Innovation Ecosystem

What we do not talk about when we talk about hope

When and where are the necessary public conversations, arguments and discussions going to take place about the future of Rhode Island?

Photo by Richard Asinof

Gov. Gina Raimondo speaks on Dec. 18, 2018, at URI, at the announcement of the three innovation campus awarded $12 million in state investment

By Richard Asinof
Posted 1/14/19
There is strength in being able to admit to and learn from mistakes, as a way to find a more successful path forward.
What are the opportunities to reshape the priorities around health care in Rhode Island, with an emphasis on investing in neighborhood health stations and health equity zones? What kinds of conversations will occur in public before any contract with Deloitte is renewed? What is the status of finding a replacement for Eric Beane, the former secretary at R.I. EOHHS? Will consumers be willing to support the new health IT products now being rolled out in support of health care? When will Gov. Raimondo be willing to sit down for a one-on-one, in person interview with ConvergenceRI – a request that she has twice before agreed to, with a handshake?

At some point, someone will publish the analysis of the relationship between the rate of property taxes, the school funding formula, and poor performance by Rhode Island students, making the budget numbers transparent. Similarly, the connection between federal policies around housing, segregation and racism and education attainment in Rhode Island need to become part of the equation.
The Raimondo administration may want to pay attention to what new Calif. Gov. Gavin Newsome has proposed: $144 billion in new general fund spending, an increase of 4 percent, $13.6 billion for budgetary resiliency, and $500 million to build new housing for communities, and the possible loss of transportation funds for those that don’t.

PROVIDENCE – There was a missing ingredient in the hopeful rhetoric of the inaugural speech delivered by Gov. Gina Raimondo as she was sworn in for her second term on Jan. 1, 2019. At first, it was difficult for ConvergenceRI to put a finger on exactly what the missing ingredient was.

On a sunny, blustery New Year’s Day, Raimondo had said: “This is Rhode Island. Let’s let our size be our strength. Here, we’re connected to our neighbors. We really do know our children’s teachers and coaches. Our lives are linked from generation to generation. We know how to come together to make Rhode Island a state we’re proud to call home.”

Raimondo continued her hope-filled address in uplifting fashion: “We’re delivering results that keep the American Dream alive and well. We’re making the promise of economic opportunity a reality through our actions. We may disagree. But in the end, we get things done.”

Translated, Raimondo strove to create common purpose around a “shared” call to action – we’re connected to our neighbors; we’re delivering results; we are keeping the American Dream alive and well; we get things done.

In Raimondo’s vision, the cure to divisiveness was action. “Let’s show everyone what Rhode Island can do. Above all, we anchor ourselves to hope. Hope makes us resilient. Hope cannot be easily taken away. And hope guides us toward lasting progress.”

The soaring rhetoric called upon all Rhode Islanders of all races, faiths and backgrounds to “unite and rise above our differences so that our progress will endure.”

[Many Rhode Islanders, however, do not see themselves as playing for or even rooting for the same team.]

There is no success like failure
It was a well-crafted speech. However, what was missing, ConvergenceRI realized, after much pondering, was this: amidst all the happy talk about success and taking action, there was an absence, a reticence, to talk about failures – and what, if anything, had been learned from mistakes during the first four years in office.

As many academic researchers and practitioners of innovation will tell you, a central principle of achieving success in the innovation process is recognizing and admitting when failure occurs.

Not all experiments achieve the intended results; not all ventures achieve financial success in the marketplace. Without the humility to understand what went wrong, it is hard to make progress in getting things right in the future.

The question is: When will the Raimondo administration pursue the opportunity to talk about the need for second-term course corrections, or to look at the mistakes that had been made during the first term? For instance, is there an appetite to share in public and talk about [not just behind closed doors] what were the lessons learned from the botched UHIP rollout?

The contract with Deloitte is scheduled to end in March of 2019, and what will happen is still anyone’s guess. There is some recent “noise” from the Raimondo administration that parts of the contract could be renewed, now that there has been a settlement in one of the lawsuits brought by the ACLU.

How can a good decision about renewing a contract with Deloitte be made without a full airing of what went wrong, and where the current weaknesses still exist?

A larger question, not yet examined or quantified, is: how has the UHIP debacle damaged the infrastructure of the long-term care industry in Rhode Island?

A further subject of needed inquiry, never answered, is this: What were the mistakes made in personnel decisions that precipitated the disaster? Was there a false belief that technology could solve human problems and create cost savings? Who was responsible for drawing up the initial contracts? What were the conflicts of interest involving the Raimondo administration? Is there any appetite to conduct a case study of what happened, perhaps to be overseen by the R.I. Attorney General’s office?

The next round of rhetoric
This week, Gov. Raimondo will once again seize the moment to present the vision for her second term, first with her State of the State address on Tuesday, Jan. 15, and then with her budget proposals for FY2020 on Thursday, Jan. 17.

Foreshadowing the content, Raimondo’s communications director told WPRI’s Ted Nesi that the governor will focus on the following: “Education, opportunity and the hard work necessary to secure a bright future.”

In the coming weeks and months, Rhode Island and the nation will face fundamental political, financial, national security and public health threats. The question is: When and where is the place to have the hard conversations, to prepare residents of Rhode Island for the difficult choices ahead – on the budget, on health care, on education, on the inevitable need to increase taxes?

Or, will the opportunity for dialogue go up in smoke by the distractions of arguing about whether or not the state should legalize recreational marijuana use?

Will the conversation occur in the R.I. General Assembly? Not likely. Despite the valiant efforts by the Reform Caucus, many of the members elected representatives who are women, backed up by many citizens who testified in favor of the package of reforms challenging the “one man decides” rule of the House Speaker Nicholas Mattiello, control over legislation and the budget and the wording of what each contains still rests with Speaker [and, of course, what occurs behind closed doors in negotiations with Raimondo and her team].

As WPRI’s Ted Nesi reported in his Jan. 12 column, Mattiello pooh-poohed [emphasis added] the debate over the House rules as being of little interest to voters. “I might have gotten no more than two emails on it,” the Speaker told WPRO’s Dan Yorke, as reported by Nesi. “Nobody is asking me about it. Nobody cares about it.” Further, Mattiello derided the reform caucus of “dissident” Democrats, saying: “This is an internal game with this ‘high-tax caucus’ wanting to gain ground so they can pass their bad bills.”

What follows is an attempt to lay out two of the issues and questions that Rhode Islanders need to grapple with in the coming new year, to jump start the conversation.

The politics of water
Rhode Island and Providence in particular have become popular of as a national destination for foodies, celebrating the diverse cuisine offered by any number of restaurants.

And, as an undercurrent to that confluence of appetite and affluence, we now talk frequently about food insecurity, identifying the zones of food swamps, corridors of fast food joints along our shopping thoroughfares, and food deserts, where finding fresh fruits and vegetables can be difficult if not impossible task, as a key factor in achieving health equity and improving public health outcomes.

There are many potential solutions underway, including Food on the Move and its mobile markets, selling directly to residents at community centers and schools, and the opening of Urban Greens on Cranston Street in the West End of Providence, a full-service food market in an urban setting.

But, are we ready to talk about clean water insecurity? The politics around Mayor Jorge Elorza’s efforts to “monetize” the Providence water supply system as a way to ward off future pension liabilities and potential bankruptcy has not yet addressed the threat posed by the potential scarcity and lack of access to safe drinking water in Rhode Island.

In the last two months, ConvergenceRI has posed the question about clean water insecurity to numerous state Senators and Representatives, asking them if they have considered drafting future amendments to any “monetizing” legislation that would protect clean drinking water access. The answers to date, unfortunately, have been: not yet. The political reality is that such preventive action has not yet registered on the legislative radar screen – or, for that matter, with news pundits and soothsayers, save for Steve Ahlquist of Uprise RI.

The threat to the state’s drinking water comes not just from the realities of climate change and the rise of ocean levels, or from power plants seeking to buy water to cool their facilities, or from the onslaught of toxic chemicals and plastics that are now to be found in our drinking water, or from the willingness of the Trump administration to roll back environmental protections, but from future demands on its use.

One question not yet asked in the establishment of three new innovation campuses, in partnership with URI, with $12 million in investment by the state, is: what will be the increase in demand for clean water, particularly for the R.I. Mushroom Company’s plans to build some 25 acres of new greenhouses? Is it sustainable?

One obvious solution would be to better protect Narragansett Bay and its watershed by beefing up the state’s enforcement capabilities and moving more quickly to handle industrial polluters accountable in court and, when appropriate, for CEOs from those firms that are bad actors to hear the slam of the jail door behind them.

Another solution would be to have the state infrastructure bank fund rain barrel systems at residences, schools and businesses, powered by behind-the-meter photovoltaic systems, so that water directly from the tap is not being used for outdoor lawn maintenance.

A third preventive measure would be to halt the use of toxic fertilizers, pesticides and herbicides on state-owned land, to prevent the dangerous poisons from entering the watershed.

Economic development officials are always quick to promote Rhode Island for its quality of life, often defined anecdotally. One way to quantify what that means would be to create a “Quality of Life Index” for Rhode Island, to be published annually, as a way to create a longitudinal measure of those things Rhode Islanders hold most dear as quality of life factors, an idea that intrigued Mary Burke, a senior economist at the New England Public Policy Center in the Boston Federal Reserve Bank Research Department.

As an astute environmental policy advocate in Rhode Island shared with ConvergenceRI, the issue around protecting the state’s clean drinking water supply is connected to protecting the land as well.

“In order to protect our water supply,” she said, “We also need to protect the land from overdevelopment and allow nature to act as a filter for storm water runoff, which can degrade our water supply.”

Further, she warned: “As we have more severe rain events [as a result of our changing climate], I’m sure runoff will only become a bigger problem if development continues apace. I would also question how water treatment chemicals might interact with the increasing nitrogen and phosphates in the water supply.”

One promising effort is the work now underway by Save The Bay to focus on the network of streams, rivers and coves that feed Narragansett Bay and serve as valuable spawning grounds and habitat for plants and animals – and support recreational and commercial opportunities, focused on Hundred Acre Cove in Barrington.

“Despite prior efforts, little has been done to remedy the pollution that threatens public health and damages the ecology of this beautiful inlet,” said Jonathan Stone, executive director of Save The Bay. “Our goal is to drive concrete actions that make a tangible difference in the cleanup of Hundred Acre Cove.”

Over the next three years, Save The Bay and its partners will review pre-existing data, conduct an existing conditions assessment, and work with project partners to develop and implement a plan for future actions to improve the water quality in Hundred Acre Cove.

The politics of Medicaid
The political divide in thinking about Medicaid and the state budget that can be addressed by answering this question: is the expansion of Medicaid coverage in Rhode Island a sign of economic strength or economic weakness?

Four years ago, as a signature accomplishment of the first Raimondo administration, the new Reinvention of Medicaid law was enacted. Today, serious cracks have become visible in the foundation under girding the law, which was supposed to be built upon the pillars of projected cost savings achieved under accountable entities.

The question is: Who is willing to talk in public about the shortcomings of the Reinvention of Medicaid? As one health care practitioner told ConvergenceRI in 2018: “Accountable entities are a clusterf**k that give clusterf**k a bad name.”

Plans for an accountable entity for Medicaid long-term care services, the most significant portion of the state’s Medicaid expenses, have been jettisoned, in large part because of the reality of the demographics of Rhode Island’s old old population and the blossoming of chronic diseases in the state’s older residents that require 24/7 nursing home care.

By the numbers, more than a quarter of the state’s FY 2020 budget will be spent on Medicaid expenses; roughly two thirds of that amount will be spent on long-term care services, but there is no “accountable entity” in place to manage those expenses. Why not? Which state legislator [or political reporter, for that matter] can define accurately what an accountable entity is?

The problems with the existing accountable entities certified by the R.I. Executive Office of Health and Human Services in 2018, in order to achieve savings through the delivery of managed Medicaid health care, run deep. First, any cost savings for accountable entities will not come into play until April 1, 2020, five years after the law was first enacted.

Second, the full implementation of the accountable entity program requires a more sophisticated, integrated health IT system than currently exists at many of the accountable entities and care management organizations [health insurance firms]. The costs of building and coordinating the new health IT systems do not appear to have been calculated as part of the overall cost of the new accountable entity system.

The next question is: which legislator is going to be brave enough to run into a crossfire from the Governor’s office and the Speaker’s team that could blow up the fragile budget assumptions under Medicaid, when the state is facing roughly a $160 million two-year deficit?

Making the agenda visible, public and shareable
One common thread in all of the ongoing efforts in Rhode Island to secure a more healthy, prosperous and inclusive future is the role that the public has played in dramatizing the issues: on health care, on affordable housing, on recovery, on climate change, on energy policy, on diversity, on gun violence, on protecting the rights of women to make decisions about their own personal health, the secret sauce is speaking up and being heard.

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