Editorials from around New England
Editorials from around New England:
The Rutland Herald
A report released this month about the health of the state’s hospitals showed there is definitely cause for concerns.
According to a Green Mountain Care Board report titled “Fiscal Year 2018 Vermont Hospital Budgets,” several Vermont hospitals appear to be hemorrhaging. Eight of 14 hospitals didn’t make money operating in fiscal 2018. (Only UVM Medical Center fell within the board’s 0.5 percent budget-variance parameter after the board adjusted the hospital’s base budget for fiscal 2018 to more accurately reflect actual revenues from 2017.)
According to the report, only six hospitals reported positive operating margins: Mount Ascutney ($1 million); Northeastern ($1.4 million); Porter Hospital ($1.49 million); Rutland Regional ($1.3 million); Southwestern ($7.6 million); and UVM Medical Center ($46.1 million).
Springfield Hospital had a negative operating margin of 12.8 percent, losing nearly $7 million. It was followed by Gifford Medical Center in Randolph, which posted a negative margin of 10.7 percent, or a loss of $5.37 million. The other hospitals that reported operating losses were: Brattleboro Memorial ($1.9 million); Central Vermont Medical Center in Berlin ($7.87 million); Copley Hospital ($2.2 million); Grace Cottage ($556,530); and Northwestern ($3.7 million). Overall, the system wide operating margin decreased 1.4 percent.
That data probably needs more analysis. While it varies from location, it certainly begs the question: What is driving up operating expenses? Experts in health care offer a range of factors, from salaries and equipment, to size and experience of workforce, to demand on services. It is hard to point to specifics here in Vermont.
There were other reported trends from the Green Mountain Care Board report:
— Overall, the 14 hospitals generated just over $2.5 billion in revenue. (CVMC brought in $194.5 million, or 7.7 percent of the total; Rutland Regional Medical Center brought in $254.2 million, or 10.1 percent of the total.) The University of Vermont Medical Center in Burlington brought in $1.25 billion, or just over 50 percent of the total.
— Overall, in fiscal 2018, hospitals experienced a 3.1 percent increase over fiscal 2017 in net patient revenue/fixed prospective payment statewide. For CVMC, that was a 0.3 percent decrease from 2017 to 2018; for Rutland Regional, it was a 5 percent increase. Gifford Medical Center was down the most, 10.1 percent.
— Hospitals also experienced a 5 percent increase over 2017 in operating expenses. CVMC was up 2.8 percent; Rutland was up 7.2 percent. Springfield Hospital, which has dominated headlines for being in financial trouble in recent months, saw the sharpest increase in operating expense of $61.8 million, or 7.6 percent over 2017.
The hospitals reported a 1.1 percent increase in acute admissions, and a 3.7 percent increase in outpatient admissions was reported.
All of that data points to bigger questions about what’s next.
Vermont hospitals are nonprofits, even though they more or less operate as businesses. As has been noted by critics of the hospital system here, while the hospitals have boards of directors to whom they are accountable, they do not have shareholders (nor do they usually pay property taxes) — like most businesses. Profits often go to salaries.
And yet their struggle is our struggle and a real one. Even when Vermont hospitals are making investments that they hope will generate dividends, they are not always able to turn around a yield. The industry in bigger cities and other corners of the nation is moving far faster and efficiently.
As we have seen, there’s no easy fix in the health care industry. While the variances in the 2017-18 comparison show nearly an equal number of positives to negatives, it would seem as though some hospitals here are in trouble. Their closure would be scary for communities that depend on them.
In a recent editorial board meeting between Rutland Regional’s CEO and president, Claudio Fort, and editors from the Rutland Herald and The Times Argus, the challenges were outlined: rising costs, greater demand on emergency rooms, workforce development and finding qualified personnel, among them. Rutland Regional has been in the fortunate position to pivot to the community needs, constantly evaluating where improvements can be made — in part because it has had the money and wherewithal to make the changes in the first place.
Smaller community hospitals have suffered in the status quo, handcuffed by the same demands the larger hospitals are facing with fewer resources or ability to adapt.
Vermont may be a canary in the coal mine for how health care challenges can be examined and resolved. But it won’t come without a hard examination and tough diagnosis.
Today, the prognosis could go either way. Let’s hope for good news in the future
During a campaign visit to Lebanon last week, Sen. Cory Booker of New Jersey discussed, among other things, the plight of rural America and what could be done to help. This is good politics, because Democrats recognize that they need to do better with rural voters than they did in 2016 if they hope to defeat President Donald Trump next year. But that aside, they have to come to grips with the fact that the country cannot truly thrive while prosperity, like the party’s supporters, becomes ever more concentrated in metropolitan areas.
To be sure, it won’t be easy to reverse rural decline. It has been unfolding over many years, and powerful demographic and economic forces are implicated. At the same time, the struggles of rural communities cannot be written off as inevitable, and the issue is now getting the attention it deserves from some Democratic presidential aspirants, such as Booker.
Among the most urgent problems that need to be addressed are the opioid addiction crisis and soaring suicide rates that have decimated many rural communities. The federal government could play an important role in combating both problems by ensuring that an integrated system of comprehensive mental health care is established and adequately funded. That need was highlighted during a visit to Claremont over the weekend by New York City Mayor Bill de Blasio, who is thought to harbor presidential aspirations himself, and especially by his wife, Chirlane McCray.
But that’s not enough. Deaths from suicide, alcoholism and drug overdoses have been justly termed “deaths of despair.” Any program aiming to revitalize rural America has to address the whole range of problems that have contributed to that sense of hopelessness.
One obvious step, which could appeal to Republican and Democratic voters alike in rural areas, would be to make the infrastructure investments necessary to improve the outlook for economically depressed communities. To cite but one example: The lack of fast, dependable broadband service in many rural areas makes it hard to prosper in the digital age, as some Upper Valley residents can attest.
Stringing fiber-optic cable where it’s needed is only a small part of the equation. Rural areas depend on their roads and bridges perhaps even more heavily than their urban counterparts, both for personal transportation and access to markets. As this infrastructure ages and crumbles, the economy that depends on it becomes less able to compete. Clean water and renewable energy are other areas in which investment by the federal government could yield big dividends and improve the quality of rural life. And as Booker noted, the federal government could give a boost to rural schools by increasing federal aid.
It’s also no secret that the farm economy in many areas, including parts of Vermont and New Hampshire, depends in part on the labor of immigrants, some of them undocumented. Comprehensive immigration reform could ensure a steady supply of willing and able workers whose legal status was not under constant threat. And, yes, attracting young immigrant families could help revitalize declining communities faced with an aging population.
An article in the current edition of Washington Monthly magazine points to another way in which federal action could boost the economy of the heartland, where farmers are squeezed by agribusiness monopolies that, on the one hand, are raising prices for the things they buy, such as seed and fertilizer, while on the other exerting downward pressure on the prices they are paid for what they produce.
The author, Claire Kelloway, writes that the sharpest decline in farm incomes since the Great Depression occurred during the three years preceding the 2016 presidential election and that farmers now receive less than 15 cents out of every dollar American consumers spend on food, compared with 37 cents as recently as the 1980s. (We’re confident that this comes as no surprise to struggling dairy farmers in New England and elsewhere.)
The answer to monopoly is vigorous antitrust action that aims to level the playing field and restore competitive markets. Only the federal government is in a position to effectively challenge giant corporations in this arena, and Democrats should pledge to do so. That’s the kind of bread-and-butter issue that could appeal to a range of voters whose views are otherwise sharply divided over social and cultural matters. More important, helping left-behind communities to catch up is the right thing to do.
Bangor Daily News
The debate over childhood vaccinations is already full of misinformation. Adding false claims about immigration into this mix is irresponsible — and downright wrong.
But, unfortunately, that’s exactly what Maine Republican Party leadership has done.
After a lengthy and contentious hearing on a bill to strengthen Maine’s vaccination requirements last week, the Maine GOP’s official account put out a series of tweets suggesting that immigrants are to blame for disease outbreaks in Maine and around the U.S.
In short, the Maine GOP argued on Twitter that Maine families should be able to forgo immunizations in the name of freedom but that immigrants must be vaccinated to protect Americans.
Even if we look past the underlying xenophobia here — and we shouldn’t — this logic is flawed. If vaccinations make sense for immigrants from a public health perspective, they make sense for American citizens as well.
In the face of criticism, Waterville Mayor Nick Isgro, the vice chairman of the Maine GOP, later said that the tweets were from him, not the party at large. But Isgro remains the second ranking party leader, and he clearly has the access and authority to tweet on behalf of the party, so that distinction means very little.
“We need a serious talk not only about vaccination but migration. Portland, & many US cities, have homeless crises driven by asylum claims & a record number of migrants crossing the border from countries lacking vaccinations. This causes certain diseases to return,” one of the tweets on the GOP account said Thursday.
“Even in states with strict vaccination laws, like California, near-extinct diseases are making a comeback. To protect Mainers & Americans, we need a pause on migration from countries that haven’t eradicated these diseases until we can figure out what is going on,” another tweet said, ignoring the fact that the U.S. hasn’t eradicated these diseases either.
The tweets were rightfully condemned by Maine Senate Republicans and U.S. Sen. Susan Collins, the Portland Press Herald reported.
Collins spokeswoman Annie Clark said the senator “disagrees with the sentiments” of the tweets and favors a “more scientific approach to safeguard the health of our children.”
“We need to make clear that Maine is a great place to live, work, and raise a family, and that we welcome all people who come here legally and contribute,” Clark said.
Maine Senate Republicans “absolutely do not approve of the comments made by Nick Isgro using the Maine GOP Twitter account,” according to spokeswoman Krysta West, who added that they have reached out to the party chair “to ask that this matter be dealt with immediately.”
Despite these strong an warranted pushbacks from some Maine Republicans, the Maine House Republican caucus doesn’t appear concerned with Isgro’s rhetoric on an official party social media account.
“Maine House Republicans are concerned about the ever increasing number of Democratic proposals that spend 99.995% of all available revenues, borrow against our children’s future, increase local property taxes and threaten the Maine economy,” House Republican spokesman John Bott said in a statement to the BDN, not directly addressing the tweets.
After claiming responsibility for the tweets, Isgro continued to conflate disease outbreaks in the U.S. with immigrants. He shared a story about a York High School student who had contracted mumps, seemingly to make his point. However, the student — who was unvaccinated — contracted the disease while traveling outside the U.S. This has nothing to do with immigration at the U.S.-Mexico border. If anything, it highlights the dangers of kids not being vaccinated.
Isgro is right that there are mumps outbreaks at some immigrant detention centers, where unprecedented numbers of detainees are held in close quarters. He is also right that diseases that were nearly eradicated are making a comeback, in the US. .and Maine. But this is not because of immigrants, it is because vaccination rates here are slipping.
The percentage of Maine kindergarteners who are not vaccinated against common childhood diseases because of an exemption is more than twice the national average and has risen in recent years. Because of Maine’s high opt-out rates, the state has seen an increase in preventable childhood illnesses in recent years. Maine has one of the country’s highest rates of pertussis, a contagious respiratory disease better known as whooping cough.
By contrast, all immigrants seeking admission to the U.S. undergo a medical exam and must present proof of vaccination. If they don’t have proof, they are vaccinated by U.S. officials.
A 2016 study found that measles outbreaks in the U/S/ were mostly attributed to unvaccinated Americans traveling abroad, rather than immigrants bringing diseases to America.
“Efforts to prevent reestablishment of indigenous measles transmission in the US should focus on evidence-based risk assessments, highlighting a greater potential measles importation risk of from US residents travelling internationally than unauthorized immigrants coming to the US,” the study, by The Journal of Travel Medicine, concluded.
If Mainers are going to have the “serious talk” about vaccines and diseases that Isgro calls for — and we should — it must be based on science and facts, not false scare tactics about immigrants.
The Connecticut Supreme Court may have found a narrow path around a federal law that protects gun manufacturers from liability in most cases when their products are used in crimes. In a 4-3 decision, the court voted on March 14 that Remington can be sued over how it marketed the rifle that was used in 2012 to kill 20 children and six educators at Sandy Hook Elementary School in Newtown.
As reported by The Associated Press, the justices reinstated a wrongful death lawsuit against Remington that had been rejected by a lower court, based on a 2005 federal law called the Protection of Lawful Commerce in Arms Act. But the majority on the Connecticut Supreme Court said that Remington could still be sued for alleged wrongful marketing under Connecticut law.
The decision seems bound to revive the controversy between gun control advocates and gun rights supporters. But with mass school shootings stretching in the public memory from Columbine, Colorado, in 1999 to Parkland, Florida, last year, there are few topics more deserving of continued debate in this country.
By taking on “the regulation of advertising that threatens the public’s health, safety, and morals ...” Justice Richard Palmer wrote for the majority, the court is suggesting that Congress didn’t envision complete immunity for gun makers when it passed the 2005 law after a wave of lawsuits against gun manufacturers and dealers.
A key contention of the Sandy Hook plaintiffs is that Remington marketed the Bushmaster XM15-E2S rifle used in the massacre in an irresponsible way, aiming its marketing at young people, including those with mental illness. The Sandy Hook shooter was 20 and had a long history of mental disturbances.
Remington has denied wrongdoing but declined to comment to the AP on the ruling. Gun rights supporters bashed the decision as judicial activism and overreach.
U.S. Sen. Richard Blumenthal, D-Conn., sees a parallel to the court victories that led tobacco companies to disclose damaging internal documents and later agree to billions of dollars in legal settlements. Others hear echoes of the lawsuits against drug companies that aggressively marketed opioid painkillers, leading to the present nationwide crisis of opioid addiction and abuse.
If the strategy used against the tobacco companies can be brought to bear against Remington in the suit by Sandy Hook survivors, there is the potential to undermine the wall of protection that gun makers have enjoyed since 2005.
While it is not a fully automatic “machine gun,” common sense tells us that the Bushmaster is essentially a weapon of war, and that no civilian needs such a weapon for sport or hunting, or even for household protection. Whether common sense can prevail in court, however, is another matter entirely.
“You can’t get there from here!”
The joke about Mainers confusing flatlanders with complicated directions is rapidly becoming a truism in eastern Massachusetts.
Simply put, the highways, bridges and tunnels to and from Boston are routinely so clogged and so congested that traveling a short distance takes a long time. A very long time. Like an hour and 45 minutes to drive what used to be a 50-minute trip from New Bedford to the state capitol. Like boarding the MBTA or commuter rail system and finding it not uncommonly breaks down, even in the middle of a route.
Several weeks ago, The Brockton Enterprise published a widely read story on the woes of driving Route 24. The 40-mile straightaway was dubbed the “Highway from Hell” in a headline and to those who must routinely commute on it, it certainly seems that way.
Built for mid-20th century traffic, the entrance and exit ramps to 24 are curved and insufficiently long; that results in vehicles entering the freeway at inadequate speeds. They can’t compete with the motorists routinely speeding along because the congested three-lane road is so straight.
State transportation officials acknowledge the fix won’t be easy and won’t be inexpensive. In fact, there are not even current plans to bring the road up to interstate standards, which would require extensive land takings to make the stretch wider, and longer on- and off-ramps that function more safely.
Gov. Charlie Baker has said that Massachusetts is now putting enough money into infrastructure to keep the transportation system functioning. The governor, however, may be misadvised on this. The state is clearly not putting enough money into infrastructure to make the Massachusetts transit system function well.
Part of the problem is that voters, by a 51 to 49 percent margin four years ago, decided to roll back automatic increases to the gas tax that were tied to inflation. For every penny the tax is raised, it would bring in an additional $35 to $40 million, which in turn would greatly increase the state’s bonding capacity, allowing it to borrow an additional $400 to $500 million a year.
State Rep. Bill Straus of Mattapoisett, the joint chair of the Transportation Committee, says he believes that voters will approve increases if the Legislature is able to explain to them that the additional money will make the roads, highways and bridges safer.
The state’s inadequate infrastructure is not just a matter of safety and convenience, however. Increasing gridlock will eventually negatively impact the state’s economy and quality of life, making the Bay State a less desirable place to live.
On SouthCoast, we are concerned about both the upgrade to Route 24 and the construction of an affordable and efficient commuter rail link to Boston.
While there are no current plans for a Route 24 remake, there have been some encouraging developments in the commuter rail area in recent months, with the announcement that Phase I, the so-called Middleboro rail route, is nearing 100 percent design. By the end of this month, the state is expected to announce its five-year capital improvement plan, and local transportation advocates like the Rail to Boston Coalition and the local legislative delegation are calling for full funding of the $1 billion cost.
Straus and Rail to Boston have been in touch with the Baker administration and say there are encouraging signs that the money needed to complete the link by the planned 2022 opening will be approved. The state has already spent $120 million on preparatory work. “I’m very optimistic it will happen,” Straus said.
Full funding of South Coast Rail, of course, will go a long way toward dispelling some of the cynicism around the long-planned project, some 30 years in the talking stage but never funded. And by full funding, we also mean the timely completion of Phase II through Stoughon, which is the only route that will bring South Coast riders to Boston quickly enough to be a truly reasonable commute.
Commuter rail is not the only missing piece needed to bring the state’s transportation system up to speed. Many upgrades to highways, roads, bridges and tunnels and mass transit are badly needed. And the thing that is needed most is better and more comprehensive planning. So that in 10 or 15 years, we can all say that Massachusetts was able to get there from here. To a first-class transportation system, that is.
The Providence Journal
Rhode Island’s expensive public-education system is failing miserably in its mission of preparing students for success. Test results released last fall made that all too clear. They showed that the state, if it were a single district, would rank in the bottom 10 percent of districts in Massachusetts.
The performance of students in the urban core was an even greater disgrace. In the Rhode Island Comprehensive Assessment System tests, only 14 percent of Providence students were proficient in English Language Arts, and 10 percent in math. Generations of poor and minority students have left our urban schools unable to compete for middle-class jobs.
Angelica Infante-Green, 48, Gov. Gina Raimondo’s choice to be her next education commissioner, thus faces a monumentally difficult task.
Fortunately, her biography suggests that she is remarkably well-prepared for this challenge.
The daughter of Dominican immigrants, Ms. Infante-Green knows much about the American dream and moving up from poverty through education and hard work.
Growing up on public assistance in New York’s Washington Heights neighborhood, she became the first in her family to go to college. She started working as a teacher and remained in education, rising to deputy commissioner in the New York state Department of Education. She was the runner-up last year for the commissioner’s job in Massachusetts, which arguably has the best public schools in the country.
She speaks English and Spanish, and is raising her children to be bilingual. As the mother of a child with autism, she understands the challenges of special needs education.
In New York, she focused on improving instruction for English language learners. Given the high numbers of ELL students in Providence, Central Falls and Woonsocket, her experience in this area could prove invaluable in Rhode Island.
We have reason to hope she will not be satisfied with today’s immense and shameful performance gap between Rhode Island’s poor city children and their richer suburban counterparts.
But, of course, a resume alone is not enough. Change must come to Rhode Island education. That will require leadership, savvy and guts. While Education Commissioner Ken Wagner deserves great credit for his work in some areas, including implementing the RICAS tests to permit apples-to-apples comparisons with Massachusetts, he sadly allowed graduation standards to be weakened, and his reforms in general were too timid.
Rhode Island must set high standards for its students. It must have a strong grade-by-grade curriculum, with excellent, well-supported teachers to implement it. It must be ready to step in early when students fall behind. It must use tests to assess how well students are doing. It must support innovative charter schools, and give parents greater choices of where to send their children. It must be willing to shake up the system when students prove to be as ill-educated as those in our inner city schools. It must start putting the students’ interests first.
And it must engage families more. One of the most shocking outcomes of the recent RICAS tests was the response of many parents around the state: dead silence.
Our editorial board has not been silent. We regard improving schools as the most pressing civil rights challenge Rhode Island confronts. And growing, high-paying businesses are looking, above all, for creative and well-educated workers. Rhode Island will never thrive until it dramatically improves its public schools.