Opinion/Editorials

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Thursday, July 13, 2017

Health Care in a Free Market

While House Speaker Paul Ryan is a believer in free-market medicine, a New York emergency medicine physician writes that "in a totally free market health care system, you must be willing to let some patients die."

House Speaker Ryan said that with health care, "You get it if you want it. That's freedom." But according to Dr. Farzon A. Nahvi in The New York Times (“Don’t Leave Health Care to a Free Market”), being given medical services that one does not consent to and getting saddled with a bill of thousands of dollars "is nothing like freedom."

Nahvi gives examples of several patients who were found unconscious by passers-by who contacted 911. These patients were then transported to New York emergency rooms and treated, then saddled with huge medical bills. He likens this to having Verizon adding extra services to your bill and charging you thousands of dollars for the bill.

In the end, Dr. Nahvi writes, "Deep down inside, we all intuitively know that health care is not a free market, or else society would not allow me to routinely care for people when they are in no position to make decisions for themselves," concluding that if we believe in truly free-market health care, we would acknowledge that we might have to let the next unconscious person we find in the street remain there, rather than getting that person medical help.

Click here to read the op-ed piece in its entirety.

Monday, May 8, 2017

Medicaid Cuts Will Adversely Affect Fla. Hospitals - and Citizens

In a decision that will adversely affect many of Florida's hospitals, state lawmakers decided Thursday "to cut $521 million from hospitals." Nearly one-fifth of those hospitals affected are in the Tampa Bay area.

According to Tampa Bay Times ("Lawmakers are cutting $92 million from Medicaid in Tampa Bay. Which hospitals are hardest hit?"), the cuts will "mostly impact the facilities that take on the largest number of Medicaid patients, including the state’s safety net hospitals." Under this plan, hospitals in the Tampa Bay area will lose $91.7 million.

This plan is expected to pass the state House and Senate today.

While state legislators are trying to balance the budget, this short-sighted plan to cut Medicaid payments will not only hurt hospitals, but those people that these hospitals serve. And it won't hurt only those people on Medicaid - it will adversely hurt all Floridians.

How? Simple. When hospitals - say, St. Petersburg's All Children's Hospital, which serves children from all over the state, including critically ill children - receive less Medicaid money to treat those receiving treatment, the hospitals then have less money to distribute in its system for treating others with more conventional insurance (or those without any insurance at all).

Less money equals less time in the hospital for those who may need longer recovery times from surgery, critical illness, and other long-term recovery in the hospital setting. It also means cut-backs in personnel, including in emergency rooms, which, again, will adversely affect patient care.

What will it take to wake the legislators up to their short-sightedness? Maybe nothing. Maybe a call to your state senators and house representatives.

To read the article in its entirety, including the list of hospitals (which includes Tampa General, All Children's, Bayfront Health-St. Petersburg, and Moffitt Cancer Center), click here.

Click here to call or email your Florida state legislators.

Monday, March 27, 2017

Trump's HUD Cuts Would Hurt Pinellas, Hillsborough Counties

For the past few decades, several programs implemented by the federal government, have helped to "improve (the) living conditions for the poor" while rebuilding America's cities. These programs have "made a real contribution" in the Tampa Bay area.

However, these programs are in jeopardy due to President Donald Trump's proposed budget cuts for 2018, according to an editorial in the Tampa Bay Times ("Editorial: Tampa Bay Would Lose in Trump's HUD Cuts"). The Department of Housing and Urban Development would lose roughly $6 billion (13 percent) under Trump's proposed budget cuts. Half of that amount would eliminate the Community Development Block Grant, while another $1 billion cuts would come from eliminating Choice Neighborhoods and the HOME Investment Partnership program. The money would be redirected for a military buildup and his Mexican border wall.

The Times argues that Trump "is wrong that these housing programs have not proven their worth," citing ways in which Pinellas and Hillsborough Counties, as well as the cities of St. Petersburg and Tampa, have improved the lives of the homeless and helping neighborhoods.

To read the editorial in its entirety, check out "Editorial: Tampa Bay Would Lose in Trump's HUD Cuts".

Friday, March 3, 2017

PSTA, HART and Declining Ridership

In recent months, the Pinellas Suncoast Transit Authority (PSTA) and the Hillsborough Area Regional Transit Authority (HART) have been seeing declining ridership, while running on “smaller budgets than most major metro bus systems in the country.” (“Editorial: Innovative bus systems still need more money”; Tampa Bay Times, January 30, 2017). While I'm not in a position to address HART's problems from a rider's point of view, I am in a position to address some of the problems I've seen with PSTA that affect riders.

In February 2016, PSTA did away with the bus hub surrounding Williams Park in downtown St. Petersburg. (“PSTA bus hub no more, Williams Park braces for change”.) While some people feel that the move might be good, giving the city a “better look” and making it difficult for the homeless to panhandle, it also makes it difficult for those using the bus system to get to and from work, home, shopping, etc.

When PSTA did away with the Williams Park bus hub, many bus routes were re-worked, but not necessarily for the better. Many of the bus routes that came nowhere near Williams Park were also redrawn around the same time.

A brief aside: At one point, PSTA had 1.2 million riders a month (https://ridepsta.wordpress.com/category/transit-data/). That averages out to 40,000 a day. If half of those people ride in the south-end of the county, with only, say, 10 percent of those people having to change buses at Williams Park, that still figures out to 2,000 people who changed buses at Williams Park. One of the reasons I had heard from several drivers was that there were homeless people in Williams Park. I seldom observed more than 50 – 75 people at any time in Williams Park who might have appeared homeless. Let me get this straight: PSTA displaced an average of maybe 2,000 daily riders over maybe 75 homeless people? (And yes, I did observe some of the homeless people scrape together bus fare to go places – hospitals, doctors' offices, homeless shelters, etc.)

Several years ago, I took classes at the University of South Florida St. Petersburg (USFSP), located at 140 7 Ave. South. There were several days when my first class started at 11:00 a.m. My trip began on the Pinellas Park Shuttle (Route 444) at approximately 9:50 A.M.. After making several connections, beginning at the Shoppes at Park Place (the 70th Avenue side, between U.S. 19 and 49th Street), I would get off the Route 4 at USFSP. The entire ride took one hour and ten minutes. The ride home tended to be a little longer, as the 444 only runs in certain areas three times a day, the last time being shortly after 5:00 PM.

Recently, I decided to meet someone at USFSP. While I can (and do) use DART, the meeting was set up shortly after 5:00 p.m,, the cut-off time for scheduling DART. No problem, I thought. I'll take the buses in. What a fiasco! That 70-minute bus ride is no more. It took an hour and 40 minutes to get there! This included several places where I had to walk a couple of blocks to make connections.

Then there's the trip planner on PSTA's web site. Nice idea – if it really worked. Yesterday, I plugged in my address (less than a half-mile walk to the nearest Route 444 bus stop) and used several times varying between 5 and 20 minutes before the 444 is scheduled to arrive at that stop. (I used USFSP's address as my destination, since I had gone that way in the past – when it was a nice 70 minute trip.) You'd think (as I did) that the trip planner would have me go to that nearby stop, since it was at the right time, and could get me started in the right direction. But you'd be wrong (as I was).

The trip planner had me walking 8/10ths of a mile to 66th Street to catch the 79 to Tyrone Square Mall, then catch the Route 20, which only runs once an hour and would deposit me half-a-mile from USFSP. This would have me on the bus (including wait time at Tyrone Square Mall) an hour and 20 minutes, not including the walk to the 79 and from the 20 to USFSP. The other option listed entailed a 1.4 mile walk to catch the Route 34. (I'll leave it at that). Had I been completely new to bus-riding and relied on the trip planner, I would have been stuck with those options.

There is also the fact that many of the buses only run once an hour. This makes it difficult for anyone who relies on public transportation to get to use the buses for shopping, going to doctors' appointments, jobs, etc. Besides the Route 20, which serves 9 Street South at Pinellas Point Drive to 4 Avenue So., ending up at Tyrone Square Mall, there are:

7 (Tyrone Square Mall to Downtown St. Pete, including St. Pete Public Library, St. Pete College – at 1300 22 St. So, etc.);

11 (PSTA facility to 25 Way So, & Roy Hanna Dr, including PTEC in St. Pete, Lakewood High School, and Crystal Lake Manor);

15 (Gulfport Casino to Downtown St. Pete, including Town Shores, Gibbs High School, Johnnie Ruth Clark Health Center – a walk to the stop from 1344 22 Street So);

16 (Downtown St. Pete to Gateway Mall, including Northeast High School & Meadowlawn Middle School);

22 (Tyrone Square Mall to 4 St & 22 Ave N, including Crossroads Shopping & Northwest Community Center – 1 hour 5 minutes);

38 (Tyrone Square Mall to Downtown St. Pete, including St. Pete Medical Center Hospital, Disston Plaza, Northeast Shopping Center & Coffee Pot Blvd.);

58 (Seminole Mall to Gateway Mall; includes St. Pete College's Seminole Campus – west bound trips only; Franklin-Templeton, Bryan Dairy Rd./102 Ave from 113 Street past US 19 & Roosevelt Blvd, with no service between 9:35 and 12:40);

61; 62; 65 (includes Largo Medical Center & Diagnostic Clinic); 66L (very limited; sponge docs to Morton Plant Hospital); 67; 68 (Tyrone Square Mall to John's Pass); 73 (Clearwater to Tyrone Square Mall); 75 (Gateway Mall to Tyrone Square Mall, including Five Towns & Rutland Plaza); 76.

These routes do take people to what might be considered leisurely activities (malls, John's Pass), they also serve a larger purpose than that, taking people to and from schools, college and university campuses, medical facilities, and yes, to work.

Finally, most bus routes don't run late into the evening, and those routes that do are few and far between, some with routes ending between ten and eleven p.m., but only on certain days – either weekends or during the week.

If someone depends on public transportation and gets a job working the third shift (11:00 P.M. To 7:00 a.m.), that person would either have to take a cab most of his or her way to work or lose the job. This may not seem like a big deal, as many places pay slightly more for someone to work third shift. But if it's a new job, it's easier to scrape up money for an all-day bus fare until the first paycheck comes in than money for cab fare. The routes that do run late tend to be the trolley system (Central Avenue Trolley, the Downtown (St. Pete) Looper, the Jolley Trolleys (mostly on weekends), Suncoast Trolley (mostly weekends), and only a handful of other routes which only run late on weekends, or, as with the 34, only during the week. This lack of late-night transportation leaves those working third shift without other transportation options having to either take cabs (expensive), bike riding (not safe, especially at night), or asking neighbors for rides.

While it would be easy for PSTA to point fingers at voters who voted down the Green Light initiative to help fund more buses, there are other ways to fund the bus system to help expand service. These could include using part of the Penny for Pinellas (http://www.pinellascounty.org/penny/) or raising bus fares by, say, 25 cents.

Also, if bus routes were set back to using Williams Park as a place to change buses, PSTA might see an increase of ridership, back to the 1.2 million seen in June, 2014 (https://ridepsta.wordpress.com/category/transit-data/). This would make it easier for people needing to change buses to get to where they're going (yay, 70 minute ride!)

While buses stopped at Williams Park might make it more difficult to view the park from the road, thereby causing possible policing problems, there is a solution. There is a building on the north side of the park, behind the band shell that PSTA used for years to sell bus passes, pass out schedules, etc. An extra room could be built onto that building for a police sub-station, with two or three officers per shift assigned to the park area. This could solve a safety issue, as well as being great public relations.

Finally, if PSTA wants to be a viable bus system, rather than something to be bemoaned, along the lines of “At least it's something,” it first needs to sit down and get serious about funding (Penny for Pinellas), then realize that if it wants to maintain ridership, it has to make riding the bus easy, convenient, safe (did I mention a police substation at Williams Park?), and that won't take riders two or three hours to go a distance that could be covered in 15 to 20 minutes by car.

Tuesday, February 7, 2017

Trump's Presidency Must Be Legitimized Before Gorsuch is Voted On

Neil Gorsuch: Love him or not, his nomination should not be voted on until Donald Trump's presidential legitimacy is established.

According to Robert Reich in a recent Newsweek posting ("Robert Reich: Gorsuch Must Wait Until Trump Is Legit"), "[T]he Senate intelligence committee and FBI must first conclude that Russian operatives were not responsible for Trump’s electoral victory, Trump must reveal his taxes and he must put his assets into a blind trust."

Reich points out that Mitch McConnell would not allow Merrick Garland, President Barack Obama's pick for the Supreme Court, to be voted on "on the ground that Obama’s term would end in 10 months. Here, we have a president whose term itself may not be legitimate."

The opinion piece, which first appeared on http://robertreich.org, brings up many valid points which need to be looked at closely.

Click here to read Robert Reich's article in its entirety.