Discover Warner’s North Dakota

My family was saddened this week by the passing of Bruce Van Sickle.  Before he was an honored federal judge, before he was the author of two landmark pieces of judicial history, before he was my family’s lawyer, he was a kid playing with my uncle in the fields around Ryder and I would like to honor his passing.  I was reminded, by his death, of a parallel situation to the issue we have before us today.  Almost two generations ago now,  North Dakota was confronted with the way that the legislature handled services to the developmentally disabled.  It was a lawsuit, in civil court,  that took control of the issue away from the legislature.  Other hands than ours reached into the resources of

North Dakota and directed those resources in a manner ordered by the court and not the legislature.  It was many years before the legislature regained control.    Beginning in the nineties, our state was confronted with an unprecedented explosion in the drug trade and the attendant addiction and social dysfunction.  The legislature was confronted with the prospect of hiring psychologists and addiction councilors; of dealing with this social disease through the human service centers.  Because we did not, it was other court action, this time in thousands of criminal court cases that took addicts off the street and warehoused them in our prison system.  Again the courts took control of social policy away from the legislature and other hands directed control of the resources of North Dakota.  This time the criminal courts.   Now here, before us today, we are confronted with a crowded, antiquated institution, our prison guards face dangerous working conditions, we have a simmering hepatitis C population which I believe will ultimately kill more North Dakotans than AIDS and  I believe that we are about one lawsuit away from having our prison system placed in federal receivership.  In recent days a prison of similar size and age to ours in one of the eastern states was compromised in this way by federal action.  

Last year the Delaware Department of Corrections became the subject of a federal probe to address prison failures.  The Department of Justice (DOJ) stepped in to look at every aspect of corrections, from operations to inmate care.  The DOJ has the authority to conduct such investigations under the federal Civil Rights of Institutionalized Persons Act.  The regulators investigate conditions of care within the state’s prisons.  The process can last for years.  The state can agree to make changes, a process closely watched by a federal monitor, of the Justice Department can file suit against the State of Delaware and the Department of Correction.   If that happens, if the courts again take control of social policy away from the legislature, it will be because of actions like we are contemplating here.  We don’t need to stall another biennium.  We don’t need another study, we don’t need a commission, we have studied this issue to death.  A few years ago we spent $300,000 having professional audit of our prison system and then promptly shelved it.  We know what to do.  The professionals that we have running our corrections system know what to do.  Our governor presented a perfectly reasonable plan for renovation and expansion of the main campus in his budget message of some five months ago.  It was prudent and made wise use of our resources.  Let us vote on it.   We don’t need to wait any more.  Bring the Governor’s plan to the floor for a straight up and down vote.  I will support it!  I suspect that the majority in this chamber will vote for it.  It’s the right thing to do.

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A few weeks ago, I was delighted to receive a gift of Clay Jenkinson’s new book, Becoming Jefferson’s People.  There is a short essay titled “Freedom of Thought” that I would like to quote here: 

As the twenty-first century begins, Americans have a paradoxical relationship with free thought and free speech.  On the one hand, we have more incidental freedom than any people who have ever lived.  We can travel at will throughout the United States, and slip into the profoundest anonymity  in almost any locality;  publish or purchase obnoxious, irresponsible, pornographic, bigoted, racist, murderous, and seditious tracts;  and shout publicly that the president or the chief justice of the Supreme Court or the bishop of the Catholic Church is a thief, warmonger, swine, imbecile, pederast, or foreign agent-all this with perfect impunity.  We can purchase virtually anything anywhere on credit, and our associations are almost never regulated in any way.  We can consume as many of the earth’s resources as we can afford to pay for.  We can profess any religious sensibility, from the dourest Presbyterianism to the most sensualist New Age massage cultism, from radical double predestination to Wicca Eroticism-all without the slightest governmental interference-and with tax exemption to boot.  By the standards of the Age of Jefferson, we are breathtakingly free, freer than any people who ever walked the earth.

 On the other hand, as all foreign visitors (beginning with Alexis de Tocqueville) realize, there is a numbing homogeneity to American thought.  Left entirely free to think for ourselves, we have permitted our capitalist systems of dissemination to squeezeo our free minds into severely limited channels. . . . . We have voluntarily enslaved ourselves to the jejune, the superficial, and the faddish.  Americans are free but they are not intellectually mature or culturally sophisticated.  Perhaps it is fear of the vast outback of our intellectual freedom that impels us to cluster together in a handful of cultural clearings, and to volunteer to be sheeplike even though there is no determined shepherd in our midst. 

The twenty-first century will present us with the greatest test of the ideals of the Enlightenment.  The electronic revolution will soon bring about a discourse infrastructure in whih anyone can post any idea in public space at any time,  without peer review, or the cumbersomeness and expense of the disseminating technologies of the past.  A breathtaking chaos of ideas will make their place on the state of twenty-first century life, and no institution, public or private,  will be able to police that stage to limit or forbid the worst excesses of free expression:  sedition,  corrosive cynicism, character assassination, disclosure of industrial secrets, disclosure of weapons design, theft of intellectual property, pornography, hate speech, unrestrained dogmatics, or exploitation of the powerless. 

Given the abuses that are guaranteed to characterize this new order of the ages, the temptation will be to back away from the libertarian model of discourse and establish some form of thought policing.  This (the Jeffersonian) must resist. . .We are going to have to get serious about education and the humanities if we do not wish to be that thing that Jefferson most feared, “a nation ignorant and free.”

NEW YORK — A public school teacher was arrested today at John F. Kennedy International Airport as he attempted to board a flight while in possession of a ruler, a protractor, a set square, a slide rule and a calculator.  At a morning press conference, Attorney General Alberto Gonzales said he believes the man is a member of the notorious Al-gebra movement. He did not identify the man, who has been charged by the FBI with carrying weapons of math instruction. “Al-gebra is a problem for us,” Gonzales said. “They desire solutions by means and extremes, and sometimes go off on tangents in search of absolute values.  They use secret code names like ‘x’ and ‘y’ and refer to themselves as ‘unknowns’, but we have determined they belong to a common denominator of the axis of medieval with coordinates in every country.  As the Greek philanderer Isosceles used to say, ‘There are 3 sides to every triangle’.”  When asked to comment on the arrest, President Bush said, “If God had wanted us to have better weapons of math instruction. He would have given us more fingers and toes.”White House aides told reporters they could not recall a more cotangent statement by the president.

The Web sites below will help you understand certain pieces of Legislation

The North Dakota Education Association
http://nd.nea.org/

The North Dakota School Boards Association
http://ndsba.org/

Education Technology Services (EduTech)
http://www.edutech.nodak.edu/ed_resources/nd/

Information Technology Department (ITD)
http://www.nd.gov/itd/

North Dakota Association of School Administrators
http://www.ndcel.org/NDASA/

North Dakota Department of Public Instruction
http://www.dpi.state.nd.us/

North Dakota Public Employees Retirement System
http://www.nd.gov/ndpers/

North Dakota Public Employees Association
http://nd.aft.org/ndpea/

North Dakota University System
http://www.ndus.edu/

North Dakota Department of Human Services
http://www.nd.gov/humanservices/

North Dakota Department of Agriculture
http://www.agdepartment.com/

North Dakota Secretary of State
http://www.nd.gov/sos/

With all of the discussion of new programs and initiatives coming out of the legislature, its easy to forget the obligation that the state owes to those who take care of the medical needs of our poorest citizens.

Medicare is a federal program that provides medical care for the elderly. There is no state money in Medicare. Medicaid is a state and federal program that provides medical care for the poor. Roughly 1/3 of the costs are born by the state and 2/3 by the federal government. North Dakota manages Medicaid and sets the rates of reimbursement but they cannot be any higher than Medicare rates for comparable services.

The Federal program, Medicare, pays pretty close to the cost of providing the service, no profits, but at least the costs. North Dakota’s medical providers are paid only a percentage of their direct costs by Medicaid. When the state doesn’t pay for at least the cost of service, that cost gets shifted to the private insurance companies and self-pay patients. For instance, hospitals are reimbursed at only about 76% of their real costs by Medicaid. The money that has to make up the difference drives up the cost of insurance to small companies who struggle to pay for health insurance for their employees. Employers respond by raising the deductibles to their employees or reducing coverage. Over time, this cost shift compounds the problem by increasing the number of people who can no longer afford health insurance or who cannot afford to pay the larger out-of-pocket costs required when they need care.

Even though North Dakota has one of the lowest Medicare reimbursement levels in the United State, that benchmark would be a significant improvement over the current reimbursement rate. It would take about 13.1 million dollars in general funds to bring Medicaid payments for all medical service providers to Medicare levels. These state dollars would leverage an additional 23.3 million dollars in federal funds. Those numbers seem large but you need to keep in mind that the entire Human Service budget in North Dakota is 1.8 billion dollars for the biennium of which 582 million is state general fund.

This infusion of federal dollars would improve the ability of the medical community to provide service in poorer areas of the state, particularly rural areas which have so much trouble recruiting medical professionals. Access to health care is an essential force in the state’s economic development efforts and improving the state’s business climate and quality of life.

Ensuring access to health care for the indigent and the poor is a core value of a moral society. To use the argument that we can’t afford to pay the people who actually provide that health care simply doesn’t hold water. Somehow or another, the poor will be cared for; either we will pay for that service out of the wealth of our society or we will shifts those costs to the sick, the injured and the dying, The Legislature needs to tie Medicaid rates to Medicare rates.

Rural legislators are often asked the question. Why should we pour more money into rural communities? While North Dakota’s cities look like they are doing well and it would be tempting to make all future investment in those proven growth centers, much of their development is the result of internal migration; people moving from Garrison to Minot or Langdon to Grand Forks. The cities’ apparent prosperity masks the fact that there is no second wave of retiring farmers moving in with their retirement money. Unless we address the growing gap between urban and rural in North Dakota cities will face the same fate as our small towns.

The exception to this general decline in rural North Dakota is the energy crescent, now stretching from Washburn to Williston. Oil, gas, coal and related industries are doing very well and if the projections are correct these things will become increasingly important in the immediate future. Those energy resources along with the water in the Missouri to develop that industry and provide for quality of life will likely be major players in the future of North Dakota.

We had one of those Tinker to Evers to Chance moments in the Senate the other day. Named for a famous baseball triple play, the phrase has come to indicate debate that has a satisfying elegance, it covered all the bases.

North Dakota has had a savings account called the Permanent Oil Trust Fund, an accounting device to take some of the ebb and flow out of state revenues that come from taxes on oil and gas. Its worked pretty well over the years; socking some money away when that industry is booming and allowing the money to flow back into the General Fund when oil has bottomed out. The debate was about a constitutional amendment to leave all of the mechanism in place but to place it in the state constitution.

The first Senator to oppose it spoke about the difficulty putting such a complicated mechanism into the constitution and the difficulty in predicting what North Dakota would be like in ten or twenty years let alone a century or two. Future legislatures should not be bound by what seems to be a good idea to those of us living with out such farsight.

The second Senator argued that the measure wasn’t strong enough; that oil is a finite resource and may run out even within the lifetime of some child listening in the galleries. A truly effective savings plan would need to be like the Common Schools Trust Fund, the only true trust fund in the constitution. Money that flows into that fund can never be withdrawn but the interest has provided an important component of our school funding formula.

The third Senator argued that it would be better to invest that money from a diminishing resource into the next generations of technology that will provide a sustainable source of energy for future development. Tinker to Evers to Chance, covering the bases.

We need to have a serious discussion about the policy that will include rural communities in that future. In the coming years we are going to have to use the money that carbon based energy brings in to leverage not only new sources of energy but new technologies that will keep rural North Dakota a place where people want to live and raise their families.

Let us begin with definitions: flotsam is the wreckage or cargo that remains in the water after a ship has sunk; jetsam, anything thrown overboard to lighten a ship in distress.

A while back, my wife and I visited an installation at the North Dakota Museum of Art. The exhibit, Mary Lucier’s Plains of Sweet Regret was a multimedia video installation commissioned by the museum in response to population shifts that are forcing the people of the Northern Plains to re-imagine their lives. Changes in agriculture and climate have swept away entire communities in rural North Dakota, leaving the survivors with a profound sense of shock and loss.

Lucier’s photographs capture unsentimental images of churches, homes and schools, devoid of human life, littered with artifacts, a doll. . . a desk. . . a bowling trophy. From a salvaged wooden desk in the corner of the room, I sat and watched the flickering images on all sides of me. In the dim, cavernous room it was possible to imagine that I was at the bottom of some vast undersea cavern. . . silent. . . watching the slow descent of objects from an overhead shipwreck, unheard and unseen except for the slow downward drift of debris.

Jan and I live in one of those communities, constantly reorganizing, constantly downsizing, struggling to reach some equilibrium if only for a moment before we are hit by the next round of out-migration or business closures. Our school district has consolidated so many times that it covers about 800 square miles but has trouble mustering even a half dozen kids per grade. Every fall the sky is dark from the burning of the last isolated farmsteads and uprooted shelterbelts.

The saddest thing though is not the wreckage. The abandoned farms and businesses are by and large the inheritance of children who have moved on to good careers in the cities and we are proud of their accomplishments. The saddest thing is not the flotsam but the jetsam, the things that we have voluntarily tossed overboard in a vain attempt to slow the breakup: the arts, clubs, associations, charities, those random acts of kindness and senseless beauty, all those sources of civility and community. We have become fearful of outsiders, distrusting of new ideas, unsure of our ability to survive in a competitive world economy.

How can we be a community when everyone is working out of town, holding three jobs to keep the farm in the family? How can we open our arms to embrace the world when we are curled in the fetal position?

 

We have been involved in a remarkably contentious discussion about forcing health insurance companies to cover injuries caused by suicide, attempted suicide and self inflicted injuries. The big companies in the state cover this as a matter of course but a handful of low end coverages refuse. As part of the discussion one of the Senators recounted an old practice in his German Catholic home town. Priests who served the community would refuse Christian burial rites to suicides and stillborn infants, burying them instead on the outside of the fence. Once a generation or so, when a priest retired or was replaced, the men of the town would go out and move the fence; bringing the banished dead back into the community. When the self appointed guardians of our holiness were away, the authentic act of holiness took place.

This sessesion, instead of trying to keep you abreast of individual bills and always be a week behind with the daily news, I’m going to try to cover some of the big issues before the state and the legislature and let you know of some of the solutions being proposed.

Sen. Judy Lee (R-West Fargo) and I are introducing an idea that we have been working on together since last summer and more recently began working on with Chandrice Covvington, Dean of the School of Nursing at UND. STEPIN ‘ up the ladder is the name given to this bipartisan legislative initiative to create a new paradigm for the education of nursing professionals in North Dakota. The acronym stands for Steps To Educate Professionals In Nursing.

Our state faces a critical shortage of nurses in the coming decade. There is evidence that we may be short as many as 5000 nurses statewide by 2020 because of retirements and the lack of new entrants into the field. This shortfall will be disproportionally spread across the state, with rural areas facing the greatest shortages at the exact same time when an aging population will be making unprecedented demands on our health care system.

Both the name and the ladder metaphor have been chosen to symbolize that this new way of looking at professional education is composed of increments which are self contained but considered within the framework of an overall structure which encourages professionals to move up the ladder at their own pace and as far as their individual situation and career goals would indicate.

Only phase one and phase two of this initiative are contained in the bill. We hope that phase three will be addressed later in the year as a Centers of Excellence project.

Phase one consists of a survey of two targeted populations, rural families and para-professionals.The results of the survey will indicate a general level of interest in the project but more importantly, the kinds of scholarship programs, distance learning opportunities and clinical practice alternatives that will make that education possible. North Dakota Farmers Union has already agreed to help recruit new students for the project and we hope that Farm Bureau will join in as well.

Phase two is perhaps the most exciting part of the project. It is a mobile teaching laboratory full of high tech simulators which will travel between the participating schools of nursing, providing an opportunity to receive up to 30% of the required clinical training in a simulator setting. The most serious roadblock to nursing training has always been the bottleneck caused by not having enough openings in clinical, hands-on programs. The use of simulators will widen that bottleneck and provide a safer environment for patients when the nurses in training finally begin working with live patients. The mobile lab will look like an oversized bookmobile. Expandable sides will allow it become 4 feet wider when in the parking lot and it should provide space for about 10 students to work with the simulators at a time. A full time professional teaching staff will move it between the participating schools of nursing depending on what the specific needs are for that school.

As I mentioned earlier, phase three is not contained in this legislation but we will try to raise the money for it later through grants with the Centers For Excellence program. Phase three will be a rewrite of some training courses so that they can be taken over the internet or using recordings such as DVDs. That way people who are already working full time can take the coursework when they have time and without driving long distances.