PROVIDENCE -- Candidates for governor debate need for costly medical initiatives
They agreed on the need to use the "state's purchasing power" to try to negotiate better prescription-drug prices and at least try to make sure Blue Cross & Blue Shield does not become the only health insurer in Rhode Island.
But the four candidates for governor who took part in a health-care debate last night at Rhode Island College were not as keen as some in their audience of health-care workers might have hoped on using the hammer of government to force hospitals to hire more nurses.
Citing a recent study that found patients in hospitals with low nurse-patient ratios at greater risk of death and complications, the president of the union sponsoring the debate -- the United Nurses & Allied Professionals -- asked the candidates whether they would support "legally enforceable staffing levels at all hospitals."
None were willing to go quite that far.
Democratic Atty. Gen. Sheldon Whitehouse called minimum staffing levels "a very good goal to shoot toward . . . [if] the cost can be met without closing wards or doing anything that would be adverse" to providing care. But Whitehouse voiced concern about the "unintended consequences."
Another of the Democrats, state Rep. Antonio Pires, D-Pawtucket, said consumers have a right to know what the nurse-patient ratio is in each hospital, but he, too, would be "hesitant to mandate certain ratios" and wasn't sure that was a decision the General Assembly should make.
Retired Cookson America president Donald L. Carcieri was even more adamant: "More regulation isn't going to solve much" in hospitals that have been "losing money for years." What is needed, he said again and again, is a look at the entire health-care system.
Only Democrat Myrth York left the door open.
Remembering that it took the threats of legislative action by lawmakers here and elsewhere to stop "drive-through deliveries," the former state senator from Providence's East Side said: if "it comes to the point the state has to mandate" staffing levels to ensure quality-health care, "then yes, the state has to act."
With the state in serious financial straits, none of the four made any big expensive promises. But they also tiptoed around some of the questions asked of them by unidentified members of the audience.
One asked whether they would be willing to try to reopen state workers' contracts to make the workers pay a share of their monthly health premiums. None of the candidates bit, though all said it was "on the table."
Without knowing "how deep the budget hole is," Whitehouse said: "We need to leave everything on the table." Ditto York: "Everything is on the table."
Republican Carcieri remarked that the state workers' health-care package is "very attractive -- more attractive than many private insurance plans." But first, he said, the next governor needs to "completely" redo the contract the lameduck Republican Almond administration gave Blue Cross & Blue Shield that relieves the insurer of most of the risk, and makes the state responsible for paying "total actual claims."
As a member of the panel asking the questions last night, low-income advocate Marti Rosenberg asked the candidates whether they would pledge not to restrict eligibilty for the state-subsidized health insurance program, known as RIte Care, and "work to repeal" the copayments, levied for the first time in recent months, that she held responsible for the recent exodus of 2,100 from the program.
State legislators have debated how much the new copayments have contributed to the departures.
But York answered Roseberg's question with a "yes and yes," explaining later that by that, she meant, she would "look at" the possibility of dropping the copayments of between $60 and $90 a month.
Whitehouse repeated an earlier promise to keep the program intact, and suggested the copayments might be a "mistake" if people are, in fact, "being driven off."
Former House Finance chairman Pires said cutbacks in RIte Care "would be one of the last issues I would look at in putting a balanced budget together." But Carcieri said he "would not stand before you and say I would never touch it," with the state facing "very, very serious [financial] problems -- much worse than most people realize" -- that the governor and lawmakers have "papered over" with an advance on decades worth of tobacco-settlement money.
The other Republican in the race, former Convention Center Authority chairman Jim Bennett, had his staff distribute a statement saying that he could not attend because "a family matter has taken me out of state."
