I have been writing in this space for several years now, sticking scrupulously to my topic of health care reform.
I am well aware, perhaps even a bit sensitive, that the title of this page is “Opinion.” I know how most people feel about opinions. I suppose personally I think opinions can be valuable contributions to most issues in the human condition if they are informed opinions.
Having spent more than 20 years studying, participating, listening, and otherwise soaking up every bit of knowledge I could on our health care system, I have become either comfortable or frustrated enough to step out on the opinion pirate’s plank.
The trouble is, few issues – and certainly not the health care mess – can be solved in a vacuum. They are inextricably interwoven with other issues, often equally complex and emotional, but about which we are less secure in our expertise. Never has this been more evident than now, as our state and many others in our great nation face extraordinary budget problems.
Like most genuinely paradoxical situations, the state budget is on the surface a rather simple choice. We are either spending too much or paying too little in taxes. My constituency, the business community, finds itself in the particularly awkward role of having advocated lower taxes for ourselves and having had some modicum of success in recent years on our entreaties.
Now we face the scrutiny of cause and effect. Are we responsible for the shortfall or has the state simply failed to contain frivolous spending?
Naturally, we maintain the latter, but it is our feeble effort to define “frivolous” that has been causing me increasing unease. Do we really mean to dismantle the social safety net our community has built over several generations? It would certainly seem so, given the budget proposal of our ally, Gov. Donald L. Carcieri.
Privately we say something much different. It is somewhat obvious to a competent business person that our problem on the spending side stems from our outdated and almost ridiculously duplicative governance structure. Our 39 cities and towns, all semi-autonomous little fiefdoms, and the legislative edema that representing them all has caused, are clearly the root cause of our public profligacy.
The administrative redundancy is stunning in so compact a state with barely a million citizens to govern. But the reason that there seems to be little momentum to change that redundancy is the local control that the system delivers to each town and school district.
If the business community falls principally on the right-wing / fiscal-conservative side of this debate, I think we will have to take some ownership for things being the way they are. After all, the governance structure evolved from gerrymandering by our functional forebears as they struggled to maintain political control even while vastly outnumbered by the waves of immigrants in the cities.
Today, the core issue is education. Taxpayers in Barrington and East Greenwich are unwilling to have their educational resources intermingled with Central Falls. We are left with deep cuts to social services, including RIteCare, as our proposed solution. I know that I’m not the only one uncomfortable about this.
On the other side of the argument, social activists and advocates on the left realize that the cities and towns have come to represent many union jobs and thus remain focused on insisting their opponents pay higher taxes as the only solution.
Neither of the choices we are left with – tax the relatively rich or cut social services – is the right one. Is there any wonder why a true solution has been so elusive?
As the emotion in this debate has elevated, so has the hollow feeling in my gut. Rhode Island is already a highly taxed environment. No one wants to pay even higher taxes. I risk becoming a pariah among my own constituency for even suggesting it – but truthfully, I would rather pay more taxes than live among hungry or homeless children in need of basic health care services. Why have our leaders left me with this horrible choice?
Retreating to what I know, let me point out that among the most pressing problems in the health care system are a shortage of nurses (as well as primary care physicians) and the need for vast information technology implementation. Both will require skilled and highly compensated people some of whome, the nurses, are likely to be filling union jobs.
This seems to me a reasonable area for compromise.
Over time, we would be trading municipal bureaucrats paid by the taxpayers for nurses and health IT professionals in the private sector. It would be awkward, for sure – as these paradigm shifts always are. And there is no guarantee that it would completely close the budget gap, nor in any case would it do it quickly enough, so both sides may need to give a little in the interim.
The real question is whether we have the political leadership to see a choice that could marginalize its own role. I suppose we will just have to wait and see. Or perhaps a few others of you would like to join me on the plank? •
Ted Almon is the president and CEO of The Claflin Co., a medical equipment supplier, and is an active participant in the debate over health care in Rhode Island. 
