Sunday, October 27, 2013

Demanding A Fair Shake From Integrated Delivery Networks

Yesterday morning I had the pleasure of working again with nurses from the SEIU on some grassroots community political action.  This past spring Altoona community members were forced to accept that the Altoona Regional Hospital would be subsumed into the UPMC network, and indeed it has been.  Our local hospital is now officially UPMC Altoona.  Today our group was working on educating people about some newly introduced legislation in the Pennsylvania General Assembly.
Me canvassing with Sue Delozier, registered
nurse at UPMC Altoona

The legislation I'm talking about are two bills that are going to be important for all of Pennsylvania and certainly right now Altoona especially.  The Altoona area is faced with a situation that's bound to become increasingly common around Pennsylvania given the trend of what's referred to as an "integrated delivery network".  Simply, an integrated delivery network is a hospital network that is also an insurance provider like UPMC or Geisinger or Highmark with its Allegheny Health Network.  The problem is the whereas once upon a time you'd have a hospital that wasn't affiliated with a particular insurance provider and so it contracted with multiple providers, now you've got hospitals whose parent networks are doing the negotiating and they're negotiating with their competitors.

Negotiation between competitors is bad enough, but what happens when negotiations break down?  Clearly hospitals have to treat you if you come to the emergency room, but you can certainly get charged out-of-network costs.  The legislation that has been introduced, HB1622 and HB1621 will require integrated delivery networks and hospital-owned physician practices to contract with any willing insurer.  I'm a supporter of this legislation and here's something to share with your Republican friends - so are Republicans.  The primary sponsors are Dan Frankel (D-23) and Jim Christiana (R-15) and John McGinnis (R-79) has already signed on to co-sponsor.  So yes, I now agree with Rep. McGinnis on something.

These bills are really important.  If we're not going to have single-payer universal health insurance then we need laws that mandate that hospitals - and most especially these integrated delivery networks - contract with all insurers because having insurance is pretty useless if your local hospital won't take it.

As a sidenote, this has nothing to do with the Affordable Care Act.  Nothing.  If you here people associating this in any way with the ACA set them straight, because the second you here "Obamacare" this or "Obamacare" that, the conversation has ceased to be worthwhile.  It is a red herring.

Besides talking about HB1622 and HB1621, our group was letting people know that nurses are coming up on their first negotiation with UPMC.  What you're going to hear about in the paper is that the nurses just want community support for their contract as though that's a horrible thing.  Our community should be supporting nurses in their contract negotiations because do you know what they're fighting for?  Safe patient-staff ratios.  Does it benefit nurses if the hospital needs to have a lower patient to nurse ratio?  Sure it does, then they need more nurses.  That ratio, however, also benefits patients.  If you've ever spent time in a hospital you know that having nurse coverage is incredibly important.  Do you want frazzled over-worked nurses that don't have time to learn one patient from the next?  I don't.  Supporting nurses makes sense for our community.
Nurses, community members, and family members who walked the
We should support our nurses because they support us.  When you need support most, you need nurses.  When you're in the hospital the doctors may make the big decisions, but the people taking care of you will be nurses.  When you read in the Altoona Mirror that the nurses are trying to negotiate for a better contract, remember the thing that the Mirror is probably not going to tell you: union nurses are negotiating for more than themselves, union nurses are negotiating for you and your health.

Wednesday, October 23, 2013

Kathleen Kane Is My Hero

Kathleen Kane is my hero.

Let me back up a minute.  Did you know that Daryl Metcalfe is (or maybe was) trying to get support for filing articles of impeachment against Kathleen Kane?  He's doing that.  You may or may not know what a total looney Daryl Metcalfe is.  I've mentioned his specific obsessions here (guns), here (gays), and here (gaginas?).  His current mania is over the impending doom that will befall us should same-sex couples ever gain the legal ability to *insert dramatic music* marry! 

So look, the wind is blowing pretty clearly.  DOMA was the the first domino in a long line that leads to nationwide marriage equality.  It is now a matter of time and smart people, like Kathleen Kane, know it.  In her capacity as Pennsylvania's Attorney General, Kane has declined to defend Pennsylvania's own law that states that marriage is between a man and a woman.  She's allowed to do that.  Daryl Metcalfe and other super conservatives are ready to eat their hats about it and so Daryl has been pounding the pavement around Harrisburg trying to find Republicans to co-sponsor his shenanigans.

How does one respond to Daryl Metcalfe?  It's hard to say.  Brian Sims did a pretty good job after the whole "open rebellion against God" thing.  He called out Metcalfe on his hatred for women and immigrants and gay people and minorities, and that was pretty awesome.  Like I said, that was pretty cool, but Kathleen Kane just laid the full smackdown on Metcalfe:
"Rep. Metcalfe's goals of media attention and political gamesmanship are accomplished through loud, arrogant and misguided claims. Instead, his priorities should be reforming education, job creation, fixing our transportation system, or making the streets safer for kids and families, and should also include cleaning up the good ol' boys' system of public corruption. Instead, he chooses to focus on wasting time and battling me because I had the gall to run for office, win and serve Pennsylvania as an independent watchdog over the government they desperately want to rule."  - Kathleen Kane, via PennLive
There's more.  Seriously, if you haven't read the whole thing, you should really go do that because it's awesome.  I'm just adding this incident to the growing list of reasons why Kathleen Kane is my hero.  

Tuesday, October 22, 2013

The Social is Economic

I wish there were more hours in the day.

As I was going through my epic and extensive RSS feed list, I came across an article about Pennsylvania and women.  Specifically, Pennsylvania is failing women.  If you're a person who's got a progressive political mindset you probably didn't need to be told this, and in the Centre Daily Times the preaching is probably happening largely to the choir, but these facts need to be disseminated broadly to every person of every political persuasion.

First of all, if you like numbers and you are a nerd for statistics then you should absolutely check out this study that was done by the Center for American Progress.  They've got an interactive page where you can check out all the data.  It's amazing.  It's a really helpful place to check out the fact that Pennsylvania has only 1 gynecologist per 19,565 women.  That makes Pennsylvania the worst place to find a gynecologist.  We are worse than Alabama and worse than Mississippi and worse than West Virginia.  Every state you've ever made fun of for being a backwater hotbed of bumpkinery, we're worse than them. This should be underlined, I feel, by the fact that, just because you've got a gynecologist nearby (and I do mean a gynecologist) doesn't mean that your one gynecological option accepts your insurance.  That means that you may well have zero access to a gynecologist, most especially in the center swath of the state that gets referred to so often as Pennsyltucky.  I'd like to take this opportunity to apologize to Kentucky who - though they rank 4 lower than us overall - has 1 gynecologist per only 4,095 women.

If only it ended there.  Pennsylvania was the 28th worst state for women, according to this study.  We got a C-.  I know a lot of college students that would high five over a C-, but when lives are on the line a C- might as well be an F.

This article seemed to drop into my lap at the perfect time.  Just today I was talking about the things that Democrats in Pennsylvania - and probably in other places where conservatives rule the roost - sacrifice in the name of appealing to a broader section of the public.  Who are the first two groups that get thrown under the bus?

LGBT persons.


Democrats feel the need to call themselves "pro-family".  They back away from supporting marriage equality (not all of them) and they back off of protecting a woman's right to control her body (again, not all of them).  In areas where people identify primarily as conservative, Democrats do things like identify as "conservative".  In Altoona we've got a mayoral race coming up in which our Democratic candidate (who is a nice guy and pro-labor and all that good stuff) who on his About page calls himself "conservative"!  I have heard Democrats who I like and respect who actively push "social issues" to the side because "we can't win on those."

I'd like to deliver some truth to you.  In 1969, Carol Hanisch wrote an essay titled "The Personal is Political" and that became the rallying cry of Second Wave feminism.  What we need to realize now is that these social issues are economic issues.  Abortion is an economic issue.  Birth control is an economic issue.  Making decisions for my body is an economic issue.  When I can't afford to drive out of my way to go to a gynecologist to diagnose a medical issue that I'm having, that has an economic impact on my life and that has an economic impact on my family and I am not the only one.  When you add up all the women who have to made their health decisions in a way that is motivated by their financial situation you have a serious economic problem.

Yesterday a young woman in one of my political science classes asked our professor what would happen if we got rid of all of our social welfare programs and my professor wasn't even really sure how to answer that question because it's so big and so complicated.  And this, by the way, is not a criticism of my professor.  He's right, that is a big huge question.  I think, however, that I've come up with a way to think about it that relates to the economic issue of bodily autonomy and access to health options.  If there is no social safety net, if there is no unemployment and no social security and nothing whatsoever, what are the things that you make choices not to do or to buy?  What happens to the American economy when only the very very richest people are able to have luxury products?  And I'm not talking about gold-plated yachts; I'm talking about blu-rays and televisions and cell phones and anything that you can think of that you don't need.  What happens to our economy which relies so heavily on our collective ability to buy crap that we don't need when we can't afford to buy the crap that we don't need?  For so many women in America, this is already a reality.

The social is economic.  For too long Democrats have allowed Republicans to frame the debate.  We will never win that way.  How do you fight against "pro-family"?  What is "pro-family"?  Are there people out there who are campaigning against families?  No, they aren't, and every time a Democrat is forced to label themselves as "pro-family" they're handing a win to the Republicans.  When we let the debate be about whether or not abortion is a moral choice then we lose because whether or not it is a moral choice is beside the point.  Moral according to whom?  You?  Me?  Pat Robertson?

It's time to take back the debate and show it for what it really is: an economic issue.  When Democrats (and Democrats in the Pennsylvania General Assembly, I'm talking to you) cave in to this pressure to see reproductive justice as something that can be tossed aside then you are effectively tossing women aside.  When you don't support reproductive justice then you don't support a woman's ability to find economic parity with men.  The social is economic, and it's time for every Democrat to heed that call.