Correspondence Fall 2010

MY MRI COST $7,200

Your article, “Overexposed,” in Com­mon­­Wealth’s summer edition was superb. It revealed so many of the failures and successes of our medical system.

I have only one thing to add: You wrote that the “price of an MRI ranges from $350 to $1,400.” When I had an MRI in 2005, the bill, of which I re­ceived a copy, was for $7,200! I don’t know what Tufts Health Plan paid.

A subsequent CAT scan, just be­fore I was to undergo surgery at the Brigham and Women’s Hospital for a subdural hematoma, revealed that the bleeding had stopped, and no further treatment was necessary. I never saw the bill for that welcome discovery.

I think the simple device of telling patients what their treatment costs might put some brakes on the inflation in procedures and expense.
I was on the Board of the Health Planning Council of Greater Boston. The certificate of need program didn’t fail. Every time we turned down a certificate of need, the hospitals had the Legislature overrule us.

Herbert P. Gleason
Boston

The writer, a lawyer, was formerly corporation counsel for the city of Boston and is a founding director of the Neighborhood Health Plan.


ENERGY EFFICIENCY NO GAMBLE

I was surprised to see Bruce Mohl refer to the state’s green agenda as “The big bet” in the summer edition of Com­mon­Wealth magazine. In it, Mohl claims that the state is betting on a future “in which carbon emissions are costly, fossil fuels are scarce, and clean tech jobs are up for grabs.” Well, the future is here. With some of the highest fuel and electricity costs in the nation and the signs of climate change nagging in the background, Massa­chu­setts and other Northeast states are taking action. Their first fuel: energy efficiency.

Unlike conventional power generation or even renewables, energy efficiency is the resource we don’t see. Yet in terms of cost-effectiveness and public benefits, efficiency is about as close to a sure bet as we’ve got. Dollar for dollar, meeting electric demand through efficiency costs about a third as much as it does to generate and deliver it from a power plant. Efficiency yields equally-impressive savings on heating fuel as well.

As Mohl points out, Massa­chu­setts is at the front of the pack in terms of our energy policy. But this is no reason to rest on our laurels; to do so would be shortchanging the state’s residents and businesses and leaving money on the table. While Mohl repeatedly referred to “green subsidies,” every dollar invested in efficiency returns $2.60 to the economy.

Mohl lumped together energy efficiency investments with bringing new large-scale renewable energy projects online. What he missed is that energy efficiency is the bridge to a clean energy future. The money we save through increased efficiency will help the region finance investments in renewable generation to further displace dependence on fossil fuels.

Efficiency is widely recognized as the pathway of choice to control energy costs, increase energy security, curb greenhouse gas emissions, foster economic growth, reduce dependence on fossil fuels, and contribute to a cleaner, healthier society. That’s why Massa­­chu­setts, along with most neighboring states, is directing utility companies to meet as much demand as possible through efficiency before turning to generation resources.

A forthcoming Northeast Energy Efficiency Partnerships study on New England’s energy efficiency potential says that over the next eight years, we could curb the region’s electric use by 20 percent. This is through existing programs and technologies that are cost-effective and already in use; it’s just a matter of scaling up to the challenge.

Energy efficiency is available now. This is no gamble—it’s smart public policy. And it will yield dividends in­cluding local job creation, a cleaner environment, and putting money back in people’s pockets.

Natalie Hildt
Northeast Energy Efficiency Partnerships
Lexington

DELUSIONS OF GREEN POWER

It ignores reality to believe that green energy will displace as much fossil fuel as needs to be displaced to salvage the environment and reduce reliance on foreign sources. Although we should develop green energy to the extent feasible, the potential of renewable energy is pitifully small compared to the energy now produced by fossil fuels, and only a fraction of the practical potential of nuclear energy.

Although the cost of a nuclear electric plant is very high, this is more than offset over the plant’s lifetime by the much lower cost of nuclear fuel relative to fossil fuels. In addition, the “hidden” environmental and health costs of the fossil fuel cycle relative to the nuclear fuel cycle overwhelmingly favor nuclear.

One can’t blame the electric utilities from shying away from nuclear, given the difficulty of financing and recovering the high construction cost and given the regulatory and political  roadblocks to licensing. But eventually the nation must find ways to surmount the institutional and political issues, and must develop the informed will to do so. Our future energy policy should be based on the concept of “Get Real!”

Meanwhile, the environment suffers from the notion that renewables alone will solve our energy problems, politicians continue to be both uninformed and lacking in courage, and the public is lulled by light-weight publicity that fails to reveal the quantitative limitations of  renewable energy and biofuels relative to our total energy and environmental requirements.

R. Murray Campbell
Cohasset

MOSCOVITCH ANALYSIS QUESTIONED

While Edward Moscovitch’s Per­spec­tives column, “Teachers Are Not To Blame,” in the Summer 2010 edition of CommonWealth is thought provoking, the methodology used raises questions about the findings.

Dr. Moscovitch’s primary thesis and conclusions are clear—teachers need more tools to improve the quality of public education and student performance—the data and analysis upon which he based his findings and conclusions, despite extensive statistical data, appear to be more hypothetical proposition and argument than a fact-based theorem.

The foundation of Dr. Mosco­vi­tch’s conclusions are based on his analysis of MCAS results using a stress-ratio model he created to compare student performance in each of the school districts against the relative wealth of the collective school districts. He defined four wealth groups “where the stress ratio is the combined percentage of students who are low income, minorities (blacks and Hispanics), and of limited English ability.”

Unfortunately, the linchpin of his analysis appears to be flawed and inaccurate. A quick check of the 2000 census data for just two of the school districts (Billerica and Plymouth) indicates the cursory approach to defining the comparative wealth groups. The census data reveals that Billerica and Plymouth were virtually identical communities based on the defined criteria.

In 2000, the US Census reported that Billerica was 93.6 percent “white alone” while Plymouth was 94 percent “white alone.” The data also indicate that 9.6 percent of Billerica’s households spoke a primary language other than English, while 6.6 percent of Plymouth’s households spoke a primary language other than English. And 32.2 percent of Billerica’s households reported annual incomes of less than $50,000, while 43.9 percent of Plymouth’s households reported annual incomes of less than $50,000.

Despite these facts, Dr. Mosco­vitch included Billerica in the “wealthiest” category while Plymouth was placed in the “medium-low” wealth category.

The 2009 MCAS results by community are equally revealing. Student performance in Plymouth was slightly better in English in all categories than Billerica. Using Dr. Moscovitch’s stress-ratio model, one could argue, based on this simple comparison, that students in a school district with a higher stress ratio (medium-low wealth) performed better than students in one of the Commonwealth’s “wealthiest” school districts. 

The issues raised in Dr. Mosco­vitch’s column are important and deserve continued research, analysis, and action. Unfortunately, Andrew Lang’s famous quote comes to mind. “He uses statistics as a drunken man uses lampposts—for support rather than for illumination.”

Sean G. Mullin
Plymouth