The first part of this week’s comment is about health, not health care. RIPTA, the organization that runs the buses in Rhode Island, is planning the largest set of route cuts in its history – to save $17.6 million. (There was a public hearing on this in Newport on Tuesday.) These cuts seem like a mistake, maybe not crazy but certainly dumb. $17.6 million isn’t a lot of money in a state budget of $14.3 billion. (It’s about one tenth of one percent). Buses serve poor and working people. They let people without cars get to work and school and go to the beach. The more bus service there is, the more people are likely to take the bus instead of driving or taking a very expensive Uber, which is what you do when you have no other choice.
But buses, and all public transportation, have well documented public health benefits. There is very strong evidence that public transportation use is associated with more physical activity and lower weight, because people who use public transportation walk or cycle to bus and other transport stops. One study showed an association between public transportation and lower stroke risk. Public transportation is also thought to promote health by reducing social isolation, by reducing motor vehicle accidents and air pollution (particularly when the buses are electric), by improving access to medical care, and by giving poor and working people better access to healthy food. I’ll bet at least a quarter that we will spend more addressing obesity and the heart disease, diabetes and stroke that obesity causes in the people who take the bus than the $17.6 million we’ll save by reducing RIPTA’s routes. Plus, having good public transportation is the mark of a civilized society. How many of us long to leave the car behind and would, if there were more frequent buses.
We shouldn’t be cutting bus routes. We should be adding them. Lots of them.
Then, kudos again to the people who organized in Newport to preserve maternity care at Newport Hospital, who preserved it for at least one more year. Brown Health announced that they will put together a study commission, which is a good thing, to look at the costs and staffing challenges of small maternity units.
That little kerfuffle reminded me of some organizing work from forty years ago, when a bunch of people organized around the Caesarian section rate at Memorial Hospital in Pawtucket. At Memorial in those years, 41 percent of first-time moms had primary caesareans (when the national average rate was 19 percent) and women in labor were sometimes put in leather restraints and sometimes struck by their obstetricians to ‘settle them down’. All this got leaked to the press and there was quite an uproar. The hospital got RIDOH to create a blue-ribbon commission, which tried to paper over the problem.
So the Women’s Health Collective put together a Community Blue Ribbon Commission, which was made up of childbirth advocates and a few doctors and nurses. We had open meetings and wrote our own, much more detailed and objective report, which kept the process unbiased. Memorial ended up with the best small maternity unit in the state by far. (It survives. It was moved to Landmark when Memorial closed.)
If I were Newport, I might just organize my own study commission to run parallel with what Brown Health is running and have Newport do its own investigation into what is best for Newport and for women who hope and expect to give birth in Newport. You can assemble your own experts, which is what we did in Pawtucket 40 years ago, draw your own conclusions, and chart your own path that way.
You see, what we have done about the community control of health care is quite crazy. We got scared about the cost and the risk, and we gave away community control to so-called experts and administrators, most of whom are very good people but most of whom live out of town. Those experts and administrators have to be accountable to boards, and regulators (and ultimately, to bondholders) but they are no longer accountable to us.
There is nothing magic about health care. It is an essential service, like police and fire protection, city water and sewer, public education and roads, all of which cities manage well for themselves. The way to be in control of health care is to take control of it. And not give that control to the very nice people from Boston and New York.
PS for my money, the best solution for maternity care in Newport is to put a Family Medicine residency at Newport Hospital. Many family physicians do maternity care and some are trained to do Caesarian sections. A Family Medicine Residency at Newport Hospital would reduce physician staffing pressures on the maternity unit enormously— and guarantee Newport a supply of primary care doctors for years to come.
