Interesting article on the rise in disability.
Here in Rhode Island, the littlest state in the nation, we don’t get to say we’re number one very often. But here’s our chance: right now it appears that we’re number one in the country for screwing the public sector worker out of long-term financial security. From the Associated Press:
Despite jeers and the threat of a lawsuit from public workers, Rhode Island lawmakers on Thursday night approved one of the most far-reaching overhauls to a public pension system in the nation.
The proposal is intended to save billions of dollars in future years by backing away from promised benefits to state and municipal workers in the state-run pension plan. Lawmakers called Thursday’s vote one of the most wrenching they’ve had to cast, though the fight may not be over if unions follow through with promised lawsuits.
When I look around the street I live on, which is a modest street in its home values, I see a lot of my neighbors who are going to be impacted by this. The cumulative loss of the additional cost-of-living increase might well cost some of these individuals their homes someday. These are teachers, administrative workers, and security workers for the state, just to name a few.
Treasurer Raimondo’s response for why EngageRI, the organization that supports her agenda, does not need to disclose its financial backers is because pension reform “benefits everyone.” This is just a bald-faced lie. A large percentage of our state’s workers just lost a big piece of long-term income security. They are now going to have to clamp down on spending and save more to fund their own retirements. These are people who will not be able to give to nonprofits or support that local band fundraiser or go out to eat but once in a blue moon to save the extra money.
If we want to benefit everyone, we need to take from those who have too much. The “too much” line in my mind gets drawn when we are talking millions and billions in income and assets. When enough people finally realize what is going on and the top 5% start to pay their share again, we might have enough money to rebuild our country. But by then, we may be too far gone.
It was morning in America until Barack Obama was elected, right? Dave Johnson at Campaign for America’s Future addresses the collective amnesia.
But here is some reality anyway, even if we’re not supposed to see it. Just ten years ago we were paying off debt at a rate that would have completely paid it all off by now. But under George W. Bush we cut taxes for the rich and more than doubled military spending. We deregulated and stopped enforcing laws. We let the big corporations run rampant. Our federal budget turned from huge surpluses to massive deficits, and Bush said it was “incredibly positive news” because it would lead to a debt crisis they could use to shock people into letting the corporate right privatize and thereby profit.
And then, under and because of Bush, our economy collapsed.
I see the Republicans lacking a leader with the decency to stand against the most crazy superstitions of their right wing– the Birthers, the privatizing profiteers and the Ayn Rand disciples who claim that paying taxes to your own country and local government is the equivalent of rape and slavery– though they’ll keep the clean water, paved roads and Medicare, thank you. If the blinkered and callous statements about the uninsured is any indicator– ‘they can just go to the emergency room’- these people are not only ignorant but happy and complacent in their ignorance.
I see the Democrats lacking the vision and daring to bring a 21st Century New Deal to the American people. They, like the Republicans, are caught in a system where fundraising takes precedence over governing. The Supreme Court decision that money is a form of free speech was one of the worst setbacks to Democracy we have seen in our history. If you want to burn down a house, or level a playing field, or start fresh– look at campaign finance. Our politicians, most of them, are more to be pitied than censured. Save them from selling themselves on the streets!
Our President, Barack Obama, is a decent, smart, principled man. He is leading in a time of crisis. I think he is looking ahead, and what he sees is something neither party will find conducive to their political narratives.
We have seven billion people on this planet. In the developed nations, people are blessed to live to advanced age. This brings us a graying population and new challenges. Medicare is one of the best solutions we have, along with the Veterans Administration, and should not be cut, but strengthened and expanded. However, ‘hands off Medicare’ is not realistic. The salvation of health care is constant assessment of what works and what doesn’t. Barack Obama’s disclosure that his grandmother had a hip replacement that did not gain her health or comfort reflects the uncertainties and hard choices I see every day in elder care. But when I attended Town Hall meetings about health care reform, I found myself staring down some guys who were holding a sign that said, ‘Obama Lies-Grandma Dies’. This is not only a vicious slur against a politician who disclosed a real truth about his actual family–it was a slur against health professionals. I mean, we nurses are all supposedly jonesing for a seat on the ‘death panels’. I wish more of our politicians knew how much hard labor it takes to keep a totally disabled person in comfort and dignity. Many ordinary Americans know, because we are caring for our families.
Health care rationing? We have had it from day one. Health is rationed out to the rich, always has been. Look at the stats. Race being less a mark of heredity than a marker of caste in our very mixed nation– you see that health is distributed unequally. This matches unequal access.
But I think using ‘rationing’ as a scare word veils the truth. We have to decide how much of our national wealth will go to health care rather than other legitimate needs, such as education and infrastructure. Throwing money at Grandma will make some medical providers rich, but won’t necessarily make her healthier or happier. We have to fund research that will question accepted treatments and judge the outcomes so that we can avoid wasting money on dead ends– treatments that are painful and do more harm than good. A national health program like Medicare will always be ‘hands on’.
Another reality we are facing is peak oil. ‘Drill Baby, Drill’ gets harder when we run out of areas where rich people won’t be inconvenienced. Worldwide the demand for fossil fuels is getting harder to fill without political and environmental damage. George Bush famously said that history doesn’t matter, because we’ll all be dead. Others believe in The Rapture. The vast majority of us, though, do think about what we will leave to our children. We can’t honestly promise an endless future of increasing consumption because physics doesn’t work that way. So what do we do? This ‘austerity’ will be working its way up from the people who are ‘used to it’ sooner rather than later. If we care about the future we have to invest in damage control today.
I hope that President Obama will get out of the middle of the road. As a former presidential candidate, Fred Harris, said, ‘The middle of the road has nothing but yellow stripes and dead armadillos.’
If Barack Obama is, as I believe, a good president in bad times, he needs our vocal support for his best ideas. If he is, as some of his critics say, just another politician– then we have to hold his feet to the fire.
Some are saying that a President Romney would galvanize the opposition and swing the pendulum to a new resurgence of the left. As I recollect the Reagan years, it doesn’t necessarily work that way. And after eight years of George Bush we are darn tired of holding signs in the rain and snow.
The time to organize is now. I’m not surrendering, and I’m not staying home on election day. The Bush administration drilled holes in the ship of state before handing it over, disaster capitalism has salvage profiteers ready. This is a mess, but if you blame the last two years of President Obama, you have to forget the previous eight when George Bush turned peace and surplus into war and deficit. That being said, it’s President Obama’s watch now. Our president and party need to offer the American people a New Deal.
AARP released a statement about the newly passed legislation on the debt ceiling. While in the first two paragraphs, it’s clear they are trying to be nice, by the third paragraph, they are getting down to business about what is wrong with this legislation. From the statement:
“We are relieved that Congress has acted on a bipartisan agreement to address the debt ceiling and prevent default to ensure that seniors will continue to receive their Social Security checks and have access to health care. We are also gratified that after hearing from millions of AARP members, the President and Congress did not cut Social Security, Medicare and long-term care in the first round of deficit reduction.
“Going forward, we are pleased that Social Security, Medicaid and Medicare benefits are protected if the so-called “super committee” fails to reach an agreement later this fall, but we will remain vigilant in our efforts to protect the health and retirement security of seniors and future retirees. We are concerned that a fast-track committee process will deny Americans a voice in the discussion about critical tax, health and retirement issues. We also are concerned about the potential use of a trigger that would arbitrarily cut provider payments under Medicare, which could unfairly shift costs to seniors.
“Seniors have worked their entire lives to achieve a level of health and economic security in retirement. As the deficit debate continues, AARP will continue to impress upon Congress the need to protect Medicare and Social Security from harmful cuts. With the compounded effect of loss of retirement savings and home equity, high unemployment and rising health care costs, cuts to the benefits seniors have earned could undermine the standard of living of not just those with limited incomes, but middle class seniors who have median incomes of only $18,500.
“AARP will continue to raise the voices of millions of Americans who rely on their Social Security and Medicare benefits and oppose benefit cuts for deficit reduction. Americans want a broader conversation around health and economic security, not one focused solely on deficit reduction.
“AARP believes that the American public deserves a seat at the table in any forum, including the newly created super committee, that discusses potential changes to these critical programs. We believe that our nation’s leaders should work together to strengthen health and retirement security for current and future generations.”
Who is going to be on this “Super Committee”? Is this “Super Committee” going to supplant Congress? How many seats on the Super Committee are going to be reserved for the already-super-influential corporations?
Great news for the Rhode Island Center for Law and Public Policy — they have received a $2,000 grant from the City of Cranston to support their legal services clinics at the Cranston Senior Center. RICLAPP is also holding an event on accessing medicaid with panelists including Elizabeth Roberts and Warwick Mayor Scott Avedisian:
Are You Or A Loved One Confused About the Medicaid System?
Come Gather Useful Information and Have Your Questions Answered at the Senior Seminar
Understanding Medicaid and the New Global Waiver
Date: April 14, 2010
Time: 12:30 – 2:30
Place: Pilgrim Senior Center
27 Pilgrim Parkway
Warwick, RI 02888
Panel of Experts:
Elizabeth Roberts, Lieutenant Governor
Scott Avedisian, Mayor of Warwick
Corinne Calise Russo, Director of the RI Department of Elderly Affairs
Kathleen Connell, State Director of AARP
Light Refreshments Will Be Served
It’s nice to be part of an organization that is having so much success at bringing important events to the community. I hope you will join us on April 14th for the event at the Pilgrim Senior Center.
Geoff Schoos, columnist for the Cranston Herald and President of the Rhode Island Center for Law and Public Policy sends along some great information on what it’s like to be low-income and insured in the United States:
In the midst of the health care “debate,” the lives of real people often get ignored or summarily discarded. Clearly, during the August of our discontent, allegations and accusations were made only to instill fear and further political agendas. This has been repeatedly demonstrated through the conduct of some participants at Town Hall meetings and the statements by such “leaders” as Sarah Palin.
Palin’s widely publicized term “death panels” inflamed the fear felt by many of our elder citizens. It was a lie then and continues to be a lie today. Making the lie worse is the fact that people promoting it know that it’s a lie. The reason for the lie, aside from instilling fear, is to distract attention from real proposals to address a real public policy problem. However distracting, lies must be addressed. Thus my August 19 column in the Cranston Herald.
On September 3, Beacon Communications published an op-ed piece from Professor Victor Morawski. I won’t even attempt to describe this particular slander. I’ll let the Professor speak for himself.
As this slander was published on my birthday, and as a contributor to Beacon Publications, I refused to let this op-ed piece stand unchallenged. Thus, this was published on September 10.
Last Wednesday, President Obama addressed both chambers of Congress and the American people to outline his principles and goals for national health insurance. As we all know, the toxicity of the last months has seeped into the most sacred of our institutions when South Carolina Congressman Joe Wilson loudly called President Obama a liar.
The next day, ABC6 called my office to elicit a response on the whole health care debate. We met at noon on the Warwick City Hall steps for a 15 minute interview. Although we spoke of many health reform topics such as private option, competition, expanded access and various economic benefits that reform can have, the focus was on the venomous discussion of health care.
One hour after the taping of that interview, I met a new client. He came to me with a variety of issues, mostly concerning his economic situation. As we delved into his issue, I asked about his expenses. He and his wife are senior citizens. The have only their monthly social security on which to live. They reside in subsidized housing.
At the conclusion of our initial interview, it became apparent that the cost of their health care consumed a significant amount of their monthly income. When the rent is paid, their disposable monthly income is approximately $ 690 per month. Out of that amount, they pay another $ 96.40 for their Plan B Medicare coverage. Additionally, they pay another $ 35.00 per month for Medigap insurance.
Since both suffer from serious medical conditions, they pay approximately $ 50.00 on co-payments for doctor’s visits. In order to control the costs of co-pays, they schedule doctor visits so that they have no more than two per month. For example, the wife, who suffers from cancer, must schedule appointments with the radiologist and the oncologist so that they don’t coincide on the same month. Otherwise, the husband, who suffers from heart disease, would need to reschedule his visit to the cardiologist. Somewhere in the mix they have to schedule visits to their primary care physicians.
Add to the above is their payment for mostly generic prescription medications. Add $ 50.00 per month in co-pays. The total payments for health related expenses, without any dire emergency situation, amount to $ 231.40. That’s out of a disposable income of about $ 690.00 per month. Put another way, that comes to 33.5% spent on health care. And that’s a normal month after juggling their access to health services in order to keep costs down.
While this isn’t the worst case I’ve seen over the last year, it is representative of what too many of our neighbors are going through. And they’re lucky. Although they do have access to health care, albeit limited, they are better off than the 11% of our fellow Rhode Islanders who have no health insurance at all.
Thus, as the discussion, evaluation, and debate on health care takes place over the next few months, we would all do well to remember those like my clients and the thousands locally and the millions nationally who share their predicament. In the end, when the sound and the fury have subsided, when the sloganeering has ended, and when the smoke has cleared, this is about the real lives of real people who through no fault of their own, struggle to survive in an increasingly complex and uncaring system.
Hospital nurse slang. You work in the units–high tech like operating room or Intensive Care– or on the floors. That’s Med-surg, general nursing. I’ve always worked on the floors, nursing home long-term-care or rehab, and later in home care.
I took my first job in health care, as a nurse’s aid, in 1984. The place I worked closed down following an incident involving a hot tub that Rhode Islanders still talk about. At the time nurses aides were not certified, we got on the job training.
This was before advance directives, DNR, Hospice and end of life issues were discussed. Our instructions were to make sure that each patient ate enough to satisfy the state regulations whether they wanted to or not. If this was not force-feeding, I don’t know what else to call it. We nagged, cajoled, tricked and forced unwilling, unhungry elderly people to swallow enough cc’s of mush to meet the regs. We have comfort care now, we had discomfort care then.
And no one was allowed to fall. That would be neglect. The charge nurse made it easy. “Posey that patient!” I can still hear her say. A ‘Posey’ is a vest with strings for tying people to beds and chairs. I haven’t seen one in years. But in those days all the patients who had not the wit to escape into their rooms were tied to chairs for the shift.
The nurses were miserable souls. They sat smoking in their nurses station, looking idle from my perspective. Nurses aides do the hands on, difficult, never enough time work. It’s no picnic on the other side of the desk, though, passing meds to 20 people with no margin for error, treating wounds, assessing condition, calling doctors, writing notes. Always knowing that the care you are able to give is far short of what you would want for yourself or your loved ones.
It was about as homelike as a mill. But the first day I saw some things clear as day.
It’s not true or fair to assume that families dump their loved ones in nursing homes because they don’t care. You see the whole range of family dynamics, but there are many who visit daily for hours, very devoted families and friends. Also, it’s not fair to blame the nursing home for all the suffering that occurs there. The illness itself is the worst villain. This nursing home–and it was a lousy one, had patients who were doing just fine. They were the ones who were well enough to get up, walk to the bathroom, dress themselves and eat. They could sit outside smoking, or walk across the street and buy stuff that wasn’t allowed on their diet. For them the nursing home functioned as an assisted living. The staff had quite enough helpless patients on their hands and had no agenda to make anyone more disabled than they had to be. On the other hand, there wasn’t much rehabilitation. Helping someone to regain function takes time, which we never had enough of.
I didn’t stay at that job for long. The pay was minimum wage. I moved to a couple of other places and began to temp. I started to see patients on feeding tubes.
I was sent to a place that has changed hands a few times since I worked there. It’s a place that was built to serve a community, and financed with their donations, and mismanaged. I thought it resembled Dante’s circles of Hell, with the highest floor being the most damned. That’s where I took care of a tiny, emaciated woman on a feeding tube who screamed nonstop. “Don’t worry”, I was told, “She does that all the time.” Other ancient people were unresponsive, or in a world of their own. I was careful to get the nurse if I had to have the feeding stopped to change the patients, but there was an incident I heard about after I’d stopped working there, where an aide mixed up some tubes and ran liquid nutrition into a patient’s lungs, or at least that’s what I think happened. Bad stuff.
I kept returning to health care from other kinds of work, there were always jobs and they were interesting. I was sent to temp in a hospital. It was the night shift, and the patient was a man dying of cancer. He had been sleeping all shift, but when I walked into his room for a last check, he sighed and ceased breathing. I did what I was supposed to do–tell the nurse. She did what she was supposed to do, call a code. He was pounded back into life and lasted a few more weeks in intensive care. I don’t know if it would have been better if I’d not walked in and he’d died in his sleep, I knew nothing about him or his family. But if there is no ‘do not rescusitate’ order then everything will be done. I’ve talked to lots of people who were coded and brought back, so if there is a fair chance of recovery it’s worth it.
Later, as an EMT, I participated in codes that made no sense. These were dying, unconscious, elderly people shipped into the ER from nursing homes. There was no DNR in their record and no one was going to take the rap for failing to do everything possible. So the patients were sent in by rescue for a futile round of CPR, defibrillation, intubation and IV’s. It’s a shame that end of life care was not discussed more, because what’s a lifesaving treatment for someone who has a chance of recovery is senseless violation for someone who is dying a natural death. I’m glad that my grandmother who died in a nursing home was allowed to stay in her bed, surrounded by her family, in peace and dignity.
Working as a nurse in a nursing home I had to cope with people who ripped their tubes out. This was not temporary delirium. These were people who were stroke survivors. One had relatives who decided to have the tube placed. They never visited. Another had to have her hands restrained. She had no relatives to make the decision for her, so the tube stayed. She was too demented for her actions to count as an expression of her wishes. I saw a man who was put on a feeding tube in his last days and passed green bile. His digestion must not have been working anymore, he didn’t live long. I saw people who did live a long time, unable to move or speak, seeing a familiar face maybe once a week for an hour. I think I’ve seen enough to say I would not want this for me or my loved ones. There are fates that seem worse than death.
I had the privilege of removing a feeding tube from a woman who had recovered enough to eat normally. It’s just a device, one that can be lifesaving and health-restoring. But at end of life we run up against a question–just because we can do it, should we do it? Is it always right to keep someone alive for a few days or weeks regardless of what they said they would want, regardless of their condition?
I worked on the floors before there was Hospice, and I saw patients die under florescent lights with the TV blasting, lie in a bed staring at the ceiling, mute, with a tube in their stomach, pushed to take food and meds that they spit out or let run out of their mouths. This is one reason people fear nursing homes.
The Terry Schiavo case never became the Republican recruiting tool it was supposed to be. Too many people have seen what their relatives went through in their last days. People who can’t ever imagine themselves having or condoning an abortion can all too easily imagine themselves helpless in a bed while politicians cut off all options for refusing care.
I think that a lot of the push for feeding tubes and interfering with dying was helped along by the profit motive. Good reimbursement.
Natural death is not always peaceful. It can be awful. It is a process. Interfering with the process does not ease suffering. It’s better to put our energy into extending good quality of life, as the patient defines it, and easing pain.
I was working in the community and a patient of another agency, a young woman with terminal cancer, died in her apartment. A nurse who had talked to the woman’s mother dropped an implication to me that the Hospice nurse had intentionally overdosed the patient. Easy to say, hard to forget. I can’t blame the mother for raging against an intolerable loss, but I wonder at the nurse who had the Hospice nurse accused and convicted in her mind and spread such slander. I myself once was preparing a dose of pain medication for a dying woman when she suddenly passed. The family was inconsolable. Would they have blamed me if I had given the med a few minutes earlier?
The kind of language going around, comparing health care reformers to Nazis, claiming that the elderly are being euthanized, is a slur not only on politicians but on health care workers. We see the reality. We see the uncertainty. It’s a slur on families who ask that their loved ones be given pain relief and not be forced to take treatments that they don’t want.
It’s one thing to sit and write about mortality, it’s a different thing to be of an age where you know your time is short. I am always impressed by the courage of old people, and the equanimity. They talk quite frankly about death. Everyone is different, some want everything done, some fear pain and loss of independence the most.
A health plan that pays for a consultation with their doctor, to discuss end of life treatment is a benefit. It’s better to listen to the elderly and let them make their wishes known.
On Monday, June 15, 2009, the Rhode Island Center for Law and Public Policy (riclapp.org) officially opened its doors. Pictured above is the Chairman of the Board, Dr. Herbert Brennan, Warwick Mayor Scott Avedisian, RICLAPP President Geoff Schoos, and Community Outreach Director Jeannine Schoos. The picture was taken by the Warwick Beacon, which has a news article on the opening here.
As a Board member for RICLAPP, I am very proud of the organization’s developing capabilities. Lawyers tend to be something only the rich have at their disposal in this country. RICLAPP seeks to do something about that disparity, helping middle and lower income folks fight back when they are wronged. Something as simple as not being paid for work you have done as a contractor, RICLAPP can help you resolve. People of all ages can also benefit from the services at RICLAPP to have a will drawn up, or to get help with the legal aspects of starting a new business. These are just a few of the ways RICLAPP is making a difference for Rhode Islanders in need of legal help.
You can learn more about RICLAPP by visiting their website at www.riclapp.org. We are planning a fundraiser for August 1st. Anyone who wants to be invited, please let me know.
Geoff Schoos has an excellent column this week about Governor Carcieri’s budget and the many ways he is throwing middle class and needy people under the bus. From the Cranston Herald:
“This is like déjà vu all over again.”
-Yogi Berra, New York Yankees great
As anyone who knows me will attest, quoting anything uttered by a current or former Yankees player pains me greatly. However, I like Yogi and thus will give him a pass. Besides, his quote is apropos to the fiscal year 2010 state budget introduced by the governor.
Let’s start with the filing fiasco. It seems that the governor couldn’t find anyone in the General Assembly who would properly file the budget bill on his behalf. According to House Minority Leader Watson, all the Republican representatives were opposed to the budget “on principle.” The Republican legislators were outraged that the governor’s proposed budget contained tax increases. More about those tax increases later.
Thus, the governor was left to his own devices as to the submission of his budget. Someone from his office hand-carried a copy of the budget bill to House Speaker Murphy’s office, where it apparently rested untouched. Thereafter, the question arose as to whether the bill had been properly submitted to the General Assembly. The consensus was that the governor’s delivery was, in fact, improper.
Finally, after standing tall on principle for about 24 hours, the entire House Republican caucus sponsored/co-sponsored the governor’s budget bill. Does that mean that they were against it before they were for it?
You just have to love Rhode Island political theater. It combines the best elements of comedy and tragedy, often at the same time. To continue with the comedic part of this theater, two days after the budget was filed, the governor retracted the revocation of a tax credit for businesses that provided dollars to private and parochial schools. As a result of pressure from the Catholic Diocese as well as communications organized by the Rhode Island Scholarship Alliance, enough pressure was placed on the governor to reconsider his position on this matter. Apparently, he was in favor of the tax credit before he revoked it and then changed his mind and reinstated the credit.
So far, this puts me in mind of another Yogi-ism: “When you come to a fork in the road, take it.”
As comedic as the back-story of the budget is, there’s nothing funny about its contents. Indeed, this is pure tragedy. In the interests of full disclosure, I haven’t read everything, but I’ve read enough to form some opinions.
Every budget rests on a set of assumptions. Without going into detail about all the assumptions contained in the 198-page executive summary that accompanied the governor’s 224-page budget, one assumption leapt out at me. On page 21 of the summary, based on calculations by the Consensus Revenue Estimating Conference, which in turn relies on forecasts from Moody’s economy.com and Global Insight, the unemployment rate for fiscal year 2009 is predicted to be 8.8 percent and rise to 9.3 percent in fiscal year 2010.
What? I understand that these forecasts and estimates were formulated last November, but doesn’t anyone read a newspaper or read the monthly reports from the Department of Labor and Training? As it stands now, in fiscal year 2009, the unemployment rate is 1.5 percent greater than the estimated rate.
Indeed, the unemployment rate is higher than the increased unemployment rate projected for fiscal year 2010!
I think this is important. It’s not that the REC got the estimate wrong. That’s to be expected, given the speed with which the economy tanked. Rather, it’s that nobody ever returned to these assumptions to make the necessary corrections.
Clearly, an economic model was in place. All anyone had to do is input the new, real numbers and press the calculate button. That would have spit out a more accurate, but no doubt less desirable result.
Why is this assumption critical? Because so much of the budget hinges on the assumption of how many employed and unemployed Rhode Islanders we have. For example, in trying to estimate state revenues derived from individuals, which constitutes about 32 percent of all state revenues, there has to be an estimated level of personal income growth. If those estimates of income growth are based on unrealistic numbers of unemployed workers, then those estimates – critical to calculating the projected state revenues from individual taxpayers – are bogus. And if those estimates are bogus, then a significant portion of the budget is wrong.
In addition to sloppy calculations, once again the governor has proposed a budget that disproportionately weighs more heavily on the poor, the elderly and the middle-class. Thirty-eight thousand low-income Rhode Islanders are going to lose dental care under this budget. The governor asserts that this is an optional benefit under the state Medicaid plan, thus the state can eliminate it.
No matter that proper dental hygiene is critical to overall health maintenance.
Add to that the 25,000 elderly Rhode Islanders who will be adversely affected by the elimination of the Pharmaceutical Assistance to the Elderly Program. It’s a fair assumption that these medications are vital to their health and well-being.
Finally, approximately 110,000 Rhode Islanders will pay an estimated $1,200 more in income taxes next year than they did this year. The vast majority of these selected taxpayers are individuals and families that earned less than $75,000 annually. This is in addition to the higher tax on cigarettes and significantly increased fees that fall more heavily on those with lower incomes.
Compare their plight with those who earn $175,000 or more. Their income tax rate will drop from a flat rate of approximately 7 percent this year to 5.5 percent next year. This decrease will continue until it bottoms out at 3.5 percent in a couple of years. Additionally, the corporate tax will be phased out completely by 2014, thus leaving an $82 million hole in the budget.
Here’s a non-Yogi-ism – the rich get richer, the poor get screwed and the middle-class gets the bill. Apart from faulty assumptions and fuzzy math, how did the governor’s magicians balance this budget scheme? Simple – the American Reinvestment and Recovery Act of 2009. On Feb. 26, the governor certified to President Obama that Rhode Island would use these funds to create jobs and promote economic recovery.
Yet two weeks later, the governor submitted a budget that promotes significant tax cuts and pays for them with “stimulus” money. Instead of reinstating the pharmaceutical program for seniors, as Florida did its Medicaid Aged and Disabled program for 13,000 seniors, the governor kept the cuts and passed the savings on to high-income taxpayers and corporations. His argument is that lower taxes will promote long-term economic growth.
This “build it and they will come” economic theory is based on a movie, not reality. And it violates the intent, if not the letter of the stimulus law.
Stimulus money is to be put in the pockets of people through short-term, shovel-ready projects; longer-term infrastructure projects (like broadband, etc.) that will promote continued economic growth, along with investments in health and public education.
Instead, we have reductions in health programs, status quo financing (if that) of public schools and, in spite of the purpose of the stimulus money, an increased tax burden on the middle class. All while high-income taxpayers skate home scot-free.
It is déjà vu all over again.
Does this upset you? If so, I would strongly recommend you contact our Cranston Representative Bob Jacquard, who sits on the General Assembly finance committee, and talk to him about why we are subsidizing high income earners while old men and women are going to suffer with broken and infected teeth or else pay out of pocket with their grocery money to get their teeth fixed. Rep. Jacquard’s email address is: firstname.lastname@example.org.
Being in the middle of starting my own private practice office here in Cranston, I have not had much time lately to devote to blogging. Therefore, I am honored to have a guest blog post on Governor Carcieri’s budget from Carville, a frequent commenter here on Kmareka and a thoughtful analyst of Rhode Island social and economic issues. From Carville:
I would like to thank Kmareka for allowing me to post on this issue. On January 7, the Governor took the unprecedented (for him) step of addressing Rhode Islander’s regarding the economic crisis the state faces and his proposals to resolve, or at least mitigate, that crisis.
Below are links to the Governor’s Supplemental Budget legislation and video of his speech (in case you didn’t see it).
Here’s my take. Call it my dirty dozen.
First, in the abstract, a statewide health plan for public school employees might be a good idea. At the very least, it takes the health issue off negotiating tables and may stabilize costs. However, this plan isn’t in the abstract. According to the Governor’s bill, health care is no longer a subject of collective bargaining. Instead, a Healthcare Advisory Council will determine provider, coverage and rates, with the employee’s co-share set at a minimum of 25% of premium. Under the provisions contained in this bill, savings won’t come from a superior negotiating position. Rather, savings will come from gutting the coverage and unilaterally increasing co-shares.
Second, the creation of the “Rhode Island School Realignment Commission” could be (stress could be) meritorious. However, this is not a plan thought out on its merits, but out of financial “necessity”. The driver’s all wrong and the timing couldn’t be worse. It’s not the most prudent approach to raise the specter of sweeping educational changes without laying a proper foundation. This new five-member Commission will be charged with developing plans and legislation for a mandatory vote by the General Assembly. As always, the devil is in the details.
I hope someone in the Governor’s administration was paying attention in the late ’60s when regionalization was first proposed. If the “realignment” is broken down by county as he indicated in his speech, there could be a problem. That was the prescription of the old Thibeault Report (Education in Rhode Island: A Plan for the Future – June 1968), which went nowhere. Why? Politics and money. The local politics was and remains that no municipality wants to lose local power over schools. It’s a New England thing I guess. The money issue is who pays, where does locally raised tax money go, and what kid goes to which school? Added to that, in the combination of services (from Administration through clerical and purchasing) who wins and who loses? This is a zero sum game no matter how it’s cut. Finally, the member of the Cranston delegation who would support a regionalization plan combining Cranston with Providence on a county regionalization basis is already on political life-support.
In short, these collaborative/regionalization proposals sound good and are proposed to please the masses. However, in the end, it’s all smoke and mirrors with no chance of success without real leadership from the Executive branch. And when was the last time you saw that?
Third, the Governor proposes to balance the budget partially on the backs of the Station survivors and families. I can’t decide if this is more tragic than obscene or vice-versa. Oh yeah. This is a one-time deferral — until the next time, which will probably be next year.
Fourth, the Governor’s supplemental already contains a $ 27 million deficit on the anticipated Medicaid payments from the Fed. The Congress has to vote on that and then the allocation needs to be made. Any bets on how correct that projection is? Remember, $ 67 million of the current deficit is related to not realizing the “savings” accrued from the Medicaid Global Waiver/Death Star because his administration dithered with the application.
Fifth, based on prior reporting, the state executive offices, including the Governor’s office, are bleeding money. Surprised there was no mention of that or a recognition that everyone is to blame — including the Governor and his crack management staff.
A Kmareka Pop Quiz: Who was the only state officer who not only didn’t have his budget cut in the Supplemental, but gained additional money?
Sixth, while touting the fact of no “broad-based” tax increase, he conveniently didn’t mention, or if he did he ran by it quickly, the increase in registry fees that many of us will pay. This will have a greater impact on lower-income people than those who live in the Governor’s neighborhood. Fees tend to be regressive like that.
Seventh, I don’t smoke, so the extra buck a pack doesn’t bother me. But, again this tax falls more heavily on the poor than others. But, hey, we’re still cheaper than Massachusetts. I know that it’s a “personal choice” to smoke and people who do (just like those unwed teen mothers the Governor spoke about a couple of months ago) make “bad choices.” So, is any of this money going to smoking cessation programs? No. Why not? Because it’s now public tax policy to keep people smoking so that we can collect an extra buck a pack.
Also, if you are a small business owner selling cigarettes, your inventory tax is going to increase as well.
Eighth, the reduction of aid to cities/towns. Again, a bomb in the middle of their budgets and not a thought-out plan for reform. In effect, he did what the Daily News headlined when Ford was President — Ford to NYC: Drop Dead. Do the contracts need reform? Sure. But it must be done in an orderly process as part of a longer-term reform effort, not like some Laffey-like gunslinger shooting up the towns (and cities).
As an aside, since this impacts education, I recall the Governor stating that his Supplemental reduced aid to cities and towns by 6%. In fact, it’s 9% in aid to education. This from someone who once wanted to be known as the “Education Governor.”
Ninth, related to eighth, the whole pension argument is sheer sophistry. The shift away from a defined benefit to a defined contribution pension plan is horrible. Don’t think so? Look at your 401(k) and see what you’ve lost. And linking his proposals as equal to the best in the private sector is ridiculous. The private sector just isn’t that good anymore – period. That’s even assuming that there’s any pension plans left as many corporations took the money previously dedicated to those plans and plowed them into stock dividends and CEO bonuses/golden parachutes. In short, like Bush, the Governor’s trying to privatize what used to be a public good.
Tenth, he set up a “straw man” toward the end by claiming that some want tax increases. Then he heroically opposed any mention of “broad-based tax increases” or an increase in the sales tax and corporation taxes. With this sleight-of-hand, he removes from the discussion the tax breaks for high-income earners passed in 2006 along with reductions in capital gains taxes. These breaks have cost the state millions and have no doubt contributed to the current mess we’re in. I’m not a “soak the rich” person, but we should all share the burden and we’re not. Not only does his position make no sense economically (in that there’s no return on these tax expenditures) but it is fundamentally unfair to have some people, many of whom are already struggling, carry the burden for those who could more easily contribute to the solution. This policy of cutting taxes indiscriminately to grow the economy is just like A Field of Dreams – it’s fiction. Targeted tax cuts based on an economic model forecasting returns on that investment are appropriate and even desirable. But this shotgun approach to lower taxes is economic and ideological blather. It hasn’t worked on the federal level and it’s not going to work at the state-level no matter how much the Governor beats that drum.
Eleventh, he could have done something with corporate taxes that wouldn’t have any impact on the small “mom and pop” corporations that pay the minimum tax each year. For example, if he even considered fundamental fairness at all, he could have proposed legislation for “combined reporting”, which would require multi-state corporations to determine their tax liability in the state. As of 2007, 20 of our sister states (including New York) have a combined reporting requirement. And in 2007, even that paragon of virtue to our north, Massachusetts, was considering such a plan. There’s no reason why we should let The Gap make a ton of money in Rhode Island and get away scot-free or tax free. Burdens should be shared equally.
Twelfth, Rhode Island’s vaunted “safety net.” In his speech, the Governor omitted Article 30 of the Supplemental. This Article would omit any family or child from medical assistance if the combined value of child’s and/or family’s liquid resources exceeds $ 10,000. Indiscriminately and unilaterally, we’re kicking those folk off because they have (gasp!) a bank account So, let’s see if I’ve got this new theory of a “safety net” down. You get laid-off from your job (not an unusual occurrence given figures released by the state), have little to no money coming in, can’t make the mortgage payments so you’re likely over time to be foreclosed on (thus rendered homeless) and now you lose health insurance because you have modest “liquid” assets? Too bad, you lose! Would that the working citizens of Rhode Island had the same “safety net” as corporations and those high-income citizens that are protected by this administration.
Finally, again regarding the “safety net” that the Governor so vigilantly guards, I give you the new Medicaid Global Waiver. Like so many proposals coming from the Governor, this waiver is driven by the bottom line and not by a desire to deliver better services to people in need. While he may argue that he won’t deny anyone in need of assistance, the Governor and his staff should go back and read the plan’s application. The application for the Global Waiver specifically states that all but those most critically in need (defined as those who, under the new plan, will require nursing home placement) will receive assistance and services if funds are available. That’s not exactly the iron-clad guarantee of services that the Governor made in his speech.
In the end, the Governor’s speech was vintage stuff. Bash public employees, use tax policy as a wedge issue between taxpayers and public servants, raise broad-based “fees”, weaken the safety net, and protect the rich and powerful on some quaint notion of tax policy and free market capitalism that would probably make Adam Smith puke (sorry for the J.D. Salinger allusion).
Instead of a plan, the Governor offered an anti-government screed. This week, when real leadership was needed, the Governor came up pretty small.
Thank you, Carville, for bringing up all of these important issues about the Governor’s budget. The months ahead give us the opportunity to address the problems with this budget and hopefully work out some successful solutions.