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Opinion | Covid Deaths Are On the Rise Again in Nursing Homes

So, No. 1, we need to strengthen people’s rights. No. 2, we need a public option: a viable public takeover plan for when the industry and the market are failing, to step in and take back the facilities. In lieu of us having a viable plan, the market and the industry will never fix themselves because there is no competitive model that will push them to do better. We have to put in competitive nursing home and long-term-facility models that can check the privately run industry.

Can you give me the nuts and bolts of what a public takeover would look like? Let’s say that there’s a failing nursing home in a city. It’s run by a for-profit chain, has all the problems that you alluded to. What does that look like for the county or state to take over that nursing home?

In places like North Dakota, which has the only state Public Bank, such an effort would be easier to execute, because we would have the public capital to leverage and go in and purchase a privately run entity that’s failing. So in lieu of a public bank in New York, we still have public capital, we have emergency funds that are still available to us.

We can leverage some of that to go in and use eminent domain, something we think is only used for private real estate development. I think we can build public capital by using eminent domain. And unless we exercise our right to do that against the private markets, they’re not going to respond. They’re going to extract and exploit because as long as you’re for profit, you have quarterly duties to return profits to shareholders.

What are the differences between government-run or even worker-cooperative models and these big, for-profit nursing home chains?

The biggest difference is the accounting of public benefits. Most nursing homes are subsidized through Medicaid and Medicare programs, and there is massive fraud by private and even nonprofit organizations. They are keeping shoddy records, creating secondary and tertiary markets, hiring consultants, providing no-show jobs to family. So basically, if Medicaid gives your grandmother a $100 benefit, by the time it reaches her she’s getting maybe 10 cents on the dollar for that, or $10 out of $100. By taking it over publicly and empowering the workers at the center, we are keeping better records and making sure that the majority of public benefits go to care and not the pockets of profiteers.

How big a lift is this politically? We’re talking about lobbyists, we’re talking about billionaires who own some of these chains. We’re talking about an entire network of politicians.

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