healthcare – RI Future

November 2, 2015November 2, 2015

Hope in the midst of controversy: A way forward for veterans

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Over the past two weeks, this series has laid out a case for why Rhode Island is in the business of empowering veterans and what the future of state-level veterans affairs can be. But a discussion about veterans can’t occur in a media vacuum and it’s impossible to ignore sizzling headlines about the VA and presidential candidates.

Snapshot: Hillary Clinton was asked about the systemic problems at the VA recently, her response included a comment that the issues weren’t “as widespread as it has been made out to be,” and veterans (as well as congressional leaders) have taken her to task for it.

The upside is renewed media attention to a significant moral issue of our time: setting the standard for providing the highest quality and timely healthcare possible to our veterans. The continued problems with access to care are heart wrenching. Just a few months ago, I was meeting with disabled veterans who were receiving sporadic care at a VA in Texas – it was difficult to hear that they were having such a hard time after being discharged, especially when most of them received consistent and quality treatment while still in uniform.

Part 1: After 125 years, RI veterans will finally get a director
Part 2: Next generation Veterans’ Affairs: Economic engine, not resource hub

The truth is that, even though there are many veterans getting excellent treatment at the VA, things are still a mess. And I hope journalists continue to draw attention to the problems as well as the progress – let’s see a real-time report card of how the VA is shaping up and (finger’s crossed) celebrate the positive changes being implemented.

But the end of this series is about Rhode Island’s Veterans Affairs. The Division needs to go through it’s own metamorphosis and today, we’ll explore two seldom discussed obstacles it will need to tackle to get there.

ONE: Inter-Generational Collaboration

About half of the 72,000+ veterans in the state of Rhode Island are over the age of 65. Who are these vets? Check out the infograph:

As reported by the Providence Journal (May 22, 2015)

While some veterans who served in Vietnam are a bit younger, many are 65 or older. And when talking about veterans, the era you served in matters. The obvious difference is how these veterans were received during their transition home; the starkest contrasts are between WWII, Vietnam, and Post-9/11 Vets. WWII veterans came home to parades while Vietnam veterans were faced with protests. Post-9/11 veterans are received with some fanfare, along with Yellow Ribbon bumper stickers and interesting “thank you” hand gestures. These differences have had a lasting impact on how these veterans see themselves and other-era vets.

Another huge difference is the level of participation in traditional veterans’ organizations. Older veterans comprise the majority of organizations like the VFW and American Legion – important groups that have been struggling to attract younger veterans (there are exceptions). This highlights the evolving way that veterans connect and what they view as useful as they come home.

Bottom Line: The Division will have to invest time and energy into developing not only a robust digital media platform, but strengthening inter-generational relationships with engaging, purpose driven programs.

TWO: Redefining the Veteran Identity

Veterans of The Mission Continues, Photo by Stephen Bevacqua

The first time I came home to Bristol, I wrestled with the title, “veteran.” While doing outreach in Boston, I learned I wasn’t alone. All veterans coming home have to answer the question: Who am I now? There are roughly three answers:

I’m a veteran living amongst civilians.
I’m a veteran and a civilian.
I’m a civilian – forget about the veteran stuff.

Understanding what informs these different ways vets identify is crucially important to not only their successful transition but also creating a strong, vibrant veteran community in our state. The less someone identifies as a veteran, the harder it is to find them. And you have to identify and engage veterans before you can empower them. Ask any Veterans Service Officer or student veteran who’s attempting to organize – they’ll tell you that attracting veterans en masse is difficult. But here’s a shout out to a few organizations I think are getting it right and broadening the veteran identity: Team Rubicon, The Mission Continues, and The 6^th Branch.

Bottom Line: The Division will have to rally around an outreach message that resonates with folks who don’t necessarily think of themselves as veterans first but who would jump at the chance to serve a greater good.

The challenges we see at the federal level are daunting. But in Rhode Island, there are plenty of readily accessible opportunities to improve the lives of veterans and our community. From accelerating the transition process for new veterans to completely reshaping the way we do outreach, the next decade has the potential to be an exciting time to be a veteran in Rhode Island. The biggest risk our state takes is in not seizing this moment. My challenge to our leaders this Fall: shake things up and make some waves.

This is the last of a 3-part series covering veterans affairs in Rhode Island: Part One | Part Two

Want to be the new Director of the Division of Veterans Affairs? Apply by November 6^th!

August 27, 2015

How the smallest state got the smallest uninsured rate

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A recent Gallup poll revealed that Rhode Island has the lowest uninsured rate in the country, at 2.7 percent, as well as one of five states that saw its uninsured rate decline by 10 points or more. But, how did that happen? Anya Wallack, director of HealthSourceRI, was able to provide some answers.

“You come to HealthSource, and right there, you can very easily sign up for coverage regardless of your income,” she said. “We’ve developed an infrastructure that’s really designed for this unified approach.”

Wallack explained Rhode Island decided to create its own exchange because it presented “significant advantages, in terms of local control and customer service.” With a state based exchange, rather than a federal one, they could better tailor their services to the needs of Rhode Islanders.

HealthSourceRI uses what she called a “one door policy,” meaning that customers could come in and not only apply for health insurance, but check to see if they were eligible for Medicaid and other benefits. This is where much of the exchange’s success comes from, since this is a policy only a few states have adopted.

Wallack said that making customers jump through hoops only serves to make things more confusing, and they miss out on important information because of it. Right now, Wallack and her team are expanding their open door policy, and making it possible for customers to begin to apply for other assistance programs like TANF or SNAP.

“When we’re done building our system, you’ll be able to sign up for those with one stop shopping,” she said.

Wallack added that there are a number of ways that customers can use this one stop shopping, that all services are provided online, over the phone, or in person. Face-to-face assistance is also provided right in the community health centers, so customers can sign up for insurance right in their hometown. HealthSourceRI also has enrollment events during the open enrollment period, which is from Nov. 1 to the end of January each year. During open enrollment, a customer can renew, reenroll, or sign up for coverage, or just change their plan. There are two other types of enrollments as well- special enrollment and Medicaid coverage. Special enrollment occurs when a customer’s circumstances change throughout the year and they need to change their plan, and Medicaid coverage happens throughout the year to see if a customer is eligible for Medicaid.

“We try to find any avenue where we can come into contact with people who may be looking for coverage,” Wallack said concerning their community accessibility.

This level of accessibility has worked for the exchange, proved not only by the Gallup poll but the hard numbers that HealthSource has collected so far for this year. In 2015, they have enrolled 32,554 individuals as of July 31. Most people who enrolled were age 55 and over, sitting at 29 percent. 53 percent of enrollees were female, while 47 percent were male. More than half of the enrollees – 59 percent – were eligible for financial assistance in the form of an advanced premium tax credit and cost-sharing reductions. These numbers show an upward trend from last year, with over 7,000 more enrollees. Small businesses are signing up through HealthSource as well, with 542 employers enrolled in 2015, compared to the 381 from 2014.

The Gallup poll found that states that set up their own exchange and expanded Medicaid saw the biggest drop in their uninsured rate, something that the Ocean State has been doing since day one. According to Wallack, as long as they continue with this, Rhode Island can serve as a model for other states and their healthcare exchanges, especially as HealthSourceRI moves forward. Within the next month, HealthSource will be releasing its own survey, which will give more accurate results than the Gallup one, because it will only look at Rhode Island. But, the national survey still shows a trend, and that Rhode Island is headed in the right direction.

“What I take from this, is that those policy decisions, as well as our decisions to take a coordinated approach, was successful for us,” Wallack said.

HealthSource’s next step is to find those last remaining uninsured individuals, and understand why they’re uninsured, as well as work with employers to make sure that they are able to retain coverage. Now, their job is to help control healthcare cost growth, provide support for small business, and provide affordable choices for everyone, especially that last 2.7 percent.

July 29, 2015

Disability forum exposes inaccessibility, discrimination across state programs

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If you thought that riding RIPTA, or receiving food benefits was difficult, imagine trying to do it with a disability. That’s what was talked about Tuesday afternoon when the Governor’s Commission on Disabilities held a public forum at the Warwick Public Library, where those in the disabled community could voice their concerns about accessibility across the state.

The forum hosted a number of healthcare professionals, who specialize in a number of care outlets for disabled patients. Different groups that were represented included the Disability Law Center, the National Multiple Sclerosis Society, the Ocean State Center for Independent Living, and the Office of Rehabilitation Services, among others. But, rather than the professionals taking up the time to speak, many community members came forward, expressing how they believe Rhode Island can do better in terms of accessibility.

Barbara Henry, a blind woman who cannot drive, frequents RIPTA, which has proven problematic for her on more than one occasion.

“When the bus pulls up, I have no idea what bus it is,” she said. “They do not announce the bus, and I feel they really discriminate against anyone who is visually impaired, or print disabled, or anything for that matter.”

Henry’s problems have ranged from not knowing that a stop had been changed, to dealing with the newly renovated Kennedy Plaza, which she said is not accessible at all. While the stop names are in braille, the bus numbers that go through those stops are not, and the bus drivers do not announce which bus they are driving.

“My bus stop is G, but my bus number is 33,” she said. “There’s the 33, the 56, and the 54 that go out of that one stop. There’s nothing in braille that indicates that. If you were standing there, I would have to come up to you, and ask, “What bus is this?” And when the bus pulls up, there’s no audio announcement.”

Henry, who advocated, in her own words, “like hell,” for braille at Kennedy Plaza, feels as though her community is not taken seriously. Henry said that she attends the RIPTA community meetings, advocating for other blind people, because there is nothing tactile for them to process when they are finding their stop, not even a map.

“Since it’s been open since January, I’m still trying to process, make a mental map, of where everything is. They didn’t make any type of map or anything,” she said.

When Kennedy Plaza reopened earlier this year, RIPTA staff were there to assist passengers and direct them where to go, but Henry said that there was nobody to specifically help disabled riders.

Henry said that these issues don’t just affect blind people, though. Many other disabled riders struggle with RIPTA, including those who are deaf, autistic, or impaired in some other fashion. Such treatment has lead Henry to believe that RIPTA discriminates against the disabled.

“I truly, truly believe, that they do discriminate against the disabled,” she said. “I feel that my safety is placed at risk.”

Kristin Clark went to the forum to represent her friend, who is disabled and experienced mistreatment and belligerent service at the hands of the Wakefield SNAP office when trying to get certified for her benefits. Clark’s friend, who was not named, went into her local Wakefield office rather than conducting a phone interview with the main Providence office.

“The staff apparently relies on phone interviews, even though they are told they can come into offices to do the recertification,” Clark said. “When she came into the office, she was treated very badly, and very hostilely, and was told several times that SNAP would be cancelled for her, and that she would have to pay back what they said was an overpayment, and now she’s left not knowing what her situation is.”

Clark added that Rhode Island Housing has been helpful for her friend and her son, who is also disabled, because she is part of section 8 housing. SNAP, on the other hand, has caused a whole host of problems for her. Clark has even spoken to Congressman Jim Langevin’s (D- District 2), who looked into the problem and asked that they also speak to the Department of Health. When her friend called, the Department of Health was not only rude to her again, but also defended the SNAP office’s treatment towards her.

“By the end of the call, my friend was just a mess, and as of right now, has no idea what her situation is,” she said. “She does not know if she’s cancelled, she does not know if somebody is going to come after her for that money that they say she was overpaid, she does not know if, come Aug. 1, if she is going to have any SNAP benefits.”

Raffi Jansezian, a staff member for the GCD, explained how their office plans to move forward with these issues.

“After all the forums are done after this week, and after all the transcripts are finalized, I’ll be going through them, personally reading them as well as running different focus groups to analyze the transcripts, to figure out which problems are coming up over and over again,” he said.

Once that process is completed, they then move to begin writing solutions for these pressing issues into legislation, and create laws that can benefit everyone who has been affected and come to them to voice their concerns.

Jansezian added that Governor Gina Raimondo has shown “fantastic” support for the GCD, and that they have already made some strides towards what they hope to accomplish.

July 21, 2015

Raimondo signs executive order for state healthcare reform

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After the successes of Governor Gina Raimondo’s Reinventing Medicaid task force, today, at the Kent County YMCA, she announced a new initiative to overhaul the state’s healthcare system as a whole. Titled the Working Group for Healthcare Innovation, the group, under the leadership of Elizabeth Roberts, the Secretary of Health and Human Services, seeks to improve Rhode Island’s healthcare landscape, making it more competitive with other New England states.

“Today we are talking about keeping a dialogue going that you so successfully started on earlier this year,” Raimondo said, referring to Reinventing Medicaid. She added that she seeks to take the work that was done there, in the public healthcare system, and move it forward.

“Today is about bringing that same level of innovation in all that we do in healthcare delivery in the state of Rhode Island,” she said.

The Governor has set forth four specific goals for the task force to achieve, under specific deadlines. They are to develop a global healthcare spending cap; plan out and implement the “80 by ’18,” goal, which would tie 80 percent of healthcare payments to quality by 2018; bring the state’s healthcare system technologically up to date; and establish a framework to achieve health and wellness goals outlined by the Centers for Disease Control.

Raimondo said that the biggest goal, which all of these are to work together to achieve, is to reduce the costs of healthcare, improve outputs, and improve the patient experience. She said that these goals are the “holy grail,” of providing healthcare, and making Rhode Island more effective overall.

“I believe it’s doable, I know it’s doable. It’s doable if we commit ourselves,” she said. “We’ve got to catch up and we’ve got to be competitive. Rhode Island has to be competitive.”

The focus of the task force will draw from suggestions made by a group of healthcare stakeholders that Governor Raimondo received back in December. Many members of this group, which was put together by United States Senator Sheldon Whitehouse and Rhode Island Foundation President Neil Steinberg, will now be serving with on the new task force.

Whitehouse also spoke in support of Raimondo’s initiative, citing that the United States spends more money per capita in relation to life expectancy than almost every other developed country. The United States’ life expectancy is also lower than many countries that pay less per capita. Whitehouse also mentioned that since 1960, health care expenditures have risen from $27.4 billion to $2.8 trillion. Healthcare spending has declined in recent years, but reducing costs remains a priority.

“It’s not a system where you can tell it what to do and it’s going to change,” Whitehouse said, speaking about how healthcare reform works. “You actually need to change the system. What you say is a whisper, how you pay is a shout.”

Secretary Roberts, who will head the group, said that even though healthcare reform is a very complex issue, the working group can find a solution because they want to get the community involved in the process. Rather than just having a conversation about what needs to be done, Roberts said, there will be collaboration on both ends of the project. By doing this, they will create a long-term plan.

“I am excited to see the Governor take a very direct interest, and give us a very direct charge, because that, to me, is absolutely crucial to a statewide approach,” Roberts said about her enthusiasm to begin working. “I am excited to see the range of people who have stepped forward to participate, and know that we will make some real progress.”

Roberts has had experience working with the Rhode Island healthcare industry in the past, as former Lieutenant Governor during the Chafee Administration. Roberts has also worked in health insurance before she was involved in government, and as a legislator, she chaired the Health Committee.

“Many of us have met before, and have worked together before,” she said. “But the charge of the Governor, to really come together, and really make some measurable differences, is going to move us forward.”

The Working Group for Healthcare Innovation will begin meeting in August, and give its first set of recommendations to Governor Raimondo in December. Members of the group come from several communities, including government, insurance, hospital workers, labor, and business. There are 36 total members.

July 10, 2015July 13, 2015

Nurses union pickets for more staff, better benefits

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The corners of Eddy and Dudley streets were lost in a blur of purple as more than 400 nurses and other professionals working at Rhode Island Hospital picketed for higher wages, retirement benefits, and more staff.

The United Nurses and Allied Professionals (UNAP) Local 5098, shared its concerns about the unwillingness to effectively staff the hospital, while Lifespan continues to pay its executives millions of dollars a year.

“With healthcare reform going the way it is going right now, staffing has become a major issue,” said Lee Meyers, a registered nurse who has worked for the hospital for 25 years. “We work on the floors, and it’s getting to be with a skeleton crew. We need to have plenty of staff to take care of the very sick people that we are getting now, because people don’t go to the emergency room like they used to.”

“We take care of seven, eight patients that are really intensive care unit type patients,” she said. “That is causing us to burn out quicker, it’s too much handle.”

Debra Page, another registered nurse who has been working for just under four years, shared the sentiment.

“It’s on every level,” she said of the staffing problems. “Its from the minute you walk into the hospital to the minute you leave. You don’t get taken care of as soon as you walk in because we don’t have staff, you don’t get the care you deserve on the floor, I don’t have the time to hold my patient’s hand if their family’s not able to be there when they’re dying. I want to be able to be there and take care of that patient, and I don’t have the time to do that.”

Hospital staff also remarked on how much the climate has changed. Bernadette Means-Tavares is a pediatric nurse, but has also had experience on the patient end. When her daughter was an infant, she spent the first six months of her life at Hasbro, and there’s a huge difference between care now, and care back then.

“[The care she received] is being given, but it’s being given under a lot of stress and restraints. What she got, there’s no comparison to what you’re getting now, what we’re giving now,” she said.

Short staffing isn’t the only issue that UNAP is fighting against, though. In a press release sent out Tuesday, the group revealed that Lifespan not only keeps their hospitals at minimal staff, but is also attempting to cut employee compensation in the new contract that will be drawn up this year.

“Lifespan is seeking to cut its contribution to the retirement security of union employees- a move which would result in the loss of thousands of dollars to a member’s retirement,” the release said. “The hospital wants to make dramatic changes to the union’s health coverage, and is proposing a pay freeze until July 2016.”

Lifespan’s top five executives and officers were paid more than $12 million in 2012, according to the most recent available IRS 990 filings. Helene Macedo, President of UNAP Local 5098 finds these conditions to be inappropriate.

“For years, frontline caregivers have been asked to do more with less while the hospital spent lavishly on high-priced public relations campaigns; millions in salaries for top executives, and on other misplaced priorities,” she said. “It’s time for Lifespan to stop shortchanging healthcare professionals and invest in patient care again.”

Page added that Lifespan has tried to take away many of their rights as employees.

“For the hard work that we do, not only do they want to freeze our pay, not do any sort of cost of living increases, and actually take away benefits from us, including the fact that we have not had a matched 401k in quite so many years,” she said. “They want to limit our healthcare, where we get to get our healthcare, a lot of things that for one of the larger employers in the state, it doesn’t look good for them.”

The union has agreed to continue negotiations with Lifespan throughout July, but the negotiating committee has been given the authorization to deliver a ten-day strike notice if they cannot reach an agreement.

February 3, 2015

‘Medicare for All’ advocates focus on Rhode Island

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Dr. Oliver Fein, representing Physicians for a National Health Program (PNHP-RI), gave a talk Monday night to a class of second year med students at Brown University’s Warren Alpert Medical School in Providence. The talk was open to the public, but due to the snow storm attendance was low. That’s too bad, because Dr. Fein’s talk was an informative and eye opening examination of both the history of public healthcare in the United States and the possibility of transforming the current system beyond Obamacare and towards a system of truly universal coverage, what supporters call, “Medicare for All.”

In the video, Dr. Fein covers the history of healthcare in the United States, starting with President Truman’s suggestion that some sort of universal health care program might be a good idea, right up to President Obama’s successful passage of the Affordable Care Act. (For Dr. Fein’s summary, go here.)

At the 17 minute 30 second mark Fein leaves history behind and explicates the ideas behind a single payer healthcare model, or what he calls an “Improved Medicare for All.” Such a system would build upon and expand Medicare to the entire population, improve and expand coverage in the areas of preventive services, dental care and long term care, eliminate deductibles and co-payments, expand drug coverage (eliminating the “donut hole”) and redesign physician reimbursement.

Several points leapt out at me during Dr. Fein’s presentation. Using data from 2009, Fein reported that 62% of personal bankruptcies were due to medical expenses and 75% of those who declared bankruptcy had health insurance. For too many people, it seems, health insurance did nothing to prevent financial disaster.

Fein also reported that overhead costs in administering Medicare run about 3.1%. Commercial healthcare runs near 20%. This means that 17 cents (or more) of every health care dollar is wasted on administrative costs or corporate profits under our current system of private insurance. This is money that could be going towards patient care.

Fein concluded that a system based on private insurance programs will not lead to universal coverage and will not create affordable coverage, whereas a Medicare for All system can lead to universal comprehensive coverage without costing more money.

“What will happen if we don’t do this?” asked Fein in conclusion, “By [the year] 2038 a person’s entire household income will… have to pay for health insurance. A condition that’s not compatible with life.”

Rhode Island

Gerald Friedman, a PhD and Professor of Economics at the University of Massachusetts at Amherst released a 41 page report earlier this month on the possibility of adopting a single payer healthcare system here in Rhode Island. Friedman maintains that a single payer plan would result in significant savings for most Rhode Islanders and only increase healthcare spending for those making over $466,667 a year.

Representative Aaron Regunberg, from the East Side’s District 4, is planning to introduce legislation for a statewide single payer healthcare plan this session. Model legislation from the PNHP is available here.

More information about the Rhode Island branch of the PNHP can be found at their website.

January 29, 2015January 29, 2015

Blizzard not a day off for low-wage chain store employee

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photo (c) Melody Lee O'Brien — (c)2015 Melody Lee O’Brien

Robin is an employee of a chain pharmacy here in Rhode Island who was required to work during Tuesday’s blizzard, from 11am to 7pm, or risk losing her full-time status. To protect Robin, I changed her name and won’t mention the name of the store.

She lives about a 15 minute walk away from the store at which she works. She doesn’t own a car, but sometimes her boyfriend might drop her off or pick her up. But of course, on Tuesday morning the streets were impassable by car or by foot. So her manager asked her to grab a shovel and dig her way to work through the snow.

“The manager wanted us to be at the store and wait for the pharmacist to open,” she told me. “He wanted us to shovel our way into work.”

The manager, who worked from home, wanted the store opened at 8am. To her credit, Robin told her manager that his plan “wasn’t happening.” The manager contacted the plow company and got the parking lot cleared. By that time the streets were plowed enough for Robin to walk to work. Her 15 minute walk took about 40 minutes.

“It was miserable,” Robin said, “and absolutely dangerous. There were plows everywhere and the sidewalks weren’t shoveled. I could have had my boyfriend drive me, but there was driving ban and I’m not on the exempt list.”

In Governor Gina Raimondo’s Executive Order restricting motor vehicle travel throughout Rhode Island, health care and pharmacy workers were exempted from the ban.

“I’m technically not a pharmacy worker,” said Robin, adding that in her opinion she, “could have been arrested.”

It turns out that the chain pharmacy corporation is quite clear with the employees as to who is a pharmacist and who isn’t. There are all sorts of rules governing the operation of the pharmacy, keeping it distinct from the operation at the front of the store. Of course, a case could be made that the front of the store operation was providing “critical services to the public,” and therefore be exempt from the governor’s order in much the same way as might a grocery store or hardware store, and I doubt any police officer would have bothered to arrest Robin if she told them she was on her way to her job at the chain pharmacy. But just as Robin isn’t a pharmacist, she’s also not a lawyer. And she can’t afford to risk a ticket she can’t pay.

It wasn’t a busy day, of course. The majority of Rhode Islanders were doing what Robin’s manager was doing: staying home and waiting for the storm to be over. “I must have gotten a hundred phone calls asking if we were open,” said Robin, “but by the time we closed at 7pm we maybe had 20 customers in all.” The customers were looking for chips, candy, soft drinks and other junk foods.

The pharmacist didn’t have a single customer all day.

After closing, Robin walked home. The blizzard had abated somewhat, but the snow was still coming down and the wind was still kicking up powdery snow. “The roads were a little better, but it was still freezing and slippery,” Robin told me. Of course now it was dark, and the plows were still out and the sidewalks still needed shoveling, so Robin was walking in the street again. She finally arrive home at around 8pm.

For her trouble Robin made about $72 on Tuesday, before taxes and insurance. I asked her if the experience was worth the money. Her answer was blunt.

“No. It was uncalled for,” Robin said, noting her co-workers felt the same way. “No one was happy. We were all extremely disappointed that no one cared about our safety.

Robin

Robin is in her early twenties and has worked at the chain pharmacy store for about four years. In December of last year she was making $8.75 an hour but when the minimum wage was increased to $9 in January, she found herself making 25 cents an hour more, the same as all the new hires. Robin has a high school diploma, and no college.

She lives with her boyfriend, and they split the rent and utilities, though he makes slightly more than she does. Because she and her boyfriend combined make enough to eke by, she considers herself middle class, but if she were on her own she wouldn’t be able to afford the rent on her apartment and would be poor.

“I can’t afford to live on my own,” she told me. Robin has worked since she was 16 and has never been on any kind of public assistance.

Because Robin is technically a full time employee, she is entitled to healthcare under the rules established by the chain pharmacy corporation. The cost of the healthcare is about 25 percent of her take home pay when she works 40 hours a week, but since the new year began all employees have had their hours cut and Robin’s been averaging 30 hours a week, if she’s “lucky.” 30 hours is the minimum amount she has to maintain to keep her full time status and her healthcare.

The technical title for Robin’s job is “Customer Service Representative” and her duties include helping customers locate items in the store, running the register and restocking shelves. When new people are hired their training technically is the responsibility of the store manager or a shift supervisor, but often the training falls on Robin, due to her four years of experience.

I asked Robin if she likes her job.

“No, not really,” she replied, “but I like some of my co-workers, especially the people who were there when I started. I love them.”

Some of Robin’s complaints about her boss are perhaps typical. “He’s not very shy about letting you know that he’s not fond of you. He micromanages and he doesn’t recognize good work. He only tells you when you’re doing a bad job.”

Others are indictments of the company’s business model. “He cut everybody’s hours down so that pretty much everybody is at part time. Then he hired a bunch of new people and we’re all fighting for hours.”

Some say if low wage workers don’t like their jobs, they should find jobs that pay more, or get an education and find better jobs. So I decided to ask Robin why she doesn’t do these things.

“It’s not as easy as you might think it is,” she answered. “I don’t have a great education, I don’t have transportation… I know it’s possible, I can go back to school, but people think it’s so easy to go back to school. Get loans. Get grants. But it’s a lot of hours and a lot of work and I’d have to cut down hours at my current job and I’d have less money. Plus I’d be paying for school.”

I asked Robin if she thinks the minimum wage should be raised to a living wage, like $15 an hour. Her answer shouldn’t have surprised me, but it did. “I know that there’s a lot of things that come with an increase in minimum wage. When you increase minimum wage, other things increase as well.”

I told her that a study just came out from UMass Amherst that purports to show that the price increases of goods in the event of an increase in the minimum wage would be modest.

Robin had never heard of this study, which is unsurprising, given the sparse media coverage given to economic reports that play against conservative business interests. Instead, she was parroting the accepted “wisdom,” a narrative that conveniently prevents employees from demanding fair and just compensation for their work.

Robin does think that there should be a law mandating double time for hourly employees who are forced to work during official declarations of disaster. Being paid fairly would help make her feel more appreciated. “This sounds a little selfish, I guess,” said Robin, “but if I were getting something extra, I’d be more willing to be there, and I wouldn’t be so upset and disappointed with my job.”

January 27, 2015January 28, 2015

RI Hospital employees and community allies speak out

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More than 500 people crowded into the meeting room of Our Lady of the Rosary Church on Benefit St in Providence for the Worker & Community Speakout for Good Jobs and Quality Care on January 17. At issue was the contract negotiation between Lifespan/Rhode Island Hospital and General Teamsters Local 251 representing some 2,500 hospital employees.

According to Local 251, “As a non-profit entity, Lifespan and RI Hospital are supposed to put the healthcare needs of the community first. Unfortunately, management has taken cost cutting measures, causing shortages in equipment and staff that undermine patient care.”

Literature at the Speakout quoted a nurse, Aliss Collins, saying, “When we are understaffed, I cover 56 patients in three units. It’s not right for the patients or the employees.” There was a story at the Speakout of another nurse who was forced to buy her own equipment for measuring oxygen levels, because the hospital did not provide it.

Obamacare has allowed Lifespan/RI Hospital to take in an additional $33 million in net revenue last year, because so many Rhode Islanders are now covered under Medicaid. Yet rather than invest this money in patient care, Lifespan pays its “ten highest paid executives” more than $16.6 million in its last fiscal year, an average of $1 million more in compensation “than the average earned by CEOs of nonprofit hospitals nationally,” according to the union.

At the same time, hospital employees such as single mom Nuch Keller make $12.46 an hour with no healthcare coverage. Keller’s pay does not even cover her rent. She regularly works 40 hours or more per week, yet Lifespan continues to pay her as a part-time employee. And in case you missed it, Keller works at a non-profit hospital, and receives no healthcare.

The Speakout was intended to show community support for the workers of RI Hospital, and was attended by Representatives David Cicilline and Jim Langevin, as well as General treasurer Seth Magaziner. There were also representatives from many other unions and community groups such as Jobs with Justice, Unite Here! and Fuerza Laboral. Many religious leaders, including Father Joseph Escobar and Rev Duane Clinker, were on hand to show support.

It was hard not to feel that something new was happening at the Speakout. The level of community support and solidarity made one feel as if a union resurgence were imminent, which many feel is necessary if obscene inequality is to be combated.

It was Duane Clinker who helped put the event into perspective for me. He said that unions have often limited their negotiations to wages, hours and benefits, and health-care unions have long argued staffing levels, but “when/if organized workers really make alliance with the community around access to jobs and improved patient care – if that happens in such a large union and a key employer in the state, then we enter new territory.”

This struggle continues on Thursday, January 29, from 2-6pm, with an Informational Picket at Rhode Island Hospital. “The picket line on Thursday is for informational purposes. It is is not a request that anyone cease working or refuse to make deliveries.”

Full video from the Speakout is below.

Speak-Out for Good Jobs & Quality Care at RI Hospital 002 — Mirjaam Parada

Speak-Out for Good Jobs & Quality Care at RI Hospital 033 — Duane Clinker

Speak-Out for Good Jobs & Quality Care at RI Hospital 080 — James Langevin

Speak-Out for Good Jobs & Quality Care at RI Hospital 172 — Seth Magaziner

Speak-Out for Good Jobs & Quality Care at RI Hospital 087 — Aaron Regunberg

Speak-Out for Good Jobs & Quality Care at RI Hospital 098 — Carmen Castillo

April 15, 2014

Dems differ on future of healthcare exchange

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One difference between the Democrats running for governor that came to light at the Economic Progress Institute’s forum last week was how they would pay for the state’s healthcare exchange when federal funding runs out. States must pay for their own healthcare exchange websites in 2015 and Rhode Island’s costs approximately $25 million a year.

Gina Raimondo stood alone in saying Rhode Island’s remarkably successful healthcare exchange should be scaled back, specifically saying the consumer services built in may have to be scaled back:

Angel Taveras said funding the exchange would be a top budget priority of his, if he is elected governor:

Clay Pell said he would be “absolutely committed to funding it.”

And Todd Giroux said we should start paying for the exchange by not paying the 38 Studios loan.

When Ian Donnis reported on this, he suggested Raimondo “was a little more specific” than the other candidates. Or maybe she’s just the only one who wants to scale it down?

Below is the full six minute segment on the health exchange and you can watch the entire Economic Progress Institute governor’s forum here.

October 24, 2013

Julian days and Healthcare.gov

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There is a great deal of gnashing of teeth going on about healthcare.gov, the Obamacare portal for people who live in a state that refused to create its own exchange. I’m sure that some of the well-reported woes of the web site are deserved, but it seems fairly obvious that a large number of the commenters, and the complainers, have little idea what they are talking about.

I have no direct knowledge of the software behind healthcare.gov, neither of the team behind it, or the technologies they are using. But I do have some expertise in web sites, software, and data management, acquired over 28 years consulting in the software industry at many different companies, and there are some things that are being said that are just plain wrong.

To begin with, the health care exchange is not “just” a web site. It is a system that has to communicate data between lots of different insurance company databases very quickly. You can’t get a quote from a dozen different insurance companies to appear in any other way. This means that a dozen different insurance company databases have to be equipped to provide that kind of real-time response to a query.

To anyone who has spent time thinking about data, this is already the knell of trouble. To anyone who is counting how many insurance companies in how many states this system must deal with, this sounds much worse.

First, a tale. Back in the early days of working with data, I ran across a measure of time you frequently see in science data, the “Julian” day. The idea here is that dealing with months and years is kind of a pain when you want to draw a graph, so let’s just number the days from the first year and ignore the months and years, and things will be much simpler. It’s not a terrible idea, until you want to exchange your data with someone else.

At that point, you discover that you were counting days from January 1, in the year 1, and they were counting them from the year zero. You point out that there wasn’t a year zero, but they say it makes the math work out better. Or you discover that you were using the days as a measure, so that day 2.5 means noon of the third day, whereas they said that day 2 was the second day and day 2.5 is nonsense. Or you discover that though it says Julian days, they were counting leap years on the Gregorian calendar so your counts are two weeks off theirs. Or you discover that you were using local time, and they were using Greenwich time. Or you find yourself looking at satellite data, where measurements can be taken from two or three different days within any 24-hour period.

I ran across this issue because for a number of years I contributed to a science data project, meant to normalize access to a whole lot of oceanographic and other earth science data. Even beyond questions of data units, there were structural problems with interoperability, too. There were two widely-used data sources in that project that, given the constraints involved, turned out to be impossible to reconcile. Which is astonishing, since they were data measuring more or less the same things about the oceans. But one of them had been created by scientists who believed the data ought to be accessed a small bite at a time while the other had been created by scientists who believed you should get big chunks at a time.

These guys had made design decisions early on that made working together utterly impossible, and with the best will in the world, the two could not be reconciled to work in real time without one team essentially scrapping its original design and putting in a lot of work while the other team sat around and waited for them. Try as they might, there was no middle ground because neither one wanted to give up their design.

These are some of the lessons I learned:

In data, even when people are talking about the same thing, they’re not necessarily talking about the same thing.
Even when people want to work together, design decisions made in the distant past might make it difficult.
When two teams have to choose between their approaches, there is very seldom middle ground. One team gets to do all the work to convert to the other’s approach, while the other team sits around and makes snide comments.
No engineer thinks another engineer’s approach to a problem is worth a dime.

Now think about trying to resolve problems like this among a few hundred databases run by insurance companies who are not necessarily going to be the most cooperative folks out there. Think about it: you’re an insurance company IT executive and the healthcare.gov folks ask you if you might change the format of your data reporting to coordinate with the other companies in your state. Your immediate response? Why should we change and not them? That’s more work for us and besides our system was designed better.

So not only are the healthcare.gov folks working against a few hundred different design decisions, but they’re also counting on having been able to anticipate all the data entry errors that might be lurking in hundreds of databases out there, and hoping that everyone has decent support staff, too.

On top of that, healthcare.gov also has to interact with a handful of databases from other government departments, so there are similar problems on that end. For those who sneer that the private sector would have gotten it right, let me tell you another time about my work on the airline reservation system that never got built, or the credit card database whose books didn’t balance, or the speech recognition system that couldn’t distinguish between “pizza” and “tractor.”

In other words, big systems are complicated. It is a scandal that the federal exchange isn’t ready yet, but no one should underestimate the social, technical, and management challenges faced by the team putting it together. When you hear someone who says healthcare.gov is “just” a web site, you are hearing someone who does not care to understand the problem.

The good news is that there is little reason to doubt that most of the problems will find workarounds soon. The issues are difficult, but the need is there to resolve them, and they will be resolved. By this time next year, the glitches will be a memory, and it often seems that is what some of the critics fear most.