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Health Care
Do you want the good news or the bad news? The good news in health care is that we have a fabulous emergency care system, medications that work and hospitals with medical and surgical capabilities not dreamed of in the 1970’s. The bad news is that we’re using a system of care developed years ago to manage acute illness when we’re trying to care for chronic health problems like heart disease and diabetes. This type of care is expensive and many Mainers don’t have insurance coverage. Also, there is poor communication between providers, which increases the risk of mistakes. We have thousands of uninsured children in our state, and the President vetoed the bipartisan State Health Insurance Program (SCHIP) legislation that would have corrected this. The President argues that he’s against any program that might shift coverage from private to state systems, but he created the inefficient and overwhelmingly expensive prescription drug benefit program for Medicare that shifts prescription drug costs from private insurers to the state. First, we need to invest in children. Medicaid is expensive for our state to administer and private insurance is expensive for young families and small business. We should guarantee that all children from birth to age 18 preventive health coverage. We need 1 administrative system that would save money for state budgets, working families and employers. Second, to lower costs we need to do a better job of managing and coordinating care. Doctors need a computerized medical record system to communicate with patients and other providers in a secure and confidential manner. Federal grants should underwrite the cost of this system. We created a system like this at my hospital through a $1.4 million grant that I helped to write. Third, our Dirigo Health Plan doesn’t work because there aren’t enough people in the plan. We need to pool together broad groups of individuals beyond state borders throughout New England to share coverage risks. In this system consumers retain their ability to choose their plan and their provider and we use market forces to hold down costs. Some have called this managed competition. Finally, untreated depression, Post Traumatic Stress Disorder and dual diagnosis disorders (mental health and substance abuse problems) make it hard for people to follow through with chronic disease management. We must use targeted case management, pay for treatment of mental health disorders and we must integrate mental health with primary care.
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Stimulus Package
1/25/08
The President and the Congress are afraid that our economy is heading into a recession. In the last two months, the subprime mortgage crisis has led our leaders to propose and enact one ineffective stimulus after another. This week, Mr. Bernanke, our Federal Reserve chairman, presided over the steepest one-day interest rate cut in the central bank’s history and President Bush called for nearly $150 billion dollars in tax relief for business and individuals.
How did this happen? NY Times reporter David Leonhardt blames it on a huge speculative bubble, first in stocks and then real estate. He said that “everyone from first-time home buyers to Wall Street chief executives made bets they did not fully understand, and then spent money as if those bets couldn’t go bad. For the past 16 years, American consumers have increased their overall spending every single quarter, which is almost twice as long as any previous streak.”
At the same time that we have an economic crisis, The Wall Street Journal said that “home construction had plunged to its lowest level in 16 years.” Lenders have “grown wary” from exposure to delinquent construction loans and new home starts were down 14% in December. This will result in a loss of jobs in the building and construction industry and make more Americans dependant on unemployment insurance and Medicaid. A short term fix is not likely to alter this decline in the housing market, but strategic investment by our federal government could make a real difference.
In the face of the economic crisis, we have a housing crisis in Maine. The crisis is two fold: First, without affordable housing within reach of Maine families, we face sprawling development as people move away from their workplace in search of affordable homes. Second, too many families are struggling to pay their heating bills and the financial support for low income families isn’t keeping pace. Maine and many of America’s towns and city’s have old homes and unused or abandoned buildings in need of rehabilitation. These older buildings are energy inefficient with poor insulation in their walls, windows and roofs. They also hold toxic chemicals like lead in their paint and pipes.
There is an opportunity here. If the President and Congress really want to promote a plan, “big enough to make a difference,” they should offer financial incentives for property owners to make their building’s more energy efficient with credits for putting in new furnaces, windows and insulation. Credits should also be available for homes and businesses to be fit with solar panels and utilize other alternative energy sources. We should promote an economic stimulus package that encourages communities to reclaim vacant and blighted properties and rewards innovation leading to energy efficient and healthy buildings, free from lead and other toxic chemicals. In addition the funds available for families struggling with their heating costs must be increased now and assistance provided to help these families make their homes energy efficient as well.
The process of renovation to create energy efficient homes will keep our building trade workers employed. The buildings will burn less fuel, decreasing our dependence on foreign oil and lowering emissions of greenhouse gases. Tax credits for “green” industry, like research, production and installation of alternative energy sources will also add to the job base and offer young entrepreneurs an opportunity to start a business. Our leaders should not react to the current economic situation out of fear.
An economic stimulus package should not offer short term relief and it is no substitute for thoughtful, forward thinking leadership and an investment in tomorrow’s industries. We have an opportunity to make a difference right now to support middle and lower income families, to strengthen our building and construction industry and provide the jobs that come with an investment in our future.
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Education and No Child Left Behind (NCLB)
Today, almost all parents work, and children are at day care after school. Many children become “latch key”, having to fend for themselves after school, often beginning at age 11. Pediatricians know that when children are left alone they are more likely to engage in risk taking behavior and less likely to complete their homework. We need to restart the Communities for Children program at every school. In this established program, schools, parents and community leaders partner to create Healthy Start programs for preschool children and mentorship programs for teens. We need an extended school day, with after school programs aimed at improving fitness and promoting a child’s interests. Maine has one of the highest High School graduation rates in the country, but a low rate for students going on to college. For those choosing to go to college, interest on student loans must be tax deductible. Scholarships should be just that and should not be taxed as income. And when employers offer student loan abatement, that money should be tax free as long as it goes to pay off the student loans The University of Maine system is in the midst of a transformation with exceptional strengths in fields of forestry, teaching, resort management, and bio tech. U Maine Farmington has been cited as an educational venue of exceptional value in the US News and World Report. Bates, Bowdoin and Colby Colleges are renowned for their quality and attract students from around the world. We need to help both State and private Colleges and Universities knock down the barriers that prevent our young adults from going on to graduation and help them graduate with less debt.
No Child Left Behind
When a child is born in a community, he or she will spend the next 18 years making friends, learning and growing in the community’s day cares and schools. We should think of our schools as the child’s second home. The money we put into our schools is an investment in the child’s future. By the time of graduation the average Maine community will spend over $100,000 per child, a clear example of Maine’s priority on education. Concerns about waste and poor quality in Public education led to a federal initiative to measure outcomes. The federal program “No Child Left Behind” (NCLB) was intended to create a measurement system of educational outcomes. Tied to outcomes, NCLB also imposed rewards and punishments on school systems, based on student testing. Unfortunately, the program has produced a host of negative outcomes after its implementation. I believe that NCLB is seriously flawed. It is a federal program with national standards that has forced states to make changes, but has not supported those changes with appropriate federal funding. Additionally in 2006, the federal government threatened to withhold 25% of federal education funding from the State of Maine because of non-compliance with the mandates of NCLB. Maine’s decision to use the SATs as the standard test for every high school student was deemed unacceptable to Washington. A vigorous defense of our educational practices has distracted our state officials from the more important work of improving our schools. Squabbling with Washington over funding has replaced cooperative or productive collaboration, and costs Maine tax payers even more money. Unfortunately, since the development of the NCLB program, too much attention has been placed on preparing children for tests, rather than preparing them for life. I believe in promoting community involvement in the local school system. Parents should be engaged in the schools early and often in the child’s life. Teachers, parents and administrators should be seen as partners in the child’s development. NCLB must be rewritten. Helping promote innovative successful educational policies must be the first priority of the federal government, not the Washington game of shifting costs but not control to the states.
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Energy
Maine has three distinct energy requirements; transportation, home heating, and electricity. These three energy sectors have unique challenges and solutions.
Transportation currently accounts for 16% of all man made carbon emissions, with auto fuel representing the largest proportion. Currently, the most promising technologies for reducing our transportation fuel demands are bio fuel development and hybrid automobiles. Additionally, we need to limit sprawl, and develop fuel efficient mass transit systems. Sprawl forces people to commute long distances, polluting the air and adding to consumer costs. Auto makers have moved only tentatively to produce fuel efficient automobiles, and individual consumers have not received enough encouragement to purchase smaller, fuel efficient private automobiles. Although bio fuels are a viable future source of energy, current development focuses on corn as a source of ethanol, with the unintended consequence of increasing the price of corn as a food source. Switchgrass, a plant that grows wildly throughout the Midwest, represents a potential alternative for producing ethanol. Switchgrass yields an impressive 540% more energy than the amount needed to produce it. Corn ethanol yields just 25% more energy. Maine’s forests may also be a future renewable source of raw materials for alternative fuel; about 25% of a pine tree is waste that decomposes naturally to methane (greenhouse gas). It produces carbon dioxide if it is burned. Producing ethanol from the tree waste represents a mechanism to capture energy with no increase in greenhouse gas production.
Home heating costs have dramatically increased, challenging Maine families financially. Maine homes are primarily dependent on oil heat, and energy saving opportunities for Maine’s homes are immense. Maine’s aging factories, apartments and single family homes are inefficiently heated and insulated. Renovating existing structures is an approach that allows a new housing industry to take advantage of technological changes in construction and insulating materials to create high efficiency buildings. Federal grants must be made available to allow Maine to move into this new building sector. We need alternative heat sources and natural gas must be available throughout our state.
Electricity supplied to the state of Maine is obtained from a range of energy sources. Maine requires that a percentage of our electricity be obtained from renewable sources. Most of our electric power is supplied by both nuclear and conventional coal burning sources. Less than five percent is derived from oil. Although nuclear energy is attractive as an alternative source of energy because of its low carbon emissions, I have worked constructing nuclear power plants and feel that the risks accompanying the use of producing nuclear energy are too high. In addition to the risk of nuclear contamination, waste management represents an ongoing problem for our nation’s current nuclear power plants. Clean energy sources such as tidal, wind and solar energy remain attractive but expensive and research and development in these areas has been under funded by the federal government. Coal processing to produce a fuel with lower carbon emissions is another technology that has promise for development in Maine. Wind, solar, and tidal power sources need significant economic incentives for effective implementation. Installation expense, concerns from local residents regarding the aesthetics of wind turbines, resistance from environmentalists and the inefficiencies of current alternative energy sources are barriers which must be addressed. Tax credits provide a platform to initiate the installation of turbines, but resistance from Washington is increasing as this energy source grows and requires more federal subsidies. Research grants are the obvious next step in the development of better, more efficient and less expensive energy capture. Maine already has developed industrial use of composite light weight materials in its boat building industry. The same science could be applied to wind power generation. Investment in innovation should include research in coal, tidal and solar power.
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The Environment and Natural resources
Our state was industrial in a time when we weren’t aware of the dangers of many of these toxins. Anyone living in Maine in the 1970s understands the effects of industry dumping in the waterways. In the past, my mill town was a booming economy whose unregulated industry unknowingly fouled the water of Lake Annabasacook to our south. Lake residents worked to identify the pollution, and the lake was designated a national Superfund site. We have cleaned up the water dramatically over the last 25 years, but we have further to go. Environmentalism is an economically sound policy for a state with strong dependence on a tourist industry. It is also the responsible thing to do for generations to come. I am fortunate to live in one of the most beautiful and natural locations in the Nation. I can walk out my door and kayak and fish in my home town of Winthrop. I am mindful of the need to balance recreation with conservation but would note that the outdoorsmen in my area are excellent stewards of the land. Logging is important to our economy and I support sustainable logging and hunting in my rural setting. We need to foster cooperation between the conservationist, the logging and paper industry and its workers, hunters, and those visitors to our state who choose to come to Maine to enjoy a unique, natural outdoor experience.
Environmental protection and the FDA
Every toddler in Maine is now tested for lead poisoning regardless of the age of their home because lead could be in the soil on their property or in their water. We have become aware of mercury content in fish and warn mothers to be wary of the type and amount of fish they eat. Many families are now worried about mercury fish oil pills and other marine based products. We must continue working with big companies to limit their toxic dumping in the environment. Mercury in products has been limited or eliminated; lead is out of paint and gasoline in the USA. Globalization, however, has led to imported products, including food and toys contaminated with toxins. Globalization has led to a loss of regulation. We must ensure that imported products are held to the same safety standards as American products. As your Congressman I will work to ensure that the products you buy are tested and safe.
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Community of Faith
Maine’s many churches, synagogues and Mosques are evidence of the rich diversity of our citizen’s approach to worship. Faith based groups have a pivotal role within our social service system, but I believe in the separation of the church and state, and will not support legislation that breaks down those barriers. I recognize the role of faith in our communities and encourage faith based organizations to work together with government to support our citizens, as did our founding fathers. Although they acknowledged the importance of faith, the writers of the constitution were careful to construct a government system that kept the mechanics of the government and the church separate and prevented government interference with freedom of worship.
Same Sex Marriage: There are a number of important points to clarify. First, I believe that people live better when they have a stable relationship with someone who cares for them. Promiscuity and infidelity can cause great harm to all involved, and a great society should promote stability in monogamous relationships. Second, the state should be interested in promoting formal contracts between individuals interested in creating a partnership. Civil Unions allow partners to enjoy the legal benefits of their bond, clarify personal responsibility, and clarify the law regarding property transfer, and emergency responsibility. Third, I feel the ceremony of marriage is a cultural, religious and family institution that has nothing to do with the state. The state should not be involved in regulating our personal religious beliefs. In summary, I support civil unions to promote stability and clarify personal responsibilities whether a partnership is heterosexual or same sex. Marriage is a spiritual celebration and I feel the state should not interfere with this personal practice.
A woman’s right to choose: In the early 1970’s, many young women had illegal abortions and as a result suffered life threatening infections, long term reproductive harm and oftentimes death. Abortion was legalized because it was better for women to have a safe abortion than death or disability. It would be wrong to return to a barbarous time when a teenager or young women didn’t have the chance to have a safe abortion. I fully support a woman’s right to choose.
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Gun Safety
I care for many families in my practice who have told me that they have a gun in their home, and many of my patients hunt. When my sons were in Middle School I was a parent chaperone at their outdoor camp. Hunting safety was one of the required activities during the camp and my boys gave the course high marks. During my military service I was trained in marksmanship and gun safety. I believe that anyone owning a gun should be certified in its safe and accurate use. I support gun control, in the form of a waiting period before purchase, background checks, and development of an improved system of tracking ownership. Felons should not be permitted to own or use a gun. More specifically, I believe further in controlling the sale of hand guns. Small, concealed weapons have limited use in hunting and are more likely to lead to an accidental shooting at home than to provide protection from an intruder.
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Housing
We have a housing crisis in Maine. To avoid economic risk, a household should pay no more than 30% of their annual income on housing, yet many in Maine are spending 50% and more. Without affordable housing within reach of Maine families, we face sprawling development as people move away from their workplace in search of affordable homes. Maine’s traditional regional centers stand ready and able to absorb large shares of projected growth by renovating vacant mills and aging homes. The Federal Homeownership Zone program allows communities to reclaim vacant and blighted properties, increase homeownership, and promote economic revitalization by creating entire neighborhoods of new, single-family homes. Unfortunately, this program is not currently funded. As your Congressman I will work to reactivate this program so that funds will be available to revitalize our cities.
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Job Creation
Maine has a traditional economy dependant on paper and textile mills, farming and natural resources from the forests and the sea. Globalization has changed much of that, moving our manufacturing jobs to other countries. We have a strong job base in defense, natural resources and tourism. We have enormous potential to draw on the traditional industry and craftsmanship of Maine natives who work in the creative economy. The Naval Shipyard in Kittery must be kept open and operational. There are 4,300 civilians and over 100 Navy staffers and each of these jobs is supported by 5 service related jobs in the community. Maine’s ship building industry has historical roots and natural resources which will continue to support this industry including deep water ports, nuclear licensure and experienced workers, We need to protect the jobs at Bath Iron Works. In 2005, Congress approved a “dual yard arrangement” with Bath Iron Works and a shipyard in Mississippi to build the next Navy Class of Destroyers. Recently it was announced that BIW has been awarded an additional 140 million for this contract, with 25% of the work to be performed in Bath. Despite this, the work force in Bath has dropped from a peak of 12,000 jobs in 1991 to less than 6000 today. The Brookings Report on the state of the Maine economy cites Maine’s strengths in our small towns, sense of community and unspoiled land and seascapes. Investing in biotech and high tech allows the Maine economy to use innovation as another natural resource. We are competing in a global economy which is increasingly led by ideas rather than raw materials, and Maine’s future economic investments must be in education, using technological advances to compete. Our state is moving forward with a consortium of non-profit labs called the Maine Biomedical Research Coalition. UNE is developing a new biomedical research center that will attract new faculty and federal grant money. Every dollar of investment in biomedical research brings a 7 fold economic return to the Maine economy. Maine won a Federal Department of Labor grant for 15 million dollars, surpassing 80 competing proposals to help create 2000 jobs in boat building and composite materials use. Maine boats and composite material moorings are now being marketed to Chinese marinas as a result. Maine’s creative economy consisting of entrepreneurial business development particularly emphasizing the arts has recently received attention as a source of community vitality and economic strength. Artisans, craftsmen, and performing artists play a vital role in making Maine a national treasure. In Washington, the National Endowment for the Arts has been neglected and its funding has been weakened. As your congressman, I would support reinvigorating this and other funds supporting artists and entrepreneurs of the creative economy. We need a multidimensional approach to job creation through the development of infrastructure, a trained and educated workforce and R&D, supported by a public-private alliance.
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Mental Healthcare
In 1989, serious problems at the Augusta Mental Health Institute led to a legal Consent Decree, which mandated the establishment of a comprehensive mental health system, increasing community resources as an alternative to hospitalization. In spite of this requirement, finding access to community mental health services is a challenge throughout Maine, regardless of an individual’s ability to pay. In addition to adults, children also face a shortage of quality, coordinated mental health services. There is a crisis in delivering these services to children; the most recent Maine Kids Count report showed that a mental health problem was the most common reason for a child to be hospitalized in Maine in 2006. The state legislature has still not satisfied the consent decree. One of the barriers to quality mental health care in Maine is a lack of providers trained in evidenced based practices. In 2002, I was named the Principal Investigator of a federal grant, administered by MaineGeneral Medical Center, to improve the quality and availability of behavioral health services for children and families that experienced serious emotional trauma. Our team engaged the State of Maine Department of Mental Health and Health and Human Services Child Welfare Division as partners in our project so that any gains we made could be sustained after our grant money was gone. We also worked with the state Disaster/Terrorism committee to develop a state of the art mental health plan to be implemented during a disaster or terrorist event. Finally, I engaged the trauma teams at Central Maine Medical Center, Eastern Maine and Maine Medical Center to improve care to children and families with a seriously ill or injured child. Through relationships with UCLA, Duke, Boston Medical Center, Yale and the Children’s Hospital of Philadelphia, our program linked Maine with leaders in children’s behavioral health around the Nation. The work we started has been sustained and expanded upon by DHHS work on the trauma informed systems of care project. This 7 million dollar grant is helping our state develop the comprehensive system of care mandated by the Consent Decree. Medical and behavioral health services should not be delivered in silos, as if they don’t affect one another. We need an integrated medical and mental health system that offers ready access to care when it is needed and clear and open communication between medical and behavioral health caregivers. Therapists should be trained in evidence based practices and primary care providers should have training in screening for mental health risk factors. Behavioral health care should be given parity with medical care in an integrated system.
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