ISSUE 04-23-22 COMMENTARY

By Barbara Bayer

In the April 9 issue of the Corrales Comment, (Commentary, A Mayor’s Perspective) former Mayor Jo Anne Roake referred to the fact that “Animal Services got a new facility, with new kennels and equipment.” In the vein of where you sit is where you stand, I think anyone who thinks this new facility is so great, needs to come out from behind their desk and take a visit.

As someone who has been in the trenches for more than 21 years rescuing animals in Corrales, the accolades for this new facility are seriously misplaced. Concrete cells do not good dog runs make!

First, the misuse of statistics. The favorite quote from the Roake administration is that Animal Services takes in only eight animals a month, or two a week. Point one, the administration conveniently dropped out the 65 animals taken in from a hoarding situation right here in Corrales.

Point two, averages do not address the actual distribution of animals in any given time period. So, even if you accept the statistic of eight animals a month, what happens if all eight come in at one time? Where would Animal Services be expected to put them? There are only two concrete cells, one of which has been used for cats. What is Animal Services expected to do with all eight animals?

The other statistics provided by the former Mayor is that animals are only supposed to be housed for 72 hours. Yet another interesting interpretation. Seventy-two hours is the stray hold for animals that are found in the village during which time animals must be held so that an owner has time to come forward.

The notion that animals have to be sent out of the village once the 72 hours has passed means no time to seek opportunities to engage residents and interested parties as either foster or adopters. Until the former mayor, Animal Services made its own decisions about how, when and to whom animals were triaged taking into consideration what was in the best interests of the animal. In the last month of the Roake administration, rescue groups were told they would not be able to take Corrales animals unless they were certified and that all animals had to go to Animal Humane. What certification? Never heard of that, so show me the forms. Also show me the certification completed by Animal Humane.

Oh, yes. The Village Administrator said there was a contract with Animal Humane. Where is that contract? There is none. Where is the memorandum of understanding (MOU)? There is none. It was established in emails. Really? And what process have they agreed to follow to assure that village animals are not euthanized, consistent with Village ordinance. None. And finally, does the former administration understand that Animal Humane does not take every animal, and for every animal they take, they charge a fee? So where are these unworthy animals supposed to go?

There is so much wrong with the ways our Village has approached animal care in the last four years, it is not possible to detail them all. While there is much that needs to be done to provide safe, sanitary, humane dog runs, a major step in the direction of returning the Village to its animal friendly designation is to move Animal Services into the Fire Department.

Fire is already doing large animals, why are large and small animals split between two departments? Wouldn’t it seem logical to benefit from economies of scale by combining similar functions? With small and large animals together under the Fire Department, there is someone available 24/7 who has trained in animal issues. The police do not see animals as their mission, nor should they.

I have worked in government most of my career, and I know when you don’t want to do something, you study it. If it is such a good idea to get an objective assessment of Animal Services going forward, why did ex-Mayor Roake fail to commission such an assessment after I met with her right after she took office?

Resolving our concerns is a no-brainer. The police chief has said he would be happy to relinquish Animal Control and the fire chief has said he would welcome having Animal Services in his department. Let the police do what they do best and let the Fire Department expand what they are already doing. And let’s not study what is plainly a reasonable resolution.

By Mary Feldblum

Executive Director, Health Security for New Mexicans Campaign

 Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the copilot, and the flight attendants. That’s how the healthcare market works. In no other industry do prices for a product vary by a factor of ten depending on where it is purchased. 

—Elizabeth Rosenthal, MD, in An American Sickness: How Healthcare Became Big Business and How You Can Take It Back , 2017

So much focus on health care centers around access issues. While it is very important to provide opportunities for New Mexicans to receive health coverage —either through public or private programs— there is another issue that must be addressed: the wasteful, costly and administratively complex pricing of health care services.

We need to think of our health care system as a jigsaw puzzle. Each piece is connected to other pieces. The puzzle cannot be solved without figuring out how the pieces are connected to each other.

Thus, just gaining access to health insurance will not address hospital costs, pharmaceutical drug prices, the frustrating (and costly) administrative burden on health care professionals, or increasing patient out-of-pocket responsibilities, which may prevent people from getting the care they need.

Our state needs to come up with a coordinated solution to address both access and cost. The jigsaw puzzle needs to be solved.

For over two decades, the Health Security for New Mexicans Campaign, currently a coalition of 170 diverse organizations and thousands of individuals, has been working on a homegrown systemic New Mexico solution. We have reached out to all areas of the state, seeking feedback on a simple idea: let’s set up our own health plan that automatically covers most New Mexicans, offers comprehensive services and freedom of choice of provider, and is overseen by a geographically representative citizens’ board (like a co-op). Private insurance may play a supplemental role, as it does in many European countries (and as is the case with traditional Medicare).

The Health Security proposal requires a major paradigm shift, one that combines and coordinates the key elements —the different puzzle pieces— of our health care system.

According to three independent New Mexico studies (the most recent in 2020), the Health Security approach will slow the rate of increase of health care costs, ensure coverage for all state residents, and simplify what has become a complex and administratively burdensome system that frustrates health professionals and patients alike.

In 2021, the New Mexico Legislature provided funding to develop the details of the proposed Health Security Plan. This funding enabled the Office of Superintendent of Insurance to hire consultants to engage in key research areas during the initial year of the design process.

While the 2019 Health Security Act provides important guidelines for creating the Health Security Plan, there are many details that stillneed to be fleshed out, including enrollment, hospital and health professional payment systems, appeals systems, IT/medical records, accountability systems, and more. Decisions will have to be made about these details before the plan can begin offering coverage. Once designed, a fiscal analysis can then be conducted on the plan as designed— not as projected.

If New Mexico is to develop a systemic solution to our health care crisis, it is important to understand how these different key elements impact each other. Unlike a jigsaw puzzle, however, these critical components of our health system require gathering information about state and international experiences, learning from them and then deciding what would work for our state, keeping in mind how each piece fits together and impacts access and cost.

During the 2022 legislative session, the superintendent presented very promising results on the three critical research topics selected.

Topic 1. Investigation of federal waivers and agreements that provided key information regarding prospective plan enrollment numbers.

Initial results: The report describes various approaches to receiving federal waivers or agreements, focusing on Medicaid and Medicare, the two largest programs in New Mexico, while ensuring the protection of recipient entitlements.

Topic 2. Exploration of provider payment system methodologies that focused on whether it is possible to standardize our complex multi-layered payment system, as many European countries have done.

Initial results: The report describes various options to develop such a coordinated system so providers and health facilities do not have to deal with multiple different charges for the same service.

Topic 3. Research on the feasibility of creating a global budget program for hospitals, a payment system in which hospitals receive a predictable, sustainable revenue stream instead of depending on an unpredictable, complicated charges system. (Maryland’s global budget program has been very successful.)

Initial results: Two reports, written by separate consultants, concluded that New Mexico could greatly benefit from such a system, whose creation can be funded by the Centers for Medicare and Medicaid Services.

In sum, the reports describe possible paths to take that will address both access and cost issues.

But more research is required.

Recently, the legislature increased the funding for this coordinated approach. The appropriation will enable the superintendent to follow up with the suggestions made in the initial reports and to investigate two additional critical topics: how to address rising drug prices and how to create a workable inter-operational IT system so that no matter which plan you have, the provider you go to will have your complete medical history.

While the design project clearly is a multi-year effort, the research on some of these pieces in the health care puzzle can lead to more immediate solutions.

For example, a hospital (and clinic) task force could be created this year to figure out how a global budget system could work in New Mexico, with the goal of applying for startup funds from the Centers for Medicare and Medicaid Services. It would be possible to create a second task force to explore the creation of a program to negotiate drug prices that could benefit all New Mexicans.

Thus, the Health Security Plan design process will enable New Mexico to phase in key pieces of the puzzle —like hospital and drug costs, keeping in mind how these programs would impact the other jigsaw pieces of the health care system and how they would align with the systemic reform the Health Security approach will ultimately bring.

New Mexico has been given an extraordinary opportunity to carefully design a workable solution to our health care crisis, one that is appropriate for our large, mostly rural state with its small population.

For more information, visit our website: www.nmhealthsecurity.org

By Jeff Radford

Shouldn’t the United Nations have stopped the war in Ukraine? What’s wrong?

Many times in recent memory, the UN  has sent military peacekeeping forces into zones of armed conflict, usually with great effect. But in Ukraine, no such UN intervention has happened or is likely to happen.

The reason is  Russia’s veto power in the UN Security Council. That’s a fundamental problem that stems from the UN Charter established at the end of World War II.

The five permanent members of the Security Council —Great Britain, France, the United States, China and Russia — were deemed so important to maintaining world peace that the brand-new world body probably would be powerless to mount any military intervention without their approval.

Or, although it was not stated, the veto power was ingrained precisely because any foreseeable major war was likely to involve one of those five, who therefore wanted to preempt any potential deterrence to their own future military ambitions.

The UN Charter, signed in June 1945,  provides no way to override or void the veto power of any of the five permanent members. And if such a mechanism did exist, or might exist in the future, it would surely mean the United States would be subject to losing its own veto power when it became embroiled in a military conflict.

Given changed conditions since World War II and in light of the war in Ukraine, does the UN need to be changed fundamentally to achieve its main objective, to maintain peace in the world?

A friend of mine —really more of an acquaintance with whom I had a continuing personal relationship— led a far-reaching project to reform the United Nations in 1997. Canadian Maurice Strong, now deceased, is best known as convenor of the seminal 1972 Stockholm Conference on the Environment. He went on to serve as founding secretary-general of the UN Environment Program.

Assigned by then-UN Secretary-General Kofi Annan in 1997 to propose urgent reforms to the world body’s structure and organization, Strong accepted Annan’s challenge  that “the organization needs to be significantly re-configured in order to do better what the international community requires it to do.”

As he was finishing his task, I spoke to him briefly at UN headquarters in New York. As usual, his thoughts headed off in many directions almost simultaneously, and he seemed to be stressed.

The organizational problems to be addressed went far beyond advisability of retaining Security Council members’ veto powers. In fact, his report, “Renewing the United Nations: A Programme for Reform,” runs more than 100 pages but mostly skirts the politically fraught matter of veto power.

The report starts by stating that “The United Nations is a noble experiment in human cooperation” and that its charter was “drafted with the searing experience of  history’s two most destructive wars fresh in mind.”

In reviewing the report, I found no reference to the Security Council’s veto powers as being a problem or even a dilemma. It was not mentioned in a section titled “Institutional strengths and weaknesses” nor in the section on “Peace and Security.”

Yet at Paragraph 102, the report states “Reform of the Security Council is of great importance for its functioning and legitimacy. Within the General Assembly there have been intensive and prolonged discussions regarding the expansion of the Council, an issue that can be resolved only by Member States. This is a key issue for the United Nations and a positive resolution of it would contribute to the prospect of moving forward with other issues.”

But it has no discussion of eliminating the veto power. Nor does Chapter 5 “Focusing on Substantive Priorities.” Nor does Chapter 7 “Prepared for a Changing World.”

So if the structure of veto power within the Security Council is immutable, what else could stop a conflict such as Russia’s invasion of Ukraine?

The prospect of after-the-fact criminal prosecution might, and in fact, was referenced in Paragraph 90, titled “International Criminal Court.” It says “For nearly half a century —almost as long as the United Nations has been in existence— the General Assembly has recognized the need to establish an international criminal court to prosecute and punish persons responsible for crimes such as genocide, crimes against humanity and war crimes.” It noted that a June 1998 diplomatic conference would be convened to adopt a treaty to establish such a court.

The International Criminal Court was, indeed, established in 2002. No country has veto power over the court… except that only 126 countries have ratified the treaty; Russia and the United States have not, so war-related criminal charges against either nation likely would not proceed for lack of jurisdiction.

Short of a change in the UN Charter’s the Security Council veto provisions or who can wield them, the only alternative may be a global grassroots movement that leads to another treaty, outside the UN structure, that could field a military peacekeeping force. But that holds grim portends as well.

Is the United States any more ready than Russia to relinquish its claim to deserved hegemony and thereby avoid war-related accountability?