Archive for the ‘Public policy’ Category

A Few Weekend Thoughts On Biden’s College Loan Forgiveness Program

Saturday, August 27th, 2022

On Wednesday of this week, President Biden issued an Executive Order to forgive some of the debt owed by those who had received college loans. In doing so, Biden was attempting to fulfill a campaign promise to forgive undergraduate student debt for people earning up to $125,000 ($250,000 for a family). “I made a commitment that we would provide student debt relief, and I’m honoring that commitment today,” he said in remarks at the White House.

According to the Office of Federal Student Aid (OFSA), an office within the US Department of Education, Biden’s plan comes in three parts. The first part extends the repayment loan pause a final time (again) to the end of 2022. Part 2 is what’s getting all the attention at the moment. It says:

To smooth the transition back to repayment and help borrowers at highest risk of delinquencies or default once payments resume, the U.S. Department of Education will provide up to $20,000 in debt cancellation to Pell Grant recipients with loans held by the Department of Education and up to $10,000 in debt cancellation to non-Pell Grant recipients. Borrowers are eligible for this relief if their individual income is less than $125,000 or $250,000 for households.

Part 3 of the President’s plan is different in that it is in the form a  proposed rule “to create a new income-driven repayment plan that will substantially reduce future monthly payments for lower-and middle-income borrowers,” according to the OFSA. The proposal would:

  • Require borrowers to pay no more than 5% of their discretionary income monthly on undergraduate loans. This is down from the 10% available under the most recent income-driven repayment plan.
  • Raise the amount of income that is considered non-discretionary income and therefore is protected from repayment, guaranteeing that no borrower earning under 225% of the federal poverty level—about the annual equivalent of a $15 an hour wage for a single borrower—will have to make a monthly payment.
  • Forgive loan balances after 10 years of payments, instead of 20 years, for borrowers with loan balances of $12,000 or less.
  • Cover the borrower’s unpaid monthly interest, so that unlike other existing income-driven repayment plans, no borrower’s loan balance will grow as long as they make their monthly payments—even when that monthly payment is $0 because their income is low.

Part 3 is consequential, and the fourth bullet point of Part 3 even more so. Interest payments can easily double the size of a student loan, and anything that reduces the interest burden will reduce the size of the loan and, consequently, the time required to pay it off. But a proposed rule is not an Order and will take time before being finalized, perhaps a lot of time.

Right now we are in the knee jerk phase of this issue. Republicans categorize Biden’s move as political and unfair to those who worked hard to pay off their loans. Why should their tax dollars now subsidize the millions who haven’t? The far right, more rabid of the bunch, have been raining tweet storms condemning the very idea of forgiving the loans, all the while forgetting to mention their own Paycheck Protection Act loans, most well over $100,000, have all been forgiven.

In thinking about this, the first question one might want to ask is: Does the President have the authority to do it? House Speaker Nancy Pelosi doesn’t think so. “The president can’t do it,” she said in July. “That’s not even a discussion.”

We can expect this decision to be challenged in the courts. But, at the very least, it offers President Biden a chance to say he is honoring a commitment, a promise, even if the Judiciary ultimately won’t let him do it.

How and why has going to college come to this? I think the answer can be found in the long, winding, potholed road to higher education of the last 55 years. It’s complicated, and people have devoted entire careers to studying it.

I’m concerned, in a practical sense, with what changed from the time I and my peers affordably attended college in the late 1960s. For instance, how and in what manner have costs increased? To what degree and why is there now a far greater percentage of high school graduates attending four year, or even two-year colleges? Have wages commensurately grown with college costs to allow parents and their children to be able to afford it all? How has the for-profit boom in colleges contributed to the college loan crisis, if it has?

To begin to answer those questions, let’s first take a look at where we are now.

Adam Looney, the Nonresident Senior Fellow at the left-leaning Brookings Institution and the Executive Director of the Marriner S. Eccles Institute at the University of Utah, is one of our foremost experts on college loans and costs. He has argued for quite some time against across-the-board loan forgiveness, because a disproportionate amount goes to people who don’t need it, Ivy League educated doctors, lawyers, etc. He has produced the following table to demonstrate his argument. The table categorizes all colleges and graduate programs represented in the College Scorecard by their selectivity using Barron’s college rankings. The left panel of the table describes the debts owed by students at these colleges. The right panel describes their family economic background and their post-college outcomes. From top to bottom, the schools are categorized by their selectivity—how hard it is to get accepted. Note that the more selective the school, the greater the average debt (with the exception of the for-profits). The same holds true for the two far right columns. The more selective the school, the greater the after college earnings. Note also that, with the exception of the Ivy Plus graduates, the average after college earnings for every other category are less than the President’s cap of $125,000 for loan forgiveness qualification.

I’m going to ignore the harm done by for-profit colleges, except to say the largest single source of student debt in America is one of them—the University of Phoenix, the gigantic online for-profit chain. Students who graduated or dropped out in 2017-2018 owed about $2.6 billion in student loans; two years after graduation, 93 percent of borrowers had fallen behind on their loans, which caused interest owed to grow like festering weeds. These are people Looney agrees need to be helped—a lot.

I thought it might be instructive to look at this through the lens of one, typical, highly reputable, selective public university. As Looney’s table shows, graduates of selective public colleges and universities make up 33.7% of the total share of college debt. I’ve picked the University of Massachusetts. UMass is representative of all state universities, and, because I’m from Massachusetts and long ago was a Trustee at one of its foundations, I know the school better than, say, Penn State or Connecticut.

The UMass flagship campus in Amherst sits on more than 1,400 acres and has about 24,000 students. Out of more than 850 US public colleges, it is #68 in US News & World Report’s current rankings. Tuition, fees, room and board total $32,168 for in-state residents, about $50,000 for out-of-staters. The Commonwealth of Massachusetts currently contributes (subsidizes) 31% of the university’s total costs, or $14,287 per student, which means students’ tuition would be considerably more without that help, somewhere in the range of the cost of a selective private college, or an out-of-state UMass student. Every state subsidizes its selective public colleges to some degree.

Nationally, in 1967, 47% of high school graduates moved on to college. Seventeen percent would drop out, 15.4% white, 28.6% black. Today, less than 10% drop out; 10.7%% of drop outs are Black. We are approaching equality in that regard.

That’s where UMass is now. Fifty-five-years-ago, when I was young, things were different. Facts And Figures 1967, from the then UMass Office of Institutional Studies, is a 163-page, deeply detailed report of the university as it was then, all of it in one spot. I do not think you’d find a similar study today.

In 1967, annual tuition and fees were $336; room and board, $939, for a total cost of $1,275. The university employed 729 full-time faculty for 9,439 students. Today, there are about 1,400 full-time faculty. In 1967, the Commonwealth of Massachusetts picked up 67% of the university’s operating costs (as opposed to the aforementioned 31% today).

What you bought in 1967 for $1.00 would now cost $8.87, with a cumulative rate of inflation of 787%. Over that time, tuition, fees, room and board at the University of Massachusetts have increased by a factor of more than 24. If the tuition at UMass had just grown by the rate of inflation, it would now be $11,310, not $32,168.

So, extrapolating from current demographic and UMass data to the national picture, four things have been at work over the last 55 years. First, student costs have grown at nearly three-times the rate of inflation. Second, the state has reduced its share of student costs by more than 50%, which is representative of the nation. Third, the percent of high school graduates who go on to college has grown from 47% to nearly 62%. And fourth. wages have not even remotely kept up with the cost of college. According to the Congressional Research Service, real wages (wages adjusted for inflation), grew only 8.8%, at the 50th percentile level of all earners, since 1979.

President Biden’s initiative will likely remain a political football at least until the mid-terms, probably beyond. My own conclusion is that it will help a lot of people who need it and will be unnecessary largesse, at taxpayers expense, for those many who don’t. And it does nothing to solve the real problem.

Unless and until we can control the cost of college, this crisis will continue for future generations.  College cost growth at three times the rate of inflation is unsustainable.

We need to do much more than forgive a slice of college loans. That’s like trying to save a sinking ship by tossing the first mate a rope of sand.

 

Paid Sick Leave: Public Policy That Makes Ethical And Economic Sense

Tuesday, August 23rd, 2022

Do Right To Carry Laws Make Us Safer?

Monday, August 15th, 2022

America is awash in guns.

According to a 2018 report by the Small Arms Survey, a Geneva-based organization, Americans in that year had in their possession 393.3 million weapons, which is 16% more than the country’s population of about 330 million people. And since that year, especially beginning in 2020, we  have been on a gun buying spree. The National Instant Criminal Background Check System, which the FBI collects and is widely used as a proxy for firearms purchases, jumped 40% in 2020 from 2019 to 39.7 million background checks. The frenzy only cooled slightly to 38.9 million checks in 2021.

With all those guns, it is only natural that people want to be able to take them with them when they leave their homes. Enter Right To Carry laws, RTCs.

In January of 2023, Alabama will become the 25th state that won’t require permits to carry a gun in public. In recent years, more and more states have enacted similar legislation. Indiana, Georgia and Ohio, did so this year. The change in Indiana made headlines as it happened just two weeks before a deadly mass shooting at a mall in an Indianapolis suburb, where a gunman killed three and wounded two more before being shot dead by a bystander who also carried a gun.

The rationale for RTC laws is always the same: They will keep us safer, because people will be able to defend themselves and their families from bad people with guns, a la the Indianapolis situation. But is that even remotely true?

To find out, John J. Donohue, Samuel V. Cai, Matthew V. Bondy, and Philip J. Cook, writing in the National Bureau of Economic Research Paper Series, in June of this year published their study, More Guns, More Unintended Consequences: The Effects Of Right To Carry On Criminal Behavior And Policing In US Cities.

The conclusion of their heavily researched, 36 page paper? “The rate of firearm violent crimes rises by 29 percent due to RTC, with the largest increases shown in firearm robberies.”

Consider this chart, which compares the incidence of violent crime in major cities in the year before  passage of Right To Carry laws and the year after.

From the Report:

The statistically significant estimates that RTC laws increase overall firearm violent crime as well as the component crimes of firearm robbery and firearm aggravated assault by remarkably large amounts with an attendant finding of no sign of any benefit from RTC laws represent a remarkable indictment of permissive gun carrying laws. Perhaps the most noteworthy and novel result is the finding that RTC laws increase firearm robbery by a striking 32 percent.

This study shoots a great big hole through the idea that Right To Carry laws keep us safer. In fact, the reverse is true.

Another consequence of RTC laws is the effect they have on the capacity and ability of police to solve crimes. That is, they cause crime to go up so much that police turn into the Ed Sullivan Plate Spinner.

 

The increasing firearm violence that RTC laws perpetuate is facilitated by a massive 35 percent increase in gun theft (p = 0.06), with further crime stimulus flowing from diminished police effectiveness, as reflected in a 13 percent decline in violent crime clearance rates.

The study authors say RTC laws may generate a host of demands on police time and resources that reduces the amount of time they have to fight crime. Processing complaints about the increased gun thefts, accidental discharges and injuries, processing RTC permit applications, and taking time to check for permit validity by those carrying guns will all encumber police resources.

For example, if the police only have the ability to solve 40 out of 100 crimes, and if crime rises by 20 percent and they still can only solve 40 crimes, the clearance rate would fall from 40 percent to 33 percent (40 out of 120).

Nonetheless, it appears we are stuck with at least half the states falling in love with Right To Carry laws. We are also stuck with the horrid consequences.

Two Stories – Only One Of Them Good

Thursday, August 11th, 2022


Photo credit – The Economist, 2018

There are two major stories roiling America this week in August 2022. One concerns the major accomplishments of the Biden administration, and the other is the political cyclone that is anything having to do with Donald Trump.

By any basic measure, Joe Biden’s presidency is off to a rip-roaring start. Not even halfway through his term, Congress has passed the $1.9 trillion American Rescue Plan and devoted hundreds of billions of dollars to upgrading American infrastructure. It’s approved the first major piece of gun reform in decades and expanded health care benefits to millions of veterans. And once the House returns from its recess tomorrow, Congress will have authorized hundreds of billions of dollars in green energy and health care subsidies. While the first and last measures were enacted entirely along party lines, the others passed with large, bipartisan majorities.

And this week President Biden signed another bi-partisan major piece of legislation into law, the CHIPS and Science Act of 2022, boosting domestic semiconductor manufacturing, a stroke of the pen we desperately needed to compete globally with the Chinese. Following the signing, the Micron company announced a $40 billion investment in new chip-manufacturing facilities in the United States through the end of the decade, and Global Foundries and Qualcomm announced a $4 billion partnership to produce chips in the U.S. that would otherwise have gone overseas.

Also this week, we learned the price of gasoline has dropped below $4.00 per gallon and inflation has decreased from 9.1% to 8.5%.

I defy anyone to prove any administration in the last fifty years has done more in such short a time (I know, it feels like forever, but it’s only the first one and a half years of a four year term).

But while that story of accomplishment should be celebrated around the country, such is not the case. It’s the other story, the Trump crazyness, that continues to suck all the available oxygen out of everywhere. And it doesn’t help when Republican congressional legislators hypocritically put on the mantle of persecuted victimhood and defend their cult leader like Davy Crocket at the Alamo.

I won’t go into all the nausea-inducing idiocy delivered with intergalactic significance by those “patriots,” but I will point out that in a time crying out for calm, patience and legislative leadership, we are given nothing but disingenuous histrionics with all the honesty of a Potemkin Village.

Here is what we know: Donald Trump is being investigated by two agencies, the New York Attorney General and the Justice Department. We know the particulars of the first, but not the second. We know a federal judge authorized the FBI to execute a search warrant at Trump’s home at Mar-a-Lago (After firing James Comey, Trump appointed the current FBI Director Christopher Wray, a Republican). To do that, the FBI would have had to persuade the Judge it had probable cause that a crime had been committed. Second, we know the former President testified in New York on Wednesday of this week in the New York Attorney General’s long-running civil investigation into his business dealings. We know his testimony consisted entirely of his invoking his Fifth Amendment rights (we also know Trump has said in the past, “You see, the mob takes the Fifth. If you’re innocent, why are you taking the Fifth Amendment?”).*

That is all we know for sure. Everything else has been speculation and a hair-on-fire, Hellzapoppin horror show in which Republicans see the Four Horsemen of the Apocalypse galloping over the nearest hill to bring fire and destruction to them and their Dear Leader. They have also pledged massive vengeance if (they say “when”) they retake control of the House in November’s election.

While there is some excellent reporting happening, especially in long form, I blame the Washington media for much of this. Yes, it has to cover the swill that comes out of Trump’s mouth and the chaos that comes next, but it has given, and continues to give, every bombastic bloviator a national soapbox from which to spill their screed. There is a rampant and profound false equivalency going on, and, reporters covering this for the national and cable networks should know better. As someone I respect said, “They should be investigative reporters, not stenographers.”

Maybe at some point in the future Americans will stand back and take a hard look at all of this. Maybe they will come to appreciate the monumental legislation that’s come out of the Biden administration. Maybe they will realize the good it will do for our country and our neighbors. Maybe Republican leadership will instruct congressional members to stand down and let things play out. Maybe Joe Biden’s approval rating will rise. Maybe pigs will begin flying past my second floor window. Maybe…

We can be certain of one thing. The Trump drama will resolve eventually. The question is, will it right the ship of Democracy, or sink it?

 

*It is not the first time that Mr. Trump has taken the fifth in a civil case. During his divorce proceedings against Ivana Trump in 1990, he invoked his right against self-incrimination close to 100 times according to Wayne Barrett’s book “Trump: The Greatest Show on Earth.” Most of the questions he was avoiding concerned his infidelity. In Mr. Barrett’s words, “mostly in response to questions about ‘other women.’”

An Indiana Power Grab Shows Politics At Its Worst

Thursday, July 21st, 2022

Fifty-two-year-old Theodore Edward Rokita, known as Todd, not Ted, is Indiana’s 44th Attorney General.

A dedicated far-right Republican, his political life is a thirsty search for one powerful political office after another. Elected Indiana’s Secretary of State at age 32 in 2002, he was the youngest Secretary of State in America at the time. He went on to capture Indiana’s 4th Congressional District seat in 2011 and served in the U.S. House until 2019.

In 2015, during his time in the House, Indiana created the Healthy Indiana Plan and expanded its Medicaid Program to take advantage of the Affordable Care Act. Rokita’s reaction to this was to say the ACA was “one of the most insidious laws ever created by man.”

He ran against Eric Holcomb for Governor in 2016 to replace Mike Pence, who had resigned to become Donald Trump’s running mate. Holcomb won convincingly, and, as I hope to prove below, Rokita never forgave him for the drubbing.

In 2017, Rokita resigned his House seat and sought the Republican nomination for U.S. Senator. He failed again.

But in 2020, in a political comeback of sorts, Todd, not Ted, Rokita defeated incumbent Curtis Hill for the Republican nomination for Indiana Attorney General, and in November 2020, he won the general election.

If that were all we ever learned of Todd Rokita, we could chalk him up as just another political hack of the Republican persuasion.

But the story doesn’t end there. It begins there. And it begins with a 10-year-old girl from Ohio.

In May 2022, a man from Columbus, Ohio, Gerson Fuentes, 27, allegedly raped that 10-year-old girl not once, but twice, and she became pregnant by him. On 27 June, a child abuse doctor treated her, but could not refer her for an abortion in Ohio, because, following the Supreme Court’s Roe reversal earlier in June, Ohio’s trigger law fired and outlawed abortions after six weeks of insemination. He determined the girl was six weeks and three days pregnant. So, he called a colleague in neighboring Indiana, where abortions were still legal in the first 22 weeks. Dr. Caitlin Bernard, an obstetrician-gynecologist, agreed to help, and the 10-year-old was quickly on her way to Indiana.

On 30 June, Dr. Bernard performed the abortion. The 10-year-old, who will bear the horrid psychological scars of this for the rest of her life, was spared the further horror of giving birth to her rapist’s child.

Among all the bureaucratic red tape government can create, Indiana has created what are called Termination of Pregnancy Reports, TPRs, and these must be completed by physicians who terminate pregnancies in the state. In the case of a pre-teen abortion, the law calls for TPR completion within three days of the abortion. Dr. Bernard completed and submitted her TPR for the 10-year-old within two days, on 2 July, thereby complying with the law.

On the first of July, one day after the abortion and one day before Dr. Bernard submitted her TPR, the Indianapolis Star ran a story about pregnant women from Ohio and Kentucky who were heading to Indiana for abortions because of the restrictive laws in their states. The story began:

On Monday, three days after the Supreme Court issued its groundbreaking decision to overturn Roe v. Wade, Dr. Caitlin Bernard, an Indianapolis obstetrician-gynecologist, took a call from a colleague, a child abuse doctor in Ohio.

Hours after the Supreme Court action, the Buckeye state had outlawed any abortion after six weeks. Now this doctor had a 10-year-old patient in the office who was six weeks and three days pregnant.

Could Bernard help?

The story later said Dr. Bernard had agreed to help. It did not say she had performed the abortion, just that she had agreed to help.

This story caught the nation’s attention, mostly for the wrong reasons. It was ridiculed. The Wall Street Journal called it “fanciful.” Republican Ohio Attorney General Dave Yost was among those who questioned the validity of the story.  Ohio Republican Representative Jim Jordan called the story “another lie” in a now-deleted tweet. Some of Fox’s most high-profile hosts — Tucker Carlson, Jesse Watters, Laura Ingraham — suggested the account of the 10-year-old rape victim was a “hoax” and “politically timed disinformation,” and claimed that the Biden administration was “lying” about the case after the Supreme Court overturned Roe v. Wade.

All this happened between the Indy Star’s story and the arrest—and confession—of Mr. Fuentes, which is when the backtracking happened. Jordan deleted his tweet, the WSJ issued a “correction,” Fox News actually took credit for “justice being served,” and Indiana Attorney General Todd Rokita, with all the empathy of an empty paper cup, saw an opportunity and took the stage.

Was he devastated that a 10-year-old had suffered such a horrific experience? If he was, he never said. What he did say, during a press conference he hurriedly called on the subject, complete with TV, Radio and Print media, was that he would be investigating Dr. Bernard for failing to provide the Termination of Pregnancy Report within the time required by law (She had).

On 13 July, twelve days after the abortion, he wrote a letter to Governor Holcomb, the same Eric Holcomb who had trounced him in the race for Governor, advising, “If  Doctor Bernard has failed to file the required reports on time, she has committed an offense, the consequences of which could include criminal prosecution and licensure repercussions.” Rokita went on to say “key” people on his staff had been trying to get the Indiana Department of Health to forward the TPR for two days, without success. Two days.

Rokita’s letter lectures the Governor, saying, “As state officeholders, we bear an important responsibility to get to the bottom of this matter immediately….” He admonishes the man who beat him in the election of 2016 by saying Holcomb should “direct the state agencies under your purview to produce immediately to my office the requested TPRs…so we can confirm Dr. Bernard’s compliance with the law.”*

Not one drop of the Balm of Gilead does Todd, not Ted, Rokita offer the 10-year-old whose life has been so tragically scarred. Nope. He can’t be bothered. He has other things on his mind. He is 100% focused on scoring whatever rancid political points he can.

No wonder people hate politicians.

 

*On 14 July, one day after Rokita’s letter to the Governor, Indianapolis TV station Fox 59 published the TPR, submitted by Dr. Bernard within two days of the procedure, which it had secured by a Freedom of Information request. Maybe Todd should have tried that.

Gavin Newsome And Insulin: An Example Of What Leadership Looks Like

Monday, July 11th, 2022

Having just returned from a wonderful and pretty much off the grid trip to America’s southwest, I discover some pennies have dropped.

Roe is now in Wooly Mammoth land; New Yorkers, and soon many others, will now find it easier to pack a bit of heat; the EPA (and, presumably a lot of other governmental agencies) is no longer going to be able to regulate what its been regulating for the last 50 years; the January 6 Select Committee continues to unearth the sewer-living sludge of the Trump Big Lie; another mass shooting happened, the 309th of 2022, at a July 4th parade no less (only in America); the charlatan Boris Johnson is officially on the way out; and, this past Friday morning, a 41-year-old Shinzo Abe hater, assassinated the former prime minister of Japan at a campaign stop.  Abe’s killer made the gun himself, because it’s nearly impossible to procure a gun in Japan—Japan, the country with the lowest rate of handgun violence in the developed world.

With all of that, I’m thinking Chicken Little was right, and the sky is about to fall any minute now and land on my bucolic, Berkshire back deck.

Nonetheless, today’s Letter is not about any of that sky is falling stuff. We’ll get to all of it later. No, today’s Letter is about a momentous, and non-COVID, medical development that happened while I was gone, when California’s Governor Gavin Newsome announced the state would commit $100 million to making its own insulin for California’s diabetics.

Diabetes kills one American every three minutes. It affects children and adults, both genders, every race and ethnic group and leaves a vicious imprint on those who suffer from it and on those who love them. It is a leading cause of blindness, heart disease, stroke, kidney failure and non-traumatic amputations.

According to a nationwide survey by the Juvenile Diabetes Foundation International, 75 percent of Americans do not know how deadly the disease is, and 38 percent believe that either insulin cures diabetes, makes it harmless, or they don’t know what effect it has.

In 2017, the nation’s total direct medical cost due to diabetes was $237 billion. Average medical expenses for diabetics were 2.3 times higher than for non-diabetics.

Based on information found on death certificates, diabetes was the 7th leading cause of death in the United States in 2015, with 79,535 death certificates listing it as the underlying cause of death, and 252,806 listing diabetes as an underlying or contributing cause of death. However, diabetes is underreported as a cause of death; studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on their death certificates and only 10% to 15% had it listed as the underlying cause of death. An example of best practice would be, “Death caused by infection contracted from hemodialysis due to kidney failure, a complication of the patient’s diabetes.”

At 10.2%, California ranks 31st among US states in the percent of adults with diabetes*. There are more than 3.2 million of them in California, the great preponderance being Type 2 diabetics.

There are close to 35 million Type 2 diabetics in the nation. T2Ds still make some insulin, just not enough. For most, lifestyle changes will improve their health, sometimes to the point where they will no longer have to inject insulin. Some will become insulin dependent, and without it, those people will face life-changing complications.

There is a rarer, but much worse, kind of diabetes. That would be Type 1, also known as Juvenile Diabetes. There are 1.6 million T1Ds in the country. According to the CDC, of all the states, California has the lowest rate of juvenile, Type 1 diabetes. T1Ds make no insulin and will die quickly if they don’t get it. Type 1 diabetes can happen at any time in life, but is vastly more prevalent in young people. My daughter came down with Type 1 diabetes at 21 years of age; my late wife Marilyn, at 12. You wouldn’t be wrong to think I’m invested in this topic.

I have argued strenuously in the past (here and here) that the country should guarantee insulin to T1Ds, regardless of their ability to pay for it. It is quite literally a matter of life and death. I can think of no other disease in which, if a patient is deprived of their medicine, death will result within a couple of weeks. But that’s the world T1Ds inhabit.

Government has been kicking the diabetes can down the road for generations. It’s been playing patty-cake with it since then Speaker of the House Newt Gingrich made it a core cause of his 25 years ago, in 1997. This has resulted in two things: government investing more money in looking for a cure—unsuccessfully, and skyrocketing insulin costs for patients. As President Biden noted correctly in his State of the Union address, insulin costs its manufacturers less than $10 per vial to make. Yet, depending on their circumstances, patients are paying anywhere from $300 to $800 for that same vial.  Reprehensible doesn’t begin to describe this situation.

While it is true that most of the ~50% of Americans who have employer sponsored insurance (ESI) only pay co-pays of $30 to $50 for a month’s supply of insulin, nearly all of them pay the full, painful cost until they meet their pharmacy deductible requirements. And one thing more to keep in mind: before Congress Passed the Affordable Care Act in 2010, the 1.9 million diabetics without ESI found their diabetes treated as a pre-existing condition. They paid full freight every time. Fast forwarding to now, some T1Ds are dying, because they either ration, or even go without, their insulin. Why? Because they can’t afford the price.

In my 2018 series on this topic, What Price Life?, I concluded:

So, here’s a question: Should anyone in the United States who requires a daily drug just to stay alive be forced to come up with the money to pay for it? Or, should that be a government-sponsored, health care right, as in the Declaration Of Independence’s “self-evident…unalienable right…to life.”

Gavin Newsome has answered that question. He has had enough. In taking matters into his own hands, he is extending a lifeline to California’s diabetics who struggle with the cost of staying alive. His move will both help those diabetics and provide good paying jobs to the people hired to build the manufacturing process and supply chain. He promises to provide California’s insulin to its diabetic citizens at “a little above cost.”

I don’t know what you think of Gavin Newsome. He certainly has his critics. But on this critical, life and death issue, he is showing a brand of leadership seldom, if ever, seen in that bought-and-paid-for vacuum of mediocrity we call the United States Senate.

_______________________

*It may not surprise you to learn the states with the highest incidence of diabetes, primarily Type 2, are the states whose citizens have the worst health care problems in the country. They are Red states, and are led by Senator Joe Manchin’s West Virginia at 15.7%, followed by Louisiana, Mississippi and Alabama. Mississippi. Always Mississippi. Pounded so low it has to look up to tie its shoes.

Gun Violence In America Is An Example Of The Worst Form Of Insanity

Tuesday, May 31st, 2022

Beginning in 1959, and as it has every year since, the Gallup organization polled Americans with this question: “Do you think there should or should not be a law that would ban the possession of handguns, except by the police and other authorized persons?”  When Gallup asked that question in 1959, 60% of Americans said “Yes.” Thirty-two years later, in 1991, the “Yes” group had decreased to 43%, and thirty years after that, in 2021, only 19% of Americans were still saying “Yes.” A whopping 80% now said “No.”

Since 1959, when Gallup also reported 78% of American saying laws covering the sale of firearms should be made more strict, the decline in support for banning guns has been inversely proportional to the 63-year steady, linear rise in gun violence. The result is what we have today. Gun violence has become a cancer eating away the heart and soul of our society.

It may interest you to know that the proposition reflected in Gallup’s question precisely mirrors the law in the UK. No one is allowed to own a gun except “police and other authorized persons.” Exceptions are made for hunting and target shooting, but these are highly regulated and controlled by government. There is very little handgun violence in the UK. To this, you may say, “Without guns, people will just find another way to kill.” To which I reply, “I’d rather try to outrun a knife than a bullet.”

Last week, immediately following the massacre of 19 little children and two teachers at Robb Elementary School in Uvalde, Texas, a British reporter asked Texas Republican Senator Ted Cruz why the US suffers a seemingly intractable and growing slaughter of innocents through mass shootings. The reporter pointed out America is the only highly developed country in the world where this occurs. So, why America? Rather than attempting to address, much less answer, the question, Cruz launched into platitudes about what a great country America is. When the reporter continually pressed him for an answer (US reporters should take this as a learning experience), the Senator, after trying the platitude thing again, simply avoided the reporter and hurriedly left the area.

I viewed this exchange as an important one. It highlighted the societal dichotomy we face. The US dwarfs the 28 most economically developed countries in the 38-member OECD* in deaths by firearms. In our country, 98 people die by firearms every single day. In those other 28 OECD countries, with a combined population more than twice that of America (712 million vs. 331 million), that number is 19.

Thinking about the British reporter’s question to Senator Cruz, I decided to dive into the actual statistics to compare our gun violence experience with that of the 28 OECD countries cited above as a whole. The year I’m using as a benchmark is 2015, because a number of peer reviewed and credible studies were done that year. I assure you, as I will note below, the situation has only gotten worse in the succeeding six+ years.

2015 (Rates per 100,000 persons)

All Homicides
US – 5.6
Other 28 countries – 0.7

Homicides by firearm
US – 4.1
Other 28 countries – 0.2

Non-firearm homicide
US – 1.5
Other 28 countries – 0.6

Accidental firearm death
US – 0.2
Other 28 countries – 0.0

Firearm death rate
US – 11.2
Other 28 countries – 1.0

Total deaths by firearm
US – 35,769
Other 28 countries – 6,965

Population
US – 331 Million
Other 28 countries – 712.3 Million

Not only is our firearm death rate nearly 25 times higher than our OECD companions, our total homicide rate is eight times higher. We are a violent country.

And what about the mass shootings that, like a knife to the heart, horrify us every time one happens?

The FBI found an increase in active shooter incidents between 2000 and 2020. There were three such incidents in 2000; by 2020, that figure had increased to 40. There have been 27 thus far in 2022.

In 2020, the FBI reports, 513 people died in mass shooting incidents. In that year, according to the CDC, 45,222 of our neighbors died by firearms. Note how that is nearly 6,000 more than we reported above for 2015.

The number of deaths from mass shootings is paltry compared to the number of total deaths by firearms nationally (0.011%).

So, now, in the face of all this mayhem, we hear that our elected legislators may be willing to take some action at an unknown time in the future regarding gun control. We know Americans support this.

Politico/Morning Consult poll published last Wednesday showed “huge support” for gun regulations in that 88% of voters strongly or somewhat strongly support background checks on all gun sales, while only 8% strongly or somewhat strongly oppose such checks. That’s a net approval of +80.

Preventing gun sales to people who have been reported to police as dangerous by a mental health provider is supported by 84% of voters while only 9% oppose it, a net approval of +75. I’m forced to wonder about those 9%ers.

A national database for gun sales gets 75% approval and 18% disapproval, a net approval rate of +57.

Banning assault style weapons like the AR-15 has an approval rate of 67% while only 25% disapprove. That’s a net approval of +42.

And fifty-four percent of voters approve of arming teachers with concealed weapons, while only 34% oppose it, a net approval of +20. Wait—armed teachers. Think about that for a moment. I can just see Sister Mary Stellan, my 2nd grade teacher, packing heat.

These numbers may lead to some kind of legislation. However, as long as we have more guns (393.1 million) in this country than there are people (331 million), do you really believe things will improve significantly?

Among US states, the rate of firearm deaths varies widely. In 2020, Mississippi had the highest firearm death rate in the nation, 28.6 per 100,000 Mississippians, according to the Centers for Disease Control and Prevention, as opposed to 0.2 in our OECD comparison (I continue to ask, “What goes on in Mississippi?”). New England states fared better, and Massachusetts, where I live, had the second-lowest rate of gun deaths in 2020 at 3.7 per 100,000, trailing only Hawaii at 3.4. However, the Massachusetts rate was still 5.3 times higher than the combined rate of gun deaths in the other 28 countries.

To put a period on this: At less than half the population, the US has 83.7% of all the deaths by firearms in the 29 most highly developed OECD member countries. If our firearm death rate mirrored that of just an average OECD country, deaths by firearm in America would drop 96%. At 45,222 deaths in 2020, that would be 43,413 folks who would still be with us.

I can only conclude that what the NRA paid-in-full Congress is thinking about doing maybe at some point in the possible near term is nothing more than nibbling at the edges of a monstrous problem, and they’re nibbling in ever so tiny bites.

This is insane.

 

*The Organization for Economic Co-operation and Development, founded by the US and it allies shortly after the close of the Second World War. Its members are the most economically developed countries.

 

Mississippi: America’s Third World Country

Wednesday, May 11th, 2022

Although I have been there only once, I can’t help thinking about Mississippi.

Mississippi has recently been in the news, of course, because its 2018 Gestational Age Act will be upheld in the same Supreme Court decision overruling Roe v. Wade, which we discovered from Justice Samuel Alito’s leaked first draft opinion for the majority.

This is not Mississippi’s first foray into restricting abortion. In 2007, the state passed its version of an abortion Trigger Law, which “bans all abortions unless necessary to save the life of the pregnant woman or if the pregnancy was caused by rape and charges have been filed with law enforcement,” and which takes effect immediately following the state attorney general certifying the Supreme Court has overturned Roe v. Wade. The Trigger law had 19 male legislative sponsors and zero female sponsors. Regardless, Mississippi has been ready for this for 15 years.

But has it been ready for what comes next?

Matthew Walther, editor of The Lamp, a Roman Catholic literary journal, and a person who will never be accused of favoring abortion, sees predictable and unpleasant consequences after Roe is no longer the law of the land. In his 10 May 2022 guest essay for the New York Times, “Overturning Roe will disrupt a lot more than abortion. I can live with that,” Mr. Walthern acknowledges what very few anti-abortionists want to admit.

Research over the years has suggested that an America without abortion would mean more single mothers and more births to teenage mothers, increased strain on Medicaid and other welfare programs, higher crime rates, a less dynamic and flexible work force, an uptick in carbon emissions, lower student test scores and goodness knows what else.

But Mr. Walther, despite envisioning a gloomy horizon, “can live with that.” I cannot restrain myself from pointing out that Mr. Walther is of the male persuasion and, consequently, faces little likelihood of ever having to “live with” personal pregnancy.

Nonetheless, he makes a good argument, which brings us back to Mississippi.

A few points worth considering:

  • Poverty: According to the Department of Agriculture, 20.29% of Mississippi’s adults and 27.6% of its children live below the poverty line. This is the highest poverty rate in America where the national average is 11.4%.
  • Income: The median family income in Mississippi is $45,081. This is the lowest in the nation. According to the National Census Bureau, the national average in 2019 was $65,712.
  • Education: Only Texas, at 84%, ranks lower than Mississippi, at 85%, for the percentage of high school graduates. The national average is 89.6%. Only West Virginia, at 21%, ranks lower than Mississippi’s 22% for the percentage of college graduates. The national average is 31.28%.
  • Life Expectancy: At 74.4 years, Mississippi has the lowest life expectancy rate in the nation. Of note, the life expectancy rate for Mississippi’s men is 71.2 years.
  • Fetal Mortality: Mississippi’s fetal mortality rate, the number of deaths at 24 or more weeks of gestation per 1,000 live births, is 6.6. This is the highest in the nation. The national average is 3.68. If that isn’t enough, fetal deaths have lately doubled among unvaccinated pregnant women who suffer COVID-19 infections, State Health Officer Dr. Thomas Dobbs said during a Mississippi State Department of Health press conference in September, 2021.
  • Infant Mortality: The Infant Mortality Rate is the number of infant deaths per 1,000 live births. At 8.27, Mississippi’s is the highest in the nation, far exceeding Louisiana’s rate of 7.53, which is the second highest.
  • Maternal Mortality: According to the Centers for Disease Control and Prevention (CDC), Mississippi’s maternal mortality rate is 20.8, again, the highest in the country, where the national average is 17.4, which is the highest among all members of the Organization for Economic Co-operation and Development (OECD). A maternal death is defined by the World Health Organization as, “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
  • Maternity Leave: Mississippi has no guaranteed Maternity or Sick Leave in its state laws.
  • Smoking: According to the CDC, 20.4% of Mississippians smoke. This is the fourth highest in the nation.
  • Autopsies: Something you probably have never have considered until now: Autopsy backlogs. According to the National Association of Medical Examiners (NAME), 90% of all autopsies should be completed within 60 days of death. The NAME has never accredited Mississippi, which has the highest backlog in the nation. The Mississippi State Medical Examiner’s Office was waiting for about 1,300 reports from as far back as 2011, records sent to the Associated Press in early April show. Around 800 of those involve homicides – meaning criminal cases are incomplete.
  • Abortion: According to the Mississippi Department of Public Health, the state has about 3,500 abortions annually. This represents 4.3 abortions per 1,000 women of reproductive age.
  • Finally: Mississippi ranks highest in the nation for Percent of Births to Unmarried Mothers, Cesarean Delivery Rate, Preterm Birth Rate, and Low Birthweight Rate.

Reading the above, one might be forgiven for thinking  there is a significant population in Mississippi who are actual victims of the state’s inability, or outright refusal, to carry out its first responsibility: to provide for the security and safety of its citizens.

Thinking about this, I have to ask: Given how well it’s doing now, how in the world is Mississippi going to cope with 3,500 new births per year? On CNN this past Sunday, Jake Tapper interviewed the state’s Republican Governor, Tate Reeves. That interview offered a glimpse of what is likely coming, a catastrophe becoming worse than it already is, which is considerable.

Tapper: Mississippi, as you know, has the highest rate of infant mortality in the United States. You have the highest rate of child poverty in the United States. Your state has no guaranteed maternity leave that’s paid. The legislature in Mississippi just rejected extending post-partum Medicaid coverage. Your foster care system is also the subject of a long-running federal lawsuit over its failure to protect children from abuse. You say you want to do more to support mothers and children, but you’ve been in state government since 2004. Based on the track record of the state of Mississippi, why should anyone believe you?

Reeves: I believe in my heart that I was elected, not to try to hide our problems, but to try to fix our problems. We are focusing every day on fixing the challenges that are before us.

Good luck, Governor. You and all those “unborn” children who are about to be “saved” are going to need a lot of it. And so are the Mississippi women who are about to become the state’s newest victims.