Thursday, July 25, 2013




          Add between 1 million and 2 million persons to the patient load of California doctors. Do not open any new medical schools or import many foreign-trained doctors. It’s a sure-fire way to create a doctor shortage – and just where California is headed right now.

          That’s probably the most severe problem the Patient Protection and Affordable Health Care Act, often called Obamacare, faces in California when it becomes fully active Jan. 1, but it’s hardly the only one. There are insurance companies refusing to write policies for some small businesses. And how about the fact that the federal government at least for the first year of the program will not demand any kind of proof that people actually qualify for subsidies designed to make health insurance affordable to almost everyone.

          Instead, a kind of honor system may be in effect. “For income verification, for the first year…, we are providing exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification,” says a rule officials just inserted into the Federal Register.

    This applies to states like California that have their own insurance exchanges, although the Covered California exchange says it might still demand pay stubs or their equivalent from clients. “That’s always been our plan, but since verification is now not required, we’re looking at our options,” said spokesman Dana Howard.

          Which means that rule could cost billions in fraud if some of
 the newly-insured lie about  their income and don’t get caught.

          But the impending doctor shortage could actually be life
threatening, making it the most severe problem that Covered
California might face next year.

          Take the example of Orange County. California’s second-
largest county will see as many as 280,000 persons now without
health insurance suddenly become eligible next year. That includes
new Medi-Cal patients previously ineligible because they were
childless or had too high an income. A single adult can now get
Medi-Cal with an income of 138 percent of the federal poverty level,
or $15,856.

    Most will probably go to clinics for their primary care. But will
those clinics have the personnel to take care of them? In Orange
County alone, a population almost as large as Fresno’s will suddenly
be entitled to care, but there will be virtually no new doctors.

          That’s one reason for the steady progress through the Legislature of several bills giving non-physicians more authority to perform some types of medical care.

          These would let pharmacists, nurse practitioners, optometrists, physician assistants and nurse midwives perform some functions now reserved for medical doctors.

          “Pharmacists are the most underused of health professionals, considering their years of education and training” says Democratic state Sen. Ed Hernandez of West Covina, author of the most sweeping bills to let non-doctors perform more medical functions.

          Many pharmacists no longer spend most of their time counting pills or filling medication bottles. Technicians and automated pill counters can do those things. Instead, many pharmacists now spend significant time counseling patients on possible drug interactions when one doctor writes a prescription without knowing what another has already written. Pharmacists also often ask patients about their ailments and advise which drugs might work best for them.

          Hernandez’ bills would let pharmacists prescribe birth control pills, vaccines and some other types of medication on their own. He contends they already do a lot of that, de facto, but doubts remain. Would pharmacists, for example, know what vaccines are appropriate for organ transplant recipients?

          The long-term answer to the physician shortage is to set up more medical schools and train more doctors. But since Medicare, Medi-Cal and other programs have gradually cut fees they pay, an M.D. degree may no longer be an automatic ticket to wealth and medical schools could have trouble attracting the top students they traditionally have.

          There’s also the small matter of how long it takes to train a doctor –  10 years or more for some specialists. So it will be awhile before the doctor shortage is overcome, and despite opposition from the California Medical Assn. and many physicians, this means somebody besides doctors will have to provide some of the care for the newly insured. Like it or not, comfortable or not with non-physicians making some medical decisions, that’s the coming reality.

    Elias is author of the current book “The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government's Campaign to Squelch It,” now available in an updated third edition. His email address is




    Bank on this: As oil drilling companies begin ramping up for large numbers of wells in the Saudi Arabian-sized Monterey Shale geologic formation, opponents will paint some doomsday scenarios.

          Here’s one they will likely conjure up: Injection wells into which drillers put waste water and chemicals from their operations will somehow set off the adjacent San Andreas Fault and cause multiple earthquakes, possibly as strong as the 1906 San Francisco shock.

          The drilling industry will downplay any such risk, saying they’ve used hydraulic fracturing in California for decades without producing quakes.

          The issue of fracking and earthquakes took on new currency in early July, when Science magazine, the thoroughly peer-reviewed journal of the American Association for the Advancement of Science, published two studies (, One, from UC Santa Cruz, reported that as geothermal electricity production rises in California’s Imperial Valley, so does the number of small earthquakes in that ever-shaky area where more than 10,000 temblors have been recorded since 1981.

          The other, from a team of researchers at Columbia University and the University of Oklahoma, found that fracking may be one reason previously stable parts of the East and Midwest have experienced some earthquakes in recent years.

          The second study raises the most questions for fracking in the Monterey Shale, which covers hundreds of square miles from eastern Monterey County south along the west side of the San Joaquin Valley and beyond.

          “A recent dramatic increase in seismicity in the midwestern United States may be related to increases in deep wastewater injection,” said the Columbia/Oklahoma study.

          As lead author Nicholas van der Elst of Columbia explained it, quakes in previously quiescent areas from North Dakota to Oklahoma and Pennsylvania are at least in part due to injection of waste from fracking and other oil drilling – a combination of water and a variety of chemicals – into separate wells near those producing oil.

          The report said waste liquid  -- used in fracking to break into shale formations and get at the oil inside – can essentially lubricate small underground faults, which then can be set off by seismic waves traveling through the earth from large and very distant quakes. “Triggering in induced seismic zones could be an indicator that fluid injection has brought the fault system to a critical state,” the study said.

          But van der Elst, who earned his Ph.D. at UC Santa Cruz, noted in an interview that rock formations in the Monterey Shale are different from most of those around oil wells elsewhere in America. “Elsewhere, waste is rarely injected into shale, but often into sandstone below where oil is found,” he said. So he stops far short of predicting that injection wells for waste fluid in the Monterey Shale could trigger massive earthquakes on or near the San Andreas.

          He notes that none of the eastern and midwestern quakes have done significant damage or killed anyone, saying “There is not necessarily greater danger in the Monterey Shale.”

          Meanwhile, Tupper Hull, spokesman for the Western States Petroleum Assn., asserts that “There appears to be a fundamental difference in conditions in the Midwest and here. The area here is already saturated with water – oil production in California results in about 10 times more water coming up than oil. The water that comes up here is routinely reinjected in nearby injection wells, without any increase in earthquakes.”

          Hull, therefore, insists that “There is no connection between fracking and earthquakes. Disposal of waste water in California has been handled on a routine basis for many, many years, in accordance with both state and federal laws.”

          But that’s unlikely to satisfy either seismic alarmists or environmentalists fretting about the possibility of ground water pollution from fracking wastes.

          So Hull says the industry expects current discussions in the Legislature of a fracking moratorium or a flat-out prohibition on fracking the Monterey Shale to produce “a more robust regulatory climate.”

          Van der Elst recommends not that California stop or ban fracking, but that “there should be long-term seismic monitoring of any long-term injection site. A lot of attention should be paid to what eventually happens to the waste.”

          All of which means there’s interesting evidence building in this emerging controversy. And that will make decisions on fracking even more complex.

     Email Thomas Elias at His book, "The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It," is now available in a soft cover fourth edition. For more Elias columns, visit

Wednesday, July 17, 2013




          Maybe Proposition 13 really still is a third rail in California politics, one that no one dares touch for fear it means instant political suicide, just as surely as if through electrocution.

          That’s about the only conclusion to be drawn from the way the Legislature has handled the possibility of fixing or changing parts of both the landmark property tax limitation measure and some of the regulations and definitions adopted in 1979 to standardize how it is administered.

          There was plenty of brave talk about fixing Proposition 13 early this year, after Democrats acquired two-thirds majorities in both legislative houses. Some advocated a “split roll,” where commercial properties would be taxed on the basis of their market values while residential would continue to be based on 1 percent of the latest purchase price.

          There was alsoDemocratic state Sen. Mark Leno of San Francisco purveying the idea of lowering electoral margins needed to pass parcel taxes for education from the two-thirds majority demanded by Proposition 13 to 55 percent, the level now required for school construction bonds.

          None of that will now happen. Maybe it was because of the fierce opposition these proposals drew from the Howard Jarvis Taxpayers Assn., perpetually a vocal defender of every word in Proposition 13 and its surrounding regulations. Everyone in California politics knows how much money the Jarvis group – named for Proposition 13’s co-author – can raise and funnel into campaigns against those it deems unfaithful or threatening.

          Whatever the reason, attempts to make any fixes on property taxes lurched to a halt when legislative leaders pronounced them dead, at least for this year.

    Next year, of course, is an election year for almost everyone in the state Capitol. With legislators’ jobs on the line, it’s hard to believe either house will touch Proposition 13. So when the leadership says changes won’t happen this year, they really mean nothing will happen for at least two years. And most likely, for many years after that.

    This is because no one knows whether Democrats in two years
will have the same size majorities they do today. If not, scratch any chance for change.

    The practical effect of all this is that today’s inequities will
continue indefinitely. Neighbors in essentially identical homes will keep getting radically different property tax bills, based upon price levels at their varying times of purchase.

    The current reassessment rules – not part of the original 1978 Proposition 13, but passed legislatively the next year – will continue. These rules often allow sold properties to go without reassessment so long as no one individual or corporation acquires a controlling interest when a property is sold. (Page 42 of the state Board of Equalization assessor's handbook ( describes how this works).

          In real life, this means limited partners buying properties as varied as vineyards and apartment buildings often escape the higher tax bills any home or condominium will see the moment a residential property gets a new owner.

          Even Joel Fox, the former chief of the Jarvis group who now runs both a political/business blog and a small business owners’ political committee, once said he liked the idea of changing those rules, which could be done by simple majorities in the Legislature.

    But that change got virtually no consideration this year, even though estimates of the revenue it might raise range as high as an annual $12 billion. That’s not what a split roll might produce, but it’s still plenty. One reason for the lack of attention: the Jarvis group and its current head, Jon Coupal, like to imply that any slight chink in any aspect of Proposition 13 opens the way to attacks on all of it.

          So the state will keep passing up revenue it could easily obtain and instead rely on hikes in regressive levies like the sales tax, which hits poor people much harder than the wealthy. Local governments and public schools, meanwhile, depend more and more on parcel taxes, which almost always assess the same amount for each piece of property, whether it be a one-bedroom condo or a shopping mall. How fair is that?

          But courage is in short supply in Sacramento, which means we will not even see a few simple rule changes that could make things much more fair and equitable than they’ve been in decades.

     Email Thomas Elias at His book, "The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It," is now available in a soft cover fourth edition. For more Elias columns, visit




          Temperatures reached 116 degrees in some urban parts of California early this month, but there were no rolling blackouts, no brownouts, no problems.

          That happened with the San Onofre Nuclear Power Station producing not even one watt of electricity. For the second straight summer, the now-retired 2,250-megawatt facility is closed, and it apparently will never reopen after leaky steam generators spewed small amounts of radioactivity into the air near the Orange-San Diego county line early last year.

          How could a state where brownouts were common just a dozen years ago lose enough electricity to power almost half a million homes and not even hiccup?

          It’s a combination of conservation and a prudent building program. More than a decade of encouraging purchases of energy efficient appliances also has had an impact. So have the solar panels installed on many homes and businesses. But the main replacements for San Onofre are “peaker” power plants that fire up mainly when demands on the grid get high. Thousands more megawatts from them are available today than 12 years ago, mostly fueled by natural gas.

          Because of the peakers coming on line this summer, there should be no need to bring power down from the Northwest, as could be done in an emergency. No need to impose brownouts on some areas to prevent blackouts in others.

          By the end of this summer, five plants will come online in the City of Industry, Walnut Creek, El Segundo, Anaheim and near Palm Desert. Together, their capacity is 2,600 megawatts, more than San Onofre’s maximum output, once the largest of any generating station in California. None of those were available a year ago, when San Onofre was also shut down and the state experienced no serious problems. So the supply situation has improved.

    It’s true that peakers are not as “green” as renewable energy sources like solar and don’t help meet the state’s demand for ever more “sustainable” power, but they only run for relatively short periods.

          Yes, the maximum demand at any one moment will likely be about 2.3 percent higher this summer than last, according to estimates from the Independent System Operator, which runs the state’s electric grid. But ISO’s official summer load estimate, issued during the spring, says “reserve margins under the normal peak demand scenario are…33.3 percent for the (statewide) system, 31 percent for Southern California.”

          ISO regulations demand only a 15 percent reserve margin, which means that even in the region most directly affected by the San Onofre outage, there is today double the reserve margin needed to keep machines, commerce and households running.

          Add to that several large solar thermal power plants nearing completion in the state’s desert areas, and there’s definitely no impending power shortage.

          And yet, the state Public Utilities Commission keeps pushing for more peaker plants that would cost consumers billions of dollars.

          Immediately after San Onofre’s retirement was announced, the commission and the big utilities sounded a most likely unjustified alarm. One recent PUC decision says the San Diego area will need at least 298 megawatts more peak power by 2018, enough to fuel about 60,000 homes. This revived an application to build a peaker of about that size near the Mexican border, costing customers of San Diego Gas & Electric Co. $80 million to $90 million per year over 20 years, almost $2 billion altogether.

          No one says that power will be needed for sure; it is, after all, just a peaker plant, reserve power by its very definition. Should rooftop solar photovoltaic power capacity grow appreciably, it wouldn’t even be needed four or five years from now.

          And rooftop solar becomes more viable every day. The Los Angeles Department of Water & Power just last month authorized a 150 megawatt rooftop program at a cost of about $500 million, power that will produce no pollution. The program can be quadrupled within the next two years, and there’s no reason something similar can’t be done in San Diego, San Jose and many other places where the sun shines most days.

          The bottom line: Every piece of objective information available says there’s no need to panic and build more polluting conventional power plants, even if the PUC pushes it.

    Elias is author of the current book “The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government's Campaign to Squelch It,” now available in an updated third edition. His email address is