Lacshrecse Aird Offers a Road to Nowhere

by James C. Sherlock

Jim Bacon today posted an important essay. If you have not yet read it do so. This essay builds upon it.

Del. Lacshrecse Aird (D-Petersburg)

Del. Lacshrecse Aird, D-Petersburg, has offered a joint resolution, apparently destined for passage, that would:

“Expand(s) the charge of the Virginia Department of Health’s Office of Health Equity to address racism as a public health crisis to ensure that statewide policy efforts are analyzed through an intersectional race equity lens and offer funding recommendations.”

The phrase “intersectional race equity lens” needs to be unpacked, for Del. Aird’s benefit as well as that of the rest of the General Assembly. The bill itself offers no definitions, so I will use the definitions from a primary source, Racial Equity Tools.  

From that source, “intersectional racial equity” in healthcare or anything else contains the following elements:

  • Intersections of Race and Ability
  • Intersections of Race and Class
  • Intersections of Race and Gender
  • Intersections of Race and LGBTQIA* Identities
  • Intersections of Race and Other (Cultural, religious) Identities

From but one of those “lenses”, a feminist journal:

“Intersectionality is a complex idea, but part of it means that when we are discussing someone’s class or ableist oppression, we must consider those things in the context of other areas where they might be marginalized as well as where they might be privileged.”

Understanding, much less rationalizing such an exceedingly abstract, exhaustive and inherently conflicting (who gets vaccinated first?) catalog of interests into coherent healthcare policy and funding decisions would occupy a huge staff in a futile attempt to solve a giant, ultimately unsolvable Rubik’s Cube.

I am sure that Aird’s resolution makes her feel good, but that is not the same as actually making a difference.  

When Republicans offered Health Enterprise Zones (HEZ) legislation last year, Aird’s Petersburg Petersburg district stood to be the number one beneficiary.  

The Robert Wood Johnson Foundation’s County Health Rankings 2020 survey ranked Petersburg as 133rd and last among all Virginia jurisdictions for both Health Outcomes and Health Factors.  

That is a record that shows disregard for the health of the people of Petersburg by their community and elected leaders, the local Health District, the Department of Health, the General Assembly and the healthcare industry.  The citizens themselves also bear responsibility but they need help.

The 2020 Republican-sponsored HEZ legislation contained provisions that would have put Petersburg first in line for assistance, including self-help, in making important improvements in public health there by increasing access to primary care.  

It was modeled after a highly successful Maryland program that had not only improved public health in some of that state’s poorest regions, but also saved that state a fortune in Medicaid payouts by reducing hospital admissions. This year that program is being expanded statewide in Maryland.

I personally wrote to Del. Aird’s office explaining its importance to Petersburg and asking her assistance. The bill passed with only one no vote in the House Health, Welfare and Institutions (HWI) Committee. Ms. Aird voted yes.

It was then referred to the House Appropriations Committee led by Del. Luke Torian, (D- Prince William). Aird is a member of the House Appropriations committee but not the Sub-Committee on Health & Human Resources to which Torian referred the bill.  

It was tabled by a unanimous vote of the Democrats on that subcommittee. No votes included Torian and subcommittee chairman Mark Sickles, who had voted yes in HWI the night before.  

Aird has been there long enough to know how the system works. Did she lobby Sickles and Torian for her constituents? There was no budget reason to reject the money-saving bill.

I hope Democrats in the General Assembly, having rejected a bill that would have really helped apparently because it was Republican-sponsored and the hospital lobby opposed it, don’t take the state down a road that leads nowhere because the resolution has “racism” in the title and Aird wants a headline.

Footnote for all of us: *LGBTQIA+

“A common abbreviation for Lesbian, Gay, Bisexual, Pansexual, Transgender, Genderqueer, Queer, Intersexed, Agender, Asexual, and Ally community”.


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Comments

28 responses to “Lacshrecse Aird Offers a Road to Nowhere”

  1. Steve Haner Avatar
    Steve Haner

    Louise Lucas is an automatic no vote on any of your ideas already…now you add Aird, maybe Chairman Torian? Man, stay away from any of my bills! If you actually want to accomplish anything within the process, you and I need to have a chat….People on this blog love to dump on me for being establishment/lobbyist/former player, but I’ve gotten some bills passed! You are just sitting outside throwing rocks. Counterproductive is a nice word for it….

    1. UpAgnstTheWall Avatar
      UpAgnstTheWall

      Yeah, philosophical discussions aside this is bad politics for someone who wants to get something implemented. Like, even if you’re a public health flat Earther when it comes to racism, wouldn’t the smart play to just be, “Delegate Aird is right on target here and this is the mechanism to use to help fix it,” but even that basic old school notion of using your programs to give your enemies what they want seems to be lost now. The primary objective is to always and everywhere deny that racism exists and then offer policy after the fact.

      As to the HEZ themselves…in the lack of any thorough analysis and given the mixed results of classic enterprise zones I remain skeptical. The one study I could find pointed to a significant reduction in in-patient stays (potentially good!) alongside a significant increase in emergency room visits (obviously bad!) and without an understanding of the mechanism at work for the cause I’d recommend the GA at best do an exploratory study before committing any further.

      1. sherlockj Avatar

        For the definitive report on HEZ, see Johns Hopkins’ https://www.jhsph.edu/news/news-releases/2018/maryland-health-enterprise-zones-linked-to-reduced-hospitalizations-and-costs.html

        The Democrat-controlled Maryland legislature is going to pass legislation this year to extend what was for 5 years an HEZ demonstration project permanently to the entire state. Maryland’s Republican Governor will happily sign it.

        Virginia politics are, on the other hand, a fetid swamp compared to Maryland.

        The thrust of your comment, like Steve’s, seems to be that Virginians should let Virginia politicians do what they do without comment, pretend its OK, lie low and try to be under the table to catch the scraps. You and Steve understandably would couch that as “realism”. I understand that.

        I have the resources – time, energy, will, and some skill at research – to call them out. Not enough other people do, especially now that the newspapers are for all intents and purposes out of the investigative journalism business.

        I am going to take the opportunity to “afflict the comfortable and comfort the afflicted” as the old – now outdated – press saying used to go. That is my niche for as long as I can do it.

        I could not care less if corrupt and lazy politicians object. Most of Virginia’s elected Democrats, unlike Maryland Democrats, are all show and could not care less about substance. I have called out Republicans by name when they fall into the same trap, and will continue to do so.

        If they object to my reports, I will know they are uncomfortable. From my email complaints from the public sector, I know they are watching.

        So they should comport themselves accordingly.

        .

        1. Steve Haner Avatar
          Steve Haner

          🙂 I don’t have to pass any anymore, but now and then I kill one. I sensed you still wanted to get these ideas considered and could advise a better way.

          “Virginians should let Virginia politicians do what they do without comment, pretend its OK, lie low and try to be under the table to catch the scraps.” Oh, come on, you’ve been reading here long enough to know better than that. I can be and will be again a forceful advocate. But if you are trying to get a bill through, it cannot be personal and accusing the legislators of being uncaring or fools tends to work against you. Mentioning three black legislators by name adds a new layer. On the outside, throw all the rocks you want.

          Seriously, would you write something like that for public view about any of the senior officers you served with? Say a black admiral? ANY of your shipmates?

          1. Nancy_Naive Avatar
            Nancy_Naive

            Kinda cynical, huh? There’s hope for him still.

  2. idiocracy Avatar

    “The thrust of your comment, like Steve’s, seems to be that Virginians should let Virginia politicians do what they do without comment, pretend its OK, lie low and try to be under the table to catch the scraps.”

    Put another way…if you want to keep getting what you’ve been getting, keep doing what you’ve been doing.

  3. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    This is a resolution, not a bill. It does not have the force of law. It would not “expand the charge of the Virginia Department of Health….” It only “encourages” VDH “to consider steps to address systemic racism….” Most resolutions like this make their sponsors feel righteous, but are ignored by agencies and the public generally.

    1. Steve Haner Avatar
      Steve Haner

      A.K.A. A brochure bill.

      1. Nancy_Naive Avatar
        Nancy_Naive

        Yes, but…

        If passed and signed, would it permit VDH to budget current, or request future, funds for the purpose? Or perhaps, to use any discretionary funds to do so?

    2. Nancy_Naive Avatar
      Nancy_Naive

      Encourage; not a command but permission.
      If you can define the problem then you may try to solve it.

      1. Steve Haner Avatar
        Steve Haner

        Trust me, none of you would want to have walked the path that young woman has had to, and here she is in the GA rising in influence. Sure we disagree on much but she knocks me out with what she’s done. Losers do find their way onto that floor from time to time, I agree, but in my experience they disappear fast. The ones that last and rise have something going for them.

        1. Nancy_Naive Avatar
          Nancy_Naive

          I assume that was directed at the hint of “righteousness” by Dick, and not at my suggestion that it constitutes permission.

        2. Dick Hall-Sizemore Avatar
          Dick Hall-Sizemore

          Nice comment, Steve.

    3. ksmith8953 Avatar
      ksmith8953

      They need to be encouraged to use funds for vaccine distribution, fairly to have and have nots alike.

      1. LarrytheG Avatar

        I see where out-of-state folks are getting priority access to vaccines in some states that don’t prohibit it.

  4. LarrytheG Avatar

    I was going to ask if the Va bill was essentially like the Md bill.. or if not, how it differed.

    So, it’s not really a bill?

    What’s the point then?

    I’m not convinced there is no cost to things like “recruiting doctors” but I support the concept as long as metrics are collected before implementation, then after, and it actually is proven effective.

    re: ”
    Unexpectedly, the analysis also linked the Zones to a large increase in emergency room visits—32.40 per 1,000 in 2013, 41.01 in 2014, 38.78 in 2015 and 31.75 in 2016—implying a total of 40,488 extra visits during the study period.

    “We think that many of these patients visiting emergency rooms normally would have been admitted to hospitals, but in the Zones, with their community-based resources, the hospitals may have been better able to send those patients home to rely on those community resources instead of admitting them,” Gaskin says.

    Despite the increase in emergency room visits, the analysis suggests that the Zones brought a large net cost savings. The 40,488 extra emergency room visits cost insurers and patients an estimated $59.9 million. The reduction of 18,562 inpatient stays saved an estimated $168.4 million for a net savings of $108.5 million, against the $15.1 million cost of the Zones initiative during the same period.”

    Did they collect metrics on people’s health outcomes before and after ?

  5. LarrytheG Avatar

    re: ” “We think that many of these patients visiting emergency rooms normally would have been admitted to hospitals, ”

    This is a collectible metric that is important to know.

    I don’t know, but I’d guess that not only visits to the ER result in admissions and I’d not be surprised if it is a smallish type number.

    Also this sounds a lot like one of the premises behind the Medicaid Expansion – i.e. give folks insurance so they can see a primary care doc instead of going to the ER.

    So for a legitimate study, you’d have to control for the Medicaid Expansion when trying to evaluate the impacts of HEZs.

    If most low income folks have Medicaid or Medicaid Expansion – at the ER visits remain high, is it because of a shortage of primary care docs that would need the govt to do something to incentivize more primary care docs to locate in that zone?

    Is that a collectible metric? i.e. the number of primary care docs in the zone – before and after?

    So all of this cries out for a pilot program that collects metrics before we have the government involve itself in “zones” that cost some folks money or shift costs. “saving money” without also collecting metrics about healthcare outcomes – to demonstrate that saving money actuall does improve outcomes… etc… get the politics out of it – and get the actual data into it, THEN argue politics!

    1. sherlockj Avatar

      To your primary question, it was the pre-and post HEZ public health-related metrics for those communities that Johns Hopkins used to assess the program.

      As for conducting a pilot program, the Maryland HEZ program was a pilot.

      The Johns Hopkins Report, as you acknowledge, showed HEZ to to be a resounding success. So much so that it is being expanded to a state-wide permanent feature of Maryland law.

      I drafted the original Virginia HEZ law to have it exactly emulate what had worked so well in Maryland, and the bill referred administrators of a Virginia program to their Maryland counterparts for lessons learned. Much of my original language got stripped away by the committees that considered it. It still passed 17-1 in the House Health, Welfare and Institutions (HWI) Committee before being tabled in House Appropriations by some of the same people that voted for it the night before in HWI.

      The bill I wrote made the Virginia HEZ program also a pilot, not because the program had not been proven to work in Maryland, but that I don’t trust the Virginia Department of Health to run it effectively and efficiently. VDH needs to be given a chance to screw up and then repair a small pilot before earning the right to run a larger one. At the end of the day, it would not surprise me if they prove not up to it.

      1. LarrytheG Avatar

        I saw metrics for money, but not for health outcomes for the people.

        Maybe I need to go back and read again.

        So true, it was submitted as a bill with specifics about how it would actually work and who would do it, etc?

  6. Jim S. can speak for himself, but I highlighted the bill in the previous post to show how Critical Race Theory is spreading like the new COVID-19 mutation through society. Pre-George Floyd CRT was largely confined to academia (at least in Virginia). Then, atoning for his blackface photo, Gov. Northam appointed his CRT crew in the Virginia Department of Education. Now we’re seeing politicians like Aird who we thought were mainstream adopting it lock, stock and barrel. CRT is no longer a fringe philosophy. It is rapidly becoming core doctrine in the Democratic Party — and that should scare the hell out of everyone.

    1. LarrytheG Avatar

      I’m curious as to WHY you THINK this happened. Is it in response to the George Floyd things?

    2. Steve Haner Avatar
      Steve Haner

      Oooo, here we cower in our fenced community of $600-900,000 townhomes, scared of leftist ideology seeking to exploit racial animus. Again, please note that with exception of the Big Kahuna, the Greatest President Ever (just ask him), the R’s kicked ass in November. “Defund the Cops” blew up. You know who cost us those two last seats in Georgia, the loser. We have three tasks:

      1) Stop the cops killing or wounding unarmed black suspects. That is a real problem, a serious problem and we as a nation should be ashamed.

      2) Get out this pandemic recession and get the economy firing on all cylinders, because Trump had a point that the last few years have been good for all Americans. And that DOES scare hell out of Democrats.

      3) Win in November on the basis of competence and opportunity, not racial appeals, which I’m getting tired of reading.

      1. sherlockj Avatar

        I agree with your three points.

        As for your last one, I too am tired of reading racial appeals – from the Biden and Northam administrations, Congress and the General Assembly. I find them ultimately destructive of the goals that they purport to advance. That is why I comment on them.

        Dividing this nation by race in public policy and accusing half of the population of racism is an actual rather than proverbial road to hell that is paved by “good intentions”.

        And as sure as night follows day, it is being insinuated here – “mentioning three black legislators by name adds a new layer” – that Jim and I and others have furtive reasons for calling them out.

        I rest my case.

  7. LarrytheG Avatar

    re: ” the R’s kicked ass in November”

    well they captured more House seats while still not taking control of the House and losing the Senate.

    Is that right? that’s “kicking ass”? 😉

    I don’t know.. you want a REAL disaster scenario even one you would hate? How about a second Trump term with control of Senate and House and all the GOP does exactly what they are told or else?

    now THAT .. WOULD BE…. “kicking ass” , right?

  8. “1) Stop the cops killing or wounding unarmed black suspects. That is a real problem, a serious problem and we as a nation should be ashamed.”

    How about white suspects…

    And what do we do when the MSM media report a suspect was unarmed when in fact he was armed.. ie,, Jacob Blake…

    1. Steve Haner Avatar
      Steve Haner

      Armed or not, Blake was shot — in the back — because he refused to do what the cops ordered, just kept getting in the car and blew them off. Three times out of four, that’s it, the suspect just refused to “obey” and the cop loses his temper. That is not sufficient reason for deadly force. Well, YOU may think so and that’s the problem. I hate to say it but the rules of engagement have to change and no deadly force allowed until the suspect fires or is clearly preparing too. Blake was just blowing off those cops and they tried to kill him for it.

      1. LarrytheG Avatar

        “comply” is the word, I think. You do what he Cop says or he apparently has the “right” to “shoot to kill” – as opposed to using other means less deadly.

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