Archive for the ‘Research’ Category

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

Thursday, February 9th, 2023

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

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

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

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

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

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

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

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

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

From the GAO study

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

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

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

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

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

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

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

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

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

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

Mississippi: Continuing To Lead From The Rear

Tuesday, February 7th, 2023

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

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

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

Medicaid expansion as of 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Consider deaths from COVID 19.

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

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

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

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

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

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

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

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

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

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

 

 

 

 

What’s The Truth About Violent Crime In America?

Friday, February 3rd, 2023

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

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

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

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

Reported violent crime in the US from 1990 to 2021

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

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

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

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

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

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

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

Why and how has the drop in violent crime happened?

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

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

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

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

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

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

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

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

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

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

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

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

Addendum

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

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

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

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

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

64.

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

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

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

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

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

Which is a scary thought.

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

 

Gun Violence: A Uniquely American Disease Devouring Our Soul

Thursday, January 26th, 2023

America suffered through 647 mass shootings in 2022, which is just a little better than the worst year on record, 2021, a year in which we saw 692 of them. In the last nine days, three mass shootings happened in California, killing 18 people. Thus far, in the first 26 days of 2023 there have been 40, which is more than any other January on record.

The 40 mass shootings in the the first 26 days of January resulted in 86 deaths. Although any death from gun violence is tragic, deaths from mass shootings make up a small percentage of all gun violence deaths. In 2022, there were more than 44,000 of them, 20,138 if you exclude suicides.  Through the first 26 days of January, there have already been 3,030 gun violence deaths nationally.   Here’s a map from the Gun Violence Archive* showing where all those deaths happened. Remember: It’s only 26 days.

If you extrapolate this for the full year, you’ll project more than 45,000 deaths. Now, mass shootings are not proxies for overall gun violence, but it could be instructive (and scary) to realize January is an historically low mass shooting month (relatively speaking).

How does America react to this continuing carnage? It yawns.

Oh, we hear from the politicians with their “thoughts and prayers” routine and go through the required few hours of television coverage (TV’s Mantra: “If it bleeds, it leads”), but after that we slip back into our desensitized cocoons. Most of the mass shootings go unnoticed. At 1.77 per day, who can keep up?

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, there should be such a law.” 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.” Credit the NRA. It has done a magnificent marketing job.

Since 1959, when Gallup also reported 78% of Americans believed 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 ownership and violence. The result is what we have today. Forty-five percent of all households now own at least one handgun. US gun owners possess 393.3 million weapons, according to a 2018 report by the Small Arms Survey, a Geneva-based organization. That is at least 60 million more guns than there are people. It is no surprise gun deaths routinely exceed the number of deaths due to auto accidents.

And it only got worse after Americans went on a gun buying spree beginning in 2020. The National Instant Criminal Background Check System, which the FBI collects, is a significant indicator of firearms purchases. It is noteworthy that background checks jumped 40% in 2020 from the previous year to 39.7 million checks. The frenzy only cooled slightly to 38.9 million checks in 2021.

Where do all those guns come from? Why, from the 71,600 federally licensed gun dealers operating nationwide, of course. That’s more than 1,400 per state.

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.”

I, like many others smarter than I, have written about this often. It almost seems as if it’s an annual requirement in which we fulfill Albert Einstein’s (possibly misattributed) definition of insanity: “Doing the same thing over and over again expecting different results.”

A University of Washington 2015 study found three million Americans carried a loaded handgun daily; nine million did so at least once a month. Since then, 19 states have passed permitless carry laws, which allow residents to carry concealed handguns in public without a license. There are now 25 states that allow this. If all this weren’t bad enough, only 18 states require “live-fire training” for people carrying concealed firearms.

Is gun violence evenly distributed around the country? Actually, no. It is far more prevalent in red states. These are the states with “stand your ground” statutes and permitless concealed carry laws. Once again, Mississippi leads the way with 28.6 gun violence deaths per 100,000 persons.

Firearm Mortality by State

Compared to the rest of the developed world, every one of our firearm statistics are staggeringly out of whack. As I reported in May of 2022, the US dwarfs the 28 most economically developed countries in the 38-member OECD** in deaths by firearms. Not only is our firearm death rate nearly 25 times higher than our OECD companions, our total homicide rate is eight times higher. Can’t get away from it. We are a violent society.

It’s not much, but there is one ever so tiny glimmer of light invading the darkness of firearm carnage in America. That would be the Bipartisan Safer Communities Act, signed into law by President Biden in June, 2022. This is the first major gun reform law in three decades. It includes $750 million in funding for states to improve or enact red flag laws and other crisis intervention programs, $250 million for community-based violence intervention initiatives, and $200 million for improving the national background check system. Millions more will go to school safety, police, and mental health programs.

Gun violence is a cancer eating away the heart and soul of America. It is amazing to realize that, despite the never-ending bloodbath, the country has managed to survive, prosper, thrive, and lead the world in so many areas.

Amazing, indeed.

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*The Gun Violence Archive is a nonprofit research group that tracks shootings and their characteristics in the United States. It defines a mass shooting as an incident in which four or more people, excluding the perpetrator(s), are shot in one location at roughly the same time.

**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.

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).

 

 

A Few Items To Ponder, Two Of Them Important

Wednesday, November 30th, 2022

Type 1 Diabetics get good news

As I have written before, Type 1 diabetes (T1D) is a horrific disease. It is a leading cause of stroke, heart disease, blindness, kidney disease and non-traumatic amputations. It also costs a lot to manage. The media has been full of stories of unfortunate people who have had to choose between taking insulin or food. The Inflation Reduction Act, passed in August, caps the cost of a vial of insulin at $35 for Medicare beneficiaries, but does nothing for diabetics not on Medicare. About 70% of the nation’s 1.9 million Type 1 diabetics are on Medicare.

Research has proven Type 1 diabetics contract the disease in three stages over time. According to a 2015 study on the presymptomatic stages of Type 1 diabetes:

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease.

Type 1 diabetics go through two stages of disease development before full-blown diabetes appears in Stage 3. Imagine a platform diver. Stage 1 is climbing to the platform and standing at the edge. Stage 2 is lifting off and moving through the air. Stage 3 is hitting the water and getting very wet. Diabetics don’t know they have the disease until they hit the water. But what if they did, and what if the time in the air between the platform to the water could be extended, say by 25 months?

On 17 November, the FDA approved a biologic therapy that delays the onset of Stage 3 by about that much.

The monoclonal antibody teplizumab, which will be marketed under the brand name Tzield, from ProventionBio and Sanofi is given daily through intravenous infusion over two weeks. And it works. Patients who take it extend Stage 2 by a little more than two years.

But there’s a catch, two, in fact. First, PreventionBio announced last week it is pricing Tzield at $193,900, which is considerably higher than insurers anticipated. Second, how does a person know they’re in Stage 2 and, therefore, should be taking the drug? The answer is screening for autoantibodes that are markers for diabetes. This will also incur a cost. More about that below.

The question to be answered is will insurers cover the considerable cost for screening and drug infusion?

In 2014, the FDA approved Harvoni as treatment for Hepatitis C, which is the leading cause of liver failure. Hep C is a life-threatening disease. Harvoni cured it. Completely. Its maker, Gilead, priced the pill at $95,000 for a twelve-week course of treatment. At the time, I was a Director at a Boston HMO. We wrestled with the cost issue. In the end, because Harvoni cured what was a horrific and terrifically costly disease, we gladly decided to provide it for our members.

Tzieild is different. It does not cure diabetes. Rather, it delays its onset. The American Diabetes Association and the Juvenile Diabetes Research Foundation (JDRF) are ecstatic about the arrival of Tzield. They point out this is the first time a successful treatment for diabetes has appeared on the scene, although it’s not really a treatment. However, they’re concerned about the screening issue.

Aaron Kowalski, CEO of JDRF, says the main challenge in prescribing Tzield will be finding people who need it. The drug is approved for people who don’t have any symptoms of the disease and may not know they’re on the road to getting it.

“Screening becomes a really big issue, because what we know is, about 85% of type 1 diagnoses today are in families that don’t have a known family history,” Kowalski said. “Our goal is to do general population screening” with blood tests to look for markers of the disease.

It will be interesting to learn how insurers and health plans react to Tzield. According to the JDRF, 64,000 people a year are diagnosed with Type 1 diabetes. If every one of them received the drug the total cost would be about $12.5 billion. But if you were one of the 64,000, my guess is you’d happily stand in line for it. So would I.

Donald Trump and the Mar-A-Lago fiasco

By now, every sentient person in America knows ex-president Donald Trump dined last week with Nick Fuentes, the poster child for anti-Semitic white nationalism, and Kanye West, who now calls himself Ye and has also spouted anti-Semitic whinge. Afterwards, when social media lit up like the Rockefeller Center Christmas tree, Trump claimed he didn’t know Fuentes was going to be there; West just brought him along.

Putting aside the fact that Trump’s Secret Service detail would never in a month of Sundays allow just anyone to drop in to break bread with the big cheese without getting clearance from the big cheese himself, I’m more concerned with the response of the Republican Party’s leadership to this. Republicans who are likely to run for President, notably Mike Pence and Chris Christie, criticized their former leader, although it took them two or three days to do it. It took more than a week for anyone in Republican leadership to put their wet finger in the air and decide to say he shouldn’t have done it.

The stench wafting from the halls of Congress is remarkable, indeed.

A personal note

Starting tomorrow I shall be away from this, and any other, keyboard for a little bit.

Since I was eight years old, I have been an avid, competitive, pretty good, tennis player. I’ve calculated that in the intervening years I have hit somewhere around just under a million overhead smashes. That’s a lot of serves and put-aways. And they have taken their toll. So, at 7:00 AM tomorrow morning, a very good doctor (I hope) will be concentrating deeply (I hope) on the job of giving me a new shoulder. I’m told it will be a little painful for a while, but on the other side lies bliss, and more overheads.

I look forward to being back at the keyboard.

The Role Of Religion In Our Divided America

Wednesday, November 2nd, 2022

Everyone who follows the political winds in the US is laser-focused on the upcoming midterms, which are six days from now. Most prognosticators expect Republicans to end up controlling the House of Representatives, and maybe the Senate, too. While that is certainly possible, perhaps even likely, if we look out farther into the future, the picture is decidedly less rosy for the Grand Old Party.

Stay with me as I try to explain why.

According to the Public Religion Research Institute’s American Values Survey, which provides insight into the beliefs of most of the nation’s faith groups, nearly three in four Americans (74%) say things in this country are going in the wrong direction, and 49% say things were better in the 1950s. That’s right, the 1950s when a third of the country, 51 million people, still had to use outhouses, a cancer diagnosis was a death sentence, rotary dial phones were how we communicated, and Jim Crow was alive and well and on the march. Sixty-six percent of Republicans believe our culture and American way of life have deteriorated since then. Thirty percent of Democrats feel the same way. PRRI sums up its September 2022 Values Survey this way:

Approximately three-quarters of Americans agree that the country is heading in the wrong direction, but there is considerable division over whether the country needs to move backward — toward an idealized, homogeneous past — or forward, toward a more diverse future. Though most Americans favor moving forward, a sizable minority yearn for a country reminiscent of the 1950s, embrace the idea that God created America to be a new promised land for European Christians, view newcomers as a threat to American culture, and believe that society has become too soft and feminine. This minority is composed primarily of self-identified Republicans, white evangelical Protestants, and white Americans without a college degree. The majority of Americans, however, especially younger Americans, the religiously unaffiliated, and Democrats, are more likely to embrace a competing vision for the future of America that is more inclusive.

When examined in concert with PRRI’s 2020 Census of American Religion, a pattern emerges that does not bode well for Republicans.

In 1996, 65% of Americans identified as white and Christian; that number is now 43%, down nearly a third. Sixty-eight percent of Republicans identify that way. Twenty-nine percent of Republicans are white evangelicals. The problem for Republicans is white evangelicals now make up just 14% of the total population. That is down significantly from 23% in 2006. The following chart depicts religious affiliation by age. It also shows vividly that white evangelicals, the rock solid foundation of the Republican party’s base, and to a lesser degree mainline protestants, are aging out of the population. They are being replaced by people unaffiliated with any religion.

Unfortunately for the Republicans, the unaffiliated are predominantly Democrats.

The PRRI data also shows younger generations, especially 18 to 29 year-olds, more often identify as Democrats than Republicans, which should be good news for the Democrats. The problem lies in getting them to vote. Seventy percent of Republicans say they are very or somewhat excited about voting next week. For the Democrats that number is only 64%.

One more startling point from the PRRI Values Survey. Among a host of other issues, the PRRI researchers asked about QAnon, and this is how they framed the subject:

To measure the scope of the QAnon movement, PRRI tracks agreement with three statements that form the core tenets of the conspiracy theory:

  1. The government, media, and financial worlds in the U.S. are controlled by a group of Satan-worshipping pedophiles who run a global child sex-trafficking operation.

  2. There is a storm coming soon that will sweep away the elites in power and restore the rightful leaders.

  3. Because things have gotten so far off track, true American patriots may have to resort to violence in order to save our country.

PRRI labels people who believe all three statements to be true as QAnon Believers. It may shock you to learn QAnon Believers now comprise 19% of the population. It may shock you even more to learn the number jumped five points in the last year. You might want to think about that.

What I take away from all of this is Democrats have a solid opportunity to take command looking out into a somewhat distant future, but they may first have to walk through the valley of death to get there. Republicans, on the other hand, will continue to yearn for “the good old days” of white isolated and insulated America. They may win next week, but that just might be the beginning of their collective swan song, a swan song the Chad Mitchell Trio suggested nicely way back in 1964 with Barry’s Boys, their white-hot roasting of Arizona Senator and that year’s Republican presidential candidate Barry Goldwater:

I wanna go back to the days when men were men
And start the First World War all over again
Back to Barry
Back to Cash and Carry
Back to Barry’s Boys.

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.

 

Racism In America: The Road To The New Jim Crow Runs Along The School To Prison Pipeline

Thursday, September 29th, 2022

The story of mass incarceration in America is bigger than American jails and prisons, even with their two million captives. And it’s bigger than probation and parole, even with the five million people held in the prison of their homes through ankle bracelets, weekly drug tests and GPS technology.

Thus, Reuben Jonathan Miller writes in the Introduction to his book Halfway Home: Race, Punishment and the Afterlife of Mass Incarceration, published by Little, Brown and Company in 2021.

Today, 19.6 million people live with a felony record, four times the size of the population on probation and parole and ten times the size of the American prison census. One-third of those people are Black. More impressive is that one-third of currently living Black American men have felony records.  Think about that for a moment. And then ponder that the number of Black women behind bars is eight times greater today than in 1980.

Since the early 1970s, we have been incrementally putting Black Americans in a crime box. Today, as Miller writes, “An entire class of people are presumed guilty of some unspecified crime long before they break a law.” Does the phrase, “Driving while Black” ring a bell?

This week, in a new study from the National Registry of Exonerations, we learn Black Americans are seven times more likely than white people to be falsely convicted of serious crimes, and spend longer in prison before exoneration.

The study examined defendants who were exonerated after serving at least part of a sentence — sometimes spending decades in prison. From the study’s findings:

  • Black people represent 13.6% of the American population, but account for 53% of 3,200 exonerations in the registry as of Aug. 8, 2022;
  • Innocent Black Americans were 7½ times more likely to be convicted of murder than innocent white people; and,
  • The convictions that led to murder exonerations of Black defendants were almost 50% more likely to include misconduct by police officers.

Most of those long-serving Black defendants were exonerated by a handful of big city prosecutorial conviction integrity units (CIUs). It appears they have only scratched the surface.

How did this happen? One reason is because of the well-maintained “school to prison pipeline.”

Beginning in the 1970s, educators figured out that kids acting out in school could seriously disrupt learning for their classmates. What to do? The answer? Suspend them. And that’s what happened. It started with a trickle that slowly turned into Niagara Falls. And the kids most often suspended were Black, followed by Latino.

According to the U.S. Department of Justice, which last year ordered school districts to respond to student misbehavior in “fair, non-discriminatory, and effective” ways, Black students are suspended and expelled at a rate three times greater than White students, while Black and Latino students account for 70 percent of police referrals.

The bias—racism—starts young. Black children represent 18 percent of pre-school students, but account for 48 percent of pre-school suspensions. Yes, we’re talking about 4-year-olds. Also, students with disabilities are twice as likely to be suspended than their non-disabled peers, and LGBT students are 1.4 times more likely to face suspension than their straight peers.

According to the National Education Association,

According to research, Black students do not “act out” in class more frequently than their White peers. But Black students are more likely to be sent to the principal’s office for subjective offenses, like “disrupting class,” and they’re more likely to be sent there by White teachers, according to Kirwan Institute research on implicit bias. (White students, on the other hand, are more likely to be suspended for objective offenses, like drug possession.)

The Kirwan Institute blames “cultural deficit thinking,” which leads educators to “harbor negative assumptions about the ability, aspirations, and work ethic of these students—especially poor students of color—based on the assumption that they and their families do not value education.” These racist perceptions create a stereotype that students of color are disrespectful and disruptive, which zero tolerance policies exploit.

You can follow all this like a bright red rope in the snow. For some kids, Black especially, going to school leads to suspensions, which leads to staying out of school, which leads to questionable behavior, which leads to incarceration, which leads to a wasted life.

The Kirwan Institute calls this “implicit bias.” I call it implicit racism.

But it’s not all doom and gloom. Many educators now realize they have been feeding the lion, rather than helping the student. In Colorado, for example a new law restricting the use of suspensions and expulsions has resulted in suspensions falling by 25 percent, while school attendance and punctuality have improved by 30 percent.

In Maryland’s Montgomery County Education Association, the superintendent and teachers put together a new student code of conduct that minimizes suspensions and allows students to learn from their mistakes. Meanwhile, other districts have signed “memorandums of understanding” with local law enforcement agencies that keep minor offenders out of criminal courts.

This represents progress, but progress only in a few places. The national school to prison pipeline still runs strong. And there is resistance to shutting it down.

Consider the tremendous efforts underway in red states to tamp down, even eliminate, discussion of race in schools. A bizarre and almost unbelievable one comes from Florida where, in April, Governor Ron DeSantis’s Education Department banned (they say “rejected”) 54 math textbooks, out of 132 submitted by publishers for the next school year. According to the  Department of Education, 26 of those math textbooks were rejected because they contained “prohibited topics,” including Critical Race Theory (CRT) and Social-Emotional Learning (SEL). 2+2 = Racism?

CRT is a graduate-level academic framework which explores “laws, policies, and procedures that function to produce racial inequality.” This is sometimes referred to as “structural racism.” It is not something you typically find discussed in a K-12 math textbook. In fact, it’s not typically addressed in K-12 at all.

Florida Commissioner of Education Richard Corcoran said the math textbooks were rejected because children deserve “a world-class education without the fear of indoctrination or exposure to dangerous and divisive concepts in our classrooms.” The Department’s announcement, showed how much DeSantis controls things when it included this quote from him: “It seems that some publishers attempted to slap a coat of paint on an old house built on the foundation of Common Core, and indoctrinating concepts like race essentialism, especially, bizarrely, for elementary school students.” Wow! I had no idea math could be so divisive. Stupid me.

The Department’s announcement also carried this jewel:

“We’re going to ensure that Florida has the highest-quality instructional materials aligned to our nationally-recognized standards,” said Commissioner of Education Richard Corcoran. “Florida has become a national leader in education under the vision and leadership of Governor DeSantis. When it comes to education, other states continue to follow Florida’s lead as we continue to reinforce parents’ rights by focusing on providing their children with a world-class education without the fear of indoctrination or exposure to dangerous and divisive concepts in our classrooms.”

“Nationally recognized standards?” “National leader in education?” “World-class education?” This proved too big to resist.

Intelligent.com publishes annual state rankings of K-12 education drawing upon key metrics related to performance, safety, community, investment, class size, and attendance for all 50 states and the District of Columbia. Where does “national leader” Florida rank in the latest analysis? Smack dab in the middle of the pack. Number 27 in academic performance and number 25 in overall performance. In no area does Florida rank in either the top five or the bottom five. That is the definition of mediocre.

I’m happy to say that my Commonwealth of Massachusetts, which DeSantis considers a socialistic state, ranked Number 1 in the latest rankings.

One last point about those math textbooks banned in Florida. Judd Legum and his team at Popular Information, a site with which I am becoming fonder by the day, bought the banned books and read them all. Try as he and his team might, they could find nothing objectionable in any of them. I mean, it’s math!

Once again, Governor DeSantis flexes his imagined Popeye muscles to push his personal, ambitiously political agenda rather than  objective truth. Meanwhile, the school to prison pipeline remains alive and well and continues to throw Black kids off the educational cliff into the oblivion below.

While we feel great empathy and sympathy for our fellow citizens weathering Hurricane Ian in FLorida, the DeSantis paranoia about any of Florida’s children learning about and actually studying the history of racism right up to the present jacks us back into a more sophisticated, but still real, still deadly, Jim Crow South.

 

 

 

 

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

Tuesday, August 23rd, 2022