LTE: Supporting single payer in Rhode Island

The following is a letter sent to the RI House Finance Committee by Portsmouth physician Mark Ryan, who submitted it for publication here.

Dear Members of the RI House Finance Committee:

We are writing to ask you to support H 7381, legislation proposing a single payer program that could ensure all Rhode Islanders have affordable, comprehensive heath care coverage. This legislation has been introduced by Representatives Regunberg, Amore, Tanzi, Handy and Almeida and will have a hearing before the Finance Committee. See http://webserver.rilin.state.ri.us/BillText/BillText16/HouseText16/H7381.pdf.

The bill is based on a 2015 Rhode Island-focused study by Professor Gerald Friedman, Chair of the UMass Amherst Economics Department. See the attached report, addendum memo and letter in support of the 2015 version of this proposed legislation. The problems Professor Friedman' identifies include the following:

  • Between 1991 and 2014, health care spending in RI per person rose by over 250% – rising much faster than income – greatly reducing disposable income.
  • Health care is “rationed” under our current multi-payer system, despite the fact that Rhode Islanders already pay enough money to have comprehensive and universal health insurance under a single-payer system.
  • The federal Affordable Care Act (ACA) cannot control rising premiums, co-pays, deductibles and medical costs, nor prevent private insurance companies from continuing to limit available providers and coverage.
  • Fully implemented, the ACA will still leave 4% of Rhode Islanders without insurance – resulting in as many as 116 Rhode Islanders dying unnecessarily from lack of insurance each year.
  • In the United States, 62% of personal bankruptcies were medical cost related and of these, 78% had health insurance at the time of their bankruptcy.

H. 7381 addresses these problems because it will:

  • Save approximately $4000 per resident per year by 2024 and put more money into the Rhode Island economy.
  • Significantly reduce administrative costs (almost $1 billion in the first year) and shift these dollars to actual provision of health care.
  • Decrease provider administrative burdens and allow them to spend more time providing health care.
  • Establish a funding system that is public and progressive.
  • Eliminate health insurance costs and administrative obligations on Rhode Island businesses and make them more competitive and profitable (e.g., in the first year, payroll contributions to a single payer plan would be over $1.2 billion less than current private health insurance premiums).
  • Contain health care costs (reduce administration and control over monopolistic pricing) and save 23% of current expenditures in the first year with larger savings in subsequent years.
  • Create a significant economic stimulus for the state by attracting businesses to and keeping businesses in Rhode Island because of reduced health insurance costs.

The high and increasing costs of health insurance puts an enormous burden on Rhode Island working families and businesses. In every other industrialized nation in the world, a universal comprehensive single payer health insurance solution exists. Although it would be preferable to have a national program and there is significant public support (e.g., HR 676), gridlock in Washington, DC, dictates that action at the state level must also be taken. You should note that the Canadian national single payer system began as a regional program in Saskatchewan.

Given your concern for the financial and health care needs of Rhode Islanders, we urge you to support this bill.

Please let us know by replying to this email (pnhp.ri@gmail.com) if you have any questions, comments or criticisms. We welcome the opportunity to discuss your concerns prior to the hearing. We would also be happy to meet with individuals or groups interested in learning more about single payer. For more information, including significant peer-reviewed research, go to: www.pnhp.org.

Thank you for your time and attention to H 7381.

Yours truly,

J. Mark Ryan, MD, FACP
Chair, Rhode Island Chapter - Physicians for a National Health Program

Howard Rotblat-Walker, PhD
Chair, Rhode Island Chapter - HealthCare-Now

Attachments:
RI Healthcare reform
Effect of RI State Funded Health Plan on Disposable Income
Friedman Testimony, May 26 2015

Want to know "How to Have a Good Day?" Read this book.

HTHAGD_3D.pngThis book should suck. Really. The title clearly over-promises (“How To Have a Good Day,” indeed) and the text attempts three of the most difficult non-fiction high-wire acts: popularizing science without making stupid errors, presenting business advice that doesn’t trigger your bullshit detector, and giving self-help tips that don’t fall off into either banality or featherbrained woo.

Nearly impossible. And yet, somehow, Caroline Webb has pulled it off.

“How to Have a Good Day” is a meticulously documented, step-by-step approach to leveraging contemporary research in cognitive science and behavioral economics to solve the real problems that keep us from being effective — and happy — in our day-to-day jobs and lives. And it’s not aimed at helping you “feel” better, but, rather, outlines a rigorously pragmatic approach to actually *doing* better: analyzing situations more effectively, making better decisions, and communicating with others with empathy and impact.

Every piece of advice comes with a footnoted scientific study — often more than one — buttressing its claims. And Webb, a former partner at a management consulting firm, peppers the text with mini-case studies, anecdotes from business leaders across a wide spectrum of industries that reinforce each of the learnings. Taken together, these present a compelling argument that the advice doesn’t just work in the lab, but in the rubber-meets-the-road environments of the shop floor and the conference room.

Webb opens the book with a section on the science. There are some familiar big ideas (the brain’s two-systems of deliberate thought and automatic or pre-conscious process; the fight-flight-freeze response which can keep us open to discovery or shut us down in defensive threat reaction; and the mind-body loop in which influence can go both ways) which Webb will weave throughout the book. If there is a core theme, it would be that by better understanding how our brain processes the world, we can become aware of and avoid the shortcuts and pitfalls of our unconscious biases and blind spots — and in so doing, increase the odds of our having successful interactions. (And that, often, it can be as simple an act as setting intentions that alerts the brain to the salient features it should be picking out.)

If you’re familiar with cognitive science (or phenomenology) some of this may be sound obvious, but Webb’s skill is in taking these insights and showing throughout the rest of the book how they lead to dysfunction in our everyday lives. We do not directly experience the world, but rather offload much of our administrative processing to sub-conscious systems — and therein lies the problem: we make snap judgements, improperly weight data, and can miss things that are literally right in front of our eyes.

One example Webb uses to demonstrate this kind of inattentional blindness is the famous “gorilla in the basketball game” video (if you’re not familiar, here’s a helpful NPR backgrounder). Webb offers a variety of tested methods for re-focusing our brain’s attention, keeping us in a creative, open state, and engaging the teams around us in ways that help keep them working at their full potential. Hint: It can be as simple as using the “yes…and” familiar to anyone who’s done improv comedy to keep other team members from going into the “amygdala hijack” of defensive mode.

One weird trick I found particularly compelling was harnessing our social brain to solve abstract logic puzzles. Webb uses the example of the Wason selection task, in which you have four cards, showing D, F, 3, and 7, and are asked which cards you would need to turn over to test the truth of the assertion that any card with a “D” on one side must have a “3” on the other. A majority of people get this wrong. But then Webb suggests reframing it in social terms:

“You’re a bartender. You have to make sure that anyone drinking beer in your bar is over twenty-one, or you could lose your license. Each of the cards below represents information about four of your patrons. One side of the card shows what they’re drinking, and the other side of the card shows their (real) age. Which card or cards to you need to turn over to see if the twenty-one-and-over rule is being violated?” The cards are: Beer, Coke, 25, and 16.

Three times as many people get this right, because they’re leveraging their social knowledge. And as Webb points out, we can easily apply this framing to everyday conceptual challenges to provide extra processing power. And that’s just one cherry-picked example. The 300 pages of this book are packed with equally powerful bits of advice.

Webb conveys this all with style and wit, in prose that is at once warm and unpretentious and yet totally at home with the complexities of the evidence she marshals to support her arguments. It is well-written down to the footnotes, and contains two helpful appendices on applying the book’s insights to the two main productivity killers of the business world, meetings and e-mail. I came away with half-a-dozen ideas for things to do differently (some as simple as single-tasking and batching the times I respond to e-mails) and I can virtually guarantee that you’ll find things that will make your days more productive and, yes, happier.

“How to Have a Good Day” by Caroline Webb, from Crown Business. Web site, Facebook. Available on Amazon or IndieBound and many other retailers.

Full disclosure: For several years, I worked with Ms. Webb’s husband, but I have never met her. I purchased the book myself, and received nothing in exchange for this review. One of the advantages of being a freelancer is that I get to pick what I write — if I don’t like a book, I simply don’t review it.

RI Department of State web site gets major revamp

16feb02_sos_site.pngSecretary of State Nellie Gorbea today announced the launch of a redesigned Department of State web site. The new site, created entirely through in-house efforts, offers a straightforward interface that will make it easier for Rhode Islanders to quickly access the information they need.

"As Secretary of State, I've been working to make this office a modern gateway that connects Rhode Islanders and their government," Gorbea said in remarks distributed to local media. "We spoke to a number of different stakeholders and redesigned the website to have a much simpler navigation, to be more user-friendly and make government more accessible overall."

Based on that feedback, the web site is now structured around four key areas:

  • The Business Portal provides a step-by-step process for entrepreneurs and current business owners to start or qualify their business in Rhode Island, along with easy access to the Department's online filing system.
  • The Elections and Voting Portal offers key information for voters and candidates. Users can link directly to the Voter Information Center where registered voters can find their polling place and learn about what's on their local ballot.
  • The Open Government Portal provides access to the Department's searchable databases including lobby tracker, open meetings, and rules and regulations.
  • The Civics and Education Portal highlights the many ways Rhode Islanders can learn about and engage with our state's rich and diverse history.

    In addition, the website offers quick access to services for frequent users such as state and local government agencies, notaries public, and registered lobbyists.
    Users are encouraged to interact with the website at www.sos.ri.gov.

    Editorial note: Written from an RI.gov news release.

Edwards offers bill to broaden campaign finance law

House Majority Whip Jay Edwards (D-70, Tiverton, Portsmouth) has introduced legislation that would increase the accountability of the campaign finance law by clarifying language. The bill will be taken up by the House Judiciary Committee on Wednesday.

“The legislation would extend the power of campaign finance legislation by clarifying which people and groups are obliged to submit campaign finance reports,” said Representative Edwards. “It also extends those provisions to those who campaign for or against financial and charter change referendums.”

The bill (2016-H 7147) would clarify the definition of the term “entity” for purposes of campaign finance as it pertains to advocating for the approval or rejection of any question presented to voters at a financial town meeting, financial town referendum, or local election involving charter amendments. The act would include business entities, political action committees, persons and exempt nonprofits in the definition of an “entity.”

“We made some good advancement two years ago in campaign finance reform,” said Whip Edwards. “But we need to revisit this topic every year to review the laws and make whatever adjustments are necessary to hold all parties accountable. I think this bill is an important one to keep the campaigning of local issues fair for everyone involved.”

The bill, which is cosponsored by Representatives Dennis Canario (D-71, Portsmouth, Tiverton, Little Compton), Mary Duffy Messier (D-62, Pawtucket), Joy Hearn (D-66, Barrington, East Providence) and Minority Leader Brian C. Newberry (R-48, North Smithfield, Burrillville), will be heard by the House Judiciary Committee on Wednesday, Jan. 27, at the rise of the House (about 4:30 p.m.) in Room 205 on the second floor of the State House.

Editorial note: Written from a general assembly news release.

Portsmouth wind turbine disassembly begins (with Rilke quote)

wenn ein Glückliches fällt<

In the tennis courts by the high school, cranes and other heavy equipment are staging to begin the disassembly of Portsmouth's wind turbine. The town has entered into a public-private partnership with a developer replace the current machine, installed in 2009, which suffered a major gearbox failure that took it offline. While it's a good deal for the town, it's still sad to see this device, which went up with such high hopes, coming down.

It reminded me of the last lines of Rainer Maria Rilke's Duino Elegies:

Und wir, die an steigendes  Glück
denken, empfänden die Rührung,
die uns beinah bestürzt,
wenn ein Glückliches fällt.

You can find reasonably good translations online here and here and an idiosyncratic one by Robert Hunter here (For Hunter fans, there's an interview with him that touches on his process).

My Arisia schedule

This weekend, Jan 15-18, the always awesome Arisia science fiction con kicks off at Boston's Westin Waterfront hotel. This four-day event features as guest of honor the inimitable John Scalzi and offers rich, diverse programming for all sf and fantasy tastes. There are multiple tracks with sessions featuring anime, comics, film and video, gaming, science, literature, media, writing and more, plus there's LARPing and filking, an always awesome masquerade, art show, and dealers' room — all with very cool fans in a most congenial space full of cosplay and whimsy.

I'll be on a couple of panels — one on interactive fiction and one on the Terminator franchise, plus I'll be one of the presenters at the Ig Nobel readings, and I'll likely be hanging out in the filk circles late into the evenings. Hope to see you there!

5:30pm Friday
40 Years of Interactive Fiction - Gaming, Panel - 1hr 15min - Alcott (3W)
Since Colossal Cave Adventure’s release in 1976, text adventures and interactive fiction have been an important part of gaming. Now with tools like Twine and Inform 7, the genre is being put into more hands and pushed in new directions. Panelists will look at the text adventures of old and tell us where interactive fiction is going.
John G. McDaid, Caelyn Sandel, Rebecca Slitt, Carolyn VanEseltine

9:30pm Friday
Improbable Research and the Ig Nobel Prizes - Trackless events, Participatory Event - 1hr 30min - Grand CD (1W)
Highlights from Ig Nobel prize-winning studies and patents, presented in dramatic mini-readings by luminaries and experts (in some field). The audience will have an opportunity to ask questions about the research presented—answers will be based on the expertise of the presenters, who may have a different expertise than the researchers.

11:30am Monday
Terminator: Is There any Hope for Salvation? - Media, Panel - 1hr 15min - Marina 4 (2E)
Terminator Genisys was not only a (domestic) box-office bomb, it was a critical failure and a mess of a movie. But the franchise doesn’t have to be terrible; we’re only a few years removed from The Sarah Connor Chronicles, which were as well received as anything since the second movie, and there’s clearly still a ton of potential here. What, if anything, can be done to save this former A-list franchise? What went so horribly wrong with the last two films?
Bob Chipman (m), John G. McDaid, Jennifer Pelland, Santiago Rivas

Linda Finn launches campaign for state rep

16jan08_finn_sm.jpgFormer Democratic state rep Linda Finn announced in a statement to local media today that she is running for State Representative in House District 72, including Middletown and Portsmouth, setting up a rematch against Republican State Rep. Dan Reilly.

“I am running for State Representative because Aquidneck Island needs more effective representation at the State House,” said Finn, who previously represented the district from 2012 to 2014 after years of leadership in community and neighborhood initiatives throughout Aquidneck Island. “Our community faces pressing issues. From securing a fair share of education funding for our schools to working for a competitive regulatory climate where our small businesses can grow and thrive, District 72 deserves an independent advocate who will fight hard for our interests every single day. I am excited to use my experience and passion to be that voice for our district.”

Known as a highly energetic and active legislator during her tenure, Finn advanced many economic development initiatives throughout her previous term. “As a former small business owner, I understand the critical importance of supporting job growth,” she said. “I was proud to work with my colleagues in the General Assembly to pass legislation increasing the size of the enterprise zone in Portsmouth, and I was excited to help establish the Rhode Island Renewable Energy Growth Program, which stimulates economic development through energy diversification.”

Finn also prioritized women’s issues in the State House. “Women remain a small minority in our legislature, and our voices are important,” she said. “As state representative, I worked hard to stand up for the safety and equality of all our citizens. I am proud to have passed legislation prohibiting insurance companies from discriminating against victims of domestic violence, and I am more inspired than ever to be a champion for pay equity in the House of Representatives. If we want independent voices in government, we need to elect independent perspectives that are willing to challenge the General Assembly’s old boys’ club.”

After the 2014 election, Linda Finn continued her advocacy as Vice President of the Rhode Island Coalition Against Gun Violence, leading statewide efforts to pass common sense gun reform. She has also engaged in many local efforts to build the community of Aquidneck Island, from serving on the board of the Aquidneck Island Planning Commission to working as Board Chair of Baby Steps, an early education program for parents and young children. She was past President of the Women’s Resource Center of Newport and Bristol Counties, and a Troop Leader and Service Unit Manager for Girl Scouts of Rhode Island for 9 years.

For more information about the campaign or how to get involved visit ElectLindaFinn.com.

Editorial note: Written with exuberant gusto from a press release.

Rep. Edwards to attend Ag Summit in Denver

House Majority Whip John G. Edwards (D-70, Tiverton, Portsmouth) will be attending the 2016 Legislative Agriculture Chairs Summit in Denver the weekend of January 9.

The summit, sponsored by State Agriculture and Rural Leaders, is designed for legislative leaders with an interest in agriculture and rural policy. The Summit is by invitation only and brings together state and provincial legislators that are passionate about rural communities and the people, the agriculture and the natural resources that fuel those communities.

“I am looking forward to meeting with legislators from other states to discuss and compare policies that address food production, natural resource management and rural development,” said Representative Edwards. “Agriculture continues to become more and more important to Rhode Island every year, and it’s important that our public policy addresses and reflects the latest issues.”

Since 2001, the LAC Summit has been providing a non-partisan educational opportunity for elected state and provincial officials with an interest in agriculture and rural communities to work together, collaborate and create problem-solving partnerships.

In addition to meeting other legislators and hearing from the experts, Representative Edwards will have an opportunity to make site visits to get a glimpse of agricultural endeavors in Colorado. These site visits include a tour of marijuana production and processing facilities, which will give Representative Edwards an opportunity to see firsthand how marijuana production has had an impact on the economy and tax base of Colorado as well as the state’s culture.

Editorial note: Written from a state house news release

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