Archive for the ‘Public policy’ Category

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.

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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.

Updates On Recent Stories I Covered

Friday, March 3rd, 2023

Israel’s judicial crisis continues as far right bills advance in Knesset

In mid-February I wrote about Israel’s descent into judicial chaos.

Israel had gone through three elections in late 2022 to elect a new government. To regain power, the historically conservative Likud Party, headed by Benjamin Netanyahu, joined in a coalition with five right-wing and religiously conservative parties, some of which are hugely influenced, perhaps dominated, by Israel’s ultra-Orthodox community, known as the Haredim. The coalition won the third election, and Netanyahu became Prime Minister for the sixth time. Six days after the election the government filed bills in the Israeli parliament, the Knesset, to severely limit the power of the country’s Supreme Court in that:

  1. A simple majority in the Knesset, 61 votes out of 120, would have the power to annul Supreme Court rulings. This would enable the government of the day to pass legislation without fear of it being struck down. It is called the “override” provision, in that the Knesset could override a Supreme Court ruling;
  2. 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?), would end, significantly decreasing judicial oversight; and,
  3. For the Supreme Court to strike down a Knesset-passed law would require 80% of the court’s 15 judges voting for such a ruling. But even if that were to happen, a simple Knesset majority could “override” the ruling.

At the time I wrote about this there was a singular complication: Benjamin Netanyahu is on trial, actually three trials, for corruption. If he is convicted of anything and appeals, the coalition government could override any Supreme Court ruling. Some might say this places Netanyahu at the mercy of his coalition partners.

Update

In order for these measure to become law requires passing three readings in Knesset committees. Last week, in a long and tense plenary session, the combined bill passed its first reading in the Knesset. Yesterday, the Knesset’s Constitution Committee advanced the bill for its second reading.

The judicial crisis was only made worse last Sunday when, in revenge for the killing of two Jewish Israeli brothers as they drove through the West Bank town of Hawara, near the city of Nablus, a mob of Jewish settlers attacked the town, torching 36 homes and 15 cars. The Palestinian Red Crescent reported one death and 98 Palestinians wounded in the attack. Three ambulances were also destroyed.

The attack was met with a public outpouring of support from settler leaders and Knesset members. Moreover, the Israeli coalition Finance Minister, Bezalel Smotrich, a firebrand of the first order, told the settlers, “Hawara must be destroyed.” It nearly was.

The U.S. condemned the violence in unusually strong terms. “Just as we condemn Palestinian incitement to violence, we condemn these provocative remarks that also amount to incitement to violence,” State Department spokesperson Ned Price said.

It does not seem too much of a stretch to conclude the new coalition government, with its uber-nationalistic sway, has emboldened the highly nationalistic settlers who continue to gobble up land and force Palestinians into ever more woeful conditions.

Israel’s other western allies, for example the UK and France, have also condemned Sunday’s violence and, along with U.S. Secretary of State Antony Blinken, have told Mr. Netanyahu—to his face—that the judicial reforms he is championing are a serious threat to the future of their relationship. So far, the Prime Minister and his coalition partners are calling their bluff.

At this point, it does not appear this situation will end well—for anyone.

Mississippi extends Medicaid postpartum coverage duration

In February, I wrote about maternal mortality in America. Bottom line: It’s the highest in the developed world. At that time, I wrote:

Federal law requires Medicaid to cover postpartum care for only 60 days following birth, which is one of the prime reasons for our lagging maternal mortality global performance. In the other OECD countries, 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.)

The  American Rescue Plan Act of 2021 (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.

Nine other states have legislation pending to follow the 35. Mississippi is one of them.

Update

I can’t tell you how happy I am to report that yesterday the Mississippi legislature passed the postpartum permanent extension, and Governor Tate Reeves signed it into law. Reeves had been opposed to the measure, but had a change of heart when he realized that a lot more babies were about to be born in Mississippi due to the repeal of Roe v. Wade and the state’s strict (to say the least) anti-abortion laws, which meant some mothers could die without the postpartum extension, and the politically astute Reeves did not want to be the one taking incoming fire for helping that to happen. To which I say: Whatever works.

Mississippi’s joining the postpartum extension club only happened because Division of Medicaid Executive Director Drew Snyder, whose department reports to the Governor and who for months has refused to take a stance on postpartum coverage extension (how medically courageous of him, eh?), wrote a letter on 27 February to House Speaker Philip Gunn voicing his newfound support for the legislation’s passage (notably, after his boss, Governor Reeves had his change of heart). Gunn had been vehemently opposed to the measure, believing it put the state in the awful position of expanding Medicaid under the Affordable Care Act, something he has vowed would never happen. In his letter, Snyder assured Gunn that permanently extending Medicaid postpartum coverage would not equate to expanding Medicaid a la the Affordable Care Act, and he urged the Speaker to come on board for all the reasons that had swayed Governor Reeves. You know, all those babies about to be born in Mississippi. He also reminded Gunn the state has a $3.1 billion surplus, the annual cost of the extension is pegged at $7.1 million, and the feds will chip in more than $35 million. Reading Snyder’s letter is like reading George Orwell.

Whatever the reasons, Mississippi has done the right thing.

Ely Lilly to drop the cost of basic insulin to $35 per vial

I have written a number of times about what I consider the obscene price of insulin for Type 1 diabetics. See here and here for the history of the discovery and how we got to this point. Bottom line, as I wrote in 2018, the three discovers of insulin, led by Frederick Banting, who won the Nobel Prize for it:

sold the patent to the University of Toronto for the princely sum of $3.00. When asked why he didn’t cash in on his discovery, Banting said, “Insulin is my gift to mankind.” With Banting’s blessing, the University licensed insulin’s manufacturing to drug companies, royalty free. If drug companies didn’t have to pay royalties, Banting thought they would keep the price of insulin low.

And they did. For decades.

But patents expire, and capitalism being what it is, people get greedy, and greed is why we have no generic, low-cost insulin today and why, over the past 20 years, insulin prices have risen anywhere from 800% to 1,157%, depending on the variety and brand. It’s why, lacking health insurance, some Type 1 diabetics have recently been driven to ration their precious insulin. Some of them have died.

Update

Yesterday, the Ely Lilly company, the first company to license Banting’s discovery, announced price reductions of 70% for its most commonly prescribed insulins and an expansion of its Insulin Value Program that caps patient out-of-pocket costs at $35 or less per month. In its press release, the company said it is:

  • Cutting the list price of its non-branded insulin, Insulin Lispro Injection…to $25 a vial. Effective May 1, 2023, it will be the lowest list-priced mealtime insulin available, and less than the price of a Humalog® vial in 1999.
  • Cutting the list price of Humalog® …, Lilly’s most commonly prescribed insulin, and Humulin® (insulin human) injection … by 70%, effective in Q4 2023.
  • Launching RezvoglarTM …injection, a basal insulin that is biosimilar to, and interchangeable with, Lantus® (insulin glargine) injection, for $92 per five pack of KwikPens®, a 78% discount to Lantus, effective April 1, 2023.

Lilly also said:

  • Effective immediately, Lilly will automatically cap out-of-pocket costs at $35 at participating retail pharmacies for people with commercial insurance using Lilly insulin.
  • People who don’t have insurance can continue to go to InsulinAffordability.com and immediately download the Lilly Insulin Value Program savings card to receive Lilly insulins for $35 per month.

This, of course, is marvelous news for the 1.3 million Type 1 diabetics in the country not on Medicare, which already has a $35 cap thanks to the Inflation Reduction Act of 2022.

It is not an exaggeration to say insulin made Eli Lilly and Company and Novo Nordisk two of the top pharmaceutical companies in the world. It also hasn’t hurt the bottom line of Sanofi, the company that rounds out the insulin producing triumvirate and is the world’s fifth largest pharma by sales. I think it is a good bet these last two will quickly follow Lilly’s lead.

The greed of these three companies over the last two or three decades has hurt a lot of people, both physically and economically. Let’s hope this move by Lilly is the first step in making amends.

 

 

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.

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.

 

Florida’s Governor Ron DeSantis Builds His Educational Petrie Dish

Tuesday, January 24th, 2023

I know it’s masochistic, but I couldn’t help it. I found myself thinking about Florida Governor Ron DeSantis and his all-out assault on education, specifically education about racism, Wokism (if that’s a word), the LGBTQ+ community, and anything else he doesn’t agree with.

I began my long and winding journey down the DeSantis rabbit hole when I learned that yesterday was the day in 1964 when South Dakota became the deciding and 38th state to ratify the 24th amendment to the US Constitution.

The 24th Amendment prohibits making the right to vote conditional on paying a poll tax, or any other kind of tax. It reads:

Section 1. The right of citizens of the United States to vote in any primary or other election for President or Vice President, for electors for President or Vice President, or for Senator or Representative in Congress, shall not be denied or abridged by the United States or any State by reason of failure to pay any poll tax or other tax.

Section 2. The Congress shall have power to enforce this article by appropriate legislation.

The 24th Amendment applied to Presidential and Congressional elections. Two years later, in 1966, the U.S. Supreme Court ruled 6–3 in Harper v. Virginia Board of Elections that poll taxes for any level of elections were unconstitutional. It said these violated the Equal Protection Clause of the Fourteenth Amendment.

Seven states never held a vote to ratify the Amendment. They are Wyoming, Arizona, Arkansas, Oklahoma, Louisiana, South Carolina and Georgia. One state voted to reject the Amendment’s approval altogether. That was Mississippi. Mississippi again. The state seems to rejoice in being the bottom of the country’s bird cage.

Four states, Virginia, North Carolina, Alabama and Texas, waited years to ratify the Amendment, with Texas being the last, in 2009.

If you don’t count Virginia, which enacted a poll tax in 1876, but repealed it six years later in 1882, Florida was the first state to make a poll tax a condition of voting, enacting the legislation in 1885. It became effective in 1889. In 1941, 52 years later, Florida repealed its poll tax.

Florida did not repeal the poll tax because its legislators were conscience-stricken and knew they had to do the right thing. No. The state repealed the tax because too many white legislative candidates (they were all white) were buying votes by paying the tax for poor black and white constituents (disproportionately black, of course) who couldn’t afford it themselves. In essence, the tax was no longer doing what it was intended to do: suppress black votes.

Florida had two other legislatively approved ways to suppress black voting. The first was the Literacy test. According to the Tampa Bay Times:

In 1915, the Legislature enacted a literacy test along with a companion grandfather clause. The clause, common throughout the South, declared that any person who had a relative who voted prior to a certain date did not have to take the test.

According to the proposed Florida law, if you had a relative who was eligible to vote on Jan. 1, 1867, you were exempt from taking the test. Since no black Floridian was voting prior to that date, all of them had to pass the test.

Blacks were frequently asked more technical and legal questions than whites. When one black applicant was asked what “habeas corpus” meant, he responded: “Habeas corpus means this black man ain’t gonna register today.”

The final way the legislature held down, disenfranchised, the black vote in Florida was by means of the Criminal Disenfranchisement Law. This law, first enacted in 1868, reenacted in 1968, and in effect even today, bars anyone with a felony conviction from ever voting. Florida is one of seven states that still retain this disenfranchisement statute, which disproportionately affects blacks.*

Disproportionate imprisonment of blacks is not something peculiar to Florida. Nationwide, according to Bureau of Justice data, 18 and 19-year-old black men are 12.4 times more likely to be imprisoned than their white peers. And it doesn’t get much better as blacks age, as the chart below shows.

With this as background (and here are 24 more charts showing pervasive racism directed at blacks), Governor DeSantis insists there is no such thing as institutional racism, especially in Florida. And he’s gone to great lengths to make sure anyone in Florida who suggests otherwise will require divine intervention to escape punishment.

Ask Andrew Warren. Last August, DeSantis suspended Warren, the twice-elected Hillsborough County State Attorney, saying he violated his oath of office and has been soft on crime (Remarkably, Florida’s Governor has the legislative authority to do this). What had Warren done? Nothing, except for signing a group statement with other prosecutors saying “we decline to use our offices’ resources to criminalize reproductive health decisions.” In other words, Warren was suspended, not for something he did, but for something he said he might do at some time in the future.

Warren sued to get his job back. Yesterday, a federal judge ruled that, although DeSantis violated the Florida Constitution and the First Amendment, he lacked the power to reinstate Warren. In his 53-page ruling, U.S. District Judge Robert Hinkle, while grudgingly dismissing the case, excoriated DeSantis and his staff for attacking Warren for purely political reasons. Nonetheless, DeSantis won, which is usually the way things work in Florida.

And now, as we are smack dab in the second day of “Florida Literacy Week,” comes the Florida Department of Education’s new rules to enforce the Governor’s Parental Rights In Education Act, known by critics as “Don’t Say Gay” or the Stop WOKE Act and Florida law 1467, the Curriculum Transparency Law, which requires school districts to be transparent in the selection of instructional materials and library and reading materials.

Taken together, these two statutes limit what teachers can teach and what their students can read.

The two statutes are supposed to apply to what goes on in the classroom. Consequently, in federal court filings, lawyers representing DeSantis insist  the statutes do not apply to library books. In practice the opposite is true. A recent 23-slide librarian training program, approved by the Florida Department of Education, asserts: “There is some overlap between the selection criteria for instructional and library materials.” One slide says that library books and teacher instructional materials cannot include “unsolicited theories that may lead to student indoctrination.”

Good luck trying to understand what an “unsolicited theory” is, or what “student indoctrination” means. Indoctrination into what?

The rules are confusing for librarians, but they’re even murkier for classroom teachers, many of whom have created little classroom libraries over the years of their teaching. The Department of Education’s new rules require “media specialists” to vet every one of the non-curriculum  books teachers may have in their classrooms, as well as all the books in the school libraries. In Florida, some school librarians earn “media specialist certificates.” These are the “media specialists” tasked with vetting all the books in Florida’s 4,202 K-12 public schools. In Popular Information, Judd Legum reports that Kevin Chapman, the Chief of Staff for the Manatee County School District, told him that County principals told teachers last week they are subject to a third-class felony charge if unvetted books in their classrooms are deemed to violate the prohibitions contained in either of the two statutes.

Needless to say, those little classroom libraries are disappearing faster than the small piece of meat I dropped on the kitchen floor this morning right in front of my 80-pound dog, Lancelot (so named because he’s not Lance-a-little).

Florida law 1467 on Curriculum Transparency is particularly pernicious, because it prohibits teachers from exercising their own educated judgement regarding what is appropriate for their particular students. For Florida’s teachers, this is scary stuff. They are going to have to be very careful with what they say, or even suggest, in their classrooms.

Some teachers, perhaps many, will refuse to give up their intellectual freedom. It will be interesting to see how that plays out. As George Orwell said, “In a time of universal deceit, telling the truth becomes a revolutionary act.”

Nevertheless, it seems Governor Ron DeSantis has achieved in Florida what all autocrats crave. He has brazenly fastened iron bonds on what the next and future generations of Floridians are allowed to know. To my mind, he has also underestimated the youth of his state whose intelligence, curiosity, global involvement, and just plain desire to know and learn cannot and will not be inhibited by anything an autocratic governor, whose overarching goal in life is to rule the world, will ever do.

My money’s on the kids.

_________________

*Angela Behrens, Christopher Uggen, and Jeff Manza, Ballot Manipulation and the “Menace of Negro Domination”: Racial Threat and Felon Disenfranchisement in the United States, 1850-2002, 109 AMERICAN JOURNAL OF SOCIOLOGY 559 (2003).

 

 

Martin Luther King—Sharing The Spotlight With Confederate “Heroes”

Tuesday, January 17th, 2023

Yesterday, the city of Boston celebrated Martin Luther King day as no other city in the nation could. On Boston Common, the oldest public park in America, Mayor Michelle Wu and other leaders unveiled The Embrace, Hank Willis Thomas’s five-years-in-the-making monument to Martin Luther King and Coretta Scott King.* 

The huge bronze hug is 38,000 pounds and sits 22 feet high and 40 feet wide. Boston’s newest monument is inspired by a photo of the Kings hugging after Martin won the Nobel Peace Prize in 1964. The monument sits in an open circle with bench seating in the middle of Boston Common within another memorial, the new 1965 Freedom Plaza, which honors Boston civil rights activists.

The Kings had met as students in Boston and were married there in 1953. Among other things, the monument signifies the linkage between them in the civil rights struggles to which they each committed their lives. Coretta Scott King, in addition to being the wife of MLK, was also an artist, an activist, and a driving force who was by his side  doing the work with him, which she carried on after he was assassinated. She founded the King Memorial Center and never gave up fighting for a federal holiday honoring King’s legacy. Mrs. King’s efforts resulted in the federal holiday we now celebrate, when President Ronald Reagan signed the holiday into law in 1983; it was first observed three years later on January 20, 1986. In 1995, Congress designated Martin Luther King Jr. Day as the first and only federal holiday observed as a National Day of Service. Congress charged the Corporation for National and Community Service with leading this national effort.

All 50 states now recognize Martin Luther King day as a state holiday, South Carolina being the last in 2000. But when that happened, the South Carolina legislature also voted to create Confederate Memorial Day, which would be celebrated on the same day we honor King. And South Carolina is not alone. As Shoshana Gordon, Jacque Schrag and Russell Contreras report in AXIOS, “Ten states — all in the South — observe Martin Luther King Jr. Day plus at least one Confederate holiday.” This from the AXIOS report:

Arkansas, Georgia, Florida, Kentucky, North Carolina, South Carolina, Tennessee and Texas all have at least one day commemorating the Confederacy on other days of the year.

Mississippi and Alabama each celebrate a total of three Confederate holidays every year — Robert E. Lee Day, Confederate Memorial Day and Jefferson Davis’ Birthday — all paid holidays for state employees.

Many lawmakers in the ten states believe it is wrong to celebrate the confederate holidays, but nobody seems to want to propose legislation to repeal any of them. Now why would that be? Here is a map showing the states honoring the confederacy:

Of particular note is Tennessee with its three days honoring the confederacy. Why? Because one of them is Nathan Bedford Forrest Day (first observed in 1921). In honoring the confederate general and first Grand Wizard of the Ku Klux Klan, Tennessee Gov. Bill Lee’s (R) 2019 proclamation saluted a “recognized military figure in American history” and a “native Tennessean.”

In these ten states Martin Luther King is lumped in with slaveholders, secessionists and murderers. The whole thing just oozes a terrible irony, especially when you consider how King’s life ended―and where―Memphis, Tennessee.

Those states aren’t the only places where Dr. King gets little respect. J. Edgar Hoover’s FBI considered King “the most dangerous man in America” and conducted decades-long surveillance of him, surveillance encompassing more than 300,000 pages of documents.

Film director Sam Pollard chronicles Hoover’s efforts in his 2020 documentary, MLK/FBI. According to Pollard’s research and as reported on NPR:

The FBI campaign against King began with wiretaps, but quickly ballooned. When wiretaps revealed that King was having extramarital affairs, the FBI shifted their focus to uncover all evidence of his infidelity by bugging and taping him in his hotel rooms and by paying informants to spy on him. Eventually, the FBI penned and sent King an anonymous letter, along with some of their tapes, suggesting that he should kill himself.

Yes, like all of us walking God’s green earth, Martin Luther King had feet of clay. But he also had a heart as big as Texas and a passionate, life-long commitment to freeing his people from the chains of racism, a struggle that continues to this day, 163 years after the civil war’s first shot.

Were he alive today, King would probably be the first to acknowledge the tremendous strides made in the long journey for true equality in civil rights. He would also be the first to acknowledge how far away the last mile really is.

______________________________

*The Embrace has not won instant acclaim from everyone. In fact, there has been quite a bit of snarky criticism, some even calling the artwork “obscene.” It all reminds me of another monument, a memorial dedicated in late 1982—Maya Lin‘s minimalist Vietnam Veterans Memorial in Washington, D.C. When it first opened to the public, politicians, celebrities, regular citizens and, most important, Vietnam Veterans, lined up to criticize it. It became known as “the black gash of shame.” Well, 42 years later, veterans go to the Wall and weep as they see the names of their fallen comrades. It is embraced by all, as will The Embrace be more and more as time goes by.

A Midterm Reminder That Bears Repeating

Monday, November 7th, 2022

The Midterms are tomorrow, and, if you’re like me, you can’t wait for the campaigning to be over. The constant emails, texts and television ads will stop―for about a week, after which we’ll begin getting bludgeoned by the 2024 campaign. God help us all.

According to Bloomberg, the two political parties and their candidates will have spent nearly $17 billion to get elected, by far the most for any Midterm election in history. That’s more than the budgets of 14 US states.

Predictions are Republicans will win in the House, and perhaps the Senate, too. If they do, what will happen then?

In early April of this year I wrote about that when I analyzed Florida Senator Rick Scott’s Plan to Rescue America. Scott was the only Republican lawmaker willing to put a stake in the ground and tell America what the GOP would do when, at least in his mind, it inevitably came to power. At that time I thought his plan so outlandish and, to use a technical term, flat out wacky, it would die a quick death. I was wrong. By my count, the majority of Republican candidates, especially for the House, have been trumpeting, Trump-like, many of Scott’s prescriptions for “rescuing” America. And that’s not all. One of the things not in Scott’s manifesto is the myriad investigations the Republican-controlled House will begin immediately upon taking power to show the rest of America all the evil things done by President Biden and his fellow Democrats in the last two years. Impeachment will likely follow. This is not hyperbole, but it sure is scary.

Therefore, today I’m republishing the April analysis to give us all an idea of what might be in store for us over the next couple of years, and maybe beyond. Fasten your seatbelts.

Rick Scott Is Going To Rescue America!

Rick Scott is the junior U.S. Senator from Florida. Elected in 2018, Scott has now served in Congress for 39 months. In November, 2020, his Senate GOP colleagues elected him Chairman of the National Republican Senatorial Committee (NRSC). His job is to get Republicans elected and reelected to the Senate.

Prior to the Senate, Scott was a two-term governor of Florida, succeeded by Republican Ron DeSantis. Before that, he was a businessman. We’ll get back to that later.

You would think the Chairman of the NRSC would be lock-step with Republican leadership in the strategy to take the Senate from the tenuous hold of the Democrats in the upcoming mid-terms. But this does not appear to be the case. Senator Scott is marching to his own drummer.

On Thursday, after no consultation with or cooperation from Senate GOP elites, Scott officially unveiled and launched the Rick Scott, 31 page, 11 Point Plan to Rescue AmericaThe Rescue Plan has 117 agenda items.

This is not a surprise to GOP Senate Leader Mitch McConnell. Scott’s Plan has been discussed for more than a month, and as far back as 1 March McConnell publicly rebuked Scott for it. McConnell is fixated on making the mid-terms a referendum on President Biden, not on laying out a Republican plan he and the GOP establishment would have to spend the entire mid-term campaign defending. He wants Biden playing defense. Scott, on the other hand, wants America to know what Republicans will do if given control of the Senate. Right at the beginning of his Rescue Plan he says, “Americans deserve to know what we will do if given the chance to govern.” If Scott gets his way, now they will. And you have to hand it to him; he certainly doesn’t tap dance around the many issues facing the country.

Before diving into his 11 point, 117 agenda item plan, Scott lays out what the future will look like if nothing changes:

The militant left now controls the entire federal government…Among the things they plan to change or destroy are: American history, patriotism, border security, the nuclear family, gender, traditional morality, capitalism, fiscal responsibility, opportunity, rugged individualism, Judeo-Christian values, dissent, free speech, color blindness, law enforcement, religious liberty, parental involvement in public schools, and private ownership of firearms.

Holy Militant Left, Batman! We need a plan to stop all that!

A few of Senator Scott’s 117 agenda items, guaranteed to be saliva-producing red meat for the trumpiest of trumpsters caught my eye.  For instance,

We will secure our border, finish building the wall, and name it after President Donald Trump.

Kids in public schools will say the Pledge of Allegiance, stand for the National Anthem, and honor the American Flag. We must foster national unity.

Teacher tenure at public schools must be eliminated

We will not allow political or social indoctrination in our schools. Teachers who refuse to comply will need to find new jobs.

We will close the federal Department of Education. Education is a state function.

Government will not ask American citizens to disclose their race, ethnicity, or skin color on any government form.

Our military will engage in ZERO diversity training, teachings on critical race theory, or any woke ideological indoctrination that divides our troops.

We will force prosecutors to prosecute. At present, many prosecutors in big cities are allowing criminals to go free with no justice, and they are doing it on purpose.

Immigrants will not be eligible to collect unemployment benefits or welfare for the first 7 years after arriving in the US.

No government assistance unless you are disabled or aggressively seeking work.

If Congress does not pass a budget, the members of Congress do not get paid. Full stop.

Other than disaster relief, the federal government must stop spending money on non-essential state and local projects until the budget is balanced.

All Americans should pay some income tax to have skin in the game, even if a small amount. Currently over half of Americans pay no income tax.

Enact term limits for the Washington ruling class – 12-year limits for Congress and government bureaucrats.

All federal legislation sunsets in 5 years. If a law is worth keeping, Congress can pass it again.

We will immediately cut the IRS funding and workforce by 50%.

Humans are born male and female, there are two genders, and to deny that is to deny science. No government forms will include questions about “gender identity” or “sexual preference.”

We will protect women’s sports by banning biological males from competing.

No tax dollars will be used to pay for any diversity training or other woke indoctrination that is hostile to faith.

We will not pay any dues to the United Nations or any international organization that undermines the national interests of the USA.

The weather is always changing. We take climate change seriously, but not hysterically. We will not adopt nutty policies that harm our economy or our jobs.

There are a few difficulties with a number of these policy tectonic changes. Ending Social Security, Medicare and Medicaid in five years being among the biggest. Also, Scott’s colleagues in Congress might have something to say about going without pay and getting sent home after 12 years. Increasing taxes on 50% of Americans may prove challenging for Republicans on the campaign trail. Pulling billions of dollars from the states until we have a balanced budget might irritate a few Republican governors. And reducing the IRS’s funding and currently understaffed workforce by 50% would have brought tears to the eyes of mobster Al Capone.*

Although Senator Scott’s plan is dead on arrival, the problem is it arrived in the first place. It’s not about getting Republican senators elected; it’s about Rick Scott.

And what about Rick Scott? As I mentioned above, before getting into government, Scott was a “businessman.” He co-founded Columbia Hospital Corporation in 1987. Columbia later merged with another corporation to form Columbia/HCA, which eventually became the nation’s largest private for-profit health care company with Scott as Chief Executive. According to The New York Times, “[in] less than a decade, Mr. Scott had built a company he founded with two small hospitals in El Paso into the world’s largest health care company – a $20 billion giant with about 350 hospitals, 550 home health care offices and scores of other medical businesses in 38 states.”

Sounds good, right? Quite the businessman.

But there were problems. In March of 1997, the FBI, the IRS, and the Department of Health and Human Services arrived with search warrants. Four months later, Scott was forced to resign by his Board. He didn’t leave willingly, but when he did, he left with a settlement of $9.88 million and 10 million shares of stock worth $350 million. Columbia/HCA pleaded guilty to 14 felonies and agreed to a $600+ million fine in what was at the time the largest health care fraud settlement in U.S. history.

The company admitted to systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about use of hospital space. It also admitted to fraudulently billing Medicare and other health programs by inflating the seriousness of diagnoses and to giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. It filed false cost reports, fraudulently billing Medicare for home health care workers, and paid kickbacks in the sale of home health agencies and to doctors to refer patients. In addition, it gave doctors “loans” never intending to be repaid, free rent, free office furniture, and free drugs from hospital pharmacies.

And that’s not all. In 2002, HCA agreed to pay the federal government an additional $631 million, plus interest, and $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims. The entire fiasco cost the company $1.7 billion. Nobody went to jail.

All on Senator Scott’s watch.

There’s one last twist. In a civil suit deposition connected to the case (there were a lot of civil lawsuits), Senator Scott invoked his 5th Amendment rights 75 times.

Somehow, all of that has been forgotten, and Scott has managed to be a governor, a Senator, and, I’m guessing, a man, a businessman, who has his eyes on the biggest prize of all, the one up for grabs in 2024.

Rescue Plan, indeed.

*Capone was a nationally famous, Chicago-based killer and crime boss who went to prison in 1931 for tax evasion.

The Earth Is Moving Under Medicare And The Price Of Drugs ― But Slowly.

Friday, November 4th, 2022

Prologue

This is a story, 16 years in the making, of government-enabled corporate greed. It’s complicated and somewhat dense. It has to be to go on that long. It’s a story of how one industry, the Pharmaceutical industry, has done Olympian good while achieving Titanic profit, which has been surgically excised, Midas-like, from the hides of American taxpayers who never felt the touch. The story ends with a different way, a better way, but a way we common folk won’t likely see.

The story

Medicare Part D, a prescription drug benefit plan for Medicare beneficiaries, became law on 1 January 2006 under the George W. Bush administration and a Republican controlled Congress. The legislation was enacted with no funding provisions whatsoever. Since then, Washington politicians have been arguing over whether this government program should be allowed to negotiate with pharmaceutical companies the prices it pays for drugs its members need. Medicare beneficiaries, all 64 million of them, and the public at large, have overwhelmingly supported such a move. Over the years, pharmaceutical companies have spent a king’s ransom donating to politicians to secure―should we say “buy?”―their votes in opposition.

What’s been the result?

  • A study published recently in the Journal of the American Medical Association concluded more than a quarter (27.2%) of Medicare spending is now for prescription drugs;
  • That would be $180 billion, as reported by the Medicare Payment Advisory Commission for 2020;
  • According to the Kaiser Family Foundation, the total we in the US spent on prescription drugs in 2017 was $333 billion; and,
  • The Rand Corporation studied and compared US prices to 32 other OECD countries (The Organization for Economic Cooperation and Development – the most developed nations) and reported our prices are “nearly twice those of other countries after adjusting U.S. prices downward to account for rebates and other discounts paid by drug companies.”

And now, the gravy train may be slowing.

In August 2022, Congress finally passed―without a single Republican vote―and President Biden signed, the Inflation Reduction Act, which, among other things, allows Medicare to move forward with drug price negotiations―sort of. Right about now, you may be asking what prevented Medicare from doing that all along since 2006 as a normal part of its drug-purchasing process?

As the Kaiser Family Foundation explains:

Under the Medicare Part D program, which covers retail prescription drugs, Medicare contracts with private plan sponsors to provide a prescription drug benefit. The law that established the Part D benefit included a provision known as the “noninterference” clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [prescription drug plan] sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”

In other words, although Medicare is buying drugs for its members, all 64 million of them, it has not been allowed to even hint that a lower price might be more fair and appropriate for the government to pay. That is the very definition of a “sweet deal” for drug manufacturers.

Giving the negotiation contrarians the benefit of a doubt they more than likely don’t deserve, their argument in opposition hangs on the slim thread that negotiations will lower the income of drug manufacturers, and that will, in turn, reduce the amount of money the companies invest in research and development to discover new life-saving drugs. My own opinion is that this argument is chock full of what makes the grass grow green and tall. And, by the way, the Congressional Budget Office agrees with me, although their analysists said it with a bit more eloquence.

And what does the aforementioned Inflation Reduction Act do, anyway?

It does a number of things, one of which is to lay down new rules for price negotiations. These are its major health care provisions, leaving out, for the moment, the negotiation issue. It will:

  • Require drug companies to pay rebates to Medicare if prices rise faster than inflation for drugs used by Medicare beneficiaries, beginning in 2023;
  • Cap out-of-pocket spending for Medicare Part D enrollees and make other Part D benefit design changes, beginning in 2024;
  • Limit monthly cost sharing for insulin to $35 for people with Medicare, beginning in 2023. This might be the most far reaching and important item in the entire legislation.
  • Eliminate cost sharing for adult vaccines covered under Medicare Part D and improve access to adult vaccines in Medicaid and CHIP, beginning in 2023;
  • Expand eligibility for full benefits under the Medicare Part D Low-Income Subsidy Program, beginning in 2024; and,
  • Further delay implementation of the Trump Administration’s drug rebate rule, beginning in 2027.

Notice the years in which these provisions take effect. In most cases, it’s 2023.

The negotiation provision of the Inflation Reduction Act:

  • Requires the federal government to negotiate prices for some drugs covered under Medicare Part D and Part B* with the highest total spending, beginning in 2026. Note the year.

This provision targets the most expensive drugs. Here’s how.

Under the new Drug Price Negotiation Program, Medicare will negotiate the price of 10 Part D drugs for 2026, another 15 for 2027, another 15 for 2028, and another 20 for 2029 and later years. The drugs to be chosen for negotiation will be selected from among the 50 drugs with the highest total Medicare spending. The number of drugs with negotiable prices  will accumulate over time.

So, beginning four years from now, the law goes after the most expensive Medicare drugs.

There are debatable reasons for delaying implementation until 2026, all dealing with operational processes. The period of negotiation between the Secretary of Health and Human Services and manufacturers of the selected drugs will occur between 1 October 2023 and 1 August 2024, and the negotiated “maximum fair prices” will be published no later than 1 September 2024 and will go into effect 1 January 2026.

This seems to me a rather long and drawn out negotiation process, but it is, after all, a political compromise.

The better way

And now for the better way.

There is another government health care organization that has never had a prohibition with respect to negotiating drug prices. It is the Department of Veterans Affairs. The VA.

In January, 2021, the Government Accountability Office released a study that concluded:

“the Department of Veterans Affairs (VA) paid, on average, 54 percent less per unit for a sample of 399 brand-name and generic prescription drugs in 2017 as did Medicare Part D, even after accounting for applicable rebates and price concessions in the Part D program.”

This means what the VA pays is in line with those other 32 OECD countries.

Moreover, the GAO found that 233 of the 399 drugs in the sample were at least 50% cheaper in the VA than in Medicare, and 106 drugs were at least 75% cheaper. Only 43 drugs were cheaper in Medicare than in the VA.

What are the operational differences between the two organizations?

For one thing, the programs pay for drugs differently. Medicare reimburses the Part D plan sponsors to pay pharmacies through the middlemen―Pharmacy benefit Managers, but the VA buys drugs directly from manufacturers. It cuts out the middlemen. The VA can get lower prices because it can:

  • Negotiate as a single health system with a unified list of covered drugs; and,
  • Use discounts defined by law that Medicare doesn’t have.

As in everything political, it all comes down to economics. The VA, with only nine million health care beneficiaries, as opposed to Medicare’s 64 million, could fly under the political radar and avoid congressional restraint. It was able to keep the congressional camel’s nose and, more to the point, its sticky fingers out of its tent.

Medicare is so big, it could never do that.

And here we are.

______________________

*Medicare will also negotiate in a similar manner the prices of Part B drugs. These are drugs administered in physicians’ offices or hospital outpatient departments.

College Test Scores Have Declined For Five Straight Years. America’s Educational System Needs Fixing.

Thursday, October 20th, 2022

Over the last couple of years there have been significant incidents in the country and the world, all vying for space in one’s brain. We’ve seen the horror of the COVID 19 pandemic, the insurrectionist attack on the Capitol, the invasion of Ukraine by Russia under the direction of Mr. Evil Incarnate Vladimir Putin, All Things Crazy with Donald Trump and his cultish followers, the ongoing implosion of Great (maybe not so much anymore) Britain where Prime Minister Liz Truss resigned this morning (at 45 days in office, she was more like a tourist than a resident at 10 Downing Street), the upcoming Midterm elections with their sucking up enormous amounts of money for political spending (you could probably run a moderately-sized country with what the Democrats and Republicans are spending to buy, excuse me, win, this election), and a host of other important events, including what the World Health Organization and the UN label as a “catastrophic hunger crisis” in Haiti. Only an Ed Sullivan Plate Spinner could keep it all straight.

Consequently, one could be forgiven for not noticing a burgeoning crisis in American education, and I’m not talking about the culture things, like whether it’s alright to discuss Critical Race Theory in class, or ways to achieve diverse and inclusive practices. No, what I’m referencing is ACT college admission test scores dropping to their lowest level in more than 30 years.

As the AP reports:

The class of 2022′s average ACT composite score was 19.8 out of 36, marking the first time since 1991 that the average score was below 20. What’s more, an increasing number of high school students failed to meet any of the subject-area benchmarks set by the ACT — showing a decline in preparedness for college-level coursework.

The test scores, made public in a report Wednesday (12 October), show 42% of ACT-tested graduates in the class of 2022 met none of the subject benchmarks in English, reading, science and math.

The decline in test scores did not begin with the pandemic; they have been dropping for five consecutive years. COVID merely exacerbated the trend.

According to ACT (American College Testing), administrator of the tests for 60 years, in its report of this year’s results:

  • Approximately 1.3 million students in the U.S. high school graduating class of 2022 took the ACT test, an estimated 36 percent of graduates nationwide.
  • The national average Composite score for the graduating class of 2022 is 19.8, down from 20.3 for the graduating class of 2021, the lowest average score since 1991.
  • Thirty-five percent of the ACT-tested graduating class took the ACT more than once, as compared to 32% for the 2021 cohort.
  • Thirty-two percent of ACT-tested graduates in the class of 2022 met at least three out of four ACT College Readiness Benchmarks (English, reading, math, and science), while 42% of students met none, and 22% met all four.

Rose Babington, senior director for state partnerships for the ACT, said, “Academic preparedness is where we are seeing the decline. Every time we see ACT test scores, we are talking about skills and standards, and the prediction of students to be successful and to know the really important information to succeed and persist through their first year of college courses.”

ACT CEO Janet Godwin put it more bluntly. “The magnitude of the declines this year is particularly alarming. We see rapidly growing numbers of seniors leaving high school without meeting college-readiness benchmarks in any of the subjects we measure.”

According to Prep Scholar, which follows and charts average SAT scores over time, scores there have also declined, although their decline has been less acute than that of the ACTs. From 2006 through 2015, SAT scores dropped 34 points, falling in all demographic groups except Asian, Asian American, or Pacific Islander, where they rose, and Whites, where they remained steady. In 2017, the SATs were massively redesigned in an effort to make them more equitable. This led to significantly higher scores in all demographics except American Indian or Alaskan Native, where, by 2021, they had declined 36 points. During the same period, Black, or African American, scores jumped 75 points, and scores of White students were up 49 points to 934 and 1112, respectively.

But there has been no large redesign of the ACT test, so the picture there is less cloudy. We can draw conclusions with more certainty.

The latest results offer a lens into systemic inequities in education, in place well before the pandemic shuttered schools. COVID just made things worse. ACT’s Babington said, “The decline hit rural, low income and minority students of color the hardest.” You know, the ones whose parents can’t afford expensive college admission test tutoring. The ones who go to schools that don’t have anywhere near as much money to invest as schools in upper income neighborhoods and communities.

Can these inequities be fixed?

Sure, but it all comes down to money. Who has it and who doesn’t.

Schools nationwide require resources to operate and the cash to fund them. The way in which schools get their funding varies from state to state and district to district. But there are some funding principles that are relatively uniform throughout the country.

According to Education Week, public school funding comes from a variety of sources at the local, state and federal level. Approximately 48 percent of a school’s budget comes from state resources, including income taxes, sales tax, and fees. Another 44 percent is contributed locally, primarily through the property taxes of homeowners in the area. The last eight percent of the public education budget comes from federal sources, with an emphasis on grants for specific programs and services for students that need them. Traditionally, Americans desire to keep control of  schools at the local level, rather than a national one. Consequently, poorer states have less money to invest in education.

For example, the World Population Review reports Mississippi has the lowest median household income in the nation at $43,781, and annually ranks at or near the bottom in high school educational attainment. Compare that to Massachusetts, which has the third highest median family income (after the District of Columbia and Maryland) at $85,843, nearly double that of Mississippi.

You’d expect Massachusetts, with all that money, to rank high in public school education. And, you’d be right. As reported by WalletHub, which compared all 50 states across 18 metrics that examined the key factors of a well-educated population: educational attainment, school quality and achievement gaps between genders and races, Massachusetts ranks first for Educational Attainment and third for Quality of Education. Money talks.

There is a trend among colleges to no longer require testing for admission as they attempt to more equitably examine students applying for admittance, and the number of students taking the ACT has declined 30% since 2018, as graduates increasingly forgo college altogether. Some colleges, such as the University of California system, even opt for a test-blind policy, where scores are not considered even if submitted. Consequently, it’s possible the days of the ACT and SAT may be coming to an end. Nonetheless, the continuing decline in test scores is alarming to educators around the country. More worrisome is participation in the ACT among Black students plunged 37% this year, with only 154,000 taking the test.

Over the last few years, we have seen another problem emerge for public education. Grandstanding politicians have parachuted themselves into the nation’s classrooms in attempts to legislate what can be taught and how to do it. This has further muddied the country’s educational system, and it should stop right now.

It is the tallest of orders, but to remain globally competitive, we need to let educators educate and reexamine how we distribute the money necessary to let them do it. Anything less is a continuing disservice to our nation’s students, bound for college or not, who deserve the best we can give them as they enter adulthood.