"The Economy and its Effect on Business & the Taxpayer”
Bibliography
Sabatini J. Monatesti
Mr. Monatesti is the President of a small management consulting business, ES Enterprises Inc. He has
thirty years of IT experience and has specialized in health care reform for the last five years. He has a
Master of Science Degree in Information Systems Engineering, Polytechnic University, 1990 and a
Bachelor of Science Degree in Electrical Engineering, Pennsylvania State University, 1970. Mr.
Monatesti’s most recent health care endeavors include two pending patents (Care Order Management
System and Public Accountability Knowledge System) as well as the “Fast Track RHIO” methodology, and
the authorship of multiple articles on health care reform, including “A Cure for American Health care (at
www.Wellneess.wikispaces.com). He is a member of the Northeast Pennsylvania Health care Reform
Task Force (NEPA HRTF) chaired by Representative E. Day Pashinsky, a charter member of Pennsylvania
e-Health Initiative (PAeHI), and the founder of the Patient Health Information Network (PHIN)
Consortium and North East Pennsylvania Regional Health Information Organization (NEPA RHIO). He
resides with his wife of 43 years in Salem Township, Luzerne County, PA.
Introduction:
The House of Representatives, Commonwealth of Pennsylvania, NEPA HRTF White Paperi, dated January
20, 2009ii, sums up the crisis faced by businesses and the taxpayers in our great State of Pennsylvania
this way: “No one can dispute that we are in a crisis! But, which one is it? Is it a financial crisis? Is it a
mortgage crisis? Is it a health care crisis? Is it an economic crisis? Or a CONFIDENCE crisis?!!! All of the
above….yes, and there is more going on in our society that portends of great danger for all of us, the
small business and the citizen taxpayer. What about it? Well, if we do nothing, the danger of
catastrophic results is beyond description.”
Business & Taxpayer Distress:
Pennsylvania is home to about twelve million citizens. About one third of these are elderly, on fixed
incomes, one third are children attending school, and the other third are persons of working age. About
one third of the citizens of Pennsylvania live in the North Eastern and North Western sections of
Pennsylvania. A little over 1% of the citizens of Pennsylvania live in towns along the river in five
countiesiii aligning the Susquehanna River basin, i.e., Northumberland, Montour, Columbia, Luzerne,
Lackawanna and Wyoming (Attachment number 4). On average, the median age is about forty, seventy
five percent have a high school education, a median household income of about $27K, and if they own a
home it has a median house value of $67,000iv. These citizens may pay consumption taxes, school taxes,
township taxes, county taxes, state taxes and federal taxes that represent about 30% of their incomev.
They also pay health insurance of about $10K per year per family of four (Reference suggestion K), if self
employed or if they are one of the many whose small business has dropped health insurance (occurring
at the drop rate of 4.5% per year, Attachment number 5) they are uninsured. They pay automobile
insurance about $500 per year per car, homeowners insurance about $800 per year, feed and household
care for their family for about $800 per month or $9,600 per year, and they must pay electric, heat,
water, sewer, telephone, cable TV or Internet fees that approach $4,000 per year.vi And in many cases,
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many have lost their retirement investmentsvii due to the financial crisisviii. And unlike government
employees they cannot ask their representatives or school boards to make good on their benefits
programix.
A Crisis of Fear, Uncertainty and Doubt:
To build a perspective it is important to review historical factors. As reported in local newspapers,
Pennsylvania citizens may be suffering from double standards affecting their health, income and health
care (Attachment number 3). There is one standard for the average “working Joe,” the elderly, the very
poor, children, and employers. There is another standard for state employees, lawmakers, teachers and
other civil servants. In Pennsylvania:
The average Joe receives a salary of $30K per year (see Attachment 1) and pays out 30% in
taxes, many of which are hidden from view, (see Attachment 2)
Teachers on average earn about $50K per year
Some health care professionals earn as much as $300K per yearx
Civil servants, the legislature and teachers have received increases of 25% to 50% in their
benefits at Joe’s expensexi.
Citizen Joe suffers from an apparent disparity in what he can earn to provide for his family because their
basic needs are not being satisfiedxii. One of these needs is a quality education. Joe understands that
his local public school is performing poorly as indicated by the lack of proficiency in math or readingxiii.
This is a problem because it directly affects one’s ability to obtain and maintain a decent job because
industry does not settle in an area with poor proficiency scores. Another problem Joe faces is basic to
his family’s survival. These needs include a decent home, good health care, affordable insurance, and a
small nest egg for their future. Joe becomes distraught when he looks around his community and sees
that many teachers, civil servants and professionals receive free benefits, such as, health care, life
insurance, and long term care insurance. The average Joe may pay for his benefits at 50% of their value
and still others pay the full amountxiv. If Joe worked at the local factory, he is not only losing his job, but
he is losing his benefits as well. Most of the employers are unable to afford health insurance for their
employees. In fact, they are dropping health insurance benefits at the rate of 4.5% per yearxv. In some
cases, employers have gone out of business due to the low cost of foreign importsxvi and the employees
in those industries expect to lose their benefits.
To make matters worse, Joe lives in an area ripe with individuals on fixed incomes averaging about $24K
per year. Based on national averages and recent research, if you want to live in the area, raise a family,
own a modest home, have a life insurance policy and put something away for retirement, then you need
a minimum of $36K per year for a family of four. Not only is Joe unable to do it, but the elderly are
faced with a decision to install sewers, buy medication, pay medical expenses or buy food. At the end of
the day they may even lose their homes. It doesn’t matter that they have lived in their home for 30
years or soxvii.
Joe and the employer look at their community’s education system and wonder about its sustainability.
They know it costs about $10K per student yearxviii. Joe and his wife attended the local school system
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and it cost the home owners $240K for their 12 years of school. They are proud of their high school
diploma and both of them have additional training in a trade. They realize that their two children will
attend the local school at a cost to the home owner of another $240K. Hence, in twenty-five years, Joe’s
family would have received a benefit from the community of $480K. He understands that about 50% of
the amount came direct from state subsidies. His employer and his retired father told Joe this
investment in education is a bad one. They noted that Joe owns a $50K home. He hopes to live in this
home for about 50 or so years, which will mean that his contribution to his education, based on paying
school tax on his home of $500 per year, will amount to about $250K. Yet despite the cost, Joe and his
family receive low value from the investment in education due to the low proficiencies in math and
reading. Just as disconcerting is the real fear that his community will be unable to sustain the ever
increasing cost of education because the community is aging and lacks new industryxix.
When Joe and his dad, along with their employer look at the health care industry in the area, they are
confronted with another problemxx The local hospitals, in some cases, have high error and infection
ratesxxi, as well as breaches in their securityxxii. The cost of health insurance for his family of four is $10K
per year. Joe is paying for one-half of the premiums. His employer has been working to initiate a
wellness program, but the costs for the program are high and eating into his margin. The insurance
company has not offered Joe’s employer a break on their insurance premiums saying that their loss
experience is still too highxxiii. To make matters worse, Joe received a note from one of the local
hospitals indicating that his family’s electronic records were compromised. And recently, when his dad
had his gallbladder removed, he contracted MRSAxxiv, which almost killed him. The hospital sent Joe’s
dad a bill even though they had contributed to his problem. Joe couldn’t understand how the infection
could have happened. He was wondering who was liable for this infection and he was told that it just
happens.
One of Joe’s associates across town just lost his job. The person had a drinking problem and was never
married. He was receiving welfare payments weekly and all of his recent health care costs, housing and
food costs were coveredxxv. It didn’t quite seem right. Joe lamented to his dad that it didn’t make any
sense to work. He was having a difficult time making ends meet and his friend was getting a free ride.
Joe told his dad that it might be better for his dad to rob a state bank; at least he would have a roof over
his head, three square meals a day, access to free health care and advanced educationxxvi.
Small Business and Taxpayer Bankruptcy:
With increases in benefits paid out to civil servants, teachers and others, and with losses in their 401K’s,
the demand for additional tax revenues is driving the middle class into bankruptcyxxvii. Joe and his family
are being asked to make up the difference in the 401K managed by the Public School Employee
Retirement System and the State Employees Retirement Systemxxviii. They had $90 billion in assets
before the recent financial crisis. Joe recently learned that the retirement cost for state workers,
teachers, and lawmakers was about to triple; these costs includes free health care for 682,000
employees and retirees. He also learned that prisoners incarcerated in the state receive free health
care, and that it cost about $36K per year to house each of these inmates xxii. Joe is understandably
angry; that is more than he can make in one year.
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Joe knows that one trip to the hospital for a major illness, with a loss of insurance, contributes to
bankruptcy (Attachment number 6)e told his wife that if he contracts cancer, he doesn’t want
treatment. Some new hires have pre-existing conditions and have great skills, but Joe’s employer can’t
hire them because he can’t afford to insure them. Joe recently read that municipal police costs continue
to rise, utility costs are increasing (PPL requested a 30% increase, profits up 98% since 2005), the cost of
home health care are uncontrolled, and, in many cases, fraud is an everyday occurrence. Joe is
distraught. His very security, his family’s security and their future are threatened. He knows that
Luzerne County has a very high rate of heart-disease deaths, and that one in every two of the elderly,
possibly his dad, will confront some form of dementia in the next few yearsxxix. Joe doesn’t have the
$72K per year needed to keep his dad in a nursing home. His dad’s house, worth $75K, and his social
security, $24K per year is all that is left. Joe is aware that he and his family will not have an inheritance.
He is very aware that unless his children leave the area they will share his fate.
Suggested Actions:
Following are 14 suggested actions that can and should be taken to help improve the lives of people in
our community who are struggling and threatened by the strains and inequities discussed above:
1. Stop giving away tax dollars to sustain retirement programs: If local governments, school
boards, and state governments changed the way benefits for public employees are funded,
the impact of benefit program losses on the homeowner would be significantly reduced.
2. Get health care reform now. NEPA HRTF noted that the American people will accept their
moral and financial responsibility to contribute to improve the health care system as long as
they know that their efforts are part of changing the present Health care System into a
better more cost efficient Health care System.
3. Consolidate local school systems. By reducing the number of school systems from 501 to
101, the administration cost could be effectively reduced by an estimated 80%.
4. Introduce a state wide health plan for all civil servants, teachers and others and make the
same benefits available to the average Joe. NEPA HRTF believes that a quality, accessible
basic health care plan for all Americans is a RIGHT and a NECESSITY; it is NOT a privilege.
National expenditures in 2007 for Health care were $2.4 Trillion. Insurance companies
routinely add on the cost of treatment services an overhead cost of operations of 15 to 20%.
A Price Waterhouse Coopers (PWC) report found that 30% to 40% of all health care
expenditures in this country are wasteful. Hence, by creating an insurance shared risk pool
with everyone insured and reforming health care, insurance premiums could be reduced.
5. Construct a non-profit regional health organization that is community focused and patient
centric to aid in the transformation to improved home health. NEPA HRTF noted that new
technologies creating E-prescribing, Medical Information Exchange, and interoperability,
etc. will create more efficiency and provide for real time information enhancing the
clinician’s ability to appropriately treat the patient. NEPA HRTF further noted that any
federal health information system must support the idea of regional health information
organization (RHIO).
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6. Provide health care for the uninsured, remove pre-existing conditions, establish a shared
risk pool, don’t allow anyone to go into bankruptcy due to an illness. A community
focused, patient centric health care system and an insurance system that place the patient
first using a shared risk pool supported by government reserves could significantly reduce
the potential for bankruptcy.
7. Develop a state wide consumption tax to pay for schools. The state currently pays about
50% of the bill. With a consumption tax, the reduction of school districts, and one contract
for health insurance the overall costs to home owners could be significantly reduced.
8. Make it advantageous for employers to offer wellness programs. Wellness programs will
directly impact loss experience. With a reduction in loss experience the savings could be
passed along to the employer and the employee.
9. Have insurance companies reduce premiums. Leveraging the shared risk pool concept
would make all insurance carriers in the state share in the risk. The carrier reserves could be
reduced by leveraging a government sponsored reserve fund for all insurers, hence the
potential for company carrier loss is reduced and the consumer would enjoy reduced
premiums.
10. Institute mandatory quality guidelines that include measuring and reporting errors and
infection rates in the local newspapers. Once the public is aware of the quality of health
care being delivered, they can make informed decisions. And once health care providers are
aware of how they compare, quality improvements are more likely to be made.
11. Require one wellness advertisement for every TV ad that speaks to junk food consumption
or use of medication and medical procedures.TV is filled with advertisements for
prescription drugs, fast foods, and medical procedures. All of this information is a driver for
the sick care industry. To add balance to the picture, inform the public about the potential
of well care (e.g., lifestyle changes, healthy food and exercise, non-medical options, etc.)
along with quality metrics so that the consumer could make a quality decision.
12. Reduce the cost of medication. NEPA HRTF noted that pharmaceutical companies are
charging the U.S. consumer 3 to 5 times more for pharmaceuticals than Canada, Europe or
Mexico. Providing legislation that would allow the State of Pennsylvania to negotiate with
pharmaceutical companies for lower drug prices would significantly lower insurance
premiums.
13. Make pay-for performance in education and health care mandatory. NEPA HRTF reports
that the cost of poor quality in health care wastes 30 to 60 cents of every health care dollar.
PENNSYLVANIA, April 11, 2005 – Although No Child Left Behind (NCLB) addresses critical
issues that concern parents, students and community leaders in Pennsylvania, the results of
a new report called Open to the Public reveal a public perception that NCLB adds burdens to
the already-serious problems in the state,
http://www.philaedfund.org/pdfs/press_release_nclb.pdf, The costs of poor proficiency in
Pennsylvania is significant but a quantitative measure was unavailable for publication.
California's high school dropouts cost state taxpayers approximately $46.4 billion annually,
according to a recent study by the California Dropout Research Project (CDRP) at the UC
Linguistic Minority Research Institute located at UC Santa Barbara. In addition, the authors
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estimate that the economic benefit from effective dropout intervention programs would be
$392,000 per high school graduate.
14. Freeze taxes for elderly retired. The elderly are already behind the income curve, cutting
them a break on taxes and moving to a consumption tax for education would significantly
reduce their out of pocket expense, estimated reduction in school tax about $1,000 to
$2,000 per year.
The 14 suggestions are what OUGHT TO be done, but we have to be practical and focus on what CAN
BE done, because any disconnects between what ought to be done and what can be done will
contribute to failure. The NEPA HRTF White Paper gives details regarding how to fund and implement
these suggestions.
Conclusion:
Since it is impossible to build a perfect system, we should focus on transforming the current system into
one that provides flexible social support and safety nets that are capable of aiding individuals, families,
and communities. People like Joe are adversely affected by health and financial problems that, in many
cases, are beyond their control. It is important that responsible members of society account for the
system failures without punishing Joe. Society has a moral obligation to find ways to sustain strong
family values, to bind our communities in a covenant of inclusion rather than separation, and ensure
that the policies put forth empower and grow Joe’s capacity to provide for his family.
It appears that the current situation is contributing to the creation of a cast society. People like Joe are
falling through the cracks; they are becoming the lower cast citizens.
Many years ago, Dr. Alfred E. Tonolo, a professor at Bloomsburg University, spoke about being a
prisoner of war, captured by the Allies in Africa. For six months prior to his capture, he slept on the
ground with very little to eat. Once captured, he was transported to a hospital at a prisoner of war
compound in the mid west. It was there that he met his wife, a US Army nurse. He arrived and he
received a bed role, a bed, a clean room to wash in and rations. When he arrived at the mess hall that
morning, the cook asked him how he wanted his eggs. Dr. Tonolo became an American citizen and
found the American dream. Joe may be getting rotten eggs or raw eggs today. It is our moral obligation
to figure out the best way to adjust the system so that Joe’s situation could improve.
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Attachment 1
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Attachment 2
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Attachment 3
Maslow’s Hierarchy of Needs
(5) Self
actualization
(4) Esteem needs
(3) Belonging ness
and love needs
(2) Safety needs
(1) Biological and
Physiological needs
1. Basic life needs – air, food, drink, shelter, warmth, sex, sleep, etc.
2. Protection, security, order, law, limits, stability, etc.
3. Family, affection, relationships, work group, etc.
4. Achievement, status, responsibility, reputation
5. Personal growth and fulfillment
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Attachment 4
Representative Community Profiles (Year 2005)
Shamokin Sunbury Danville Bloomsburg Berwick Hazleton Wilkes-Barre Scranton
Communities
Population 7,581 10,086 4,640 12,195 10,352 21,125 41,337 73,120
Median 40.8 36.7 37.6 22.4 39.5 40.8 38.8 38.8
resident age
Median $20,173 $25,893 $30,498 $24,868 $27,442 $28,082 $26,711 $28,805
household
income
Median $29,000 $62,200 $74,300 $86,000 $71,100 $67,200 $64,700 $78,200
house value
High school 73.5% 71.4% 78.5% 84.6% 71.9% 78.5% 76.8% 78.2%
education
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Attachment 5
Decreasing Employer Employee Insurance Benefit
Employer Employee Benefit Problem
Canaries in the Mine:
The Erosion of Private Sector Coverage
90
• 32% drop in 80 76 Private Sector Jobs With Health Benefits
80 77
coverage in 12 73 71
70 70
years. 70 64
61 FullTime
56
• 1991-2000 - 60 66 65 Workers
% 63
2.3% avg 59
58
50 57 44
annual erosion All Workers 53 52
rate. 40 45 34
• 2001-2003 - 30 Source: William J. Wiatrowski: Documenting Benefits Coverage
28.7
4.5% avg For All Workers, US Bureau of Labor Statistics Report, 5.26.04.
20
annual erosion 89- 90- 91- 92- 93- 94- 95- 96- 98 99 00 01 02 03 04 05 06 07 08 09 10
rate. 90 91 92 93 94 95 96 97 Year
15
Presented at Wilkes University, NEPA RHIO meeting, July 2006
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Attachment 6
Health care Crises
The Health Care Crises
The Health Care Cost Explosion
Between 1999-2004, Health Care Premiums Grew
2.3x As Fast As Health Care Premium Growth from 1999 - 2004 As A
Business Revenues Multiple Of Other Key Economic Measures
5.5
4.0x As Fast As
4.0
Workers Earnings
2.3
5.5x As Fast As
Products and
Services
Business Income Workers' Earnings General Inflation
14
Presented at Wilkes University, NEPA RHIO meeting, July 2006
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i
http://www.pahouse.com/pashinski/documents/121%20Health%20Care%20Reform%20Book.pdf
ii
House of Representatives, Commonwealth of Pennsylvania, Northeast Pennsylvania Health Care Reform Task
Force (NEPA-HRTF) NEPA HRTF Meeting on Health Care Reform Proposal Meeting held on December 18th, 2008 at
6 PM, State Representative Eddie Day Pashinski, 152 S. Pennsylvania Avenue, Wilkes–Barre, Pa.
iii
NEPA RHIO, A Community Healthcare Utility, Wilkes University 84 W. South Street, Wilkes-Barre, Pennsylvania,
18766, USA, July 22, 2006
iv
2005 Census Figures, Situation assessment NEPA RHIO 2006
v
Taxes Nibble Away All Day, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, April 15, 2007
vi
Taxes Nibble Away All Day, Press Enterprise, April 17, 2007
vii
134 Jobs Unravel, Bloomsburg Mill Closes After 120 Years, Press Enterprise, 3185 Lackawanna Avenue,
Bloomsburg, PA, 17815, April 1, 2009
viii
About 1 in 5 Can't Afford Basic Needs, Reference: Center for Economic & Policy research & the Center for Social
Policy at the University of Massachusetts, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815,
October 15, 2007
ix
Pension Crises Looms for Taxpayers, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815,
December 12, 2006
x Geisinger Salary and Benefit Average $321K, Press Enterprise, October 26, 2006
xi
Premiums Increased 25-35% Last Few Years, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815,
October 6, 2007
xii
Maslow’s Hierarchy of Needs, http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs, A Theory of Human
Motivation, proposed by Abraham Maslow in his 1943 paper
xiii
School Progress Reports, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, November 25,
2007
xiv
Merck Ups Some Retires Fees, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, November
29, 2006
xv
Canaries in the Mine, The Erosion of Private Sector Coverage, NEPA RHIO, Wilkes University 84 W. South Street,
Wilkes-Barre, Pennsylvania, 18766, USA, July 22, 2006
xvi
Struggling for decades against influx of cheaply made foreign fabrics, seek benefits quickly, man misses chance
for surgery before losing health insurance, Bloomsburg Mill closes after 120 years, Press Enterprise, 3185
Lackawanna Avenue, Bloomsburg, PA, 17815, April 1, 2009
xvii
Unpaid Medical Bills in the Millions, Dave Folley, GMC spokesman, Press Enterprise, 3185 Lackawanna Avenue,
Bloomsburg, PA, 17815, September 17, 2007
xviii
Taxes Nibble Away All Day, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, April 15, 2007
xix
Gov. Rendell wants to slash the number of school districts statewide, eliminating about 400 of the current 501
Pennsylvania public school systems. The controversial proposal would make a more efficient public education
system. Public school funding is to increase by $265.3 Million, a 2.8% increase over last year. Inquirer Staff
Writers, February 4, 2009
xx
Health coverage: the life and death difference, More than 45 million Americans uninsured, another 50 million
may be underinsured, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, April 8, 2007
xxi
Why 90,000 Americans die every year, killer infections and dirty hospitals, Jan 07, Vol 48, No 1, AARP; Geisinger
policy violated, Report examines role of unlicensed pharmacist in premature baby death, Press Enterprise, 3185
Lackawanna Avenue, Bloomsburg, PA, 17815, February 19, 2008;1999 report: Institute of medicine, Medicare to
stop paying bill for hospital mistakes, Mistakes kill 98,000 patients a year, Press Enterprise, 3185 Lackawanna
Avenue, Bloomsburg, PA, 17815, September 4, 2007
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xxii
Geisinger patient data stolen, 25,000 patents affected, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg,
PA, 17815, December 14, 2006
xxiii
Subscribers’ interests must come before protecting the status quo at the Blues. The Blues argue that their
enormous reserves are a necessary hedge against unforeseen future catastrophes. Health insurance costs,
however, are a full-fledged catastrophe right now. Years of skyrocketing health insurance costs are forcing virtually
every employer to reduce or even terminate health care benefits. Unlike the threat of a meteorite or the storm-of-
the-century, this is a real disaster – and it is getting worse, http://www.smc.org/Article.cfm?id=329, SMC Business
Councils
xxiv
MRSA spreading, Study: Staph infections killing more in US than AIDS, Press Enterprise, 3185 Lackawanna
Avenue, Bloomsburg, PA, 17815, October 17, 2007
xxv
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA, Pub.L. 104-193,
110Stat. 2105, enacted August 22, 1996) is a United States federal law considered to be a fundamental shift in
both the method and goal of federal cash assistance to the poor. Purpose “end welfare as we know it” many
believe the new system has been ineffective.
xxvi
Cost of incarceration, State of Pa, Total cost per inmate in 2002 was $80.83 or $29,502.95 per year, $9.2 Million
of the Department of Corrections budget is to house an increasing population, the population grew 5.5% from
2001 to 2002, total inmate population 49,666 (March 2009), total budget $1,298,500,000 Fiscal year 2003/2004,
http://www.cor.state.pa.us/stats/lib/stats/2003_budget_presentation.pdf
xxvii
Municipal Police Costs, 22 communities spend an average of $81 per resident for police protection, Salem
Township properties 4,269; 2007 expenditures for police $252K; General Fund Budget $667,279; police protection
represents 37%, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815, October 14, 2007
xxviii
A deal was struck that guaranteed 50% pension increases for most legislators and 25% increase for more than
300,000 state workers and teachers, Retirement cost for state workers, teachers, lawmakers about to triple,
includes free health care; 682,000 employees and retirees $90 billion in assets, Public School Employee Retirement
System, State Employees Retirement System, Press Enterprise, 3185 Lackawanna Avenue, Bloomsburg, PA, 17815,
December 17, 2006
xxix
Luzerne County is No 2 in state for heart-disease deaths, Times Leader, September 9, 2007; the Pennsylvania
Health Care Quality Alliance (PHCQA) is a voluntary group of health care organizations collaboratively working
together to improve the quality of health care for the people of Pennsylvania. Average quality as perceived by
patients (eight topics) for five local hospitals was 58%, http://www.phcaq.org/reports/compare/index.php, The
CDC says that approximately 17,000 people die in the US from hospital acquired MRSA (HA-MRSA) annually. This is
almost completely preventable.
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