Archive for May, 2023

A Weekend Potpourri Of Things You Might Have Missed

Sunday, May 28th, 2023

Life expectancy from another angle

Earlier in the week I wrote about life expectancy in the U.S. and how our woeful public health system negatively impacts it.

Another under-the-radar issue affecting how long we live is where we live. That is, living in a blue or red state can either add years to your life, or deprive you of a few. Significant research is bearing this out.

A report from the Population Reference Bureau, with funding support from the National Institute on Aging, concludes that life expectancy is influenced by policymaker decisions at the state level. According to the report:

Life expectancy differences among states have widened in recent years, as state policies have become more polarized. In general, states where policies have become more liberal have added years to their residents’ lives more quickly, while states where policies have veered conservative have seen slower gains in life expectancy.

This study builds on research published by Jennifer Karas Montez, et al., in the Millbank Quarterly in August 2020. Their paper, US State Policies, Politics, and Life Expectancy, found that states with more conservative marijuana policies and more liberal policies on the environment, gun safety, labor rights, economic taxes, and tobacco taxes were related to lower mortality in working-age Americans between 1999 and 2019. In particular, gun safety laws were associated with a lower suicide risk among men; labor protections like minimum wage and paid leave were tied to a lower risk of alcohol-related death; and tobacco taxes and economic taxes were linked to a lower risk of death from cardiovascular disease.

The authors estimate if all states enacted the most liberal policies, 171,030 lives might have been saved in 2019. On the other hand, enacting the most conservative policies might have cost 217,635 lives. Looking at it from another perspective, they concluded that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies.

It would be nice if research like this persuaded politicians in red states to consider liberalizing some of their policies with an eye to making life better for their constituents. At the very least, they could read the studies (I did) and invite the researchers to discuss their findings.

Meanwhile, deep in the heart of Texas

You probably don’t know this if you don’t live there, but for months, top Republicans in the Lone Star State have coalesced into two warring camps. On one side are State Attorney General Ken Paxton and his followers. Facing off against them are Speaker of the House Dade Phelan and the House Committee on General Investigating. The Texas House has long been seen as far less far rightish than the Senate and Paxton’s base. The result is that though they have total control over the Legislature and every statewide office, Republicans have not always agreed on what to do with their power.

For some time it has been apparent the two sides don’t like each other very much.

A bit of history is in order.

There has been a cloud of scandal hovering over Attorney General Paxton for years. The ever-darkening cloud includes an extramarital affair and actions taken to benefit an Austin real estate developer who donated to Paxton’s campaign and renovated his home. Despite the scandal, and an indictment in state court for securities fraud dating back to 2015 (he has repeatedly succeeded in delaying his trial), he won re-election to a third term last year, largely by closely aligning himself with Donald Trump and his MAGA supporters.

The barely concealed disdain of the two factions for each other, brewing for months, burst into public view this past week when the Attorney General accused Speaker Phelan of performing his duties while drunk and called for the speaker’s resignation.¹

That accusation last Tuesday sent a shock wave through Austin. Then, less than an hour later, word came that Paxton might have had a personal motive for attacking the speaker: The aforementioned House Committee on General Investigating had subpoenaed records from his office, as part of an inquiry into the Attorney General’s request for $3.3 million in state money to settle corruption allegations brought against him by his own former high-ranking aides.

The House Committee met the next day, Wednesday, for several hours to discuss accusations against Paxton brought by those former aides in 2020, as well as allegations of retaliation from the same former aides.

The four top aides — turned whistleblowers — had taken their concerns about his activities to the F.B.I. and the Texas Rangers. Paxton then fired all four.

The aides — Ryan Vassar, Mark Penley, James Blake Brickman and David Maxwell — are all former Deputy Attorneys General, and Maxwell is a former director of the office’s law enforcement division. They told investigators that the Texas AG may have committed crimes including bribery and abuse of office. They have also sued Paxton.

This is where the $3.3 million comes in. Paxton wanted the state to pay that amount to settle the lawsuit brought by the former aides. Speaker Phelan has said that he did not believe there were the votes in the House needed to approve the payment; he also has said that he did not himself support doing so. If the state paid the aides the $3.3 million settlement it would be like giving Paxton a very expensive Get Out Of Jail Free card.

After hours of testimony on Wednesday from five House investigators who outlined the evidence they had collected against Paxton, the attorney general suggested on Twitter that he believed the Texas House was preparing a case to impeach him.

“It is not surprising that a committee appointed by liberal Speaker Dade Phelan would seek to disenfranchise Texas voters and sabotage my work as attorney general,” Paxton said in a statement aimed at his base of supporters, many of whom view the Speaker as aligned with Democrats.

Thursday evening, the Committee on General Investigating unanimously filed 20 articles of impeachment against the Texas AG. The Committee is composed of two Democrats and three Republicans.

And last night, despite a last minute appeal by Donald Trump, the Texas House overwhelmingly voted to impeach Attorney General Paxton, temporarily removing him from office while he undergoes trial in the Senate. The vote was 121-23. He is the first statewide office holder to be impeached in Texas since 1917.

Regardless of the lopsided impeachment vote, one can be forgiven for thinking a conviction in the Texas Senate will be about as difficult to achieve as a conviction in the US Senate was, twice, for Donald Trump.

_____________________

¹ After a 12 hour day of pushing through bills as the House’s term was approaching year-end, 57-year-old Speaker Phelan appeared to slur a few words in one sentence. This was recorded on video. It went unnoticed by most. But apparently not by Paxton.

Medicaid work requirements — raw meat to the Republican base

Late yesterday, President Biden and Speaker Kevin McCarthy, the Republican House leader, announced yesterday that they had reached a deal to increase the amount of money the government can borrow. The deal includes additional work requirements for food stamps and welfare.

Getting tougher with Medicaid work requirements was one of the sticking points in resolving the ridiculous debt ceiling crisis. It is something the more conservative, that would be most, elements of the Republican Party have demanded for at least the last two decades.

But what would that achieve in terms of reducing the national debt and helping people get healthier so they can escape poverty?

I have written before about the resource-rich Econofact.org, a product of the Edward R. Murrow Center for a Digital World at The Fletcher School at Tufts University. Econofact, created by eminent economist Michael Klein, is a network of economists and public policy specialists from all over the country who contribute to the non-partisan publication designed to bring key facts and incisive analysis to the national debate on economic and social policies. Unlike most things on the internet these days, Econofact is free to readers. It is well worth subscribing.

Regarding the work requirements continuing dispute, I would like to show you three charts produced by Econofact thought leaders² to put the issue in perhaps a better perspective. Basically, the data show adding to work requirements already in place won’t reduce US spending and, besides being not worth the administrative and bureaucratic effort, would negatively impact many children currently living in poverty and make it more difficult for them to rise out of it.

First, what is the size of the population we’re actually talking about?

It’s the bottom four bars, totaling 11.57 percent of the population, we’re talking about.

Now, how is that 11.57 percent spending its time?

Less than six percent are unemployed, but looking for work.

Finally, to what extent does expanding access to Medicaid increase the probability of rising out of poverty?

This Letter began with research showing that states more liberal in their constituent services experience greater life expectancy. Medicaid is one of those services. The Econofact charts show  most people on Medicaid who can work, already are. They also show, in addition to greater life expectancy, enhancing Medicaid benefits is the best way to achieve what should be the desired goal of Medicaid in the first place: getting people healthy, so they can raise themselves out of poverty into productive lives.

This debt ceiling deal, while possibly ending the crisis (if it can actually pass in the Congress), will not help to achieve that goal.

______________________

² The first chart was produced by Econofact contributors  and , of
the University of Maryland, Aspen Economic Strategy Group, and Gusto; the second, by , of UC Davis and the Center for Poverty Research; and the third by , of Georgetown University.

Posted in 6 January Select Committee, Misc. | Comments Off on A Weekend Potpourri Of Things You Might Have Missed

Will Our Debt Ceiling Crisis Put A Knife Through The Heart of America’s Public Health System?

Tuesday, May 23rd, 2023

As I have written before, despite the cost of health care in America being nearly twice the average of the other 37 countries within the Organization for Economic Co-operation and Development (OECD), we achieve poorer health care outcomes than the average and our life expectancy of 76.1 years¹ is 4.9 years below the OECD average of 81.

If we reach the age of 65 when Medicare becomes available, life expectancy improves to 84.5 years, but that puts us still below the OECD average of 84.9 and 13th from the bottom of the pack. By way of further comparison, the Brits, whose National Health System we so cavalierly denigrate, outlive us by 3.9 years; Canadiens, by 5.3 years. They must be doing something right, and they do it for significantly less money.

One often overlooked and, for the most part, unexamined reason for our high health care costs and sub-par outcomes can be found in our woebegone Public Health System. Of all the gaping holes COVID-19 exposed in the nation’s approach to health care and emergency preparedness, our Public Health System, fragmented, uncoordinated, underfunded, but critically important, is the deepest.

COVID turned the health care world upside down, especially with regard to health care funding. Although CMS reported U.S. health care spending grew 10.3 percent in 2020, it slowed to 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.  As a share of GDP, health spending accounted for 18.3 percent, down from 19.4 percent in 2020.

Less than 4% of that $4.3 trillion went to our Public Health System. Moreover, Trust for America’s Health, a non-partisan organization that tracks health issues, reports public health spending as a proportion of total health spending has been decreasing since 2000 and falling in inflation-adjusted terms since the Great Recession. Health departments across the country are battling 21st-century health care wars with mid-20th-century weapons.

Our Public Health System is supposed to address everything having to do with health, from diseases like COVID-19 to tornados, hurricanes, wild fires, floods, rat infestations, and the like. It lives at the local level, from states, to counties, to cities and towns. My little Berkshire town of Becket, Massachusetts, population of 1,931, has a functioning Health Department.

The CDC, through grants to the states and large cities is the primary funder of federal public health. The system and funding for it worked pretty well until, in 2001, terrorists brought down the Twin Towers on 9/11, killing 2,996 of our fellow citizens. Suddenly, money that had been earmarked for public health was syphoned off for the War on Terror. In attempting to right the ship, Section 4002 of the Patient Protection and Affordable Care Act of 2010 (ACA) established the Prevention and Public Health Fund. Also known as the Prevention Fund or PPHF, it is the nation’s first mandatory funding stream dedicated to improving our nation’s public health system. By law, the Prevention Fund must be used “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs.” The law mandated funding: $18.75 billion between fiscal years 2010 and 2022 and then $2 billion annually thereafter.

The Fund’s intentional mandatory design was meant to ensure consistent, predictable, and expanded resources for prevention and public health that are not always politically viable in the annual appropriations process, where public health and prevention programs compete against other priorities.

The Fund’s statute is broad and authorizes use of funds for a number of activities and grant programs:

The Secretary shall transfer amounts in the Fund to accounts within the Department of Health and Human Services to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act [42 U.S.C. 201 et seq.], for prevention, wellness, and public health activities including prevention research, health screenings, and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign Regarding Preventive Benefits, and immunization programs.

But nowhere in the statute does it say that the President or Congress cannot redirect the Fund’s money for some other purpose. And that is what has happened.

Redirecting the Fund’s cash for some other purpose would not be, per se, a bad thing as long as the new purpose advanced public health. However, political expediency, partisan grandstanding, the republican-led 63 attempts to repeal the ACA, the law that established and governs the Fund, have done damage. For example, in February 2012, Congress passed and President Obama signed legislation to cut the Fund by $6.25 billion over 9 years (FY2013 to FY2021) to correct the Medicare sustainable growth rate and prevent cuts to physician services in the Medicare program (known as the “doc fix”). To believe these measures actually advanced our Public Health System is to believe pigs really can fly.

A less controversial move that still violated the Fund’s legislative intent happened in FY2013, when Republicans, who controlled the House of Representatives, refused to appropriate funding for ACA enrollment activities. In response, the Obama administration used the Fund’s money to do that.

As congressional partisanship deepened in the following years, Republicans began to question the Fund as government overreach, calling it the “Obama slush fund.” In 2017, the Republican-led House passed the American Health Care Act of 2017, which would have cut the Fund by $1 billion. It was defeated in the Senate, but it exemplifies the rancor in the Halls of Congress.

Our current it-would-be-farce-if-it-weren’t-so-serious debt ceiling crisis is not helping. As Devon Page wrote for the Association of State and Territorial Officials discussing the impact of the recently passed  House bill to raise the debt ceiling—H.R. 2811, or the “Limit, Save, Grow Act of 2023,” that would reduce discretionary spending by 22 percent:

If enacted, the proposed discretionary spending cuts alone would have a near-ubiquitous impact, from public school funding to public safety programs. State health agencies could see core federal funding lines—some of which are already underfunded—threatened.

At stake is nearly $17 billion in unobligated funding at the Department of Health and Human Services, with about $4 billion at CDC and $2.5 billion for the Strategic National Stockpile (SNS). This includes dollars designated for the infectious disease rapid response fund, research and development of vaccines and therapeutics, payments to hospitals and nursing homes, and genomic sequencing of COVID-19 samples to identify variants.

A government’s first duty is to protect the safety of its citizens. The arrival of COVID-19, laying bare our still woeful Public Health System, showed us we were unprepared to address that sacred duty, and, as of one week ago, 1,128,903 of us have died to prove the point.

We could have learned from that. We could have, but we didn’t.

We could have done so much better.

_______________________________

¹ This figure is from the National Vital Statistics Report, August 2022, and is for 2021. Preliminary indications are that life expectancy rebounded in 2022 by 1.07 years to 77.45.

 

 

Tags: , ,
Posted in Public Health Policy | Comments Off on Will Our Debt Ceiling Crisis Put A Knife Through The Heart of America’s Public Health System?

Does Ron DeSantis Actually Believe In What He Says And Does?

Friday, May 19th, 2023

When Hitler’s Nazis took complete power on 5 March 1933 the first groups they and the Brownshirts went after hammer and tong were Communists, other political parties (within three months they were all gone), intellectuals and the Jews. Among the intellectuals, they focused on university professors, who they judged not sufficiently “reliable” to parrot the Nationalist Socialist ideology, and the music directors of large orchestras, who were mostly Jews.

During the first few months of the 3rd Reich, the Nazis eviscerated higher education. On 7 April 1933, the Reichstag, the German parliament now controlled by Hitler, passed the Enabling Act, which contained a civil service provision that provided for the dismissal of “politically unreliable” state employees. This was a catch-all phrase for Jews, Communists, non-Aryans, as well as anyone who had had the temerity to criticize the Nazis. And since, unlike other countries, all colleges and universities were state-owned, that meant many of Germany’s best and brightest were now out of work and facing physical danger. This included 20 past or future Nobel laureates. Albert Einstein was one of them — Germany’s loss; Princeton’s gain. But the Nazis never cared.

They easily had already coopted university students. On 10 May 1933, at the instigation of Minister of Propaganda Joseph Goebbels, German university students organized an “act against unGerman spirit” (a euphemism for non-Nazi ideology) in nineteen university towns across the country. They compiled a list of “unGerman” books, seized them from all the libraries they could find, piled them up in public squares, and set them all alight.

I mention this history, because I’ve been thinking about what is happening in Florida, as well as in a number of other red states. But it’s Florida that interests me most, because of its Governor, Ron DeSantis, who little by little unveils his nakedly ambitious and relentless drive to become our president.

I started down the Ron DeSantis rabbit hole more than a year ago when he revoked the Walt Disney Company’s Special Taxing District designation, which had been in effect for 55 years, because Disney CEO Bob Chapek had the temerity to criticize the Governor’s “Don’t Say Gay” bill. Take that, Goofy!

Then, in an act of cavalier cruelty, he sent two planes full of undocumented immigrants to Martha’s Vineyard, Massachusetts, to stick it in the eye of northern liberals.

Next, once again flexing his imagined Popeye muscles, he had his Commissioner of Education ban 54 math textbooks because of their potential to indoctrinate Florida’s children with Woke ideology (I never knew math could be so divisive).

And, speaking of book banning, acolytes of DeSantis have had a field day doing just that all over Florida, most notably in Escambia County where more than 100 books have become restricted, or just plain banned altogether, taken off the shelves of school libraries and put in permanent storage.¹

Moving right along, DeSantis fired a prosecutor, elected by the citizens of Hillsborough County (yup, a governor can do that in Florida), because he said the prosecutor, Andrew Warren, had been “soft on crime.”

He bullied a group of high school students for wearing masks at an event at the University of South Florida. “You do not have to wear those masks. I mean, please take them off. This is ridiculous,” he told the teens just before slamming his folder on a lectern. He all but said, “Don’t you know Covid-19 won’t hurt you?”

He’s Florida’s grand puppeteer who wants to be America’s grand puppeteer. For whatever reason and by whatever means the Governor seems to have every Republican legislator in Florida dangling from his many-fingered hands. Whatever he demands, they do. Last week they passed a law that changes what was Florida law and allows him to remain Governor as he runs for President (Is that a sign of a lack of confidence on his part, or just careful planning?).

On Monday of this week, after spending months beating the Woke out of what was once an excellent state educational system, the Governor signed a law prohibiting state colleges from offering courses in DEI (Diversity, Equity, and Inclusion). I can’t think of any other colleges that explicitly prohibit a specific course from being taught because of ideology. Can you?

“If you look at the way this has actually been implemented across the country, DEI is better viewed as standing for discrimination, exclusion and indoctrination,” DeSantis said during a news conference at New College of Florida in Sarasota. “And that has no place in our public institutions.”

You tell ’em, Ronnie.

As if all that weren’t enough, yesterday the Governor-wanna-be president signed five newly-passed bills (at his instigation and encouragement) that will govern student pronouns in public schools (they’re out), limit access to gender-affirming care (that’s out, too), and allow group prayer before sporting events (that’s in, thank God).

To add to the theme, he signed the bills on a stage at Cambridge Christian School in Tampa.

From banning books, to muzzling teachers, to eviscerating DEI, to criminalizing any teaching that racism is endemic, to slapping down any discussion of gender identity, to picking a huge fight over a small issue with Walt Disney and Mickey Mouse, Machiavellian DeSantis continues to find new and improved ways to wage the full scale culture war he thinks will lead to 1600 Pennsylvania Avenue.

And just now, the Tampa Bay Times has reported DeSantis will formally announce his candidacy at Miami’s Four Seasons Hotel next Thursday, 25 May. Should be quite the show.

But here is a question for you: Do you think Ron DeSantis, Yale undergrad, Harvard Law, actually believes what he’s spewing all over the Sunshine State (and now in Iowa and New Hampshire, too)? Or, is he the consummate hypocrite trying to see what really resonates with the MAGA crowd and beyond by throwing the worst of the worst up against the wall to see how much sticks?

It’s got to be one or the other. Both are bad. Really bad.

And now for a house selling update

I cannot allow Ron DeSantis to have this entire page, and I know you’re curious. It seems that realtors Kurt and Tom were right. We have many people who want to see the place. Maybe one of them will want to buy it. Maybe more than one of them. Wouldn’t that be nice? I’m beginning (barely) to forget the six weeks of drudgery lugging all those boxes and plastic bins. It seemed there’d never be an end to them. But now, here in the Berkshires, even Lancelot the wonder dog seems happy for us.

Open House isn’t until Saturday, but we already are loaded with what Kurt and Tom call “showing  appointments.”

Friends, this is beginning to turn into a fun project.

________________________________

¹ For a deeper dive into Escambia County’s book banning shenanigans, see Judd Legum’s continuing and relentless coverage of this miscarriage of educational justice in Popular Information.

Tags: , , ,
Posted in Politics, Public policy | Comments Off on Does Ron DeSantis Actually Believe In What He Says And Does?

Fifty-one Years Of Stuff

Wednesday, May 17th, 2023

The story of the stuff.

Friends, I’m exhausted.

I’ve been away from this beloved keyboard for six weeks, and, because I’m addicted to Mr. QUERTY, the withdrawal has been painful. But have I been slacking off, ignoring my responsibility to do my best to afflict the comfortable? Not a bit. Why? Let me tell you a story about the stuff, the dumpsters, a painful ending, and a bright beginning.

Fifty one years ago, after spending a few years in the U.S. Army, two of which on an all-expenses-paid trip to Southeast Asia, property of the 101st Airborne Division, my late wife Marilyn and the two-year-old daughter I was just beginning to know left the red clay of Fort Benning Georgia, returned to Massachusetts and, after some time getting reacquainted with parents and friends, bought a house in Central Massachusetts.

Thus began the Great Accumulation.

A few years later we enlarged the house to accommodate Marilyn’s parents who had sold their spacious  home and were entering the period in life my wife Karen calls the “smallening down phase.” A few years after that, having achieved some professional success, we enlarged the house further—a lot.

We now had 13 rooms, a great big attic, an even bigger basement, and a large garage with storage area above.

I’m sure you will recall the old adage, “Nature abhors a vacuum.” I’m living proof.

Over the succeeding years, the family managed to accumulate an immense amount of what George Carlin famously called “stuff.”¹

The trouble is, we never knew we were bringing so much stuff into the house, because, after using it, we always packed it away in the cavernous attic, basement or garage. Oh, and don’t let me forget the closets—they can hold more than you think, and we had a lot of them, big ones, too.

And then, of course, there was the storage unit.

Why didn’t we have the occasional purge of stuff? My excuse is it seemed like a big job (I was right), and we were busy all the time, and, besides, we couldn’t see it; it was all hidden away. So the stuff kept growing, sort of like the carnivorous monster alien from outer space in the 1958 horror movie, The Blob, that kept growing by eating everything in its path.²

Since the pandemic began, we’ve been living at our place in the Berkshires, the place where I write these Letters. About six months ago we concluded it didn’t make a lot of sense anymore to have two big homes, so we decided one of them had to go, and Central Mass drew the short straw.

Thus began the Great Disaccumulation.

Little did we know what we were in for. But this will sum it up. One 17 Yard dumpster and three (yup, three) 1-800-Got-Junk full dumpster trucks later (with one more still to go when we get rid of the last humongous pile in the garage), we have emptied the house of 51 years of stuff, and the Central Mass beauty went on the market today. If you’re interested in a house in Central Massachusetts with a great big basement, attic, garage, and closets, the place can be yours.

After six weeks of travail, I cannot tell you how good it feels to sit at this keyboard and not be lugging boxes.

By the way, about that place in the Berkshires? It doesn’t have an attic, the basement is fully furnished (it’s where the pool table is), and the closets are normal. Not much chance of another Great Accumulation. Moreover, although I find it hard to believe, odds are we won’t be here for 51 years.

___________________________

¹ Watch the video—it’s hilarious.

² Trivia moment—The Blob was Steve McQueen’s movie debut. He played the teenage hero.

 

 

 

 

Tags: ,
Posted in Misc. | Comments Off on Fifty-one Years Of Stuff