Doctors could prescribe houses to the homeless under radical Hawaii bill

Newly introduced bill would classify homelessness as a medical condition, as research suggests healthcare spending falls when people have been housed

One day last month, Stephen Williams asked a passerby for help and then collapsed on the sidewalk. When the ambulance arrived in downtown Honolulu, his temperature was well over 104F.

A life-threatening staph infection had entered his bloodstream. Williams, who lives on the dusty streets of Chinatown, spent seven days hooked to an IV, treatment that can cost $40,000, according to the hospital that admitted him. But Williams didnt pay: the bill was covered by government dollars in the form of Medicaid. Over the past four years, he has been to the hospital for infections 21 times, he said, a consequence of psoriasis flare-ups in a humid climate and unsanitary conditions.

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Cases such as these have prompted a groundbreaking new proposal in Hawaii. Instead of prescribing medication to homeless patients like Williams, what if doctors could prescribe something else that might ameliorate their health problems more effectively? The prescription would be housing.

With this aim in mind, a state senator, Josh Green, has introduced a bill to classify homelessness as a medical condition. Green, who is also a physician, said the idea originated in his own work in the emergency room, where he saw many homeless patients arrive for treatment of basic conditions at great expense, but no real long-term benefit. Im really just applying a band-aid, he said of his medical work. But these problems require intensive long-term support.

A small number of homeless people require a disproportionate amount of medical treatment. According to Green, a recent internal study by a major Hawaiian insurer found that over half of the states $2bn Medicaid allotment was consumed by a tiny fraction of users, many of whomare dealing with homelessness, mental illness and substance addiction.

Yet research suggests that healthcare spending for those who have been homeless for long periods and struggle with mental illness and addictions falls by 43% after they have been housedand provided with supportive services. Green said many of the individuals he hopes to house cost the healthcare system an average of $120,000 annually, yet the annual cost to house an individual is $18,000. He thinks that the total savings to the state could be hundreds of millions of dollars a year.

As envisioned by Green, doctors could prescribe housing on a case-by-case basis. In order to qualify, the patient must have been homeless for at least six months and suffer from mental illness or a substance addiction.

Were already spending the money on homeless people, were just paying for it in the most inefficient, expensive way possible, he argued. We have a lot of capacity, but lack the political will.

The bill is winding its way through the state legislature, and faces a key vote this week. It has already found supporters. I think this bill is a great idea, said Daniel Cheng, an emergency room physician at the Queens Medical Center in Honolulu. Last year, treatment for homeless people at the hospital cost $90m. When emergency medical services are being heavily overused by a population thats being poorly served, it costs everybody, Cheng added.

Cheng said he most commonly sees homeless patients for the treatment of psychiatric issues, infections, problems related to substance abuse and general medical concerns such as a stomach ache or chest pain. Often, patients return re-infected just a week after he treats their wound, he said. Instead of paying for an antibiotic, lets take that $5,000 visit and pay for housing. Wed be way more ahead.

In Chengs eyes, hospitals are already expected to pick up the tab for societal ills. Weve clearly seen the medicalization of social problems like alcoholism and homelessness, he said. People who are intoxicated no longer go to a rehabilitation facility, they come to the hospital. Its become a medical treatment.

But not everyone agrees that homes should be part of the pharmacopeia. In testimony last month, the Hawaii department of human resources development, which oversees various social services, suggested housing is beyond the healthcare systems remit and expertise.

And there are concerns that such an approach might spread the states resources too thinly. There is a population of homeless [for whom] it is clearly a medical condition the substance abusers and the mentally ill, Bob McDermott, a Republican lawmaker, was reported as saying last month. But other than that, it seems to be a stretch.

Honolulus largest homeless services provider agrees. You dont want to broaden it so much that everyone is eligible, warned Kimo Carvalho, a spokesman for the Institute for Human Services. He said he is in favor of the bill but that without strict parameters, healthier homeless individuals could take advantage and drain the system.

Another concern: walkouts. If you give mentally ill people housing, nine out of 10 will just walk away and go back outside, Carvalho said. He added that he thought the best use of Medicaid was targeted housing for people with specialized needs, such as mental health group homes, or addiction recovery housing, because many of the neediest clients targeted by Greens bill might refuse accommodation.

One such woman was perched outside a drugstore in downtown Honolulu recently, fumbling with the strands of her turquoise muumuu. A homeless-services coordinator, Justin Phillips, who works in the surrounding area, said the woman is frequently transported to the hospital for psychiatric treatment after good Samaritans find her wandering in the middle of busy streets, unable to communicate.

Despite high costs to the medical system, she has declined shelter for years, Phillips said. She assaulted the last caseworker who offered her assistance, and was recently released from the overcrowded state mental hospital.

Until she gets medication, shes not stable enough to live in housing, and even then shes going to require a higher level of care, said Phillips.

Whatever the case, the bill seems like a no-brainer to some of those dealing with poor health in hard circumstances.

Williams, the man who suffered from the staph infection, rested his swollen legs on a brick wall on the outskirts of Chinatown.

Its very clear to me, he said. If I could get a place to stay, I wouldnt have to go to the hospital so often.

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Sex symbols: what does a blue hankie in your left back pocket mean?

Hal Fischer took the language of the instruction manual and applied it to the jocks and leathermen of gay San Francisco in the 70s. He explains the code

In one of the first photographs Hal Fischer composed for Gay Semiotics, we see two sets of male buttocks, each clad in high-cut, form-fitting Levis. One sports a blue bandana in the left back pocket, which, according to the overlaid text, indicates that the wearer will assume the active or traditional male role during sexual contact. The other has a red bandana in the right back pocket, indicating that the wearer takes the passive role in anal/hand insertion. But, the text cautions dryly, red handkerchiefs are also employed in the treatment of nasal discharge and in some cases may have no significance in regard to sexual contact.

Made in 1977, when Fischer was in his 20s, the Gay Semiotics series is a wonderfully poker-faced portrait of queer male culture in San Franciscos Castro and Haight-Ashbury neighbourhoods at their carefree apogee. As well as deciphering the codes of hankies, key chains and earrings, Gay Semiotics guides us through archetypes, street fashions and various BDSM practices. Forty years on, the images can now be seen at Project Native Informant in London, along with other Fischer works from the 1970s.

The work was very subversive, and I still get a kick out of that, says Fischer, in London for the shows opening. I wanted people to see the photographs first, then get up close. I wanted there to be a certain innocence when they started reading, then of course theres a little shock, and some punchlines, then people start laughing.

The meaning of earrings, from Hal Fischers Gay Semiotics. Photograph: Hal Fischer

For Fischer, the humour, the labels, the instructive text and the use of greyscale all served to undermine the romanticism that still surrounded photography in the US at the time. Its a visual language borrowed from banal instruction manuals. Even the images dealing with domination are composed with a lightness of touch and salting of humour that is decidedly unmenacing. I dont think someone who was really into the S&M culture would be drawn to these, because theyre really too playful, says Fischer, pointing out that in his experience, giggling is something of a mood-breaker in such situations.

It was reading Lvi-Strauss the anthropologist, rather than the manufacturer of denims that inspired Fischer to codify the dress and behaviour of San Franciscos gay community. Anthropologically, this was going on all around me: it was amazing and nobody was dealing with it like that, so I just went for it.

Unlike the distant anthropologist, Fischer was quite literally embedded in the culture he portrayed. Fischer encountered one of his subjects hanging around outside his local cafe, and another at Guss Pub. The chap who posed for the Basic Gay picture worked in the photo store down the street. Its where youd go on Wednesday and put in your marijuana brownie order, because then Brownie Mary if she wasnt in jail would drop off the brownies on Friday.

An explanation of Dominance. Photograph: Hal Fischer

All the men from the Jock in his snug satin shorts to the leatherman with a cockring on his epaulette are sporting their regular clothes. Fischer was inspired by the German photographer August Sanders People of the 20th Century in portraying his subjects on their own terms. The thing that appealed to me about Sanders work was the idea of letting the person present themselves to you. I did not tell these people what to do, what to wear or anything.

The figures selected for inclusion are, by and large, those who Fischer was interested in looking at himself: It is, on a certain level, a lexicon of my own desires, though maybe a little broader than that. I didnt put in anybody in drag and there were people in drag around. I was part of the clone group.

The codes and dressing-up fulfilled an important function at a time when the ability to read a situation accurately was imperative: The reality of some of this is, back in the day, if you hit on a straight man, it could have had not-good consequences.

Shortly after completing the works on show here which also include the 1979 project A Salesman, in which a naked man with a moustache appeared on a billboard in San Franciscos Castro district Fischer decided to cease working as an artist. Today his photographic output is largely restricted to iPhone snaps of his dog, Jasper albeit in appropriately extravagant costume. When I had my first solo show in 1977, the critic part of me kind of took over. I thought to myself, Youve hit the perfect moment, everything has come together. Culturally, youre doing this at exactly the right time. Art-wise, youre involved in something that has methodology and is conceptual. Most people dont even get this once. And Id got it.

Gay Semiotics is at Project Native Informant, London, until 1 April. The book has been republished by the LA gallery Cherry and Martin.

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Betsy DeVos sparks ire by linking historically black colleges with ‘school choice’

Education secretary calls HBCUs real pioneers on conservative issue, despite fact that racist admissions policies elsewhere spurred institutions growth

Betsy DeVos, the controversial newly appointed secretary of education, is facing scorn on Capitol Hill and around the country after releasing a statement that compared the emergence of historically black colleges and universities (HBCUs), amid pervasive and overt racial exclusion, with the battle for school choice.

In a statement tied to a listening session with HBCU leaders, DeVos said HBCUs are living proof that when more options are provided to students, they are afforded greater access and greater quality.

HBCUs are real pioneers when it comes to school choice, the statement said.

DeVos appeared to by trying to make the point, popular with conservatives, that when schools operate in a marketplace, they tend to fill the otherwise unserved needs of students.

To many the intended argument didnt survive the contradiction of associating HBCUs, born out of necessity when black Americans were almost uniformly barred from existing universities by racist admittance policies, with the idea of choice.

Yesterdays attempt to whitewash the the stain of segregation into an argument for privatizing our public schools is perhaps a new low in her current position, said the Michigan congressman John Conyers, who also called the statement shocking and insulting.

Rep. Barbara Lee (@RepBarbaraLee)

Tone-deaf, uninformed statement from DeVos. #HBCUs werent more options for black students for many years, they were the ONLY option.

February 28, 2017

Major Beige (@MajorBeige)

DeVos saying HBCUs are examples of school choice is like saying the underground railroad is an example of social mobility.

February 28, 2017

The comparison was also awkward because the issue of school choice virtually always refers not to colleges but to K-12 education where, traditionally, students are assigned to a public school district according to their address.

School choice is at the foundation of DeVoss public education agenda. The billionaire education secretary, with no formal background in the field, has long been a proponent of allowing parents to opt out of public schools. Most experts in the field counter that school voucher systems and other similar programs tend to exacerbate the unequal distribution of educational resources. These schemes do nothing to help our most vulnerable students while they ignore or exacerbate glaring opportunity gaps, argued the National Education Association in November in reaction to her nomination by Donald Trump.

Nikole Hannah Jones, a reporter who has written extensively on school segregation, added that much of the contemporary conservative rhetoric about school choice is actually a function of the same racist, segregationist impulses that made HBCUs necessary in the 19th-century US. In many places in the country, the push for school choice has been pioneered by white parents seeking ways to remove their children from integrated or predominantly black public schools.

Ida Bae Wells (@nhannahjones)

HBCUs arose because white schools did not want, refused to enroll black students. School choice, vouchers, arose from EXACT same thing.

February 28, 2017

DeVoss statement comes, somewhat ironically, as Trump signs an executive order to relocate the White House Initiative on HBCUs, a program that has existed since 1980, to the White House. It had previously been administered by DeVoss Department of Education, but will now be led by an official who reports to a senior adviser to the president.

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Publicly shaming the Oscar accountant was wrong

(CNN)On Monday night, PricewaterhouseCoopers released a statement claiming to take “full responsibility” for Sunday evening’s Oscar screw-up in which a staffer gave the wrong envelope to Warren Beatty and Faye Dunaway, who falsely announced that “La La Land” had won the Academy Award for best picture. But that isn’t exactly what PricewaterhouseCoopers was doing.




Internet mocks the Oscars blunder


While PricewaterhouseCoopers shouldn’t have named Cullinan publicly, it should have immediately announced that the (unnamed) staffer(s) responsible for the error had been fired or reprimanded. It also should have begun to outline other measures it’s implementing to fix its procedural problems. That would have demonstrated it was taking swift action to ensure that it never messes up like this again.
But by subtly trying to shift the blame instead of solving the problem, PricewaterhouseCoopers will only deepen the damage to its reputation.
It will also deeply wound Cullinan. People are already using the hashtag #YouHadOneJob to vilify him on Twitter. One man tweeted: “@BrianCullinan he had one job- but too busy taking pictures- typical dumb American.” Another tweeter wrote: “I bet @BrianCullinan got paid big bucks for the ONE job he failed to do. America wants a refund.”

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In his book “So You’ve Been Publicly Shamed,” Jon Ronson explains what’s next for people who have been publicly pilloried — such as former IAC public relations representative Justine Sacco, who facetiously tweeted in 2013, “Going to Africa. Hope I don’t get AIDS. Just kidding. I’m white!” By the time she landed, she was being excoriated on Twitter and had lost her job. Sacco told Ronson she had “cried out my body weight in the first twenty-four hours. It was incredibly traumatic. You don’t sleep. You wake up in the middle of the night forgetting where you are.” And, she said, “It’s not like I can get a date, because we Google everyone we might date.”
This kind of punishment is out of proportion for the “crimes” committed by people such as Sacco and Cullinan.
In fact, the idea of public shaming — such as exhibiting criminals in the town square — was rejected by America’s founders as too cruel. In 1787, Benjamin Rush, who signed the Declaration of Independence, wrote a paper arguing that “ignominy is universally acknowledged to be a worse punishment than death.” Within 50 years of its publication, public shaming was eliminated in every state except Delaware.
Cullinan should be fired for his error because it caused such a massive public embarrassment for a firm that relies on a reputation for accuracy and has put its future work with the Academy of Motion Picture Arts and Sciences in jeopardy. But he doesn’t deserve to be meted out a punishment worse than death by a company ill-advisedly trying to shirk its own responsibility.

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Conservatives say they’re tired of seeing Obamacare drafts via leaks

Washington (CNN)More than 20 members of the House Freedom Caucus huddled over Panera dinners Monday night in a Rayburn office building committee room to talk about their greatest emerging concern: the House GOP leadership’s trajectory to dismantle Obamacare.

After a draft of the House bill to repeal Obamacare leaked Friday, conservatives have had ongoing concerns about how leadership is structuring refundable tax credits and Medicaid expansion among other items. But they are also upset about how few details they feel they are getting from their leaders.
According to a source in the room, a Republican member said what others were thinking: instead of learning about the drafted legislation in conference, they were learning about it from places like CNN or Politico, which first obtained the draft legislation.
“We’re hearing about all of this secretly… We’re hearing about the leaks,” Virginia Republican Rep. David Brat told CNN.
Lawmakers across the board have been emboldened to speak out against their leadership’s plans. House Freedom Caucus Chairman Mark Meadows told CNN that he would vote against the draft. North Carolina Republican Rep. Mark Walker, the chairman of the Republican Study Committee, said in a statement he wouldn’t accept the “current path” the Republican leadership appeared to be on.
Leaders have reiterated that the draft in question was old and no longer “viable” but there is growing fear among conservatives, that the leaked draft incident reveals a bigger problem: leadership is hiding the ball on how exactly they will repeal the Affordable Care Act. As members rely on Power Point presentations and bullet points, the media is reporting on behind the scenes progress they are in the dark about.
“They aren’t being as open as they should be,” said North Carolina Republican Rep. Walter Jones. “At some point in time, they will have to be totally, totally sunshine.”
As part of the legislative process, members routinely send drafts of legislation to the Congressional Budget Office to get a sense of how a bill will affect the budget. But members say they’d like to know that is the progress that has been made instead of reading about it in the news.
“We didn’t even know it was being scored,” Brat said. “No one announced there was a score.”

How powerful are the conservatives?

Repealing and replacing the Affordable Care Act has been a top agenda item for Republicans for seven years now, and House conservatives are determined to have a major say in the path forward. After years of watching their efforts wither in the Senate or be vetoed by former President Barack Obama, conservatives don’t want to temper their efforts.
What is unclear now is how much power they really have in Trump’s Washington.
“I think there is going to be a big surprise when folks find out that a lot of people aren’t willing to to do more socialism. It didn’t work the first time around, and I don’t think we want our reputations voting for round two of what just failed,” Brat said.
Republican leaders insist that their proposals are conservative and the same ideas members of the House Freedom Caucus have been rallying around for years.
House Speaker Paul Ryan Tuesday said the plan under consideration is similar to one former Rep. Tom Price — now Trump’s secretary of Health and Human Services — worked on previously.
“The Price Plan was considered the conservative gold standard at the time last year. Many conservatives co-sponsored that plan. That plan looks a lot like what we’re working on right now,” Ryan told reporters.
A senior House GOP leadership aide insisted that the White House and congressional Republicans are all on the same page.
“So I haven’t seen any vote totals on any of this so we’ll continue to work forward. We still have a lot of work to do, but at the end of the day we’ve got to repeal Obamacare,” said House Ways and Means Chairman Kevin Brady.
It’s not that Republican leaders haven’t tried to keep members in the loop. Key leaders hosted a series of listening sessions on Obamacare taxes and Medicaid reform before members left for the February recess. And leaders announced Tuesday that they plan to host two more listening sessions this week. But, conservatives say the sessions aren’t really a substitute for actual legislative text.
“Truthfully, I went to two listening sessions last week. I’m going to try to go to the two this week and all I could think about was this is a hell of a lot more complex than I thought,” Jones said.

Moderates unhappy as well

It’s not just the conservative wing of the GOP that leadership has to contend with.
Rep. Tom MacArthur, a co-chair of the moderate Tuesday Group, said he and his colleagues are watching closely, but it is “too soon” to weigh in on whether he could support draft legislation.
“The details on what will help the people in the individual marketplace to be able to afford decent insurance is still too murky for me to weigh in on, but I’m going to be looking at that very carefully,” he said. “Personally, I think it’s premature to weigh in on a leaked, in-process document.”
Republican schisms over Obamacare are nothing new, but they seem to be especially pronounced just hours ahead of Trump’s address to a joint session of Congress Tuesday night. While leaders expect the President to endorse some key elements of the Obamacare repeal and replace, conservatives are hoping that Trump doesn’t.
“I hope they do not go along with this plan,” Brat said. “I don’t want them adding their weight to that plan.”
No matter what, expect the debate to continue, one veteran lawmaker said.
Kentucky Republican Hal Rogers, the former chairman of the House Appropriations Committee, said he wasn’t too worried the GOP discord over Obamacare would ultimately doom the outcome.
“It’s Congress,” he said. “The product has not yet gelled and this is going to go on for awhile.”

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Labour MP Gerald Kaufman dies at 86 – BBC News

Media captionSir Gerald was the longest serving MP in Westminster, so was given the title of Father of the House

Sir Gerald Kaufman, Labour MP for Manchester Gorton and Father of the House of Commons, has died aged 86.

His family made the announcement late on Sunday, calling him “a great socialist and parliamentarian”.

Sir Gerald, who was the oldest serving MP, famously called his party’s left-wing 1983 election manifesto “the longest suicide note in history”.

Labour Party leader Jeremy Corbyn led tributes to him, calling him an “iconic and irascible figure”.

Former Labour Prime Minister Gordon Brown said: “There was no one quite like Gerald Kaufman: a brilliant speaker, a compelling writer, an acerbic wit and a conscientious constituency MP.

“With his sharp insights, he not only penned many famous lines but gave the wisest of advice to Labour leaders who relied upon him throughout his 47 years in Westminster.”

Tony Blair, Labour prime minister from 1997 to 2007, said: “Gerald was an extraordinary man, passionate, principled, acerbic and absolutely dedicated to the cause of social justice and the Labour Party.”

A family spokesman confirmed he had been suffering from a long-term illness.

‘Committed’ MP

Prime Minister Theresa May said she had been “very sad” to learn of Sir Gerald’s death.

“His was a life of remarkable commitment to his constituents in Manchester and to the political life of the nation… as Father of the House (a title taken by the longest serving MP) his wisdom and experience will be very much missed by MPs on all sides of the House.”

Sir Gerald became an MP in north-west England in 1970, first for the Manchester Ardwick constituency and then for Manchester Gorton, which he had served since 1983.

He was a junior minister between 1974 and 1979, and held a number of senior shadow cabinet posts through the 1980s, before returning to the backbenches in the early 1990s.

A family spokesman said: “Sir Gerald dedicated his life to serving those who he believed would benefit most from a Labour government and Labour values in action.

“He believed that policy and principle without power were simply not enough to deliver the better life that he fought for on behalf of his constituents for almost 50 years.

“[Throughout his illness], he remained firmly committed to, and focused on, the activities and wellbeing of his beloved constituency.”

‘Persistent interrogator’

Image copyright PA
Image caption Kaufman (r) was a junior minister in the 1970s

By BBC obituary editor Nick Serpell

Gerald Kaufman rose from a working-class background to become one of the longest-serving MPs of his generation.

He gained a reputation as a persistent, often waspish, interrogator whose withering putdowns became a feature of his time in Parliament.

A practising Jew, he was best known for his fierce opposition to the policies of the Israeli government and its treatment of the Palestinians.

Possessed of a sardonic wit, he was a prolific writer and columnist who also wrote satirical sketches for the BBC, an organisation that he later frequently criticised.

Read more in Gerald Kaufman’s obituary

Sir Gerald was a member of the Jewish Labour Movement and was known for his criticism of Israel, calling senior politicians from the country “war criminals” in 2002.

Mr Corbyn said: “Gerald came from a proud Jewish background. He always wanted to bring peace to the Middle East and it was my pleasure to travel with him to many countries.

“He loved life and politics. I will deeply miss him, both for his political commitment and constant friendship.”

Former leader Ed Miliband said he was “an outstanding servant of the Labour movement”, adding: “His principles, values and friendship will be sorely missed.”

Image copyright PA
Image caption Sir Gerald was the longest serving MP in Westminster, so was given the title of Father of the House
Media captionTony Lloyd remembers his friend and colleague Sir Gerald Kaufman on Radio 4’s Today

Tributes from across the political spectrum have been paid to Sir Gerald.

Shadow Chancellor John McDonnell tweeted: “Sad to hear of Gerald Kaufman’s death. He was a tremendously dedicated servant of his constituency and our party. A man of absolute principle.”

Commons Speaker John Bercow called him an “outstanding representative” and a “passionate campaigner for social justice, here in Britain and around the world”.

Former Labour shadow minister Chuka Umunna tweeted: “Very sad to hear of Sir Gerald’s death. A true Labour man and one of the most eloquent parliamentarians. Thoughts are with his family.”

Conservative MP Michelle Donelan MP said: “So sad to hear that Sir Gerald Kaufman MP for Manchester Gorton and Father of The House of Commons, has passed away.”

And Tory MP Peter Heaton-Jones tweeted: “Sad to hear that Sir Gerald Kaufman, Father of the House of Commons, has died. Extraordinary public service: 47 years an MP.”

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