Solutions for the Underaffiliated

The Importance of Basic Community Health in the Productivity of America

America’s health crisis is about more than mental and physical conditions, and it costs even more than you think.
It will require  the seemingly impossible task of working together to make the United States healthy.
We spoke with Ted Smith, Associate Professor of Medicine and Pharmacology and The Director, Center for Healthy Air, Water and Soil at the University of Louisville.
Today interconnected forces, like poor food quality, insufficient transportation, limited access to healthcare, weak public education, and other social factors have created entire communities characterized by poor physical and mental health, violent crime, incarceration, unemployment and drug and alcohol abuse.
The more unhealthy people and communities there are in the United States, the more we all pay. Whether it is violence in our cities or insurrections at our nation’s Capitol or higher healthcare costs, or homelessness, or incarceration rates. Americans pay in money, safety, and freedom as more places become undesirable places to live and visit.
The idea of helping people establish a baseline of health to restore these communities is stuck in a debate over whether and how to fund the array of supports people need to live healthy lives.
Some say that’s socialism and people should pull themselves up by their bootstraps. Others say, these people and communities don’t have boot straps. They say that capitalism no longer exists because competition has been allowed to die at the hands of monopolies.  
Further, any notion of sharing wealth seems to be gone, as we seem to feel threatened that someone is going to take we we have or deserve.
The solution is not as simple as solving for one issue. They are all integrated. We can look to history, work together, and change how we live to build healthier communities, and therefore, a healthier nation.
Working together can be done. Americans rallied together to defeat Nazi Germany, Japan, and Italy in World War II.
Capitalism and socialism have always co-existed in the United States. After World War II, The Federal Government helped people buy houses and pay for their education. It started Social Security in 1935, and started Medicare in 1965.
Like a world war, improving the health of all these unhealthy communities requires sacrifice and sharing. Are we up to the task?

Affordable housing is the key to stable, vibrant communities. Let’s build it back

We are all better off when people can afford their homes. Community Land Trusts (CLTs) are one way to expand affordable housing, but we need more homeowners to get on board.
Anna Zuevskaya, Executive Director, and Crystal Sheriff, Community Relations Manager, of the Asheville Buncombe County Land Trust explained the societal benefits of using community land trusts to provide affordable housing.
Community Land Trusts help provide permanent affordability to housing, so low-and-middle income families can buy homes. Homeowners get equity, so they can earn money on the sale of their homes and invest that in a nicer home.
Meanwhile, the original home only increase in value a small amount, so a new family in need of affordable housing can buy it. 
Here’s why it’s needed.
Owning land defines people’s value today. It gives us identity.
Where there is affordable housing, neighborhoods are stable. Where housing is run down, neighborhoods are not stable.
There is a direct correlation between the housing that was built by the Housing Authority starting in the 1960s, during urban renewal efforts, and the housing that was taken away from Black people.
Black people were told the move would be temporary and that they could return or buy a home somewhere else. 
They stayed in Housing Authority housing, and vibrant black neighborhoods disappeared.
The displacement is slow and silent — just like gentrification movements today — as upscale condominiums replace walk-up apartments and high-end retail replaces stores that cater to local tastes.
By taking away the chance to own a home, urban renewal made it difficult for Black people to establish an identity as anything other than a reflection of their poor neighborhood.
CLT’s need help because houses are expensive, and it takes time to build a community, 
The Asheville CLT received $1 million from the city to buy homes and land, but needed more because house prices went up.
It would be helpful if more home owners shared CLT’s mission to provide affordable housing and were willing to sell their land and write off the difference between the appraised value and the sales value.
AirBnB owners can donate a portion of their monthly proceeds to a CLT.
People can volunteer and donate to help CLT’s operate.
Background on Asheville Buncombe Community Land Trust
One of over 160 of community land trust organizations across America. There is probably one where you live.
Its goal is to establish permanently affordable residential, commercial, and community spaces that empower Black, Indigenous, People of Color, and low- to moderate-income residents to build social, economic, and cultural capital.
Community land trusts are nonprofit, community-based organizations which provide affordable housing in perpetuity by owning land and leasing it to those who live in houses built on that land.  
CLTs can be used for commercial space, multifamily rental housing, housing cooperatives, urban farms, community centers, playgrounds, or any other use the board sees fit.

The story that healthcare cost data is telling us about health system consolidation

Health provider consolidation pushes up the cost of care for people with employer-based coverage. In the process, it drives people who can’t pay from their bank accounts to put off care or go into medical debt.
We talked with John Hargraves, Director of Data Strategy of the Health Care Cost Institute (HCCI), a non-profit, non-partisan organization focused on in Washington, D.C. It has a multi-payer, longitudinal commercial claims dataset, covering one-third of the employer-sponsored insurance (ESI) population in the United States. 
HCCI’s data shows that healthcare costs are going up, especially in metro areas where there are fewer health care systems — meaning there is less competition.
Health system consolidation can also mean longer drives to get care, which drains productivity, so is an added cost to Americans and our employers.
Unless  a group like HCCI studied it, we wouldn’t know prices rise. All we see is a bill.
How setting prices in healthcare works and why we are defenseless:
We use the healthcare system.
Insurers negotiate with health care providers about how much they will pay for the facilities and services they deliver based on that history.
If an insurer or provider has less competition, it is easier to say, “Take it or leave it.
That means 1) the provider cares for so many patients that the payer has to agree to the price or 2) the payer has so many members it can use another provider at a lower cost.
They agree on the prices.
You get care.
You pay the premium, co-pays and deductible you are assigned based on how those negotiations turn out.
The provider sends you a bill for the rest.
You can’t negotiate down. You have already received care. If you go elsewhere, you will likely have to pay more because of your employer’s agreement with the insurance company. 
The result: Prices go up, and people with less money either go into medical debt or put off care. 
More about HCCI
Marketplace Index Report
Health Care Cost and Utilization
 
HCCI offers interactive and printable visualizations of cost and utilization across a range of metro areas related to facilities, professional services, and drugs people use. Interested parties can license and use the data to publish research.

Testing water and bugs to solve an invisible problem, save the Snot Otter, and shape local action.

Ann Marie Traylor, the Executive Director of the Environmental Quality Institute (EQI) (www.eqilab.org), leads a team of volunteers who gather data to help stop chemicals from poisoning streams, bugs, amphibians, birds and so on up the food chain.
When it rains, water carries fertilizer, salt, and other chemicals from industrial and small farms, roofs, roads, parking lots and leaky sewage pipes to streams and creeks where bugs, fish and amphibians live.
This makes the water unsafe to play in and drink. Meanwhile, the chemicals travel with the insects, amphibians and fish to birds and land animals ... and hunters, fishermen, and their families.
EQI tests stream and lake water for chemical and physical properties snd samples streams for bugs to provide a greater understanding of water quality and habitat changes.
It uses the data it collects to provide local non-profits, government and citizens with a color-coded map of the water quality of streams in the region it serves. These groups can take the data to the farmers and industries and collaborate to find ways s to reduce the flow of chemicals into the water.

Why your healthcare costs will increase unless you vote for government action.

Does the current healthcare system work for you?
If you can pay, your health is likely to improve or at least not get worse. 
Otherwise, premiums, deductibles, and costs of drugs and care are so high that many people put off care until they are eligible for Medicare, or they go into medical debt.
To help make the case for change, Solutions for the Underaffiliated explored three reasons our healthcare costs will continue to rise without government intervention with Kip Sullivan, author and advocate for a more equitable affordable health system:
The healthcare system is focused on reducing utilization, not prices, which are what is driving excessive costs. 
The focus on usage leads insurance companies and healthcare providers to invest in staff, activities, consultants, technology, and communications to manage doctors’ and our care and behavior. All that is expensive, and both providers and insurance companies pass those costs to us in the form of higher prices, premiums, and deductibles. 
Health insurance, drug, health care, and medical device companies have consolidated, eliminating the competition that would drive down prices.
Since, there is limited evidence that the current system leads to better health quality and outcomes, let’s focus on the financial part of healthcare.
Would paying for insurance coverage through taxes each year for a single-payer that provided universal coverage be less expensive than the premiums, co-pays, and deductibles we pay today with private insurance?
Of course it depends on a household’s individual needs, so do we believe we should all pitch in for the greater good, knowing one day it could be us that needs it?

To protect and serve the land and the planet, we must reconnect with it. Here’s how.

Filmmaker and historian David Weintraub spoke with us about his latest film, Nature’s Wisdom Through Native Eyes
It is the confluence of storytelling, native wisdom and nature’s intelligence that will help us heal our broken relationship with the living world. It's an intriguing look at history, culture and hope through the eyes of our nation’s First People. 

It’s easier and less expensive to install home solar power than you think + How to focus change in the energy industry

Watching the weather? It’s simpler and less expensive than you might think to outfit your home with solar power, reduce your reliance on energy companies, and help reduce carbon emissions. 
We still need energy companies, but the right action can drive a faster and smoother transition. Advocate for more competition in power generation from wind and solar power companies; expanded use of solar panels on houses and commercial businesses; and an economic model for the management and improvement of power distribution that benefits consumers and energy companies.
Solutions for the Underaffiliated spoke with Ned Ryan Doyle, a long-time advocate for the efficient and effective use of sustainable energy. He simplified a very complex situation for us.
Paying for Solar is Easier than you think 
People are not racing to install solar panels because it seems to cost so much upfront.
But when we buy cars, we put a little money down, sign a lease or financing agreement, and three things happen. We get the car. It starts to depreciate. We usually pay for it monthly.
Installing solar panels costs around $20,000. Here are five reasons you can afford for that. 
There is a federal solar tax credit, which you can apply to the cost of putting in the solar power system. 
Look at your energy bill and find a line that says something like “energy use charge”. Compare that to the total bill. Figure out your average monthly energy use charge and multiply it by 12. That is about how much money you will save each year.
Explore other financing options, including refinancing your home with the new amount baked into your mortgage and spread over 30 years. I bet your monthly payment doesn’t increase much.
The system lasts, so it will increase the value of your house when it’s time to sell. The new owners will never see a high energy bill.
You can disregard those warnings from the energy company and use your appliances when the sun is out!
Politics and Power
The shift to wind and solar will involve energy companies, and they are not going to change from fossil fuels without a push.
In Western North Carolina, Duke Energy and land developers killed legislation that would have allowed wind mills above 3,500 feet on commercial lands. The wind mills would not have been on public land, nor near the touristy Blue Ridge Parkway, so they wouldn’t have detracted from the natural beauty of the mountains.
But Duke and developers didn’t want windmills on commercial land because they wanted future customers to build houses there.
We can find solutions in simplification.
Power generation and distribution are the two main parts of the energy business, so companies want to maximize profit, and shareholder value, from both. 
The built energy distribution system of wires, connections and switches functions well. It serves a public good. Replacing it would be costly and inefficient.  In North Carolina, the state utility commission regulates the amount of money Duke can charge for distribution. In other states, like California and Texas, energy companies can make money from distribution. 
To enjoy the benefits of that distribution system, there should be a price we pay. One debate is about defining an approach to this that benefits consumers and keeps energy companies profitable.
The more an energy company relies on power generation for profit, the more it will fight to use energy sources it can control, like coal and natural gas, and keep out alternative sources like solar and wind that they cannot control.
That’s why energy companies are generally opposed to competing power sources. They don’t want fewer users of their energy. 
But what value does burning fossil fuel create for the public? We now know it harms the public good. We know that wind and solar are better for all of us. 
It seems like we need to advocate for an energy industry that serves the public good. That means advocating for:
The use of solar panels on houses and commercial businesses;
New solar and wind power companies to compete with energy companies or be added to the distribution network at a reasonable fee;
A deal on an economic model for the management and improvement of power distribution that benefits consumers and energy companies.

How city governments can do more to serve people than they are today.

David Morris of the Institute for Local Self-Reliance explains how local government has more power than even they may realize. They have the authority, financial capability, bargaining power and responsibility to serve citizens. From sustainable electricity and broadband to healthcare and affordable housing, city governments can do more.  Read More

Fix homelessness with opportunity and a support network, not penalties for misfortune.

We spoke with Marcus Walls of Homeward Bound, who told us about the types of people who are homeless, the experiences that land them in homelessness, and how hard it is to get out without a support network. Read More

Real-time mental health resources to call when you don’t know where to turn

Mental Health GPS provides connects people in with peer counselors and mental health resources in urgent, but non-crisis, situations. Read More