Hub & Spoke

Solano & Contra Costa Health Depts Pull Down $14 Million in Federal Funds

A hearty congratulations to the health departments of both Solano and Contra Costa counties, which, as the White House announced this week, will be among the 85 health centers nationwide to receive millions in federal stimulus funding for bricks-and-mortar expansions.  

In Solano, as this article details, the $2.1 million award is going to construction of a dental clinic as part of the planned William J. Carrol Government Center in Vacaville (map of the proposed site below).  The Center will be a hub for health and social services, and now it looks like dental care will be part of the package.  I don't have any details yet about how Solano County will staff and maintain the clinic, given that the federal funds only cover capital projects, and not operations.  But with safety net dental services scaling back throughout the state, it's good news that in our region we're planning expansions.

In Contra Costa County, the $12 million award is earmarked for a new health center in San Pablo - adjacent to and on the site of Doctors Medical Center (and across the street from Brookside Community Health Center).  The new clinic would take the place of the Richmond Health Center, and could work in partnership with Doctors hospital to integrate primary and specialty services.  

Again, congrats to both departments!

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World AIDS Day

As anyone who's visited Google's homepage today knows, it's World AIDS Day - a time to take stock of where we are in the fight against a devastating global disease. 

I'm not an HIV/AIDS expert and don't pretend to be, but even a layman's glance at the "Evolution of HIV/AIDS in California 1981-2008" by the state's Office of AIDS shows that public health and medical science have made dramatic gains in the past decade.  

AIDS deaths have fallen steeply:

 As have diagnoses:

  

The authors of the study describe these and other positive trends as the result of successful prevention, care, treatment, and surveillance activities in California and nationwide.  Hear, hear!  

The problem, of course, is that these programs just got smashed to bits in the latest state budget cycle.  HIV/AIDS education and prevention; HIV counseling and testing; early intervention projects; HIV/AIDS housing; home and community-based care; therapeutic monitoring.  All completely eliminated in a combination of cuts approved by the legislature and line item vetoes by the governor.  

In turn, cuts trickled down to counties, which had to make their own cutbacks, like these in Contra Costa that we blogged about a few weeks ago.   

So on this World AIDS Day, I'm thinking less about the World and more about my neighborhood.  Cuts to HIV/AIDS prevention and education threaten to reverse the great work that's been done in California.  

Restoring funding should be a priority in 2010.   

Financial Responsibility & First 5

I was paging through First 5 Contra Costa's new strategic plan the other day, and soon enough I found it - the chart that's become de rigueur for any institutional report written during our current recession, be it issued by nonprofit, foundation, or government.  

The graph, whose general shape will be familiar to many readers, plots expected revenue over the next 10 years, and looks like one of those nausea-inducing Great America rides that starts you out 100 feet in the air and 2.6 second later has you buzzing the heads of pedestrians below.

Steadily-declining tax revenue and a bad economy will not be kind to First 5.

But that's all to be expected.  Everyone knows that tobacco taxes have fallen over time and are projected to continue their downward path.  And as I mentioned, all sorts of organizations are reporting and coping with falling revenues due to the economy.

What sets First 5 apart isn't their revenue projections.  It's their spending plan.  Which is shaped more like the Bonneville Salt Flats.  Spending remains stable.  

First 5 saw revenue declines on the horizon and then actually did something to plan for it, building up sizable reserves in order to stretch its funding as far as possible.

So despite the fact that revenues are falling faster than the legislature's approval ratings (and that's fast), Fist 5 Contra Costa will continue funding programs at current levels over the next 5 years.  They want to do that because now, in the height of a recession, is not the time to scale back on safety-net programs and social supports.  They can do that because they're pulling $30 million out of their reserve account.  

I'd say that's the result of pretty impressive planning.  Sacramento, take note.  Instead of threatening to strip the reserves of First 5's across the state, members in state government should take a page from First 5's version of fiscal responsibility, which allows it to be a safety net that works as it should: when the scaffolding breaks. 

Cool new video on the need for healthcare reform

Today the Democratic National Committee's community organizing project, Organizing for America, announced the winner of its video contest, in which anyone in the US could submit homemade promos on the need for national healthcare reform.  Thought I'd pass it along with the caveat that the Community Clinic Consortium is not affiliated with the DNC or any political party, is not a partisan organization, and does not endorse the "ask" for donations at the end of the video.  

But we do strongly support healthcare reform that would cover millions more Americans and provide them access to comprehensive care.  And in that light, this is a great video (maybe even better than the one we made), so enjoy!

A modest proposal

Bad news for the teeth of children living in Solano County. 

Trying to get a handle on a multi-million dollar deficit, the County’s Board of Supes voted on Oct 27 to cut about $165,000 from the Smile in Style program. 

Smile in Style teaches students how to maintain good oral health, screens for dental decay, provides kids with cavity-fighting rinses, and runs school-based dental sealant clinics.

Instead of 12,000 children served over the next year, Smile in Style will now reach only 5,000. 

For context: in California two-thirds of all kids suffer from an oral health problem by the third grade.  Over a half-million students miss at least one day of school due to non-routine dental issues.  California ranks second-to-last among all 50 states in children’s health status (beating only Texas)

As programs like Smile in Style lose funding, we’re likely to see even worse outcomes (worse than Texas!).

That’s why I think the state should change its strategy on oral healthcare for kids.  I suggest that we simply require full extraction of every California child’s teeth by age 8.  In place of teeth, each child will be issued his or her own set of dentures, upgradable every 3 years. 

Consider the benefits.  First, it’s a fiscal no-brainer.  By eliminating teeth, and thus all tooth-related diseases, we could close all state-supported dental programs. Unused funds would be redirected to other under-funded programs not as amendable to creative solutions.

Americans reportedly spend $2 billion per year on toothpaste, mouthwash, and floss.  Millions would be saved from a switch to baking soda-based denture solvents.

And estimates have it that we spend an aggregate of 38.5 days over an average lifespan standing in front of the sink, toothbrush in hand.  Imagine what you could do with an extra month of life!

Rather than slowly starving programs like Smile in Style to death – which solves neither our long-term fiscal deficits nor our healthcare problems – let’s pull the plug and start afresh.  No teeth, no problems!

Or we could raise the taxes necessary to adequately fund cost-effective preventive oral healthcare programs like Smile in Style. 

Either way.

Dr. Walker to Resign from American Academy of Family Physicians

Just saw a media advisory from Contra Costa County's health department announcing that to protest a deal recently struck between Coca-Cola and the American Academy of Family Physicians, Dr. William Walker - the county's Health Director - will be withdrawing his membership from the association. 

Press conference is set for Wednesday at 12:15 at CCRMC in Martinez.  

Here's a good summary from NPR on the Coke-AAFP alliance, noting that the doctor's assn will be paid "in the strong six figures" and will use the funds to teach people how to incorporate soft drinks into a healthy lifestyle.  

In the press release, Dr. Walker draws an apt comparison between the Coke-AAFP deal and doctors' endorsements of cigarette health in the 50's.  

For my part, I think Coke should consider continuing its PR blitz - clearly geared to head off soda tax proposals - by putting its famously rotund Santa Claus icon on a diet.  What better way to demonstrate to kids how healthy it is to guzzle liquefied corn sugar by the liter than by posing a slimmed down St. Nick with that famous Coke bottle in hand?

After all, as the company itself claims, Coca-Cola's done as much as anybody to create and solidify our image of the man from the North Pole.  I'll leave you with these words from the official Coke website:

Most people can agree on what Santa Claus looks like -- jolly, with a red suit and a white beard. But he did not always look that way, and Coca-Cola® advertising actually helped shape this modern-day image of Santa.... Through the centuries, Santa Claus has been depicted as everything from a tall gaunt man to an elf.... For inspiration, [Coke artist] Sundblom turned to Clement Clark Moore's 1822 poem "A Visit From St. Nicholas"... Moore's description of St. Nick led to an image of Santa that was warm, friendly, pleasantly plump and human. For the next 33 years, Sundblom painted portraits of Santa that helped to create the modern image of Santa -- an interpretation that today lives on in the minds of people of all ages....  

TCE Report on DRA Citizenship Verification Provokes Hot-Tempered Tirade (by me)

The California Endowment and the California HealthCare Foundation are out with a new study of the impact of the citizenship verification requirements under Medi-Cal.  

It’s a succinct summary of on-site interviews conducted across 6 California counties, including – notably – Contra Costa.  

The report finds that results are mixed.

If I were an anti-illegal immigrant zealot, I’d focus on the part of the study that makes the so-called ‘DRA requirements’ look reasonable.  For example, that with rare exceptions, the citizenship checks have not resulted in denial of needed medical services to existing enrollees or applicants.  

If I were not an anti-illegal immigrant zealot, I would retort that perhaps the reason that citizenship verification has not resulted in denial of services is that IT’S A HUGE WASTE OF TIME demonstrated by the fact that not one person interviewed for the report could point to a single example of a Medi-Cal enrollee or applicant misrepresenting her citizenship status.   

Not only that, I (as a now increasingly impassioned non-anti-illegal immigrant zealot) would say, IT’S ALSO A HUGE WASTE OF MONEY because if there isn’t a fraud problem to begin with, then there’s no point in dumping hundreds – probably thousands – of hours of county staff time in implementing a program to catch fraud.  

I would finish my fuming non-anti-illegal immigrant rejoinder by noting that at a time when Contra Costa’s human services department is really hurting for funds, cutting staff and increasing remaining staff’s caseload, forcing it to comply with a time-consuming and utterly meaningless program means that there are fewer resources to do what they come to work to do in the first place: help people in need enroll in services that can help.  

All that said, I think perhaps the best part of the report is when it states matter-of-factly that when it designed the citizenship check requirements, the federal government estimated that it would take Medi-Cal clients 10 MINUTES to obtain and present their birth certificates to county offices.  

Ten minutes.  Some mornings, it takes me 10 minutes to find my wallet and keys.  

AP Article Examines Demand for Clinic Services Now & Post-Reform

Just a quick post to share an article that came out on the wire yesterday - featuring community clinics here in Contra Costa/Solano and Nor-Cal.  It does a good job of covering the steep increases in demand for clinic services, our plans for growth in the next several years, and the role we'll play if/when national health reform passes (looking to Massachusetts' experience so far).  

Good news from Solano County's Board of Supes

Grand Jury Report: Rejected!

Good news from Solano County.  The Board of Supervisors on Tuesday voted unanimously to reject the Civil Grand Jury's recommendations to wall off public funding to community providers - like La Clinica North Vallejo - that provide services to patients regardless of their immigration status.  Follow this link for a video of the brief discussion on the topic, which featured a former Solano Coalition for Better Health board member speaking out in favor of La Clincia and Supervisor Reagan stating his personal thoughts on the matter, which despite his official vote are more along the lines of the Grand Jury's recommendations.  Scan ahead to 3:06 on the video player to start from the relevant part.  

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CA's healthcare system gets a D, but that's not the whole story

Today's Sac Bee runs a story on a new Commonwealth Fund study showing that California's health care system comes in 31st among 50 states and DC when scored on factors like access, prevention and treatment, avoidable hospitalizations, and healthy lives.  In other words, when scored on anything that matters, our healthcare system is - when compared to 60% of the states in the U.S. - sadly under-performing.  

Except, that's not quite true.  The 31st-out-of-51 rank is an average of over 30 indicators and masks where California does well - in leading healthy lives.

Here, we ranked number 5 overall.  Minnesota took first, and Hawaii second, if you were curious.  And with all that trudging through snow and hiking over volcanoes, respectively, I think their populations have an unfair advantage.  

Healthy living, in the study, is determined by a combination of mortality amenable to health care, infant mortality, breast cancer deaths, adults limited in activities, adults who smoke, children obese/overweight, and some others.  

These are important indicators not just of health but of overall good living and happiness.  I think it's interesting how a state like ours can rank so low when measured by our overall healthcare system but can finish in the top 5 when ranked by - frankly - how healthy we are.  

More evidence, I guess, that our state's and nation's health is determined by far more than how many hospitals or doctors or clinics we have.  Or, as the report itself says,

There is little question that health outcomes are heavily shaped forces both outside and inside the health care system. Income, education, and housing and work environments significantly influence the extent to which people are able to live healthy and productive lives. Other health determinants that are closely intertwined with cultural and socioeconomic factors also affect people’s expectations of and interactions with the health system.

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Millions remain uninsured under federal reform proposal

New York Times and others report this morning on the US Senate Finance Committee's health reform legislation - just recently scored by the Congressional Budget Office.  It's an $800 billion proposal (below the $1 trillion ceiling set by Obama) that would actually cut the deficit (another of Obama's edicts - not to raise the deficit - met).  

But here's what we have to remember: millions would remain uninsured (25 million, to be exact, the vast majority of whom would be US citizens), and the uninsured will still need places to go for health care.  

(Insert shameless plug for community clinic funding here.)  

Clinic Consortium Makes a YouTube Video on Healthcare Reform

We here at the Consortium have been frustrated - over the last several weeks - about the tone and tenor of the debate over national health care reform.  Too many distracting issues - like illegal immigration or a supposed government takeover of the free-market economy or, yes, those panels to knock-off granny - have been dominating the airwaves and flat-screens from New York to California.

For anyone who works in community healthcare, the basic issue is and should remain the fact that 46 million people in this country lack health insurance and thus proper access to medical care of all kinds. 

So in the grand tradition of the Internet Age, our response at the Consortium was to make a 5-minute YouTube video.  It focuses on the stories of 4 people in the Bay Area who deal with the realities of either not having insurance themselves, of not being able to afford it for their employees, or of working with people who are uninsured but in need of medical attention. 

We hope it will - in its own small way - help get the national conversation back on the right track as Congress buckles down to hammer out legislation in the next several weeks.