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Sue Sulham has been caring for developmentally disabled people in the Blackstone Valley for more than 20 years. She makes just $11.20 an hour.
“I don’t want to live beyond my means,” Sulham said. “I just want to be able to make a payment on time, to go grocery shopping and maybe luncheon meat would be nice … instead of peanut butter and jelly. I’d be able to live better if I could have $15.”
It can be too easy to forget that real Rhode Islanders have to live on the low wages that some of us only know about in abstract political terms. But Sulham now has a way to tell us about her plight.
SEIU 1199NE, the union that represents Sulham and about 4,000 other health care workers in Rhode Island, is producing video testimonials of local workers who are struggling to get by on their current incomes. Sulham’s is the first:
The videos coincide with state leaders considering making huge cuts to the state Medicaid program. “Our view is that Medicaid investments should be directed towards high-quality frontline care and towards ensuring that no health care worker is living in poverty,” said SEIU 1199NE Executive Vice-President Patrick J. Quinn. “It’s time that our society shows that we truly value the work that our caregivers do each day.”
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“Lifespan executives have angered employees and the community by rejecting common-sense proposals, including a proposal to require the Hospital to “maintain sufficient staff and adequate supplies,” said the press release. “Lifespan even rejected a proposal that, “providing quality care to patients and their families is the top objective of the Hospital and that poor working conditions, inadequate staffing levels, inadequate supplies, and improper equipment undermine quality care.”
Rhode Island Hospital Senior Media Relations Officer Beth Bailey said, “We are committed to bargaining in good faith toward a fair labor agreement that reflects the positive contributions of our employees. Our proposals to date have included increases to wages for all three years of the contract and shift differentials, and a comprehensive plan to help union employees impacted by technology changes. We are confident in the quality of the care we provide and the investments we have made in technology, equipment and staff to support the delivery of quality care.”
Local 251 represents 2,200 employees at Rhode Island Hospital, including non-medical staff, such as secretaries, janitors and landscapers. “But they also represent the unit assistants, the folks who check on patients to make sure everything’s okay, and the CNAs,” said Strecker. He said he had no idea how many people would show up for the vote. “We hope lots!”
Tomorrow’s vote is one step in the process of calling for a labor strike, said Jess Strecker of Jobs With Justice.
“It’s an authorization vote,” he said in an email subsequent to sending the press release. “The contract negotiating committee will then make the final call about when or whether to strike. Then they would actually give a 10 day notice to Lifespan before going out on strike. The strike could last as long or as shortly as it has to.”
A FAQ sheet sent from Local 251 to the 2,200 members said, “Voting to authorize a strike notice does not mean we will issue a 10-day notice right away. We will continue to negotiate and try to reach a fair agreement. A strong Yes Vote will send a message of unity to the Hospital and give the Negotiating Committee more leverage to win a fair contract. A No Vote would send management the message that we are not united. Management would have very little reason to make a fair contract offer.”
The FAQ says, “The bottom line is there can be no strike without a second vote by members to go on strike.”
Kathy Ahlquist, says the press release, “blames understaffing for her father’s medical tragedy.” Kathy is the wife of RI Future contributor Steve Ahlquist, who has reported on some of the previous employee actions as a new contract was in negotiation.
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As the sun was setting and temperatures dropped, over seventy workers and supporters took to the sidewalks with illuminated “Yes We Can! $15” signs chanting in both English and Spanish outside Blackstone Valley Community Health Care (BVCHC). According to their press release, the workers help to “deliver primary care to low- and moderate-income families primarily from Pawtucket, Central Falls, and the surrounding regions,” and are members of SEIU District 1199NE.
“We’re here,” said Kelly Medieros, who has worked for BVCHC for ten years, “because we want fair wages and affordable health care.”
In a written statement, Anabel Garcia-Campos, an Administrative Medical Assistant, said, “many of us who work here can barely afford to live—some employees earn less than $25,000/year, and we have to pay $5,000 for family health care.”
BVCHC has been expanding recently, capitalizing on the increase in business the health care provider has received under Obamacare. The number of patients served by the company has increased to over 15,000.
To meet demand the company has constructed of a new building in downtown Pawtucket for nearly $7 million and purchased another building for $1.4 million in late 2014.
“Management can definitely afford to pay us living wages,” says Anabel Garcia-Campos, “but while they’re getting richer, they’re leaving us behind!”
Christine Constant, a registered nurse, said in a statement that “low wages and high turnover take a toll on how we do our jobs” and says that a living wage and affordable health care will “stabilize our workforce so we can keep providing consistent, high-quality health care for our community.”
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Just as working class taxpayers are casualties of economic disparity. Just as law enforcement has no interest in correcting their unjust actions and medical and psychological professions are interested in creating repeat offenders for monetary gains.
These are not new discoveries. But seeing how these entities work in conjunction with each other to fuel the disturbing medical-mental-prison construct has pushed the need for awareness to a new brink. Public services continue to serve the interests of private sectors grinding our dollars to the bone. The New Kennedy Plaza is evidence that we want the common person’s money, but not the common person.
In the middle of a severe snowstorm free bus fare did not exist to ensure that travelers who may be caught in such conditions get to there destinations safe. That’s because public transportation is interested in collecting from the consumer and not perpetuating the producer. Fare should be free, along with our cities senior citizens. This shouldn’t be a request but a requirement. Just like heated bus shelters. Just like free produce. Instead our state spends our money on racial profiling and intimidation, mental conditioning, and ridding our societies of the trash and vagabonds as they’ve been defined.
Let us return to our fellow sister Tina for a moment. She was forced and coerced into going to the hospital, at the behest of the police despite voicing her right to refuse medical and psychological services. Her rights were blatantly ignored and infringed upon by Providence police and paramedics. The law enforcement system has already shown what they do when “criminals” don’t comply with their shoot-first-sign-paperwork-later tactics. If these entities aren’t too be trusted why do we put our faith in them?
Just as Tina needs an advocate, Eric Garner needed an advocate. Why can’t we the people be that advocate?
Let us build our own public service initiative so that we may be free of those who pull our strings and call it a service to our society. Our federal government has imposed sanctions on the working class if we do not comply to have health insurance. Businesses have complied to offer full benefits to workers employed for 30+ hours a week, but how many workers hours were cut to avoid such payout? For every drone that has been built, for every location service that is included in our apps, our federal government shows it is NOT in the business of ensuring our safety.
They want to know what we are doing and what attracts us for means of psychological stimulation and operant conditioning. To have a collective of Pavlov’s dogs ready to salivate at any glimpse of freedom and economic relief. Instead of SNAP benefits, pay our farmers so they can provide free produce. Give us back control over our lives, or we will take control.
I am calling out to all medical and mental professionals. High priced care does not equate to quality care. Ask the number of patients who have lost the fight to cancer but have truly won the fight for Freedom. A shaman has a duty that came with that title to ensure the health, guidance, and well being of its village. This duty shouldn’t be aligned with a monetary incentive.
Let us build our own public service initiative so that we may be free of those who pull our strings and call it a service to our society. Let us build solidarity, not wait for it to be handed down. We don’t need to be dependent to the hand that feeds us. You cannot put us all in Bellevue if we don’t comply. You cannot put us all in prison if we don’t comply. Your prisons and mental institutions are not big enough for everyone. You can’t kill us all.
I, for one, am tired of the intimidation tactics, the genocide. Anarchy is not as radical as extortion. We shun one because of its portrayal and accept the latter because we have been conditioned to accept it as norm. If you are unwilling to change your environment, then you are as lost as a hamster on the wheel. My people, step off and join me in liberation.
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Health care workers, 1199 SEIU Rhode Island members and allies will hold an informational picket at Women & Infants Hospital, a Care New England hospital, to protest Care New England’s failure to invest its resources toward quality patient care and staffing.
Corporate management decisions by Care New England are hurting quality care, patient satisfaction, and the Rhode Island economy – and damaging the stellar reputation that Women & Infants has built up over decades.
WHEN: Thursday, January 15th, at 3:30 p.m.
WHERE: Women& Infants Hospital, 101 Dudley Street, Providence, Rhode Island
More Background: Management at Care New England, led by CEO Dennis Keefe, has focused their efforts on expanding the Care New England network by affiliating with and sinking money into new facilities. However, patient satisfaction and staff morale at the hospital are down, due to a lack of investment in staff and quality care.
Since 2011, the hospital has consistently brought in out-of-state “Traveler Nurses” instead of hiring local nurses for permanent jobs. These temporary travelers, who are unfamiliar with the hospital, have likely driven down patient satisfaction and quality outcomes.
According to the independent patient-satisfaction auditing agency Press Ganey, patient satisfaction has generally been down since Keefe took over in 2011. Yet despite these worsening outcomes, CEO pay is up. In 2012, the most recent year for which data is available, Keefe made $1,049,426 in total compensation.
Keefe’s decisions to sink money into expanding the network, refusal to hire more permanent local staff, and million dollar salary have all come at the cost of reinvesting in the hospital and achieving high quality outcomes for patients.
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Lt. Gov Elizabeth Roberts is a big supporter of marriage equality.
Lt. Governor Elizabeth Roberts, Rhode Island’s most prominent healthcare advocate, is slated to become the next director of the state Health and Human Services Department, according to a press release from Governor-elect Gina Raimondo on Sunday.
“Elizabeth Roberts is the right leader for HHS because she has the key combination of management skills and compassion for the thousands of people the agency serves. We will keep Rhode Island families healthy, while also cracking down on fraud and focusing on fiscal discipline in order to cut costs,” Raimondo said in the release. “The Lieutenant Governor’s years of experience working on various health and human services issues, coupled with her unwavering dedication to making our state stronger, makes her the best choice to lead this office.”
Roberts said in the press release: “I am honored to be joining the Raimondo administration and look forward to rolling up my sleeves to make sure Rhode Islanders of all ages have access to the quality services they deserve. Once confirmed, I will focus on how to improve our delivery systems across all agencies to make sure we are providing the best care, while reassessing our cost structures and contracts. I look forward to serving on the team that will advance Governor-elect Raimondo’s vision for ensuring a healthy future for Rhode Islanders and a healthy economy for our state.”
The Providence Journal reports Roberts will focus on healthcare policy, about which Raimondo said Roberts is “one of the nation’s experts in this issue.” But the department has other responsibilities as well.
It’s $3 billion budget represents about 40 percent of state spending, according to the ProJo story. And Karen Ziner also reports, “the agency oversees the Department of Children, Youth and Families; the Department of Health; the Department of Human Services [including the divisions of Elderly Affairs and Veterans Affairs]; and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.”
Prior to taking office in 2007, Lt. Governor Roberts spent over a decade as one of Rhode Island’s most respected advocates for quality, affordable health care for families and small businesses and earned a statewide reputation for being a tireless leader on health and medical issues.
While serving in the Senate, Roberts was an acknowledged leader on healthcare reform issues. She is credited with creating the Office of the Health Insurance Commissioner, an important mechanism for controlling health insurance costs and expanding primary care in Rhode Island. She championed legislation to protect the safety of residents in nursing homes. Then-Senator Roberts also led the effort to reform the corporate board structure at Blue Cross and Blue Shield of Rhode Island, providing for more transparency and public accountability. As Lt. Governor and most recently as chair of the state’s Healthcare Reform Commission, Roberts has led the implementation of federal health reform in Rhode Island, a nationally recognized success in reducing the number of the uninsured and lowering the cost of health insurance.
According to her bio page: “Roberts has led the fight to ensure that all Rhode Islanders have access to high quality health care at a cost they can afford.”
Watch this video of her talking about healthcare in Rhode Island and HealthSourceRI to the League of Women Voters.
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I’m a healthcare worker, Queer activist, and consider myself to be pretty well-informed and connected and yet if you had asked me about PrEP as recently as September, I would have wondered what you are talking about. I’m up here today because I feel that the word PrEP needs to be on the lips of every sexually active person and the people they love.
PrEP which stands for Pre-Exposure Prophylaxis is a once a day dose of an anti-retrovirus drug called, Truvada; which is also used for people who are HIV Positive to help keep viral loads low, but in people who are negative, if exposed to HIV, kills the virus before it has the chance to infect you. Numerous studies have shown it to be pretty darn effective.
Being newly single, and sexually active, this naturally piqued my interest; if a one a day pill can help prevent an unwanted condition, why wouldn’t I be on it?
But for good measure, I took to social media to see if anyone in my extended networks had any thoughts or experiences with it. The results were somewhat unsurprising, but worth breaking down:
Two people reached out to me privately to tell me their stories, which were well-received and appreciated, but I wondered why they didn’t feel safe to say publically they were PrEP users. Until I saw some of the other public responses (most of which were positive), but there were a strong current of people who were telling me that I weren’t being “sleazy” I wouldn’t have to worry about this or that they felt that this pill will encourage “bad” behavior.
Kilby and Dr. Amy Nunn
This line of thought is nothing new…54 years after the Birth-control Pill hit the market and 41 years after safe and legal abortion was won, people are still saying that contraception will encourage “bad” behavior.
Well I’ve got news for them. “Bad” behavior does not need encouragement. At all. And furthermore, there is nothing bad, dirty, or shameful about sex. We owe it to ourselves, our partners, and the people we love to first and foremost, enjoy ourselves, but also to do everything we can to protect ourselves and other.
We as a society need to come to grips with the fact that sex-positive and queer-inclusive sex education not being a part of our public school curriculum is nothing short of a public health crisis; creating a layer of young people with lots of misinformation and questions who are afraid to seek out answers for fear of judgment. This is dangerous. Silence, in this case, literally equals death.
I, along with my Doctor, Dr, Chan, did decide that going on PrEP was the right decision for the type of life I lead. I was very fortunate to thus far not experience and of the side effects (nausea, vomiting etc.). And if you’re wondering, it didn’t encourage and more or less “bad” behavior.
To conclude, I would be remiss if I didn’t discuss how equally important access to this drug is to it’s availability. I am lucky in that I have a good job with good health insurance, so access to PrEP was no issue for me. But there are so many people in vulnerable demographics (I think of sex-workers and IV drug users especially) may not be as lucky and cannot afford to pay the over $1500 out-of-pocket cost of a monthly supply of Truvada. PrEP has the potential to make new HIV infections a thing of the past, but it cannot do that if no one’s heard of it and people who need it the most cannot access it.
These are the facts, but our challenge as healthcare providers, law-makers, activists, and people who want to see a world without HIV/AIDS is to overcome them. We have come so far already; research in tandem with activism has taken HIV for a death sentence to a chronic, but mostly manageable condition, and now we have the capability to prevent it in the first place. We need to be screaming about this from rooftops, flyering every gay bar, I also liked Dr. Nunn’s idea about using sites like grindr and scruff as tools for outreach, and also making the phrase “ask your doctor about PrEP” as recognizable a slogan as “get tested” and “know your status” is now!
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In a pointed and detailed statement, Congressman David Cicilline called out the United States Supreme Court for its Hobby Lobby decision made public today saying, “women, not their bosses, should be in charge of their own personal health care choices.”
Women, not their bosses, should be in charge of their own personal health care choices. While much work remains, we have made tremendous progress in affording women full equality over many years and this decision rolls back that progress by limiting women’s access to contraceptive health care services.
The Affordable Care Act is designed to ensure women have access to quality, affordable health care, including contraception and family planning — services that are critical to a woman’s health care needs. In fact, an overwhelming majority of women use birth control or contraceptives at some point in their lives and the idea that they should be denied access to these basic health care services because their boss finds it religiously objectionable is ridiculous. While today’s ruling will not undo all the benefits under the Affordable Care Act that allow millions of women to access birth control, it wrongly dictates that a CEO’s religious beliefs outweigh a woman’s right to access affordable contraception. This unfair discrimination contradicts the values of a majority of Americans and has no place in the 21st century. Importantly, today’s decision also sets a bad precedent encouraging other for-profit corporations to deny health care coverage to their employees based on their owners’ religious beliefs.
I am deeply disappointed with the Supreme Court’s ruling and will continue working to stop attacks on women’s access to complete health care services and to advance women’s basic rights. This fight is not over.
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Rhode Island Senator Sheldon Whitehouse said the so-called Hobby Lobby decision is another in a long line of pro-corporate rulings from the high court.
In a statement, he said:
This is just the latest example of the activist Roberts Court siding with the narrow interests of corporations over those of the American people. Ignoring the clear will of Congress, the Court’s five conservative justices today ruled that corporations have religious beliefs that they can put ahead of the medical well-being of the women who work for them. The decision sets a dangerous precedent by allowing for-profit corporations to meddle in decisions that should be left between a woman and her doctor, and I’m deeply disappointed in the Court’s ruling. It follows an increasingly predictable pattern of five activist, conservative Supreme Court justices deciding in 5-4 decisions that the Constitution and our laws mean whatever the Republican Party and big corporations want them to mean
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If there is one thing a documentary film should strive for, it is exposing people to a little-known aspect of life. This is precisely what filmmaker Edgar Barens has done with his Oscar nominated film, “Prison Terminal: The Last Days of Private Jack Hall.” It premieres on HBO, on March 31st, and is poised to stir up some substantial changes in America, the global incarceration leader, where approximately 250,000 aging people are behind bars.
According to the Bureau of Justice Statistics, between 2001 and 2011, cancer and heart disease were the leading causes of over 3,000 annual deaths in state prisons. Another 1000 people die every year in local jails, often with little or no health care.
I met Edgar Barens in 2009, when he had 300 hours of footage from the Iowa State Penitentiary’s hospice unit, shot over six months in 2006-2007. Prison administrators invited him to do a story after seeing his previous documentary Angola Prison Hospice. This latest product is a 40-minute film nominated for an Academy Award. Coincidentally, Prison Terminal is about the death of Jack Hall, a World War II POW survivor, while the winning film was about the last survivor of the Holocaust.
Jack Hall is proud of his military service, yet remains haunted by the hundreds of farm boys, tradesmen, and regular folks he killed while wearing the uniform. It is interesting that the government awarded medals for these killings, but sentenced him to die in prison for killing the man who sold drugs to his son. The latter was probably the only time he had a genuine motivation to end someone’s life, but Jack’s story here is not about that homicide. The story is deeper, taking us to a crossroad of multiple dilemmas in America’s criminal justice system.
Pvt. Jack Hall.
The Disposable Heroes
Incarcerated veterans are vastly growing in number, as they historically do after every war, with estimates ranging from 140,000 to 250,000 currently behind bars. It should come as no surprise that Jack Hall’s experience of killing, seeing friends die, and being held in an enemy prison might leave more than a few scars. It is understandable that any such person might seek to suppress their thoughts with alcohol or drugs, and may also have a hard time holding down a regular job. This PTSD and effects, and effects of effects, helps explain the record high disposable heroes currently locked up in prison after their Iraq and/or Afghanistan tours. It is only amplified by America’s shortcomings in soldier reentry and rehabilitation (words typically used for prisoners returning home, but soldiers’ experiences can be frighteningly similar).
At the heart of Prison Terminal is a hospice program, where fellow inmates are serving as the volunteers and providing end-of-life care. In another twist on presumptions, Jack is a former Segregationist who found himself living in the most intense racial experiment throughout history. The viewer doesn’t experience Jack’s evolution over the previous years, but what we see is the shared love and humility of two primary caretakers in action: “Herky,” and “Love,” both Black men. Both also convicted of killing someone and will apparently also die behind bars. As they see it, what they do for Jack will hopefully be done for them when the time comes.
Herky, a prison hospice volunteer.
Many members of the general public develop their views of prisons through television shows such as Oz, Orange Is The New Black, and LockUp. Furthermore, most documentaries focus on a wronged situation, such as exonerations, drug war casualties, and political prisoners. Prison Terminal defies stereotypes and presents a familiar world to those who have been incarcerated, and their families. Herky and Love are like hundreds of people I know: just waiting for a burning car on the side of the road so they can save some kids. It will never erase the terrible things that gets someone into prison, but will at least make looking in the mirror a little easier by creating a counter-narrative, about helping humanity rather than hurting. Not to imply that everyone in prison is an angel, nor even that the majority are there for something terrible, but the number of lifelong malicious and selfish people in prisons is a far smaller than most would ever imagine.
It should not come as a massive surprise that the majority of hospice workers in Iowa are Black. As examined in the book, “Mothering in Prison,” some communities unfortunately have learned to expect travesties. Coming up out of slavery and through a challenging American history, Black people have had to adapt to survive, and take care of their wounded family. Here, Jack Hall is part of this family regardless of his color. And to Jack’s credit, healing his previously-strained relationship with the son who turned him in is a core part of the dying process.
Prisoner health care: an oxymoron
Prison health care in America primarily consists of popping pills, and scant staffs struggling with sparse budgets. If they are going to take control of someone’s body, the government has a legal and moral duty to take care of it. However, not every person enters prison with a clean bill of health. They go in with cancer, diabetes, HIV, and every other ailment afflicting the general public. Perhaps on the outside they had a job, insurance, or even coverage under the Affordable Care Act. And then they are sent into this jungle. The diet is terrible and, at times, the exercise non-existent. Leave someone in prison long enough and they will certainly contract any ailment one would expect on the outside.
There are only 75 hospices in the thousands of American jails and prisons, and only 20 are staffed with prisoner volunteers. People should die with their families, especially the ones closest to their hearts. Iowa’s hospice program struggled since the film was made, as a new director was not as passionate about the program. This signals the need for specific policies to be in place, to survive turnover and attitude. The program costs absolutely nothing, with everything donated (including hospital beds) or made by prisoners. Hospice actually saves money by weaning people off costly medications and treatments in their final days.
Some states have responded to the medical crisis by building multi-million dollar medical facilities that will need to be staffed and maintained over the years. This also creates more overall beds in the system; beds to be filled. Every prison should instead convert space already in place, and consider Medical Parole whenever possible. Not everyone has somewhere to go in the final years, and granting homelessness to sick people is not providing dignified deaths.
Edgar Barens is taking Prison Terminal on a tour that will include dozens of prisons throughout the nation. This film should be seen. A five-minute version should be screened for politicians. Hopefully they, like Iowa, will recognize that it is possible to do better. They can respect families and religions, and make a considerable reform within this terrible phenomenon of mass incarceration. Furthermore, the Veterans Affairs administrators can watch this film and reconsider the final crime in Jack’s case: the VA would not allow him to be buried with honors due to the “Timothy McVeigh” rule, barring people convicted of capital crimes from a final acknowledgment of their service. Jack’s final respite, despite fears his service would send him to Hell, was to be buried as a soldier. Instead, the prison fingerprinted and disposed of him, his life, and death.
Pvt. Jack Hall escaped from a POW camp, yet could not escape that one moment of rage as an unwilling soldier in the War on Drugs.
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AEI is, according to Right Wing Watch, “one of the oldest and most influential of the pro-business right-wing think tanks. It promotes the advancement of free enterprise capitalism, and has been extremely successful in placing its people in influential governmental positions, particularly in the Bush Administration. AEI has been described as one of the country’s main bastions of neoconservatism.”
Said Whitehouse about his decision to participate, “I expect my views on these issues will differ greatly with those of the leaders at AEI, but I look forward to a forthright discussion. Fair and efficient markets have always been the engine of broadly shared opportunity and prosperity in America. This is especially true for our health care and energy markets, where the stakes could not be higher.”
Whitehouse will participate on two panel discussions: on one he’ll talk about “the promise of health care delivery system reform,” according to his office, and on the other he will discuss “the market distortions created by the economy-wide costs of carbon dioxide pollution from fossil fuels.”
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I read in Monday’s newspaper about the terrible state of the retiree health-care system in our cities and towns. The trust funds that are supposed to pay for retiree health benefits (called “Other Post-Employment Benefits” or OPEB) decades into the future are deeply in the red. But as usual, there are some very troubling assumptions made in order to paint this bleak picture. If you do the math, you’ll see that the actuaries who predict this disaster do so by assuming a catastrophe.
Where does this terrible debt come from? It comes from the exploding cost of health care, extended out a few decades into the future. Even a small inflation rate, sustained over 50 years, can become a huge number. So what have the actuaries assumed in order to make these bleak predictions? I surveyed some of the reports, and found that Providence’s actuaries assumed that 2011 would see 7.5% inflation, scaling down to 4.5% in 2022 and for all the years thereafter. From my casual survey, this seemed typical, even low, and it sounds reasonable, right? East Providence’s actuaries assumed 9%, sloping down, Barrington’s 8% and so on. Health care inflation has been at 8-10% for far too long, so a declining rate of inflation actually seems optimistic, doesn’t it?
But let’s do more math, because there’s an interesting story lurking in it. There are lots of city and town employees who will still be getting this health care benefit 50 years from now. (And state employees too. The report on Monday was about municipal benefits, but the state system has the same problem.) So what will happen 50 years from now? According to these projections, in the year 2061 health care costs will be around 12 times what they were in 2011. A procedure that costs $1,000 in 2011 will cost $12,000. If we make a similar projection with ordinary inflation, 50 years out we’re looking at around a factor of three, as in the graph above. So the actuaries are predicting that your income, food, gas, whatever, will be up by a factor of three, but health care more than four times as much.
That is a truly remarkable number, and should be scary for anyone who is promising these benefits to their employees today. One way to look at the problem is to panic that our cities, towns, and state have not put away nearly enough money to pay for these benefits down the road. This is the point of the OPEB benefits report, and the unquestioning articles that fan the panic over these costs. This panic has serious results, including tax increases, cuts to other important services, and the potential for still more municipal bankruptcies. Providence is said to owe over $1.1 billion, Pawtucket $300 million and Warwick over $230 million. Collectively the debt is over $3 billion, more than the cities and towns owe for their pensions. Indeed, that was the screaming headline of the email I received from the “RI Taxpayers” group on Tuesday morning.
The other way to look at the problem is that it’s a complete crock. I cannot predict the future, so I don’t know how exactly it will happen, but I am quite confident that 50 years from now health care costs will not be 12 times what they are today. More importantly, if costs are as high as that, the matter of how to pay them for people who have retired will be the least of our worries.
Let’s do a little more of the math. These days health care costs run a little more than half of average housing costs. Do you believe in a world where health care costs more than twice what you pay for your mortgage? That’s what these projections predict. Health care costs today — for employees, prisoners, poor people, DCYF clients, and so on — represent about $2 billion, around a quarter of the state budget. By these projections, in 50 years they will be well over half the budget. What few private corporations who still offer health insurance will be paying equal amounts in salary and health benefits. Looking at the share of GDP that goes to health care, our nation will be paying well over 20% for health care, approximately twice as much as any other developed country today.
These are not sustainable increases. I do not have to know how or when these increases will be reined in, but only observe that they are not feasible to know that they will be reined in somehow. Herb Stein, economic advisor to Richard Nixon, put it this way, “Things that can’t go on forever, don’t.”
In other words, these OPEB projections are complete malarkey, compiled by actuaries whose noses are so deep in their spreadsheets that they can’t seem to see they are predicting the end of civilization as we know it and wondering how to pay for retiree health benefits when it happens. Put it in perspective. As I said, the state’s budget contains around $2 billion in health care costs. The cost for retiree health care? Around $50 million. I sometimes while away idle moments wondering about what would happen if an asteroid hit the earth, but my concerns are about survival, not how would I pay the electric bill. Yes, it is true that runaway health care costs are a serious threat to our nation, but to imagine that the threat is only to our system of paying health care for retirees is laughable.
The good news is that health care inflation rates have tumbled since Obamacare became law in 2010 — current estimates are about 1.3% per year — rendering the doom and gloom of these reports even less relevant to the real world then they were when they were made a couple of years ago. This is a big deal. Providence is said to have a $1.1 billion deficit, using those inflation rates. Rates of 1-2% instead of 7-8% over the next two or three years could cut $200 million from Providence’s OPEB deficit and have a similar effect on everyone else’s deficit.
The lesson here is this: if you’re serious about fiscal responsibility, you prove it by being serious about finding ways to reduce health care costs, which drive the vast bulk of the increases in state and local government expenses over the last 20 years. You do not show seriousness by simply negotiating these benefits out of contracts, or by cutting benefits. Rising health care costs are a problem for everyone, and a solution that benefits everyone is the only solution worth consideration.
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It’s 7:00 in the evening. You, a Rhode Island resident, are at the mall in Attleboro. You’re out to dinner in Seekonk. You’re on vacation on the Cape. Suddenly, your teen-age child collapses, unconscious.
What do you do?
Do you call an ambulance? The child is unresponsive. His eyes are rolled back in their sockets. He appears to be breathing shallowly. I repeat: what do you do?
Do you call 911? Or do you try to assess whether the situation is dangerous, whether you should try to take him to the hospital yourself, or whether you should just take him home and call a doctor in the morning? Which do you choose? And no, you’re not a doctor, and no, you don’t even play one on TV.
Some would suggest we should choose the latter route. Or, if we decide to go the ambulance route, we should call several providers, trying to see who has the best price, then see if we can haggle it downward a bit. Or maybe ask if they’ll take a chicken as a discount. In the meantime, your child is still unconscious. But being the hyper-rational homo economicus that you are, you pull out the copy of the local yellow pages you always carry in case of situations like this, or you use your smart phone to search the web for the local services, and then you coolly work the market and see what sort of price you can get.
OK, you’ve done that, only to find that the best deal you can get is $2,999.99. Now, you have insurance, but it will only cover 80% of the charge after the deductible is satisfied, and only if the situation is deemed an emergency. Well, your kid is unconscious; does that, in and of itself constitute an emergency? Are you a doctor? No. Do you have a clue whether it’s truly an emergency? No. And, 20% of that ambulance bill still comes to $599.98, assuming that everything goes as planned, that your deductible has been met, and the insurance will actually cover the 80%.
So what do you do? Does this change your behavior?
And remember: you get your insurance through your employer, so it’s not like you can negotiate your own deal with the insurance company. And that’s a good thing.
And what if your checkbook balance is somewhere south of $800 at the moment, and you still have to make the car payment? That $599 will take a pretty good bite out of that. If you’re making RI median, your next check will come in somewhere between $1200 & $1300 (depending on deductions, etc). And remember, this is just the ambulance. If you do go to the ER, there will be a plethora of other charges: for tests, x-rays, CAT scans/MRIs, physician services, and so on.
One thing that’s important to remember is that something like an ambulance, or an ER, has to be staffed and prepared at all times. An ER will probably use its facilities on a fairly constant basis, so there isn’t a lot of down time. That is not necessarily true for an ambulance. Maintaining and staffing that ambulance 24/7 costs money. Now, if you depend on paying for the ambulance by billing the people who use it, a significant part of the bill will be for maintaining that service when it’s not in use. So that means the price has to be a lot higher than just the cost of that particular run. A lot higher.
Now, we could subsidize the ambulance service as a common good; but that means taxes have to go up to pay for that. Since people who decide the level of taxes probably don’t have to worry about a couple of grand if they need an ambulance, they won’t see the point of having to pay taxes all the time to support an ambulance service that they may never need. Let the people who need it pay for it. Sounds ever-so-sensible. So the poor schnooks who do have to worry about having to pay a couple of grand for an ambulance will pay for all that down time out of their pocket.
But that’s fair, isn’t it? If you make the bad choice and get sick, well, hey, you made that choice. No one put a gun to your head and made your kid pass lose consciousness.
So you go that route. You kid goes to the ER, gets half-a-dozen tests, and, thank the Lord, appears to be fine. So you all go about your business for another month or so. And then the bills (note the plural: bills) start to come in. The first is for the ER, and that’s around $4,500. But your insurance works as planned, so your only responsible for $900 (which is 20% of the total). Then there are the bills for the MRI, the blood tests, physician services, yadda yadda yadda. These clock in at another $1,500, so you only have to pay $300. So we’re over a grand already.
Then the ambulance bill comes. Oh, that was out of network. So sorry! You’re not covered!
So now you’re faced with the whole $2,999.99.
And the whole episode cost something like $9000 (Well, technically, $8,999.99, using the figures I’ve presented).
Now, how would you have acted when your kid collapsed? Would you have rationally balanced a potential bill of about $4,300 against some unknown ailment with unknowable consequences? Would you have considered the hole this was going to blow in your budget and said, “well, I have no idea what’s wrong with my kid, but maybe it’s not a big deal?” Or do you go the ambulance/ER route with no clue what it’s going to cost?
It’s hard to imagine that in the year 2013 women still have to deal with inequality in the workplace.
Their wages are typically lower for the same level of education and expertise than their male counterparts, but this inequality does not stop at the pay check. Women also pay much higher premiums for their health insurance coverage, so, in addition to making less money, they’re forced to pay out more in insurance premiums.
This is a practice known in the insurance business as gender rating.
While the Affordable Health Care Act will eventually make gender rating illegal, some 14 states across the country including California, New Jersey and New York, have taken steps to ban or cap gender rating in the individual insurance market. Some local lawmakers would like to add The Biggest Little to that list.
A bill (S201) sponsored by Senators Sosnowski, Miller , Nesselbush, Cool-Rumsey, and Gallo would prohibit insurance providers in Rhode Island from charging women of child-bearing age higher premiums than men. This is the third time that similar legislation has been introduced by Sosnowski.
Planned Parenthood of Rhode Island is one of the womens’ advocacy groups that has led the charge locally for evening out this disparity. We caught up with Paula Hodges, Rhode Island Public Policy and Advocacy Director for Planned Parenthood, and asked for her take on the the built in sexism of gender rating by insurance companies.
The Senate Committee on Health and Human Services heard testimony from the bill’s prime sponsor, Sen. Susan Sosnowski, who said, “It’s outrageous that in 2013, we have to deal with this discrimination.”
“I bristle at the term discrimination,” said Shawn Donahue, lobbyist for Blue Cross/Blue Shield RI, “it is an actuarial fact that young women visit doctors more frequently. Insurance companies charge discriminatory rates for smokers. Men are discriminated against when it comes to life insurance.”
Committee Chairman Sen. Josh Miller grilled Donahue during his testimony, asking, “Just from a public policy point of view, do you have any data on the cost to the state for women that have dropped out of the insurance pool due to cost.”
Donahue had no answer.
During her testimony, Ms. Hodges, visibly annoyed, said, “I resent that gender is being equated to something situational like riding a motorcycle or smoking.”
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Right now there is no statute regarding the licensing of genetic counselors in Rhode Island, opening the door for those without appropriate training and codes of ethics to exploit and potentially harm patients. Fifteen states have licensure laws, and seventeen more have bills in consideration or preparing to be introduced.
On Wednesday, a Senate subcommittee discussed a bill that could make Rhode Island the 16th state to permit counselors to give advice about their potential medical future based on what can be gleaned from their genes.
Rhode Island’s bill was crafted by Senators Perry, Nesselbush, Sosnowski, Miller and Pichardo. It is a fine bill and has the complete approval of the National Society of Genetic Counselors. Genetic Counselors from Rhode Island are keen to see the bill passed, as it speaks to their professionalism and commitment to proper patient care. Passage of such a bill should be an easy slam dunk, as it will prevent patients from being victimized by the unscrupulous and the improperly educated.
So of course this bill can’t be passed by our General Assembly. Why? Because anti-abortion rights activists have stymied the bill for years. Let that sink in. For years versions of this bill have been advanced, only to be continually sidelined by activists like Barth E. Bracy, Executive Director of Rhode Island Right to Life, who said, in 2010:
Genetic counseling can be used for good or for evil, in the same way that fire can be used to cook food or burn down a house. Insofar as genetic counseling can be used in order to enhance and sustain human life and well being, it is a good thing. And we agree that the State of Rhode Island has an interest in regulating the practice of genetic counseling… Our primary concern regarding the Genetic Counseling Licensure Act is to include at least some conscience protection for genetic counselors who do not accept abortion as a valid treatment option in cases where some disability or undesired trait is possible, probable, or even present in an unborn child.
The position statement of the National Society of Genetic Counselors is quite clear on the issue of reproductive freedom:
REPRODUCTIVE FREEDOM: NSGC supports the right of all individuals and couples to make reproductive choices. These include using information from genetic counseling and/or testing to decide whether to pursue a pregnancy, to utilize assisted reproductive technologies, to prepare for the birth and future needs of their offspring, to make an adoption plan, or to end a pregnancy. NSGC firmly believes that reproductive decisions should be made in the context of unbiased and comprehensive information, free from discrimination or coercion.
As a result of this conflict between the medical professionals of the NSGC and the anti-abortion zealots represented by Bracy, a so-called conscience amendment was added to the bill:
5-86-8. Counseling concerning abortion.- Nothing in this chapter may be construed to require any genetic counselor to participate in counseling with respect to abortion, nor shall licensing of any genetic counselor be contingent upon participation in such counseling with respect to abortion, and the refusal of the genetic counselor to participate in such counseling with respect to abortion shall not form the basis for any claim of damages on account of the refusal or for any disciplinary or recriminatory action against the genetic counselor, provided that the genetic counselor clearly informs the patient, in a manner consistent with ethical standards… that he or she will not participate in counseling with respect to abortion and offers to give the patient a list of licensed councilors in the state. The genetic counselor’s disclosure of non-participation and offer of a list of other licensed genetic counselors shall be made at the start of the counseling relationship and at other appropriate times, if any, based on the genetic counselor’s professional judgement.
Steve Brown, Executive Director of the Rhode Island ACLU, noted, in a letter to Senator Perry that this amendment:
…Would allow genetic counselors to refuse to counsel “with respect to abortion,” a counselor could potentially use this as an opening to, for example, withhold information about potential fetal abnormalities from women who are pregnant or considering becoming pregnant. A counselor could, by omission, mislead a patient about her options when serious fetal abnormalities are detected late in the pregnancy. A counselor could even suggest that no other options are available, but so long as the counseling was otherwise “consistent with ethical standards,” the amendment could appear to immunize the counselor from any state regulation or sanction.
In other words, it seems that the bill to license genetic counselors, with this amendment intact, would do nothing to assure the public that genetic counselors are professionals bound by a code of professional ethics to serve the best interests of their patients, because the bill will contain a loophole that will allow potential licensed genetic counselors to place their own consciences above that of their patients rights and needs. As a result, the ACLU proposed small modifications to the language, but these modifications could not win the support of Bracy’s RIRTL.
Speaking at the subcommittee meeting Wednesday evening, Benjamin Brown, a 4th year medical student speaking on behalf of Medical Students for Choice, put it quite well:
What concerns me here is that you have heard from the genetic councilors in the room that it is not within their code of ethics not to discuss abortion. And you have heard from other people speaking today that that is a professional requirement. So why would it be necessary to include this language about not talking about abortion if people are going to be acting within their code of ethics of their profession which states that they must discuss abortion? So to me this language makes no sense, it has nothing to do with professional regulation, and it has nothing to do with the professional standard practice of the profession of genetic counseling. It has to do with the fact that there are people who want to restrict access to abortion. This language has no purpose except to give an anti-choice genetic councilor room to hide behind a legal excuse for not providing information about abortion when the code of professional ethics says that you should have given that information, they can say, “Well, but I practice in Rhode Island.” [emphasis mine]
We should be clear at this point: The genetic counselors in Rhode Island would greatly prefer a clean version of this bill bill, one without the amendment, but so desperate are they to get some sort of licensing structure approved that they are willing to make a deal with the devil. They are willing to take the bill with the amendment. But what they might not realize is the precedent they are setting here. Paula Hodges, of Planned Parenthood, said it well:
There is a broader concern … that with the approval of such an amendment this committee will have all but formalized the practice of allowing legislation regarding liscensure in the medical field to be held hostage until the wishes of those opposed to abortion are considered and incorporated into the bill’s language.
…
We know that the Rhode Island ACLU has offered specially crafted improvements to this language which has not been adopted. Regardless, should this committee approve this amendment, with or without improvements, we head down a path where we all meet in these hearings, year after year, as each type of profession seeks to routinely improve or expand its scope of practice. The irrelevant demands of abortion opponents will need to be placated year after year.
The genetic counselors of Rhode Island are just following their code of ethics in capitulating to the unreasonable and irrelevant demands of anti-choice zealots like Barth Bracy and RIRTL. They are seeking to protect the interests of their patients at any cost, counting on their national group’s code of ethics to carry them through the ethical morass created by the amendment. Right now all fourteen people covered under this bill are pro-choice, but what of the future? What is to prevent someone who is anti-choice from becoming licensed and withholding information that would serve the best interests of their patients? In the amended bill, nothing prevents this.
Senator Nesselbush early on pointed out that the language in the bill is specifically crafted for those who are not pro-choice. Is it really necessary in our society to start crafting two sets of laws, those that cater to the whims of the religious, and those that serve the rest of us? With all the trumped up fear mongering being spread about such nonsense as Sharia law in America, why are we unable to make the small cognitive leap to the emergence of a two-tiered justice system respecting conservative Christian values?
Further, since when has the General Assembly had any luck crafting these last minute conscience clauses to their bills? Those who remember the much less than satisfactory civil unions bill of last year may recall that any rights such a bill ostensibly granted were seriously undercut by the Corvese amendment, which in some cases may have taken away rights enjoyed by committed same-sex couples who had gone to the trouble of establishing durable powers of attorney for each other. This genetic counseling licensure bill with the amendment included may have a similar effect of establishing a short term gain but a long term loss in the quality of the counselors licensed as anti-choice advocates move into the field, perhaps to work at one of the many fake pregnancy counseling centers that exist only to trick women into not realizing all their health care options.
When a group of bright, committed medical professionals, with the full support of the medical establishment, presents itself to the legislature and asks for legislation that will serve to protect the integrity of their profession and the health of their patients, the legislature needs to listen to them, and not to anti-choice cranks who care nothing for the health and safety of anyone save for the the unborn.
This bill should be passed, immediately and without any amendments.
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It’s time to liberate capital. Of course, the General Assembly won’t do that, because we’re committed to one simple principle right now: austerity. Cut budgets, cut taxes on the rich, and watch the middle class flee the state while the impoverished remain behind.
See, we were facing a pension crisis and we had to tackle that. But the jobs crisis in Rhode Island? Well, we couldn’t possibly be bothered to pass a single bill aimed at alleviating that.
Luckily, Forbes magazine has the answer: single-payer healthcare. It will surprise our readership to discover that even some Republicans oppose the Affordable Health Care for America Act because they are holding out for single-payer.
Why? Because it makes fiscal sense. It’s simply cheaper to let the government cover healthcare than to force every business to pay a percentage of everyone’s ever-greater premium. And this is because, contrary to libertarian thinking, government actually is good for things. Infrastructure, education, utilities, etc.; these are all more affordable and more cost-effective when the government takes care of them than when the private sector does.
This actually isn’t something new. This is really old. We’ve mythologized the New Deal into this story of the Democratic Party under FDR taking drastic steps to establish things like the Works Progress Administration and Social Security. But the reality is that Roosevelt was opposed to large parts of the New Deal, which were enacted by Congress without his direction. Furthermore, Social Security wasn’t created just because some concerned legislators felt bad about poor old people, it was also advocated by rich businessmen who realized that they would have to end up paying pensions to their workers. Social Security acted as a relief, freeing capital up for use elsewhere in the company.
Rhode Island needs to think seriously about establishing a single-payer system of healthcare. Think about all of the costs associated with the current system: ER visits, premiums, the exorbitant cost of any procedure. These are things citizens and small businesses end up paying. Or not, as the situation may be (I’ve met plenty of homeless or formerly homeless folks who ran up so much debt on their healthcare they lost everything). Rhode Islanders will be willing to shoulder the costs of increased progressive income taxes if it means they can visit the hospital without worrying about the cost. The association between the tax increase and the service will be near impossible to break.
What does this mean? More spending. More hiring. More profits. Alternatively, we could decide to let ever greater healthcare costs decimate our small businesses and our people. It’s time to liberate capital. You can call it socialism, but I’ll just call it common sense.
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Rightfully, Sen. Frank Ciccone is emerging as the biggest loser in the incident in which his senate colleague Dominick Ruggerio was arrested for allegedly driving drunk and refusing a breathalyzer. Ciccone is accused of attempting to coerce Barrington police officers to let Ruggerio off by threatening legislative retribution. We’re not sure exactly which is more dangerous to society: inebriated elected officials operating motor vehicles or inebriated elected officials using their positions to gain personal favor. Neither should be taken lightly.
Thank you Gov. Chafee, for declining to give URI professors 3 percent raises at the same time that tuition is going up 9.5 percent. (I’m sure to hear from an ex-prof or two for this line, but oh well…)
As Providence is asking retirees to take a cut in benefits, the city failed to apply for $1.6 million in federal reimbursement from the Affordable Care Act to help offset these kinds of costs. Remarkably, the Capital City said it asked two health care providers to complete the application for it! I guess the old saying is true: if you want something done right, do it yourself. If you don’t, hire a health care provider.
More bad news for Barry Hinckley’s campaign for Senate. His spokesman John Loughlin has resigned after an erroneous attack on Sheldon Whitehouse’s Buffett Rule bill. No word yet on whether Loughlin will be replaced by Hudson Hinckley, the previous campaign insider to give the candidate some bad press…
Sen. Jack Reed will be at the soon-to-be-operational Wickford Junction train depot this morning, which is slated to start service later this month. The developers of the project have been waiting some 30 years for rail service in North Kingstown.
Please, local media, give us less updates on lottery winners …. after all, lotteries are little more than a “cheap tax on the poor.”
Congrats to President Obama, who now seems guaranteed to get to run against Mitt Romney for re-election. “I’ve yet to meet a single person in the Republican establishment that thinks Mitt Romney is going to win the general election this year,” GOP cheerleader Joe Scarborough said yesterday.
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Antonin Scalia observes in court that the government cannot compel a citizen to purchase broccoli, and the government’s lawyers are Struck Dumb. They clearly do not spend time in my local pub. Every week some bonehead appears there with the “broccoli” canard. And there is a simple answer to that stupid assertion:
The government can bomb Pakistan with drones; the government can declare one man the property of another; the government can intern Japanese citizens; the government can declare a corporation a citizen; the government can tax your income at 99 cents on the dollar; the government can make it OK to shoot unarmed strangers in your neighborhood; the government can declare who is President without regard to the popular vote or to the Constitution.
Yes, Antonin. The government can make you buy broccoli.
I practice law in the trenches with ordinary people for clients. Ask them what the government can make you do. You have to be willfully blind to think our government lacks the power to make you buy broccoli. Willful blindness can, of course, be useful to a Supreme Court justice.
This is how John Locke describes government: Government is the power of coercion, up to death, to compel citizens to act for the common good (2nd Treatise of Civil Government, §3). Your “freedom” is the freedom to elect the government that coerces you—a government for the people or a government for the privileged. That is the beginning and end of your freedom, Judge Scalia.
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Sue Sulham has been caring for developmentally disabled people in the Blackstone Valley for more than 20 years. She makes just $11.20 an hour.
As the sun was setting and temperatures dropped, over seventy workers and supporters took to the sidewalks with illuminated “Yes We Can! $15” signs chanting in both English and Spanish outside 
BVCHC has been expanding recently, capitalizing on the increase in business the health care provider has received under Obamacare. The number of patients served by the company has increased to over 15,000.
