Print Edition: Oct. 17, 2019 by Shepherd Express

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The High Cost of Prescription Drugs ... page 4

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SHOW TIME! MARK FARNER’S AMERICAN BAND

OCT. 19

RUBEN SINGS LUTHER

AN EVENING OF LUTHER VANDROSS

10/24

WINGER 11/7

CINDERELLA’S TOM KEIFER

10/31

EXPOSÉ 11/15

JOHN WAITE

11/1

THE MOODY BLUES’ JOHN LODGE

11/13

PATTY SMYTH & SCANDAL 11/22

BIG BAD VOODOO DADDY’S WILD & SWINGIN’ HOLIDAY PARTY 12/6

FRANK CALIENDO 11/23

PHIL VASSAR CHRISTMAS SHOW 11/30

HILLBILLY CASINO PRESENTS A HOLIDAY HOOTENANNY AT THE CHRISTMAS CARNIVAL 12/19-20

BODEANS 12/27

MONTELL JORDAN

11/14

EVEN MORE HOLIDAY TALES WITH JOHN MCGIVERN 12/3-5 & 7 SUPERTRAMP’S ROGER HODGSON WITH BAND 2/17-20

WANT MORE? See all shows on paysbig.com/shows

TICKETS AVAILABLE AT ticketmaster.com or buy & save on fees at the NLT Box Office 1721 WEST CANAL STREET I MILWAUKEE, WI 53233 I MUST BE AT LEAST 21 YEARS OLD TO ATTEND SHOWS FOR MORE INFORMATION, CALL 414-847-7922 I ALL SCHEDULES SUBJECT TO CHANGE I MANAGEMENT RESERVES ALL RIGHTS ©2019 FOREST COUNTY POTAWATOMI COMMUNITY, WISCONSIN

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::NEWS&VIEWS

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FEATURES | POLLS | TAKING LIBERTIES | ISSUE OF THE WEEK

Bipartisan Efforts

Wisconsin Rep. Gwen Moore speaks at the “Don’t Cut Pills, Cut Profits” Town Hall event at the Italian Community Center in Milwaukee

The High Cost of Prescription Drugs Town hall focused on bipartisan initiatives to curb rising prices ::BY EVAN CASEY est Allis resident Nancy Koch has an autoimmune disease. “It’s not going to get any better,” she said with a look of concern on her face. At least she qualifies for a patient assistance program that helps pay for one of the medications she needs—which totals nearly $4,000 a month. However, that could all change next year. Koch says she doesn’t have the money to pay for another drug that is similar if she doesn’t qualify for the patient assistance program in 2020. “We [Koch and her husband] live on Social Security, so there’s no way we can afford $171 a month. If I’m lucky, I can afford $20 a month,” she said. Koch is one of the many U.S. citizens who are suffering from the rising cost of prescription pills across the nation. The data that revolves around drug companies and prescription pills is “appalling” to Koch, who is part of the American Association of Retired Persons (AARP) advocates group. According to data from the National Committee to Preserve Social Security and Medicare (NCPSSM), the average annual cost of a brand-name drug has more than tripled in the past decade, jumping from $1,868 in 2006 to $6,798 in 2017. Retail prices for specialty prescription drugs also increased by 7% between 2016 and 2017, while the general inflation rate only rose 2.1%. Medicare beneficiaries’ average out-of-pocket cost for some brand-name drugs also rose by 40% from 2011 to 2015, according to the NCPSSM. What is one of the main reasons for this? A 2003 law that says that the federal government cannot negotiate with drug manufacturers to lower the cost of drugs. Current laws also benefit larger drug companies when it comes to patents. This means that many makers of less expensive generic drugs must overcome many obstacles to make their product available on the market, meaning less competition. The pharmaceutical industry also received federal tax cuts five times from 2005 to 2016, according to NCPSSM.

4 | OCTOBER 17, 2019

However, there could be help coming soon in the form of a few bipartisan plans to curb the increase of drug prices. One of these plans, from Democratic Speaker of the House Nancy Pelosi, authorizes Medicare to negotiate prices for some of the most expensive drugs on the market. Koch was one of many who came to the recent “Don’t Cut Pills, Cut Profits” campaign event at the Italian Community Center in Milwaukee that discussed some of those plans. Event attendees included Wisconsin Rep. Gwen Moore, Wisconsin state Sen. Tim Carpenter and Lt. Gov. Mandela Barnes. At the event, they discussed federal and state initiatives to help ease the pain. The “Don’t Cut Pills, Cut Profits” national campaign, which is being organized by NCPSSM, includes town halls, voter education, petition drives and outreach to members of Congress to push them to support legislation that would reduce drug costs. Milwaukee is one of three locations across the nation where a town hall event is being held these next three months. “I asked the question, ‘why have drug prices gone up so high?’” said Khelan Bhatia, manager of voter engagement for the AARP, during the event. Bhatia was part of a panel that answered questions from the audience. “It’s because drug companies can do it.” Those at the event were encouraged to make their voices heard by signing a petition that tells Congress to work now to stop the increase. Representative Moore said House Democrats are now discussing the Lower Drug Costs Now Act. Mainly, the act would create new tools to force drug companies to discuss price reductions. It would also put a cap on out-of-pocket costs for Part D beneficiaries at $2,000 each year—down from $5,100 under current law. “The annual growth of medical spending is unsustainable,” Moore said at the event. She also explained that she is taking a drug that costs $18,000 a month. “I don’t know which part of that copay anyone thinks I can afford as a member of Congress,” she said.

‘Picking Up a Medication Shouldn’t Break the Bank’

State lawmakers also want to get into the discussion. Lt. Gov. Barnes spoke about the creation of the Governor’s Task Force on Reducing Prescription Drug Prices, which Gov. Tony Evers created in August. The task force will look at what other states have done to reduce costs and recommend legal, regulatory or community-based approaches to address the issue in Wisconsin. Barnes is part of that task force, which will make its recommendations to the governor at the end of every year. “Picking up a medication shouldn’t break the bank,” said Barnes. “Ultimately, we’re all paying the price.” Mayor Tom Barrett even made an appearance at the event, giving support to all those who attended, which included a large number of AARP members. “This is an issue that clearly can be won,” said Barrett. “It’s about being mobilized. I think the more we can make this an issue at the state level, the more we can make this an issue on the national level.” But in the meantime, it’s people like Nancy Koch that will be waiting to hear about a possible solution. Comment at shepherdexpress.com n

Nancy Koch PHOTOS BY EVAN CASEY

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O C T O B E R 17, 2 0 1 9 | 5

NEWS&VIEWS::TAKINGLIBERTIES

Don’t LGBTQs Still Have Equal Rights in America? ::BY JOEL MCNALLY

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HEN THE U.S. SUPREME COURT LEGALIZED SAME-SEX MARRIAGE IN THE LANDMARK 2015 CASE, didn’t the court say the Constitution guaranteed everyone will be treated equally under the law regardless of sexual orientation? It was on TV and in all the papers. Surely, the Supreme Court hasn’t forgotten already. So why was the court holding a hearing last week to decide whether a 1964 civil rights law prohibiting discrimination against anyone on the basis of sex would somehow permit employers to fire someone for being gay or transgender? If being gay or transgender isn’t based on sex, what in the world is it about? An open-and-shut case. The biggest question before the court wasn’t really about discrimination. It’s obviously discrimination to fire someone based on sexual identity rather than job performance. The U.S. Equal Employment Opportunity Commission has protected gay and transgender individuals against job discrimination since 2015. The cases before the court were particularly egregious. A county social worker ran a successful program for abused children for a decade until he was abruptly fired after joining a gay softball league. After years of therapy, a transgender plaintiff was told by her doctors to live for a year as a woman before transitioning through surgery. She was fired when she told her boss she would begin dressing in appropriate female business attire. The real question before the current court is whether Donald Trump’s two rightwing appointees will vote to reverse the continuing recognition by the court that LGBTQ Americans have the same legal rights as everyone else. Both Neil Gorsuch and Brett Kavanagh were law clerks for retired Justice Anthony Kennedy, the deciding vote who wrote many of the majority court decisions affirming LGBTQ rights, including same-sex marriage. Kavanaugh, who replaced Kennedy, asked only one question during the hearing, giving little indication how he was leaning. Gorsuch aggressively questioned an attorney for the transgender woman, asking whether the court should “take into consideration the massive social upheaval that would be entailed” in a

decision providing job protections for gay and transgender employees. Gorsuch said “drastic” changes could include creation of gender-neutral bathrooms and abolition of dress codes. The bafﬂed attorney simply replied there was no existing evidence of any such “massive social upheaval” ever occurring.

What ‘Upheaval?’

Indeed, Wisconsin experienced no such cataclysmic upheaval in 1982, when it became the ﬁrst state in the nation under then-Gov. Lee Sherman Dreyfus, a Republican, to ban discrimination in employment and housing against gays and lesbians. Neither have any of the other 20 states and Washington, D.C., that have since adopted similar laws outlawing discrimination based on sexual orientation. The fantasy of the U.S. Supreme Court worrying about such “massive social upheaval” was especially bizarre coming from Gorsuch. Gorsuch just published a book, A Republic, If You Can Keep It, arguing judges shouldn’t “do anything other than interpret statutes according to the ordinary meaning of their terms” and should never try to guess at legislative intent or produce particular outcomes. Contrary to the rightwing political philosophy of “originalism” that the Supreme Court should return to the “original” intent of the language written by the founding fathers—you know, back in the good old days when women, African Americans and anyone who wasn’t a wealthy property owner had no rights at all in our democracy—the “ordinary meaning” of words in our statutes does change over time and become more inclusive. My wife, Kit, and I have direct personal knowledge of how little the words of the Civil Rights Act of 1964 outlawing discrimination “based on race, color, religion, sex or national origin” actually meant until years later when courts began enforcing their “ordinary meaning.” We both graduated in journalism from Indiana University two years after the passage of that civil rights law. Despite the law, it was routine for newspaper editors conducting job interviews on campus during our senior year to specify they only wanted to interview male graduates. They usually said they didn’t have any openings in their “women’s sections,” devoted to fashion, cooking and other subjects of interest to women. Because Kit’s gender couldn’t be determined by her name, she signed up for those interviews, anyway, to tell editors they were overlooking outstanding female graduates capable of doing any job in their newsrooms. It took decades for most newspapers to realize that. Many industries still have to be forced by the courts to cease brazenly discriminating against women and racial minorities. When I started to work for The Chicago Tribune that fall, Kit passed on working for another company that wanted her to agree not to become pregnant for three years. That’s why we should only elect presidents who will appoint Supreme Court justices who will keep expanding equal rights and opportunities for everyone instead of moving our nation backward by deﬁling and dismantling democracy. Comment at shepherdexpress.com. n SHEPHERD EXPRESS

ERIN BLOODGOOD

::HEROOFTHEWEEK OFTHEWEEK

Octo B er 26, 2019 Shawna Whitehead

Shawna Whitehead Works for Workplace Diversity

thous ands in cash and prizes! costume co ntest j udging fro m 9pm-11:30PM FI NAL w in ner c h os en at M idn ight

::BY ERIN BLOODGOOD

hawna Whitehead has always been an entrepreneur, motivated to make her own path. With a bodacious and outgoing personality, she has a way with people and has dedicated her time to improving the lives of others. In the past, she ran a daycare center, beauty salon, nail salon and recruitment center, but it wasn’t until two years ago that she founded the company that brought all of her passions together. That company is called Destined to Succeed. Her newest business trains people in cultural diversity and job preparation to help them adapt to the workforce. More than that, Whitehead structures the programs to help people find what they are “destined” to do. The idea to train people in cultural diversity came from Shawna’s personal experience in 2015. When she applied for a human resources job at Northwestern Mutual, Whitehead understood her audience and specifically dressed the part. “My hair was professional, I had my French manicure, short lashes; I had my gold teeth, but I had my suit on,” she explains. The image she put on for the hiring manager was far from how she usually chose to express herself, but she knew she had to appeal to a corporate team. Even with her efforts, her recruiter told her that she likely wouldn’t make it to the second interview because “you have gold teeth. You do not look like our demographic.” Whitehead felt belittled by the situation and chose to pour her frustrations into helping others navigate diversity challenges in the workplace. After starting Destined to Succeed, she hasn’t looked back. In addition to cultural diversity workshops that teach people how to communicate with others from different backgrounds, she offers certifications for corporate etiquette and customer service. The company also assists people in getting their GED, aids in job placement and hosts mock job interviews. As if that wasn’t enough, Whitehead instituted her Pipeline Program, which helps those coming out of prison to re-enter society and find work. The Pipeline Program gives previously incarcerated men and women a chance in the job market, especially when there are few resources available for them when they leave prison. Whitehead was tired of seeing these people in her community struggle, so she began enrolling them in a two-week job preparation program. She contacts local employers that are looking for new hires and are willing to hire these potential employees the moment the program is finished. Whitehead is not only changing the lives of the participants in the program but is encouraging workplaces to hire previously incarcerated people. She is fighting the stigma associated with incarceration by showing companies that these are hardworking people and they just want to get their lives back on track. These programs barely scratch the surface of what Whitehead has done to effect change in the city. Her other two business ventures called Second Chance Transportation and her Christian talk show “Walking in Your Destiny” contribute to the work she is doing to give the underrepresented an advantage. And she’s not stopping there. Learn more at facebook.com/Destined2SuccedInstitute. For more of Erin Bloodgood’s work, visit bloodgoodfoto.com. Comment at shepherdexpress.com. n SHEPHERD EXPRESS

Fo r M o r e I n fo r m at io n , V i s i t B ra dyst r e e t. o r g

Prospect Avenue High Rise is looking for a Part-Time 2nd Shift Garage Attendant. What We Look For:

We are looking for flexible, hardworking and courteous individuals who enjoy working with people and excel in a fast-paced environment.

Job Description:

• Hours are 3:30 PM to 11:30 PM Saturday and Sunday. • Promptly and carefully park residents’ vehicles. • Greet and open garage lobby door for all residents. • If appropriate, assist residents with groceries, packages and luggage.

Requirements:

• Must be able to drive vehicles with manual transmission. • Must have a valid driver’s license and insurance. Please contact Lori Ferguson at 414-326-3575 or by email at lferguson436@gmail.com for more information. You may also fill out an application in person at 1610 N. Prospect Avenue, Milwaukee, WI 53202. OCTOBER 17, 2019 | 7

::SAVINGOURDEMOCRACY ( OCT. 17 - OCT. 23, 2019 ) The Shepherd Express serves as a clearinghouse for all activities in the greater Milwaukee area that peacefully push back against discriminatory, reactionary, homophobic and authoritarian actions and policies of the Donald Trump administration and others who seek to thwart social justice. To submit to this column, please send a brief description of your action, including date and time, to savingourdemocracy@shepex.com.

Thursday, Oct. 17

Inclusion Workshop with August Ball @ UWM Union WisconsinRoom, 2200 E. Kenwood Blvd. 5-8 p.m.

Laughing Liberally Milwaukee @ ComedySportz Milwaukee, 420 S. First St., 8-10 p.m.

As Laughing Liberally Milwaukee lists on their blog, it is a show “hosted by comedian, cartoonist and progressive talk radio host Matthew Filipowicz whose work has been featured on CNN, NPR, PBS, HBO, BBC, Ain’t It Cool News, New York Times, Wall Street Journal, The Atlantic, The Nation” and more. Comedians performing on the bill include Brian Green, Marcos Lara, Cynthia Marie, AJ Grill and Dana Ehrmann. The event will also have an interview with Lane Hall and Joe Brusky from the Overpass Light Brigade.

Monday, Oct. 21

August Ball, the CEO and founder of Cream City Conservation & Consulting LLC, empowers people of color to take positions of leadership within the green economy. As a result of this session, participants will be able to “articulate the basic definitions of diversity, inclusion, equity and unconscious bias, begin to identify ways in which bias impacts leadership and team experiences and understand the relationship between bias and diversity, equity and inclusion,” says the UW-Milwaukee University Recreation department.

Saturday, Oct. 19

African American Community Leadership Forum @ Johnson Controls Volunteer Center, 200 W. Pleasant St., 9 a.m.-3 p.m.

The 2019 African American Community Leadership Forum will include topics that range from the census, employment, Real ID, driver licenses for all and unlocking the vote. Admission is free and lunch is included.

Peace Action of Wisconsin: Stand for Peace @ the corner of South Howell and East Howard avenues, noon-1 p.m.

Every Saturday from noon-1 p.m., concerned citizens join with Peace Action of Wisconsin to protest war and literally “Stand for Peace.” Signs will be provided for those who need them. Protesters are encouraged to stick around for conversation and coffee after the protest.

CNS Panel with 2020 DNC Organizers @ Silver Spring Neighborhood Center, 5460 N. 64th St., 6-7:30 p.m.

As Carvd N Stone Inc. (CNS) says on their event page, they are “hosting a community panel that will feature leaders from the 2020 Democratic National Convention and the Milwaukee 2020 Host Committee to share information on the current status of the convention plans, the expected impact of the convention on Milwaukee and the ways the community can get involved.” Panelist representing the 2020 DNC will be Joe Solmonese, the CEO of the Democratic National Convention Committee; Liz Gilbert, the 2020 Milwaukee Host Committee president; and Lafayette Crump, the 2020 Milwaukee Host Committee vice president of diversity, vendor accountability and growth. CNS President Nyesha Stone will moderate the panel. The event will be geared towards youth, but all are asked to come.

Wednesday, Oct. 23

Budget Town Hall Meeting @ Milwaukee Public Library, Capitol Branch, 3969 N. 74th St., 6:30 - 7:30 p.m.

Milwaukee County Supervisors Sequanna Taylor and Eddie Cullen will be holding a town hall to discuss the 2020 Milwaukee County budget. “The most important part of the budget is you! Come and make your voice heard, bring questions and join the conversation,” says the Budget Town Hall Meeting event page. Comment at shepherdexpress.com.

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8 | OCTOBER 17, 2019

SHEPHERD EXPRESS

SHANK

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SHEPHERD EXPRESS

O C T O B E R 17, 2 0 1 9 | 9

::OUTOFMYMIND

Healthy Cultures Respect their Elders ::BY PHILIP CHARD

hen sizing up a prospective mate, women are often told, “Watch how he treats his mother.” Generally, that’s good counsel. In turn, it invokes another question worth considering when assessing a person’s character: “How does that individual treat his or her elders?” Increasingly, we witness disappointing answers to that question. For example, I was in a slow-moving grocery checkout line, made so by an elderly lady struggling to find and count her money. Behind her were several younger people increasingly exasperated with the delay. One began muttering under his breath while the others laughed derisively, using terms like “senile” and “senior moment.” Kindly, the clerk helped the lady and, after a bit more fuss, she got the job done. As she shuffled out, I heard one of these miscreants whisper, “Somebody should put her out to pasture.” Leaning forward, I told them, “Your day will come.” Not long after, I happened upon an absurd road rage incident where some emotional dolt with an ultra-short fuse was honking, leaning out the window and screaming, “Move it, grandpa!” to the car in front of him. As I pulled up behind this goon at the next stoplight, he again screamed at the driver and occupant of the so-called offending vehicle in words I cannot share. The target of his verbal venom was an elderly couple clearly frightened and intimidated by his tirade. As we proceeded, it was apparent the senior citizen behind the wheel was driving safely and at the posted limit. His crime? He was old and not subject to the same frenetic hurry sickness as other drivers in his midst.

10 | O C T O B E R 1 7 , 2 0 1 9

Elder Abuse is Increasing

While the incidence of elder abuse, both physical and emotional, is increasing in our nation (and likely under-reported), so also, it seems, is an attitude of disrespect for and impatience with the very old. In a culture obsessed with youth and inebriated with speed and personal entitlement, the willingness to tolerate, let alone honor our elders seems in peril. “Partly, it’s the breakdown of extended families,” an older friend hypothesized. With fewer elderly people living with their extended families, youngsters are less likely to learn to respect and care for their grandparents, as well as elders in general. Increasingly, seniors collect in retirement communities and care facilities, away from the social mainstream. This creates an “out of sight, out of mind” scenario in which people don’t make time in their busy lives to include the old. “Deep down, I think it’s because we scare them,” another senior told me. “They don’t want to believe they will ever get old like me. And, have you ever seen a culture more afraid of aging and death?” Other elders tell me this is just part of a general loss of civility and compassion in our society. The old simply make easier targets of opportunity because they seem less able to defend themselves. Whatever the causes, the effects are reprehensible. Do we want to create a society where the old are too often forgotten and, when in our midst, treated like worn out shoes destined for the landfill? If so, we discard a treasure trove of experiential wisdom our elders won through years of facing life’s challenges, an asset that many other cultures recognize, honor and rely upon. The following story speaks to our cultural blindness in this regard. An exasperated woman sends her son out to purchase a wooden bowl for her feeble mother (his grandmother), who keeps dropping and breaking their porcelain ones. When the boy returns, he brings two bowls instead of one. “I only wanted one!” his mother fumes. Her son replies, “I bought the other one for you, for the day when you are old.” Whatever bed the younger are making for their elders will one day be theirs to sleep in. For more, visit philipchard.com.

SHEPHERD EXPRESS

NEWS&VIEWS::POLL

You Disagree with Ron Johnson

Last week, we asked if you thought Wisconsin Republican Sen. Ron Johnson is right when he asserts that Russia did nothing wrong during the 2016 U.S. presidential election; instead, it was Ukraine that did. You said: n Agree with Johnson: 17% n Disagree with Johnson: 83%

What Do You Say?

While Donald Trump’s order to pull American forces out of northern Syria means that about 1,000 U.S. troops will be redeployed, it also green-lighted a Turkish invasion of Syria. Now, terrorist ISIS forces are escaping detention, 130,000 people have been displaced and our longtime Kurdish allies are under assault. Do you agree with Trump’s order to withdraw all U.S. forces from Syria? n Yes n No Vote online at shepherdexpress.com. We’ll publish the results of this poll in next week’s issue.

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We will keep you informed each week about the growing availability of legal cannabis products in Milwaukee and what’s happening at the state level with respect to Wisconsin’s movement towards legalization, what’s happening in other states and in the rest of the world.

Wisconsin Hemp Association Fosters Communication in a Growing Industry ::BY SHEILA JULSON

he first week of October brought lots of rain to the southern half of Wisconsin, but that didn’t stop Phillip Scott, founder and president of the Wisconsin Hemp Farmers & Manufacturers Association (WIHFMA), from eagerly helping one of their association members harvest hemp. “Most crops look pretty successful,” he remarks. “As long as it’s dry next week with good air movement and a little bit of sun, we’ll be happy.” WIHFMA is a nonprofit focused on hemp education and reform. “We educate the community, farmers, law enforcement—anybody who needs that education to help hemp streamline and move forward,” Scott says. “In the meantime, while educating those people, we learn from speaking with people in the industry about how to guide laws and future amendments that might happen to make sure this is set up for success for everybody, not just a select few.” Scott became intrigued by hemp with the cusp of the medical marijuana movement on the West Coast. When the 2014 farm bill was signed into law, allowing states to develop hemp pilot programs, he saw the potential for hemp as a useful commodity. He was a United Parcel Service driver at the time, and he used his accrued vacation time to travel to both coasts and network with hemp industry processors, farmers and manufacturers. “I gained a lot of knowledge and experience,” Scott says. In 2017, when discussion began in Wisconsin about implementing a hemp pilot bill, Scott and others in the state who were excited about the prospects of hemp attended open meetings but wanted to be sure that that everybody would be included in the industry. That goal of inclusion led to the incorporation of WIHFMA in February 2018. During the short time WIHFMA has been in existence, their board of directors expanded, and they now have five subcommittees dedicated to processing, manufacturing and farming; a cannabis committee to examine future regulations; and a statewide roundtable to call other alliances in the industry to network and advocate for a successful hemp industry. During their first year, Scott says they helped approximately a dozen hemp farmers get their product to market. Scott also emphasizes how WIHFMA encourages communication among farmers, processors and manufacturers. “One thing I learned from all my travels was that the farmer didn’t talk to the processor, and the processor didn’t talk to the farmer, and those two didn’t talk to the manufacturer. That could hinder growth, so communication is one thing we wanted to encourage.” One challenge in the hemp industry Scott has found, both in Wisconsin and nationwide, has been getting good genetics that produce quality flower and a good crop yield. He’s also seen challenges with drying and curing to prevent mold and bud rot. But he again cites communication among hemp industry participants as one of the biggest successes. On the farming end, WIHFMA has attracted both farmers looking for an additional cash crop and growers who already had knowledge and appreciation of the cannabis plant. Scott credits the adaptivity of the Wisconsin farmers to build or modify their current equipment to work with the hemp crop. He notes that some farmers are also looking beyond the “green rush” and considering cannabis for uses other than cannabidiol (CBD) processing, such as fiber and paper. WIHFMA’s manufacturing members include labs, extractors and testers, as well as insurance companies, e-commerces and banks. “There are many parts to our industry, and we’re playing into all of those parts to give the whole network a chance to be successful. Everyone within our network is from Wisconsin,” Scott concludes. For more information, visit wihfma.org. Comment at shepherdexpress.com. n 12 | O C T O B E R 1 7 , 2 0 1 9

Australian Capital Legalizes Recreational Marijuana ::BY JEAN-GABRIEL FERNANDEZ

he Australian Capital Territory (ACT), which includes that nation’s capital city, Canberra, became the ﬁrst Australian jurisdiction to enact a law legalizing recreational marijuana. The bill, which passed on Wednesday, Sept. 25, allows residents 18 and older to possess up to 50 grams and grow up to four cannabis plants per household; it takes effect on Friday, Jan. 31, 2020. While it may seem like a major triumph for cannabis legalization that one place or another is making such strides, they are often merely baby steps, limited to a territory or a state rather than affecting an entire nation. Only a few countries, such as Canada, South Africa, Georgia and Uruguay, have opted for nationwide legalization. Recreational marijuana is still federally banned in Australia, carrying a potential prison sentence of up to two years for possession, although medical use has been legal nationwide since 2016. Even in the ACT, cannabis users still risk arrest, ﬁnes and jail time under Australian federal law. “This does not entirely remove the risk of people being arrested un-

der Commonwealth law, and we are being up front with the community about that,” ACT Atty. Gen. Gordon Ramsay told the Legislative Assembly.

America Leads the Charge

That the ACT’s new policy contradicts federal law is not unlike the situation in the U.S., where 11 states and Washington, D.C., have legalized recreational marijuana but it remains a federal crime. That is not a coincidence. As the bill’s explanatory statement explains, the moves to legalize marijuana in various North American jurisdictions guided the decision to support legalization in the ACT. “Recent international developments have seen nine U.S. states and the District of Columbia legalize cannabis not just for personal use but legalizing the industry. Canada has also legalized the sale and possession of cannabis and is in the process of setting up their market,” writes the Australian Labor Party’s Michael Pettersson, who sponsored the bill, in its explanatory statement. Even matters of domestic policy in the U.S. signiﬁcantly inﬂuence the rest of the world, as the international community has its eyes on us. While the U.S. is mostly insulated from international news, American news make international headlines daily. Virtually every person on the planet has by now heard about Donald Trump’s latest scandal, seen the latest Hollywood blockbuster or knows at least the broad lines of public debate in America. Other countries like Australia—but also New Zealand, in which a referendum is currently being prepared to gauge interest in cannabis law reform—often follow in our country’s footsteps. As such, it is our responsibility to be a role model worth following. Comment at shepherdexpress.com. n SHEPHERD EXPRESS

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Medicare for All! But Are All for Medicare? ::BY BOBBY PETERSON WITH RICHARD LAVIGNE, HEALTHWATCH WISCONSIN, INC., WRITTEN EXCLUSIVELY FOR SHEPHERD EXPRESS

“M

edicare for All” is the oft-used political slogan to rally the masses to rethink our dysfunctional systems of health care coverage payment and delivery. The term gained renewed traction as a campaign buzzword in the Democratic presidential primary. This lofty concept, proposing a “Big Bang Theory” for health care reform, deserves serious attention, as it would completely remake America’s health care financing system in a way that hasn’t happened since World War II. But Medicare for All can be a different concept based upon political leanings and plan details. Specific differences emerge as you peel back the layers of competing proposals.

Breaking Down the Ideas Roughly speaking, the field of competing health reform policies breaks down into four categories: Medicare for All, Medicare if You Want It, the Public Option and Medicaid for All. Among those categories, the first—Medicare for All—may be the easiest to understand. Simply put, the dominant Medicare for All proposals would eliminate the current system of profit-driven health insurance. It eliminates most other government-run insurance programs, including Tricare, the Federal Employees Health Benefits program and Medicaid. After a transition period, U.S. residents could enroll in a modified version of the existing Medicare program. Vermont Senator and Democratic presidential candidate Bernie Sanders’ plan, for example, virtually eliminates out-ofpocket costs, premiums and copayments, and it would do away with insurance provider networks. In theory, Americans could choose any doctor, anywhere, at any time. Medicare for All proposals offer simplicity and predictability with the potential to reduce America’s uninsured rate to zero. Naturally, though, the radical restructuring of health care coverage and delivery in the U.S. is never SHEPHERD EXPRESS

simple. Implementing such a plan raises big political and process questions and creates enormous challenges under the best of circumstances. The prospect of eliminating millions of private insurance industry jobs and infrastructure would face stiff political resistance. While unified systems of administration could offer leverage and negotiating power, consolidating power in one entity may give unintended power for a bureaucracy to generate mind-numbing red tape. Sorry, folks, costcontainment strategies to control costs will continue in any system we create. Therefore, at a minimum, any time patients and family members must confront monolithic bureaucracy, public or private, they need help and the assurance of a system that includes strong consumer protection accountability and effective enforcement of patient rights. For some, Medicare for All proposals resurrect the fear factor of swollen “government bureaucracy.” The public is generally apprehensive about placing health care coverage and insurance decisions in the hands of government. Our current insurance system is already highly bureaucratic and complex. Currently, roughly a third of the population is already insured under Medicare or Medicaid, where government agencies determine benefit packages and criteria for covered services, but will the 60% or so covered under private insurance be willing to take the same leap of faith?

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How Much Will Medicare for All Cost? A third concern, common to all health reform proposals, centers around cost control measures. The Medicare for All proposals use purchasing power and streamlined administration to help leverage lower costs and reduce administrative expenses. Think Amazon-style purchasing power, only bigger. Medicare for All could establish payment rates for most medical services—either based on the current Medicare rate-setting scheme or through a global, annual, budget negotiation process. Opponents of “government rate-setting” paint such proposals as an existential threat to capitalism guaranteed to result in hospital closures that will strand millions of people without access to medical services. Although health care costs in America have proven to be driven by anything but the invisible hand of supply and demand, it remains to be seen whether American voters will stomach reforms that so visibly constrain the mythical free market economy. The political hot button is cost. How much will Medicare for All cost? The simple answer is a lot, at least in the short term, but in the end, we may all pay less. In general, the Medicare for All proposals anticipate offsetting costs through the elimination of funding for other government insurance programs. All of them, though, will Health continued on page 14 >

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require additional funding from other sources, which raises the specter of tax increases. As a practical matter, the elimination of employersponsored health insurance could free up additional tax revenue. Instead of employers and employees paying more for private insurance, they would redirect those funds (some persuasively argue fewer funds) to pay for the program. Although the tax level is shockingly high, the net cost could be lower, and the money that American businesses currently spend on tax-free employee insurance could convert to taxable salary increases, which are needed to attract quality employees in the absence of health plan incentives. Regardless, as much as Americans may like the idea of universal access to affordable health care, they hate the idea of paying more taxes with at least as much passion. People hear “tax increase” and stop listening, probably to their detriment. That sentiment offers an easy tagline for opponents and may be the greatest vulnerability of any campaign to pass Medicare for All.

What About the Alternatives to Medicare for All? All of these concerns underscore the alter-

14 | O C T O B E R 1 7 , 2 0 1 9

natives to Medicare for All, along with additional questions about the role of the private insurance market and personal responsibility for health care costs. The “Medicare if You Want It” or “Medicare Buy-In” plans envision expanding eligibility for the existing Medicare program as an alternative to private insurance. Eligible individuals could choose to enroll in insurance plans offered through their jobs but would not be prohibited from enrolling in Medicare if they chose to opt out of their employer’s insurance plan. In general, most buy-in schemes imagine an ongoing role for commercial insurance plans in the health system. They would roll back regulations that undermine the Affordable Care Act’s health insurance marketplaces, where consumers can get income-based premium assistance for purchasing individual health plans through commercial insurance companies. Buy-in plans generally offer some competition to the commercial insurance market through premium assistance features for buying into traditional Medicare, but they would also extend premium assistance to Medicare Advantage plans run by commercial insurance companies. Out-of-pocket costs would essentially be the same as they currently stand under existing marketplace, Medicare and Medicare Advantage plans. Most Medicare buy-in proposals limit eligibility based on age. In general, only people over age 50 could secure the buy-in opportunity, so the overall system impact on lowering the uninsured rate is reduced when compared to a Medicare for All system and probably less than the competing “Public Option” proposals. At first glance, Public Option proposals look a lot like the Medicare If You Want It proposals. In fact, two of the leading contenders create a health insurance program named after the Medicare program: “Medicare-X” or “Medicare-E.” The key difference, though, is that Public Option proposals create an entirely new insurance option that directly compete with existing commercial insurance plans. They propose government-run individual health plans alongside marketplace and nonmarketplace commercial plans, as well as group health plans in the small and large employer markets. Premium assistance is available for the proposed individual plans, and small employers could secure tax credits to subsidize employee health plans. With some variations, Public Option proposals generally tie payment rates to the current Medicare rate-setting scheme. With restrictive cost controls, a potentially very large risk pool and Medicare’s relatively low administrative costs, a Public Option plan might provide powerful competition with enough clout to drive a paradigm shift across the entire health insurance industry. Rounding out the field are the “Medicaid for All” proposals. Despite perhaps getting

the least amount of publicity, these proposals revive a concept and discussions that could provide individual states a great deal of flexibility to implement. Medicaid Buy-In plans would authorize a state to charge premiums to enroll certain, normally ineligible populations into its Medicaid plan. The majority of state Medicaid programs already partner with commercial insurance companies to provide managed care services, so a Medicaid for All proposal could simply expand on commercial insurers’ existing roles. Think of Wisconsin’s BadgerCare Plus program, a current public-private partnership to deliver health insurance services. Currently, Wisconsin contracts with private managed care plans to provide BadgerCare Plus coverage to enrollees across the state. A Medicaid Buy-In plan could look like BadgerCare Plus if it were expanded for additional populations.

What’s the Bottom Line? Each health reform idea comes with its pros, cons and big questions. At the end of the day, Americans must decide just how much government they want in their nation’s health care system. Despite the hue and cry of “socialism!” from the right, years ago, a more civil society determined the role and involvement of government for public schools, roads, libraries, police and fire services and much more, yet much of health care is still caught between two worlds and two ideologies. Decisions tend to turn more on emotion than on the specifics of any given plan, but one critical fact remains: Health insurance is confusing, and the devil is indeed in the details. That’s as true for Medicare and Medicaid as it is for any commercial insurance policy. Any effective plan or proposal must include strong consumer assistance, accountability and enforcement of the rules. Some proposals on the table include funding for outreach and enrollment assistance, like the Affordable Care Act’s Navigator programs. That’s a small step in the right direction, but policy makers must recognize that consumer assistance needs to extend beyond just enrollment assistance. Claim denials, billing errors and bureaucratic red tape are, sadly, baked into almost all health care systems, whether they’re government-run or fully privatized. Insurance doesn’t do anybody any good if they don’t know how to use it, how to keep it or how to challenge mistakes. Populations impacted by health disparities face the greatest threats to access. To really get the most bang for our buck, we must commit serious resources to helping people—many of whom are ill themselves or are helping an ill or elderly family member secure needed services—navigate the system. Whatever that may be. For more information, visit healthwatchwisconsin.org. Comment at shepherdexpress. com. n SHEPHERD EXPRESS