Kayla Soren: Small towns need public transit, too

A bus of the Berkshire Regional Transit Authority, which serves Berkshire County, Mass., much of which is rural.

— Photo by Cogiati

Via OtherWords.org

With the pandemic taking a devastating toll on local budgets, the U.S. public transit system is battling to survive. For much of the country, this funding crisis jeopardizes an already withering lifeline.

For many Americans, public transit is the only option to get to work, school, the grocery store, or doctor’s appointments. But nearly half of us have no access to public transit. And those that do are now confronting limited routes, slashed service times, and limited disability accommodations.

This isn’t just a worry for people who live in cities — over a million households in rural America don’t have a vehicle. In rural communities like Wolfe County, Ky., Bullock County, Ala., and Allendale County, S.C., fully 20 percent of households don’t have a car.

Recently, dozens of transit riders and workers joined together for a two-day national community hearing to testify about their needs for public transit.

“My bus pass is the key to my independence,” testified Kathi Zoern, a rider from Wausau, Wis., with a vision impairment. But limited routes prevent her from performing basic tasks. “I can’t get to the Department of Motor Vehicles to get my voter ID,” she said, “because it’s outside the city limits.”

Unfortunately, situations like this are typical. Over 80 percent of young adults with disabilities are prevented from doing daily activities due to a lack of transportation. And there aren’t enough resources to properly train transit workers for accommodating people with disabilities.

Nancy Jackman, a transit-mobility instructor from Duluth, Minn., helps people with visual or hearing impairments ride transit. But she feels exhausted from the uphill battle. “Transit workers seem very overworked and under-appreciated for the types of problem solving that is demanded,” she reflected.

Public transit is also crucial for essential workers during the pandemic.

Sister Barbara Pfarr, a Catholic nun in Elm Grove, Wis., helps operate a Mother House where sick and elderly sisters reside. But at least half of her food and health-care workers don’t have a driver’s license, she said, and they’re missing shifts due to a lack of transit. As a result, residents in facilities like hers “don’t get their services because their workers can’t get to work, through no fault of their own.”

Barbara is also considering that as she ages, she may also become transit-dependent. “When I’m older and can’t drive anymore, I want to be able to get around.” Many smaller towns and rural areas tend to have disproportionate numbers of older people, and seniors are now outliving their ability to drive safely by an average of 7 to 10 years. Without transit options, many of these seniors will lose their independence.

The hearings also emphasized that survivors of domestic abuse disproportionately rely on transit.

Shivani Parikh, outreach coordinator at the New York State Coalition Against Domestic Violence, testified that a lack of public transit makes it harder for survivors to get help. Service cuts can “greatly influence their sense of isolation, their experience of abuse, and their perceived ability to leave,” she warned.

Throughout America, millions are forced to depend on transit that doesn’t fully meet their needs, while millions more have no access at all. This is unacceptable.

Congress can help. Public transit needs at least $39 billion in emergency relief to avoid service cuts and layoffs through 2023. But more broadly, we need to revise the “80-20” split that’s plagued federal transit funding since the Reagan era — with 80 percent going to highways and less than 20 percent to public transit.

Part of the justification for this disparity is that only people in dense, urban areas use transit. This is upside-down logic. The hearings reveal that when people don’t use transit, it’s because it is nonexistent, unreliable, or inaccessible.

The funding to meet everyone’s transit needs exists — it’s just not being allocated correctly. It’s time we invest in public transit for all of America.

Kayla Soren is a Next Leader at the Institute for Policy Studies.

Lia Spiliotes: To narrow N.E. rural healthcare gaps, boost nurse practitioners

Rural America lives with layers of demographic and geographic obstacles to health care, and not surprisingly, rural Americans face bigger health challenges than their urban and suburban neighbors. Berkshire County, the second most rural county in Massachusetts, is no different.

More than residents elsewhere in the state, our neighbors and communities struggle with high rates of obesity, cancer, diabetes, cardiovascular disease, mental illness and addiction to smoking and other drugs. The suicide rate in Berkshire County was the highest in the state in 2013, and admissions to mental-health facilities are above the norm.

Berkshire County mirrors other remote rural geographic regions in the nation, where recruiting primary-care providers is an ongoing challenge of economics, retirement, the allure of specialty medicine and big-city compensation. In these areas, the supply of primary-care physicians falls below federal standards. (Kaiser Foundation 2015).

The good news is that the education, experience and quality of physicians and nurse practitioners at Community Health Programs in Berkshire County, where I have been interim CEO since January, is on par with any of the best healthcare organizations in which I have worked in Massachusetts. Equally important is the work we are doing to educate patients about the front-line role that nurse practitioners play in the delivery of high quality primary care. Increasingly, patients understand that nurse practitioners are excellent partners in providing primary care.

National studies have shown that patients assigned to either nurse practitioners or primary-care physicians have comparable health outcomes. More than a dozen states — including Maine, Vermont, New Hampshire and Rhode Island — have long-since passed measures freeing nurse practitioners from physician oversight in treating, diagnosing and prescribing medication to patients.

States that have already done so show fewer emergency-room admissions, improved health status, and better overall healthcare experiences. Yet in Massachusetts, physician organizations have resisted giving nurse practitioners sufficient autonomy to practice to the full extent of their training. We need to maximize the use of nurse practitioners as a vital healthcare resource.

This lack of full practice authority for nurse practitioners has broad implications for healthcare access in Massachusetts, particularly in underserved communities. Competition for primary-care providers is intensifying. Physician salaries at community health centers, which serve mostly lower-income residents, remain 25 to 30 percent below entry-level salaries at many hospitals and private physician practices.

Outdated practices

At rural health centers, which continually struggle to attract providers away from urban areas, the impact is even more profound if nurse practitioners cannot provide the full range of patient care. The health of rural communities is compromised by policies that protect outdated ways of delivering primary care.

The role of nurse practitioners should grow as our health system moves toward the team-oriented, patient-centered care approaches — the foundation of post-Affordable Care Act healthcare delivery. Often referred to as the patient-centered medical home (PCMH), this coordinated model emphasizes a critical shift to staying well, not just getting better.

In addition, care for higher-risk patients with chronic needs, who account for so much of our overall healthcare spending, is better managed. In states that have lifted restrictions on nurse practitioners, early data show a reduction in ER admission rates, improvements in residents’ health status and increased patient satisfaction.

The time has come for the Massachusetts legislature to pass House Bill 1996/Senate Bill 1207. The bills, which draw upon guidelines developed by the Institute of Medicine, would remove barriers preventing nurse practitioners and certified registered nurse anesthetists from practicing to the full extent of their training. The bill also ensures that Massachusetts can meet workforce demands, address gaps in access to care and adopt new care models tied to healthcare delivery and payment reforms.

According to the National Council of State Legislatures, of the 2,050 rural U.S. counties, 77 percent are designated as health- professional-shortage areas. Around 4,000 additional primary- care practitioners are needed to meet current rural healthcare needs. There is no single fix to meeting the health needs of rural Americans, but by elevating the role of nurse practitioners, we believe we can begin to close the gap.

Lia Spiliotes, a Cambridge Management Group (cmg625.com) partner and senior adviser, is interim chief executive officer of Community Health Programs, the Federally Qualified Health Network in Berkshire County, and serves on the board of the Massachusetts League of Community Health Centers. This piece first ran in The Berkshire Eagle.

Of class and charity

By ROBERT WHITCOMB

Philanthropic contributions by very rich people get a lot of attention. An example around here is Thomas Ryan, a former head of CVS who recently gave $15 million to the University of Rhode Island for a brain-science center to be named after his parents.

Besides the satisfactions of giving per se and the plaudits of the general public, gifts are sometimes meant to show other rich people how successful the givers are. This explains why so much new money rushes into already very rich “nonprofit” institutions, such as Ivy League colleges and big art museums. Wouldn’t giving a pile to, say, a community college serving poor people do more for society than adding yet more to Harvard’s $31 billion endowment?

And this is not the age of the anonymous contribution. Of course, nonprofits, besides appealing to altruism and ego, know that publicizing the names of the donors may encourage an arms race of giving by other rich people.

Anyway, URI alumnus Ryan commendably gave to a local and grossly underfunded public institution. A few years back, the arena at URI was named after him as a result of gifts by him and CVS. In his last 14 months as CEO, he made $124 million, reported Dow Jones. Of course, if the very rich paid a tad more in taxes, then public institutions could more often build such public facilities out of public money and not always be selling “naming opportunities.”

Large public companies’ senior execs have rarely been romantic altruists. But there’s no doubt that they have adjusted their missions, and sense of civic duty, in the past 30 or so years via tax and other legal changes engineered by their lobbyists.

Most of these companies used to consider themselves as having a fairly wide range of stakeholders — not just senior executives and other big shareholders but nonexecutive employees and the communities within which the companies operated. The idea was that the long-term success of the companies would depend on addressing the welfare of all constituencies.

Now the aim above all is to maximize and speed compensation for senior execs, on which, because of lobbyists’ success in creating tax dodges, many pay remarkably little tax, considering their wealth. Investment gains via stock options, etc., are much tax-favored over wages. (The quickest way to maximize their personal profits is to lay off and/or cut the compensation of lower-level employees.) This explains in part, along with globalization, computerization, automation and the loss of local ownership in many places — laying off your neighbors is tough — explains some of the woes of the middle class the past 30 years or so.

Then there’s American feudalism. The Walton family has a fortune of about $100 billion. They have so much money, in part, because their company pays their employees so little. Some Walmart stores have food drives for impoverished Walmart employees.

The holders of current and future dynastic wealth arrange through tricky trusts (including the creative use of charities) and other perfectly legal mechanisms to pay remarkably little or no estate or gift taxes and thus help ensure the self-perpetuation of power and wealth for their heirs. Readers should read about the wonders of “donor-advised funds” for charities — also a cash cow for financial firms because of the fees — and “charitable lead annuity trusts,” used to boost dynastic wealth by avoiding taxes.

The usual structure for these things is the "foundation,'' which can sometimes be more of  creature for perpetuating private dynastic wealth and power than a device for good works.

Some more reasons that the government is broke.

Among other benefits, this dynastic wealth gives favored families access to the fanciest schools with the best-connected faculty and students, which, in turn, reinforces the vast advantage that the lucky heirs already have. Thus there’s less social mobility in America than in most of its developed world competitors.

The public might want to at least consider whether society would be better off if the very rich shared a tad more of their wealth further upstream rather than through the charities they create to do good works, glorify their names and/or avoid paying taxes that pay for public services such as URI.

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A good thing about this sometimes gray, sometimes golden time of the year is that you don’t have to weed for a while and it cleans out the mosquitoes. No wonder farmers tend to like November and December. They get a rest. Too bad the holidays have to ruin it.

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Everyone understandably bemoans Rhode Island’s jobless rate of 9.2 percent. But bear in mind that the state’s tininess and industrial history skew those numbers. If you spun off eastern Connecticut, parts of Berkshire County, Mass., or upstate New York into separate states, they’d have similar rates. Still, Rhode Island should have done a lot more to capitalize on its location, ports and fabulous design community.

Robert Whitcomb (rwhitcomb4@cox.net; rwhitcomb51@gmail.com; newenglanddiary.com) is a former editor of The Providence Journal's Commentary pages, where this column started, and a Providence-based editor and writer.