Arroyo to stay in city government

Impending Mayor Marty Walsh announced today he's naming outgoing City Councilor Felix Arroyo to be chief of health and human services:

Felix brings a wealth of knowledge and City of Boston experience to my Administration. Felix knows how to bring people together and work collaboratively. He values and understands the importance of directly addressing the needs of Boston’s most vulnerable residents, and he will have a huge impact on our City in this role.

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A hierarchy of who I blame for high health costs

From highest to lowest:

-Hospitals. Just post a damn price board already. Don't lie to me, I'm from Vermont, and I know what (expletive) smells like. Why do people have such great difficulty in telling the truth?

-Wussy people who treat minor ailments as grounds for emergency room visits. I vomited seven times in eight hours one day two years ago. Didn't go to the hospital. That's my threshold. Suck it up.

-Insurers. I mean, they have a right to make money, but they disgust me in using their influence to bully people to buy their increasingly worthless product.

-Doctors. I wouldn't be some schmo that does general practice either if I could make four times more as a specialist, especially when paying six figures and spending 8 years on an education.

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Bzzt, wrong

The primary reason for our current out-of-control healthcare costs is Pete Stark (D-CA) and Ronald Reagan and the attachment of EMTALA to the COBRA law in 1985. EMTALA says that hospitals have to treat you, no matter what, if you have an emergency and show up at their doorstep. This meant as more Americans had no healthcare coverage from their employer, more people used the ER as their doctor's office or waited until a serious problem (meaning huge medical bills) occurred. There was nothing in EMTALA that said how the hospitals were supposed to pay for all this uninsured care. It is the greatest unfunded mandate in American history, passed by a Democratically-led Congress, Republican Senate, and signed into law by Ronald Reagan because it was "budget neutral" (aka "unfunded").

The hospitals have to live up to EMTALA to receive any Medicare funding so they pass the costs on to all of the other services as overhead. Your $5/can of soda in your $1,000/night room? All to pay for EMTALA services provided to uninsured people entering the ER.

Yes, pharmaceutical companies do take advantage of the fact that the government doesn't mandate price restrictions and therefore insurance companies just have to raise your premiums in order to cover the rising cost of medicines. But it's a drop in the bucket compared to what hospitals have to pay out for uninsured care each year which means your insurance has to prepare for an unexpected $50,000 hospital stay if you need your appendix out.

It's times like this I wish we could downvote

Some of the specialists I see deserve 10x what they get because they helped me NOT DIE from a serious medical problem I went through in my 30s.

Don't confuse middling access to service with the service itself. We are damned lucky we live in Boston and have some of the greatest hospitals and specialists you can imagine. I have gotten cutting edge help from some of my doctors because they're thisclose to the latest research (some of them publish research themselves).

If I were going to blame anyone, I'd go after the pharmaceutical companies. I have to take several medications a day and the retail price of one of them is around $800. It's not a new medication so it's not like they're recouping R&D costs. It is a brand name because the generic of this medication doesn't work for me. There's no excuse for a medication I have to take to live being as expensive as my mortgage.

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More like all the other

More like all the other countries in the world threaten to not honor US pharmaceutical company patents for medicine if not given special pricing. So the US customer base winds up paying all the R&D costs in addition to subsidizing the freeloading rest of the world.

Not the customer base

The taxpayer. The pharmaceutical companies talk a good game about "R&D costs", but a fair amount of those drug research costs are borne by NIH grants.

The pharmaceutical companies have to scale up and produce, sure, but don't kid yourself about who is paying up front for drug development.

This is kind of dated, but gives a sense of the scale of the issue: http://www.citizen.org/publications/publicationredirect.cfm?ID=7065

A huge part of the inflated cost of drugs in the US Market: marketing. Yep - ED drug ads in the Super Bowl and everywhere else.

Healthcare in Mass and Mass

Healthcare in Mass and Mass life expectancy are better than the US overall. Unless whenever you are ill you intend to leave Mass and seek treatment in Miss. your remark is not relevant to the issue being discussed here.

Former Councilor failed to make Council proceedings accessible.

The former City Councilor Arroyo failed to make accessible the Stenographic Record of Public Meetings of Boston City Council for hard of hearing folks. Stenographic software should be used that's accessible for hard of hearing folks, that the plain text Stenographic Record be readily available for hard of hearing folks. Current protocol at Boston City Council is improper and wrongful. The original stenographic file is removed from City Hall instead of remaining at City Hall and a copy made for the editing. The Contract provides for it. Help get released the plain text Stenographic Record of Public Meetings of Boston City Council for hard of hearing folks. More complete than Minutes the Stenographic Record is only released in an inaccessible format that requires an additional file held back by the City Stenographer in spite of the contract providing for all materials are city property.

"All work papers, reports, questionnaires and other written materials prepared or collected by the Contractor in the course of completing the work to be performed under this Contract shall at all times be the exclusive property of the City."
--Contract

>'...merely a tool by which the stenographer creates a "public record," in the form of meeting minutes, on behalf of the City Council.'
--Shawn A. Williams, Supervisor of Records in the Office of Secretary of the Commonwealth of Massachusetts William Francis Galvin

File is made, edited, supplemented, created during the Public Meeting of the Boston City Council. Determination failed to take into account the file is made, edited, supplemented, created during the Public Meeting of the Boston City Council. Supervisor of Records unfamiliar with the internal mechanisms of the technology and software. Boston City Council officials unfamiliar with the internal mechanisms of the technology and software. Stenographers unfamiliar with the internal mechanisms of the technology and software.

"2.3 City is entitled to ownership and possession of all deliverables purchased or developed with Contract funds. All work papers, reports, questionnaires and other written materials prepared or collected by the Contractor in the course of completing the work to be performed under this Contract shall at all times be the exclusive property of the City."
Article 2.3 Contract for Stenographic Services Form CM11
City Of Boston Standard Contract General Conditions
Article 2 -- Performance:
https://muckrock.s3.amazonaws.com/foia_files/fritch_37966_1.pdf

I can understand giving

I can understand giving rivals who enjoyed significant support a spot in the administration. It is a nod to the people whose preferred candidate lost and shows a willingness to listen. But it would make more sense to do this with Richie, who came in third. My guess is Richie is too busy with her nonprofit... and Arroyo's interests are more aligned with Walsh's because Arroyo is also union. Although I'm not sure that this is the right position for Arroyo, I do appreciate that Walsh is giving such a position to a person of color. Someone like Walsh is perfectly positioned to reduce racial tensions in Boston because he really is a blue-collar guy at heart (just one who happens to be very rich)... So maybe people will actually listen to him rather than seeing him as an outsider trying to "change" Boston. That is, assuming he himself listens to the issues facing communities of color. I hope that he does more than just appoint a token and makes an effort to have a truly diverse administration. I know there were a fair number of women on his campaign, which is a good start...

Arroyo knows health and human services

Ironically, this comes from his union time, so welcome to management, Felix.

As for Walsh's wealth, he's not "very rich." He ain't poor, and he'll be taking a pay cut to be mayor, but he's no Bloomberg or Patrick. He's "comfortable" or close to that.