As reported in the Des Moines Register, a jury recently found the State of Iowa guilty of illegal discrimination against a transgender man. He had not been allowed to use the men’s bathroom or locker room, and he had been denied health insurance coverage for gender re-assignment surgery. (See link below to Register article.)
It is morally correct and good public policy that our government not discriminate against a people based on their gender identity. But refusal by government or private employers to cover gender reassignment surgery under their health insurance plans should not be considered wrongful discrimination, unless the plans cover other types of cosmetic procedures for people who feel similar dysphoria. People may feel mental distress over their teeth being crooked, or their nose being too big, or many other aspects of their body, but that does not mean health insurance plans should be required to cover procedures to make people feel better about their appearance. We have already seen that requiring health insurance plans to cover almost everything makes the premiums unaffordable for many people. There is nothing inherently wrong with expecting people to pay their own way for cosmetic procedures.
The Des Moines Register recently published an editorial that showed how out-of control Iowa and other states are in giving incentives to businesses to locate in their state. To help reverse this situation, Congress should exercise its Constitutional power to “…regulate commerce… among the several states…” and should limit states’ ability to bribe companies to locate in their state. States should be prohibited from giving custom incentives to specific businesses to locate in their state. They should only be allowed to use schemes that provide uniform incentives to all companies that locate their business or otherwise create new jobs in that state.
According to an article in the Des Moines Register, The American Association of University Women (AAUW) issued their annual report on the “pay gap” between women and men. According to the report, women in Iowa earn about $10,000 less per year than men. This article, and the related report, are excellent examples of misuse of meaningless statistics. (See link below.) Comparing the median pay for all women with the median pay for all men tells us nothing about whether or not sex discrimination is taking place. A valid analysis would compare the pay of women and men who do the same work for the same employer. The report by the AAUW did not do that.
This report tells us more about the bias of the AAUW than it does about bias in the workplace. As you reported, Kim Churches, chief executive officer of AAUW, said, “It’s unacceptable. There is no gender differentiation when it comes to quality, skills, and talent. It’s time to close this gap and give every woman in Iowa and across the country the salaries they deserve.” She advocated for more regulation.
Based on the facts given in the article, and assuming that women and men can and do perform equally, then it is fair to presume that the AAUW would agree that if any woman wants to earn the same pay as a man, then they should go for the same jobs that men go for. When the relevant qualifications, working conditions, and job duties are accounted for, the difference in pay between women and men reduces dramatically. The pay gap has been reducing for years. Our current laws are working. We don’t need to add more regulations.
I appreciate the good intentions of farm owners Maggie McQuown and Steve Turman who are making good effort to conserve their farmland and our environment. In their Iowa View essay published in the Des Moines Register they wrote, “… transitioning farm practices takes time to understand and accept, and requires resources to implement. ” They urged Congress to renew and increase funding for the Conservation Stewardship Program (CSP) as part of the Farm Bill. CSP pays farmers to implement conservation practices. They implied that their farm operator might not continue conservation practices if he loses his CSP payments. (See link to Iowa View essay below.)
The problem with CSP, which started in 2004, is that it is not a transitional program. It doesn’t create any permanent solution. It creates dependency. Conservation efforts continue only so long as payments continue. If we stop paying the subsidies the conservation stops. We need to use both “the carrot and the stick.” Maybe now is the time to start penalizing farmers who pollute our water and air – just like we do to every other business.
Recently, candidates for office in Iowa have been asked to promise future Iowa public employees that they will make no changes to the Iowa Public Employment Retirement System (IPERS) retirement plan. Instead, politicians need to state clearly that they make no promises to future employees about their retirement benefits. The fact that IPERS is currently underfunded by about $7 billion shows clearly that we already have over-promised benefits when compared to what we expected taxpayers and public employees to pay.
(When government has a defined benefit plan, the participants seem to think that any over-funding is their asset, but any under-funding is a liability of the taxpayers. In the past, when IPERS was over-funded, benefits were increased!)
The way to make sure that we don’t make retirement benefit promises that turn out to be more expensive than we expect to pay is to put new government employees on a defined contribution retirement plan – just like most employees in the private sector. This will cause the unfunded liability to come due over the next 50+ years, but at least it won’t get worse.
Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.) I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.
Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less. Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
Consider shortening the amount of time that government grants a monopoly for patents. Patents are not natural property: humans have copied one another since the beginning of time. Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work? Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items. A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items. Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place. If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs. Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.
Our health care wants are unlimited. Our ability to pay is not. We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost. We should expect our government to NOT do things that increase costs, or reduce our choices.
We need to oppose the push by various Iowa public school supporters to extend the state-wide one-cent sales tax that is used for infrastructure and technology: (“Advocates hope to extend tax for schools” 7/30/2018 – see link below.) The original local option taxes that started in 1998 were supposed to expire after 10 years. Then, in 2008, the Iowa Legislature expanded the tax to the entire state and extended it for 20-years – to expire in 2029. Now, school sales tax advocates want to extend the state-wide tax for an additional 20 years!
Taxpayers might ask why anyone would want to extend the tax now, since the current tax doesn’t expire until more than 10 years from now. The answer is that many school districts have already borrowed against and spent the not-yet-collected future taxes. They did this by issuing bonds and pledging the future taxes as security.
It is understandable that people may want to fund school infrastructure with a sales tax rather than a property tax. But it is not clear that all that every school district in Iowa needs the additional revenue. We need to let the current tax expire in 2029 and then give local school districts a local option if citizens feel the additional tax is really needed.