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Wednesday, September 15, 2021

The Threat of Competence

 Who is Politicizing Alaska’s Health Care Crisis?

(2021©donnliston.com)


David Morgan’s career includes over 40 years professional senior level operational management and administration, focused on community health center operations, healthcare financial operations, budgets preparation, strategic planning and networking. His technical qualifications include a background in analytical program planning for hospitals, tribal health organizations and primary care clinics with community engagement.

As a former employee at Providence Alaska Medical Center, and chair of former Mayor Dan Sullivan’s Health Care Commission, David Morgan asks the hard questions and has demonstrated with his own actions how principles of economics can provide better care at cheaper rates, while assuring health care providers make enough money to stay in business. That’s the real reason why the Anchorage Assembly challenged his recent appointment by Mayor David Bronson to head the Municipality of Anchorage (MOA) Health Department.

 

The Assembly majority isn’t qualified to shine Morgan’s shoes and doesn’t want Mayor Bronson to be successful in bringing Anchorage out of the mess created by these misfits. When Morgan realized the caliber of people he was being judged by in the confirmation process, he withdrew his name from consideration.

 



The problems I ran into had to do with my past political affiliations, said Morgan in our recent interview. Republican Party conservatives want to reduce healthcare costs at the state and local levels. This is in contrast with the Alaska Hospital Association and the Alaska Medical Association—the industrial state of healthcare. They are not happy with me because anywhere I have worked costs go down, service goes up, and I produce more revenue, without increasing costs or restricting competition, but by providing better services through efficiencies of scale.

 

[1]

 

Morgan has an impish smile and talks Kentuckian, as does my wife Waneta. They determined it is possible they are cousins.

 

How could the majority of elected officials on the Municipal Assembly understand this approach as they strive for politically-charged government dependency over individual Alaskan autonomy?

 

The point is the entire system of health care for the state of Alaska is designed NOT to have competition, Morgan continued. Opponents to my appointment were upset because I pointed out the military option. Their biggest argument for making us wear masks and require lockdowns was a shortage of ICU beds. They don’t want anybody to know the JBER 673rd Medical Brigade can staff 55 ICU beds anytime and hasn’t. If all the local hospital beds are really full, in five days new ICU units could be set up in the parking lot of Providence Medical Center or Alaska Native Medical Center—we could have 30 or 40 beds with professional staff quickly available. For the mere price of $1 such an intervention would be called a “training exercise.”

 

These would be high quality care facilities, too.

 

[2]

 

My goal for the short time I was Health Director wasn’t a political goal, continued Morgan. My goal was to meet five-year budget projections by reducing costs by eight percent and increasing healthcare for Alaskans. While on the previous Muni health commission under Mayor Sullivan we found that the health department was doing stuff that had nothing to do with the mission of that department. It was doing stuff for politics.

 

Morgan also served on the State Health Commission for 5 years, representing Primary Care (CHCs) Programs and Clinics for the State of Alaska. That Commission was dissolved by the Legislature--as it started to get to the heart of the healthcare cost and access problems for the State. This was explained in MUST READ ALASKA story: Lawmakers Took Big Bucks From Hospital Group, And Vetoed Accordingly.[3]


This practice continues to today. A number of bills in the Alaska Legislature to reform healthcare were killed in the 3rd Special session.


Both political parties have members who are captive to the Healthcare Lobby, according to Morgan. Nothing the Alaska Legislature or the Anchorage Assembly majority have done is about providing a better quality of life for Alaskans or Anchorage property owners who pay for this circus.

 

Read Story Here: https://donnliston.blogspot.com/2021/01/destiny-happens.html

The argument they are using is “it’s a panic,” said Morgan. In reality, we only have a pandemic of the unvaccinated. There is no reason we cannot reduce cost and provide better health care for Alaskans overall. I have done it. I have a track record of doing it but they won’t do it because they don’t know what it would require.

 

Alaska’s Colony Status




 

Anybody who has lived in Alaska for any amount of time knows this state was a marriage of convenience with the United States of America. University of Alaska History Professor Steven Haycox wrote an entire book celebrating this reality, Alaska; An American Colony.[4] The result is that public policy is convoluted and skewed to benefit a few short-sighted special interests over the long-term good of Alaskans.

 

In the case of healthcare, that means Alaska has a lot of rich doctors.

 


 

Over more than a year Covid-19 has shed a light on the problems of our healthcare cartel. It has become a reason to suspend rights under the US and Alaska Constitutions, with a disproportionate reaction given our state’s many other serious health care needs.

 

Morgan explained: We are the only clinic other than the military hospital that treats people with TB in airtight rooms. Sexually Transmitted Diseases (STDs) also require special protocols by health professionals for their protection. Homeless people can get runny sores, polyps, and samples must be taken to be cultured. Sometimes when that is being done it can spray—from everywhere on the human body that sexual activity can happen. We don’t judge, we are simply trying to stop syphilis, gonorrhea, and other life-threatening communicable diseases. I required all health workers in the Anchorage health Center to wear N95 masks.

 

But the myopic political focus of the Assembly is on Covid:


 

Around twenty percent of Alaska hospital beds are being used for Covid patients.

 

A couple of times in the past we have been full, said Morgan. But the argument is never about increasing supply, it is about requiring everybody to get a vaccination, everybody to wear a mask, everybody to lockdown, and we aren’t going to have normal public school, either.


 

Read story here:  https://donnliston.blogspot.com/2021/08/what-would-don-and-roberta-sheldon-have.html


Previously I used my training to reduce costs, expand service and make money for the provider, continued Morgan. I might reduce the amount we billed, but money from the state and federal governments through Indian Health Services plus Medicaid Treaty Rights provisions expanded it overall. What we got was not based on billing, it was based on how many people we served. I started applying community health standards to see people who are not part of the tribal organizations. For people who were not Alaska Native but were living in Barrow, later in Sand Point, it is a $900 trip to go to the doctor for a typhoid shot. We got grants for the rest of the people living in those rural communities because we were seeing them anyway, with agreements with other providers like Providence Hospital, to provide tertiary care.

 

More recently, as director to yet be confirmed by the Assembly, Morgan had begun the process of gaining nurses-in-training for the MOA. Approved candidates could have their entire tuition paid for by working in Alaska hospitals designated as high need areas. This was a supply-side effort that has gone away now in favor of hysteria of overworked nurses driving healthcare decisions by misfit Assembly Majority members.

 

The Political Threat of Competence

 

Morgan came from a family of physicians. His grandfather was a doctor, his grandmother was a nurse, his father and two brothers are doctors, and 14 cousins are doctors. He was weaned on the medical profession but chose to train in healthcare service administration.

 

From 1983 t0 1986 I worked for a health co-op called Hunter Health at Bartholomew County Hospital, said Morgan. It had started back in the 1800s in Lexington, Kentucky. I was assistant manager for budget and cost. We had 28,000 members. That organization had started as an agriculture co-op, but at the turn of the century they couldn’t get a doctor. The way agriculture co-ops work is everybody pays a little money to buy a number of tractors, for instance, so the cost of a tractor for an individual farmer member is half. They also sold their crops as a collective. They had a small clinic with two doctors, three nurses and 4 or 5 beds. Back then the doctors actually went on rounds by horseback.

 

Read story here: https://donnliston.blogspot.com/2021/02/the-best-thing-about-being-in-anchorage.html

 

In 1987 Morgan went to Providence Hospital in Alaska, where he worked as manager of patient accounts until 1991. After that, until 1996, Morgan was Finance Director and Acting City Manager for the City of Whittier and Alakanuk. He was next elevated to Deputy Director for Operations and Finance for Eastern Aleutian Tribes, Inc. where he managed day-to-day administration and financial operations for five primary care clinics, supervising 24 employees, until 2001. From 2001 to 2003 Morgan was ANA Project Manager for the Chugach Region’s Chugachmiut Inc. as ANA Project Director. Next Southcentral Foundation employed Morgan as Reimbursement Director to direct revenue cycle operations, compliance and Medicare/Medicaid Medical and Home Health Costs. Since 2015 Morgan has been a consultant with Affordable Healthcare Consulting Services providing strategic financial and data analysis, auditing services, planning recommendations and other technical services.

 


 

Most recently Morgan led a group of Alaska Roundtable community leaders in development of a comprehensive policy paper on healthcare. He provided a copy of the executive summary of that 28 page book with tables for this story. I provide it here in complete form:

 




 Personally, as a citizen journalist, I admit being intimidated by the challenge of providing an overview of the healthcare crisis we face as Alaskans. It’s a complex and specialized problem, but I am struck by the smallness of some elected officials who are so dogmatic that they cannot see the value in having a proven administrator like David Morgan put the Anchorage Department of Health on a solid administrative footing, ultimately for the good of all Alaskans.

 

Mayor Bronson knows we can do better but it may take an election of new Assembly members to reimagine local government competency.

 

Resources:

 

[1] Alaska Health Care Costs compared to other states


 

[2] JBER Medical Personnel Deemed Best

https://www.jber.jb.mil/News/News-Articles/NewsDisplay/Article/1515433/jber-medical-personnel-deemed-best-in-pacaf-air-force/

 

[3] Lawmakers Took Big Bucks From Hospital Group, And Vetoed Accordingly

https://mustreadalaska.com/alaska-lawmakers-took-big-bucks-from-a-hospital-trade-group-and-then-voted-accordingly/

 

[4] Dr. Stephen Haycox, Alaska; An American Colony, University of Washington Press, 2002.


 _____

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Saturday, September 4, 2021

Is this any way to run a Railroad?

 The Alaska Railroad Deception

(2021©donnliston.com)

 



 

Alaskans love the Alaska Railroad. I was reminded of what a delightful part of Alaska this historic railroad represents when Waneta and I won a free trip to Denali during the Willow Winter Carnival raffle in 2019. We enjoyed every minute of the trip in mostly empty cars during summer of 2020.

 



 

This is our train. Alaskans subsidize its operation.

 

The Alaska Railroad was turned over to the State of Alaska from the federal government in 1982 under US Code Title 45, Chapter 21, the Alaska Railroad Transfer Act “ARTA.”[1]

 

Read Story: https://donnliston.blogspot.com/2021/01/destiny-happens.html


 

ARR has been our baby for 30 years.

 

The Alaska Railroad Corporation 2020 Annual Report reveals the decline in revenues it has recently suffered. Waneta and I were two of the mere 32,000 passengers—down from an average ridership of half a million passengers—who rode the trains last year. We used free tickets.

 


 

Milepost 1- March 12, 1914

The US Congress agrees to fund construction and operation of a railroad from Seward to Fairbanks. Estimated construction cost - $35 million.

 


 

Tourism is only part of ARR’s function. Passenger travel is not enough to sustain the corporation that manages this system. The bread and butter of ARRC is 1) hauling freight, 2) grants from the government, and 3) real estate. Passenger revenues are typically 20 percent of revenues. 2020 saw another financial downturn in that respect: ridership declined and grants again increased.

 


 

This corporation is hungry.

 

From the corporation Press Release, April 1, 2021: ANCHORAGE, AlaskaThe Alaska Railroad Corporation (ARRC) released its 2020 annual report today. Audited financial statements show a net loss of $7.8 million, with total revenues of $150.7 million and total expenses of $158.5 million.[2]

 

Those are the big numbers.

 

In short, freight revenues for 2020 were down to $73,649,000 from 2019’s gross of $85,340,000—a loss of $11,691,000. Passenger revenues in 2020 were down to $3,348,000 from 2019’s $39,571,000. Covid-19 has taken its toll, but operation of trains is only one part of the equation.

 

Milepost 2- July 15, 1923

President Warren G. Harding travels to Alaska to mark the completion of the Alaska Railroad by driving the golden spike in ceremonies at Nenana, one of the state's largest cities at the time. President Harding died from an attack of food poisoning on his return trip to San Francisco on August 2, 1923.

 

Read story here:  https://donnliston.blogspot.com/2021/08/what-would-don-and-roberta-sheldon-have.html

For an overview of how our State Railroad has performed, I have gone through the financial report for every year since 2005 to consider how the leadership of the company describe results of their efforts. Since the primary mission is to operate a railroad, I gleaned from the annual reports basic operation costs/expenses and created an overview chart with those simple numbers. I am not an accountant and the complicated financials of this corporation are far beyond my training, but as Alaskans we can reach some general conclusions about the railroad gifted to us by the federal government, and perhaps explanations for current business practices.

 



 

Milepost 3 January 14, 1983

President Ronald Reagan signs into law legislation authorizing transfer of the Alaska Railroad to the State of Alaska.

 

Read Story Here: https://donnliston.blogspot.com/2021/02/the-best-thing-about-being-in-anchorage.html

This railroad is considerably more than the train some of us we were gifted under the Christmas Tree as children; we like our railroad, and we want it to be successful. But some Alaskans have begun to express concern about business practices regarding easements on privately owned land. They have become an organized political force.

 

Facebook Page: https://www.facebook.com/groups/1711686915617367

 


Blog: https://alaskansforpropertyrights.com/

 

WHO ARE WE AND HOW CAN YOU HELP STOP THE INJUSTICE?

ALASKANS FOR PROPERTY RIGHTS is a joint response public relations campaign to educate the public on the injustices caused by the Alaska Railroad. We are a group of Alaskan Citizens, Businesses, Municipalities, and Utility Companies fighting for the injustices being caused by our own Alaskan Company; The Alaska Railroad Corporation.

And their message has become shrill:

 


 

I first learned of these concerns as staff for Rep. Lora Reinbold in 2018 when an effort was made to address railroad easement property right concerns with House Joint Resolution No. 38. I recall extensive conversations with representatives of ARRC--including former Gov. Bill Sheffield who is now Director Emeritus on the ARRC Board of Directors. Sheffield is the only Alaska governor to be impeached but he has been a mainstay on the ARRC Board.

 

Milepost 4 April 1995

Former Governor Bill Sheffield is appointed to the Board of Directors and elected chairman.

 

See my previous story about Gov. Sheffield here:  https://donnliston.blogspot.com/2019/12/alaska-corruption-and-failed.html

 

Another bill in the 2017-18 Alaska House (HB 93) had a companion bill in the Senate (SB 68), sponsored by then-Sen. Michael Dunleavy clarifying state law to protect landowners with ARRC easements. [4] That resolution (HJR 38) went through two committees and was rolled into HB 119 which passed the legislature in the very last hour of the session despite a huge lobby effort against it by the ARRC. It established the intent of the Alaska Legislature and expressed concerns about ARRC business practices.[5]

 


 

Alaska Congressman Don Young was part of the deliberation that transferred ARR to the state in 1982 and in an April 16, 2018 letter to Alaska Rep. Chuck Kopp the intent was spelled out:

 

House Joint Resolution 38 outlines what can only be described as a failure by the agencies to understand clear direction from Congress and to dutifully recognize basic tenets of due process, needlessly resulting in a cloud on title for both the Alaska Railroad and its neighbors along the right­of-way. There is no way a bill quietly annexing private property rights, especially without any notice or compensation, would have passed Congress in 1982. You only have to read the plain language of ARTA to know that -the transfer of "rail properties of the Alaska Railroad" over privately owned land only included the "Federal interest" in those lands. If the federal government did not own it, it was not included in the transfer. There is no canon of statutory construction, or even common sense reading, that could argue an unconstitutional taking of private property rights was the intent of Congress.[7]

 

ARRC Doesn’t Care

 

Direction from the Alaska Legislature and our US Congressman didn’t solve the problem, which seems to be getting more elevated. The parties are likely to be in court before too long although Gov. Dunleavy has urged mediation of the issue. These Alaskans who own land with railroad easements are facing a corporation with tremendous resources. As recently as August 2, 2021 Gov. Dunleavy sent a letter to ARRC Vice-Chair Judy Petry urging the corporation to back off. In that letter Gov. Dunleavy conveys his view that the transfer of the railroad rights-of-way for train tracks and utilities does not mean exclusive use ownership. Because ARRC has sued a South Anchorage Homeowner’s association, Flying Crown HOA, and asked the court for summary judgment, other interests have stepped up to charge they have also been harmed by ARRC. [8]

 

In their legal brief ARRC in federal court asserts that there are two questions at issue:

 

 (1) the scope of the interest reserved by the federal government in the Federal Land Patent issued to defendant’s predecessor in interest; and (2) the scope of the interest conveyed by the federal government to the state of Alaska in its right-of-way over the same property.[8]

 

Defendants have alleged that the State cannot give to ARRC what the Federal Government never possessed. They have launched a public education campaign to explain this point.

 



 

Other interest’s Legal Briefs

The Municipality of Anchorage on August 8, 2021 filed a brief in opposition to ARRC’s request for summary judgement. (Case 3:20-cv-00232-JMK Document 86). It concludes the following:

As described above, the right of way reservation in patent under the 1914 Act reserved an easement limited for railroad purposes similar in kind to the types of easements created under the 1875 ROW Act and the 1898 AK ROW Act. Contemporary legislation and legal precedent support this conclusion in addition to broader legal precedent and public policy considerations. Further, no more than the easement limited for railroad purposes which was reserved under the 1914 Act was transferred to ARRC by ARTA. To find otherwise would go against the public policy supporting the determinant nature of deeds and create an impermissible, unconstitutional interpretation of ARTA resulting from a federal taking of property rights previously conveyed under patent.

 

Enstar Natural Gas Co. also submitted an amicus legal brief August 23, 2021 in support of Flying Crown’s Opposition to Motion for Summary Judgment. (Alaska Railroad Corp. v. Flying Crown, Case No. 3:20-cv-00232-JMK)

 

The width of the 1914 Act railroad easement is “one hundred feet on either side of the center line of any such road.”  At Potter Marsh, the pipeline runs parallel to the tracks between railroad mileposts 100.33 and 103.12 along the Turnagain Arm.  The pipeline is buried approximately 80 to 97 feet to the southwest (ocean side) of the tracks. This is well outside of the railbed itself.  The majority of the pipeline at Potter Marsh is within the Turnagain Arm tidal area—an expanse of mudflat that floods at hightide and is scraped by ice in the winter. The fee interest to the relevant Potter Marsh land was conveyed to the State of Alaska in 1969 by Patent 50-69-0199, subject to a reservation for the 1914 Act right-of-way easement.  The Railroad currently charges $5,875/year for ENSTAR’s permit to this stretch of subsurface tideland. This is more than six times what ENSTAR would pay were it to simply acquire a right-of- way from the State of Alaska Department of Natural Resources, the actual owner of the tideland.

 

ARRC has already initiated a payment scheme for recreational users, rock climbers and wind surfers on the ROW along Turnagain Arm and has expressed interest in expanding this practice.

 

Alaskans love our railroad. We are proud to take visitors on the trains through pristine wilderness to magical destinations. We respect our railroad’s need to be profitable and accept the reality of that challenge. Historically, intrepid Alaskans have settled Alaska homesteads and depended upon the Alaska Railroad, accepting its need for room to operate on lands it doesn’t own outright. But that is where our charity ends; we do not expect the Alaska Railroad to be a predator organization, usurping land, overcharging for use of land or dragging good Alaskans into federal court at great expense to bully landowners who must rally popular support for justice. That isn’t the Alaskan way; this bull-headed business practice tarnishes the brand when we all know the AARC future is bright for many reasons.

 

This spectacle needs to end and ARRC can end it NOW.

 

Resources:

 

[1] “ARTA” US Code Title 45 Chapter 21

https://www.alaskarailroad.com/sites/default/files/akrr_pdfs/Corp_ARTA_2005.pdf

 

[2] ARRC Press Release April 1, 2021

https://www.alaskarailroad.com/sites/default/files/Communications/04_01_2021_ARRC_2020_AnnualRpt_Release.pdf

 

[3] AARC Annual Reports (2011-Present)

https://www.alaskarailroad.com/corporate/leadership/reports

 

[4] 2017 Legislation RE ARRC Right-of-Ways

http://www.akleg.gov/PDF/30/Bills/SB0068A.PDF

http://www.akleg.gov/PDF/30/Bills/HB0093A.PDF

 

[5]House Joint Resolution No. 38

http://www.akleg.gov/PDF/30/Bills/HJR038A.PDF

 

HJR 38 Supporting Documents: http://www.akleg.gov/basis/get_documents.asp?session=30&docid=54490

  

[6]Letter to Rep. Chuck Kopp from Congressman Don Young

https://www.railroadedalaska.com/wp-content/uploads/2018/04/Don-Young-letter-41618-re-HJR38.pdf

  

[7] Gov. Dunleavy recent response to ARRC Legal Action:



[8]Alaska Railroad Corporation vs Flying Crown HOA

https://www.railroadedalaska.com/wp-content/uploads/2021/01/ARRC-Complaint-v.-Flying-Crown-HOA-1.pdf



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The Threat of Competence

  Who is Politicizing Alaska’s Health Care Crisis? (2021 © donnliston.com) David Morgan’s career includes over 40 years professional se...