Rising Health Care Costs - Some Reasons

Part of the "Healthcare Crisis" which has everyone calling for relief is the fact that the cost of medical services keeps rising. It's getting more and more expensive to see even a primary care doctor, and the time we actually see doctors in those visits seems to keep getting shorter and shorter.

For one of the many reasons this is happening, we need to look back in history some 50 years. Back to the "good old days." What's changed since then?

Back in the day, there were insurances, yes. Blue Cross and Blue Shield policies were probably among the most popular at the time. Many plans offered an 80/20 split, where the Blues would pay 80% of the charge, and you'd pay 20% as a co-insurance.

But millions of people didn't have any. They didn't really need it.

You'd go to the doctor, he'd see you for, say, 20 minutes, and charge you $25.00. If you needed penicillin, he'd come through with the pills you needed, charge you a nominal fee for the drug, and you'd be on your way. If he wanted you to take something he didn't have in stock, he'd write a prescription, and you'd take it to the drug store.

If you had no insurance, you'd pay the $25.00 in full and that would be it. If you had the Blues, you'd pay $5.00 and be out the door, with Blue Shield picking up the $20.00. Easy, right?

Well, yeah, basically.

Then along came President Lyndon Johnson, a Democrat, with his Great Society program. They were going to end poverty, fix all the social ills, and a new utopia was going to emerge. Under his administration, the government got involved in a lot of areas where it hadn't before. Enter federal involvement in health care.

Stories abounded how grandma had to eat cat food because she couldn't afford to go to the doctor. (No, I don't think grandma should have to eat cat food, either--that's not what I'm saying!) But, something had to be done about it! So, Congress worked and worked.

The result was Medicare in 1965.

At the start, Medicare acted just like a regular health insurance. They paid 80%, and the patient paid 20%, allowing the patient to have a little more cash available for other expenses. Many doctors accepted Medicare because it was just as good as Blue Shield. Some seniors even picked up Blue Shield or another insurance policy like AARP to pay the 20% co-insurance.

But, sooner or later, with the War in Vietnam in full swing, it became time to save money in the federal budget. So, what happened?

In a cost-cutting move, Medicare began to say:

"We have decided that the office visit you're charging $25 for is really only worth $20, so that's what we're going to allow you to be paid for a Medicare patient in your care. That means we're going to pay you 80% of what we allow, or $16, and you can collect $4 from the patient."

"Oh," the doctor replies, "so what happens to the $5 you don't allow?"

"You have to write it off, of course! You cannot bill the patient for the difference."

Well, now it's time to do a little simple math.

Let's say Dr. Smith needs revenues of $50,000 per year to meet her expenses for office space, office staff, taxes, and to give herself a salary. 20% of her revenues are Medicare patients with that level of service, or $10,000. Medicare revenues are now $8,000, instead of $10,000, a hit of $2,000, or 4% of gross revenues. Maybe that's absorbable, maybe it's not.

Now, let's say Dr. Jones has an older practice, and he serves mostly the elderly. Many of his patients love him and have been with him for years. He still needs that $50,000 in revenues, but fully 50% of his practice is on Medicare. $25,000 in charges turns out to be $20,000 in Medicare allowed charges. He's writing off that $10,000 in revenue, but that doesn't meet his expenses. He's taken a 20% hit in revenue, and cannot make ends meet on that level.

What is going to happen in either case? Something's gotta give to bring the gross revenues back up to the $50,000 level, right? Well, there are five obvious answers. The doctors either have to:

*(1) Raise the prices for office visits for all patients to make up the difference in what Medicare is forcing them to write off, or

*(2) Work longer hours and see more patients to make up the difference, or

*(3) Refuse to take new Medicare patients into the practice, or, worse yet for the patients

*(4) Refuse to take any Medicare patients, forcing them to go to other doctors, or

*(5) Simply close up shop (or, like what's happening now, set a date certain, then refuse all insurances and become a "boutique" doctor, where the patient pays a large retainer to call the doctor 24/7 when needed.)

Well, of course, the most common answer was #1. Raise rates. Maybe Dr. Smith could get by with raising her rates only $5.00 a visit, but that paltry amount wasn't going to get Dr. Jones' budget back in shape. And, guess who gets hit hardest by these increases? Who else--the patient without insurance!

Additionally, every year, Medicare revises its fee schedule--the allowed amount for the coming year for a host of procedure codes.

Is this a simplistic presentation? You bet! But as simplistic as it seems, it's accurate for what has happened.

In the 1970s, inflation ran amok. Inflation was measured by the "market basket." Remember it? The cost of a specific set of products at the supermarket would change month-to-month, and, imagine that, the cost of that basket pretty much always rose. The dollar bought less and less as it fell in value. Guess what happened to all the other prices? Same thing, they had to go up.

Since medical expenses are not in a bubble, they went up, too. And, insurance policies became pretty much an absolute necessity in order to help patients pay for medical care.

Although we haven't had the roaring inflation of the 70s since then, inflation hasn't stopped, it's only moderated a bit here and there. Prices of goods still go up even though inflation is fairly low, especially over the course of 30 years.


Next post: "Managed care" comes on the scene.

Health Care Reform? The Debate Looms. . .

A brief introduction. . .

For the first few months of this year, I have been a frequent flyer as a consumer of medical care. I was an inpatient with three stays at two different local hospitals as well as an outpatient with a number of different providers, even including urgent care. Additionally, my work as a medical biller has helped me keep my own health care costs more contained. As the debate on healthcare reform nears, it is one in which I have some very definite ideas.

-----------------

Starting off, I want to say that I believe our healthcare mess did not develop overnight, and no "magic bullet" is going to fix it immediately. It's also an issue that cannot be discussed in a single post, so watch this space for new postings in the next few days. There isn't just one factor contributing to it, there are many, and they involve many different groups. In the next few posts, I will name names of those I think have had a hand in bringing the problem about. Some may even surprise you.

I don't have all the answers, and I won't claim to. I do have some ideas that should alleviate some of the crisis aspects, but they're not going to turn this situation around quickly. Nor will any of the "reforms" being discussed at this point in Washington or Annapolis.

All that having been said, welcome! Please, if you see something with which you disagree, post a comment! Likewise, if you see something with which you happen to agree, please feel free to add your comments, too. Lively discussions can be both very informative and helpful in framing an issue. Who knows? Offer a convincing enough argument, and you may get someone else to think differently. Maybe even me.

Some of the questions we'll explore will include:

* Why are health care costs so high?
* Why are health insurance rates so high?
* What about a single-payer insurance system?
* Why are people willing to gamble on no insurance coverage?
* Should people be forced to have health insurance coverage?
* Should we have a national health care system like Britain or Canada?
* Should we develop our own version of a national health care system?
* Why shouldn't the government just go ahead and regulate health care costs?

All right, then. I've already been working on my first "culprit" post, and I should have it done by tomorrow midnight or so. If real inspiration hits, there may be more "culprits" exposed by that time. Watch this space, and let's have a good discussion!

A Personal Cautionary Tale...

Hello, and sorry for the delay of getting new stuff posted. If you haven't seen much here lately, it's because I haven't been able to do any posting. But, now I'm back! (I think...)

I offer a cautionary tale on many levels. There are no morals to the story here, just a bunch of stuff that happened that may give you something to take with you. If so, wonderful! If not, hey, I tried.

You know when they tell you you should never ask what ELSE can happen, because it's probably better that you didn't know? Take it from me--HEED that advice, and pronto!

DON'T ask.

Don't even THINK about it!

A combination of family emergencies and personal health crises has arisen over the last several weeks that basically took me out of circulation. It's going to be an interesting road back, and I'm going to have some commentary on some things that have happened, but, the bottom line is that I'm trying to get back into some sort of "regular" life pattern, and we'll see where we go from there.

Unbeknownst to us at that time as being somewhat related, I began having mild headaches around the first of the year. They weren't overly bothersome, but I could take an occasional dose of Tylenol (tm) or other non-aspirin product to get over the edge. In short, it was very manageable, and I didn't think any more about it.

In mid-month, my mother ended up being admitted to a hospital in Cumberland with multiple problems. She had been an active, vital eighty-two year old who was still driving on her own, had a bunch of different irons in the fire, and so forth. It was somewhat unexpected.

Not having a full-time job at the time, I was able to go up, stay with my sister, and help manage some things at that end. The headaches, of course, continued, and got a little worse. Still, what would you think? Stress? Duh.

Mom got better that next weekend, and I came home to start a new project. Headaches? Yup, a little worse. I'd been on blood thinners and decided to risk taking NSAIDs like ibuprofen, even though I knew that I probably shouldn't have, but wasn't getting relief with the other stuff any more.

The first night on the new project, Mom slipped away. I was in Cumberland in the wee hours. The headaches, of course, were kicking harder by then.

After a sort of decent night's sleep, we went about making arrangements, looking over the will, all that good stuff, and planned for a Friday funeral. Mom had done a lot of pre-planning, thankfully, and some of the expected expenses had already been covered, especially at the cemetery.

The head kept going.

I spoke for our family at her service and came home later that weekend, ready to go back to my project. The headaches became near crippling. I called my primary care doc's office for an appointment the following day (Wednesday), and they were able to squeeze me in in the afternoon. That Tuesday evening, I remember driving back home, lights bothering me, doing the best I could so I could down some naproxen.

Wednesday, my doctor ordered a brain CT. We tried to get a late afternoon scan, but to no avail. The radiologist's scheduler looked up my insurance and said that I needed a pre-auth. I duly reported it to the doc's office, and they told me they'd get me one the next morning. I did some pre-registration with the radiology office over the phone, and they said they'd be ready once I had the pre-auth to go from there.

My doctor's office called early in the morning, said she had talked with my plan, no auth was needed, but gave me a reference number in case I wanted to give it to the registrar. A 2 PM CT scan was scheduled.

I could still drive, but barely.

A CT scan without contrast turned into one with and without. I was asked to sit in the dressing room for a minute while they read it. Within another minute, the radiologist popped in and asked, "Say, do you like hospital food?"

"Not particularly," I replied, "but I figure that's where this is headed."

"OH yeah. I've spoken to your doctor, he's getting you ready to be admitted to Harbor. He thinks it's OK for you to grab a few things and get over there, they'll be ready for you."

Last couple of points in this tale:

The diagnosis was a subdural hematoma. Surgery was indicated, and fairly quickly. Blood thinners complicated the process because I couldn't have the surgery until I had plasma infusions and my bleeding time normalized. Surgery was done Tuesday. Recovery 4-6 weeks, though, since I'm able to do net stuff right now, I may be able to do some of my project a bit earlier.

So, there it is. I leave the gleaning of any lessons to you, and thanks to all of you for your prayers and support!

A "Throwaway" Poll for You. . .

I was watching the Inaugural ceremonies this past Tuesday, and actually enjoyed most of the buildup and our new President's Inaugural Address. I'm happy to see some of the things he's done in just the first couple days in office that will start to reverse the damage done by the Bush Administration, and I wish him the best for our nation.

It's amusing that the news media has been taking certain elements of the program and picking them apart, though.

Last night, we found out that the musical number with Yo-Yo Ma and the rest of the gang was (gasp!) pre-recorded. It was still a beautiful selection, very nicely arranged, and performed well. I can understand that, due to the extreme cold, the instruments would probably not have kept in tune and the results could have been disastrous. I'm OK with that.

You gotta hand it to the folks that decided to attend and stand in that weather for a long period of time. I couldn't have done it.

The real amusing thing has been the "controversy" over The Hat, though. Aretha Franklin's grey bow hat with Swarovsky crystals. You couldn't forget it. Not that it wasn't interesting, it was! Not that it didn't go well with the rest of her outfit, it did! But the first words out of my mouth when I saw her come to the podium were, "oh, NO, she DIH-int wear that hat!" My sister, sitting with me, said, "oh yeah, she DID."

Seems that Ms. Franklin has a regular chapeau maker named Luke Soon, with whom she's had a long-term buying relationship. It's actually a combination of two hats that the Queen of Soul saw when she was shopping for her Inaugural duds. Apparently she wanted the bow from one hat and the cap from another combined, which, of course, Mr. Soon was only too happy to do. Ellen Degeneres wore a knockoff (apparently available for $178.00) the next day on her show, and, of course, CNN, Fox, and a few other tv networks had things to say about it.

So, here's the throwaway poll. You can see it in the sidebar. I realize there aren't enough choices to really give a chance to express an opinion, so, please make a comment if you wish as well.

New Stuff? I Need to Apologize

For all my fans, all three or four of you, I apologize for not having new postings up in the last week or so. There has been a family emergency and I've been out of town, not really having the time or energy to think of new things to post. I fully expect that I may have some new stuff at the beginning of next week, so please check back after January 26 and see if I've done so.

Maybe This Year for Zero-Based Budgeting?

You gotta pity poor Martin O'Malley and the Two Mikes in Annapolis. Really, you do.

Now that tax increases seem to be off the table, there's some real budget cutting that's got to happen. Call out the usual suspects: we're going to have to cut education, public safety, health services, you name it. It's the typical scare tactics they trot out every time.

Not this year, they won't! It won't fly.

The Governor is already saying that there is likely going to have to be layoffs of state workers. That's a real kick in the teeth for the folks that put him there, just like the furloughs were. Now, there are going to have to be job cuts, too.

Well, there are a couple of things to consider in trying to fix the budget mess. It's not an exhaustive list, by any means, but it's a couple of steps in the right direction.

1) There are phantom employees budgeted in a number of State agencies. A phantom is a worker whose salary is in the budget, but there is no employee doing any work. Let's say that our agency, the Bureau of Obfuscation, budgets 20 employees for the year, but we only really keep 18 filled. With 2 unfilled positions now we have money that *would* go toward salary and benefits if there were employees in those positions.

If each of the spots would pay $30,000, then that's $60,000 in "extra" money we can move around because we know we're not going to fill them in the first place. We don't have to put $37,000 in the budget for project X that we really want because we can take money from "salaries" and move it to X, and we'll still have $23,000 left over! And our Bureau isn't the only one in State government that has them.

Sure, but now the situation is dire enough that, even after you lay off all the phantoms, there will still be real people losing their jobs and benefits.

2) However, there's something even more galling, and both State and Federal departments do this. Our Bureau of Obfuscation got a $10 million appropriation for this year. We spent our money fairly wisely, and we still have our two phantoms, and now our total spending was $9 million. Uh oh!

We need to spend the other $1 mil and do it quickly, before the end of the fiscal year! Why? Because if we don't, those who make the appropriations process will see that we didn't spend all of our money, and they'll think we won't need $10 million or more for next year. I've mentioned this to friends of mine who actually are government employees, and they vouch for the fact it happens all the time.

Now, we go into panic mode and start ordering anything and everything we can. We stack our office supplies room to the ceiling with boxes of paper; grosses of pens, pencils, and highlighters; millions of binder and paper clips and other things. But we've only spent $100,000. What to do? What to do?

Well, we have to go on a spending spree! That office furniture we bought only two years ago is looking kinda rough. Suzie Q down the hall complained that the fabric was frayed on her arm rest. Get her a new ergonomic one, right away! The carpet in our posh lobby from last year has a tiny worn spot in it already, and the copiers we bought three years ago have been worked to death. Or have they? But, if we replace the carpet and buy two new copiers for each floor, we might get close to spending the entire $1 mil left in the budget. We'll get our appropriation for next year, and we can do it all over again!

Oversimplified? Yeah, admittedly. But a lot closer than you'd like to believe.

There's an alternative, though. Sooner or later, the State is going to have to look at it. Could this be the year? Under this Governor?

It's called zero-based budgeting. Instead of looking at what your budget was last year, you start at zero. How much are we going to need for real employees? Add it in. How much are we going to need for office supplies? Add that in. What's our phone bill? Add it in. And so forth.

Now, how much do we need for the programs we actually administer? What are the historic costs we've incurred in administering this program, not what number have we decided to pull out of the air because it sounds cool? Are there inefficiencies we can correct to save even more money?

Do we let our lights burn all night instead of shutting them off when nobody's in the building? Is our HVAC system set so that it doesn't provide the heat or AC to keep the mice nice and comfy at night, but is good for working hours? Do we shut our computers off at night, keeping only the essential servers going?

OK, you want to add $1.5 million in the XYZ program. What does the XYZ program do? How much did we spend last year? Why? How effective was the program, how many people did it help? How will the new money be spent? What is your budget for XYZ? Basically, you justify your expenditure proposal. It could happen.

Let's say your 12 year-old child comes to you and says, "Mom, when we go shopping today, would you give me $20.00?" Your first reaction isn't going to be, "sure, honey, here it is. Enjoy. Buh-bye."

At least that's not what MY mother would have said. (If you would say it, could you adopt me, please???)

No, you're going to ask why the child needs the $20.00, what she intends to buy with it, why she needs the item, and you'll probably have a whole host of other questions.

In this period of budget crisis, and even in good times, we should do no less with government budgets.

What can we do about it? Contact your legislators, both your Senator and your Delegate(s), and let them know you want a different approach to budgeting! You can find out who your folks are by going to the General Assembly website at: http://mlis.state.md.us/ and put your address in the "Find Your Legislator" box.

And, while you're at it, why not drop Gov. O'Malley a little note asking the same thing? http://www.gov.state.md.us/mail/

UH OH! Guess What Happens Wednesday?

The Maryland General Assembly opens its 90-day Session in Annapolis on Wednesday, January 14, 2009. Although the State is going through some tough economic times right now, various legislative leaders seem to indicate that tax hikes are not likely, but that budget cuts are. (Whew!)

I'm already looking at the synopses of bills that have been pre-filed, and I've got a couple of them that have me scratching my head. Once I see the synopsis, if I have other questions, I'll go into the text of the bill itself.

SJR 1, for example, would have Maryland finally ratify the 17th Amendment to the US Constitution, which provides for the direct election of US Senators. It was ratified on April 8, 1913. (And we need to do this, why?) http://mlis.state.md.us/2009rs/bills/sj/sj0001f.pdf

What will they get into this year? I don't know, but stay tuned! I'll try to report on it as best I can. And I welcome comments!

Just remember, if the 2007 Special Session didn't prove the following quote, nothing will:

"No man's life, liberty or property is safe while the Legislature is in session."

Now, I digress. Do you know who said that? The answer may surprise you!

A lot of people think that it was either Mark Twain or even H. L. Mencken that came up with the saying. In doing research on the net, I wasn't quite satisfied, so I looked for as many references as I could find, and one source seems to have done exhaustive work on it.

The American Dialect Society has a number of citations as to where the quote was first found, and it determined that it was neither Twain, nor Mencken, nor even Ambrose Bierce (1842-1914), a journalist and short-story writer during his lifetime.

The answer? Judge Gideon Tucker. Who? He ruled in favor of a widow in a negligence suit [1 Tucker 248 (NY Surr 1866)] because her attorney did not advise her on the most current law dealing with settling her husband's estate. That's when he uttered the quote.

It seems that Twain somehow got hold of the statement, used it, and Noah Webster apparently credited Twain with it rather than the judge.

If you'd like the citation, drop me an email and I'll send it to you.

Anyway, Wednesday's going to be the first day of many of fun. And, think of it! We'll soon have Governor O'Malley delivering the State of the State Message!

A Poll on The Economy, Just for Fun

Just how confident are you that President-Elect Obama's economic team will be able to do much of anything with the economy in the next 12 months? Will the Wall Street banker types and the head of the New York Federal Reserve Bank be able to start fixing a badly-broken system in that time?

I thought I'd put up a poll to see what you all had to say about it. You'll see it down on the sidebar, so please take a moment and cast your vote. When it's done, I'll post the results and we can discuss them. I wanted to see if there was a market for occasional polls on this site, because they might be fun to do.

Meanwhile, this post is open for your thoughts about the economy in the next year and what we think or hope will happen with it.

I will admit I haven't taken a real close look at the PE's economic plan yet, especially since he just announced it the other day. What the mainstream media boils it down to and what was actually said can often turn out to be two different things. I prefer going to as close to the source as I can for something like that.

Has anybody looked at your 401(K) or other retirement plans yet? I'll admit, I'm scared to open mine, especially since the company I worked for had lousy choices in the first place. I know that a friend of mine has looked at his 403(B) since the meltdown, and he's down to around $20,000 from $35,000 this past summer.

How's that bailout working out for US?

It appears that our new President is going to have a lot of Bill Clinton's retreads on his team. That could be good or bad news, because, on balance, the Clinton years weren't all that bad economically.

Will that be enough to bring consumer confidence up so that people will start spending again? Will businesses start expanding again? Will the jobless rates go down, even slightly?

Will the opinion-makers in the press and media be able to convince Joe the Sixpack that everything's far rosier than it is? (Remember Josef Goebbels.)

OK, now I'm getting farklempt. I've put a lot of questions out there! Discuss.

Noon on January 20 Can't Come Fast Enough

Dear Mr. Bush,

The title of this post says it all. Your presidency has been an absolute disaster for just about everybody concerned, and I can't wait until your last moment in office. No, I didn't vote for you in either 2000 or 2004, neither did I vote for your Democratic opponents.

As a Republican, you belied everything that the GOP stood for. If I hadn't decided to leave your party in 1996, I would definitely have hit the road during the early portion of your first term. The "Compassionate Conservative" turned into the "Big Government Socialist Warmonger," ruining just about everything you and your neocon cohorts could get your mitts on.

The assault on civil liberties following 9/11 -- and what DID you know and when DID you know it beforehand? -- by the USA PATRIOT Act and other legislation is reminiscent of the Clinton reaction to the 1995 Murrah Building incident in Oklahoma City. The bottom line is that we've lost a hell of a lot of our civil liberties in the last two administrations.

"No Child Left Behind" was based on a fraudulent program in Texas and has been shown as the mistake it was in the years since its passage. Discipline problems run amok, schools can't take the steps they need to correct these problems for fear of losing federal funds. Teachers don't like it, school systems have to hire extra staff and spend extra money to administer it. And to think that developmentally disabled children who can't even take care of themselves with basic life skills are going to be able to pass Algebra II by a certain age just flies in the face of reality. It needs to be either radically reworked or, better yet, scrapped.

An attack on Afghanistan *might* possibly have been justified on the basis of the Taliban's aid and comfort for al-Qaeda. However, the war in Iraq, which has cost thousands of American lives and countless Iraqis, and spent untold bagazillions of dollars, was absolutely over the top and unjustified. Now, we're in a morass where someone else is going to have to clean up *your* mess.

On the basis of "UN Resolutions" you stubbornly led a coalition into Iraq. I'm sorry, but when are US troops supposed to be used to enforce UN Resolutions? Especially when the UN has NOT requested that they be used?

The US Constitution (remember that old thing?), which you swore "to preserve, protect, and defend" does NOT call for this nation to be the world's policeman. Nor are we to arrogantly tell others how they must live or mandate what system of government we think is best for them. That's what's gotten us into this situation in the first place!

You've consistently grown the government you talked about paring back. New departments, new fiefdoms, new titles, new powers assumed, new regulations.

Your economic policies haven't been much better. Although I did agree with the tax cuts to help stimulate the economy, I did not think your cozy relationships with all the Wall Street crowd was terribly helpful. There were many warning signs that the subprime market was going to bite us in the rear, but your administration ignored them.

Then, when it all went south, Hank Paulson's "solution" was the big bailout in September, making the Sec Treas the "Bailout Czar," with the sole and ultimate authority to decide who got what funds. (And those are his to give, WHY? )

Sure, there's plenty of paper stock at the Bureau of Engraving and Printing. Roll 'em out, don't worry that our dollar may well free-fall.

Last time I checked, a free market didn't guarantee that if you made bad decisions, the government would bail you out. If you made bad decisions, it was your problem to figure out. We haven't had a free market in decades, though.

But I nearly went through the roof when the bailouts occurred. Taking over AIG made us, for the first time, a socialist nation. The government now owns a certain percentage of equity in exchange for funds in a company that immediately sponsored a lavish vacation for its inept executives at a posh spa. Great.

And it didn't stop there! Now the government has equity in a number of banks and other companies that are "too big to fail."

I've suggested that we scrap the "Star Spangled Banner" for "The Internationale." I'm only half kidding.

No, sir, I'm not going to miss you and the rest of your gang. That all this damage could have come in just eight years is astounding. I'll give three cheers that "The Decider" has finally left the building and we'll be through with him. It will be up to the new administration (which, I'll also say in full disclosure I did not vote for) to try to rebuild our foreign relations, our economy, our morale.

I'm looking forward to the "change." It certainly can't be much worse...

Unintended Consequences of MD Slots?

Back in November 2008, you almost would've forgotten that there was a presidential election going on in this state. Why? After all, at 8:00:01, you *knew* Obama had 10 electoral votes.

Megabucks (and not the multi-state lottery game) were being spent by both sides trying to convince us to either approve or shoot down a Constitutional amendment to permit Video Lottery Terminals (slots) gaming in our dear state.

It's funny how in 2003, when Bob Ehrlich (R) was governor, Mike Busch (D) couldn't see his way to permitting slots in the state. It was a horrible idea, and we didn't need them, and all sorts of evil would befall the state if we were to allow them. And, for 4 years, we didn't get slots.

Fast forward to 2007, now Martin O'Malley (D) is governor, and the economy is starting to go to hell in a handbasket. O'Malley called a Special Session and Speaker Busch jumped right in line saying that, hey, the economy was bad, and slots would now be good.

Comptroller Peter Franchot (D), a slots opponent all along, to his credit, said that he still thought it was a bad idea. I'm not going to rehash all the arguments, the election is over. (Whew!)

However, I gotta tell you, it's not the lottery terminals I had a problem with. It's the METHOD of bringing them to Maryland that stunk. Those who opposed the amendment will be able to point out next year that the slots, which will just possibly be coming online, are not going to live up to the promises made, and may organize to oust the rascals that voted to put the question to the voters. Can I help?

You see, if the Assembly had grown a pair, they could have simply passed a bill authorizing slots and the parlors could be well under construction or even open right now. There really was no need to amend the Constitution to do it. The bill could not have been sent to referendum because, under the Constitution, it is a "revenue bill," and, therefore, not referrable.

I did mention unintended consequences, right? Back in 2002, I was spending an evening at the Charles Town Races and Slots in West Virginia. They had just begun construction on a new garage and expanded gaming floor, and I had the chance to speak to a security guard. He told me that they hoped that MD would pass slots in 2003. Why? Because the WV General Assembly would be ready to consider adding table games in their state. Now that slots are also in Pennsylvania, how soon do you think they can pass it?

Cool! No more 2-1/2 hour drive to Atlantic City to have to deal with their attitude. No more 5 hour flights to Vegas, where western hospitality was a lot of fun, but the jet lag sucks. We may soon go to WV and get it all there!

Full Disclosure: I have gambled in slot parlors in PA, DE, WV, and other states, and will likely also do so in MD. I have no problems if an adult wants to spend some of his entertainment money playing slots. But, in the end, I also voted "AGAINST" the amendment.