Archive for February, 2023

Ukraine: One Year In And It’s 1915 All Over Again

Friday, February 24th, 2023

This morning, politicians, diplomats, generals, and just plain folks all over Europe and America are asking the same questions: Where do we go from here and how do we get there?

One year ago today, Vladimir Putin launched his Blitzkrieg invasion of Ukraine. It failed to capture the capital Kyiv. This is reminiscent of the German invasion of neutral Belgium on 3 August 1914. Germany’s plan called for an all out sprint through Belgium to capture Paris and defeat France before the French could mobilize their defense. Although the Germans made it to 90 miles from Paris, they never got there, and following an August filled with German atrocities, the arrival of the British to join the slaughter, French counterattacks, and the absolute refusal of America to become involved, everyone settled in for four years of trench warfare, where millions of rounds of artillery shelling bracketed wave after wave of soldiers insanely charging across “no man’s land,” to capture a few feet of ground they would lose the next day.

It wasn’t until 1917 when the discovery of the Zimmermann Telegram¹ gave President Woodrow Wilson the excuse he needed to bring America into the war that the tide began to turn leading to Germany’s surrender in November, 1918. The Versailles Treaty that followed completely changed the world’s political geography and furnished the political ammunition that led to Adolph Hitler and the Second World War.

The trench systems on the Western Front in World War 1 were roughly 475 miles long, stretching from the English Channel to the Swiss Alps, although not in a continuous line. In Ukraine today, the battle line extends about 600 miles, and the Russians are dug in all along it. The trench system they have built is formidable. The two sides exchange artillery constantly, while Russia periodically fires more Cruise Missiles into Ukrainian cities. The ones Ukrainians fail to shoot down kill more civilians and destroy more infrastructure. That’s the whole point of them.

No one, I mean absolutely nobody, knows how the current war in Ukraine will end. What we can say is what most observers thought would happen a year ago hasn’t. One year ago, I wrote:

Ukrainian troops are fighting valiantly, as did so many in Hitler’s way in 1939, but, as with those long ago heroic defenders, they fight alone and their cause is hopeless. True, they will make Putin pay a high cost in Russian blood, but it seems inevitable that Kyiv will fall. Putin will decapitate the government, assassinate the leaders he can find, install a puppet regime, declare Ukraine restored to its rightful place in the arms of Mother Russia, and that will be that.

Like everyone else, I was wrong, but happily so. Still…

British and American Intelligence agencies think around 200,000 Russian soldiers have been killed or wounded over the last year. That includes thousands of the infamous Wagner mercenary group, financed by wealthy catering tycoon, ex-convict, and all around Russian loose cannon Yevgeniy Prigozhin. He enlisted thirty to forty thousand convicts from Russian prisons, and then used them as cannon fodder, which is one reason he’s having difficulty getting any more prisoners to trade their cells for an extremely remote chance of staying alive long enough to get a taste of  freedom. The Wagner group, however, does have around 15,000 actual soldiers experienced in small squad tactics, but, despite all the press their leader has garnered, “they have played only a minor role in the war thus far,” according to Michael Kofman, the Russian studies Research Program Director at the Center for Naval Analysis.

Despite far-right congressional Republican opposition here at home to aiding Ukraine, up to this point the United States has succeeded in keeping NATO and the European Union united in resisting Putin’s immoral, illegal, and savage aggression. The western powers have levied economic sanctions and provided a vast amount of military aid. Thus far, the sanctions have hurt the Russian economy, but not its defense industrial production; Iran and North Korea have stepped in to restock Russian shelves with armaments, but that supply will eventually run out like toilet paper during the pandemic. Which is why Putin is turning to China and the Global South, particularly Africa and India, which has increased its importation of Russian crude oil by a factor of more than seven since the conflict began. Much of the Global South sees America as an Imperialist power and will not join in sanctioning Russia.

The U.S. has, over the last couple of weeks, repeatedly warned China not to provide “lethal” aid to Russia, but China is in a difficult position. It desperately wants Russia not to lose the war, because if that happened America and the West would assume even more global domination. The problem is China has a vast supply of ammunition and other armaments, and Russia needs them, but China would risk significant economic and diplomatic harm by providing them.

Right now, Russia has begun its long-awaited winter offensive, without much success to this point. It’s anticipated that the Ukrainian plan is to ward off this Russian attack and then begin its own spring offensive when it might have more and better western armaments to throw into the fight.

Meanwhile, back in Russia, Putin, who has been planning this invasion for more than a decade, has finished consolidating his power. Elite Russians who vociferously opposed the war at its beginning have left the country; the people who stayed have gladly swallowed the propaganda. The independent press, that is, what was left of it before the invasion, has been eviscerated. Ditto to his political opponents, who have all been jailed. Even Patriarch Kirill of Moscow, head of the Russian Orthodox Church is a strident supporter. The result is that Putin is, quite literally, preaching to his choir.

And he seems more than ever in for the long haul, believing he can actually outlast the opposition, in that western unity will over time crack apart like Humpty Dumpty’s egg.

At the one-year anniversary of this barbaric war, we should ask the question: What if that happens? What if western support slowly goes away?

Here’s a scenario hard to contemplate. Most experts now agree this is a multi-year war; it’s a long slog. Less than two years from now America holds a presidential election. If a far-right-leaning, Russia-tolerating Republican wins that election (it happened in 2016³) with a platform saying the war has cost America far too much, we should now get out, and the Ukrainians should fight it out by themselves, the entire European and Ukrainian picture could change. It’s hard to imagine this happening, but without U.S. leadership, Russia and its stone-cold-killer² president would then have license to hold nothing back.

Another scenario. What if western unity remains strong? What if a staunch Ukrainian independence supporter wins our presidential election and Putin realizes the egg will not crack? What if Ukraine pushes Russian forces back to the boundaries of 2014?  What if Putin realizes he is in danger of losing Crimea, which, as opposed to a year aqo, President Zelenskyy now says is a solid goal Ukraine will achieve?

Would Putin then think it was time for a tactical nuclear strike? Would he be that crazy? What would China do then?

What would we do?

So many questions with not an answer in sight.

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¹ In January 1917, British cryptographers deciphered a telegram from German Foreign Minister Arthur Zimmermann to the German Minister to Mexico, Heinrich von Eckhardt, offering United States territory to Mexico after the war was won in return for joining the German cause.

² Former Secretary of Defense Bob Gates’s term for him.

³ Ask yourself where we’d be, where Ukraine would be, if the Russian invasion had happened on Donald Trump’s watch.

 

 

 

 

 

 

The Roger Ailes Road To Shame And Infamy, Twenty-Five Years In The Making

Wednesday, February 22nd, 2023

In 1996, trying to replicate the success that made him a billionaire in Britain, Rupert Murdoch hit the US airwaves with Fox News Channel. The news and political commentary network operated under the umbrella of the Fox Entertainment Group, the film and television division of Murdoch’s 21st Century Fox (formerly News Corporation). Murdoch hired Roger Ailes to run the new  network as CEO. Ailes had been a senior Republican consultant and strategist during the presidential campaigns of Richard Nixon, Ronald Reagan, and George H. W. Bush, a campaign in which he and Lee Atwater came up with the Willy Horton ad that doomed the candidacy of Mike Dukakis.

When he was dying of inoperable brain cancer, Atwater apologized to Dukakis for the “naked cruelty” of the Horton ad; Ailes never did.

Ailes lasted at Fox for 20 years, until in 2016 Murdoch forced him to resign in disgrace after several female Fox employees, including on-air hosts Gretchen CarlsonMegyn Kelly, and Andrea Tantaros, accused him of sexual harassment. Murdoch and Ailes’s accusers eventually settled all the cases for about $45 million. Ailes, himself, walked away with a severance package of $45 million. Crime pays.

Ten months after leaving Fox, Ailes, a hemophiliac, died from injuries he suffered in a fall at his home.

During his 20 years as CEO, it was Roger Ailes who set Fox News on the highly successful road of right wing, conservative “opinion reporting” by the likes of Tucker Carlson, Sean Hannity, Jeanine Pirro, Lou Dobbs, Maria Bartiromo, et al. Ailes and Fox attracted a base of fiercely loyal viewers for whom Fox became the one and only place to hear their truth, regardless of what the real truth was. Fox’s news division reported actual news with a conservative slant, but it was the prime time opinion shows with their hyperventilated hyperbole and outright lies that propelled Fox’s ratings.

A television network makes money in a number of ways, but the two primary ones are through licensing fees cable operators pay to carry the channel and through advertising. Licensing fees are based on multi-year contracts, but advertising rates are determined by viewership, the market where the ads will appear, the time of day they’ll run, and how often, with viewership being the most important. What an advertiser pays will be based on how many thousands of people will see the ad. It’s called Cost Per Mille, or CPM. Viewership determines ratings, and ratings determine what a network can charge for an ad. For 20 consecutive years, under Roger Ailes’s leadership, Fox News Channel outscored all its rivals in viewership, which led to huge profits for the Murdoch family and big paydays for its on-air personalities.

All of that became threatened with the presidential election of 2020, the election Donald Trump lost by more than seven million votes.

Four years following the Ailes departure, the road he built led to a single moment a whisker after midnight on election night when all the fecal matter in the Fox television universe thwacked into the giant whirring instrument sitting in the middle of the company’s New York City headquarters. For that was the moment Chris Stirewalt, Fox News’s digital politics editor, polling chief Dana Blanton and analyst Arnon Mishkin called Arizona, and its 11 electoral votes, for Joe Biden. That was the moment everyone in Trump-world began to think something might be very wrong.

Stirewalt later testified before the House Special Committee Investigating the January 6th Insurrection. In his testimony he took great pride in calling Arizona for Biden. “We were able to beat the competition,” he said with a broad smile.

For beating the competition, Fox fired Stirewalt in what it labeled “a company-wide restructuring.” Bill Sammon, a longtime Fox News executive who was also involved in the Arizona call was forced to resign as the network cleaned house.

At that singular moment when Stirewalt and the Fox Digital Election Team gave Biden Arizona, the Fox election desk team came to a fork in the Roger Ailes Road. On one side, a trail led to announcing the unfortunate result, bemoaning how terrible they thought it was that their favorite had lost in Arizona, and then moving on. The other trail, the one that bore to the right, the far right, led to disputing the results in all the states Trump eventually lost, fabricating conspiracies to account for the losses, hosting whack-a-doodle theorists in prime time to vividly detail the fake conspiracies, thoroughly and publicly agreeing with all the nuttiness, while privately calling it “insane” and “crazy”—and blaming everything on Dominion Voting Systems, a company that provided voting technology machines to 28 states during the 2020 election, including swing states Wisconsin and Georgia. The conspiracy accusations, made with almost biblical certainty by Trump election advisors Sidney Powell, Rudy Giuliani, and My Pillow CEO Mike Lindell claimed the Dominion machines had been “rigged” to falsify votes so Biden could win.

Remarkably, that was the road Fox took. Three months later, on 26 March 2021, Dominion Voting Systems Corporation sued Fox News Network, LLC, for $1.6 billion. This, after another voting technology company, Smartmatic, which provided its technology to one county in America, Los Angeles County, had already sued Fox, Powell, Giuliani, and others for $2.7 billion.

Last week, after significant Discovery, Dominion filed its Brief in Support of its Motion for Summary Judgment. It’s damning in how it shows Fox’s political commentators saying one thing on-air and the opposite privately to each other.

Before he resigned in the “company-wide restructuring” that purged Stirewalt, Managing Editor of the Washington , D.C. Bureau Bill Sammon said, “It’s remarkable how weak ratings make good journalists do bad things.”

When Stirewalt and his independent crew called the Arizona race, Tucker Carlson and Sean Hannity were angry and concerned, texting each other, as well as Fox executives, that the network was in danger of losing those fiercely loyal viewers who would feel betrayed by the Arizona call. Losing those viewers would lead to diminished ratings, which would impact profits, which would jeopardize big paydays for them.

They were right. After the Arizona call, viewers immediately began to pound Fox on social media for betraying President Trump. They headed for the Fox door and the Fox far-right competition, Newsmax and OAN. By January, 2021, Fox viewership had dropped 20% and CNN’s had soared. But by the following June, the viewers had returned to the nest as Fox fed them what they wanted to hear. From April to June, Fox averaged 1.2 million viewers per day, far ahead of MSNBC (847,000) and CNN (654,000). In primetime, it was even further ahead (2.2 million viewers to MSNBC’s 1.5 million and CNN’s 914,000).

In hindsight, Fox executives and on-air talent believed that, while Arizona had been truly lost to Trump, most of the danger would have been avoided had Fox waited until other networks called it and then gotten in line at the rear. As it happened, Biden won Arizona by 11,000 votes, but other networks did not make their own calls until eight days had passed. Eight days of terror for Fox. It was during those eight days that the conspiracy nutjobs took their seats of honor at the Fox dinner table.

Three days after the election, Maria Bartiromo interviewed Sydney Powell on Fox Business. Powell claimed Dominion created a secret “algorithm to calculate the votes they would need to flip. And they used the computers to flip those votes from Biden to—I mean, from Trump to Biden.” Bartiromo agreed with her. And it was Powell who told Lou Dobbs on his show that Smartmatic and Dominion Voting Systems conspired with Venezuela’s communist leadership, ditto with Cuba, and “likely” China to create software to fix the election for Joe Biden against Donald Trump.

Night after night, for nearly two months, the hosts on the opinion side of Fox News fed the conspiracy dragon. Not one of them ever said publicly the conspiracy theories were “crazy” or “insane,” but that is exactly what some of them said to each other, as the Dominion Brief makes crystal clear.

Pirro, Bartiromo and especially Lou Dobbs, who had been with Fox since Day 1, repeatedly repeated the lies. Dobbs was the highest-rated host on Fox Business. He often doubled his lead-in’s ratings. But 24 hours after he and Fox were named in the $2.7 billion defamation lawsuit filed by Smartmatic, Murdoch fired him. Fox News’s official reason for canceling Dobbs’ show —”a post-election programing adjustment”—is a nice way of saying they had to throw some high-rated somebody over the side.

The Dominion Brief says the company tried an eye-popping 3,600 times without success to get Fox to retract the nonsense.

The Fox defense is the same one Sydney Powell made when Dominion sued her individually: No reasonable person would be expected to believe this stuff.

Except people did, reasonable or not, and the Roger Ailes road, the one he started building 25 years earlier, ended with five dead and 140 injured at the January 6th Insurrection, a day of national shame and infamy, unrivaled since the Civil War.

 

Israel: A Democracy Facing A Judicial Disaster

Monday, February 13th, 2023

In Israel, the Knesset is the legislative branch of government. It is joined by the Executive, which forms the Cabinet, the Presidency, which is mostly ceremonial, but carries significant gravitas, and the Judicial, headed by the Supreme Court. As in America, the legislative branch passes laws, and, if challenged, the Supreme Court rules on their constitutionality. It’s democracy in action. Checks and balances just as in the USA.

That may be changing.

When Israel’s Bennett-Lapid government fell on 30 June 2022, a caretaker government took control until 1 November when the country held elections intending to install its 37th government since 1948. There are 120 seats in the Knesset. Consequently, to take control requires 61 seats, and through two rounds of elections a clear winner did not emerge.

That shifted on 29 December 2022, when the third round of elections created a coalition government, a government unlike any that came before it, a government that is threatening the very fabric of democracy in Israel.

The coalition government consists of six political parties—Likud, United Torah Judaism, Shas, Religious Zionist Party, Otzma Yehudit, and Noam—and is led by Likud’s Benjamin Netanyahu, who has taken office as the Prime Minister of Israel for the sixth time. With the exception of Likud, the other five parties are right-wing and religiously conservative, hugely influenced, perhaps dominated, by Israel’s ultra-Orthodox community, known as the Haredim.

The Haredim have long enjoyed benefits unavailable to other Israeli citizens: exemption from army service for Torah students, government stipends for those choosing full-time religious study over work and separate schools that receive state funds even though their curricula barely teach government-mandated subjects.

In the December election, Netanyahu’s Likud party corralled 32 seats, the other five parties another 32. The coalition, with 64 seats, took control of government and formed a Cabinet, a far right, autocratic Cabinet.

Nearly the first thing the new government did was to announce plans to limit the power of the Supreme Court.

Under the plans announced by Justice Minister Yariv Levin on 4 January, a simple majority in the Knesset, 61 votes, would have the power to effectively annul Supreme Court rulings. This would enable the government of the day to pass legislation without fear of it being struck down. It’s called the “override” provision, in that the Knesset could override a Supreme Court ruling. This would absolutely happen, because, unlike in the U.S., where legislators may vote their conscience (of course, they may pay for that later), Israeli Knesset members must vote as their coalition demands.

The new plan also seeks to end the Supreme Court’s ability to revoke administrative decisions by the government on the grounds of “reasonability” (what would a reasonable person say about this?), significantly decreasing judicial oversight. And it envisions giving the government and the coalition in parliament absolute control over appointing judges. Unlike the U.S., Israel’s Supreme Court has a say in appointing judges, at least for the moment.

The final spanner the new government threw into the judicial works is that for the Supreme Court to strike down a Knesset-passed law would require 80% of the judges voting for such a ruling. But even if that happens a simple Knesset majority could “override” the ruling.

There is another issue to deal with. The religiously conservative coalition members have long been fervent advocates for more Jewish settlements in the occupied West Bank. The proposed law could make it easier for the government to legislate in favor of such settlements without having to worry about challenges in the Supreme Court. To blunt international criticism of settlement construction, Israel has in the past pointed to the power of the court to rule against it. If the Override law passes, the country won’t be able to use that defense again, exposing it to even fiercer critiques.

This plan passed out of its Knesset Committee this morning, which is significant, and is now on the way to passage in the full Knesset (it will have go through three votes to cross the finish line—a matter of a week or two).*

The Biden administration, the American Jewish community and most of the European Union are dead set against this remaking of the Israeli judicial system. As is the Bank of Israel, whose governors opined the change will do significant harm to the nation’s economy. As are the CEOs of the country’s leading industries, especially technology and manufacturing.

American Secretary of State Antony Blinken publicly criticized the Israeli government when he met with Netanyahu on 2 February in Israel. The next day, Netanyahu flew to Paris where French President Emmanuel Macron told him to his face the plan would “hurt Israel’s place in the world economy.” Macron “expressed bluntly” that the proposed judicial shakeup “threatens to break the power of the Supreme Court, the only institutional counter-power in the government,” and that, “Paris should conclude that Israel has emerged from a common conception of democracy,” if the planned changes take effect. And yesterday, President Biden also politely suggested the plan is a bad idea when he said, “Israeli democracy is built on an independent judiciary.”

You can add the Israeli public to the naysayers. Yesterday, hundreds of thousands poured into streets around the country to protest, 80,000 of them outside the Knesset.

In this witch’s brew there exists a significant looming complication: the Three Trials of Benjamin Netanyahu, a long-delayed, 3-part felony corruption case.

Prime Minister Netanyahu faces bribery, fraud and breach of trust charges, each being tried separately at the same time in Jerusalem. He  has denied all accusations, vociferously attacking those who seek to prosecute him. Sound familiar?

Israel’s former Justice Minister brought the charges against Netanyahu in 2021, but circumstances, mostly pandemic-oriented, forced two delays. But that’s in the past, and the trials are ongoing now. Netanyahu has said that he will not use his new authority as Prime Minister to upend the legal process, he’ll be mindful of “conflicts of interest.” However, Netanyahu is the leader of the coalition carrying this foul-tasting, stink-producing, judicial bag of ten-day-old fish through the Knesset.

And here’s a question, a pretty big “what if.” What if the Knesset passes the override law as is and Israel’s Supreme Court rules it unconstitutional? In that event does the government simply say, “No, we’re overriding you?”

Amir Tibon, Senior Writer and Editor for Harretz, a leading Israeli liberal newspaper, has reported that as far back as a decade ago Netanyahu staunchly defended Israel’s judicial system and continued to do so right up until this latest government. To get along with his coalition partners that faith in the judiciary may be a thing of the past.

Last night, recognizing that this road ends with a long fall from a high cliff, Israel’s President Isaac Herzog in a surprise address to the nation stressed the importance of reaching a broad compromise and presented his own plan for Israel’s balance of powers. Harretz reported today that, in what might be a violation of Netanyahu’s “conflict of interest pledge,” following the President’s address he and Justice Minister Yariv Levin met late into the night to discuss it and plan a response.

Will any of the national and international criticism make any difference? The religious political parties are basing their passionate advocacy on deeply held religious beliefs. Netanyahu and Likud need them to stay in power. How does one ask people to temper their beliefs?

Israel and America are longstanding, dedicated partners. Despite meaningful differences in our approach to the middle east, our two countries aspire to similar values. Tearing apart Israel’s judiciary will remove an important, perhaps vital, brick in its house of justice, its house of democracy, a brick we each have long held dear.

The coalition government is doing its best to pound a square peg into a round hole. I know it can be done. I also know if it is, the peg will no longer be round, no longer be square, but it sure will be ugly.

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*Sorry, I could not resist a reference to Sunday’s Super Bowl, a game where, once again, I picked the losing side.

Maternal Mortality In America: The American Rescue Plan Act of 2021 Is Here To Help

Thursday, February 9th, 2023

The maternal mortality rate in the US is the highest in the developed world.

The World Health Organization and the OECD define maternal mortality as “the annual number of female deaths from any cause related to, or aggravated by, pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.” The rate of maternal mortality is the number of these deaths per 100,000 live births.

The U.S. defines it differently. In the U.S., the maternal mortality ratio (MMR) covers a full year following birth, not the 42 days of the WHO and OECD. This is why the CDC reports the latest MMR figures  in the U.S. as 17.3, while the OECD has it at 5.8 (for 2020). To confuse things even more, a highly regarded study in The Lancet in 2016 noted, ” The overall decrease from 1990 to 2015 in global maternal deaths was roughly 29% and the decrease in MMR was 30%.” However, the same study pointed out the U.S. rate for 2015 had risen to 26.4.

But regardless of how you count it, our rate still outpaces all the other developed nations. Moreover, according to the CDC, the U.S. rate has been rising since 1987, while our OECD global competitors have seen theirs decline since 1990.

In America, the maternal mortality rate is much higher among Black, Hispanic, and Native American communities. An October 2022 study by  the GAO (Government Accountability Office) put it this way:

• The maternal death rate for Black or African-American (not Hispanic or Latina) women was 44.0 per 100,000 live births in 2019, then increased to 55.3 in 2020, and 68.9 in 2021. In contrast, White (not Hispanic or Latina) women had death rates of 17.9, 19.1, and 26.1, respectively.
• The maternal death rate for Hispanic or Latina women was lower (12.6) compared with White (not Hispanic or Latina) women (17.9) in 2019, but increased significantly during the pandemic in 2020 (18.2) and 2021 (27.5).

Disparities in other adverse outcomes, such as preterm and low birthweight births, persisted for Black or African-American (not Hispanic or Latina) women, according to GAO analysis of CDC data.

The GAO study lays this squarely at the wide open door of racism:

Additionally, racism negatively affects the health of millions of people, according to CDC. We previously reported, and research has shown, that racial and ethnic disparities in maternal health outcomes persist, even after controlling for other factors like socioeconomic status, education, and access to care.¹ Some studies described specifically how racial discrimination can contribute to worsened maternal health outcomes. For example, chronic stress associated with racism can cause physiological changes and adverse health conditions. Moreover, bias or discrimination within the health care system can create communication challenges between providers and their patients, which may increase the risk of adverse outcomes. For example, pregnant women may be reluctant to ask questions about their condition if they faced discrimination from their provider.² In addition, the COVID-19 pandemic has highlighted racial and ethnic health disparities.³

From the GAO study

MMR is highest in Louisiana, at 58.1, and lowest in California, at 4.0, which is the average for the OECD.

Federal law requires Medicaid to cover postpartum care for only 60 days following birth, which is one of the prime reasons for our lagging global performance. In the OECD, mothers not only receive postpartum care for a year, they also average 51 weeks of paid maternity leave. (The U.S. is the only OECD country with no requirement for paid maternity leave.)

Enter the  American Rescue Plan Act of 2021 (ARPA), the Act Republicans derided and didn’t vote for, but love to take credit for back in their home districts. The Act offers significant resources for states to extend postpartum care for Medicaid beneficiaries.

Here’s how it’s working. ARPA created an option for states to extend postpartum coverage for Medicaid beneficiaries from 60 days to a full year. Under the Act, the option was scheduled to expire in 2027. Under the Consolidated Appropriations Act of 2023, the 12-month extended Medicaid postpartum coverage option was made permanent. Now once states take up the option to extend the postpartum period from 60 days to 12 months, federal matching funds will continue to flow. Thus far, 35 states have already taken advantage of the option and the federal cash that goes with it.

And today, the Washington Post’s McKenzie Beard, author of The Health 202 newsletter, reported Republican legislatures in nine red states have pending legislation to extend postpartum health coverage for their Medicaid beneficiaries, thereby joining the other 35 states in taking up the option created by the ARPA.

For these nine states, and their red state peers, this is all in response to the repeal of Roe v. Wade, a highly unpopular decision all around the country, which could create a significant uptick in pregnancies. There is a quite justified fear among Republican Governors and legislators that as they severely tighten restrictions on abortion our already horrible maternal mortality rate will worsen even more and they will be the ones held responsible. By extending postpartum care for 12 months they may avoid that unhappy and unfortunate political outcome while actually doing something good for the poorest of their citizens.

This is the one positive thing I have seen come out of the Roe v. Wade decision.

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¹See two studies of severe maternal morbidity in New York City: E. Howell et al., “Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities,” Obstetrics & Gynecology, vol. 135, no. 2 (Feb. 2020): 285-293; and
M. Angley et al., “Severe Maternal Morbidity in New York City, 2008–2012,” New York Bureau of Maternal, Infant and Reproductive Health (New York, N.Y.: 2016).

²See R. Hardeman et al., “Developing Tools to Report Racism in Maternal Health for the CDC Maternal Mortality Review Information Application (MMRIA): Findings From the MMRIA Racism & Discrimination Working Group,” Maternal and Child Health Journal, vol. 26 (2022): 661–669.

³See Centers for Disease Control and Prevention, “COVID-19 Weekly Cases and Deaths per 100,000 Population by Age, Race/Ethnicity, and Sex,” accessed 9 February 2023.

Mississippi: Continuing To Lead From The Rear

Tuesday, February 7th, 2023

Tonight, President Joe Biden will deliver his State of the Union Address to the nation and a packed Congress. It will be performative, with Democrats applauding and Republicans sitting on their hands. It always makes for a pretty good show. One of the things Biden will ask this Congress for is greater expansion of the Affordable Care Act’s Medicaid provision.

A week ago and a world away, Mississippi’s Republican Governor Tate Reeves stood on the steps of the state capital in Jackson and delivered his State of the State address. Like Biden will tonight, he talked about the Affordable Care Act’s Medicaid expansion provision—and his rigid determination to have nothing to do with it.

Since Congress passed the ACA and President Obama signed it into law on 23 March 2010, 39 states and the District of Columbia have taken advantage of the Medicaid expansion provision. And last November, South Dakota became the seventh state to do so through ballot initiative. The state now has until 1 July to set up a system that would be ready to enroll the estimated 42,500 people who will then become eligible for health insurance coverage under the Affordable Care Act.

Medicaid expansion as of 2023

The one argument Governors and state legislators make in states that have not adopted Medicaid expansion, and the one South Dakota Governor Kristi Noem (R) made before the ballot initiative, is that it is unaffordable and will put untenable strain on states’ budgets.

Nearly 13 years of research has proven this to be untrue. As my dear father would say when presented with a similarly specious claim, “That is an argument full of what makes the grass grow green and tall.”

Of course, there is another argument, the purely political one, and Governor Reeves made it in his State of the State address as reported by the Mississippi Free Press:

During his State of the State address on Monday, Gov. Reeves told Republican lawmakers not to “cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine.” (The governor often invokes “socialism” when criticizing ideas or opponents, including his 2019 Democratic and Republican  challengers).

In reiterating his opposition to expanding Medicaid, Reeves said, “Instead, seek innovative free-market solutions that disrupt traditional health-care delivery models, increase competition and lead to better health outcomes for Mississippians. Do not settle for something that won’t solve the problem because it could potentially and only temporarily remove the liberal media’s target on your back.”

That statement has the intellectual weight of a soap bubble. The Governor refuses to focus on the real and terrible problems of Mississippi’s health care system.

In May, 2022, the Center for Mississippi Health Policy, an independent, non-partisan, non-profit organization that provides objective information to inform health policy decisions, published its 56-page analysis entitled, Healthcare System Performance – Mississippi Indicators & Healthcare Infrastructure: Opportunities for Improvement. 

The very first sentence in the report’s Executive Summary says, “The performance of Mississippi’s healthcare system is consistently ranked as one of the lowest in the nation.” In four other places it hammers this home:

“Over the past decade,…Mississippi’s healthcare system has continued to rank as the poorest performing state healthcare system of the United States and the District of Columbia.” (page 5)

“Despite diligent efforts, Mississippi continues to maintain the worst performing state healthcare system in the United States.” (page 7)

“Since 2009, Mississippi has ranked last on overall health system performance every year.” (page 8)

“Mississippi has the highest rates of potentially preventable hospitalizations for chronic conditions in the United States.” (page 12)

On every level, in every category, the Center for Mississippi Health Policy’s report is a ringing indictment of health care in the Magnolia State.

Could it look any worse for Mississippi’s health care performance? Well, yes, it could.

Consider deaths from COVID 19.

From the beginning of the pandemic Mississippi experienced the third highest rate of deaths in the nation at 444 per 100,000 people, trailing only Arizona and Oklahoma (but not by much). And in the number of deaths in excess of what would have been expected based on historic mortality patterns, Mississippi led the nation.

The Commonwealth Fund is another organization that analyzes health care performance, both in the US and globally. For the US It publishes annually a Scorecard on State Health System Performance. Last June, it released its 2022 Scorecard.

This is even more damning when one considers that the Commonwealth Fund’s analysis of  US health care performance with respect to its global peers is nothing short of woeful. The Fund’s 2023 report, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes, paints a picture that should disgust any American who reads it. In nearly every metric measured, our country lags behind its global competitors.

To put it bluntly, in a country that spends far more than any other developed nation, close to 2 to 1 on the average, yet trails its peers in nearly every health care category, in a country where life expectancy at birth is three years less than the OECD average, in a country with the highest maternal and infant mortality, in a country obviously in desperate need of serious health care improvement, Mississippi is dead last.

With all this as background, I now sincerely ask: Why has Mississippi chosen for 12 years in a row to reject availing itself of the proven benefits coming out of the Affordable Care Act?

Accepting Medicaid expansion has nearly eliminated people going uninsured in expansion states, and, because of the federal matching payments of 90% has made it economically neutral, at worst. It has lowered costs and improved health care.

A recent white paper by Manatt Health, prepared in partnership with the Commonwealth Fund and the Robert Wood Johnson Foundation, estimated the fiscal impact of Medicaid expansion in Mississippi. It demonstrated that Medicaid expansion is a better fiscal deal than ever before, especially when you consider that under the American Rescue Plan Act the federal government will increase its portion of payments by 6.2%. In addition to significantly increasing insurance coverage, the paper projects that expansion in Mississippi would cover more than 220,000 adults and, along with significant ongoing savings, would result in zero net cost to the state for more than six years. Yet for 12 years in a row Mississippi has chosen to throw nearly a quarter of a million of its citizens into the land of the uninsured, where hospital emergency rooms become primary care providers.

Which brings us to Uncompensated Care. Right now, at this very moment, 54% of Mississippi’s rural hospitals are on the cusp of closing—38 of them, because they don’t get paid enough for taking care of poor rural people, most of them uninsured. Yet states that have adopted the Affordable Care Act have seen substantial drops in their uncompensated care costs. Between 2013 and 2015, states that were early adopters of the ACA saw Uncompensated Care decline by $8.6 billion, or 23%. But Mississippi doesn’t seem to care. This is a slap in the face and a punch to the gut for the state’s rural communities, which make up 79.3% of the state’s 82 counties.

You won’t find peer reviewed, published studies demonstrating that states have been harmed by ACA expansion. We’ve had more than ten years of research with solid findings in many areas, including expansion’s positive effects on health outcomes, access to services and medications for behavioral health and other needs, providers’ financial stability, and employment. Some recent analyses that include outcomes beyond those typically examined in Medicaid expansion research show that expansion is associated with decreased mortality overall and for certain specific conditions; reductions in rates of food insecurity, poverty, and home evictions; and improvements in measures of self-reported health and healthy behaviors.

There are smart people in Mississippi, a lot of them, and they know the research. They know what expansion would do for their poor neighbors, for their state, for themselves and their families. But there are also modern day troglodytes in Mississippi, and it seems the troglodytes are in charge.

 

 

 

 

What’s The Truth About Violent Crime In America?

Friday, February 3rd, 2023

Let me ask you a question. In the last 30 years, has the rate of violent crime in America:

  1. Increased (by a little, by a lot, doesn’t matter);
  2. Stayed about the same; or,
  3. Declined?

I’m going to suggest that you, like 63% of Americans surveyed by Gallup, picked number 1.

But you all would be wrong. Not wrong by a little, but wrong by a lot. The rate of violent crime in America has declined precipitously since 1991. How precipitously? By nearly 50%, from 758 reported incidents per 100,000 persons in 1991 to 403 in 2021, according to the Department of Justice. Our rate of violent crime today is the same as it was in 1970.*

Reported violent crime in the US from 1990 to 2021

But it hasn’t always been like this. Here is another chart showing violent crime levels since 1960.

Putting aside the steep rise from 1960 to 1991, we’re faced with two more questions:

Why do so many Americans believe violent crime hasn’t dropped?

Gallup has surveyed Americans perceptions about violent crime since 1994. In that year, 80% of us believed violent crime was on the upswing, and the second chart would bear that out. Since then, however, the rate of violent crime has dropped like a brick off a table, but 63% still believe crime is on the rise. Interestingly, they see their own environs as fairly safe and stable; it’s everywhere else that’s seeing violent crime rise.

It seems to me there is one overarching explanation for this faulty perception, and it is the way local, national and social media present news to us every day. Tune in to your evening news, either locally or nationally, and I guarantee you will see and hear about at least one violent crime that has happened that day, usually a murder or two, maybe more. Social media only amplifies the bombardment of the blood and gore. And when we’re faced with a mass shooting or an instance of police brutality the media guns start blazing even more.

Super fast and broad-based technology has enabled us to learn of all the bad things that happen in the world as they are happening, and Twitter, Facebook, et al, keep it front and center all the time. We can be forgiven for thinking we’re heading decidedly in the wrong direction. This perception is also constantly reinforced on cable news channels, especially Fox, although it is interesting to note that immediately following the recent midterm elections Fox’s focus on violent crime nearly disappeared.

Why does our media lead with the bleed? Well, there’s a lot of money to be made in selling bad news.

Why and how has the drop in violent crime happened?

There is no single, simple answer to this question, which is why it is so complicated. There are a lot of things that have, in their own ways, helped to drive down the rate of violent crime. Trouble is, people crave simple, wrapped-tight-in-a-sound-bite, answers, and the simple sound bite most often tossed out concerns incarceration.

The lock-em-up-and-throw-away-the-key crowd point to our imprisonment rate as the prime mover in the drop of violent crime.

As we have experienced our three decade decline in violent crime, we have seen a concomitant growth in our prison population. It’s tempting to view this as a cause and effect phenomenon, an assumption having some validity, but not as much as you might expect.

Although the U.S. has only 5 percent of the world’s population, it has nearly 25 percent of the world’s prisoners. As of 2022, there were 2.2 million people in prisons and jails in this country. With an incarceration rate of 710 inmates per 100,000 people, which is more than six times the average rate in the 38-country OECD, the United States trails only the Seychelles in the frequency with which it deprives its residents of liberty, and vastly outpaces that of Iran, Zimbabwe, and even notoriously punitive Singapore. Here is our incarceration diving board.

While it might be intuitive to latch onto the idea that locking up all the usual suspects led directly to the decline in violent crime, we should go gently down that road. Reasonable as it might sound, the research shows this to be far less conclusive. A panel from the National Academy of Sciences looked at the existing research for its landmark 2012 report on the American prison system. They concluded that “on balance,” higher incarceration rates had a “modest” effect on the decline. But they also cautioned that a lack of clear evidence means any benefits were “unlikely to have been large.” The researchers conclude “the United States has gone far past the point where the numbers of people in prison can be justified by social benefits and has reached a level where these high rates of incarceration themselves constitute a source of injustice and social harm.”

Moreover, a 2022, 3-year study from the Brennan Center For Justice, examined data from 1.56 million prisoners (The Center could not get access to the data for the nation’s other 640,000 incarcerated people, because most were in jails around the country, which made data accumulation difficult). The study underscores the National Academy of Science’s work taking care to validate our rate of incarceration is only minimally responsible for the drop in the rate of  violent crime. Yes, there is a relationship between the two, but it’s tenuous at best. According to the Brennan Center’s study:

Rigorous social science research based on decades of data shows that increased incarceration played an extremely limited role in the crime decline. It finds that social and economic factors, and to some extent policing, drove this drop. Though this truth is counterintuitive, it is real.

Studies from the Brookings Institute’s Hamilton Project and the National Academy of Sciences corroborate findings from the Brennan Center and leading economists: “When the incarceration rate is high, the marginal crime reduction gains from further increases tend to be lower, because the offender on the margin between incarceration and an alternative sanction tends to be less serious. In other words, the crime fighting benefits of incarceration diminish with the scale of the prison population.” Although there is some relationship between increased incarceration and lower crime, at a certain point, locking up additional people is not an effective crime control method, especially when imprisoning one person costs $31,000 a year.

An editorial comment about our incarcerated population: It is hugely and disproportionately comprised of people of color, primarily blacks. According to the Pew Research Center, “In 2017, blacks represented 12% of the U.S. adult population but 33% of the sentenced prison population. Whites accounted for 64% of adults but 30% of prisoners. And while Hispanics represented 16% of the adult population, they accounted for 23% of inmates.” If this is not an example of racism run amuck, institutional racism, I don’t know what is.

In addition to imprisonment, what else could account for the drop in violent crime? Here are a few suggestions:

  • Law enforcement and better policing – In 2015, the Brennan Center found a “modest, downward effect on crime in the 1990s, likely 0 to 10 percent” from increased hiring of police officers.
  • Income growth – Some researchers theorize that greater opportunity for legal income reduces the need for illegal sources of it. The Brennan Center’s analysis attributed about 5 to 10 percent of the 1990s decline to it, a relatively modest amount. However, following the Great Recession of 2008 when unemployment soared and income declined, violent crime did not go up; it continued its downward trajectory.
  • A drop in alcohol consumption – How closely related are alcohol and crime? The National Bureau of Economic Research found correlations between its consumption and aggravated assault, rape, and some types of theft, but not murder and burglary. Since assault is the most common violent crime, it’s logical that increased alcohol use leads to higher crime rates. Americans only drank slightly less beer, the most common form of alcohol consumption at that time, between 1990 and 2000. But it was enough for the Brennan Center to attribute to it a 7.5 percent drop in crime during the 1990s.
  • Roe v. Wade – In a 2019 paper, the economist Steven Levitt and fellow economist John Donohue argued that the 1973 ruling reduced the number of children born in unwanted circumstances, thereby reducing the number of children predisposed to violent crime later in life. Overall, they estimated this 20-year-lag effect might account for as much as half of the crime decline in the ’90s. However, The Guttmacher Institute estimates between 700,000 and 800,000 women terminated a pregnancy each year in the decades preceding Roe. If large numbers of women prevented unwanted births prior to the ruling, the sudden availability of legal abortion might not have radically changed the overall number.

For years, scholars have been trying to understand why our violent crime rate has dropped since the 1990s as steeply as it rose in the prior three decades. Personally, I see a constellation of efforts from many disparate sources that, taken together, have somehow brought about this desirable result. Yet, although we’re heading in the right direction, we’re still an outlier, and a distant one at that, when compared to our OECD peers. Clearly, we need to do more.

Addendum

Jonah Goldberg is a conservative columnist whose writing I admire but whose political policies I tend to differ with. He’s the co-founder of The Dispatch, a daily publication liberals would find thought-provoking and interesting. He’s what I call a “thoughtful conservative” who recoils at the very name of the creature who used to occupy 1600 Pennsylvania Avenue until being disgorged, unwillingly, in early 2021.

In addition to his other duties at The Dispatch, Goldberg writes a rather long form weekly piece on whatever is taking up space in his capacious brain at the time. Yesterday’s was entitled The Race to Racism.

I’m not going to comment here on his thoughts about racism, but I am going to comment on his thoughts on violent crime, specifically intentional homicide. In his post, Jonah Goldberg wrote:

Whenever you hear people talk about America as uniquely or exceptionally flawed—or superior!—the first question you should ask is, “compared to whom?”

For instance, we hear a lot about how America has a murder problem. And it does!  But you know where America ranks internationally on homicides?

64.

Now, in one sense America could be No. 1 or No. 195 on the international intentional homicide rate charts and it really wouldn’t matter much. Because by definition, one murder is too many. But it’s worth knowing if we’re doing much worse—or better—than other countries for all sorts of practical reasons. Maybe some country had success or failure trying X or Y? That’s worth finding out for policy reasons.

Mr. Goldberg snuck that number 64 into his argument as if to say, “Hey, we’re pretty good. There are 63 countries more ‘flawed’ than we are. We should feel a bit better.”

Trouble is, of the 172 countries in the UN Office on Drugs and Crime’s International Homicide Statistics database quoted by Jonah, the only OECD country with a worse intentional homicide rate than the US is Mexico, and in certain parts of Mexico, murder is king.

At number 64 in the rankings, the rate of intentional homicide in the US is 4.96 per 100,000 people. Putting Mexico aside, the next OECD country in the rankings is Chile with a rate of 4.4, followed by Turkey, at 2.59. Countries that are more our peers, the UK, France, Canada and Germany, all have rates of intentional homicide well below 2.0.

Jonah Goldberg wasn’t saying, “Think how lucky we are.” But he was saying, “Hey, things could be a lot worse.”

Which is a scary thought.

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*Before complimenting ourselves too strenuously, we should remember our homicide rate is still three times that of the OECD average.