
Puerto Rico’s Health Care Is in Dire Condition, Three Weeks After Maria - stablemap
https://www.nytimes.com/2017/10/10/us/puerto-rico-power-hospitals.html
======
dang
There's (almost) nothing of intellectual curiosity in this thread and a
plethora of partisan battle. That's the inverse of the values of HN, so I've
buried the submission.

Sometimes a politically charged topic has an intellectually interesting aspect
and the discussion is able to balance itself with both. Such threads are ok;
this isn't one.

All: if you haven't recently, would you mind learning about the values of this
site by reading
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html),
then (going backward in time)
[https://news.ycombinator.com/newswelcome.html](https://news.ycombinator.com/newswelcome.html)
and
[https://news.ycombinator.com/hackernews.html](https://news.ycombinator.com/hackernews.html)?
Those will fill you in. The default tendency on the internet is so strongly
toward entropy that we'd appreciate your attending to what kind of site HN is
trying (and trying not) to be.

------
r00fus
Trump administration FEMA says it's "not our job" [1] to distribute food/water
in PR. Trump administration has also declined to extend the Jones Act
exemption allowing non-US built ships to send aid tariff/tax free [2].

Therefore non-US approved international aid incurs fees/taxes. So we don't
treat Puerto Ricans as US Citizens but don't allow other countries to assist
without impounding taxes and duties on the supplies.

Willful negligence.

[1] [https://www.dailykos.com/stories/2017/10/10/1705685/-FEMA-
No...](https://www.dailykos.com/stories/2017/10/10/1705685/-FEMA-Not-our-job-
to-deliver-water-and-food-to-Puerto-Ricans-Think-I-am-making-this-up-Wrong)

[2] [https://www.cbsnews.com/news/dhs-will-let-jones-act-
waiver-f...](https://www.cbsnews.com/news/dhs-will-let-jones-act-waiver-for-
puerto-rico-expire/)

~~~
Aloha
The Jones act only prevents cabotage[1], which is to say shipping something
between two places in the same country. It in no way prevents the Dominican
Republic from shipping supplies or people, or any other country for that
matter in shipping stuff there.

It's my opinion that while the Jones Act probably does increase the cost of
shipping goods two and from the island, its not a magic catchall fixit - and
beyond that, every report I've read makes it clear we've enough stuff there to
take care of people, but its not making it from the places where it landed, to
the places where people are - and therefor complaints about the Jones Act seem
mostly to be political haymaking - as the old saying goes, never let a good
crisis go to waste.

[1] -
[https://en.wikipedia.org/wiki/Cabotage](https://en.wikipedia.org/wiki/Cabotage)

~~~
forapurpose
Interesting thoughts but ...

> It's my opinion that while the Jones Act probably does increase the cost of
> shipping goods two and from the island, its not a magic catchall fixit

No offense, but based on what? And then what is the impact of the Jones Act?
If you have expertise in that industry to support the analysis, that would be
great. Could you link to some of these reports?

~~~
mikeyouse
The Federal Reserve thinks that it doubles the price of shipping between
Puerto Rico and the US Mainland:

> _It costs an estimated $3,063 to ship a twenty-foot container of household
> and commercial goods from the East Coast of the United States to Puerto
> Rico; the same shipment costs $1,504 to nearby Santo Domingo (Dominican
> Republic) and $1,687 to Kingston (Jamaica)—destinations that are not subject
> to Jones Act restrictions._

Page 23 in the PDF (numbered 13):

[https://www.newyorkfed.org/medialibrary/media/regional/Puert...](https://www.newyorkfed.org/medialibrary/media/regional/PuertoRico/report.pdf)

Terrible for disaster relief but also on a daily level, terrible for
imports/exports. How can you have a competitive economy with that type of
anchor weighing on your Ex/Im?

~~~
Aloha
It's probably not important for disaster relief (there doesnt seem to be a
shortage of relief supplies, but rather a shortage of on-island transport to
distribute them) - but I'd agree it is a huge drag on the local economy.

------
jph
To give help:
[https://hispanicfederation.org/unidos/](https://hispanicfederation.org/unidos/)

The Unidos fund has 100 percent of donations going toward relief for Hurricane
Maria.

~~~
ceejayoz
Wow, someone's on a serious downvote brigade tear on this article if _this_ is
(edit: was) getting downvoted to grey.

~~~
drawkbox
Within the last few weeks especially the botnets have gone on overdrive on all
touchy topics, very interesting indeed.

~~~
rory096
Botnets with >500 karma per account on Hacker News? Seems unlikely.

~~~
drawkbox
You might not be a bot, but it is definitely bot talking points, you just fell
for them. You fell for the "whataboutism". People are dying in PR, but but
what about ... debt and and .. kneeling.

~~~
rory096
What?

~~~
drawkbox
Botnets are out in force on touchy subjects in force recently. You cannot see
private upvotes/downvotes so you don't know the user that upvoted or downvotes
a comment. I think eventually we will have to see this on reddit/hn etc as the
botnets are en masse now and mostly just brigading when there is an important
subject.

I wasn't calling you a bot per se but I see lots of people puppeting botnet
"whataboutisms" that is some hardcore propaganda and getting giddy when they
are upvoted by these same fake users. Strangely the brigading is mostly when
the news is political. Just based on what I have seen the last few weeks
especially, they are ratcheting it up. It is making discussion of serious
topics relegated to battling bot armies rather than individual opinions, a
losing battle unless you have your own bot army.

~~~
rory096
Have you considered that they may be people with different opinions than you?

Reddit is one thing, but Hacker News does not allow downvotes until a user
earns _500_ karma. That's a high bar to cross for a bot.

I also don't see where I subscribed to any "whataboutisms." My point is that
you shouldn't attribute to botnets what can be adequately explained by the
existence of people who disagree with you.

------
drawkbox
We need to make them a state finally and never allow this to happen again.

For people putting this on budgets/PR, lots of states are in dire situations
with budgets/funds and healthcare on the mainland. If you swapped a few states
with Puerto Rico in the "big water" you'd have the same exact situation. Many
states are in the red. A country should stand up for their citizens in
emergencies and tragedies and that includes Puerto Rico.

~~~
chisleu
I think this is the intended effect. They operate in a special grey area
created by generations past to great advantage. Then they have corruption and
mismanagement in their politics until their economic wellness is a dumpster
fire. They literally did this to themselves by selling bonds that they can't
pay back that they are obligated "before even necessary services are provided
for the citizens".

It's sad that they abuse their tax free status and made themselves into a tax
haven that is abused without actually bringing much income into the country,
then changed tax regulations and increased deficit spending before being
forced into austerity.

[https://en.wikipedia.org/wiki/Puerto_Rican_government-
debt_c...](https://en.wikipedia.org/wiki/Puerto_Rican_government-debt_crisis)

I hope they will allow Congress to incorporate them into the USA as a state
after this.

~~~
forapurpose
> selling bonds that they can't pay back

That is not at all unique to PR.

It's a widespread problem in U.S. government. That's the reason the city of
Detroit went bankrupt. Many, many government entities have liabilities,
especially pensions, that they can't afford. Many companies have the same
problem; it drove General Motors to bankruptcy. The federal government toys
with bankruptcy each time Congress needs to authorize additional debt, and now
the leading tax legislation will drive up debt considerably more.

But the overwhelming example is the Great Recession of 2008, which was due to
the exact same problem, on a very wide scale, on Wall Street. In that case,
the bonds (and other financial instruments) were based on fraudulent housing
loans.

In most of the above cases, the taxpayers of the U.S. stepped in and rescued
the debtors. Also, in the West, debtors prison is no longer considered a good
thing - bankruptcy lets debtors recover. There's no reason PR shouldn't
benefit from the same support.

~~~
chisleu
>That is not at all unique to PR. You cut off the part that is unique, which
was that PR citizens are also US citizens but they do not pay federal income
tax unless they come to the mainland. They do not pay capital gains tax
either. They sold bonds with special clauses that they must be paid back, even
before critical services are provided to the people. They defaulted and now
they are being forced to pay it back even though they can't fund their
emergency preparedness, hospitals, or infrastructure and emergency response.

PR was not at all prepared for something that was obviously coming and they
are trying to use political pressure to get the huge anti-Trump sentiment in
the country to think it was all Trump's fault when he has little to do with
overseeing FEMA's response. I'm sure there are things he could have done
better. His statements have been asinine and politically tone deaf for sure,
but this isn't about him. This is about the mess PR made. If they want to be a
state, then be a state. Otherwise, they offer nothing to the USA and in my
opinion should be dissolved as a US territory.

~~~
forapurpose
> Trump's fault when he has little to do with overseeing FEMA's response.

Trump is the elected President and is directly responsible to the citizens for
the Executive Branch, including FEMA. His job is, specifically, the
performance of the Executive Branch. If FEMA isn't delivering, he needs to see
to fixing it ASAP. He needed to see to it that they were prepared.

> PR was not at all prepared for something that was obviously coming and they
> are trying to ...

Is there more to that then words typed in a web forum? That is all I've seen;
nothing to support that story.

> Otherwise, they offer nothing to the USA and in my opinion should be
> dissolved as a US territory.

Membership isn't based on contribution, nor is past contribution a prediction
of the future. Should poor people be kicked out? What about Mississippi? The
US has always been based on the belief that people, if given freedom and
opportunity, can prosper and achieve.

~~~
leereeves
FEMA is dealing with the aftermath of 3 hurricanes at the same time. Their
entire staff is working hard to respond. They aren't failing to deliver;
they're facing a unique challenge.

All while being condemned for their inability to wave a magic wand and fix
everything immediately, and attacked by the media's endless anti-Trump
campaign.

~~~
forapurpose
If you could provide any basis for any of that, it would be valuable.
Otherwise, it's just characters someone typed into a field on their web
browser.

~~~
leereeves
As opposed to what? Characters someone typed into a corporate content
management system?

Which part do you dispute?

The Pew Research center found that, excluding the right-wing media, only 5% of
the media's coverage of Trump was positive.

[http://www.journalism.org/2017/10/02/covering-president-
trum...](http://www.journalism.org/2017/10/02/covering-president-trump-in-a-
polarized-media-environment/)

Edit: 6% of the centrist media's coverage, for those inclined to nitpick.

~~~
forapurpose
> As opposed to what? Characters someone typed into a corporate content
> management system?

I don't understand your point

> Pew Research center found

Some information at last! That's what I'm talking about.

First, "excluding the right-wing media" is a pretty major omission. Excluding
my right leg, I have no easy means of walking. The right-wing media is
enormous, including the leading media companies in many segments (Fox, WSJ,
talk radio, etc.).

Second, reading the report, the number the parent quotes excludes both media
with a right-wing audience and with a politically mixed audience (the report
defines it by the political leanings of the audience, not of the news outlet);
the number includes only media with a predominantly left-wing audience.

Third, the parent comment implies that 95% was negative, omitting that 39% of
the coverage, even in media for left-wing audience, was neutral.

So here's the actual data, for media consumed by predominantly left-wing
audiences: 5% positive, 39% neutral, 56% negative.

When right-wing media lambasted Obama day and night for over 8 years, opposing
everything he did, calling him everything from Kenyan to Communist, I don't
recall such an uproar about coverage. And the left serve as his propaganda
outlet either, the way Fox et al serve Republicans - the progressives didn't
like him, and there is no Democratic propaganda front with major reach.

~~~
leereeves
> When right-wing media lambasted Obama day and night for over 8 years,
> opposing everything he did, calling him everything from Kenyan to Communist,
> I don't recall such an uproar about coverage.

Because that's expected from the right-wing media, just like HuffPo is
expected to hate Trump.

The problem is that the "centrist" media is biased. Only 6% of their coverage
is positive.

> just characters someone typed into a field on their web browser

Every post on Hacker News is just characters someone typed into a web browser.
Every text post on the Internet is just characters someone typed into a text
box. What was your point there?

------
olivermarks
Given the incredible amounts the USA spends on 'defence' one wonders where all
the assets the pentagon buys are to help US citizens after a violent attack by
the elements. Why isn't the army mobilized to help with all aspects of
infrastructure including healthcare?

~~~
neolefty
They're at least somewhat mobilized. For example the "medical treatment ship"
_Comfort_ is on the scene:

> There are urgent attempts to help. The federal government has sent 10
> Disaster Medical Assistance Teams of civilian doctors, nurses, paramedics
> and others to the island. Four mobile hospitals have been set up in hospital
> parking lots, and the Comfort, a medical treatment ship, is on the scene. A
> 44-bed hospital will soon open in badly wrecked Humacao, in the southeast.

> But even as the Army Corps of Engineers is installing dozens of generators
> at medical facilities, and utility crews work to restore power to 36
> hospitals, medical workers and patients say that an intense medical crisis
> persists and that communications and electrical difficulties have obscured
> the true number of fatalities directly related to the hurricane. The
> official count rose on Tuesday to 43.

> Matching resources with needs remains a problem. The Puerto Rico Department
> of Health has sent just 82 patients to the Comfort over the past six days,
> even though the ship can serve 250. The Comfort’s 800 medical personnel were
> treating just seven patients on Monday.

I don't really know enough to say whether our military is doing all it can,
but it's certainly doing something significant. And they appear to still be
hobbled by the laws of physics and the limits of human resourcefulness and
endurance.

------
jbob2000
As much as the current administration deserves blame for the mishandling of
this crisis, I think it's disingenuous to stop the conversation there.

The island was pretty much wiped out. Even with billions of dollars and
hundreds of thousands of people, you'd still have people dying. Right from the
article:

> The Puerto Rico Department of Health has sent just 82 patients to the
> Comfort over the past six days, even though the ship can serve 250. The
> Comfort’s 800 medical personnel were treating just seven patients on Monday.

They do have resources, but I bet it's just extremely difficult to move people
and supplies around on an island that is barely above water. You just can't
fight nature and expect to come out with no losses.

Also, the heartless cynic in me thinks that the powers that be are letting
this get a little drawn out so the poor people on public health assistance die
off and eat up less resources. If 6,000 people no longer need dialysis, you're
saving $300,000,000/year.

------
toomuchtodo
Supplies are still not being distributed across the island:

[https://twitter.com/lucianrandolph/status/917507001902665728](https://twitter.com/lucianrandolph/status/917507001902665728)

Power is still out for the vast majority of the island:

[http://www.status.pr/](http://www.status.pr/)

I have previously [1] suggested [2] crowdfunding the expatriation of Puerto
Rican residents. If you know of someone in Puerto Rico, get in touch, get them
a job on the mainland, and get them out of there on a commercial flight. If
they're a retiree, consider taking them in.

EDIT: @ bueble

I suppose will throw out the statements and facts from the thread link about
people dying from not getting the basic medical treatment they need due to
power and facility shortages?

[1]
[https://news.ycombinator.com/item?id=15412122](https://news.ycombinator.com/item?id=15412122)

[2]
[https://news.ycombinator.com/item?id=15416635](https://news.ycombinator.com/item?id=15416635)

~~~
ceejayoz
A part of the United States with more people than Kansas is 90% without power
and 35% without water weeks after a disaster. Shameful, and disturbing how
little attention is being paid to it by government and media.

> I have previously suggested crowdfunding the expatriation of Puerto Rican
> residents. If you know of someone in Puerto Rico, get in touch, get them a
> job on the mainland, and get them out of there on a commercial flight.

Preferably, to a swing state. The current lack of political power - no
senators, no congresspeople, no electoral votes - will always mean PR is
treated very differently than even the smallest state.

~~~
jedmeyers
"Preferably, to a swing state."

Yep, move people who voted for the local governemnt that left them unprepared
for a disaster like this and make them vote for the same government in a swing
state.

~~~
ceejayoz
The PR government may indeed deserve some blame (maybe even a lot!), but IMO
it's _absurd_ to think that their disenfranchised status on a national level
doesn't play a role.

Their debt is $72 billion. We authorized $700 billion for TARP to bail out
failing banks, and $17.4 billion to bail out the Big Three automakers.

~~~
rayiner
As to the debt (not the natural disaster): Let's be clear, Puerto Rico is a
wealthy place. It's richer than Spain. It's $72 billion debt is from overly
generous public benefits. It's basically Illinois or Detroit. The Federal
Government isn't bailing those places out either, because unlike TARP (which
we recovered with a slight profit), we'd never get that money back.

~~~
ceejayoz
What are these "overly generous" public benefits?

They get substantially lower Medicare and Medicaid funding per capita, can't
join the Federal healthcare exchange, and their citizens aren't eligible for
ACA subsidies. [https://www.nytimes.com/2015/08/03/us/health-providers-
brace...](https://www.nytimes.com/2015/08/03/us/health-providers-brace-for-
more-cuts-to-medicare-in-puerto-rico.html)

Puerto Rico's per-capita GDP is also lower than any US state.

~~~
rayiner
> What are these "overly generous" public benefits?

Puerto Rico's debt arises from overly generous benefits to public employees
and retirees and underfunding: [https://www.reuters.com/article/us-puertorico-
debt-budget/pu...](https://www.reuters.com/article/us-puertorico-debt-
budget/puerto-rico-budget-to-protect-pension-payments-governor-idUSKBN18R3C8).
As in Illinois, Detroit, etc., this is purely a local issue, the result of
local expenditures not matching local revenues. It has nothing to do with the
federal government.

As for federal support, on the whole, Puerto Rico receives more in federal
support than it pays in federal taxes:
[https://www.finance.senate.gov/imo/media/doc/Arthur%20MacEwa...](https://www.finance.senate.gov/imo/media/doc/Arthur%20MacEwan%20and%20J.%20Tomas%20Hexner%20\(Submission%204\).pdf).
It's sandwiched right between Louisiana and Vermont in that regard.

> Puerto Rico's per-capita GDP is also lower than any US state.

Yes, but on a purchasing power adjusted basis, it's higher than South Korea,
New Zealand, Italy, Spain, and other countries that manage to have solvent
public services without relying on outside support.

~~~
toomuchtodo
It seems like the options available are:

1\. Default on pension obligations, put those retirees on social security and
eat the cost (transfer from general fund to SSA) if they haven't contributed
in via FICA

2\. Bail out their underwater pensions

3\. Default on pension obligations, allow retirees to die in poverty

I put them in my preferred order of operations.

~~~
rayiner
I agree the first one is the best option.

------
vermontdevil
And Trump's administration has even released a video showing everything is
fine.

~~~
choward
I don't know. Mark Zuckerberg teleported there and it still looks pretty
messed up.

