who have completed at least a bachelor’s degree, rose three percentage points during the pandemic.

The uncertainty that COVID brought prompted many to end their professional careers earlier than anticipated. They didn’t know, though, that their 401k would soon suffer losses and that inflation would make it tougher to stretch their retirement dollars. Some will likely come out of retirement and rejoin the workforce.

And they could become the perfect solution to the challenges in education.

There’s something we know about people with graduate degrees in business, communications, computer science, engineering, environmental science, physics, psychology, and many other advanced degrees who enjoyed successful, professional careers—they’re not idiots. 

It’s possible that some of these individuals, in their post-retirement world, can re-imagine life in a way that can help our youth.

The problem of learning loss from the pandemic deserves our attention. It cannot be a headline one day and then forgotten the next. This is an “all hands on deck” moment.

Early retirees, with advanced degrees, may be able to help in the classroom. It would mean another look at what is required to be certified to teach in the state. Also, guidance from a mentor teacher would be crucial.

But the bigger problem is that they won’t do it for $38,000.  

Iowa is using $75 million in federal funds for a program that will encourage high school students to pursue a career in teaching by funding college credits. It’s something that might help dwindling teacher numbers, but it still doesn’t address new teacher compensation.

Nobody goes into teaching to get rich, but even a modest bump in salaries could be meaningful in solving education problems. It might be enough to prompt some early retirees to consider using their talents in the classroom.

Acknowledge learning loss, give teachers a raise, and start thinking outside the box on who can be admitted to the education club. Focus on results, not rules.

Not everyone has what it takes to teach. But some do.

It’s time to do something.

More personal responsibility, less COVID-blaming, needed in education

This blog was previously published in the Des Moines Register.

More personal accountability, less COVID-blaming, needed in education

Solving an education problem is never easy, but it’s helpful to at least identify what is not at fault.

A recent Des Moines Register article, “How DMPS is trying to get kids back into class after COVID” suggests that the pandemic is the cause of a high percentage of chronic absences in the district. It then likens Des Moines schools to schools nationwide, facing the same problem.  

Misery loves company because it reduces personal accountability.

It’s likely there are several schools suffering with attendance problems, for a number of reasons, throughout the country. But the knee-jerk response is to blame COVID.

The Iowa Department of Education tells a different story. Average daily attendance for Iowa schools was 94.7% for the 2018-2019 school year, which was pre-pandemic. Attendance fell to 92.8% for the 2020-2021 academic year. A total difference of 1.90%. Only slightly downward. And with a starting point of about 95%, there wasn’t much ceiling room.  

Certainly, COVID may have factored into the slight state-wide decline. But it doesn’t explain the huge drop experienced by Des Moines schools.

About one-third of the 327 schools listed had numbers that remained the same or actually increased in attendance percentage. Only two schools had a double-digit percentage drop in attendance—Des Moines at 10.60% and Davenport at 12.50%. Four schools saw a 5-7% decline: Ames, Burlington, Red Oak and Waterloo. Most of the remaining 200 schools saw attendance decline near the state average of about 2%.

What jumps out is that no other schools experienced the catastrophe that Des Moines and Davenport faced after that two-year period.

If the pandemic was the real culprit, double-digit decreases in attendance would be plaguing every school district in Iowa. COVID came for all of us, not just Des Moines and Davenport.

Stakeholders in this dilemma are teachers, families and school administrations.

Teachers are the difference makers in education. Placing a really great teacher in every classroom is one of the biggest determining factors in a student’s academic success. But it’s hard to see how the responsibility for student attendance should rest on their shoulders. We have to get them there, before they can take it from there.

Why aren’t families getting them there? There could be several reasons why some students are missing too much school. Perhaps the student has a chronic illness. Maybe, due to poverty, he or she also works to supplement a family income. It’s also possible that the student simply chooses not to go to school and that the parents are either indifferent to that decision or incapable of requiring school attendance.   

All of those situations can and do happen in the other 325 school districts that did not experience a 10-12% drop in attendance. Family problems are not unique to Des Moines and Davenport.

That leaves the administration.

Schools are hierarchies. It’s a top-down system of power and authority that must accomplish a lot. But its main role is to constantly and consistently set clear expectations of the student body. Expectations from ruling administrators and school boards can look quite differently from district to district. And lack of problem-solving ability, poor judgement, and weak leadership during these last couple of years may have done harm that is only now being quantified.

That’s not a COVID problem. It’s a people problem.

There are so many moving parts with education issues that it’s difficult to nail down a true diagnosis. But we can stop using the pandemic as a scapegoat.

We’ve had a toxic love affair with COVID-Blame, but it’s time to end it and start assuming personal responsibility again.  

Don’t over-correct the education system

This blog was previously published in the Des Moines Register.

A speed bump was placed on the outskirts of a small, Iowa community. It was put there to slow down a teenager who “lit ‘em up” on his way out of town as he was traveling to school. As I watched the lone town motor-head, it occurred to me that he would also be the type who would fight for our country. He joined the Marines after graduation.

But before that, the speed bump was installed.

Public safety is important. Speed limits are good. Enforcing speed limits is better. But installing the speed bump was an overreaction.

It happens all too often. We get a good idea and then take it too far.

All around the country, parents have been a positive force in the education system. Throughout the pandemic, they demanded that teachers return to in-classroom teaching, questioned the efficacy of masking students, and challenged the teaching of critical race theory or any type of racism or discrimination. 

Parents have been successful, and it’s prompted our legislators to introduce meaningful education bills.

But, now, we’re starting to see a few examples of education bills going too far.  

A bill was introduced in the Iowa House that called for cameras in the classroom, allowing parents to view live footage. The bill failed—thankfully.

Most school administrators and teachers would welcome a parent who wanted to sit in and personally observe a classroom. But sitting at home, day after day, and remotely viewing through a supposedly secure Internet connection is too much. It’s unnecessary surveillance of the teacher and improper videotaping of children.

Parents can still do what parents have always done. Ask their children about what’s happening at school at the kitchen dinner table. There will undoubtedly be “fork-drop” moments. At that time, parents can set up meetings with school officials and discuss any concerns.

Cameras in the classroom are not needed.

In Indiana, House bill 1134 is on the move and will require teachers to post annually by August 1, every textbook, all printed material, audiovisual materials, electronic and digital sources, Internet sources, library materials, presentations, lectures and any other educational activity that will be used for instruction in the upcoming year.

The writers of the bill did smartly exclude copies of tests and scoring keys.  

It’s a lengthy bill that covers many areas, but at least this section of it seems to reach a certain level of ridiculousness.

Communication is helpful. A provided syllabus is good. Stating class goals is better. But requiring the posting of a year’s worth of every scrap of resource a teacher may use is too much.

The whole point of in-person instruction is so the teacher can, in real time, gauge whether the students are comprehending an idea, answer questions, determine where further reinforcement is needed or a new approach is warranted, and know through a continuous process of a type of “call and response” when the lesson plan can move forward.

Children aren’t computers. It’s not a simple matter of inputting data. Even the very best teachers will not be able to rigidly adhere to previously posted lesson plans, and it’s because they’re good teachers that it won’t happen. 

A 2021 survey found that nearly one in four teachers were likely to leave their profession. Job-related stress was a big factor.

Attempting to put cameras in classrooms or regimenting the academic year before it even begins only adds to that stress.

Nobody loves these children more than their parents, and it is right and good for them to be involved in their kids’ education. But let us be reasonable in the pursuit of improving the education system.

If too many speed bumps are placed on the career path of teaching, there will be no teachers left who are willing to join parents in the fight for a quality education for all.  

Absentee voting should have a place, not a priority


Image by Shutterstock.

Here’s an easy New Year’s resolution. It doesn’t involve weight loss, exercise or financial goals. In fact, you’d only have to alter your schedule once or a few times each year.

Make the resolution to vote at your local precinct, when possible.

Too many are voting with absentee ballots.

There’s a place for absentee voting.

According to the National Conference of State Legislators, the practice originated with Civil War soldiers. Then, members of the military who were stationed overseas were given the opportunity. By the 1970s, it became available to many more—the elderly, the disabled, the business traveler, the vacation-goer, and just about anyone for no particular reason at all.

The Election Assistance Commission now reports that two out of five votes are cast early or with an absentee ballot. It more than doubled from 24.9 million in 2004 to 57.2 million in 2016. And unfortunately, that increase is not from new voters. The majority are citizens who had historically voted on Election Day at their local precincts and are now choosing to vote with an absentee ballot.

Despite the big numbers, absentee voting has its drawbacks.

Citizens who vote an absentee ballot at home may be more susceptible to pressure from other household members to vote for particular candidates. At a precinct site, it’s just the voter and a privacy booth—with no helpful suggestions from those around you.

There’s a certain amount of trust that goes along with sending in an absentee ballot. The voter gives up ownership of the ballot to a county auditor’s office for safe handling until Election Day. But at a precinct site, the voter inserts the completed ballot into a ballot machine where it is instantly accepted and counted.

Absentee ballots must be reviewed at the county level with an absentee board. Missing signatures, signatures that do not closely match or other directions not properly followed could result in ballots that are rejected and not counted. However at the precinct site, election officials obtain information from the voter and most questions are typically addressed immediately and resolved.

The absentee ballot must be postmarked the day before the election, and yet the post office is not required to postmark absentee ballots. Probably very few in Iowa knew this until dozens of mail-in ballots in Winneshiek and Fayette counties were not counted because of missing postmarks. An Iowa House seat in that district was decided by just nine votes.

Because the absentee ballot must be mailed early, the voter runs the risk of not having late-breaking information that could sway a vote. Election Day precinct voters have current information.

And perhaps the biggest concern with absentee ballot voting is the consolidation of election power into fewer hands. There are about 1600 precincts in Iowa where voting takes place on Election Day, but there are only 99 county absentee boards.

We will always have absentee ballot voting. It’s necessary for those who truly depend upon it to exercise their right to vote.

But keeping the vote decentralized as much as possible is pretty important.

It was former President Obama who once stated, “There is no serious person out there who would suggest somehow that you could even—you could even rig America’s elections, in part, because they are so decentralized and the numbers of votes involved.”

Obama is right. A decentralized vote is the best way to run an election.

And the vote is most decentralized on Election Day at the precinct level.

Alabama shows that voter identification laws work

id cardSometimes the habitual complainer of foul play gets a little embarrassed when fairness rules the day after all.

That’s how opponents of voter identification laws should be feeling after the recent Alabama senate race. Despite their dark premonitions, voting laws didn’t hurt turnout or seem to affect the outcome.

According to the National Conference of State Legislatures, Alabama is one of 34 states with voter identification laws. It requires its citizens to present a photo ID prior to voting. Voters may use a driver’s license, a non-driver, state-issued, or federal-issued ID, a US passport, a student or employee ID from a college or university, or a military or tribal ID. If the citizen does not possess any of these, he or she may receive a free Alabama photo voter identification card from their county Board of Registrar’s office. In addition, the Alabama Secretary of State’s office visited every county with mobile units to offer another way to receive a free voter identification card.

The Alabama program sounds reasonable and helpful—not a burdensome hindrance intended to suppress the vote, as opponents of voter identification cards have argued

And yet there persisted much grumbling about these laws. Just days before the election, the New York Times, MSNBC, the Huffington Post and the Daily Beast all ran stories fretting about how voter identification laws would likely hurt turnout and possibly swing the election to Republican candidate, Roy Moore.

Elections without a presidential vote typically have lower turnouts. The 2014 midterm election in Alabama had a 33 percent turnout, and expectations for this special senate election were to equal that number or come in lower.

Instead, voter turnout surged to 40 percent and Democrat Doug Jones won the election.

It was also a win for the merits of voter identification laws. There may have been some isolated instances of short-term voting delays, but the long-term benefit of knowing that the vote was legitimate exceeds any inconveniences.

Many elections in this country over the past 200 years have been decided by a mere percentage point or two. The Jones-Moore race falls into this category. The Alabama Secretary of State lists the unofficial results of the election as Jones beating Moore by 1.54 percent. That’s close. But because the state had voter identification laws, we know the Alabama election was run with the highest integrity possible. Moore, who hasn’t conceded yet, should do so.

And while lawmakers like to fuss about voter identification laws, it doesn’t match the sentiment of most voters—no matter what their political persuasion. According to a 2016 Gallup poll, 80 percent of all voters were fine with them.

Voter identification laws don’t suppress the vote. Apathy does, and that’s not something that can be legislated. When people choose to participate in the political process, their voice is heard.

Iowa just enacted its own voter identification laws. According to the Secretary of State’s website, “During calendar year 2018, voters will be asked to show their ID before voting at the polls. Anyone who does not have the necessary ID will be asked to sign an oath verifying their identity, and will be allowed to cast a regular ballot. Beginning January 1, 2019, Iowa voters will be required to show a driver’s license, non-driver’s ID, passport, military ID, veterans ID or Voter ID Card at the polls before they vote. Voters without the necessary ID will be offered a provisional ballot and can provide ID up until the time of the county canvass of votes.”

These voting laws will be a good thing for Iowa.

And as Alabama has shown, it will be fair for all.

Adoption subsidies and home-schooling can be lethal combination

blue ribbonTaxpayers are funding adoption subsidies that sometimes provide a generous, supplemental income to abusive parents.

It’s an unintended consequence of a well-meaning law. Until the 1980 Adoption Assistance and Child Welfare Act, foster parents were discouraged from adopting children because foster care payments ended once the adoption went through. The new law gave an adoption subsidy close to what was received in foster care payments. It was for those who had a lot of love to give—but maybe not the financial resources—to adopt hard to place children out of foster care.

Foster parents, though, are closely monitored. Those with full adoptive parental rights are not.

A hard to place or special needs child is defined as a Caucasian child who is eight years of age or older, a minority child who is two years or older, or a child with physical, mental or emotional problems. According to the North American Council on Adoptable Children, parents who adopt a hard to place child out of Iowa’s foster care system may receive monthly payments of up to $500 – $900, depending upon their special needs status.

That’s for one child. Multiply the money when more children are involved. The subsidy is an entitlement, and the adoptive family’s income is not considered when negotiating financial support.

For the average family trying to provide a loving home for these children, the subsidy is likely not enough. And, it’s not why they do it. Most want to give these forgotten kids a permanent home and a good start in life. The subsidies are just one tool they can use to help provide for the well-being and needs of their adopted children.

On the other hand, abusers see foster kids as dollar signs. These adoptive parents use subsidies as supplemental income that will benefit themselves—not the children. If money didn’t come attached to the kids, there would be little interest in adopting them.

Once the adoption goes through, abusive parents can use home-schooling as a method to isolate these unwanted children and conceal neglect and abuse.

Three recent cases in Iowa show the vulnerability of these children. Natalie Finn, 16, died of emaciation. Malayia Knapp, 17, ran away from her home, reported abuse to the police, and is a survivor. Sabrina Ray, 16, was found dead in her home. Initial reports are that she was severely malnourished.

All three girls were adopted out of foster care and being home-schooled by parents, who were receiving adoption subsidies.

These cases have been so distressing that in an effort to find a fix, some want all parents who home-school their children to submit to new regulations.

But home-schooling, alone, is not the problem. Many children, from all walks of life, are achieving excellent academic results and are thriving in the home-schooling atmosphere.

Adoption subsidies, alone, are not the problem either. Many children have found a loving and permanent home with a family that would not be possible without this financial support.

The problem is the potentially lethal combination of the two. Isolation plus money equals a fraud that can kill. And taxpayer dollars are funding it.

When there’s public money involved, there needs to be transparency. If parents are accepting adoption subsidies, it should be under the condition that the children be enrolled in public or private schools. It’s not enough for Iowa’s Department of Human Services to become involved after a complaint is filed. One visit does not compare to regular observations from the public or private school system.

Whenever tragedy strikes, there’s a tendency to overreact. We don’t need to shut down home schools or discontinue adoption subsidies. Both do a lot of good. We do, though, need to look at the link between home-schooling and adoption subsidies.

It’s a false narrative to say that Natalie Finn fell through the cracks. It implies that she was an unfortunate enigma, but that all is well everywhere else. And all the while, Malayia, Sabrina, and an unknown number of other children suffer.

It’s not a crack. It’s a chasm, and it demands a policy change.

It’s time to go for the gold in education

gold-medal-usaEducation reform and the reduction in poverty must be tackled simultaneously to improve our education system.

The Organization for Economic Cooperation and Development launched the Program for International Student Assessment in 2000 as a tool to assess education achievement on an international level. In 2000, there were just 41 countries reporting data. That year, the United States ranked 16th in reading, 20th in math, and 15th in science. Finland, Canada and New Zealand took first, second and third in reading while Hong Kong, Japan, and the Republic of Korea took the top three spots in math and science.

The 2015 PISA report included data from 70 countries. The United States ranked 23rd in reading, 39th in math and 25th in science. Singapore and Hong Kong were the education heavyweights.

Americans are more competitive than that. We want the gold, the silver, or at least the bronze—not 39th.

But when it comes to education, we tend to lose our all-in, competitive drive to succeed and instead fall back on protective, territorial natures.

New Education Secretary, Betsy DeVos, has received blistering opposition from teachers’ unions and others. Lily Eskelsen Garcia, President of the National Education Association, said that she is, “…dangerously unqualified and lacks the experience we demand…”

But teaching experience hasn’t historically produced exceptional results in this leadership role. During the first 15 years of the PISA report, Rod Paige, a former superintendent for the Houston Independent School District, served as Education Secretary during the Bush Administration and Arne Duncan, a former CEO of Chicago Public Schools, served for the Obama Administration. Going from 20th in math out of 41 countries in 2000 to 39th in math out of 70 countries in 2015 is not an improvement, despite having very qualified and experienced educators at the helm.

DeVos gave a less than stellar performance at her confirmation hearing, but one theme that stood out was her desire to empower parents. Nobody cares more about the education of our children than their parents. Maybe it’s time to allow them greater decision-making through school choice. If private schools were to receive public funds, though, it should be required that these institutions—just like public schools—be non-selective in accepting students and be accountable and transparent through standardized and reported testing.

The competitive scramble for those finite, public dollars could affect infrastructure. High performing schools may expand. Low performing schools may close. One thing that won’t change is that we will always have parents who want the best for their kids, students who want the opportunity to realize their full potential, and teachers who want to help them reach their dreams. The particular building in which they accomplish that is less important.

But even a monumental decision to implement school choice wouldn’t solve the poverty factor. Teachers have been telling us for a long time that student poverty is one of the greatest challenges they face in successfully educating our youth.

According to both the OECD and UNICEF, the United States has one of the highest relative (less than one-half the nation’s median income) childhood poverty rates among developed nations. The argument that poverty is affecting the success that teachers have in the classroom has merit, and it’s not the job of the educator to fix that. That responsibility belongs to our legislators.

Legislators must do everything possible to bring good-paying jobs to their state. For those families still struggling in low-paying jobs, an immediate increase in the minimum wage to $9.00 could be a real help. Small businesses have shown that reasonable increases can be absorbed.

It’s tough to instantly produce good-paying jobs, but raising the minimum wage is entirely within their power. Until legislators increase the minimum wage, they cannot sincerely say that they are doing their part to improve education.

We must do something different to better compete at the international level on education. School choice has been talked about for decades. Perhaps the time has come to act instead of talk. Trusting parents, instead of the government, to make education choices for our youth might be the sea change that is needed.

If we can make bold moves and reduce poverty, maybe we could even medal at the 2030 PISAs.


“Buyer beware” is necessary to help contain health care costs

value-and-priceSome people, who had never cast a ballot before, voted in this past election solely as a protest to the financial burden that Obamacare had placed upon their families. Voting is a good tool, but there’s something more immediate that can produce good results in containing health care costs—taking personal responsibility.

Consumers think in terms of caveat emptor, or buyer beware, when purchasing all sorts of goods. Not much is purchased without asking, “What’s this going to cost and what value will I receive?”

That basic question gets left out many times when purchasing (non-emergency) health care services. In the past, individuals didn’t see the need. Most insurance plans had small deductibles.

But that’s changing, particularly in the individual health insurance market. Opting for $5,000 or $10,000 deductibles is necessary, just to get the monthly premium down to an affordable rate.

There are, though, a couple of things that all individuals can do to help reduce health care costs.

Get used to asking your doctor for an estimate on what a particular procedure will cost. Having the money talk with your physician might feel a bit uncomfortable, but those feelings dissipate when you realize the damage that can be done to your pocketbook by remaining uninformed.

For example, knee and hip replacements are becoming increasingly common among our aging population. What’s not common is any type of standardized pricing for this procedure. Insurance provider, Blue Cross Blue Shield, in its report called, “A Study of Cost Variation for Knee and Hip Replacement Surgeries in the U.S.,” found that total knee replacement surgeries could vary between $16,772 and $61,585 within the same geographical market.

Asking a few questions could save not just hundreds or thousands of dollars, but tens of thousands of dollars.

After receiving an estimate from your provider, utilize price transparency websites as much as possible to verify that estimated costs are within an acceptable, average range. Although price transparency in the health care field has been met with some legal challenges, most states are continuing to move forward with providing or referring some type of informational system.

The Health Care Incentives Improvement Institute monitors states and their health care price transparency efforts. In its annual “Report Card on State Price Transparency Laws,” it gave Iowa a “F.”

Iowa is not alone. Only seven states were given passing grades. Many failed because pricing data collected was insufficient or in an incorrect format, quality of care data was left out, websites were not easily navigable, or sites were not even up and running at the time the report was issued.

Iowa does not have a state all-payer claims database. The Iowa Hospital Association does provide some pricing comparisons on its website,, but its data is based upon prices charged, not actual payment received from negotiated insurance contracts. It also lacks quality of care comparisons.

Still, it can be of some help. After first searching for “musculoskeletal system,” and then selecting knee replacements, its data show that even within the Cedar Valley there can be a $10,000 swing in average charges for knee replacements of comparable difficulty.

More information is better, but having some comparison data is better than having none at all. It’s a start.

A knee replacement surgery is a high-cost procedure. Patients may fall into the trap of thinking that pricing doesn’t matter because the $5,000 or $10,000 deductible will be exhausted, and insurance will pick up the rest. But many insurance plans require a patient co-pay percentage of ten or 20 percent, after the deductible has been reached, which can become quite costly. Many other procedures will fall below the deductible threshold, meaning the patient will pick up 100 percent of the tab.

If all health care consumers got into the habit of making smart purchasing decisions, premiums and deductibles could come down for everyone.

It may seem harsh to arm yourself with a “buyer beware” mentality in the health care field. Health care, after all, is no more onerous than any other industry.

At the same time, it’s no less.

Beware of comprehensive legislation


Image by Shutterstock.

“Comprehensive” is the dirtiest word in legislative language.

We’ve had comprehensive health care reform, which is a success mainly by the measurement of increased government spending. There’s talk of comprehensive immigration reform, which would likely be an overkill solution. And some counties in the state are using the comprehensive approach to increase the minimum wage through automatic, annual increases that are usually too steep and objectionable to pass.

Comprehensive is code for, “Let’s really screw this up.” Instead of focusing on a single, fixable issue, comprehensive legislation keeps adding to the bill until it either becomes unpassable or it passes, but creates additional problems.

The biggest, single issue that needed fixing in the health insurance world was to eliminate underwriting for pre-existing conditions. According to The Statistics Portal, in 2014 about 84 percent of our population received health insurance through either Medicare—insurance for the elderly, Medicaid—insurance for the poor, or through group workplace plans. About six percent purchased health care off the individual market. The remaining 10 percent were uninsured. Many of the uninsured likely had a pre-existing health condition and were denied insurance. This is the one group we needed to help. The Affordable Care Act, or Obamacare, provided that help, but the 2,700 page bill created more problems by doing so.

Before Obamacare, those who purchased health care off the individual market were self-sufficient and paid for their own health insurance—without the help of taxpayer subsidies. Because premiums are higher in Obamacare, insurance has become unaffordable to this group that had previously paid their own way. More than 85 percent of Obamacare enrollees receive some type of financial assistance. That means taxpayers are helping to support not only those who were being underwritten, but now also many who were previously self-sufficient.

Comprehensive immigration reform is a talking point on the campaign trail. The one problem that needs fixing with immigration in the country is that our laws are not being enforced. There’s been a reason for that. Employers are benefiting from cheap labor provided by undocumented workers, and consumers are benefiting by purchasing the cheap goods they’re producing. In some ways, we’ve all been part of the problem.

But we don’t need comprehensive immigration reform. Simply enforce the laws we already have, particularly for those who illegally migrate to our country and then commit felonies. After we’ve neglected our laws for decades, it may be too late—logistically and morally—to deport millions of productive human beings who have assimilated to our nation’s core values. But strong leadership can make it clear to the world that arriving in the United States will now be through legal methods only. Others will be deported.

Then there’s the minimum wage conundrum. Because our state legislators failed to solve the problem, some counties in Iowa have grappled with the issue. Comprehensive ideas about multiple, steep increases through successive years are making it hard for local leaders to find consensus. For some, the only acceptable solution is a guaranteed path to $15.00 per hour. Meanwhile, there are workers languishing at $7.25 an hour who could really benefit from even a modest increase right now.

Don’t elected officials work every year? Can’t a reasonable increase to $9.00 per hour be made now and then discuss a future increase in—the future? Work now and work later. That’s what most people do. Elected officials can do the same.

Politicians like to use the comprehensive sound bite, suggesting that it’s the only way to solve a problem. But the effect is the opposite. Either nothing gets done, or there’s a solution overkill that causes more problems than it solves.

We can accomplish more, without going comprehensive.