Red, Green and Blue

I’ve been thinking about the polarization of America along the famous Red and Blue state lines and thought I’d do a little investigating. Specifically, politicians from Red states have consistently promoted a line of lowering taxes and keeping government out of people’s lives. This message is currently on tour with a new Tea Party campaign which will run a route from California through the Plains states and into the Deep South – basically a red state tour.

In trying to diagnose why Plains-state and Southerners are so concerned about federal taxation and government programs, it dawned on me that perhaps the difference between Red and Blue staters is in our everyday experience with governmental activity. Specifically, Blue states are more industrialized and have larger, more dense populations than Red states. As such, Blue staters see road projects, bridges, governmental agencies, public security, help for the poor, programs for the elderly, etc every day. Thus, they see the “benefit” of government programs every day. Conversely, if you live in a rural county, down a country road or across a big corn field, perhaps you don’t “see” the benefit of government spending and thus, don’t see the value of your tax dollar.

So I looked for research on which states pay the most taxes and which states receive the most federal dollars – assuming that Red states are net tax payers and Blue states are net federal funds receivers. I was dead wrong.

In fact, Red states are overwhelmingly beneficiaries of federal funds. Federal expenditures (from a Tax Foundation report - see below) are the sum of federal purchases, direct payments (social security, medicare, etc), and salaries to federal employees. In addition to state-by-state per-capita tax burden and expenditures, the report calculates the ratio of the same. For example, if your state has a ratio of 1.10 this means that for every tax dollar paid by residents, the state receives back $1.10 in federal spending.

The state with the greatest per capita federal spending and the second highest ratio of spending to taxes paid is: Alaska! With over $13,000 in annual spending per resident and a ratio of $1.87, Alaska takes the cake as the largest beneficiary of the federal government! The highest ratio state is New Mexico at $2.00 received for every dollar in taxes paid. (Perhaps this is because we keep all the UFO’s that have landed in the US in New Mexico and they are expensive to maintain??) In fact, the top 10 states that are making out in federal spending are, in order of ratio: NM, AL, WV, MS, ND, AL, VA, HI, MT and SD. By my count, that’s 8 traditionally Red states and two Blue (NM and HI)!

And who are the “losers” – ie, the “donor states”? The top ten donors are NJ, CT, NH, MI, IL, NV, MA, CA, NY and CO – or 8 Blue states and two Red (NV and CO)! In fact, the ratios for the biggest donor states are very low with New Jersey (the “biggest loser!”) at 55 cents, CT at 66 cents and NH at 67 cents. For my reading audience in NY and MA, your ratios are 79 and 77 cents respectively. And my pals in PA and VA, your ratios are $1.06 and $1.66. I think Virginia’s ratio is likely skewed because so many northern Virginians work for the government in DC and thus their salaries, etc would be in the ratio.

I did my own calculation of the average ratios for Red and Blue states but added the wrinkle of defining several states as “Purple” – meaning that they have mixed populations that sometimes swing Democratic and sometimes Republican. The purples are: LA, WV, VA, AR, MO, AZ, OH, FL, CO, NH and NV. My calculated average ratio for Red states is $1.34, for Purple $1.20 and for Blue states $1.00. The average for the entire US was $1.17 which implies that domestic expenditures exceed federal taxes received by 17% - hence a big national deficit!

There’s much more detail in the report and data to parse, but in short, the people who pay the least taxes and get the most back from the government want less taxes and less government. And, the people who pay the most taxes and get the least back from the government are willing to expand the system. So, unlike many things in life, who get the most “Green” doesn’t explain who is Red and who is Blue!

My source of info is a report issued by the Tax Foundation in 2006 (latest available). The report “Federal Tax Burdens and Expenditures by State” can be found here: http://www.taxfoundation.org/files/sr139.pdf

Round 25 and My Scan

Went for Round 25 last Thursday. It was a gorgeous day in NYC. Dr. S was on vacation so I met with another doctor for my checkup before chemo. My scan came back stable again (woo hoo!). So, although the doctor can’t make the decision that Dr. S and I have to discuss, I asked his opinion of me getting a break. He said that a recent study came out that looked to prove that taking a couple of months off if you are stable doesn’t negatively affect outcomes. Unfortunately, the study showed the opposite – stable patients who took time off had worse outcomes than those who kept up their chemo. So, I think my hopes for some time off may be dashed and I’ll stay on the great ferriswheel of chemotherapy - staying in the same place but having my ups and downs. We’ll see what Dr. S says next time.

Since it was a very nice day, I walked over to Rockefeller Center and had lunch with a former colleague at AXA. No cranberry bogs this time but a nice time nonetheless…

More on my trip to DC

I thought I’d share a little about the experience of working with an advocacy group in talking to MoCs. Our day on the Hill started with a breakfast at the Capitol Hill Club. The CHC is right behind the three buildings that hold the offices of Senators and Congressmen. It is also the home of the National Republican Club of Washington DC. The CHC is well decorated in formal style and houses quite a large collection of elephant statues and trinkets. I ate my breakfast under a large portrait of Dwight D. Eisenhower next to a cabinet full of little crystal elephants. But they served no peanuts…

After breakfast, we all made our way to the Rayburn office building to hold a press conference. The Imaging folks gave us all T-shirts to wear at the “presser” – which I thought was a bit hokey. The room held about 100 people, including the 30 or so patients. The PR firm that organized the conference also made hand-painted signs – ala a grass roots protest. They asked some of the older ladies in the front of the room to hold them up in their seats. I thought this was a bit cheesy as well (see pic above). The speakers were allotted 4 minutes each for about 6 or 7 key people to make a short statement. The first to go was the CEO of Colon Cancer Alliance – the group that sponsored my visit. He took 20 minutes. The next was a doctor who runs an imaging clinic in Arkansas. He took another 20 minutes. By then, several patients had to leave to start their day of meeting with MoCs! They cut the speakers to just two more – each of which took their allotted 4 minutes. As a result, the press conference ran about an hour instead of a half hour. And I have now added a new expression to the “Great Book of Brianisms” – “Give a man a seat and he’ll chat for 5 minutes, Give a man a podium and he’ll talk for an hour”

After the “presser”. I had a few hours to kill so I returned to the hotel for a quick lunch and a good nap.

I was a bit surprised that you don’t need an appointment to get into the MOCs office buildings. You just go through a metal detector and you are free to roam the halls. And there are plenty of halls! All marble with high ceilings. As you stroll about, you pass the offices of Senators and Congressmen along with doors marked for committees such as “Ways and Means” or “Democratic Caucus”. I arrived at the appointed time at Rep. Schwartz’ office but she was in the Capitol voting. So, her staffer in charge of health (who was meeting with us, too) took us to the basement. There, you go through another metal detector, have your bag hand inspected and get a little pass to wear on your jacket. From there, we went through a passageway into the Capitol and up an elevator to the floor where Congress meets.

We waited for the Representative in a large room – about the size of a tennis court - with a very high ceiling and a huge portrait of George Washington. The room was packed with people meeting in small groups at sets of couches and conference tables. At the largest conference table, Rep. Eleanor Holmes Norton (D-DC) was holding a meeting. Several other politicians I recognized came through as well, including Sen. John Boehner (R-OH, Minority Leader) and Sen. Mitch McConnell (R-KY) . I’m sure there were many other Reps there as well who I just didn’t recognize. The room was loud and a real buzz of activity as the various parties huddled together to hear each other. After Rep. Schwartz finished voting, she came out and we met in this room – standing – as all the seats were occupied.

For my later meeting with Rep. Pallone, we met in his office. The office suite for a congressman isn’t very large. It had three rooms and a foyer. The two staff rooms held more than one staffer each. Rep. Pallone’s office is spacious, with a seating area of couches enough to hold about eight people. He also had a framed poster of Bruce Springsteen on his wall (after all, he represents Asbury Park!)

After my day of meetings, I returned to my hotel and then went to dinner with my cousin at a nice place around the corner. It was a very long day, but quite interesting. And you can definitely sense the atmosphere of work and activity in the Congress.

Meeting Members of Congress (MoCs)

At the meetings in DC, there were about 30 or 35 patients along with some doctors and lobbyists for various groups including advocates and medical imaging equipment manufacturers. The patients were from various parts of the country based on which MoCs were scheduled for meetings. There were quite a number of MoC’s – both Senators and Congresspeople on the list including Senators Schumer (NY), Durbin (IL), Franken (MN), Lincoln (AR), Hagan (NC) and Mikulski (MD). The House side Representatives were from a variety of states including NJ, NY, PA, FL, TX, SD, MD, MI, AL, IN, WI and so on. I was assigned to meet with Rep. Allyson Schwartz (D-PA) who represents a part of Philadelphia and western suburbs and serves on the House Ways and Means Committee and Rep. Frank Pallone (D-NJ) who represents a convoluted central NJ district that stretches from Plainfield through New Brunswick and then down along the shore to Asbury Park. Ah, the gerrymandering of congressional districts! Rep. Pallone is the chair of the House Subcommittee on Health.

At each meeting, I was part of a group of about six people including one other cancer patient, a couple of advocacy group lobbyists and a lobbyist for an imagining equipment manufacturer. In one case it was Seimans and I don’t recall the firm of the other.

Both meetings lasted about a half an hour. In both cases, the representatives showed an excellent command of healthcare issues and in Rep. Pallone’s case, a great familiarity with the minutia of imaging issues. Both Reps had their staffer who was in charge of healthcare attend. Most of the talking, as you might imagine, was done by the lobbyists – with the Reps asking specific questions. The lobbyists stuck to their key talking points (which we patients were all briefed on the night before). The Reps were interested in hearing a little from we patients and also commented that bringing actual patients into meetings with MoCs was an effective way to gain their attention.

In both meetings, I thought the lobbyists did a good job of explaining the issues succinctly and I was impressed by the Representatives’ demeanor, intelligence and logic. In neither case could they make promises about what any final legislation would hold but both were very sincere in their interest and supportive. So, overall, I think the meetings went well and the points were made. The lobbyists were all happy after the meetings – feeling like they got a chance to be heard.

Medical Imaging – The Issue

It was a pretty full day and a half in DC so I will post several entries. But to start, I thought I would get to the core of it. The purpose of going was to meet with members of Congress on the relatively narrow issues surrounding medical imaging. The brief version of the talking points is that 1) the Deficit Reduction Act of 2006 cut Medicare reimbursements for imaging (MRI, CT scans, etc) by 20% 2) the Senate and House health reform bills use further cuts in reimbursement and an excise tax on equipment manufacturers to pay for the bill 3) the coalition of manufacturers, doctors and patient advocacy groups is asking congress not to cut as deeply on the reimbursement and not pass the excise tax. If both go through “as is” in the Baucus (Senate) bill, there is deep concern that access to imaging will be severely restricted or unavailable.

Medical imaging can actually save money – but it’s more difficult to “prove a negative” statistically so I will give you my personal example. Earlier this year, I was on the drug Avastin at a cost of about $10,000 per month. Because of the severity of the side effects, I asked the doctor about coming off of it (something he was hesitant to do). We decided that, if my next scan was stable, I could come off Avastin. That scan (and every scan since) has been stable. So, for the cost of about 4 scans (at $2,000 each or $8,000 total), I have not taken Avastin – which would have cost about $60,000 total since the spring. Hence, monitoring and adjusting my meds through the use of the MRI has saved my insurer about $52,000 this year. I used this example with the Members I met.

Round 24 at the Cranberry Bog

Yesterday I went for Round 24 (but who's counting...) of treatment. At the break, I decided to take a walk over to Rockefeller center to see the old "neighborhood" from my work at AXA (the office was right around the corner on 6th Ave.) To my surprise, I ran across a cranberry bog (see picture)! It was set up right next to the skating rink (which is now set with ice for you skaters). There were cranberry experts wading around in it and explaining how cranberries are grown and harvested. It was a fun diversion - there's always something interesting happening in NYC!

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As for the treatment, it was the "usual". But the doctor did tell me that I now have macrocytosis which is an enlargement of the red bloodcells. I understand that it is yet another side effect of chemo (you can also get it if you have liver disease or are alchololic). In any case, they are doing a few additional blood tests. But it seems that the therapy for macrocytosis is to take a vitamin B12 (folic acid) supplement. I'm sure I can fit another pill into my regiment! Other than that, I am scheduled for my next CT scan on the 20th and hoping for good results...

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Enjoy the fall colors - and have some cranberries! They're good for you! BB

Mysemicolonstory goes to Washington!

Next week, I will be going to Washington DC as a part of a coalition of cancer-related organizations to speak with congress people about health care. Specifically, we will be talking to them about medical imagery - CT scans, MRI's etc - and the critical need to have these tests as a core tool in treating cancer patients. I hope it will be a productive visit and I look forward to sharing the story with you all! I don't go until mid-next week, but I'll let you know all about it when I get back!

And I promise to wear matching socks....