New England editorial roundup

Foster’s Daily Democrat of Dover (N.H.), Nov. 21, 2013

During a news conference President Obama was asked if he knew beforehand the disaster that awaited when Healthcare.gov opened for business.

“I wouldn’t be going out saying, ‘Boy, this is going to be great,'” replied the president. “You know, I’m accused of a lot of things, but I don’t think I’m stupid enough to go around saying, ‘This is going to be like shopping on Amazon or Travelocity,’ a week before the website opens, if I thought that it wasn’t going to work.”

Fair enough. But what about Obama’s White House staff, Health and Human Services Secretary Kathleen Sebelius or those more directly involved who did know that a disastrous rollout was in the making? Where were they while the president proclaimed Healthcare.gov would be ready to go on schedule and would work like a charm?

We are reminded of an oft-used phrase: “The emperor has no clothes.” The notion comes from an 1837 fairy tale by Danish author Hans Christian Andersen, “Keiserens Nye Klæder,” which translated to “The Emperor’s New Clothes.”

The plot involves an emperor obsessed with his clothes and always showing them off. One day two supposed tailors show up claiming to “have invented an extraordinary method to weave a cloth so light and fine that it looks invisible. As a matter of fact it is invisible to anyone who is too stupid and incompetent to appreciate its quality.”

Once donned in new robes made of this material, the emperor paraded through the streets. His subjects applauded the royal robes, too fearful to admit the king wore nothing. That is until a child had the innocence to tell the emperor he was naked.

Soon the crowd joined in, “The boy is right! The Emperor is naked! It’s true!”

Anderson’s tale concludes: “The Emperor realized that the people were right but could not admit to that. He thought it better to continue the procession under the illusion that anyone who couldn’t see his clothes was either stupid or incompetent. And he stood stiffly on his carriage, while behind him a page held his imaginary mantle.”

The robes in this tale remind us of the Affordable Care Act and the Democrats which made it the law of the land. It was the bill which had to pass so we would know what was in it, to paraphrase then House Speaker Nancy Pelosi. It was a bill so magnificent that the Democratic members of New Hampshire’s congressional delegation stood, as Anderson’s parade watchers did, in awe of the emperor’s new clothes — unwilling or unable to see the flaws.

But now that implementation has begun, the problems are becoming undeniable. A few thousand instead of millions have signed up. Rates for many are not lower, but higher. There is no longer hope of the $2,500 a year savings President Obama promised each and every family.

Meanwhile, the young and healthy are choosing to opt out of Obamacare. They would rather pay the penalty than sign up for health insurance they don’t want or need — and based on rates used to subsidize the costs of insurance for older, sicker Americans.

This and expected changes in Obamacare, such as dropping the medical device tax, have undercut another promise of the president — that the Affordable Care Act will turn a profit over time and reduce the federal deficit.

With all this — and undoubtedly more problems to be unearthed — it is time for the president and Congress to admit the Affordable Care Act has left the emperor naked and get serious about making things right.

The Record Journal of Meriden (Conn.), Nov. 21, 2013

There’s a bill before Congress — the Registered Nurse Safe Staffing Act of 2013 — that would set minimum standards for nurse-to-patient ratios at hospitals, at least at hospitals that treat Medicare patients. All the nurses’ organizations seem to be for it, on the grounds that a shortage of RNs, plus hospital-budget pressures, has resulted in “fewer nurses working longer hours and caring for sicker patients.”

Those exact words can be found on the websites of any number of nursing groups, which are all in favor of setting minimum staffing levels. What’s much harder to find is any mention of that bill (H.R. 1821) on the websites of hospital management groups or associations. There’s another bill, though — this one is before the Connecticut General Assembly — that would merely require hospitals to regularly report their staffing ratios. But the Connecticut Hospital Association is against it, on the grounds that numbers alone aren’t indicators of quality care, and that there’s “no scientific evidence” to support such numbers.

If true, that’s a startling hole in our knowledge of such an important — literally, life-and-death — topic, and we can only wonder why neither Congress nor our state legislature has seen fit to learn whether there is such evidence. And there is some work done by Linda H. Aiken a decade ago at the University of Pennsylvania (it was mentioned recently in The New York Times) that seems to show a specific correlation between an increase in nurses’ patient loads and an increase in patient mortality. According to Aiken, 20,000 people die each year because they are in hospitals where the nurses were overworked.

And yet, only California has a rigorous and thorough law setting RN staffing levels for hospitals. Earlier this year H.R. 1821 was referred to a subcommittee, from which it may never recover.

Hospitals certainly have a justified interest in controlling costs, and nurse salaries are a big part of their budgets. But those of us who are neither nurses nor hospital administrators may find it difficult to resolve in our minds the sumptuous salaries that so many top hospital executives receive — even and especially at hospitals that never tire of telling the public that they’re not for profit — and what can easily be perceived as corporate stinginess when even one more patient is added to the workload of even one more nurse on even one more shift.

And now that the baby-boom generation is getting old, it will only need more nursing care, but there’s no reason to believe that the number of registered nurses will keep pace with that need.

The way it looks right now, working conditions for RNs won’t be getting better anytime soon.

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