Archive for April, 2021

A Day For Gloating!

Tuesday, April 27th, 2021

In early 2003, I was honored to be part of a group that wanted to bring better health care to some of the neediest citizens of the Commonwealth of Massachusetts. Dr. Bob Master, former Commissioner of the state’s Medicaid program, had the idea that if a number of us put our collective heads together we could actually do that. With him leading the effort, we created Commonwealth Care Alliance (CCA), an HMO dedicated to serving people who were dually eligible for both Medicare and Medicaid. These were the Commonwealth’s sickest of the sick and poorest of the poor. Paradoxically, their health care was woebegone, but the cost of providing it was astronomical.

CCA was a Dual Eligible Special Needs Plan, known in the business as a D-SNP. D-SNPs were created by the Medicare Modernization Act of 2003 (MMA), and are overseen by the Centers for Medicare and Medicaid Services (CMS). The potential afforded by the MMA was what intrigued Bob Master. He realized that if correctly harnessed, the power of the MMA could do a world of good for people at the lower end of the health care totem pole. And he was right.

Over the years, CCA took on the persona of The Perils Of Pauline, going from crisis to crisis. Our Board, comprised mostly of academics and clinicians, constantly fought above its weight. But, thanks to health care leaders in Massachusetts who saw the value of what we were trying to do, we were always rescued from our own folly. With their help, we grew and thrived—precariously.

In November, 2015, after Bob Master retired as CEO, the Board made the best decision in its history, hiring Chris Palmieri to take over the reins. Chris was a health care executive possessed of zeal, deep dedication to the cause and profound intelligence. Under his leadership CCA  for three years running was ranked number one in its class of health care providers nationally. I chaired the Board during this time and had a ring-side seat to the growth and respect CCA achieved.

During this time, the Board was deeply concerned about the diversity of our employees. We wanted them to look like the thousands of members we served. Great effort went into making that happen. It wasn’t easy, but management established protocols and stuck to them.

My term as Board Member and Chair ended 31 December 2019, but, as you can imagine, I have avidly followed the organization, especially as it navigated the terrible 2020 COVID-19 pandemic. During the last year, under Chris’s leadership, CCA has continued to perform at a superior level. I never doubted that it would.

Today, though, is special. Today, the Boston Globe published its rankings for diversity in hiring of all Massachusetts firms. When I saw that CCA ranked Number One in the Commonwealth!, I thought my chest would burst with pride. This is a remarkable achievement, brought about by the entire organization taking to heart the idea that all of us, working together, are better than some of us, working in ethnic, gender, racial and demographic silos.

Slowly, America is moving to a more inclusive society. After the darkness of the last four years, we are coming into the light. Although much work remains, diversity accomplishments and the recognition that comes with them, as demonstrated by Commonwealth Care Alliance, will propel us toward becoming all that we can be, not what we have been.

It’s Always Been Tough Being A Nurse. Now It’s Worse.

Thursday, April 22nd, 2021

The OSHA Incidence Rate of work injuries (cases per 10,000 workers) for nurses is 12.7; for all other industries, it’s 3.8. Moreover, 40.8% of all nurse injuries involve physically dealing with patient needs, like moving, turning and lifting them, resulting in the highest rate of sprains and strains of all professions.

That nurses experience high rates of injuries is nothing new. Lynch Ryan’s very first client, the year was 1984, was a community hospital where injuries to nurses caused the hospital’s workers’ compensation insurance experience to be nearly three times worse than its peers in Massachusetts. We solved that by creating the concept of modified duty, returning injured employees to work with physician-specified physical restrictions prior to complete recovery.

What is less well known is that America’s health care workers, principally nurses, are victims of violence in the workplace at three times the rate of all other industries, including manufacturing and construction. Among registered nurses, what the Bureau of Labor Statistics (BLS) calls “violent events” make up 12.2% of all occupational injuries; for all other industries it’s 4.2%. Clearly, nursing has been a challenging profession since the time of Florence Nightingale.

The COVID-19 pandemic has made things even worse. A new Washington Post – Kaiser Family Foundation Poll reveals roughly three out of ten health care workers are considering leaving the profession and more than half report being “burned out” due to the overwhelmingly horrific year they’ve just spent trying, and often failing, to save the lives of COVID inflicted patients.

Couple this potential decrease in health care workers with the BLS’s projection (as of 9 April 2021) that health care jobs will be the fastest growing segment of the economy from 2019 to 2029:

Employment in healthcare occupations is projected to grow 15 percent from 2019 to 2029, much faster than the average for all occupations, adding about 2.4 million new jobs. Healthcare occupations are projected to add more jobs than any of the other occupational groups. This projected growth is mainly due to an aging population, leading to greater demand for healthcare services.

So, we were already facing a future serious shortage of health care professionals. Now, the pandemic threatens to thin the ranks even more. Despite this, enrollment in baccalaureate nursing programs increased nearly 6% in 2020, to 250,856, according to preliminary results from an annual survey of 900 nursing schools by the American Association of Colleges of Nursing. In order to hit the BLS projection of 2.4 million new jobs, nursing enrollment will have to grow at this rate every year. That is a tall order.

Meanwhile, occupational injuries, violence events, and, now, illnesses due to the pandemic will continue to plague the health care sector. Try as I might, I have been unable to find any kind of cohesive national strategy to confront and deal with this looming health care catastrophe.

Just another example of our sweeping a coming disaster under the rug for posterity to trip over.

How Far We Must Go

Wednesday, April 21st, 2021

In 1675, the first and one of the deadliest wars ever fought on what is now American soil began. Fifty-six years after the sailing of the Mayflower, the tenuous Native American-Puritan bonds, built with careful distrust, burst asunder with disastrous results for everyone.

In 1616, European traders had brought yellow fever to Wampanoag territory, which covered present day Provincetown, Massachusetts, to Narragansett Bay, Rhode Island. The epidemic wiped out two-thirds of the entire Wampanoag Nation (estimated at 45,000 at the time). So, when the first batch of Puritans landed in 1619, Massasoit, Sachem of the Wampanoags, was on high alert. He waited until 1621 to meet the new immigrants, and then forged a guarded relationship between his people and theirs. In late-March, 1621, he and Governor John Carver signed the Wampanoag-Pilgrim Treaty. In the Treaty the two peoples agreed to do no harm to each other, to come to each other’s aid if attacked by third parties and to have equal jurisdiction over offenders: if a Wampanoag broke the peace, he would be sent to Plymouth for punishment; if a colonist broke the law, he would be sent to the Wampanoags. In addition, the Wampanoag leaders agreed to tell neighboring indigenous nations about the treaty.

For fifty years, the entente, occasionally fraying, held. But as more and more English immigrants arrived with weapons native Americans had never seen, and as the new immigrants began asserting themselves more and more over the indigenous nations, it became a when, not an if, a war would break out.

When Massasoit died in 1665, his son Philip became Sachem. Philip had few of his father’s diplomatic skills, and his people were becoming more and more angry at the dictatorial actions taken by the white people. After three of his trusted lieutenants were executed by the pilgrims in a woeful miscarriage of justice, Philip had no choice but to go to war if he wished to remain in power. In 1675, he did just that.

King Philip’s war brought tragic consequences for all. As so often happens, the white settlers of Plymouth Colony grossly underestimated the tactical skill of the warring indigenous nations, but in the end European firepower won out. Before the war, historians estimate about 80,000 people lived in New England. Nine-thousand died during the fourteen months of King Philip’s War, more than 10% of the total population. Proportionately, that’s more than in both the Civil War and the Revolution. One-third of the towns in New England lay in ashes, farms were abandoned and the fields lay fallow. Philip was hunted down in Rhode Island’s Misery Swamp and killed. His body was quartered and pieces hung from trees. The man who killed him, John Alderman, sold his severed head to Plymouth Colony authorities for 30 shillings.

And so we come to war’s end in 1676, and Josiah Winslow, the governor of Plymouth Colony, had a problem. Namely, what to do with hundreds of native Americans—surviving leaders of King Philip’s War and their families.

Winslow decided to get rid of them by loading them all, including Philip’s wife and nine-year-old son, onto several ships bound for the Caribbean, one of which, ironically, named Seaflower.

As Nathaniel Philbrick writes in his masterful Mayflower (Viking Penguin, 2007):

In a certificate bearing his official seal, Winslow explained that these Native men, women and children had joined in an uprising against the colony and were guilty of “many notorious and execrable murders, killings and outrages.” As a consequence, these “heathen malefactors” had been condemned to “perpetual slavery.”

Thus, joining Rome and other ancient societies, our white ancestor enslaved a conquered people.

Yesterday, 345 years after the Seaflower sailed from Plymouth harbor, a jury of his peers, a diverse jury, convicted Derek Chauvin on all three counts of murder in the death of George Floyd. What struck me most, the image that cannot be unseen, is the smirk on Chauvin’s face as he kneeled the life out of a man who did not look like him. I imagine it to be the same look Governor Winslow had on his face as he signed the certificate condemning hundreds of indigenous people, who did not look like him, into perpetual slavery.

How far we’ve come. How much, much farther we must go.

 

If Not For The Water: Georgia’s Stick In The Eye Of Democracy

Monday, April 5th, 2021

Major League Baseball and Major League Corporations are turning on the state of Georgia. The baseball All-Star game, originally scheduled for Atlanta’s Truist Park in July, is picking up its bats, balls and gloves and heading somewhere else, depriving the stadium of more than 43,000 fans and all the money they bring with them.

This, of course, is due to the Georgia Election Integrity Act, a 98-page, nearly 2,500-line piece of legislation signed into law by Governor Brian Kemp a week ago Friday behind locked doors in the presence of nobody but six older white guys and a painting of Calloway Plantation. None of the more than 100 people the Calloways enslaved are pictured in the painting. In addition to MLB, the Coca Cola and Delta Airlines corporations, headquartered in Georgia, sharply criticized what they considered terrible voter suppression by the majority Republican legislature.

Coca Cola and Delta did not stand alone. The following major corporations have issued sharply condemnatory statements: Merck, Porsche’s North American operations, headquartered in Georgia, Georgia-based UPS, Mercedes-Benz, Microsoft President Brad Smith, Bank of America Chairman and CEO Brian Moynihan, Cisco CEO Chuck Robbins, Home Depot, headquartered in Georgia, JPMorgan Chase CEO Jamie Dimon, American Express, Facebook, and Viacom CBS.

Texas, a few states to the west of Georgia, appears ready to pass similar legislation, prompting American Airlines and Dell, both based there, to issue similar strongly worded rebukes before any legislation has been voted and enacted. Texas Governor Greg Abbott says he will sign the legislation when, not if, it reaches his desk. And Lt. Governor Dan Patrick, the powerful Senate leader, slamming the corporations’ criticism, said, “Texans are fed up with corporations that don’t share our values trying to dictate public policy.”

As of March 24, legislators have introduced 361 bills with restrictive provisions in 47 states, according the Brennan Center for Justice, which tracks voting legislation around the country. Arizona, alone, has 23 in the hopper.

It seems that the irresistible force is about to meet the immovable object as corporate America issues a ringing indictment of what it considers perfidious attempts by red states to restrict voting rights. What caused this immediate and strong opposition? MLB traditionally takes a long time to decide anything, let alone a law about voting.

I submit it has everything to do with water.

More than half of the Georgia Election Integrity Act deals with absentee and early voting. Reading those parts is like trying to negotiate the Labyrinth without Theseus’s ball of twine. However, there is one, immediately understandable sentence found on page 73, a section of which reads:

No person shall…offer to give…any money or gifts, including, but not limited to, food and drink, to an elector…within 25 feet of any voter standing in line to vote at any polling place.

Violation of this section is a crime, albeit a misdemeanor.

The state of Georgia holds primary elections during or near summer. Summer is hot in Georgia, and the state is the seventh most humid in the country. Voting lines can be long in Georgia, and will be longer now due to the new law decreasing voting places and limiting drop boxes to either one per county or one per 100,000 people, whichever is smaller. People standing in long lines in the summer heat will get thirsty. Perhaps they will not have brought water with them. The urge to give a drink of water to a thirsty person in a long line in the Georgia heat is something very human, very Christian. What is neither human nor Christian is having to do so by putting the drink on a 26 foot pole.

This is the one thing that got America’s immediate attention, one person in particular: the President of the United States, who, during his first press conference, called it “sick.” Nielson reports 32 million people watched him live.

Biden calling out the provisions dealing with absentee ballots or early voting would have left many saying, “Well that’s a matter of opinion. He’s a Democrat, so, of course, he’ll criticize a new law Republicans wrote.”

But there’s no “matter of opinion” about the water. It’s a Black and White thing (the whole law is, but this part is special). If Georgia’s Republican legislators had told the genius who came up with it, “Now, hold on, son, we can get what we want without this,” it would have been ever so much harder to get corporate America to go full out in opposition.

Republicans in Georgia, especially Governor Kemp, are not backing down. No, they’re doubling down. But they’ve now set something in motion that will be hard to stop. And former friends in high places are aligned against them. In the long run, the Georgia Election Integrity Act may prove to be the best thing that ever happened to the Democratic Party in Georgia — and beyond.