Should doctors write job prescriptions?

Posted April 25, 2017 by Rachelle Chang
Categories: Community, Government

Tags: , , , , ,

Last month, news of Hawaii’s homeless challenge gained national attention on HBO’s Vice News (Hawaii News Now, 3/30/17). The 5-minute segment spotlights that “Hawaii legislators are debating whether to classify homelessness as an illness and housing as a treatment. (via HBO).” This Vice News report is not the kind of attention that Hawaii wants, but maybe it’s the attention that Hawaii needs.

Correspondent Caroline Modarressy-Tehrani interviewed four people to get their perspectives on the proposal to redefine homelessness as a medical condition. Gary Grinker, who is chronically homeless and has a heart condition; he visited the emergency room 241 times in 2016, costing taxpayers $1.2 million in healthcare. Senator Josh Green, who introduced a bill to redefine chronic homelessness as a disease and allow doctors to write prescriptions for housing. Representative Bob McDermott, who believes that Hawaii has “turned the safety net into a hammock.” And Dr. Daniel Cheng, an emergency room doctor at Queen’s Medical Center, which handles two-thirds of all homeless encounters in Hawaii.

I had three successive reactions to the news report.

First, doctors’ first responsibility is to take care of patients’ physical and mental health. A “prescription” for housing would probably involve time filling out forms and coordinating with social workers – time that doctors need to help patients.

Second, having a home may not make people more responsible for their health or reduce emergency room visits. It may even exacerbate health conditions, if people have health emergencies in their home and are unable or unwilling to seek help.

Third, if a solution to rising healthcare costs and chronic disease were housing, we would have more people living in shelters and healthier people at home. But in Hawaii, an alarming 82% of adults have at least one chronic disease or condition and 53% have two or more chronic diseases (heart disease, heart attack, stroke, diabetes, asthma, disability, cancer, chronic obstructive pulmonary disease, high blood pressure, high blood cholesterol, or obesity), according to the Department of Health’s “Chronic Disease Disparities Report 2011: Social Determinants.”

Instead of a “prescription” for housing, maybe doctors should write a “prescription” for a job.  Research shows that employment increases health status and healthy people are more likely to work, according to a Lead Center Policy Brief, “The Impact of Employment on the Health Status and Health Care Costs of Working-age People with Disabilities” (2015).

“Work is at the very core of contemporary life for most people, providing financial security, personal identity, and an opportunity to make a meaningful contribution to community life,” according to the National Alliance for the Mentally Ill (NAMI) factsheet, “Facts about mental illness and work” (1999).

A job gives people dignity as well as a paycheck. Doctors can assess a person’s physical and mental ability to work, and offer a referral to an employer – who could assess their skills, experience, and trustworthiness.

Do you think that we can reduce healthcare costs by prescribing housing? Could having a job help people be healthier?

Celebrate Earth Day 2017

Posted April 18, 2017 by Rachelle Chang
Categories: Community

Tags: , ,

Celebrate Earth Day on April 22 and year-round with events, beach clean-ups, recycling, and more. This year, Earth Day spotlights Environmental and Climate Literacy. Let’s all educate ourselves, take action, and make small changes to be better stewards of Hawaii.

Enjoy an Earth Day event in Honolulu

  • On Wednesday, April 19, attend the Earth Day Festival at University of Hawaiʻi Mānoa Campus Center, 10 am to 3 pm. On Friday, April 21, stop by Earth Fest ’17 at Kaiser High School, 1:30 pm to 8 pm. On Saturday, April 22, participate in the free Mauka to Makai Environmental Expo at the Waikīkī Aquarium, 9 am to 2 pm. On Sunday, April 23, go to the Earth Day Weekend Service and Green Fair, 9:30 am to 1 pm, at Honpa Hongwanji Hawaii Betsuin.

Clean our community by getting dirty around Oahu

There are so many opportunities help clean our beaches, improve our schools, and help with planting. Remember to bring a reusable water bottle, use sun protection, wear closed toe shoes, and choose clothes you don’t mind getting dirty.

  • On Saturday, April 22: Volunteer for the Pūpūkea Paumalū Community Work Day, 9 am to 11 am at Sunset Beach Elementary School, helping to restore the trail from Sunset Beach Elementary School to the pillbox. Meet in the SBES lower parking lot. Contact for details. Join the Sustainable Coastlines Hawaiʻi Earth Day Event, 9 am to 2 pm at Waimānalo Bay Beach Park. Buses begin departing at 9:30 to different locations nearby. Help out at the Garden of Eden Community Workday, 9 am to 1 pm, Blanche Pope Elementary School, Waimānalo, to help spread mulch and plant trees.
  • On Sunday, April 23: Show your love of nature at the Waimea Valley Workday, 9 am to 3 pm in Waimea Valley. Volunteers are needed to help with native planting, invasive species control, and a new sediment control project on Kalaheʻe Ridge. Email Laurent to RSVP.

Learn about litter, illegal dumping, and environmental enforcement

  • On Tuesday, April, 25, attend the Hawai‘i Environmental Court Workshop, 1 pm to 5:30 pm, at the UH Mānoa Richardson School of Law. The workshop is free and open to the public and will focus on “O‘ahu Litter, Illegal Dumping and Community Environment Enforcement.” Register online.

Clean up your clutter

  • Drop off recyclables, gently used items, and more at the Going Green event on Saturday, April 22, 9 am to 1 pm, at Kapolei High School; and at the Aloha ʻĀina Recycling Drive on Saturday, April 29, 9 am to noon at Moanalua Elementary & Middle School.

Mālama the Honolulu Zoo

  • On Saturday, April 29, attend the Honolulu Zoo Children’s Discovery Forest Ribbon Cutting Ceremony and help pull weeds and plant seeds at the Children’s Discovery Forest Work Day, 9 am to 11 am at the Honolulu Zoo. Meet at the Honolulu Zoo’s Gate #6 across the Waikiki Shell parking lot at 8:30 am. Then spend the afternoon at the Zoo.

Bring your own bag (BYOB) to Foodland

  • When you shop at Foodland and bring your own bags, Foodland is offering customers a $.05 bag credit or 3 Hawaiian Miles for every bag used. During April 2017, you can choose to donate your $.05 bag credit to the Kōkua Hawaiʻi Foundation.

Plan your own Earth Day event

  • Host an Earth Day barbeque or picnic at the beach – any day of the year. The Earth Day Network offers a free downloadable Earth Day Action Toolkit to help you organize and coordinate Earth Day events in your community.

How will you celebrate Earth Day?

We’re growing the wrong tax tree

Posted April 11, 2017 by Rachelle Chang
Categories: Government, Taxes

Tags: , , ,

I published this post in 2010 and again in 2013. For those of you who are new to Better Hawaii, and for all of us who could use a reminder, I think it’s worth repeating.

Let’s ignore, for the moment, the fact that the IRS tax code is over 44,000 pages, is so complicated that even tax experts don’t understand it, and desperately needs simplification. Let’s ignore the benefits of a national sales tax or a flat income tax.

Think about this: like a tree struggling to shade us from harm, our tax system needs more sunshine, more pruning, and a lot less graft.

In fact, we are growing the wrong tax tree entirely.

Our current tax system is an overgrown banyan tree, with roots extending down and spreading over the whole economy. The federal government has higher income tax rates, ranging from 0% to 35%. The states have lower income tax rates, ranging from 0% to 11% – with Hawaii at the top – but are dependent on federal funds and must comply with unfunded mandates.

It makes more sense to have a tax system like a strong pine tree, simple and orderly. The federal government, which has national responsibilities and a larger tax base, should have lower tax rates. The states, which directly care for citizens but have smaller tax bases, should have higher tax rates and not rely on the federal government for funding.

The only rational explanation for this upside-down, overgrown tax code is that the federal government wants the power to redistribute taxes among the states. They want to create welfare states and ensure that states are dependent on the federal government.

Does this make non-sense? Do you have another explanation – or better yet, solution? Does anyone have ideas about how states can reclaim their power and independence from the federal government?

Lessons from the carnival

Posted April 4, 2017 by Rachelle Chang
Categories: Family

Tags: ,

Looking back at the carnivals I went to as a kid, my strongest memories are of jail, the swing ride, and cows. I remember the bamboo jail where people got “locked up” and had to wait for a friend or family member to “bail” them out of jail. I remember the swing ride because I was afraid of it, until my best friend finally convinced me to ride it, and I really enjoyed it. And I remember cows because at the State Farm Fair, the cows were large, bored, and pungent.

We had good times at the carnival recently. At the keiki carnival, my 10-year old son disappeared with his friends and popped up later to ask for more scrips. At the neighborhood carnival, we walked around with friends, tagging along as he played games and enjoyed different rides.

Here are a few lessons we learned (and re-learned) at the carnival:

It’s okay to spend money… within reason. Usually, my son has a hard time spending his own money. He hoards it like… gold. But at the carnival, he didn’t hesitate to use his own money. He was having a good time, and he knew how much he was willing to spend. The neighborhood carnival made it a little too easy to spend money. Instead of counting scrips, we reloaded a FunPass, and the credits flew by.

Competitive games can still be friendly. We should all cheer each other’s successes. My son congratulated his friends if they won and was enthusiastic, but not boastful, if he won. He even gave a prize to a friend because she wanted it, and he had one already.

Try something new. I may have been afraid to ride the swing as a kid, but my son didn’t hesitate to try it for the first time. Then he jumped off and ran to the Magic Maze. I had a harder time convincing him to take a bite of funnel cake for the first time.

Look out for others. My son is an only child, but he looked out for the younger kids in the group. He even rode the carousel (not the most exciting ride for a 10-year old) and encouraged a younger boy to hold on tight and not be afraid.

Carnivals are always better with family and friends. When was the last time you went to the carnival? What is your favorite part of the carnival?

“Georgia O’Keeffe’s Hawaii” by Patricia Jennings and Maria Ausherman

Posted April 1, 2017 by Rachelle Chang
Categories: Book Reviews

Tags: , , , ,

In 1939, Hawaiian Pineapple Co. (later the Dole Company) asked artist Georgia O’Keeffe to paint two pictures. According to a February 12, 1940 TIME Magazine article, “She agreed, on condition that she could paint whatever she pleased.” And in fact, stymied in her attempt to visit a plantation and dismayed by a cut-up pineapple, she refused to paint a pineapple.

“Georgia O’Keeffe’s Hawaii” (2011) offers a personal glimpse into O’Keeffe’s 1939 visit to Hawaii. Her visit is seen through the eyes of 12-year old Patricia Jennings, who served as O’Keeffe’s personal guide while the artist was on Maui, written with author and teacher Maria Ausherman. O’Keeffe spent 9 weeks in Hawaii, visiting Oahu, Kauai, Maui, and Hawaii Island. She painted 18 paintings in Hawaii, and two after she returned to New York.

The book is divided into roughly three sections: an introduction by Jennifer Saville, adapted from her book “Georgia O’Keeffe: Paintings of Hawaii” (1990), which offers a factual account of O’Keeffe’s visit; a personal narrative written by Patricia Jennings, who was 12 years old when O’Keeffe visited Maui and stayed at her home in Hāna; and an afterword by James Meeker, which highlights Hawaii’s lasting impression on O’Keeffe.

Through Jennings, we see a side of O’Keeffe who was daring enough to travel across the country alone to a new land, thoughtful and caring about a young girl, intensely private as she painted, temperamental about getting her way, and successful and confident enough to choose art instead of commercialism.

Of Jennings, she wrote in a letter to her husband Alfred Stieglitz: “The child too is so lovely – a flower in full bloom with the sun on it –“ In turn, O’Keeffe made a lasting impact on Jennings – she wrote, “But the deepest gift she offered me was the experience, in some way for the first time in my life, of really being listened to and appreciated for who I was.”

There are beautiful color prints of O’Keeffe’s paintings, as well as those of artist Robert Lee Eskridge, excerpts from letters, photographs, and transcripts of letters written in O’Keeffe’s curling, flowing handwriting. Interestingly, O’Keeffe used wavy lines to separate her thoughts and sentences, instead of standardized punctuation.

As I read “Georgia O’Keeffe’s Hawaii,” I asked my then 9-year old son to read “Georgia in Hawaii: When Georgia O’Keeffe Painted What She Pleased” (2012) by Amy Novesky. We talked a little about O’Keeffe’s decision not to paint pineapples: she was true to her artistic vision, but she also didn’t fulfill her implicit obligation to Dole Company. My son’s perspective: pineapples aren’t fun to paint, but O’Keeffe should have kept her word.

2017 Hawaii Legislative Watch: Unnecessary and Wasteful

Posted March 28, 2017 by Rachelle Chang
Categories: Government

Tags: , , ,

The 2017 Hawaii Legislative Session started on January 18 with prayers, speeches, and music. Hawaii residents definitely need the prayers – our lawmakers have been busy, introducing 1,601 bills in the House of Representatives and 1,317 bills in the Senate. It’s a mountain of paperwork, negotiation, tax dollars, and details.

Every year, I do a legislative round-up that spotlights bills that could have a big impact on Hawaii. I will focus on taxes, education, individual rights vs. government powers, controversial issues, and (in my opinion) unnecessary and wasteful spending. With over 2,900 bills being proposed in 2017 and less time than ever to read through them, I rely as always on bill summaries to accurately reflect the bills’ intentions.

Here is an overview of controversial, thought-provoking, and argument-inspiring bills being proposed in the 2017 Legislative Session. This is a long post, so I’ve organized the bills into four sections: 4 bills that seem wasteful and ineffective, 11 bills that seem unnecessary, 7 bills about government treating us like children (and maybe rightfully so?), and 7 bills that seem like wasteful spending. If I’ve missed other wasteful or ineffective bills, please let me know!

4 bills that seem wasteful and ineffective:

  1. Prescription: home. SB2 would require all health plans in the State, including EUTF health plans and Medicaid managed care programs, to provide coverage for the treatment of homelessness. Doctors are trained to keep us healthy; they are not trained to be social workers.
  2. A water fountain show at the State Capitol. HB106 would add a choreographed water fountain show with light displays and Hawaiian music to the State Capitol reflecting pool. The State Capitol is not a tourist attraction.
  3. Reproduction guaranteed by health insurance. HB1562 and HB1573 would require health insurance coverage for reproductive health (embryo, oocyte, and sperm cryopreservation). I think that we need a cultural change in perspective to value all children, not just biological children.
  4. Which comes first: the license or the employee? HB438 would requires prospective commercial marine licensees to provide the Department of Land and Natural Resources with a copy of the work contract of all of fishers that it employs, prior to being granted a license. Why would you hire someone if you don’t have a license yet?

11 bills that seem unnecessary:

  1. The right to choose your last name. HB799 and SB123 would allow parties to a marriage or civil union to choose any middle or last name. We already have the right to change our names.
  2. A state microbe for Hawaii. HB1217 and SB1212 would designate Flavobacterium akiainvivens as the official microbe of the State. Why do we need a state microbe?
  3. Colored sea salts. SB1221 would fund a study about the use of color additives in sea salt products. This should be funded by private businesses.
  4. Health insurance coverage for paddling, hula, and lua. SB1315 would require health insurance companies to cover Native Hawaiian culture-based activities, including but not limited to canoe paddling, hula, and lua. A nice thought, but it sets a precedent to require coverage for all fitness and exercise classes/expenses from every culture.
  5. Domestic violence classes for hairdressers. HB680 would require barbers and hairdressers to complete a one-time, one-hour training program on intimate partner violence awareness and education. A nice thought, but it sets a precedent for bartenders, sales clerks, and anyone who deals with the public to take this class.
  6. What is Lunar Architecture? HB960 and SB1246 would create the Multinational Lunar Architecture Alliance to devote to hold an International Lunar Development Summit and implement prototype lunar architecture. This is over my pay grade.
  7. Dark night skies protection. HB427, HB1159, SB140, and SB1025 would create a Dark Night Skies Protection Advisory Committee to preserve dark night skies and reduce light pollution. Do we need another committee to handle this?
  8. Candidate filing fees fill political party coffers. HB1376 would require a partisan candidate for state office to pay a $100 filing fee, $80 of which shall be provided to the candidate’s party. This seems like a tax to benefit the political party.
  9. In Hawaii, air travel is a necessity, not a luxury. SB105 would require state agencies to participate in a carbon offset program to offset carbon emissions caused by their employees’ air travel. Maybe we should prohibit off-island travel and require video conferencing instead (a half-serious idea).
  10. In Barack Obama’s footsteps. SB269 would place markers in the State to indicate significant sites in the life of President Barack Obama. I think that there are few “significant sites” in Hawaii.
  11. Who needs to know? SB354 would establish a temporary task force to define a “bona fide agricultural producer.” We don’t need a task force for this.

7 bills about government treating us like children (and maybe rightfully so?):

  1. Hiker safety public awareness campaigns. HB479 would fund a public awareness campaign to educate the public about hiker safety and preparedness.
  2. “Previously frozen” in big letters. HB905 specifies the font size for the words “previously frozen” on frozen food product labels. (I’m not making this up).
  3. Diaper-changing stations in every restroom. HB956 would require public restrooms built or renovated after June 30, 2017 to provide baby diaper-changing accommodations. I like the idea of a family restroom for parents, which would accommodate p infants and the elderly.
  4. Making public urination and defecation illegal. HB16 and HB1595 would make it illegal to urinate or defecate in public. It pains me that we need a law about this.
  5. Is that really a service animal? HB1599 would make it illegal to lie about whether an animal is a service animal. If we cannot ask to see a service animal license, how could we prove that someone is lying?
  6. Safety helmets for mopeds. SB178 and SB179 would require safety helmets for drivers and passengers of motorcycles, motor scooters, and mopeds. I am torn between the desire to keep people safe and the right to do reckless things.
  7. No riding in the back of the truck. SB587 would make it illegal to ride in the back of pickup trucks. I am torn between the desire to keep people safe and the right to transport additional people.

7 bills that seem like wasteful spending:

  1. “I voted” stickers. HB532 would distribute “I voted” stickers at polling places. There are better ways to encourage voting.
  2. Filipino Veterans Legacy Exhibit. HB886 would fund a Filipino Veterans Legacy Exhibit at the Honolulu International Airport. I think this should be funded by private donors.
  3. 50th anniversary celebration of the state capitol. HB1225 and SB1074 would fund celebrations for the 50th anniversary of the Hawaii State Capitol. There are better things that we could celebrate.
  4. Basalt rebar market study. HB1326 would fund a basalt rebar market study. Shouldn’t market studies be conducted by private businesses?
  5. Stipends for volunteers. HB1445 would offer stipends to volunteers assisting in the point-in-time homeless count. If they receive a stipend, they are not really a volunteer.
  6. A new symbol and all-new signage. SB189 would require a new international symbol of access: a dynamic character leaning forward with a sense of movement. Is this really necessary?
  7. Billfish tournament grant. SB1256 would fund the 58th Annual Hawaiian International Billfish Tournament. I think this should be funded by private donors.

The 2017 Hawaii Legislature adjourns on May 4. Please think about these issues and how they may affect you, everyone around you, our children, and our grandchildren. Whether you have concerns or feel strongly about an issue, speak up, talk about it, and be part of the discussion!

2017 Hawaii Legislative Watch: Up for Debate

Posted March 21, 2017 by Rachelle Chang
Categories: Government

Tags: , , ,

Hawaii Legislature 2017

The 2017 Hawaii Legislative Session started on January 18 with prayers, speeches, and music. Hawaii residents definitely need the prayers – our lawmakers have been busy, introducing 1,601 bills in the House of Representatives and 1,317 bills in the Senate. It’s a mountain of paperwork, negotiation, tax dollars, and details.

Every year, I do a legislative round-up that spotlights bills that could have a big impact on Hawaii. I will focus on taxes, education, individual rights vs. government powers, controversial issues, and (in my opinion) unnecessary and wasteful spending. With over 2,900 bills being proposed in 2017 and less time than ever to read through them, I rely as always on bill summaries to accurately reflect the bills’ intentions.

Here is an overview of controversial, thought-provoking, and argument-inspiring bills being proposed in the 2017 Legislative Session. I’ve organized the bills into two sections: 9 controversial bills that are sure to spark debate and 5 bills that are a little puzzling. If I’ve missed any important bills, please let me know!

Marijuana on our minds. One issue that I’m not going to discuss: the use, taxation, and regulation of marijuana. I don’t know enough about marijuana to have even a half-baked opinion, and I don’t understand why there are so many bills that want to change legislation with so little information about the effects of current legislation.

Oxybenzone out of our waters. One issue that I don’t think is controversial is the prohibition of sunscreens and sunblocks with oxybenzone. Sunscreen chemicals that may be safe for our skin, but not for coral reefs, fish, or the ocean. I think it’s reasonable to require more testing to ensure that sunscreens are safe for the environment.

9 controversial bills that are sure to spark debate:

  1. Making prostitution legal. HB1532 and HB1533 would make prostitution legal. I usually support the rights of consenting adults to act without government interference, but I oppose making prostitution legal. Many people are forced or pressured into prostitution because they feel that they have no other options. Legalizing prostitution would make it easier and even profitable to exploit those who are vulnerable, naïve, or who lack supportive families.
  2. Raising the minimum wage. HB5, HB442, and SB544 would increase the minimum wage. HB441 would increases the state minimum wage to $22 by 2022. SB14 would increase the minimum wage to $14 by 2023. SB107 would increase the minimum wage to $15 by 2019. SB267 would increase the minimum wage to $14 by 2022. SB1165 would increase the minimum wage to $15.10 by 2023. I believe that minimum wage increases help employees in the short-term, but inevitably prices go up and buying power goes down again.
  3. Sick leave, family leave, and maternity leave. HB4, HB1434, and SB638 would require minimum paid sick leave. HB213 would allow family leave. HB214 would require 4 weeks of paid family leave for full-time State employees. HB683 and SB521 would require 6-week paid maternity and paternity leave for government employees. HB986 would require sick leave. SB207 would create a shared leave program for State employees. SB516 would allow an employee to take family leave in addition to victim leave. I support family leave for parents of newborns, but I don’t think we should mandate one-size-fits-all paid leave policies.
  4. Making death easier for the dying. HB150, HB201, HB550, SB357, and SB1129 would allow terminally ill adults to choose to end their life by prescription or lethal dose of medication. I would like this choice if I am ever in this situation. While I don’t think doctors should be responsible for death, I don’t know who else we could trust to make these decisions.
  5. Gambling: lotteries, shipboard gaming, and online fantasy gambling. HB348 would create a state lottery. HB766 would allow shipboard gaming. HB855 and SB204 would allow online fantasy sports contests. SB677 would allow Internet gambling. I think a lottery would be such a bad thing.
  6. Banning polystyrene take-out boxes. HB371, HB1545, and SB1109 would prohibit polystyrene food containers and require compostable containers. In theory, this sounds good, but what would we eat on? Would restaurants become bring-your-own-bowl and start to offer washing stations?
  7. Preserving Affordable Care Act (ACA) benefits. HB552, HB687, and SB403 would make certain health insurance benefits a requirement. While I agree with some provisions, such as covering people with preexisting conditions, I have reservations about others, such as extending dependent coverage to age 26.
  8. Single-payer health insurance in Hawaii. SB1120 and SB1199 would establish a single-payer universal health care insurance system. This may seem to simplify health insurance for consumers and providers, but I have concerns that it would be costly, inefficient, and have burdensome regulations and paperwork for healthcare providers.
  9. State support for Hawaiian sovereignty. HB1297 would require the State to support a model of sovereignty and self-governance chosen by the Hawaiian people that complies with federal and state law. I don’t think it’s a good idea to support something without knowing what it is.

5 bills that are a little puzzling:

  1. More inherent and inalienable rights. HB1582 would make access to 1) clean drinking water, 2) meaningful health care, and 3) a quality education inherent and inalienable rights.
  2. An interisland ferry doover. SB117 would create an intra-island or inter-island ferry system. We had a ferry. Proponents said that permits were streamlined; opponents said that permits cut corners. Now we don’t have a ferry.
  3. Specific homeless rights. SB589 would make 1) equal access to housing, jobs, and shelters, 2) equal treatment by government agencies, and 3) access to life-sustaining activities and essential services inherent rights of homeless individuals. Everyone has the right of equal access to services and treatment. We also have the right to be safe in our homes, workplaces, and public spaces.
  4. Hawaii becoming a loan officer. SB869 would create a pilot program to allow Hawaii to make consumer loans of 600 to $5,000. I think that micro-loans could be done by local credit unions, not the government.
  5. Hawaii getting involved in home ownership. SB1106 would create the Family Self-Sufficiency Program to provide matching funds so that public housing tenants could purchase housing units. We don’t have a right to home ownership. I think that government should help subsidize affordable housing, but should not subsidize home ownership.

The 2017 Hawaii Legislature adjourns on May 4. Please think about these issues and how they may affect you, everyone around you, our children, and our grandchildren. Whether you have concerns or feel strongly about an issue, speak up, talk about it, and be part of the discussion!