Tuesday, June 02, 2009

Interview: Patrick Hope

The interview with Mr. Hope took place on Friday May 1 at the Starbucks Coffee in the Ballston Commons Mall.

To get this interview, as well as the others that I conducted, to a similar, readable size, I had to cut quite a bit of material. If I took out more than a word or two (or if the words I erased were more substantial than “and” or “but”), I inserted a three-dot ellipsis (…). If I inserted anything the speaker did not actually say, I used square brackets [like these] to show my insertion.

Otherwise, the words are full quotes. Despite having to remove a lot of content from each of the interviews, I try to make sure the quotes still make sense and are in context. I will happily run corrections or clarifications if the candidate or his campaign can show that it is merited.

My own questions were edited, at times, for clarity and length.--ST

Buckingham HeraldTrib (Steve Thurston): You really can’t be sure who’s going to come out and vote. I don’t get a sense that people are motivated to vote.

Patrick Hope: We’re to the point now where we’re starting to really [make] distinct the differences between the five of us. The main thing that we talk about a lot is first my community experience. You know, I’ve been active in the community for the last 10 years. Whether it’s civic association things, or Special Olympics or it’s human services, affordable housing, all those things I’ve been involved in over the years. That’s one thing that distinguishes me from the other candidates…

I’m responsible for bringing in several million dollars into Arlington. And by working together with people, and bringing together interest groups at the local level…As chair of the community services board, we oversaw, mental health, substance abuse, and intellectual disabilities. All three of those different disability groups have three different interests, and they’re not always the same. They all have their groups. Their parents are out there. They’re very single [issue] focused. And it’s a challenge to bring even those groups together into one…

(Click to enlarge the image.)

So, at the local level, we’ve been able to all of us get together on the same page. It means, though, that we leave stuff off the table. Everyone comes to the table with their interests, but they also leave that meeting, meaning that some of their high priorities are not going to be dealt with. So, we all come together on a single, common message, whatever that may be for the year…

Compromise is hard. But the stakes are just so high. So many people are suffering that, you know, if it means that thousands of more people are being served today than weren’t before, it’s worth it. You always have an end goal,…you always have this ideal where Virginia should be in caring for the most vulnerable populations…

Virginia ranks seventh in the nation in income per capita but yet we rank 48th in the nation in Medicaid funding. So, think about it, our funding, our safety net program for the sickest, the poorest people…those people get the short end of the stick every time. Every time. So many people are not even covered.

If they want these services—whether it’s health care, they end up going to the emergency room when it’s frequently too late, and it’s so expensive, we’ll cover them there. I mean, we’ll pay for a $40,000 foot amputation, but we won’t pay for a $140 visit to the podiatrist…

[We need to] focus on preventive care…

BHT: What are we talking about in an economy like this? Where’s the money going to come from?

PH: We spend the money in the system. We don’t have to spend a dime. And I wouldn’t even propose that we spend more money, more tax dollars. We have enough money in the system, we just spend it in the wrong places…

I mean, think of it this way: when someone comes into the jail, that’s an addict, they get out of jail still an addict. Someone who has a serious mental illness, they come in with mental illness, they go out still mentally ill…It’s a merry-go-round…

One thing I’ve been active in creating in Arlington is a drug court. Someone that is presented with a misdemeanor, not a felony, but I’m talking about a misdemeanor, maybe it’s possession. We’re tending to see that their rates of recidivism are very high. So they’ll be back in jail for another reason once we let them off with this misdemeanor, but the next crime it won’t be a misdemeanor, it’ll be a felony. It’ll be burglary. They’ve got to support their habit. And so if we can get to them early and start getting them treatment—and we’ve seen efforts with drug courts that are very rigorous and the rates of recidivism are extremely low.

BHT: But that can’t be cheap, either. It seems to me what it takes is an intense will of the person to want to get dry and sober, and an intense will of the system to sort of continually chip at this person to keep him or her dry and sober. It seems to me that we’ve used the prison model because, though possibly expensive, it’s fast and doable.

PH: It doesn’t work, though…and there’s a real incentive for the individual to get into this [drug court] program. It’s very rigorous,…almost daily drug tests, you have to be actively searching for a job, and you appear before the court on a weekly basis…If you fail, then the punishment is more stricter than it would have been originally. But the incentive to do it is that the crime will be stricken from your record…

(Click to enlarge the image.)

BHT: Your ideas for preventative health care is basically the HMO model, right? Get people care regularly before they need it.

PH: It is, but you have to make sure that it’s run correctly. First of all, you’ve got to be in the system. Right now people aren’t in the system. So there’s no incentive for you to even get care…

What they’ve done in North Carolina is first they’ve expanded coverage…to bring more people into the system. And for those most expensive chronic diseases like heart disease, diabetes, asthma, hypertension, the most expensive and the most common ones, for the rural areas—this works very well in the rural areas—is you make sure you have case managers and nurses.

Once you identify the diabetic, you go to their home, literally [a case worker] goes to their home and makes sure the patient know how to check their blood, makes sure that they are eating right; they’re taking their medications, they get them filled. If they need an appointment with a podiatrist, not only is the appointment set, but they actually have transportation to get there. They actually make sure that they show up to do it. That way, you’re managing their disease…

BHT: I can hear conservatives, and even the conservative part of myself, saying that we’re too involved. Are you sure this is revenue neutral?

PH: It is. North Carolina did a study on it, and they spent $10 million on their case managers. And just to be clear, the case managers and the nurses are in the rural areas. In the urban areas, like northern Virginia, you put the money in the practice. North Carolina pays $2.50 per month per patient…So, let’s say I have 500 patients under Medicaid with heart disease…I would get paid $2.50 per month per patient to manage their care. So I would hire the nurse.

BHT: Wait. $2.50 times 500—what is that, at most $1,500 a month for a nurse?

PH: Think of it this way, you probably can already absorb that in your practice, anyway.

BHT: Oh, please. How many doctors are lining up to absorb this?

PH: Many of them are because they get together, and so the practices will sort of team-up, and they’ll share a nurse between several different practices. The model works very well because you get paid whether or not someone comes in your practice or not…So you have an incentive to keep them out of the office, to keep them well.

BHT: Or to not know what’s going on with them.

PH: That’s a problem because Medicaid will know. They’ll wind up in the emergency room and there’ll be a cost. The data they’ve had since 2006 in North Carolina, they’ve spent $10 million on all of this. And they save $260 million every year in a reduction in their Medicaid expenditures. So North Carolina’s doing this; Pennsylvania’s doing it; Wisconsin is doing it…

BHT: What happens when a patient disappears? These people are on the edge, so they might just disappear. And if they end up in the hospital, what teeth does Medicaid have to censure the doctor since a doctor could say, “Hey, I was here, it’s not my fault they didn’t come in.”

PH: There’s an [annual] accreditation process, where you have to make sure that you have the staff and that people actually are communicating. If you fail these things, then you’re out of the program. It’s not just $2.50, just to be clear. You still get paid for the visit. You’re still getting Medicaid reimbursement…

All that to my point was that I think we already spend enough money in the system. I think if we were just to spend it differently we could spend it in different ways, we could save a lot of money and expand services, expand care to people.

Another area is homelessness…I was very instrumental in starting [Arlington’s] Housing First program, permanent supportive housing…a ten-year plan to end homelessness. Since 2006, we have placed over a hundred people in our permanent supportive housing program. We’re taking people that are homeless off the streets and give them a home… They’re [the homeless are] not thinking about getting a job. They’re not thinking about seeing a psychiatrist. They’re thinking about where [they’re] going to sleep tonight…

We’ve found that when you give someone an affordable housing unit that they start to think about getting a job. They start thinking about trying to see a psychiatrist, getting clean and sober. And then they do do that next step…

It costs over $100,000 to keep someone homeless…but to give them a home, it costs $40,000 a year…So it’s a different way to spend money.

BHT: Everybody at the Arlington County Democratic Committee debate said they supported universal Pre-school. Assuming the budget is still tight, what would be the second best program or alternate idea that you would fight for?

PH: The compromise is at-risk kids. We can identify who those kids are. They’re kids at low-income, many kids are from minority families. There’s been data out there, studies out there, that show that there really is no difference between the kids that are from wealthy families and how they perform in later years, whether they get Pre-K or not, but there is a significant gap and a significant distinction for those kids that are at-risk who get Pre-K and those who do not. So the evidence clearly shows that if you’re going to target any population it ought to be those at-risk kids, so that would be my fall-back position on expanding Pre-K. I know it’s a cost…but it’s an investment, too.

BHT: About the environment and energy policy. What can we really do in the next year or two in reducing coal emissions and that kind of thing?

PH: You know, I don’t think we’re going to be able to flip the switch and cut ourselves off of coal. I’ve said before, I think coal is our past and its present, but it doesn’t have to be our future. We’re not going to be able to flip that switch…I do think if coal represents about 45 percent of our energy right now, there’s no reason to say…we can reduce this by five percent a year, about every five years.

BHT: But how?

PH: I think we start looking to renewables, wind and solar. I think everything should be on this table, natural gas. I mean I saw a picture of [gubenatorial candidate Terry] McAuliffe wading in algae, you know, seeing if you could use that, and he talks about chicken waste. Look at all the different options, put them all on the table, and let’s slowly reduce the amount of our consumption of using coal…

And let’s set a standard, a mandatory standard, of saying let’s reduce our consumption by 2025, let’s reduce it by 20 percent. And that 20 percent, we replace it with renewables. You go down to the coal country, and you ask those workers what they know about black lung disease, what they know about their average life-span of ending at 55-years-old, or what they know about asthma, or not allowing their kids to play out in the front yard. They’d like a new life for themselves. They’d like a new job, a green job. And invest, invest in these coal areas, you know, put some of these facilities down there, so people can transition and get a new job…

(Click to enlarge the image.)

Let’s teach this [lower consumption] in the schools. Let’s teach [children] about consumption. And let’s teach them about…conserving. It’s the lightbulb, and it’s also turning off the light. Families can have responsibilities, too. Weatherizing your home. Let’s have a program where we can weatherize homes. Let’s reduce your consumption individually by 10 or 15 percent over the next few years…

BHT: [Readers: this final question was one I had on my mind a lot, but never wrote down. Therefore, I forgot to ask it in the interview. I wrote it as an email, and Mr. Hope responded via email. ] As a long-serving member of the Arlington Democratic Party, you’re the "establishment" candidate. How do you (or do you at all) shake that moniker?

PH: I'm proud of my endorsements in this race because I know how I received them: I earned them. I've established my credibility and reputation over the years not in the Party but in the community. These endorsements come from my associations, efforts, and years of working with community leaders to make Arlington a better place.

The support I've received are not from IOU's or friendships, they are made out of mutual respect and appreciation for the results I've delivered. Arlington's State and County delegation is made up of some of the best policymakers and thought leaders in the country and I'm honored to have their support. I look forward to continuing to work with them as a member of the General Assembly.

Click here to return to the main interview site. --ST

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