By Steve Novick of Portland, Oregon. Steve spent nine years as an environmental lawyer at the Federal Justice Department, has spent the past fifteen years engaged in public policy and progressive activism in Oregon, and is running for the Portland City Council. He is a two-time winner of Willamette Week's "best activist" award.
Hi. I’m Steve Novick, and I’m running for the Portland City Council. My web site, NovickForPortland.org, explains why I’m running. But I’ve decided to use my BlueOregon candidate guest appearance to focus on a group of specific issues. I’m going to go on at some length, and I realize that most of you will be too busy to read all of this. So I’ll preview the topics and give you a chance to sift through and focus on what matters to you.
The topics are: “economic development through health care cost control,” “a new deal on public safety,” “hotels versus classrooms,” “what should we do with the money we saved on the Lake Oswego streetcar?,” “responsible banking,” and “what Bureau I most want.” Here goes:
Responsible banking. I’m leading off with this, because I know the Mayor has a responsible banking resolution in the works as we speak, which focuses on having the City make deposits in credit unions and other local financial institutions. I think that’s a fine idea, but my understanding is that it’s an idea that only goes so far: that there are practical and legal barriers to putting the bulk of the City’s money in smaller, local entities, and to a great extent we’ll be stuck with the big national banks. The Mayor’s resolution implicitly recognizes that, by also calling for the development of new ‘responsibility’ criteria to be used in all the City’s choices of financial institutions. It seems to me, though, that if we really want the big banks to change their policies, strength is in numbers: we should try to forge an alliance of local governments throughout the region – heck, perhaps even throughout the country – adopting a common set of criteria on issues like foreclosure practices, and saying “all of us will shift our business to the national bank that does the best job of meeting these criteria.” So I would encourage the City to try to join with the County, Metro, Beaverton, Gresham, if possible Vancouver, Seattle, etc., in developing and adopting such criteria.
Economic development through health care cost contro: I started my campaign by saying that we are going to revive Portland’s economy by borrowing the health care ideas of the Atlantic City casino workers’ union, and I still think that’s true. I go into this in more detail on my campaign web site, (which, again, is Novickforportland.org), but here’s the gist. Given the huge burden that rising health care costs place on families, governments, and businesses, I believe that the City has a huge interest in developing a strategy to make Portland the best city in America at controlling health care costs without sacrificing health care quality or simply pushing costs onto workers. If we can become a low-health-care-cost mecca, it will make our existing businesses more competitive, and have something big to offer businesses we are trying to recruit: “Hey, we may not offer you the lowest taxes, but we’ve figured out a way to help all our businesses control health care costs.”
I believe the Atlantic City casino workers (as detailed in Atul Gawande’s New Yorker article, “the hot spotters”) have developed an excellent model. They identified the union members who were incurring the highest health care costs, and built their own little primary care clinic, consisting of a couple of doctors, a couple of nurses, and a group of health care ‘coaches’ – most of whom did not have any health care background – who call and visit people to get them to take better care of themselves. “Ms. Johnson, are you taking your meds? Are you REALLY taking your meds? Are you getting any exercise? What are you eating? Do you think you could give quitting smoking another shot?” The members who join the clinic do so voluntarily – nobody’s forced into it. – and seem to appreciate the nudging. The purpose of this clinic – staffed with salaried employees – is to keep the union members OUT of the regular, fee-for-service hospital – and – specialist – heavy health care system as much as possible.
And it is working. The union is saving money. And now a bunch of private employers in Atlantic City have signed up, and are sending their high-cost people to the same clinic, and they’re all saving money. It costs $1.3 million a year to run the clinic, and there are 1500 people in it now, and their health care costs (compared to what they were before) are down by $170 to $200 per person per month. That’s $3 million or more a year – so the net gain is at least $1.7 million.
How could you take that model throughout a city? Well, let’s say the City of Portland itself, perhaps joined by another major employer – just for fun, let’s use an imaginary name, “Tri-Met” – started a clinic like that. And it worked. Then let’s say the city convinced three major private sector employers to join in. And they started saving money. Then let’s say twenty other major employers expressed interest, and we built a few more clinics, geographically distributed around the city …
Now, if this idea sounds a lot like what Governor Kitzhaber is trying to do with Medicaid clients – if this coaching / nudging service sounds a lot like what the Governor wants to get the new “coordinated care organizations” to do – you are right. But the Governor only has control over Medicaid. Nobody controls the private health care marketplace in the same way. Ultimately, what we should do is have the whole medical industry change to the ‘coordinated care’ model. And I think the City and other major employers and unions should start talking to the hospitals and other provider groups about how we get there. But in the meantime, the casino workers’ union model looks to me like a great start.
And yes, I have talked to some folks in both Tri-Met management and the union (ATU) about the model. They seemed at least somewhat interested. And if I win my race in May, one of the things I hope to do with my free time is arrange for Neil Patel, one of the doctors who started the Atlantic City clinic, and whose sister lives in Portland, to visit with both of them and explain how the model works.
A new deal on public safety. Why do the Portland police spend so much time acting as first responders to what are really mental health crises? Well, it’s partly because the County doesn’t have enough money for mental health (and no, I’m not saying they don’t do a good job – just that they don’t have enough money) -- which is partly because the State has cut funding to the counties -- which is partly because the State spends too much on prisons. The logical response would be to switch some resources from prisons to mental health services. But the way public safety is organized makes it really hard to do that. The State doesn’t have a choice as to how much it spends on prisons; if a DA is able to get someone sentenced to five years in prison, the State has to hold onto him for five years. And if a DA thinks she can put someone away for five years instead of three, she really has no incentive to choose three – because if she chooses three, she doesn’t get anything for it; there’s no reason for her to believe the saved money will be spent on public safety. She might agree that it would make more sense to send the guy to prison for three years, put an ankle bracelet on him for two, and spend the saved money on treatment for three mentally ill people who have had run-ins with the law, but she doesn’t have that choice. All she has is the choice of three years or five.
But we can redesign the system in a way that gives her that choice. Right now we have a non-system where the State gives the counties a bare-bones budget for treatment and supervision but in effect an unlimited budget for prisons. But we could have a system where the State gives the county a lump sum budget for public safety services –and tells the county, in consultation with the cities in the county, to divide that budget up as it sees fit. When the DAs send people to prison, the costs come out of that lump sum budget. When the county puts an offender through a drug treatment program, or launches a gang outreach program, that comes out of the lump sum budget.
A system like that would give county and city officials, from DAs to community corrections officers to county and city commissioners to police chiefs, both more power and more responsibility than they now have: they’d have the power to sit down together and allocate public safety resources in a rational way, and the responsibility to do it right. I think that’s the way it should be: the local officials have to live with these offenders in their communities, they are best suited to decide how to handle them.
One major caveat is that I wouldn’t put the price of prison for homicides, rapes and other sexual assaults into the ‘lump sum budget’: the cost of prison for those offenses would continue to be ‘free’ to the DA’s office. But for other offenses, the local officials would have a chance to make deliberate tradeoffs between prison, jail, treatment, and intensive supervision.
An important point about this idea is that it’s an idea which will (I think) shift resources away from prisons without changing Measure 11, the mandatory minimum sentences law. Measure 11 would still exist as a tool for prosecutors to use; they’d just have to be conscious of the cost of using it. By the way, prosecutors have huge discretion in how to use Measure 11. The vast majority of criminal cases are plea-bargained; Measure 11 sentences are only truly ‘mandatory’ in the rare cases that go to a jury and result in a guilty verdict.
I realize that transforming the entire safety budget system isn’t something one city commissioner can do: this idea would require buy-in from the Governor, the Legislature, and, of course, County government. But the City, as a major piece of the public safety puzzle, has a major interest in making this happen. And I’ve already run the idea by Multnomah County Chair Jeff Cogen, who thinks it’s worth pursuing. And I’ve run it by Governor Kitzhaber, who seemed rather intrigued. And I’ve run it by a couple legislators.
We can start smaller, however, just by coordinating the City’s and County’s public safety budgets. Even though the City and County governments are right across the river from each other, there’s not a joint public safety priority-setting or budgeting process. They do sometimes share resources, but generally in the form of (in the parlance of our times) “one-offs”: the City pays for an extra prosecutor for a special purpose, or the City and County put one mental health worker and one police officer in a “mobile crisis unit.”
That’s not a comprehensive strategy. In 2005 and 2006, the Public Strategies Group, the consulting firm where (among other luminaries) former Multnomah County Chair Beverly Stein, prepared a report arguing for a true joint priority-setting and budgeting process: (a) the City and County would join together to set a total dollar figure that they, collectively, are willing to spend on public safety (again, a ‘lump-sum budget’ idea); (b) City and County leadership and community members would identify priorities; (c) City and County departments and bureaus would propose strategies to address those priorities within the context of the global budget; (d) City and County leaders would evaluate the proposals, pick the best ones. That sounds pretty good to me.
By the way, this ‘global budgeting’ idea is very similar to the way Governor Kitzhaber thinks we need to revamp the health care system. The Governor points out that our disorganized health care system allocates a lot of money to dramatic ‘reactive’ procedures like open-heart surgery, but little to prevention. His solution is to create the aforementioned “coordinated care organizations,” which are responsible for managing their patients’ overall health; in his system, if these organizations do a good enough job at prevention that they avoid having to do too many open-heart surgeries, they’d make more money.
The public safety system is kind of like the health care system: Lots of money for dramatic reactive procedures (long prison terms), not enough for prevention. In my ideal world, the local governments would act as the crime equivalent of the Governor’s coordinated care organizations. “Coordinated crime organizations,” if you will.
Hotels versus classrooms. This isn’t really a policy proposal – just a story from the campaign trail. A couple of weeks ago I met with a group of business folks who had interests of one kind or another in the Lloyd District, and they asked if I would provide the necessary political leadership to get a convention center hotel built. I said that if that meant spending city money to build a hotel, the answer was probably “No,” for two reasons. One, I don’t think tourism is a great economic development strategy – New Orleans has lots of tourism and is still desperately poor; hotel and restaurant jobs just aren’t great, high-paying jobs. Two, as long as we have crumbling schools throughout the City I would feel silly spending a bunch of money on a hotel. I realize the City can’t afford to rebuild all of Portland’s crumbling schools – but if we had enough money lying around to build a hotel, I’d be inclined to look to see if there were some schools we could help instead. I think having strong schools is a much better economic development strategy than building hotels.
By sheer coincidence, the very next day I visited Harrison Park Elementary at 87th off Division, where the teachers and kids told me that a few months before, it was 58 degrees in one classroom and 89 degrees in another, and they had to move heaven and earth to get that fixed – and that was just one of their infrastructure problems.
What should we do with the money we saved on the Lake Oswego streetcar? Speaking of finding a lot of money lying around: I realize that the City didn’t really have the $15 or 20 million it was planning to spend on the Lake Oswego streetcar, before Lake Oswego decided it didn’t want it. But just for fun, when I visited Tri-Met I asked them what they could do with $15 million. I specifically asked what that could buy in terms of frequent bus service along 122nd, which Outer East Side folks have told me is a high priority for them. Tri-Met gave me the following list, and said I could publicize it as long as I made it clear that their own priority would be restoring the formerly frequent bus service that they have had to cut back:
Examples of what TriMet could do with ~$15M in one-time funding
Sidewalks and crossings:
Depending on finish level and need for stormwater treatment, 50 to 150 blockfaces (2.5 to 7.5 miles) of sidewalk along bus lines and leading to/from bus stops and transit stations. It could be significantly more if sidewalks just need to be expanded or completed, not built from scratch.
Bus Rapid Transit
Local match for on-street bus rapid transit on Powell-Division from downtown Portland to Gresham.
If used for service, would restore all Frequent Service bus lines in City of Portland to pre-cut levels for more than a year:
- 8-Jackson Park/15th
- 15-Belmont/NW 23rd
- 54/56 – Beaverton-Hillsdale Hwy/Scholls Fy
- 72 – Killingsworth/82nd
- 75 – Cesar E Chavez/Lombard
- (note: 2 other Frequent Service lines serve entirely outside the City of Portland)
- Or increase Line 71 – 122nd/60th to Frequent Service for more than a decade.
What Bureau do I really want? First of all, I want to make it clear that since all of the City bureaus deal with fascinating issues and have terrific, talented people, I'll be happy with whatever the Mayor gives me. But I would really like to have Fire, partly because it fits with my interest in making Portland a leader in controlling health care costs. The Fire Bureau is itself a high-cost health care provider that is trying to figure out how to control those costs. Both the union and Chief Klum and his top managers told me that these days, people don’t just call 911 when they’re having heart attacks; some people use 911 as their primary source of health care. They are trying to figure out what to do about that, through a combination of changing the way calls are screened and trying to figure out who else these folks could call, and where, other than emergency rooms, they might go. I would love to have a chance to work with them, with the Bureau of Emergency Communications, with the County, with non-profit service providers, and with the health care industry to figure out some solutions. Also, when I met with the Chief I had a chance to meet with the soon-to-be new Chief, Erin Janssens, and was very impressed; I think it would be great to work with her.
March 01, 2012
Posted in guest column.
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