I picked up my daughter, Amy, early Saturday morning from an overnighter at her friend’s church. Halfway home I noticed her staring vacantly out the window. “A penny for your thoughts,” I said, and she responded that she was thinking about garage sales. The truth is, my brain was also mulling over something that had captured many of my thoughts recently.

Proponents of the Indigent Defense bill (HB 5804) have been attempting to rush this legislation through the Michigan House of Representatives over the past few weeks. The well-intentioned, seriously flawed bill attempts to improve statewide access to one of our 6th Amendment rights which guarantees, among other rights, the “Assistance of Counsel for his defence (sic).” This right is as “American” as mom, hotdogs at the ballpark, and apple pie at Thanksgiving. And anyone who has watched Law & Order or other crime dramas knows that “if you cannot afford an attorney one will be provided to you.”

The effort to improve the indigent defense system comes largely from efforts of the Michigan Campaign for Justice per the indigent defense systems study published by the National Legal Aid and Defenders Association in 2008.

HB 5804 is intended to improve provision of legal counsel to indigent persons across the State. Proponents of the bill cite many problems with the current system that range from the structure of how the service is provided to ethical and moral issues that have emerged in some areas. One of the stated goals is to remove judges from the process of selection and approval of the attorneys who provide counsel to indigent persons. Possible concerns include the fear that judges will select rookie attorneys who will work for less money and will somehow be more malleable for the judges to direct court results. It is also alleged in some parts of the state that judges collect campaign contributions from those awarded indigent counsel work. The “fix” presented in HB 5804 is to take judges out of the process and to create a mostly independent State commission empowered to have the final say on indigent attorney services. It is anticipated that the commission would base its requirements closely upon the American Bar Association’s Ten Principles of a Public Defense Delivery System. While the system overseen by the Judges meets most of these standards, there are some to which our local judges are philosophically opposed.

The proposed legislation in its current form would likely increase the cost of providing these services in Ottawa County by close to a half-million dollars. Ottawa County Judges already have a robust system for the selection and evaluation of attorneys to represent indigent clients. This annual review process sometimes results in the removal of attorneys and the addition of new attorneys. The process is already accountable to the Michigan Supreme Court via its administrative arm the State Court Administrative Office.

The reality is that the problems that HB 5804 purports to fix are not problems in Ottawa County. The legislation will end up costing taxpayers more and could very well have a negative impact on the quality of indigent legal services. Ottawa currently pays the highest hourly rate for indigent defense counsel in Michigan and has a waiting list of qualified attorney’s desiring this work. Contrast this to other areas of the State where very low hourly rates many times attract only recent law school graduates and perhaps attorneys with insufficient experience to perform competently. At the same time, Ottawa cost of indigent legal counsel per capita is only $5.58 compared to the estimated State-wide average of $7.25 per capita. This speaks well of a large population with a relatively low crime rate. We have also been blessed by the quality of judges elected from our Ottawa County electorate. We simply and thankfully do not have ethical and moral issues among our Judges who steadfastly work to maintain the balance between the public good and individual right to have a fair trial. One of the ways our Judges work to maintain this balance is by appointing competent counsel, many of whom have 20 to 30 years of experience working with indigent clients. In fact, Chief District Judge Brad Knoll worked this docket for more than 25 years prior to becoming a Judge.

Specifically, these are our concerns regarding HB 5804 and the speed with which it is moving through the Michigan legislature:

• The bill could cost the County nearly $500,000 in additional expense.
• The bill could require Judges to adhere to some of the ABA principles that they philosophically oppose. Just two examples of this include a requirement that the County pay for continuing legal education for indigent counsel and caseload limitations would be artificially placed on the number of cases that indigent counsel could handle at any given time. Because of the relatively high years of experience held by attorneys performing indigent legal service in Ottawa County, they are able to handle more cases per attorney than could an inexperienced attorney.
• Assignment of attorneys to indigent work would be assumed by the new State Commission and greatly reduce the role of our County Judges and the Ottawa County Bar Association who actually know much more about the local attorneys who apply to do this work.
• The Michigan Association of Counties estimates that the legislation could cost the State $120 million and not the $70 million currently projected and this does not include cost to counties.
• The proposed legislation has not been fully vetted by either the House Fiscal Agency or the Senate Fiscal Agency, which exist for this very purpose.
• The legislation went directly from the House Judiciary Committee to the full House and we believe it should have gone to the House Appropriations Committee so it could figure out how to fund the legislation.

Circuit/Probate Court Administrator Kevin Bowling and I have testified before the House Judiciary Committee and the Senate Judiciary Committee in the past few weeks. It is likely that this legislation will continue its race through the House but we believe the Senate will likely be more deliberative and cautious as they should.

We very much support reform of the system to ensure indigent legal services in areas where there is disrepair. However, we do not support efforts to fix these broken counties through a system that drags down counties that are doing a great job. Effective counties should be exempted through objective criteria such as prison commitment rates; percentage of not-guilty verdicts and dismissals; client satisfaction; reversals on appeal; cost per case; or complaints for ineffective assistance of counsel.

Silence resumed for a few minutes after Amy’s answer and then out of the silence her voice from the back seat said, “Dad, where’s my penny?” As I dug a penny out of the ash tray and handed it back to her, I thought, “Where’s my penny, indeed.”

It has been a month and a half since my final Weigh to Wellness appointment. Over the 26 week program, I lost a total of 82 pounds and took 15 inches off my waistline. (A Weigh to Wellness record, I was told!) A body scan completed at the ’79-pounds-lost’ mark revealed 77 of the pounds lost were fat, 1.5 pounds were water and only half of a pound was muscle. My lean muscle index actually increased slightly during the diet. Other stats include:

While these statistics speak volumes, other benefits cannot be quantified but are equally tremendous:

•  I can bend over to tie my shoes. No need to put my foot up on something or engage in other gymnastic maneuvers to get them tied.
• I can go from sitting on the floor to standing by simply standing up instead of crawling to find something to pull myself up on or by use of a hydraulic lift.
• I don’t snore anymore.
• I can go up the 14 steps in my home without getting winded and without knee pain. I recently climbed the 352 steps to the top of the Capitol Dome alongside Congressman Huizenga without getting out of breath or even breaking a sweat!
• I can get in and out of the car much more easily and fit in the car better as well.
• When playing with the kids out in the yard, bending over to retrieve balls or chase them down is much faster and easier.
• Running around in heavy wool uniforms during Civil War reenactment activities is much easier and realistic. (Anyone ever seen photos of an obese Civil War soldier?)
• Along with 82 pounds, I have also lost my acid reflux, allergy problems and back pain.
• As for the young lad at church a few years ago who asked his father if I was going to have a baby – obviously some remedial action was necessary in that case…
• I am honored to learn that my story has inspired many others to lose significant weight, including two Ottawa County employees as well! Each has lost over 60 pounds and one has been able to reduce their diabetes medication by over half! I applaud those who have begun or successfully completed this journey.

Weight loss and dieting have now been replaced with maintaining my current weight. A key factor has been to learn my calorie burn rate and adjust my calorie consumption accordingly. My burn rate for a normal day is 1,700 calories and 2,200 calories on a day when I exercise. Though I can eat anything, I emphasize protein, deemphasize starches plus take in 64 ounces of water each day. I indulged in cake at my 50th birthday party (plus the three days following), and put on a few pounds. I quickly changed course and returned back to my lower weight. Exercise has also become part of my regular routine and includes swimming (my favorite), running and racquetball. While not a speedster by any stretch of the imagination, I have cut 8 minutes from my swimming time and 16 minutes from my 5k time. I recently added weight training and intend to add biking in the future.

I have been asked if I took diet pills or other types of medication during the diet. There was absolutely no use of diet pills. I took (and still take) a one-a-day multi-vitamin, additional Vitamin D, fish oil, low dosage cholesterol medication, and COQ10 (supplement with cholesterol medication). I hope to be off the cholesterol medication in another couple of months. Others have inquired about the Weigh to Wellness program which was operated by Advantage Health. Sadly, Weigh to Wellness is no longer in business, however Medical Weight Loss and Grand Health Partners offer similar programs.

Thank you everyone for your words of encouragement and positive feedback along the way. It meant so much to me. Included in this post are my before and after pictures. As you can see, I was still smiling in the second photo! You know, prior to the weight loss, I didn’t see this obese guy when I looked in the mirror. I think I saw myself as I wanted to see myself. The weight gain didn’t happen all at once but was very much like the parable of the boiled frog where if you throw a frog into a pan of boiling water it will immediately hop out but if you put a frog in a pan of luke-warm water and slowly turn up the heat the frog will stay in the pan until and end up getting cooked. When you look at the future health problems that I was facing, things like diabetes, heart problems, hypertension among many others, it took radical action to avoid that future.

Ottawa County will soon implement the next phase of the new health management plan. This year will be known as “know your numbers” and biometric testing will be provided at County facilities to make gathering this data as convenient for employees and spouses as possible. Next year, 2013, will be known as “work your numbers” as employees and their doctors look for possible ways to improve health. More on this soon…

“Most people are about as happy as they choose to be.” ― Abraham Lincoln

This is an interesting quote considering Abraham Lincoln struggled with clinical depression his whole life.

Abraham Lincoln experienced a major amount of loss in his family life and failure in many career pursuits from the time of his birth in 1809 to his election as President of the United States in 1860:

• 1812 – his brother Thomas died in infancy
• 1818 – his mother Nancy died of illness
• 1820 – his sister Sarah died while giving birth
• 1831 – he failed in business
• 1832 – defeated for State Legislator
• 1833 – he failed again in business
• 1835 – his fiancée Ann Rutledge died
• 1835 – he had a nervous breakdown
• 1843 – defeated in run for Congress
• 1848 – defeated in another run for Congress
• 1850 – his son Edward Baker Lincoln died at 3 years, 11 months
• 1851 – his father Thomas died
• 1855 – defeated in run for US Senate
• 1856 – ran for Vice-President and lost
• 1859 – ran for US Senate again and lost
• 1862 – his son Willie died

Lincoln, Commander-in-Chief during the Civil War, which by far generated the most casualties of our nation’s wars also acutely felt the immense loss of so many young lives.

Additional stress resulted from Lincoln’s decision to appointment his most prominent political enemies; Henry Seward, Edward Bates and Salmon Chase to his cabinet after and had to endure the endless intrigue of Salmon Chase and General McClelland to replace him as President in 1864. He overcame much to preserve the Union, end slavery, and become, along with George Washington, one our most revered presidents in US history.

I am fortunate to work mostly with people who have great attitudes yet we all know well those with poor attitudes as well. The Gallup-Healthways Well-Being Index found 87.5% of workers satisfied with their job in April 2011. The 2011 Ottawa County Employee Satisfaction Survey reported that 87% of County employees are somewhat, very or completely satisfied with their jobs. Sometimes it only takes one very bad attitude to ruin the work experience of many other employees.

I posted the following quote on each of our children’s bedroom doors shortly after discovering it many years ago:

“The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company…a church….a home. The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. We cannot change our past…we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude…I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you…we are in charge of our attitudes.”
― Charles R. Swindoll

Ultimately, the attitude of an entire organization is cumulative of the attitudes of the employees that it is comprised of. Cheerfulness in the face of adversity, a smile and friendly word for a difficult person, and putting aside personal differences to solve a problem for the good of the order are worthy goals for each of us to strive for. Considering the major adversity that Abraham Lincoln overcame to save the Union and eliminate slavery, I believe he would have it no other way.

Many of you have been a source of encouragement for me on my wellness journey and many have also asked about how I am doing so I thought it was about time for an update.  I’ve held off on doing an update on my progress in the Weigh To Wellness Program to wait for metrics on cholesterol, but since they will not be forthcoming for another few weeks I’ll wait until then to report progress on my biometrics including BMI, blood sugar, blood pressure, cholesterol, etc.  However, I will report on one major statistic – I recently lost my 75^th pound.  Take a look at the photo included below.  Mr. Tim Sobie, owner of Sobie Meats with his wife Teresa, located on Remembrance Road in Walker, put together 75 pounds of meat in two tubs to show what this weight loss looks like in terms of red meat.  I was initially hoping for 75 pounds of fat which would look much larger, but they don’t ever have that much fat on hand.  I think you’ll agree that it is quite the pictorial representation for my weight loss!

My first appointment with the good folks at Weigh to Wellness was back on September 21 and I was put on 1,000 calories per day to get  ready for the beginning of the program the following week.  For that first week I ate Lean Cuisine and Michelina’s Lean Gourmet type meals.  On September 28, I was put on an 800 calorie per day diet through December 19^th.   Meals during this phase consisted of product purchased directly from Weigh to Wellness.  All products (with the exception of the protein bars) came in a small packet which was mixed then with water and either heated or just drank in the case of the shake.  The products were soy based and had high protein content.  A typical schedule/diet for the 800 calorie per day phase looked like this:

6:00 a.m.              Oatmeal

10:00 a.m.           Shake

12:00 Noon         One of four types of soup or chili

3:00 p.m.             Protein bar

6:00 p.m.             Two pancakes

9:00 p.m.             Protein

On December 19, I graduated to the 1,000 calorie per day phase and was allowed to remove one to two meal replacements and add up to 6 ounces of lean meat and up to 4 cups raw or 2 cups cooked green or non-starchy vegetables per day.  On Wednesday of last week I graduated to the 1,000 to 1,200 calorie per day phase. This added to my diet fruits, grains, dairy, and pretty much everything except sugar.   My first day eating “real food” I had an egg and toast for breakfast and a yogurt and cheese for lunch and it tasted wonderful. 

I have a doctor appointment at Weigh to Wellness each week, usually on Wednesday mornings at 7:00 a.m.  I weigh in, have my blood pressure taken and meet with a doctor or nurse to discuss progress and how I’m doing.  I’m also doing a lot of reading on the psychology and biology of eating and meeting with a behaviorist every other week to discuss the readings and ultimately how to prevent regaining the weight once the program has ended. 

The program emphasizes a lot of water intake, a minimum of 64 ounces per day.  Cells have to be hydrated at a certain percentage for weight loss to take place.  Strenuous exercise is prohibited until the carbohydrates are added back into the diet.  If someone exercises too much in the 800 to 1,000 calorie stage, it can force the body into survival mode, or what I have fondly come to call the “lost in the woods mode.”  If you were lost in the woods you would might be desperately exerting yourself to find a way out and if you were also without food your body would retain water and fat for your protection.  This happened to me three times on the diet, once when I swam and walked in the same day and once when I split and stacked wood for 4 hours.  In that case I ended the day 5 pounds heavier than I started the day! I started out walking 1.5 miles 3-4 times per week and then doubled this to 3 miles.  I also began swimming ¼ mile per time and will now increase this to ½ mile each time.  I am definitely looking forward to stepping up the exercise to racquetball and running now that I’m past the 800 calorie stage.    

I have about 17 more pounds to lose and have about 9 weeks left in the program.  Perhaps in a future blog I’ll try to enumerate some of the many benefits I experience daily from losing the weight so far.

Many have asked me for the contact information for Weigh to Wellness.  Weigh to Wellness can be contacted at 616-685-1490 and http://www.advantagehealth.org/services/weigh_to_wellness.  Since their locations are on the East Beltline and Wealthy St. in Grand Rapids, I included the contact information for a similar program that offers services in Grand Haven and Holland in a recent Digest.  This program is The Medical Weight Loss Clinic and can be contacted at 1-800-GET-SLIM.   If you know of other programs I would be glad to put them in the Digest or a future blog.  The best way to access a program is to start with your doctor.  If you have a certain number of risk factors that exceed certain benchmarks, our Priority Health insurance will cover the program.  I’ve already had some employees tell me that they checked this out and though they are overweight they did not have enough risk factors present to allow their doctor to prescribe them to the program and have the cost of the program covered by the health insurance benefit. 

Support at home is crucial.  My wife Leslie has lost 37 pounds since I started the Weigh to Wellness Program.  She started about the same time I did and basically cut her portion size to about palm size and eventually began counting calories.  She did not change the type of food she ate.  It also helps a lot that she is an excellent cook.

It is a strange feeling to completely start over with clothing at close to age 50.  Almost every stitch of clothing that I owned has been given to Goodwill, Inc., given away, thrown out, or reduced to the rag bag.  I haven’t wanted to purchase much in the way of clothing when it will only last a month so I have purchased some clothing from Goodwill, Inc. until the weight loss is completed. 

I’ve learned much over the past four months and look forward to the last couple months of the program.  I approach all of this with proper humility as my failures with keeping weight off dwarf my successes over the past 25 years.  I believe that with the knowledge and practice that the program affords that the outcome will be different this time.  More important than knowledge and practice is the mindset that this isn’t a diet that ends when the weight loss stops but a major lifestyle change that is permanent. 

A very strange and bizarre part of this process has been that I have become unrecognizable at first glance to many colleagues and friends who have known me for a long time but haven’t seen me in the past 2-3 months.  It started when two Grand Valley Metro Council Board members walked right past me and didn’t know who I was and since then a significant number of people, including my own doctor have failed to recognize me at first, though I realize that part of this was shedding the moustache.

The Health Management Committee is hard at work on wellness program development.  One facet of the wellness program will include disincentives that will require some employees to pay more for their health insurance.  The great news is that the only way to have to experience a disincentive is to refuse to participate in the wellness program or refuse to follow your physician’s advice.  Even if your specific condition does not improve, as long as you follow your physician’s advice, you will not pay a disincentive.  My doctor, Dr. Jerry Witherell, worked with me on diet issues for three years before prescribing me to the Weigh to Wellness program.  I didn’t always follow his advice and even canceled a couple of appointments so I wouldn’t have to face him.  I would have had to pay a disincentive had the wellness program been in place then.

This has been quite a journey so far with much work to go.  The bottom line is I feel great!  The good news is that if I can do this, anyone else can too!

There are references in the Bible and in the work of ancient philosophers such as Plato about the relationship of the individual to the greater good. I believe this holds is true in many different contexts such as community, city, state, nation or organizations such as a government, business, non-profit, or churches. Common wisdom dictates that that the organization will not be better than the sum total of the individual talent that it consists of. This is why such great care is taken in the hiring process to make sure that outstanding individuals that fit the organization are found. Ottawa County has truly achieved its place as one of the top performing counties in the State, a county that has developed and even pioneered programs and policies that have been emulated on the state and sometimes even national level. This has clearly happened because of the quality of employees that Ottawa County has at every level of the organization and because the quality of the citizenry that elects the Board of Commissioners, Judges and Elected Officials.

The County has accepted the responsibility for providing health care insurance benefits for its employees for many decades and also the responsibility for managing these benefits as efficiently and effectively as possible. However, the County can only do so much and will only achieve future health, savings and efficiency in proportion to how individual employees manage their own personal health – both from a healthy lifestyle and from a financial informed consumer perspective. While many employees have worked and continue to work to make Ottawa County a place of continuous organizational improvement, we need to take the same approach to our own personal health. Ultimately, the aging process takes its toll and we will all pass from this world, but how quickly and in what condition we are when we get there will be determined by how we manage our health between now and then.

The Health Management Plan rolled out on January 1, 2011 represents a major initiative on the part of the County to create a healthier future workforce and to control future claims cost. The first year of the plan focused heavily on incentives to try to develop awareness and data in order to better target health plan initiatives. Employees were presented with three action items, each of which if completed by the employee and spouse had a $50 incentive attached. The three action items included completing a health assessment on the Priority Health website, completing a physical, and completing one action item, the easiest being the online stress evaluation. Any individual data collected is maintained by Priority Health and individual health care offices. We only see aggregate data for the entire group. I need to reiterate that County Administration does NOT have access to individual health data per federal HIPAA requirements. A health management committee was named a few months ago and they are digging into health management culture. The ultimate health management plan will be rolled out over a minimum three year period. In the second year, 2012, work on developing baseline data will be completed and disincentives identified for application beginning on January 1, 2013. Disincentives could take various forms but will have the net impact of costing certain employees more for insurance. So when would a disincentive apply? The disincentive will ONLY apply if individuals choose to NOT participate (after a certain point in time) in completing screenings or physicals, or refusal to follow doctor’s orders. As an example, if an employee (or spouses) physician identifies their condition as leading to diabetes unless behavioral changes are made and the person refuses to follow their doctor’s advice, the disincentive would be applied whether diabetes is ultimately experienced or not because that person increases the cost for the County and for every other individual in the plan. It makes sense for that person to pay a higher cost for their health insurance. On the other hand, if the person follows doctor’s orders and still gets diabetes, there would be NO disincentive applied.

A great example of this thought process is the person who makes the lifestyle choice to smoke. Information provided by Gallagher Benefits, the County’s health insurance agent, shows that the average smoker costs their health plan $2,400 extra per year. I don’t know how many smokers we have in our workforce but if our County workforce mirrors the general population, 9 percent of employees would be smokers. We have 1,348 employees and spouses on the County health plan. We don’t know how many of our employees and spouses smoke but we do know from the 2011 Ottawa County Behavioral Risk Factor Surveillance data that 17.2% of Ottawa County adults are “current smokers”. Thus, we can estimate that 232 County employees and spouses are smokers. That results in additional estimated health plan cost of $556,800, or $413.06 in extra cost per employee and spouse in the plan with the greater portion of this expense borne by non-smokers.

Another major area is obesity. Michigan’s combined rate of obese and overweight adult residents is 67 percent! Unfortunately, I am among this group. We all respond better to new initiatives when the people who lead them actually walk the walk and not just talk the talk. Thus, if I am to talk about how we all need to take personal responsibility for our health, I need to take responsibility for my own weight as I meet the technical definition of obesity. A study in the journal Health Affairs noted that per person health care spending for obese adults is 56% higher than for normal-weight adults. Over 15 years, the additional costs incurred by obese adults with private health care insurance versus normal weight adults increased from $272 to $1,244 per person per year. Health care costs are 75% higher for severely obese workers which results in an additional cost of $2,441 annually per employee.

My slow climb to obesity started as I transitioned from high school jobs in landscaping and as a cook in Grand Haven’s Rendezvous Restaurant to office jobs where much of the day is spent sitting while at work and in meetings instead of constantly being on my feet as the previous jobs required. The amazing thing is that I have the will power to lose weight and once I put my mind to it I can rather easily lose weight. I have lost 30 to 58 pounds or more at least seven times in the past 25 years on diets including Slim-Fast, a fruit and vegetable diet, Cabbage Soup diet, Adkins, Body For Life, purge diet, etc., etc. For all of the things that I have worked hard at in my life and career and been satisfied with the results, I have failed miserably at keeping weight off. The insidious nature of this is that each time I lost weight I eventually gained even more back. My lack of success keeping weight off reminds me of a certain king in Greek mythology, Sisyphus, who incurred the wrath of Zeus and received the punishment of having to roll a huge boulder up a hill and just before reaching the top, watch it roll back down, and then forced to repeat this process continuously throughout eternity. My personal challenge for myself is to finally break this futile cycle of weight loss and regain and hopefully prevent being like Sisyphus in the future.

My doctor prescribed my participation in the Weight To Wellness Program, a 26 week program that includes a pretty severe 12 week diet (800 calories per day for 12 weeks) and then retraining on how to eat without putting the weight back on for the duration of the program and hopefully for life beyond the end of the program. Priority Health covers the cost of the program if prescribed by a doctor and if certain diagnostics exist. In my case, the combination of BMI, cholesterol, blood pressure and weight made me a candidate for the program. I can’t be a leader with where we are going with health unless I walk the walk. Obesity leads to many different serious diseases that will shorten my life and cost my employer much more money if I do not get it under control. I have noticed that many employees have started down a similar path and are getting great results. My peak weight was 282.2 pounds when I began a purge diet in January of 2010. I started the Weigh to Wellness Program three weeks ago and my weight was 262 and today it is 240 with a long way yet to go.

In the most recent Casting For Comments, I mentioned that the State approach to health management is almost non-existent and that the State corporate posture to-date has been to debate and determine what percentage of health care expense should be borne by public employers versus the portion that should be borne by public employees. Governor Snyder’s September address on healthcare clearly shows that he understands the issue of improving individual health and by extension lowering future health claims expense. He listed evidence based practices that can significantly improve personal health such as a healthy diet, regular exercise, annual physical exams, and avoiding tobacco use. He also listed corresponding health measures that are tied to incidence of chronic disease including BMI, blood pressure, cholesterol, and blood sugar. He challenged individual citizens to take personal responsibility to improve these measures. Helpful information is available on Michigan.gov. Governor Snyder also announced that a new Michigan dashboard with key public health metrics will be used to measure progress on a state level.

If you’re struggling with or have defeated the same condition, or just have some insight, I would welcome your response to this message, either via a post on Casting For Comments or via email message to me.

I have dealt with health benefit cost control in local government management since early in my tenure as City Manager of South Haven. Double-digit annual increases in the cost of providing healthcare benefits to employees began in the early to mid – 1990s and have not abated since. Increases of 5 to 15% are painful enough but recently many governments have faced increases of 30% and above. As a point of reference, a 30% increase in Ottawa County health benefit cost would equate to over $2 million.

Ottawa County became self-insured in 1983 as a method of controlling cost more effectively. This worked for many years but beginning in January 2011 we went back to a fully funded insurance plan with Priority Health. The stars aligned in many ways and we were able to achieve first year savings of $4.8 million what we would have paid had we not changed.

The Michigan Legislature adopted Senate Bill 7 (SB-7) on September 7, 2011 which was subsequently signed into law by Governor Snyder on Saturday, September 24. The new law was named Public Act 152 of 2011. PA 152 mandates that public employers can pay no more than $15,000 for a family health insurance plan; $11,000 for a individual and spouse “ two-person” plan; and $5,500 for a single plan. The dollar benchmarks are commonly referred to as “hard caps.” A public employer can opt out of the hard cap requirement by a majority vote of its governing board or council and implement what is referred to as an “80-20 plan” wherein the employer cannot pay more than 80% of the total cost of employee health insurance. A governing board of a city, village, township or county can also opt out of this requirement by a two-thirds vote.

The County currently provides three health insurance plan options for employees: the 100-80 fully funded plan; 90-70 plan; and High Deductible Health Plan with a Health Savings Account where the County currently pays the full cost of the deductible, $1,200 for single coverage and $2,400 for two-person and family coverage.

Ottawa County is well ahead of the State in attacking future health care expenses with our focused intent to reduce future health plan claims cost. State policy has been driven largely by the battle between the Republican legislators and the Michigan Education Association (MEA) over how much public employees should pay toward health care expenses and not directed at the problem itself: escalating health care costs largely due to burgeoning claims cost. Governor Snyder’s recent healthcare speech and his call to action at a health care forum attended by 500 leaders last week seems to offer an improved future focus. Studies have shown that a high percentage of diseases that cost health plans the most money and in some cases are most debilitating for employees can be eradicated two to three years before they even happen through a good health management plan. This is where real cost savings can be achieved and not just rebidding, reshuffling and redistributing health care cost which has been the game for far too long. The companion strategy with the high-deductible HSA is the health management plan whereby employees will benefit by becoming increasingly sophisticated consumers of their own healthcare.

The Ottawa County approach to attacking long term health care expense is highlighted by the health management program rolled out in January. The first year of the program included three action items for employees, and spouses (when applicable) with a $50 incentive attached to each: 1) complete on-line health screening; 2) have an annual physical completed at your doctor’s office; 3) complete one actionable item at webmdhealth.com.

So how will Ottawa County respond to SB-7? Initially, no response is necessary because if you average all health care premium costs by single, individual and spouse and family plan; add the cost of the fully paid deductible; and subtract the amount employees pay toward the premiums, the County is currently under the hard cap limits established by SB-7. We expect that the County health plan cost will exceed the hard cap amount set by the State in the next few years. We do not view the hard cap method as a good long term solution as annual health inflationary increases will far outstrip the average “medical care component of the U.S. Consumer Price Index” which currently averages 3 percent. We also do not view the 80-20 plan as a viable alternative because it doesn’t provide the same level of incentive for employees to move into the high deductible plan.

We are on a positive course to better control expenses in the future, a future that the State has yet to take practical, concrete steps to get to. Thus we plan to increase the premium cost share on the fully funded 100-80 plan to 20 percent from the 10 percent that it is currently at. Only 18 employees are currently enrolled in the 90-70 plan. If we keep this plan, the premium cost share will also be set at 20 percent. The plan for at least the next year will be to keep the high deductible HSA plan at 5 percent employee premium co-pay with the $1,200 and $2,400 deductible amounts paid by the County. And of course, we will continue to implement the health management plan over the next few years. Good To Great author Jim Collins conceptualized the BHAG, or Big Hairy Audacious Goal. Our health care BHAG is to take an axe to future health claims cost through our focus on healthy lifestyles and decision making.

We encourage employees to study the high deductible plan. It is no secret that the County has funded this plan so that an employee has a very similar benefit to a 100 percent fully insured plan. In 2011, the County funded the entire deductible and will do the same for 2012. The current deductible is $1,200 for singles and $2,400 for two person or family. Once an employee has exhausted the deductible amount, which the County has funded, the plan turns into a 100/80 fully insured plan. The County saves approximately $3,600 each time an employee currently in the 100-80 fully insured plan chooses to change to the high deductible plan. Equally important, the employee saves on average of six to seven percent of salary depending on what plan they move from and their level of coverage in that plan, i.e. single, two-person or family.

Ottawa County Facilities Manager Bill Morse retired at the end of June. Bill is a very humble and unassuming man and wouldn’t allow us to do much to recognize his 23 years of service. Under Bill County facilities were always spotlessly maintained to the point that I have never served anywhere where the condition of government facilities generated so many compliments.

Bill and I had a few extra conversations prior to his departure and I learned some interesting history about our County facilities. Twenty-three years ago Bill was coming fresh out of a 32 – year career in the private sector. Serving in the public sector was a new experience to Bill and as such he kept a few notes about important things to remember in public service and Bill said that he referred to the list frequently over the years. Bill pulled the worn list out of his wallet one day and shared it with me. As I read Bill’s list I realized how wise his thoughts were and are and thought that not only myself but all public employees could benefit from occasionally reflecting on Bill’s list, so here goes:

1) Treat all County employees and co-workers with the same respect regardless of their status or position.
2) Make all decisions with the best interest of the County at heart.
3) Remember you are accountable to a lot of people, fellow employees, supervisor, taxpayers
4) Be a good steward of county monies, get competitive prices. And make good financial decisions.
5) Nothing is Private all transactions are Public knowledge if they desire it.

Thanks to Bill for his excellent work and for the fine example that he set.

As an old friend of mine used to say, “its’ been a long time between drinks of water.” Since my third blog came out on December 10, time has been taken up by many different issues and I failed to get into a groove with Al’s Blog. In addition, my daughter Sam provided me with information that suggested that you should never use the word “blog” in a blog title so I decided to reformat a bit. The new header shows a background photo of “The Vanderberg Brothers” and the new blog title CASTING FOR COMMENTS. My Vanderberg forefathers were commercial fishermen in Lake Michigan and the North Sea in the Netherlands.

The success of our democratic institutions relies heavily on an informed and involved citizenry. Much as my ancestors for six generations plied the waters off Grand Haven, Muskegon and Ouwerkerk in Zeeland for fish to feed their families and others, CASTING FOR COMMENTS seeks food for thought – thoughtful comments and discussion to blog posts so that a learning community about County government can be created and maintained.

I intend to blog at least a couple of times per week unless I’m out of the office.

I received a question from Larry asking if I could help get his road plowed.  While we can certainly pass Larry’s concern to the Road Commission the County Board and Administration really have no operational authority over the Road Commission.

I wrote the following article for the County Connections employee newsletter a while back and thought it would be useful to inform readers how the County of Ottawa and County Road Commission relationship works.

COUNTY CONNECTIONS,  COUNTY ADMINISTRATOR’S CORNER,
January 16, 2007

 ROADS AREN’T US

The biggest misperception regarding County government is that we are responsible for of County roads.  My opinion has been formed by numerous citizen complaints received by Commissioners and my office and from the citizen survey that Ottawa residents completed and a similar survey done in Kent County a few years ago.  In both counties, citizens rated the effectiveness of County government as high, but when ask to list their concerns, road maintenance was rated first.

The County government has no authority or responsibility for road maintenance or construction.  The Road Commission is a separate governmental organization from the County.  Its budget, audit, pension, policies, facilities and property ownership are independent of the County.  The only authority that the County Board of Commissioners has over the Road Commission is a statutory responsibility to appoint the three-member Board of County Road Commissioners.  Or alternatively, the Board of Commissioners could require the Board of County Road Commissioners to be chosen by election of County voters.  The County Treasurer manages Road Commission investments per state law.

The history of road commissions began in 1879 when a group of prominent bicyclists organized the League of American Wheelman because they were tired of riding on rutted roads.  The group became the first good roads advocate group in the country.  They were opposed by farmers in particular who accused the group of pursuing a selfish interest for better roads when no one else wanted better roads.  The first government action in Michigan regarding roads took place in 1883 when the State Legislature created the first district road board in Bay City and encouraged other counties to create good roads.  The Wayne County Road Commission became Michigan’s first road commission in 1909 and introduced concrete roads to the world that year as well.  Henry Ford was a member of that first road commission for one year.

The earliest roads in Ottawa County were trails created by Native Americans.  After the arrival of the first settlers, roads existed as walking and horse trails between settlements.  The Ottawa County Road Commission was formed in 1911 by vote of County residents who voted to have the County adopt the road system and the Board of County Road Commissioners held their first meeting that year.  The new road commission had authority over 206 miles of County roads.

Today the Road Commission has legal jurisdiction over all roads in Ottawa County with the exception of those inside city boundaries and state and federal highways.  This includes 401 miles of primary roads and 1,250 miles of local roads.  The Michigan Department of Transportation contracts with the Road Commission for maintenance of another 506 miles of roads.

Part of the confusion may be due to the fact that the road commission managed the County parks system until about 1990. In Michigan, early parks were roadside parks for automobile travelers to rest in.  Since the road commissions were the only county organization with heavy maintenance equipment, a state law authorized counties to contract with road commissions for maintenance and oversight of County parks.  As park investment and development escalated in some Counties, oversight was changed to park commissions or to the board of commissioners and administration.  The Board of Commissioners formed the Parks Commission in 1986 and made a three-year commitment to continue maintenance services through the Road Commission.  The Park Operations Center was built, maintenance plan created and staff was hired and most Road Commission services were terminated by the spring of 1990.  

Ottawa County contracts with the Ottawa County Road Commission for management of the Public Utilities Department which oversees the County’s interest in the South West Ottawa County Wastewater Treatment Plant, the County interest in the Grand Rapids and Wyoming water pipelines and over planning for water and sewer service in the non-municipally served areas.  The County helped fund the River Ave. bridge construction project in Holland through the Infrastructure Development Fund.  The Road Commission uses the County seal as an identifier instead of its own seal on its website and that could be a confusing factor for some.

The County enjoys a close working relationship with the Road Commission in many areas including quarterly update meetings between Board and staff leadership of both organizations. 

One current hot issue is the composition of Road Commission boards.  A law was recently enacted over the protests of the County Road Association of Michigan, which represents road commissions in Lansing that allows county boards of commissioners to increase the size of road commission boards from 3 members to 4 or 5 members.  The decision whether to increase road commission board size will undoubtedly be debated in many Michigan counties over the next few years.

So the next time someone refers to County government and roads, you can now let people know the scoop and who is really responsible for them.

Thanks to those who posted comments on the first “Al’s Blog”.  Dr. Mohr brought up the topic of county reapportionment so I thought I would include information on how the process is done.

County apportionment began in 1967 when the state legislature changed the way in which Michigan counties select the members of their board of commissioners.  County commission seats became elected at that time and the name county board of commissioners also originated at that time.  Previously Michigan county government had been organized on the New York model.  The board of supervisors was made up of each township supervisor and an elected or appointed representative of each city ward.  A 1964 U.S. Supreme Court decision required that all legislative districts be apportioned on a one-person, one-vote basis.  From 1967 on, counties must reapportion districts in time for the second election of each new decade.  The process starts after new census data is released by the spring of the year that reapportionment occurs.

The team who actually draws the new district maps includes the county clerk, county treasurer, county prosecutor, and the county party chair of the two dominant political parties.  The apportionment commission usually has 60 days to complete the task of redrawing commissioner districts.  The legal standard is that districts must be “as nearly of equal population as is practicable.”  Some of the other standards include the following:

• Districts must have contiguous land area
• Districts must be compact and as square as possible, depending on geography
• Townships and cities cannot be combined with others or divided except to meet the population requirement
• Precincts can only be divided to meet the population requirement
• Districts cannot be drawn for partisan political advantage

The apportionment commission can also decide the number of county commission seats.  Ottawa County had 13 Commission seats prior to the 2000 census and the apportionment process eliminated 2 Commission seats leaving the current Board with 11 seats. 

The reapportionment process is potentially as political at the county level as it is at the state level.  Much of the information in this blog was adapted from Guide to Michigan County Government, the seminal book on the nuts and bolts of county government by Dr. Kenneth Verburg.  Verburg writes: “The last of the reapportionment standards – districts are not to be drawn to effect partisan political advantage – must bring at least a little snicker to even a casual observer of apportionment politics.”

There have been claims in several counties including Ottawa that apportionment has been undertaken with different political agendas.  As Dr. Mohr suggested the reapportionment process will indeed be interesting when it unfolds next year.  Any concerns that I have would just be that reapportionment happen in a scientific manner and not to reward or harm individuals for their positions on the issues of the day. Ottawa County is the only Michigan county to grow at a rate of 10 percent or higher in population from 1960 to 2000 and early estimates are that the County grew 9.5 percent from 2000 to 2010.  Proper representation is important for effective representation of the growing population.