Portland Press Herald. May 19, 2024.

Editorial: Decline in overdose deaths is something to build on

In response to the news, Gov. Mills encouraged ‘cautious optimism.’ That’s the right approach.

According to provisional national data released Wednesday, the number of fatal overdoses in Maine dropped by 16% last year. It was the first annual reduction in fatalities since 2018.

This is a welcome and persuasive development for our state. Nationally, the reduction in overdose fatalities was 3%. Statistically, only three states – Nebraska, Indiana and Kansas – fared as well or better than Maine. Nonfatal overdoses in Maine also declined last year, by 7.5% (from 9,760 to 9,047).

More recently, January of this year was the first month in more than two and a half years that the Portland Police Department says it did not respond to an overdose fatality.

Although the road ahead of us is still long and steep, Maine has succeeded in turning things around after an especially discouraging five years. The deadly grip of the opioid crisis grew tighter still during the extraordinary isolation, anxiety and disruption caused by the COVID-19 pandemic.

“These results stem from the extraordinary efforts by many people across the state who have stood up to take on the opioid crisis, including those in recovery who are helping those struggling with addiction and Gov. Mills and the team she put together to lead the state’s efforts,” said Dr. Erik Steele, past president of the Maine Medical Association and member of the 1,000 Lives Campaign, a doctor-led initiative to reduce opioid-related deaths by 1,000 from baseline predictions over the coming five years.

Investment in prevention efforts, recovery community centers, in-patient detox capacity and the expansion of medication-assisted treatment in a variety of settings all play a part in the turnaround.

Many local experts and advocates have attributed the hard-won decline in overdose fatalities to the increased availability of the life-saving antidote naloxone, or Narcan, supply of which has been a priority of the Mills administration – in stark contrast to the administration that preceded it.

Former Gov. Paul LePage’s response to the opioid crisis, by belittling it and wishing it away, stood to fuel it. Narcan’s utility is in its availability – it has to be administered quickly in order to to be effective, meaning it needs to be very readily available.

In 2016, vetoing a bill that would have allowed Maine pharmacists to dispense Narcan without a prescription, LePage coldly said the drug served to “merely extend” lives until the next overdose. The bill had been supported by members of law enforcement and health organizations during its legislative hearing.

Two years later, LePage dragged his feet on rubber-stamping new rules under a law (passed over his objection, without his signature) that allowed pharmacists to dispense Narcan. As this editorial board wrote at the time: “Indeed, there’s no need to veto a bill when losing is assured, and you can just sabotage it later.”

Mercifully, the times have changed. As of last September, Narcan is available over the counter and online in Maine. As of last November, our public high schools began offering Narcan education alongside CPR and AED (defibrillator) training. As of January, state law enforcement officers were required to carry the drug.

In her State of the State address earlier this year, Gov. Mills said Maine had spent the past five years using “every proven tool we have to respond to the opioid epidemic.”

This work is not easy. Drug addiction is one of the most complex problems a populace has to confront. It’s made harder again without the interest and understanding of state leadership; thankfully, that is not something we have been without in recent years.

Dr. Noah Nesin, medical director of research and innovation at Community Care Partnership of Maine, told the Press Herald last week that he thought Maine doctors’ recent willingness to prescribe higher doses of Suboxone, a medication that decreases the severity of withdrawal symptoms, was also helping to reduce drug overdoses. Larger doses of Suboxone are necessary as drugs like fentanyl become more and more potent.

“We are much more nimble at adapting our systems than other states,” Nesin said.

Here in Maine, as nationally, this is still a very serious crisis. We have to stay nimble.

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Bangor Daily News. May 17, 2024.

Editorial: With or without late fees, please return those library books

Check this out: Maine libraries are missing a lot of books, and unsurprisingly, the librarians would like them back.

We’re not about to call in Lt. Joe Bookman, the fictional “library cop” from Seinfeld tasked with investigating overdue books, but we will join local libraries in calling for people to please return those overdue books — no matter how past-due they are.

“My message always when it comes to people holding our materials for too long is ‘Please return them so others can enjoy them,’” Director Lisa Ladd of Buck Memorial Library in Bucksport told BDN reporter Marie Weidmayer recently. “If I don’t have the book that means someone else is being denied the use of the material.”

That message should be enough to convince people to return any overdue books. Holding on to library materials doesn’t just impact the library, it impacts our friends and neighbors.

If you’re worried about late fees, you might feel better knowing that most of the libraries in the Greater Bangor area no longer charging them. That matches a trend elsewhere in Maine and around the country, where libraries are ditching the fees in an attempt to make their materials more equitable and accessible.

And if you’re thinking that this approach to late fees discourages accountability and could be the culprit when it comes to the large stack of missing items, experiences elsewhere would seem to tell a different story. New York City libraries saw a wave of returns after late fees were ended there, for example, and libraries in Ontario, Canada said they saw more people returning books on time even after late fees had been ended.

We all can hold ourselves accountable, with or without late fees, by remembering that librarians and other patrons are relying on us to return books, movies and other materials on time. People shouldn’t need the threat of a monetary penalty to do the right thing.

So rather than reversing course on waiving late fees, we think it would be better to spread the word and make sure people know that many libraries have in fact waived those fees. We also encourage people to double check that they haven’t forgotten to return books somewhere in the ever-shuffling chapters of life. And if they have, we hope that they will do the right thing and return them.

Kelly Brooks, the Orrington Public Library director, said a woman recently returned books that had been overdue for 35 years, after she found them in the back of a closet while cleaning.

“Never be ashamed to bring back library books,” Brooks said.

We usually associate libraries with being quiet, but in this case, we can’t be loud enough: If you have overdue library books or other materials, please return them so that others can enjoy them, too.

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Boston Globe. May 20, 2024.

Editorial: We ask too much of primary care doctors. 26.7 hours a day, to be exact.

Primary care is in crisis. Doctors need better pay and more administrative help to ease their paperwork burden.

If you’ve recently tried to find a new primary care doctor (spoiler: it isn’t easy ), the fact that primary care is in crisis is no surprise.

Data released Thursday by the Center for Health Information and Analysis and Massachusetts Health Quality Partners show how bad the situation has gotten. In a 2023 survey, 41.2 percent of Massachusetts residents reported difficulty obtaining necessary health care in the past 12 months, up from 33 percent in 2021. While 81.3 percent of residents reported having a preventative care visit with a medical professional in the past year, only 68.4 percent of Hispanic residents had one.

While state policy makers and health officials are understandably consumed with the financial crisis at Steward Health Care, they should not lose sight of the other crisis looming: the lack of access to primary care. After all, a strong primary care system is necessary to keep people out of hospitals. It is not coincidental that Hispanic residents were also those most likely to report an emergency department visit that could have been avoided had a general doctor been available, according to the CHIA data.

“If you don’t have primary care, you go for alternative care, you go to specialty care, emergency departments,” said Barbra Rabson, president and CEO of Massachusetts Health Quality Partners. “Primary care is usually the front door to the health care system, the one place to form a relationship to monitor care over time. If you miss that, prevention goes out the window, monitoring chronic disease goes out the window. People are going to get sicker … and it will cost a lot more.”

There are two main ways to shore up primary care, and neither is simple: pay primary care doctors more and reduce the administrative burden. After all, if the perception of primary care is that it pays too little and asks too much, medical students will naturally enter specialty fields.

These days, according to the CHIA, primary care doctors are jumping ship. Between 2019 and 2021, the percentage of Massachusetts physicians leaving primary care jumped from 3.1 percent, which was below the national average, to 5.6 percent, slightly above the national average. A third of primary care doctors in 2021 were over age 60, suggesting a wave of impending retirements. As of 2023, only 22 percent of Massachusetts medical school graduates were working in primary care six to eight years after graduation.

One probable reason is money. “Primary care is substantially underpaid,” said Russell Phillips, director of the Harvard Medical School Center for Primary Care. “So many things are being asked of primary care, but we lack resources to be able to do those things as well as we should be doing.”

According to the CHIA data, in 2022, pediatricians were the lowest paid medical specialty in Massachusetts, earning on average $166,270. Family care doctors earned on average $247,560, while the highest paid specialty care physicians, dermatologists, earned on average $414,270. While these salaries are not low, Philips said the average primary care doctor works 60 to 70 hours a week.

These numbers reflect the lack of financial resources dedicated to primary care throughout the health care system. Massachusetts insurers spend about 7 percent of their budgets paying for primary care (less for Medicare Advantage, which covers seniors), according to CHIA. Our primary care spending rate is similar to the national average, according to the Milbank Memorial Fund.

There have been initiatives to increase the amount of money spent on primary care. Former governor Charlie Baker introduced legislation in 2019 that would have required providers and insurers to increase the amount of money spent on primary and behavioral health care by 30 percent over three years without increasing total health care spending. A bill sponsored this session by state Senator Cindy Friedman, who cochairs the Joint Committee on Health Care Financing, would require providers and insurers to gradually scale up to spending 12 to 15 percent of health care dollars on primary care.

The challenge is how to do this without raising already high health care costs. Efforts to increase pay for primary care — through assessments on other parts of the health care system, hospital price caps, or lower specialist reimbursement rates — will draw opposition from those who would lose money. But there are ways of saving money systemwide, like reducing low-value care, which are procedures or screenings that offer little benefit to patients and which the Massachusetts Health Policy Commission estimated in 2021 generated $38 million in costs. (Some examples are Vitamin D screening for patients without chronic conditions, preoperative EKGs, or imaging for heel pain, unless someone’s unique medical history warrants it.) Payment models that pay to keep a patient healthy rather than fee-for-service could theoretically incentivize providers to focus on preventative care.

Another way to attract more primary care doctors is by reducing “pajama time,” time spent on administrative tasks. A 2023 Massachusetts Medical Society survey found that the top stressors for physicians are administrative: increased documentation requirements, a lack of administrative support for nonclinical tasks, and time spent dealing with insurance.

This is an area ripe for experimentation with new technology, like the use of artificial intelligence to generate medical notes or the simplification of electronic medical records. Insurers should reconsider what services require prior authorization and whether there are ways to simplify that process. Hiring medical scribes to take notes could help.

Ensuring primary care offices are fully staffed with nurses and physician assistants would let physicians focus on clinical tasks where their expertise is most needed. One study supporting a team-based approach to primary care estimates that to provide appropriate preventative care, acute care, chronic disease management, and documentation, a physician working alone would need 26.7 hours in a day.

Massachusetts’ hospitals are at capacity, and that problem deserves attention. But the best way to address hospital overflows is by preventing people from showing up in the first place — and that requires robust primary care. As a state, we need to train more primary care doctors while ensuring that the job is manageable and doctors are paid adequately for their vital work.

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Boston Herald. May 22, 2024.

Editorial: Maura Healey poisons progress

MassFiscal poll shows electorate wary of her administration

Gov. Maura Healey is lucky she’s not up for re-election until 2026.

That’s because a poll out Tuesday clearly signals Massachusetts voters are fed up with the cost of … well, everything. Reading between the lines, the governor is facing heat.

Economic anxiety is a reality in households across the commonwealth due to inflation, high interest rates, and limitations on purchasing power. A trip to the grocery store now requires a cost-benefit analysis by household members.

Toss in stresses coming from Beacon Hill, and Team Healey should be sweating the cliff their candidate is heading toward if her administration refuses to moderate. But that would take leadership and upsetting your base and we doubt Healey has the political courage to do so.

Here’s what the MassFiscal poll is saying:

1. 59.87% are against the new “net zero” emissions goals built into the state building codes, which can hike the cost of a new home by an estimated $23,000.

2. 53.60% are “highly concerned” that the migrant crisis — and all the payouts to shelter dwellers — will harm the housing and rental markets.

3. 55.20% say Healey’s “real estate transfer fee” idea, which would tax 0.5% to 2% on the portion of a property sale over $1 million or the county median home sale price, is a bad idea.

4. 44.80% dislike the MBTA Communities Act mandating higher-density housing. Go ask Milton about this one.

And we’re not talking about the cross tabs, where the largest political party in Massachusetts — “unenrolled” independent-minded voters — make up 63.61% of the electorate.

Looking at one category in the poll, it’s clear Healey is treading water with independents. A robust 30.69% responded they have “strongly unfavorable” views of her administration; 14.83% are “somewhat unfavorable,” and 13.81% are “unsure.”

Unsure? These voters could tip the scales in a race. Because the governor is doing a good job at angering more and more residents every week. In Norfolk, the Herald reported one resident was so popular in her concerns about migrants moving into an abandoned prison that someone shouted out, “Run for governor!”

“The bottom line is we don’t have the space, and I know the government loves to simply throw money at the problem with the expectation that it will be fixed, but that won’t work,” Norfolk school committee member Lauren Vives said last week at an emergency community meeting where she was cut off by a booming standing ovation, yells from the crowd — including the urge to run for the Corner Office.

Politicians have a saying for this, they call it retail politics. Getting on the ground, but for Healey and other progressives, packing the room with like-minded followers won’t win you re-election. (U.S. Sen. Elizabeth Warren should take note, but that’s a topic for another day.)

Healey’s edicts and lack of immediate and get-tough reaction to what ails Massachusetts residents will make her a one-term governor. We can’t wait for reality to finally catch up to her thinking.

The summer is on our doorstep and now is the time to stop the state’s right-to-shelter law, help who’s here now and turn the focus back on the residents who keep paying taxes. Or, more will leave the state.

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Hearst Connecticut Media. May 17, 2024.

Editorial: What does end of session tell us about CT’s aspirations?

If you were placing bets at the start of a Connecticut General Assembly session (no, that is not a suggestion for a new revenue stream), it wouldn’t have been much of a gamble to predict doom for the proposals that drew the biggest headlines.

This was true long before Gov. Ned Lamont learned that lesson during his first year in office, which was defined by his humbling failure to revive tolls.

Early in the 90-day 2024 session, it would have been wise to wager on a different transportation breakdown for Lamont. His proposal to end the sale of gas-powered new vehicles after 2034 was abandoned on the side of the road before logging too many miles. The initiative was ambitious, but may have been premature.

Any session’s end is reason enough to pause for consideration of who we are as a state. The 2024 edition does little to define Connecticut as aspirational.

Nothing fit that category more than what became known as the “Green Monster” bill. The Connecticut Climate Protection Act of 2024 included many strategies to address the climate crisis. At its core, though, was the intended declaration that there is a climate crisis. That alone drew plenty of blowback. On a practical level, it aimed to define a more aggressive target for the reduction of greenhouse gases. This monster was never going to survive the session intact, but it wasn’t even able to land on the Senate calendar for a vote. In a state reliably cast as progressive that was a significant win for conservatives.

Similarly, Connecticut didn’t make any notable progress regarding housing, another buzzword commonly paired with “crisis.” The Work, Live, Ride bill, which strives to promote housing construction near bus and train stations, failed yet again.

Such setbacks raise the question of how serious Connecticut really is about addressing precarious housing and climate challenges. A bill was passed that will mandate an annual report from municipalities documenting building permit applications. It will be interesting to measure future compliance among towns. And some modest reforms were made in bills, such as incentivizing development of medium-density housing. But there is no sense that Connecticut lawmakers have the will to reimagine housing across the state in a way that could stabilize life for countless residents.

Lawmakers in different corners of Connecticut politics all could claim victories in this ho-hum session. For Gov. Lamont, success came in the form of maintaining fiscal guardrails and getting a spending plan passed absent significant drama.

But too many problems remain unresolved. Lawmakers did yield to the Connecticut State College and Universities’ plea for more funding, but CSCU Chancellor Terrence Cheng and others acknowledged that the one-time infusion is merely a temporary reprieve.

Lawmakers also deferred to the governor after he threatened to veto a bill aiming to regulate artificial intelligence. Lamont reasons that a better strategy is to collaborate with other states.

We hope he’s right. But we suspect that even an AI program would assess the session and conclude that the 2024 model of Connecticut is not aspirational.

END