MEDICAID MELTDOWN

MEDICAID MELTDOWN CRUCIAL PSYCHIATRIC CARE DRASTICALLY CUT

Hawai'i is seeing a catastrophic unraveling of health-care for our poorest and most vulnerable citizens, especially the seriously mentally ill.

Most severely mentally ill receive healthcare funded by Medicare and Medicaid (Medicaid "dual eligibles"), and by the Adult Mental Health Division, which has been providing community-based case management and psychiatric services. Their medications are covered by a confusing patchwork of Medicare D plans.

Last month AMHD drastically cut case management and psychiatric services for these patients. On Jan. 1, Medicare D plans cut their formularies, eliminating many crucial psychiatric medications. Psychiatrists have had frantic calls this week from patients unable to fill their prescriptions.

On Feb. 1, Hawai'i Medicaid is slated to transfer the "dual eligibles" to two Mainland for-profit managed-care plans. A Jan. 4 article in The Dallas Morning News documented widespread deception, inappropriate denial of care, and claims processing problems by these same managed care companies in Texas, New York, Missouri, and other states. Most Hawai'i doctors don't trust these plans and few have signed contracts.

Many "dual eligibles" will lose access to their doctors next month, leaving them with no recourse except emergency rooms. We don't have the ER facilities or psychiatric beds to accommodate them.

Is Hawai'i prepared to see our seriously mentally ill stripped of community support services, medications and doctors, all at once?

ECONOMIC STIMULUS

TRILLION-DOLLAR PLAN WOULD ONLY HURT MORE

Obama's $1.2 trillion economic stimulus plan might as well be named the New Deal No. 2. Government expenditures must eventually be paid by taxes or through inflation. When the government spends $1.2 trillion, the taxpayers (consumers) are $1.2 trillion poorer.

In a 75 percent consumer economy it is absurd to take away from that which drives the economy in order to stimulate the economy. We are only looking at the immediate consequences. What we will not see is everything that would have been created if the $1.2 trillion was not taken from the consumers.

What really happens is that the government takes from everyone to employ a few. Instead, we need to cut government spending to make government a smaller burden on society and restore fiscal sanity.

We must abolish the Federal Reserve Bank. This private bank controls our currency and interest rates for profit at the expense of taxpayers. This would rid the economy of an inflationary boom-and-bust monetary policy, restore sound monetary policy and allow the free market to actually work. History has shown that massive government spending combined with a fiat currency always results in national insolvency and runaway inflation.

FUNDS LACKING

'EWA DEVELOPMENT PLAN SEVERELY FLAWED

When we examine the blueprints to transform Kapolei into the Second City, it stands to reason that both the city and state need to fund more than what they can accomplish. The 'Ewa Development Plan therefore is severely flawed from the outset.

On transportation alone, no monies exist this decade to complete the North South Road from Kapolei Parkway to Keone'ula Boulevard; erect one street light at the intersection of Roosevelt Avenue and Renton Road; restripe Renton Road at Fort Weaver Road to permit two solid left-turn lanes; add a second lane on Kunia Road to access the H-1 Freeway eastbound; require the East West Connector Road be completed through private property; widen Farrington Highway; link Keaunui Drive to Renton Road over the railroad tracks; finish the Leeward Bikeway; and provide for an overpass at the North South Road intersection with Farrington Highway.

This whole exercise to formulate a sound 'Ewa Development Plan is as good as trying to complete a paint-by-the-number-set picture kit without any paint but plenty of brushes to go around.

DEVELOPMENT

KAKA'AKO, RAIL SYSTEM NEED BETTER PLANNING

I watch with some dismay the actions of the agencies who are in charge of future development here on O'ahu

I refer specifically to the HCDA with regard to the shape and composition of a redeveloped Kaka'ako, and to the City Council for its backwards approach to the build-out of the rail system.

In Kaka'ako, what is needed is for the community (yes, the community and not an agency catering to special interests) to decide what kind of residential and commercial densities are needed and then to determine the building types best suited to achieve the desired result. (I am quite sure that the present pattern of high-end, amenity-laden ultra-highrises on huge footprints is not the optimal solution.)

As for the rail system, the political deal-making regarding route and stops defies belief. As far as building the leg from Kapolei to Waipahu first, the question simpy needs to be asked: "Who is going to ride the rail from Kapolei to Waipahu?" (The answer is: Not too many people are going to utilize this leg, so ridership will be low and revenues virtually nonexistent.)

I don't hold out much hope that reason and the public's needs will be met under current planning regimes, but it would be nice to hope that we could get the politics and money out of these decisions and put the people's needs first.