The LA Times is reporting that 26,000 thousand California teachers are being laid off today.

26,000.

That figures to about 1 in 1000 people in California. I know that some people are claiming that these numbers have been inflated for political effect. By whom? By some coordinated effort amongst school districts mostly run by cranky retired people who hate paying taxes for whippersnappers? I don’t think the Teachers Unions were down for that gambit either.

My wife was one of the 26,000.

She is a former county teacher of the year. She has earned tenure in two different school districts. She’s laid off. So, yes, this is personal for me, even though my precious function as an attorney dwarfs her income.

flip

Remember back in the stone ages when the Legislature was fighting over a budget, and arms were being twisted to get votes? And all the responsible folks said this is what we have to do? I called bullshit. I’ve been calling bullshit since last Fall, and now that it’s coming home to roost, I feel vindicated.

No offense to construction workers, but their cry of 20,000 jobs lost during the budget stalling seems to ring a bit hollow now, doesn’t it?

There are few things in education science that routinely show results in controlled studies. One of those is teacher to pupil ratio. This will blow that up.

There are–what–six more bullshit referenda on the ballot this May, and none of them could be a vote on whether it really makes sense to do this? Monetary policy (which the state does not control) has been exhasuted. Stimulus is required. The feds did it. But California? BOOM. Reverse-stimulus.

And here’s the kicker. This wonderful fix, which is subject to these six votes, is already $8 billion short!

I agree that with another diary that there are good people in California but the system is set up to fail. But those good people did nothing to reform the system. There’s no incentive. Safe districts. Party leadership discipline to get on the Waste Board when you’re termed out of the Legislature. Punt on tough issues to “voter initiatives.”

All so what? So you have time to introduce a bill and shepherd it through to censor Google Earth?

Well, here’s what I say to the Legislature, to the spineless Democrats and the meanspirited Republicans and the useless Governor, to quote Jon Stewart this week:

FUCK YOU

You have failed.

A report by California’s Interagency Climate Action Team released this week shows that sea levels can be expected to rise 55 inches by the end of the century, impacting hundreds of thousands of residents along the coast, as well as billions of dollars’ worth of infrastructure and construction.  The worst areas would be San Mateo and Orange Counties, where over 100,000 people would be affected.  The report isn’t necessarily looking at how to combat climate change; it’s looking at how to deal with its obvious reality.

The group floated several radical proposals: limit coastal development in areas at risk from sea rise; consider phased abandonment of certain areas; halt federally subsidized insurance for property likely to be inundated; and require coastal structures to be built to adapt to climate change.

“Immediate action is needed,” said Linda Adams, secretary for environmental protection. “It will cost significantly less to combat climate change than it will to maintain a business-as-usual approach.”

We’re talking about flood zones in residential neighborhoods in Venice and Marina del Rey.  We’re talking about the SFO and Oakland airports being covered with water.  Same for the ports of Los Angeles and Long Beach.  It’s truly terrifying.  And with this being a global problem where the worst scenarios are increasingly being realized, California is little more than a bystander to this calamity, able to plan against the worst disasters and reduce development in the most affected areas, but unable to truly combat the problem without the rest of the world joining in.  We will get the worst of this, to the point that livability becomes a question.

The full report, The Impacts of Sea-Level Rise on the California Coast, can be viewed here.  They’ve also prepared detailed maps showing the changes that would result from a 55-inch rise in sea levels.

As Arnold Schwarzenegger starts the campaign for the May 19 special election ballot measures, the Legislative Analyst’s Office points out that the budget deal will come up short by $8 billion and that it hasn’t solved our structural revenue shortfall problems:

“Unfortunately, the state’s economic and revenue outlook continues to deteriorate,” the Legislative Analyst’s Office (LAO) said in a review of the package, which covered the remainder of this fiscal year and all of the next.

“Even in the few weeks since the budget was signed, there have been a series of negative developments. Our updated revenue forecast projects that revenues will fall short of the assumptions in the budget package by $8 billion. Consequently, the Legislature and governor will need to adopt billions of dollars in additional solutions in the coming months to bring the 2009-10 budget back into balance.”

Taylor had some more bad news for the state’s political leaders. Because so many of the “solutions” adopted last month are temporary, “without corrective actions, the state’s huge operating deficits will reappear in future years – growing from $12.6 billion in 2010-11 to $26 billion in 2013-14.”

The full LAO report in fact makes some assumptions I would consider rosy, such as a recovery in employment and personal income in 2009, when many economists do not expect this to occur until the second half of 2010 at best.

What this means is that the budget situation is still a total mess, and that improvement is far away. The May 19 election will have little meaningful impact on the state’s financial health, although a spending cap would ensure that services will continue to be gutted. Republicans and Arnold Schwarzenegger are likely to use the deficit projections as an argument for Prop 1A, when all that will accomplish is an even worse destruction of core services, such as schools which could face larger cuts than what we’re seeing now, a truly frightening thing to consider.

This also means political leaders who deny the need to find tax solutions, like Jerry Brown, are not being realistic. Fundamental change is necessary, and perhaps a constitutional convention alongside the elimination of the 2/3 rule conservative veto can help get us there.

One thing is certain – if anyone thinks California can remain a competitive place to do business and attract jobs and employees with the worst school system in the nation and no ability to address our water, transportation, or health care crises, they are deeply deluded.

It's time to lay to rest the myth that spending billions on more high tech is the salvation for rising healthcare costs. Some people will peddle any notion to avoid addressing the best way to rein in costs, pushing the insurance companies out of the way with a single payer system.

It's become an article of faith that a national system of electronic medical records would produce huge savings.  President Obama made it a centerpiece of his healthcare plan during the campaign (as did Sen. John McCain), and has emphasized it repeatedly in legislation and speeches.

As a first step, the stimulus bill allotted $17 billion in incentives to prod doctors and hospitals to get on board during a five year period beginning in 2011, along with financial penalties if they don't.

The administration has relied in large part on a RAND study claiming savings of $80 billion a year through the nirvana of what Wall Street Journal reporter Anna Wilde Mathews caustically referred to as “whizbang computer systems.” The President cited the $80 billion figure again during the White House health-care summit last week. Or, as White House press secretary Robert Gibbs asserted, “The health IT in the economic recovery plan will make health care more affordable, will save patients' lives, and increase the quality and the outcome of the health care that millions of people are provided.” He might want to take a mulligan. As a series of reports this week make clear, the bloom is coming off the rose. Writing in the Wall Street Journal, Harvard Medical School faculty Jerome Groopman and Pamela Hartzband debunk the received wisdom, noting:

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

It's not, they conclude. And they are not alone. The RAND study has been sliced and diced fairly regularly now by, among others, one Peter Orszag, now the White House budget director.

Last May, when Orzag was director of the Congressional Budget Office, CBO examined the Rand report and a parallel study concluding they “appear to significantly overstate the savings for the health care system as a whole — and, by extension, for the federal budget.” Summing it the CBO findings, Orzag concluded that while the technology, in combination with other moves, may help reduce expenses, “by itself it typically does not produce a reduction in costs.”

Another report from Avalere Health, quoted by the Associated Press this week, concludes it will cost providers far more to implement the golden goose systems than they will get back in return.

Using government cost estimates, Avalere researchers found that it would cost about $124,000 for a single doctor or small practice to upgrade to electronic health records over the five year period from 2011-2015 when the stimulus bill offers incentives to do so.

But the total incentive payments a doctor could get over that time period only add up to $44,000. In 2015, penalties start to kick in for doctors who haven't switched to electronic record-keeping. But in one scenario mapped by Avalere, the starting penalty would be $5,100 a year — far less than how much it would cost to install and maintain an electronic health system.

In other words, a pig in a poke. And, that's just the supposed financial benefits. Registered nurses have long raised alarms that some of the technology may be intended to displace staff or an RN's professional judgment, which is especially critical with the complex medical conditions seen in the patients who get through the hospital doors these days, and said those billions could be better spent on actual care delivery. Many doctors, like those in the Journal report, are speaking out now as well. Groopman and Hartzband note “there is no evidence that electronic medical records lower the chances of diagnostic error.” And they point to studies that raise further doubts. For example:

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that “current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems.”

Another such warning came from MD Scott Haig this week in Time who describes the frustrations of doctors who are forced to use such systems “or risk losing our hospital privileges” if they don't. Yet some big hospital chains are spending billions of dollars for the high tech hype with despite the lack of evidence it will produce either cost savings or improved healthcare. Haig wonders who is really behind it and concludes:

Not surprisingly, nationwide adoption of Electronic Medical Records is being pushed hardest by those who would profit financially from it. The slightly embarrassing financial reality of EMR is that large, mechanized medical operations like hospitals, clinics and big multi-doctor practices stand to make quite a bit of money by adopting them — given our current convoluted system of paying for health care. Two clear factors make EMR a money-winner: improved billing and internal cost control.

And, there's another hook for the insurers here, Haig notes:

Computerized medicine means both more information — and less medicine. Less therapy, less surgery and less testing too. That's how it saves money. A variety of promising terms describe it — terms like targeted treatment, algorithmic patient-care, fiscally responsible medicine and evidence-based practice — but for doctors treating patients, one word describes how computerized records save money. Denial. EMR has the potential to greatly increase insurance company denials of the tests and treatments that doctors order.

Big profits, for the tech corporations that manufacture them, and the software companies that design them. Better bill collection for the hospitals. Improved billing, and fewer nettlesome claims for the insurers whose first priority is always receiving payment, not actually paying for care. Who would have guessed? A boondoggle for some, it looks like, and misplaced priorities for the rest of us.