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Raimondo Admin’s Dodgy Non-Response to ProJo’s APRA Request

So as you probably know, Rhode Island’s new computer system (UHIP) for qualifying applicants and disbursing social program benefits is a mess. The problems have been well publicized to the point of infamy: a backlog of applications; benefit payments delayed; nursing homes (who have no easy way to stop their expenses) wracking up serious amounts of uncompensated care; even a security “glitch” that could have exposed the personal information of 200-1,000 customers.

It has gotten to the point that the feds were compelled to step in again – this time, breathing fire.

The agency continued to warn that the DHS could soon lose federal funding for administrative costs because of the system’s “failure to meet FNS statutory and regulatory requirements.”

And a Rhode Island House committee held its second hearing into the matter on Monday.

The question is, who is responsible for all of this? Was this a failure by the vendor setting up the new system, Deloitte Consulting? Or did the Raimondo administration force a transition to the new system from the old too quickly? (This, in fact, was a blunt warning by the feds to the Raimondo administration in early September.) If so, why?

In order to shed some light on the matter, the Providence Journal’s ace reporter Kathy Gregg sent the Raimondo administration an APRA request on September 7 for

all correspondence between the state and the company that designed it: Deloitte Consulting.

We pause here to go back, review and note that the subject of Gregg’s request was “correspondence”.

Gregg reports in yesterday’s Providence Journal that six weeks later – on the night before Thanksgiving, to be precise – the Raimondo administration gave her a thumb drive that purported to respond to the request. It contained only reports from Deloitte – and those only through September 6. Critically, the thumb drive contained no correspondence whatsoever between the Raimondo administration and Deloitte.

To reiterate: Gregg asked for correspondence. What she got was reports. (In the same way, Gregg might ask a Raimondo-operated fruit stand for a bag of oranges and receive, instead, a small bag of turnips.)

This non-responsive response by the Raimondo administration would appear to conform to neither the letter nor the spirit of Rhode Island’s APRA law. Nor is it the action of a Governor who, in an interview with Rhode Island Public Radio thirteen months ago, claimed to be “deeply committed to transparency”.

I asked the CEO of the Rhode Island Center for Freedom and Prosperity (full disclosure: I work with the Center), Mike Stenhouse, if he had a reaction to this. He responded,

A curious, honest, and relentless free-press is vital to preserving democracy in our free society and in holding elected officials accountable to the people. In this case, the administration’s pitiful non-response certainly makes it appear as if they have something to hide.

When a reporter like Kathy Gregg asks questions, she isn’t just asking for herself and her newspaper, she makes the request on behalf of all Rhode Islanders. Something went wrong with the launch of a major new state computer system – a system, remember, that has come in at over triple the originally budgeted cost. We are all minimally owed answers about the why and how of all of this. It is time to move from the dodgy non-responses to the straight answers and transparency to which the Governor herself has indicated that she is “deeply committed”.

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HealthSource and Defrauding of Taxpayers

Ted Nesi reports that HealthSource RI — the state’s ObamaCare health benefits exchange — wouldn’t accept two lower-cost plans from Neighborhood Health.  Even on its surface the decision is an outrageous scam:

A Kaiser Family Foundation analysis, which originally included the two Neighborhood plans rejected by HealthSource, suggested they would have lowered the average premium for HealthSource’s second-cheapest mid-tier plan by 14% in 2017. Instead that number will only decrease by 0.5%, according to HealthSource.

But HealthSource officials said their decision was driven by the federal formula for premium subsidies, which are provided to about 90% of the Rhode Islanders who buy insurance through the marketplace.

In other words, Rhode Island officials didn’t want prices to go down too much because they want to force federal taxpayers (ultimately through debt) to pay $17 million more for Rhode Islanders’ health care than they ought to.  The openness with which “HealthSource officials” admit this shows they believe Rhode Islanders are happy to have their government stealing on their behalf, but some of us aren’t so immoral.  As a side benefit to local government agents, the after-tax cost of the exchange’s average health plan would have gone up 42% if they didn’t rig the market, making the exchange look even worse in the public eye.

And that’s not all.  Earlier this month, we learned that Neighborhood initially set its prices too high because its inexperience in the market left the organization no good basis by which to set prices.  So, they ended up refunding $2 million to members, probably with much of it simply a transfer of money taken from taxpayers as subsidies.

In summary, Neighborhood Health, which was arguably more like a quasi-public welfare agency before ObamaCare, overcharged its customers from the start, which forced us all to pay more in subsidies in our capacity as United States citizens.  It then refunded a chunk of the excess to its members, none to taxpayers.

Now, state government officials have refused to allow Neighborhood to charge less for plans in order to steal more money from taxpayers.  This action may very well result in another big transfer of wealth to Neighborhood members through another refund next year.

And on it will go.  If a private organization behaved like this, politicians and pundits would be declaring it scandalous.

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You Mean People Make Money by Selling Drugs?

Sometimes following the news makes one feel as if everybody else is willfully living in some sort of fantasy.  Today’s Providence Journal article on the profits of medical marijuana in the state, by Jennifer Bogdan and Tom Mooney, gives me that sensation:

Medical marijuana is big business in Rhode Island. It wasn’t intended to be.

Advocates wanted dispensaries to provide a safe, ample supply of medicine for those who needed it. But the program has proliferated virtually unchecked, offering yes, relief for the ill, but also opportunity for investors who can operate behind the opaque screen surrounding Rhode Island’s three dispensaries. …

There were so many questions that they couldn’t answer at the time [legislation was crafted]. “I mean who knew?” How should the dispensaries operate? How much marijuana should they be allowed to grow? Would the legislature be more receptive if dispensaries weren’t influenced by shareholders?

“We said they were supposed to be nonprofits. Why? Well, first of all, we didn’t want them to be in it for the money.”

Oh, come on.  Are people really that unable to break down issues to their core components and categorize them properly in order to predict outcomes?  With medical marijuana, our (famously corrupt) state gave oligopoly authorization to three entities to sell an otherwise illegal product.  As I put it in 2011, the state was estimating that each dispensary would be “an instant $20 million business facilitated by the Department of Health.”  According to today’s article, the profits appear to be smaller and not quite so instant, and yet, the article presents 78% growth over a year, to $17 million for all three dispensaries, as if it’s unexpected and suspicious.

To the extent that the organizations aren’t making big returns on their investments, the article expresses suspicion about other ways in which participants are trying to make money.  It never fails to surprise that people really believe that those who work for non-profits can’t be “in it for the money” and that government power tends to breed corruption.

Look, there’s nothing wrong with making a profit.  Money is just an indication of value, and our economic system is supposed to determine what people value and provide it — whether that means innovating to create new products or building new capacity to produce and supply existing products.  People value drugs, but it takes an investment to get the industry over a start-up hump, and then it takes the flow of money to prove the consumer interest.  (As a society, we love to harvest the fruits of investment, but we never want to pay the reward.)

The way in which Rhode Island legalized marijuana was almost expressly designed to ensure that the government maintained pent-up demand in order to drive up prices and increase the tax take.  That’s been obvious along; people who are surprised really need to go back and review the assumptions that they have about the way things work and reevaluate how they believe government should behave.

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The Problem When Government’s an Economic Player

This should be an uncontroversial story offering the latest in medical thinking on a vaccine:

Since the HPV vaccine went on sale a decade ago, three doses have been needed. The panel decided Wednesday that two doses are enough.  

“It will be simpler now for parents to get their kids the HPV vaccine series, and protect their kids from HPV cancers,” said Dr. Nancy Messonnier of the Centers for Disease Control and Prevention.

As readers of the Current know, Rhode Island responded (arguably) more strongly than any state in the country to the nationwide push to mandate that all students receive this vaccine — which is produced by a single company — as a condition of attending school.  That nationwide push makes one think it awfully convenient that the government would recommend 50% more shots than it now says is necessary.

On the other hand, with ObamaCare, government is increasingly (and disastrously) involved in handling payments for health care, and excess vaccines may not make the cut as it balances its desire to make people pay for other people’s services with the voting-and-campaign-donating payers’ willingness to sit idly by as their wallets are raided.  With premiums continuing to rise, and the government positioned to take the blame, spending isn’t all fun and games.

Obviously, these two dynamics are not mutually exclusive.  The government may have loved the idea of prodding consumers toward excessive utilization of a monopoly drug while it wasn’t so directly visible in the funding stream, but is now reevaluating the corporate cronyism in light of its own accountability.

So if we take away the government’s incentive to meddle, what would be the recommended dosage of this vaccine?  Unfortunately, the question points to the most profound reason to resist society-by-government.  Who knows?  The same entity we’re supposed to trust to give us an analysis of the data is in bed with those who profit from higher recommendations and on the hook if the prices get too high.

Somewhere in this great muddle of health care policy, there’s the intention that government agencies could be objective voices coming to conclusions on the basis of medical science and leaving the market to work out the consequences and individuals to make decisions about resulting priorities.  Trust in that intention has now reached the point of naiveté, and we’ll all be poorer and less healthy for it as long as we allow it to continue.

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Sticking with Principles Isn’t Retreat

With an eye on the moral-legal weather vane, Wesley Smith notes the move afoot in Canada to force Catholic hospitals to kill people who want to be killed.  Quoting the Canada’s Charter of Rights and Freedoms provision on “conscience and religion,” he writes (emphasis his):

That’s an explicit and enumerated right.

If that right is to retain any heft, Catholic and other religiously-affiliated institutions should promise to close their doors before buckling under to the boot of the state.

That would leave Canadians with a choice: Do they want more good hospitals available, some of which won’t allow euthanasia, or would they prefer fewer facilities all of which willingly allow homicide.

Progressives’ political calculation on such matters puts morally traditional institutions in a difficult position.  The progressives rightly understand that Catholics (for instance) engage in these activities because we feel called to do so in order to help others and because we understand that only a visible light can attract wanderers (i.e., only public behavior can attract converts).

As a strategy, therefore, the Left seeks to corrupt those activities or to drive Catholics out.  We can keep doing them, but only if we continue to shrink the observable difference between our practices and those of the secular world.  As Smith’s example illustrates, the preferred method is to further make Catholics do things that seem to prove some teaching or other of the Church’s negotiable.

The other option is for traditionalists to do as Smith suggests and close up shop.  Such an action, while powerful as a threat, also opens us to the accusation that we care about some controversial social policy more than helping people, including clients, employees, and communities.

Unfortunately, we’re getting to the point that this is the better option.  The tests will become harder and the demands for compromise more thorough and more forceful.  If we’re to salvage the principles that define us, moving sooner is better than waiting for resistance to become even more difficult.

That doesn’t mean going about our lives, though.  It means moving back a step and making the charitable activities more fundamental.  Take the lesson of Saint Teresa of Calcutta.  If Catholics can’t operate a hospital, per se, then we should find some way to help those whom hospitals won’t take or for whom they can’t do anything.  We should go out in the community and help people to do such things as keep them out of hospitals, and so on.

That is, if we don’t replace charitable occupations with some other activity of life, but with more charity, it will be clear that we didn’t choose our pro-life, pro-marriage, or pro-whatever stance over helping people, but were pushed away from doing more good because progressives have made society into a moral trap.

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Health Care Farther Along Our Path

This every-parent’s-nightmare story out of Venezuela brings to mind my fears when the forces of big government make a gain in the United States, as they did with ObamaCare:

Two surgical residents sterilized a used needle and injected Ashley with anesthetic. It took them half an hour to clean and drain her knee. They had become experts in the procedure over the summer, as more children come in with complications from simple injuries. The only thing unique about Ashley was how well-fed she seemed; healthy enough to fight to save.

The family celebrated a week later as Ashley was able to breathe without her oxygen mask. Her fever was running below 100 degrees (37.8 degrees Celsius). With any luck, she would soon be back to dancing on her bed to music videos.

But the next day, the fever was inexplicably worse again, 102 degrees. By the end of the week, she was quaking under her Dora the Explorer sheets, drenched in sweat, with a fever of 106 (41 Celsius).

Ashley is three years old, and her months’ long ordeal resulted from the infection of a scraped knee and would have ended very differently without the effort of parents and an extended family scouring the region for hospitals and clinics with the ability and the remaining resources to help.  A basic medical machine that costs $100 in the United States meant hours of calls and searching.  Inadequate supplies of drugs turn into new complications, like the rare heart infection with the symptoms in the above quotation.

The United States is a long way from Venezuela, in its condition… or at least we can still reasonably believe that it is… but as we make decisions, we have to look farther down the slippery hill.  The shortages threatening children like Ashley are not the result of some natural disaster or disappearance of natural resources; they result from a lack of freedom and rule of law, preventing people from figuring out ways to produce or import products and services.  They are unnatural, and for the most part they result from a too-heavy reliance on government.

Add in the damage that Americans have done to family and community structures, and we may not have to fall as far as Venezuela before we find ourselves in our own nightmare stories.

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Refund or Redistribution from Neighborhood Health?

Something about news that Neighborhood Health Plan of Rhode Island’s $2 million in rebates to overcharged customers is nagging at me, but since it’s become so difficult to find contacts for data inquiries in this area, I’ll just describe the question.  Here’s the basic story:

Refunds are mandated by the Affordable Care Act for policyholders whose health plans did not spend at least 80 percent of their premiums in a given calendar year on doctors, hospitals and other health care services or activities to improve healthcare quality. That leaves 20 percent for salaries, bonuses and other administrative expenses.

Because Neighborhood was essentially a Medicaid processor prior to the government’s need for easily controlled insurance providers who would make it look like customers actually had a choice through HealthSource RI, the state’s ObamaCare health benefits exchange, the organization didn’t have much experience from which to determine what to charge its new government-mandated customers.  So, it overcharged for its plans, which is also why the insurer requested a premium decrease in the upcoming year.

But here’s the thing:  Neighborhood is the lower-end provider covering 49% of all “paid” customer plans for an exchange on which 88% of plans are subsidized.  The question is, therefore, how much of this $2 million in rebates is going to Neighborhood clients because taxpayers gave the insurer too much?

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Two Steps Down Our Health Care Road

It sure was good of the British to embark on socialized medicine some decades ago.  If Americans were inclined to learn lessons from failed left-wing experiments, then this would be a great one:

Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations. …

Under the latest restrictions, patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight. …

Smokers who refuse to quit will have planned operations postponed for six months, but may be included on surgeons’ waiting lists earlier by proving they have given up for at least eight weeks.

From this point, the argument could go in multiple ways.  “Why should we all finance the bad behavior of some people?” To which others might respond, “Who gets to pick these particular bad behaviors rather than, say, promiscuous sex?”  Alternately, “Are you saying that wealthy obese people should be able to buy knee operations while poorer people can’t get life-saving treatments at the same cost?”  To which the response might be, “Doesn’t this zero-sum game only arise because government has taken over the industry?”

The more immediate observation, though, is that progressives never seem to want us to get to these central questions until they’ve changed the system in their favor.  Prior to passage of ObamaCare, they proclaimed it a lie that the law might lead to panels that choose who gets operations and who doesn’t.  It will only be after the system is such that almost everybody is dependent on government for health care (or at least believes as much) that we’ll be permitted to have the discussion of whether government control is worthwhile with this as one of its consequences.

But that’s what puts the “progress” in “progressive”: One suspects they know what the end game looks like, but they want to ensure that the rest of us “progress” along convenient stages of finding out.

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Reed, Whitehouse Hope Rhode Islanders Don’t Pay Attention

Leave it to our own Democrat Senator Sheldon Whitehouse to weigh in on the recent price increase of the EpiPen in a way that is both blindingly insidious and enlightening:

The sky-rocketing cost increase of the EpiPen is just the latest evidence that our regulation of prescription drug pricing is broken. (The) system is rigged by the pharmaceutical industry to allow this price-gouging, and that is what needs to be corrected.

Drug pricing doesn’t have to be regulated; it’s regulation of drug production that’s the problem.  Everybody from The Guardian to the Wall Street Journal knows that the pricing of the EpiPen is made possible by the government’s enabling of Mylan’s “near monopoly” (as Whitehouse and other senators characterize the company). A Wall Street Journal editorial explains:

… the steady Mylan rise is hard to read as anything other than inevitable when a billion-dollar market is cornered by one supplier. Epinephrine is a basic and super-cheap medicine, and the EpiPen auto-injector device has been around since the 1970s.

Thus EpiPen should be open to generic competition, which cuts prices dramatically for most other old medicines. Competitors have been trying for years to challenge Mylan’s EpiPen franchise with low-cost alternatives—only to become entangled in the Food and Drug Administration’s regulatory afflatus.

Of course, when I write “everybody,” I’m limiting my set to those who are modestly well informed.  A little economic understanding helps, too.  Let me repeat something I write regularly: Prices are measurements of value.  If a price goes up a great deal, especially if it does so quickly, that means people want more of the product than they’re able to get, and it’s a signal to other producers that they should enter the market, even at great expense.

Immediately after a devastating hurricane, it may seem predatory for people with chainsaws and water bottles to charge super-high prices, but their doing so not only forces affected families to weigh the value of the assistance, but also sends a signal far and wide that it’s worth people’s time to invest in tools, supplies, and gasoline and travel to the affected spot.  Of course, as a moral matter, we should all approach such situations in a spirit of charity, but by the same principle, we shouldn’t stroke our own moral vanity by insisting that only those with the right intentions can help.

In the case of pharmaceutical gouging, the focus of Congress should really be on creating laws that require smarter, lighter handed, less capricious regulation and therefore allow more companies to offer comparable products at competitive prices.  Unfortunately, it’s so much more profitable for progressive politicians to empower unaccountable bureaucracies to manipulate the market and create “near monopolies” that make the politicians’ corporate friends and donors rich and allow the politicians to posture in meaningless poses while grabbing more power to repeat the process.

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The Clinton Pay-to-Play and RI’s Mandatory Vaccine

Sarah Westwood sketches in some of the details of what many see as the pay-to-play scheme involving the overlapping activities of the Clinton Foundation and Secretary of State Hillary Clinton (via Stephen Green):

The confusing structure can make tracing the precise destination of donations to the foundation a difficult task. However, donor records show major pharmaceutical firms — including Pfizer, Merck & Co., and Sanofi — have written generous checks to the Clinton Foundation. …

During Clinton’s first year at the agency, Merck lobbied the State Department to ease regulations restricting the distribution of its drugs “in certain Latin American markets,” according to lobbying disclosure forms from 2009. That placed the drug company’s international interests squarely on Clinton’s desk. …

As a senator, Clinton had reportedly written a letter urging the Department of Health and Human Services to approve Merck’s human papillomavirus vaccine in 2005.

By 2011, under her purview at the State Department, the U.S. government had teamed up with Merck to provide that same HPV vaccine to women in Latin America and sub-Saharan Africa. The initiative was set to cost $75 million.

Merck, of course, is the company that produces Gardasil, the vaccine for HPV (which cannot be transmitted in any ordinary school activity) that the state of Rhode Island has mandated for all girls and boys entering seventh grade in a public or private school and for which the state’s Dept. of Health is actively advertising with mailers and robocalls.

Like Hillary Clinton’s misdeeds, however, these connections and the strange enthusiasm of government officials for specific drugs that push the boundaries of their purview are not high on the list of mainstream journalists.  We all might chuckle that the federal government has apparently been pushing dental floss for over 30 years without any scientific basis (but much corporate enthusiasm, no doubt), but it isn’t enough simply to shrug and assume that this is how things work.  It shouldn’t be.

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Riding ObamaCare Down the Mountain with No Brakes

According to data from the federal Centers for Medicare and Medicaid Services (CMS), the number of Rhode Islanders enrolled in Medicaid/CHIP increased by 126,486, that’s an 81% jump, from December 2008 to March 2016, and the total is rapidly approaching 30% of our entire population.  Almost one in three people.

This gigantic surge resulted from the state government’s decisions to jump into the ObamaCare Medicaid expansion with both feet (and no public debate) and then to advertise its new exchange so aggressively and draw new Medicaid recipients into the system.  Granted the federal government picks up more than half the tab for non-expansion enrollees and will perpetually pay most of the cost for expansion enrollees, but ratcheting up the recipient side of the equation spells trouble for the payer side of the equation at both the state and federal levels.

That’s especially true because, nationally, original projections for the expansion were way low, even on a per-enrollee basis:

… By 2022, projected per enrollee costs for this newly eligible population is more than 40 percent higher in the 2015 report than it was in the previous two years. The outer years of this projection are most important from the state perspective because it is when they will begin to bear some of the costs of the Medicaid expansion population. States that have moved forward with the Medicaid expansion might be forced to pursue significant fiscal adjustments to other aspects of their Medicaid programs, or to other components of their budgets.

In short, we’ve got more beneficiaries than expected costing more money each than expected.  Where do lawmakers expect to find the money to cover this program?

Let’s play the “making matters worse” card, too.  Stephen Green highlights several stories finding that fewer people are signing up for payed ObamaCare plans, and they’re less healthy than hoped (costing more to insure and care for).  Meanwhile, ObamaCare is also strangling innovators and forcing small players to hand cash directly to major players with inside connections, like Blue Cross.

ObamaCare and Rhode Island’s full embrace of it were terrible, terrible ideas, and we’re all going to pay for it.  Unfortunately, precious few will understand the source of our pain, and progressives and partisan Democrats (whose party is fully responsible for the result) will work overtime (often on our dime) to distract people and prevent them from allocating responsibility where it belongs.

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What’s Really In Your Best Interests? Aimee Gardiner On The No HPV Mandate Movement

On this episode of “What’s Really In Your Best Interest?” I interview Aimee Gardiner, director of Rhode Islanders Against Mandated HPV Vaccinations, on the movement against the HPV Mandate in the Ocean State. Rhode Island parents deserve the freedom to make private family choices without government involvement. The mandate on the HPV vaccine for Rhode Island students is an important and symbolic violation of our rights.

Recently, the RI DOH undertook a marketing campaign directed at the children of our state. Do you think this is a proper use of taxpayer dollars? The government should include parents in the discussion when dealing with minors, not bypassing our families! This is a very disturbing trend. The #NOHPVmandateRI movement stands to reverse the HPV vaccine mandate in RI. Please watch the new videos of our interview now.

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RI Foundation Tells Rhode Islanders to Shut Up and Take Their Medicine

The lede of a Wall Street Journal op-ed by Daniel Henninger describes its point concisely: “Barack Obama’s presidency of moral condescension has produced an electoral backlash.”  The notion of this condescension from our elite betters came immediately to mind when I opened up a Rhode Island Foundation email promoting this video, which is part of its “what’s next” initiative, and which is slap-in-your-face offensive:

The video opens with a blank screen and marching thrum before the following phrase appears: “Actual quotes, From actual Rhode Islanders.”  The text doesn’t specify which Rhode Islanders, or where these phrases were found.  It’s just us; things we’ve said as we’ve participated in public debate.  (At least its those of us who don’t fit the obvious political profile of the people included in the RI Foundation’s “community contributions” section.)

The slap comes immediately and with deliberate offense, with video of a child being beeped for reading swear words from a notepad.  Child 2 is beeped again, reading another quote from an “actual Rhode Islander.”  Child 3 looks up in disbelief after reading his quote.  A small girl offers the first commentary after hers:  “Who says this?”

Next, our local elite betters put their own words in the kids’ mouths: “Stop! … Stop complaining. Stop blaming. Stop trolling.”  We (“actual Rhode Islanders”) aren’t making things better; we’re making them worse.  Not to worry, though, because these kids “are what’s next.”  They’re going to solve the problems of the world when they’re adults, but in the meantime, they need us to “be nice or be quiet.”

That’s right.  The message of the people promoting this slick video…

  • who rope all of us broadly into the suspect category,
  • who include the very act of complaining on the list of things that we should stop,
  • who deliberately slap us with the shock of putting swears in the mouths of children,
  • who tell us that we’re merely a hopeless generation occupying space until the saintly kids grow up

… is that we’re not being nice, that we’re being dismissive.  That we should just shut our traps and not complain about the treatment to which the powerful in our state subject us or when they do things like impose new fees, take away our rights, and slush around money sucked from our economy in a corrupt whirlpool (or when they use non-profit organizations to push political agendas) or blame them when things continue to go wrong, year after year.  We’re just “trolling.”

Who are the condescending people behind this message, hiding behind children?

Well, the Rhode Island Foundation we know.  It’s interesting to note, though, the group behind this video, NAIL Communications, because it’s received almost $2.5 million from the state government through HealthSource RI, our ObamaCare health benefits exchange, over the past few years.

So, yes, shut up and pay your taxes, you nasty Rhode Islanders, so that people who think they’re better than us can get big paydays from government ventures that limit our freedoms as well as redistribute our money.

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Something UHIP This Way Comes

Rhode Island won’t forever be able to avoid the arrival of the state’s Unified Health Infrastructure Project (UHIP) monster, although the latest from Lynn Arditi is that it won’t darken our state until the leaves begin to shade and the season of evil approaches in the fall (appropriate to an election season, this time around, too).  It’s a sinister beast, too, this dependency portal, which weaves itself in sly language.  Witness (emphasis added):

The new system will allow the state to verify eligibility for programs such as Medicaid, the insurance program for low-income residents, and integrate them with other state assistance programs, officials said, to improve service and weed out fraud. …

“Rhode Island has been running the same enrollment and eligibility software since the Reagan Administration,” Roberts said. “This new system is a smart investment that will result in better customer service and significant savings for state taxpayers. As we move toward the September launch, we will continue to incorporate best practices and lessons learned from other states. We are confident that setting a launch date in September will allow the state ample time to anticipate and prepare for any issues that may develop during a transition from an aging software system to a modern, digital portal that meets our 21st century needs.”

In our traditional understanding of such concepts, one does not “verify eligibility” to receive “customer service,” and the wise reader should expect that “significant savings” will be measured against what the costs would have been to expand benefits by some less-efficient route.  That’s what UHIP is going to do.  As with the expansion of Medicaid and its implementation through the ObamaCare health benefits exchange (which was the first key piece of the portal), “verifying eligibility” will not prove to mean stopping people who apply from receiving benefits inappropriately, but rather, verifying that people who didn’t know they were eligible and who were not really seeking benefits are indeed eligible and should indeed receive taxpayer dollars.

Like some magical being, efficiency of this sort can be a positive when it is pursued in the proper spirit.  When the spirit is corrupted, though, efficiency merely accelerates the spreading of its dark shadow, particularly when the bureaucratic cult that summoned the beast has so mastered the technique of shaving its two pounds of flesh.

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Speaker & OHIC: Stopping Some of the State Taxpayer’s Bleeding

As with his pulling of Budget Article 18, another reason to praise Speaker Mattiello this week: he is not seeing why state taxpayers should be forced to step into the breach left by the drying up of federal funds.

The office responsible for protecting consumers from excessive health insurance rate increases stands to lose nearly its entire staff if the House on Wednesday approves a budget amendment passed by the House Finance Committee. The $1.03-million loss in funding for 9 of its 12 full-time staff would leave the Office of the Health Insurance Commissioner (OHIC) with only three employees …

Governor Raimondo’s budget included $1.03 million to replace federal grant funding for the nine staffers when the grant runs out on Sept. 30, but the House Finance Committee last week voted not to replace the funding. “When the money runs out the programs are off,” House Speaker Nicholas A. Mattiello said during a budget briefing last week. “Every time a federal grant expires everybody wants the funding to continue. You have a government that Rhode Island cannot afford.”

If I understand correctly (let me know if I’m wrong here), these FTE’s are in ADDITION TO the staffing of Rhode Island’s (completely useless) ObamaCare exchange, HealthSource RI. Staffing levels of this department have fluctuated somewhat but have generally suffered as the tide of federal ObamaCare funds has receded (as scheduled).

There needs to be some thought before state officials agree to implement a federal program with funds that sunset. State taxpayers simply don’t have the capacity to take on the funding of ever more, new programs.

And if the sitting Governor (in this case, Governor Raimondo) feels that the program should continue with state taxpayers picking up the tab from the lapsed federal funding, he or she should make cuts elsewhere in the budget to find that revenue, not simply heap another burden on state taxpayers.

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Credit Where It’s Due (At Least for Rhetoric)

Here’s a quote from Speaker of the House Nicholas Mattiello (D, Cranston) that one doesn’t expect to read in Rhode Island.  On the topic of a cut to funding of the Office of the Health Insurance Commissioner (OHIC), as reported by Lynn Arditi:

“When the money runs out the programs are off,” House Speaker Nicholas A. Mattiello said during a budget briefing last week. “Every time a federal grant expires everybody wants the funding to continue. You have a government that Rhode Island cannot afford.”

Of course, as Andrew’s charts make clear, the overall level funding of government arises only because an increase in local funding made up for a loss of federal revenue, but at least the speaker is articulating important points.

Also from Mattiello, yesterday, was a statement that the green-energy article of the House budget would be removed altogether.  Many on the right have seen that as a good sign, but note this sentence in the statement (emphasis added):

Over the past several days, I have received feedback on Article 18 and have reached the conclusion that there are pieces of the article that do not need to be in the budget.

Most of the legislation in Article 18 was already submitted as bills in the House and Senate.  For example, the RI Center for Freedom & Prosperity’s Freedom Index shows that the controversial energy-producer interconnect component of the article has already passed the House as H7006.

So, again, at least we’re getting evidence that sounds of reality and reason are penetrating the State House walls.  Whether they’ll have a real effect (or produce consequences if they don’t), we’ll have to wait and see.

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The Panopticon State Moving Forward with Prescriptions

For the 2013 Freedom Index, the RI Center for Freedom & Prosperity highlighted legislation that was ultimately signed into law “to create a state-controlled electronic prescription database storing all information related to electronically distributed medical prescriptions.”  We gave it a -2, and naturally the General Assembly passed it and Governor Lincoln Chafee signed it into law:

  • S0647, sponsored by Democrat Senator Donna Nesselbush (Pawtucket, North Providence)
  • H5756, sponsored by Democrat Representative Joseph McNamara (Warwick, Cranston)

Well, surprise, surprise, legislators are in the process of expanding the reach of this database in newly invasive and frightening ways, and naturally the Senate passed the legislation last night, with only Republican Elaine Morgan (Charlestown, Exeter, Hopkinton, Richmond, West Greenwich) voting “nay.”  This legislation will “empower the state Dept. of Health to combine its drug prescription database with any other source of data to analyze the behavior and personal connections of patients and pharmacists, under the pretense of finding abuse”:

  • S2946, sponsored by Democrat Louis DiPalma (Little Compton, Middletown, Newport, Tiverton)

Add this database to the information that will be produced by gantry-based tolling systems and license-plate readers looking for the uninsured, and then mix in the comprehensive data to be collected by the Unified Health Infrastructure Project (UHIP) and that which is already collected for taxation and other economic activity, and everybody in Rhode Island will have a frighteningly complete digital profile accessible to unaccountable bureaucrats, following the lead of a gang of elected officials best known for violating ethics rules and being investigated by the feds.

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Little Tastes of Big Government

Imagine a system in which people chose what products and services they valued, and the people who provided them determined what made it worthwhile to provide the service.  Then, under mutually agreeable terms, the customer could use some sort of measure of value (represented by money) to compensate the provider.

That’s the question that came to mind when I read Bill Rappleye’s WJAR story about confusion in the area of home health care workers, thanks to a new system:

“We really want the providers to know, and we’ve told them, that we will continue to keep the old system in place, so that if it hasn’t worked yet, for them, because this is about coordination from both sides, then we will continue to accept records on the old system,” Roberts said. “Claims and validations, on the old system.”

[Director of the Rhode Island Partnership for Home Care Nicholas] Oliver said that’s news to him. He’s meeting with Roberts on May 20. He said if he can’t get the deadline for switching to the EVV system changed to September, he will try to get the General Assembly to act, and if that fails, he may seek a legal injunction to try and straighten out the training and implementation process, before the system is introduced.

This isn’t a matter about which I’ve heard much, elsewhere, so I can’t say whether the new system is better or worse, or what’s driving its implementation.  It’s the whole exercise that gets my mind spinning.

The payment stream for this particular type of work has been consolidated to such a degree with government that it’s become worthwhile for the providers to pool money to fund a lobbyist.  The state implements a change about which the providers are unsure, and the next thing you know, we’ve got sympathetic stories raising vague anxieties and the potential for changes to state law, which would become more chips for political horse trading and yet another issue preventing voters from making straightforward decisions about elected representatives in order to ensure the sort of government that they want.

Now multiply this by everything that the state government does. No wonder government becomes ever-more expensive and people are becoming cynical about the degree to which it actually represents anybody but inside interests.

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A Political Business Network That Puts Businesses First?

Increasingly, over the years, I’ve become disenchanted with and cynical about groups that are supposedly active in politics to support businesses and the political philosophy that allows them to thrive without micromanagement from government officials.  A sampling of reasons:

  • When legislators placed a representative of the Greater Providence Chamber of Commerce on a commission to study the reduction or elimination of the sales tax, his most notable contribution was the opinion that it would be “a crime to threaten” a government revenue stream.
  • When the RI Center for Freedom & Prosperity proposed ways to reduce state spending by nearly a quarter-billion dollars (perhaps to invest in a sales tax cut or some other pro-growth policy), the RI Hospitality Association went to bat for big spending, mostly to maintain the annual six-figure sums the association receives from the state.
  • When it comes to the state government spending over $100 million to get a government-run health insurance broker off the ground, the Cranston Chamber of Commerce joined with socialists in looking forward to the ability of government agents to take over health care completely (which is becoming more obviously the motivation as ObamaCare and the insurance exchange prove to be costly and under-performing debacles).

As I’ve summed it up multiple times, Rhode Island’s public square doesn’t have groups that advocate for constituencies — in this case, business groups that pressure government for the benefit of members — but a network of insiders who represent the government to their members.  The “business voices,” and even most of our elected representatives, depend mostly on their government connections and unerringly put those connections before the well-being of the people they’re supposed to be representing.

Hopefully, cynicism can be healed with a group, like the Gaspee Business Network, that does exactly what we used to assume the chambers and other groups were doing.

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A Mini Lesson in Media Bias

News coverage creates a tilted narrative, even where it’s ostensibly supposed to be neutral.  If consumers were taught well how to infer an author’s point of view from the choices that he or she makes with language, Americans would have a clearer understanding of what’s happening in the world.

An Associate Press reprint in today’s Providence Journal illustrates the point very well.  The opening paragraph of the story is actually unusually clear:

In a setback for the Obama health care law, a federal judge ruled Thursday that the administration is unconstitutionally subsidizing medical bills for millions of people while ignoring congressional power over government spending.

But on such matters of technical legal and political concern, the great majority of people will skim the headline and maybe the “At a Glance” summary, rather than read the text.  Here’s the Projo’s headline: “Judge says Congress bypassed on spending.”  Note the passive voice.  “Bypassed” by whom?  Read quickly, the headline might actually make one think that Congress has done something wrong, in that it “bypassed” something it was supposed to do.

That error almost seems deliberately intended when one turns to the first summary bullet:

U.S. District Judge Rosemary Collyer ruled Thursday that the Affordable Care Act unconstitutionally subsidizes health care costs without the approval of Congress.

That sentence doesn’t make logical sense, in the context.  The Affordable Care Act can’t provide a subsidy against the approval of Congress, because if the act allowed for the subsidy, Congress would have approved of it by definition.  What’s actually happened is that the Obama Administration has violated the Affordable Care Act in providing the subsidies.

Tolerating this sort of spin from their news departments is a big part of newspapers’ lost credibility over the last couple of decades.  When readers decide not to tolerate it anymore, they just go elsewhere for information, and there’s no shortage of options, these days.

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When Insurance Isn’t Insurance

Jeff Jacoby has it right on our health care system: “The purpose of insurance is to protect policyholders from unforeseen or catastrophic expenses.”  What’s more:

When Americans rely on a third party — private insurance, Medicare, or Medicaid — to pay most of their medical bills, they forfeit their power as consumers. Our ill-conceived system of subsidized health plans provided by employers and taxpayer-funded “free” treatment through the government ends up stripping patients of their economic clout. Doctors and hospitals have little incentive to compete by lowering prices, because patients rarely bother to ask about prices. By and large, health care providers in the United States do most of their negotiating with insurers or the government. After all, they’re the ones paying the piper.

Money is just a measure of value, and prices are just the balancing point between the seller’s requirements and the consumer’s willingness.  The only reason to hide any of these numbers is to pull something over on somebody.  Prices should be high for things that people greatly value and that aren’t particularly easy to supply.  The decision between, say, a life-saving operation and an indulgent vacation should be clear.  An effort hide the prices is apt to wind up costing somebody less powerful than the vacationer something more important than the vacation.

This principle obtains even with the legitimate concern that the price that our society as a whole sets for medical procedures will be beyond the means of some people even if they sacrifice everything they have.  But hiding the prices — whether in the name of the “dignity” of the poor or because politicians are using the transaction to buy votes — only disguises the real problems:  that people wrongly value a great many things over each other’s health and that the economy isn’t allowing people to increase their own resources.

Filtering everything through government does great damage on both counts.

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What Was the Point of the Health Benefits Exchange, Again?

Back before President Obama and his fellow Democrats in the U.S. Congress and Senate decided that the nation needed more government involvement in its health care system, whether the people wanted it or not, and back before Rhode Island Governor Lincoln Chafee decided he would implement a health benefits exchange by executive order because the people’s elected legislators had declined to do so, while a small group of unelected bureaucrats decided that the state would jump into ObamaCare’s Medicaid expansion with both legs and without so much as a peep of public debate, back before these events were completed, I asked why a state like Rhode Island needed a government-run health insurance marketplace.

For most intents and purposes, the state had two health insurers, Blue Cross & Blue Shield and United. I forget the exact time line, but I’ll be generous and say that Tufts was kinda sorta on the scene, and I’ll even let government supporters claim welfare health care through Neighborhood, back then, as “insurance.”  Even so, how is it conceivably worth millions of dollars in expense every year to build and maintain an exchange with so few options?

Of course, the question answers itself:  The purpose of the expense must have been something other than the convenience of Rhode Islanders… something like imposing more government control of our lives and funneling more power and money for government insiders.  As United exits the exchange, HealthSource RI, that interpretation is only clearer:

Rhode Island’s health insurance exchange, HealthSource RI, is among public health exchanges that UnitedHealth will withdraw from, according to a spokeswoman for the exchange, Maria Tocco. 

On Monday, United notified the health insurance commissioner of its intention to leave the exchange’s individual and small-group markets, Tocco told The Providence Journal in an email. …

“… we do not see this largely impacting our customers,” she said.

HealthSource is already so non-viable as a self-standing operation that it requires both direct subsidies from taxpayers and fees imposed on all health plans, even those that have nothing to do with the exchange, in order to stay afloat.  How then can its employees brush off the fact that one of the two real providers on the exchange is pulling out of it?

Let’s ask this again:  What is really the purpose of HealthSource RI?

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Hospital Mandate as Proof RI Government Is Off the Rails

In a state in which at least one hospital is losing $3 million every month and is facing bankruptcy, some legislators have the jaw-dropping gall to introduce legislation (H7863 and S2695) that would set maximum numbers of patients who can be assigned to each nurse, with very specific differences depending on the patients’ condition.

Folks, we have to begin taking the warning that such legislation provides.  On a case-by-case basis, these thousands of bills every year may seem inconsequential; they might even meet the standard of representatives and senators who believe they should pass any bill for which they can’t see the downside.  “That sounds like a good idea” is a fine standard while sitting around chatting at a family gathering, but when it comes to actually passing laws, that standard is dangerous.

It is not the government’s role to be a corporate board for all aspects of the economy or the society.  It is not the government’s role to put strict limits on our behavior, our interactions, and our commerce in the name of protecting us from all harm or risk.

We’re coming to a real and final tipping point.  If Rhode Islanders don’t begin insisting that elected and appointed officials are not parents for every adult, child, and pet in the state, we’re going to find ourselves losing all of the services and opportunities that the little tyrants think they control.

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Very Troubling Revelations About State’s Administration of Child Foster Care as It Transitions to Adult Foster Care

In the wake of the terrible deaths of three children in or related to Rhode Island foster care, we learn from a report by outgoing state Child Advocate Regina M. Costa that

The state Department of Children, Youth and Families is allowing children in its care to live in more than 320 unlicensed foster homes. In more than 100 cases, those homes have been unlicensed for more than six months in violation of state law.

This is only the latest troubling revelation about DCYF. An audit last year revealed that the agency had squandered millions of tax dollars due to very poor oversight and accounting practices.

We await answers, accountability and solutions to both these completely unacceptable financial irregularities and, much more importantly, the issue of the safety of children placed in foster care by the State of Rhode Island. It is all the more important that the state get this right in light of the fact that it is in the process of transitioning the care of developmentally disabled adults from group homes to adult foster homes. To state the obvious, we CANNOT see the terrible events involving DCYF repeated down the road with adult foster homes.

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