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Most Expensive Place to Live in U.S.? Hawaii, Where Toilet Paper Costs More Than Anywhere in the World
NW: For the seventh year in a row, Hawaii has been voted the worst state in which to make a living by MoneyRates, a personal finance website. To work out the stats, MoneyRates looked at the median salary, taxes, the unemployment rate and the general cost of living.
Although the islands have the 10th highest median wage in the United States, average living expenses are astronomical, up to two-thirds higher than the rest of the country. For example, the average salary in the island’s capital, Honolulu, is $60,328, according to the website Payscale, but the state has one of the highest tax rates in the country, at 5.3 percent. According to the Bureau of Labor Statistics, the average U.S. salary, as of 2017, is $44,148.
Expatistan, a website that works out how much it costs to move to a new city, estimates that lunch costs $15 a head in Hawaii. The same site says that to live in a "normal" (rather than expensive) area, a couple would have to fork out $2,024 for a 900-square-foot apartment in Honolulu.
A basic dinner out for two in a neighborhood pub is an eye-watering $62, while 2 pounds of apples hovers around the $5 mark.
To put Hawaiian prices into context, it is the most expensive place in the world to buy four rolls of toilet paper ($6), and the priciest place in the U.S. to buy gas. ….
(In socialist Venezuels, toilet paper is the equivalent of $4.20 per four rolls.)
Experts also blame Hawaii’s high cost of living on the extortionate cost of electricity, which is twice as high as Alaska’s, the next most expensive state for energy…..
read … Newsweek
No Incentive: HMSA Puts Pediatricians on Welfare
SA: Dr. Jeremy Lam has treated some of the most vulnerable patients over 40 years as a Honolulu pediatrician, but retired eight months ago partially because of a new payment model that is causing anxiety among physicians.
On Saturday, pediatricians will be the last of the Hawaii Medical Service Association’s primary care doctors to undergo a change by which they will be paid a fixed monthly rate per patient in a practice instead of being reimbursed for each procedure or patient visit.
“For a patient with special needs or patient who doesn’t come in, the doctor will get the same payment. (This) is not an incentive for anyone,” said Lam, 70, who intended to practice part time but ended up retiring early. “They have no incentive to go above and beyond and work with the families to see them. Many years ago we’d go in for all our patients. It makes it sometimes easier now for (doctors) to say, ‘Just go to the ER or urgent care,’ because a physician is not getting paid for seeing that patient after hours. It hurts the continuity of care because you have no monetary or other incentive to follow your patients closely.”….
Under the new model, pediatricians estimate they will be paid an average of $24.94 per member per month.
“I can’t even get a plumber to come to my house for $24,” said Honolulu pediatrician Dr. Galen Chock. “The basis of payment transformation is that, ‘You know, doctors, you’re really seeing patients too often, so if we just pay you a fixed amount, you guys will figure out you don’t need to see them as often as you have in the past.’ Unfortunately for pediatrics, we have a lot of mandatory visits for newborns.”….
In the first year of life, doctors see babies about 11 times, not including visits for unexpected illnesses, according to Chock. Under the new payment system, pediatricians would be reimbursed roughly $300 in the first year for a newborn versus about $1,000 in the current fee-for-service model, he said.
HMSA said 120 out of 125 — or 96 percent — of pediatricians who are part of a physicians organization have agreed to accept the flat rate. Ninety three percent — 531 of 572 — of primary care doctors who care for more than 90 percent of HMSA’s members will be paid that way starting next month….
Even with the high enrollment numbers, some physicians say they had little choice but to accept the new payment model. If they didn’t accept it, their payments from HMSA would be reduced, and they would see a substantial drop in revenue.
Aiea pediatrician Dr. Brent Tamamoto said doctors already are spread thin and that the new payment model lessens the incentive for providers to improve patient care and invest in new technologies and in-office procedures….
State Sen. Josh Green, an emergency room doctor on Hawaii island whose physicians group has been part of the new model since April 2016, said it has been working well, once providers got accustomed to it.
“Once people get used to it, they don’t even think about it anymore. They don’t even think about the old days of billing for each case,” he said. “The best part is that this has enabled us to focus on population health and prevention, things that we never got reimbursed for before. The downside is we’re still working out the glitches like attributing patients (to the right providers). Doctors who are worried are still focused on the day-to-day challenges. It’s natural for them to be worried, but it is a very strong model.”
read … HMSA tweaks the way it pays to treat keiki
Progress Slow on Affordable Housing
SA: …The pent-up demand for affordable housing on Oahu (estimated at a whopping 24,000 units) is being addressed by a marketplace that’s adding only 2,000 to 3,000 housing units to the supply annually, with most priced in the luxury bracket. Most of the demand — 75 percent — is for households earning less than 80 percent of area median income (AMI). That translates to $80,450 for a family of four, according to data calculated by the U.S. Department of Housing and Urban Development (HUD)….
Last year, the Legislature passed Act 127, which set a goal of developing at least 22,500 affordable rental units by 2026. The legislation notes ominously: “Without sufficient affordable rental housing, the future social, community and economic consequences for Hawaii may be dire.”
Right now, it’s unclear how the state can adequately ramp up affordable housing inventory, but the agency that manages public housing for low-income residents, the Hawaii Public Housing Authority, is eyeing possibilities. Among them is a 10-project idea that could add as many as 10,600 units along the planned Honolulu rail route. The biggest in that bunch could open up 2,140 rentals through the redevelopment of Mayor Wright Housing in Palama. That offers a glimmer of hope, but only if the city’s cash-strapped rail project is able to proceed with plans for transit-oriented development….
Reality: How A&B Wins Big From Environmental Litigation
read … Slow
Ige: “Quiet But Ineffective.”
CB: A common gripe is that few can point to any notable accomplishments under Ige, though he has been in office going on three years now. With the Democratic primary a little over a year away, the talk is that someone — Kauai’s mayor, maybe, or the former Ways and Means chair, or a member of Congress, or a media mogul, someone — might dare to challenge the sitting governor….
Ige didn’t have much to say about modernizing the state’s tax collection system, something that a news report suggests isn’t going quite as planned….
Ige practically squirmed in his chair….
read … Ineffective
Kealohas Tried to Discredit Police Commissioner In Corruption Probe
CB: Newly released records show that Honolulu Police Commissioner Loretta Sheehan was an early target of police chief Louis Kealoha and his wife, Katherine, a city prosecutor, who has described Sheehan as being “racially insensitive.” (I’m the police chief and I am still a victim, LOL!)
The documents highlight the lengths the Kealohas — who are under federal investigation for public corruption and abuse of power — have gone to maintain their innocence and launch attacks on their accusers, including prosecutors and the press.
Last week, Sheehan released records detailing how Louis Kealoha’s attorney, Kevin Sumida, planned to get her disqualified from voting on whether to provide the ex-police chief with taxpayer-funded legal counsel in a lawsuit related to the corruption probe.
Included was a Sept. 7 letter Katherine Kealoha sent to members of the city police commission, urging them to ignore Sheehan’s call for an investigation into her husband. Sheehan, who was sworn in Aug. 15, had only been on the job a few weeks.
“The Police Commission has to date courageously resisted the political winds fueled by innuendo, media leaks, and baseless allegations,” Kealoha wrote. “This is the reason why the Police Commission is appointed as an independent body.
“I applaud your continued courage and ask, not merely for your support because we had done nothing wrong, but for your continued devotion to your duty to be objective and dispassionate, and to not give in to political expedience.”
(Translation: With Cronies like you around, they can’t touch us.)
read … Discredit