Editorials from around Pennsylvania:
COMMONWEALTH MUST FIND WAY TO KEEP DOCTORS IN THE STATE
As affordable access to health care gathers ever-increasing importance, Pennsylvania has an ever-decreasing crop of younger doctors.
The two truths are troublesome in combination, particularly in a complex medical web that is widening under the Affordable Care Act. An aging physician population in correlation with a growing patient population is not a concern in itself — not if the flow of young professionals continues to fill the physician pool to prevent its future depletion.
But that is not the case, according to disconcerting data from the Association of American Medical Colleges. As reported recently in the Reading Eagle, our state ranks a robust eighth nationally in total doctors, and 10th in physician-patient ratio, with 253 active doctors per every 100,000 Pennsylvania residents.
“Pennsylvania finds itself in a relatively healthy situation today as far as our statewide data go,” said Dr. Bruce A. MacLeod, the Pennsylvania Medical Society president. “But there are signals that new physicians are looking to practice elsewhere.”
There’s the rub.
Though the state ranks an impressive fourth in percentage of medical-school students, it sputters across the line at 37th when it comes to retaining its newest trainees. Only 58 percent of the physicians cutting their teeth in state programs stay in Pennsylvania to practice, according to the association’s annual report.
“Plenty of doctors are being trained in Pennsylvania,” St. Joseph Regional Health Network spokesman Michael B. Jupina said. “(But) they are leaving for a variety of reasons.”
We have no doubt the high cost of practicing in Pennsylvania, where mandatory liability insurance is cumbersome to say the least, is among those reasons. We also speculate that many of the trainees are not native to the state and may choose to return to their home regions.
Obviously one way to ensure that more recently graduated doctors stick around is for state leaders to lessen doctors’ onerous liability burdens. But there are other ways to improve retention, and major health providers must play the lead role.
First and foremost, the hospitals or health systems must plant the seeds when their new trainees begin. St. Joseph, Jupina said, does just that.
“We have always tried to keep our doctors in Pennsylvania,” he said, “and we start working with them during their internships, even before they become residents, to consider staying in Berks County to practice.
“They spend three full years in the community during their residency, and during that time we work very hard with them to help them to see how great a community Berks County is to live and practice.”
Dr. Kristen Sandel, associate director of emergency medicine at Reading Hospital, said her employer’s approach is simply to expand the residency program in order to recruit young physicians to Berks County to meet these growing needs.
Whether it’s via cost-lowering legislation, residency expansion or salesman-like encouragement, one thing is certain: With more than a quarter of the state’s active doctors now 60 or older, Pennsylvania and its biggest health providers must make young-doctor retention a top priority.
DECREASE NUMBER OF PA. LAWMAKERS
A proposal to decrease the number of Pennsylvania’s full-time lawmakers recently inched its way through the House, raising the possibility the General Assembly’s ranks could shrink sometime after the 2020 census.
First, state senators must sign off on the idea when they resume session in 2014. Much later, voters like you would need to give their blessing to this drastic legislative roll call reduction, enabling a change to the state constitution.
Do we at The Times Leader support such a maneuver?
That requires a two-part answer.
On the question of whether to trim the Senate from 50 members to 38, we say, let’s explore it. A healthy debate could diminish public concerns that the move would result in huge districts — unwieldy for senators to adequately visit, much less represent — or in potentially risky concentrations of power.
On the question of whether to downsize the House from 203 members to 153, we can be much more emphatic.
Yes! Yes! A thousand times yes!
That’s a point we have tried to hammer home in past editorials.
Four years ago, in an October 2009 editorial titled “Pa. government overhaul overdue,” we wrote: “The General Assembly is bloated, with 253 members. It costs too much and delivers too little, especially considering its public servants, unlike in some states, are paid to work year round.”
In January 2012, in a piece titled “Back leaner look for state Legislature,” we wrote: “In total, this state has 203 representatives, each costing $82,000 — or much more, if he or she holds a “leadership position” — plus health and other benefits, plus the expense of his or her staffers. Toss in the 50 state senators and their worker bees, and the General Assembly gobbles up about $300 million in taxpayer dollars. Every year. Are you getting your money’s worth? We don’t think so.”
Other Pennsylvania newspapers, including the Philadelphia Daily News and The York Dispatch, have expressed similar sentiments that were reprinted on these pages. For example, The Centre Daily Times in State College published an editorial in April 2011, stating: “Pennsylvania is sixth in population among states, yet its Legislature is the second-most expensive in the country, it’s second among all states in spending as a percentage of general government operations and it employs one of every 11 legislative employees in the nation despite having only 4 percent of the U.S. population.”
The years may pass. The representatives serving in Harrisburg might change. But the reform-minded calls from government observers across the Keystone State remain the same.
Scale back the House of Representatives.
—The (Wilkes-Barre) Times Leader
EX-MINISTER SCHAEFER TAKES FIGHT FOR GAYS AWAY FROM UNITED METHODIST PULPIT
The United Methodist Church had no option but to defrock Frank Schaefer, former minister of Zion United Methodist Church of Iona.
We want to believe that Schaefer had no choice but to hold to his personal beliefs, represented most prominently by his officiating at his gay son’s wedding in 2007.
Now, the former minister has neither a congregation nor a pulpit from which to preach, but he still has a mission and a message. It’s one that deserves to be heard.
“I cannot voluntarily surrender my credentials because I am a voice now for many — for tens of thousands — of LGBT members in our church,” Schaefer said at a news conference Monday during which he refused to step down, as directed by the church.
Specifically, he was directed to surrender those credentials if he was unable to follow the denomination’s Book of Discipline. Schaefer maintains the book discriminates against gays.
This is delicate ground on which to tread. We believe it is within the rights of every individual to determine for himself whom he would choose to join in a life partnership. The troublesome word is, has been and will be “marriage.”
A marriage carries religious connotations, bringing it within the purview of church doctrine. The Bible is clear in its determination that marriage is to be between one man and one woman; that homosexuality is an abomination.
We didn’t write the words. We don’t agree with the words. Some denominations have chosen to modernize their stances, to allow for same-sex marriages within their churches.
Some have not, the United Methodist denomination among them.
Schaefer has set himself up as a prominent voice for change within that church. Whether his quest leads to changes within the denomination or not, that is a function of time. He certainly has the credibility to speak on the specific issue of gays within that church, the clergy’s view on them, the Book of Discipline and other internal church matters.
“I am actively committing to having those discriminatory laws changed and banished from our Book of Discipline,” Schaefer said. “That’s the only way I can reconcile being a United Methodist at this point.”
It is up to the church to determine how it should proceed. The union of same-sex partners is going to be the law across the United States, and sooner rather than later — even in late-to-the-party Pennsylvania. Those of the faith, who also happen to be gay, are seeking further inclusion and acceptance: the official imprimatur of a church marriage.
We don’t want government forcing the matter onto the denominations. That skates on dangerously thin First Amendment ice. While not an establishment of religion, the determination of church doctrine is too close for comfort.
No, this is an issue for denominations, congregations and clergy.
We want Schaefer to be successful. We want the United Methodist Church, and all denominations, to recognize that love is love, and its expression in the form of marriage should be a celebrated right for any two people.
—Lebanon Daily News
GAMBLING REVENUE ISN’T SOMETHING LEGISLATORS SHOULD COUNT ON FOREVER
Coming on the heels of a report noting that total revenue from Pennsylvania slot machines for November was down 1.3 percent from last November, the state Senate recently passed a resolution, calling for a study of gambling in Pennsylvania, including the possibility of legalizing online gambling.
The Legislative Budget and Finance Committee will conduct the study with a report due May 1.
Senate President Pro Tempore Joe Scarnati called for the study, noting in interviews with Harrisburg reporters that he was concerned about declining revenues at the state’s 12 casinos.
Scarnati, R-Jefferson County, said he’s particularly worried about revenue from the casinos because they employ 6,000 people and provide nearly $1 billion a year in property tax relief and hundreds of millions more in aid to local governments and economic development programs.
“I’m not an expert on what is cutting edge in the gaming industry, but what I can tell you is we’re losing revenue and. we better make sure we step it up,” the senator said.
“We can just watch our revenues from (casino) gaming — that we use for property tax abatement — just continue to go down, or we can try to step in and look and see what suggestions can come from other states, can come from gaming operators, can come from consultants on how to maintain or grow those revenues,” he added.
New Jersey went live with internet gambling last month, projecting about $150 million in new state revenues.
The question for Pennsylvania lawmakers is whether Internet gaming would take away even more revenues from the casinos or would it bring in a younger audience of people who rarely go to the casinos?
And this all comes on top of Gov. Corbett signing a bill, giving the state’s bar and tavern operators the chance to run monthly raffles, daily drawings and other small games of chance in their premises, bringing in a projected $156 million in new state tax revenues.
Scarnati said the state is going to be facing some serious financial problems in the coming year and finding new revenue is going to become very important.
“The bad news is we’re facing a $1 billion dollar structural deficit, and that’s not spending one more dollar on public education; that’s not spending one more dollar on higher education, or a dollar more for nursing homes and hospitals,” Scarnati said. “That’s just maintaining the status quo.”
Of course, all of this is worrisome, and you can only wonder how long Pennsylvania can tap the state’s gamblers for more money, especially considering that revenues from the Lady Luck Casino Nemacolin in Wharton Township have been lower than expected since the facility opened last July.
While the casino might not be closing its doors anytime soon, local officials probably won’t be seeing the tax revenues the facility was expected to produce.
And it might be a cautionary tale for the state as a whole. If the gambling revenue doesn’t add up, what will Pennsylvania lawmakers do?
Certainly, there’s nothing wrong with doing a study of gaming in Pennsylvania, and we can only hope that something good will come of it.
In the end, though, Pennsylvania won’t be able to legalize new ways of gambling forever. At some point, Pennsylvanians will have to either start raising taxes or cutting programs.
Given the looming financial challenges ahead, it’s probably better that state legislature start dealing with the problem sooner rather than later.
—Beaver County Times