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Last Sunday I wrote about the Alabama struggle to balance the budget. I pointed out that due to 100 years of budgetary sleight of hand, we found ourselves voting to take money out of an inviolable trust in order to “prevent the mass release of prisoners” and also provide funding to Medicaid allowing us to continue the program. The vote passed by a 2 to 1 margin, in part because the turnout was below 20% and in part (it is speculated) because the bulk of those who turned out worked in or around the healthcare field (don’t know how the prisoners voted).

Now that the program has been saved, the damage control begins. In an editorial in the local “paper” (soon to go to 3 days a week in paper form so I guess it will soon be the local “web feed”) found here, the politicians have promised to “make it right.” Per them:

Unlike the out-of-control federal government that’s adding nearly $4 billion a day to our $16 trillion national debt, we believe state government should live within its means — without raising taxes on Alabama families and businesses. Next session, expect to see an aggressive push to pass a strong agenda of government reforms that will continue building the foundation for a more conservative, fiscally-responsible state government.

I will take this opportunity to remind them that the Affordable Care Act will provide them with an opportunity to move over 350,000 Alabamians from the roles of uninsured to insured via Medicaid expansion at no cost to the state for 3 years. These Alabamians (per Kaiser Family Foundation) tend to be from working families and unable to afford family coverage, allow themselves to get sicker (thus creating a drain on the system), and have trouble making ends meet as a consequence of medical bills. I will also remind our policy makers that, as Kaiser also points out to conservative politicians considering opting out,

“Part of the legislation actually involves the federal government pulling away some dollars called DISH, or disproportionate share funding, that went to safety net hospitals, primarily who see a lot of uninsured,” he reasoned.

Dr. Adler points out that, when the Affordable Care Act is fully in place, that money – DISH money – goes away.

The DSH money is part of what is being used to fund the Alabama Medicaid Fund so when it goes away, there will be no do-over. . I guess we’ll see just what fiscal responsibility means.

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The town in which I live has seen its share of trouble. Some of the trouble is caused by nature. As I sit here writing this, we are being visited by a violent thunderstorm, as we are almost every day during the summer. Not only do the thunderstorms sometimes cause damage, but the heavy rains provide an environment where mosquitoes (as well as other insects)  propagate at a level most people cannot even imagine. It was no accident that William Gorgas, E O Wilson, and others focused their great intellects on insects after growing up in Mobile. We got a lot of bugs, many of which cause diseases in humans. Oh yeah, and every couple of years we get hurricanes. Some, like Katrina, create enough of a stir that we forget about the bugs for a while.

As if this weren’t enough, humans seem intent on adding to our woes. Southern novelists have filled books on the theme of  “man’s inhumanity to man.” In one of the greatest ironies of all, America’s quest for cheap oil (drill, baby, drill) landed 4.9 million barrels of oil in the Gulf of Mexico. Much of this oil went on to disrupt the economy of Alabama either directly (can’t catch fish through oil) or indirectly (wanna drive 300 miles and see if the beaches are clean today?).

Given hurricanes, oil spills, lots of mosquitoes that might carry West Nile disease, not to mention the general hardships of living, life can be tough. This being the case, we on the coast should cultivate and value the ability to quickly recover from disasters and get back to status quo.

That is why I read with interest that a “Resilience Capacity Scale” has been developed. The initial story that I read (“What’s our resilience capacity?” Mobile Press-Register, link now available) did not lead me to believe this new scale would be useful. The article implied that the information used to create the scale was unfairly biased against Alabama and Mississippi. In searching for that article to link to, I found another article from an Alabama newspaper, with site comments that do seem to show anger at this perceived bias. Here is a representative response:

This study was funded by the John D. and Catherine T. MacArthur Foundation and administered by the University of California, Berkeley. No doubt the 12 economic, socio-demographic, and community connectivity indicators are from the perspective of the socialist mentality of the John D and Catherine T. MacArthur Foundation and their fellow travelers at the U of California at Berkely [sic].

I have subsequently spent a little time with the instrument, found here. The purpose, it turns out, is not to further the socialist agenda  but:

One way to assess a region’s resilience is by its qualities to cope with future challenges, a concept we label resilience capacity. Developed by Kathryn A. Foster, member of the BRR research network and director of the University at Buffalo Regional Institute, the Resilience Capacity Index (RCI) is a single statistic summarizing a region’s score on 12 equally weighted indicators—four indicators in each of three dimensions encompassing Regional Economic, Socio-Demographic, and Community Connectivity attributes. As a gauge of a region’s foundation for responding effectively to a future stress, the RCI reveals regional strengths and weaknesses, and allows regional leaders to compare their region’s capacity profile to that of other metropolitan areas.

The capacity is determined by an assessment of regional economic capacity (resilient communities have a narrow range of income across households, diversification of the  economy, affordable housing relative to income levels, and hospitable business environments as measured by business churn and access to venture capital and broadband), socio-demographic capacity (resilient communities have high levels of college-educated people and low levels of non-high school graduates, low proportions of the population with disabilities or living in poverty, and high proportions of people with health insurance) and community connectivity ((resilient communities have high rootedness and familiarity, with low in- and out-migration and high homeownership coupled with commitment to place demonstrated by the presence of civic organizations and high voter turnout). Mobile did not do badly in economic resilience (170/361) and community connectedness (171/361) but did very poorly in socio-demographic  (303/361).

So our global score of LOW (229/361) does not reflect the discounting of church membership (as was suggested in our local paper) but instead is reflective of our poorly educated populace who have a relatively high rate of disability, who are less likely to be employed and more likely to live in poverty, and who are less likely to have health insurance than all but 61 of the metropolitan areas assessed.

Following the Gulf Oil Spill, a leadership driven process produced a report entitled A Roadmap to Resilience. In this process, several hundred community leaders came together to “Build regional capacity for long term resilience.” They pledged to “Keep it simple.” This report is 194 pages and includes everything from drug education to building a $500,000,000 bridge with federal funds. Turns out, they could have greatly increased the resilience of Mobilians by focusing on three things:

  • An education system second to none from K-graduate school
  • Universal access to healthcare
  • Full employment

I think for those of us down here on the mosquito coast, that’s not too much to ask.

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