Always buy local
Always buy local
The County of Hawaii has a new slogan, “Buy Local.” That’s all well and good, but just how serious are we in doing just that?
Along this line, consider that Kona blend coffee contains as a minimum of 10 percent Kona beans. Where might the other 90 percent be from? And then there is Kona Brewing Co., pretending that ALL of its beer is made right here on the island. Guess again.
Why do you suppose that the price is comparable to imported? Because it IS imported … from the West Coast, where it’s brewed. But the name says it all, and when people see “Kona” on these two products, they buy.
The concept of purchasing “local” is great on a number of counts. For one, the money for the transaction remains in the state. But there is also the factor as to where it was manufactured. How much intrinsic value is there to a product that’s made in China or Japan (as examples)? Does the country of origin pay anything to support some of those things that we take for granted? Like defense or education? Or social programs?
Then there is the ultimate form of contempt: Our own county has a tax collector located out of state. If your real property tax wasn’t paid in person, what was the address on the envelope for remittance? Seattle! Do you suppose that any of the employees at the tax collection agency in Washington State pays any of their income, in the form of taxes, to Honolulu or Hilo?
It all comes down to, “Do as I say, not as I do.”
Michael L. Last
Na‘alehu
Save midwife program
I am writing in support of the North Hawaii Community Hospital Nurse Midwifery program. I am a certified nurse midwife myself and completed my clinical rotation at NHCH with the nurse midwives there. This hospital-based program has been a model of what nurse midwives can accomplish if given the opportunity.
With the utilization of nurse midwives, NHCH has been able to achieve outstanding safety statistics. Their overall cesarean rate is 22 percent, where the statewide average is 32.8 percent; their epidural rates are 13 percent, and statewide epidural rates are as high as 85 percent. These health indicators boil down to real cost savings for insurance companies.
The problem is that the Island of Hawaii has the highest Medicaid population in the state. Medicaid reimbursement is very low for maternal health, which boils down to situations such as hospitals losing significant money as the costs to deliver the care is higher than the actual reimbursement. This situation also filters down to overburdening physicians and forcing them to take increasing numbers of patients to remain solvent. This does not provide for good care for women.
In the extreme, this is a women’s issue. Unfairly low reimbursement in maternal health care results in high cesarean rates, long wait time in clinics, less individual care and poorer overall maternal health care outcomes. This is not fair to women nor to maternal health care providers.
A better solution would be to incentivize the best practices in maternal health care in Hawaii. Hospitals that maintain low cesarean rates and utilize their resources wisely … should be given significant additional funding.
I do not think that downsizing the midwifery program is the way to go. However, I do lament that women on the Big Island are being short changed, and this is disgraceful. We need more midwives, not less.
I urge the community and insurance companies to recognize the cost savings that midwives can provide and work on incentives that recognize good maternal health care practices in Hawaii.
Roxanne Estes
President, Hawaii Affiliate of the American College of Nurse Midwives