We are finally getting down to business; that is the lives Americans are leading in the richest country on earth.

To pick up The Letter's thread about Mississippi:

‘Every Medicaid expansion bill dies without debate or vote’

‘More than 15 bills that would have expanded Medicaid to provide health care coverage to primarily the working poor died on Tuesday night without debate or a vote.’

‘No committee chair in either the Senate or House held a hearing on those Medicaid expansion bills. The House Medicaid Committee, where Speaker of the House Philip Gunn assigned all of the his chamber’s expansion bills, did not even meet a single time before the Jan. 31 deadline to consider general bills.’

‘Legislative leaders killed the bills as a worsening hospital crisis grips the state and Mississippi continues to be among the unhealthiest states with the highest percentages of uninsured residents.’

‘State Health Officer Dr. Daniel Edney told lawmakers in late 2022 that 38 hospitals across the state are in danger of closing, and all are facing financial hardships. ‘Physicians and hospital leaders have said expanding Medicaid, which would result in more than $1 billion annually in additional federal health care dollars coming to the state, would help hospitals pay their bills. Beyond just helping hospitals, expanding Medicaid would provide health care coverage to many more Mississippians — up to 300,000, according to some studies.’

‘But many in the Republican leadership of the state, primarily Gunn and Gov. Tate Reeves, have been adamant in their opposition to expanding Medicaid as 39 other states have done, including many led by Republican politicians.’

‘Meanwhile, data shows that support for Medicaid expansion is growing among voters. A Mississippi Today/Siena College poll conducted in early January indicated that the vast majority of the general public, including 70% of Republican voters, favor expansion.’ (MississippiToday)

READ MORE: Poll: 80% of Mississippians favor Medicaid expansion

'As hundreds of thousands of working Mississippians struggle to afford healthcare, state lawmakers have again decided not to consider Medicaid expansion and do not seem poised to do so anytime soon.'

'States have had the option to expand Medicaid eligibility to most people with incomes under a certain level — about $30,300 annually for a family of three — since 2014. Mississippi remains one of 12 states not to expand despite profound financial benefits and an increased federal matching rate under the American Rescue Plan Act of 2021.'

PS Take a look at the mortality rate for Americans.

'The Number One Health Story From 2022 Is The Troubling Decline In Life Expectancy'

'The biggest health story from 2022 isn’t Covid-19. It isn’t RSV or influenza, either. It isn’t cancer, diabetes, or cardiovascular disease. It’s something that encompasses all these diseases and much more. It’s the troubling decline in U.S. life expectancy.'

'Life expectancy in the U.S. is at the lowest point in 26 years. To solely blame this on Covid-19 is wrong. U.S. life expectancy was stagnant between 2012 and 2019. And, prior to 2012, beginning around 1990, the upward slope was much flatter in the U.S. than any of our peers. Washington DC, we have a major life expectancy problem that needs to be taken much more seriously.'

'This is not about healthcare expenditures per se. The U.S. spends much more per-person on healthcare than any other large wealthy country, yet its residents die an average of at least four years younger. For decades the gap has been widening. This damning statistic “never seems to sink in with the public and policymakers.” (forbes)

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The greatest danger to this country is the imbecilc, retrograde republican party and climate change.

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So, Pence and you other Republicans, how are we doing? Do you give a _ _ _ _?

'U.S. has lowest life expectancy among its peers.


'Healthcare isn’t the only determinant of life expectancy. But it’s certainly a key factor. Here, affordability, and availability are much greater problems in the U.S. than our peer nations.

Apart from having a fragmented system, there’s government lassitude when it comes to public health issues. Take one example of how the federal government’s myopia gets in the way of having a rational approach.'

'In 2022, Covid-19 persists as the third leading cause of death. Nonetheless, the U.S. government has decided to drastically reduce its Covid-19 preparedness, even as a massive surge is underway throughout China, which could have far-reaching implications outside its border. Congress’s recently passed Omnibus bill has no new funds for Covid-19 vaccines, testing, and treatments.'

'The laundry list of neglected areas in U.S. public health is long. Below is an enumeration of just some of the issues that U.S. public health is faring poorly on.'

• Obesity, for example, is a public health crisis in this country, to an extent not observed among our peers. The correlations between obesity and many diseases is well established. These include diabetes, cardiovascular disease, stroke, hypertension, and cancer. Wegovy (semaglutide) and other newer weight loss agents will help. But, none are elixirs. And, to be effective they all require a concomitant concerted effort at diet control and exercise. Moreover, obesity prevention is critical. While genetic predisposition to obesity can be a factor, diet and exercise can counteract that propensity. But, judging by federal investment in nutrition research, the federal government appears indifferent. The share of federal research dollars allocated to nutrition has stayed largely flat for at least 30 years. Funding for nutrition research by the National Institutes of Health and the Department of Agriculture - the two largest entities to fund nutrition studies - pales in comparison to many other areas of research.

• The U.S. is the only industrialized nation in the world where maternity mortality is rising. And, the U.S. already has nearly the highest maternal mortality rate among high-income countries. Yet, incomprehensibly 17 states refuse to cover postpartum care through Medicaid.

• Gun violence is a public health issue in the U.S. For purely political reasons it’s never addressed head on in Congress. After each mass shooting incident - more than 660 occurred in 2022 - “thoughts and prayers” ring hollow. Yet, an offering of thoughts and prayers is the most that many in Congress do in response to gun-related deaths.

• Underinsurance is a public health issue in the U.S. when people with health insurance still can’t afford to use healthcare. And it’s more than just accessing prescription drugs. Mental healthcare coverage, for instance, is deficient in the U.S.

• Illicit fentanyl is currently the biggest public health issue in the U.S. Yet, the federal and state policy responses have been and continue to be woefully inadequate.

Let’s hope we Americans begin to care more about life expectancy and public health in 2023. But it’s unrealistic to think we will. Part of this is politics. As mentioned in my predictions for 2023, many politicians have railed against public health for years, and appear determined to undermine whatever authority is left in our public health agencies. But, part of the problem is the outsized role of money and profits in our healthcare system. There’s simply not enough money to be earned in public health. And money drives healthcare in the U.S. to a degree that is unparalleled among our peers; from investment and research funding decisions to the the vested interests of important stakeholders.

From the drug industry’s perspective, investments must be made in therapeutic areas where the chances of clinical, regulatory, and commercial success are comparatively high. This generally does not include public health focused areas such as drug addiction, bacterial infections, and even cardiovascular disease. So, despite the fact that women have a tenfold greater chance of dying from heart disease than breast cancer, there’s much less funding in cardiovascular health (for men and women) than breast cancer.' (Forbes) For more on this subject, see link below.


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I really have trouble trying to figure out how Pence ever got to his age being so stupid. What an idiot. He actually believes that 5th grade pap.

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“Biden told his audience that ‘once every three, four, or five generations, there’s a fundamental shift in world politics and national politics’ and that we are in such a shift now.”

If we aren’t careful, the middle class will be gone and we will be ruled by a class of totalitarian “elites”!

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"Literally give younger Americans the ability to take a portion of their Social Security withholdings and put that into a private savings account."

Having all but destroyed pensions in the private sector the money grubbers are coming for social security. Pence lays it out here: they'll turn it into a 401k like plan under the guise of being a "personal account you control". There will be no guaranteed funding. Make no mistake this is intended to turn our , collective social security over to the Wall Street investment "community".

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Do we need any more evidence that the courts have lost their humanity? The decision by the 5th circuit is simply cruel. It will cause unneeded deaths unless it is reversed, but there is little hope of that.

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Great Post!!!

It would be an interesting experiment in one of the more progressive states to prevent corporations such as Amazon from using the "Socialism" derived benefits that their owners do not want to pay their fair share of. The point would soon get out that we perhaps need a little of what they call "Socialism". And that they need to pay their fair share of it.

Where would Amazon be if they had to build their own roads, instead of the ones that everyone pays for? Good luck with that.

Drones? That would require licensing by the FAA, another "Socialist" benefit that they do not want to pay for.

Electricity or Water? Although much of this is privately produced this is done with the public blessing, and community owned right-aways. Forget about any power or water from any public utility.

What is most frustrating is that the Republican narrative succeeds in convincing their belief base that the progressives and the policies are the root of their problems, as the Republicans and their corporate handlers rip off everyone. Its a masterpiece of projection and larceny that they have been getting away with for far too long.

I am glad I do not live in Florida.

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Sad news from Mississippi. Rural hospitals also failing in MO despite this: the good people of Missouri, including my suburban Republican parents, passed a ballot in 2020 that « directed the expansion (of Medicaid) to be in effect by July 1, 2021, the legislature excluded expanded coverage from its fiscal year (FY) 2022 budget and the circuit court judge held that the state was not required to implement.» Voters overwhelmingly said yes to expansion but the GOP governor and cronies have blocked its implementation. How many other states have actively blocked voter’s choices on healthcare? I haven’t done deep research on all states but the scariest part of this to me is the GOP, set on defying voter’s intentions, is using the courts to negate our democratic elections. How do we change that?

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Feb 4·edited Feb 4

The Stern's article in Slate (https://slate.com/news-and-politics/2022/11/democratic-senate-majority-trump-biden-judges.html) is cited and highlighted at the end of today's Letter, but perhaps it is taken a bit out of context.

The main goal of the Slate article is to implore Democrats to appoint judges and stop dithering and dinking in doing so. (Read it, all of it, at the link above.) The part cited from the article is simply some evidence to support the urgency to stop the dithering and dinking in appointing ethical judges, and that evidence was focused on gun safety by removing possession of guns from domestic abusers.

Well, WHO are the abusers? We've known this for years. Both parties have known this for years. We don't need the smokescreen the court is using to know why they will not remove current guns from current domestic abusers. The reason they will not do so is because removing guns from domestic abusers could disarm up to 40% of the force the political forces in our history recruited and militarized largely to protect property, including the slaves of the wealthy merchants and land owners. (Look up origins of policing in the USA. I believe that is the actual historical precedent the courts seek to maintain.) The original historical purpose of creating police to protect wealth and privilege simply broadened over the decades to protect property and control citizens that might otherwise organize against oppression.

Now as to where the abusers are located: https://browardcriminallawyer.com/2016/07/what-profession-has-the-highest-rate-of-domestic-violence/

"We have seen some disturbing stories in the media in recent years about professional football players charged with and convicted of domestic violence. Close to half of Americans believe that athletes should be banned permanently from the National Football League for these crimes. However, in fact, the rate of domestic violence among NFL players is 45 percent below the national average. So which occupation has the highest rate? That would be police officers. Studies have found that a minimum of 40 percent of families of officers have experienced some type of domestic violence. This can include anything from harassment and stalking to homicide. That’s well above the 10 percent of the population as a whole."

In most years, institutionalized violence of police kill more citizens than do the highly publicized aberrant violence of mass shooters. (The medical journal Lancet recently reported that the 1000 to 1200 police killings commonly reported by corporate media is only about half of the actual killings.) The actual number may be closer to between 2000 and 2500. https://time.com/6102324/study-police-killings-significantly-underreported/

And not coincidentally today, the DNC of the Democratic Party refused to allow a vote or any discussion on the proposal to get dark money out of politics, thus seeming to act consistently with the right wing Republican courts prioritizing the interests of the wealthy property owners to buy government by buying political parties. https://www.commondreams.org/news/dnc-blocks-dark-money-ban However, government and corporate mainstream media sought to divert our attention from both and focus the issue of the day on the Chinese threat posed by a balloon over Montana.

This was not a good day for American citizens, at least those of us who are working class Americans.

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I must have understood this wrong. It is the right of the abuser to keep

his gun even though his wife’s life is in danger by him. Hmmm sounds like a safe secure home for children to grow up in. I wonder why we have mental health issues? Abusive families perpetuates abuse for generations. Supporting gun rights is destroying our society. Sandy Hook parents have done a great job of communicating this. When will the lawmakers get this? After years of working in the mental health field Maslow’s theory of basic needs being met is still true. We all need shelter, food, nurturing, and Safety.

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Republican say "They believe that cutting taxes to enable those at the top to accumulate wealth will enable them to invest their money in businesses, creating more jobs. Wealth will trickle down, and everyone will do better. "

Where and when has anything like this ever come to pass on a broad scale and sustained basis? If there is, I don't recall anyone pointing to it. It's just another big lie. Where do the giveaways to the 1% end up? Stock buy backs? Shooting cars into space? Panama Papers, Pandora Papers,Paradise Papers?? When the ultra wealthy and deregulated buy everything is sight, and major company after major company fall over the event horizon of super massive corporate black holes, does that create jobs or "downsize" them? Offshoring? Gig employment? Retirement benefits? Cost of higher education? Jobs that pay so little that full time workers qualify for "food stamps"? Trickle down or torrent up? It's anti-democratic, anti-social justice and it's BS.

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This is brilliant letter and so clearly states the key issues of today and the future. It’s no wonder that Abraham Lincoln saw the Declaration of Independence in its clearly stated principles as a roadmap of goals of the development of the Constitution, not as a slab of stone with rules but a living document. The 2nd amendment is perhaps the most misinterpreted amendment in our system of government . At the time of its writing we only had muskets and single shot pistols. By the time someone threatened to shoot you could be in the next county. As I recall the Founding Fathers ( there should have been founding mothers) did not wear AK15 pins. Regarding Mike Pence and the privatization of social security, it’s just another way of pushing money to the rich. During the 1968 conventions one of the major news outlets featured commentary of a debate between the Author Gore Vidal and William Buckley Jr.. when William Buckley brought up the trope of Democrats believing in Socialism Gore Vidal responded that the Republicans in their pursuit of tax cuts were pushing Socialism for the rich. Every time I hear the term “States rights” I see slavery and the confederate flag. It’s early morning , I am ranting….sorry!

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The phrase “race to the bottom” comes to mind

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I recall privatization of Social Security raised its ugly head during the Bush 43 administration. Has anyone ever thought to model a theoretical privatized retirement plan and how it would compare to what people receive today with SS? Don’t you think that would provide some means of moving the conversation forward in a way everyone could better understand? And make sure to show the percent profit such a plan would yield to those pros who would administer such a plan.

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I am a physician who has been embedded in the medical system for 40 years. I have seen how we got to this place.

The standard positions of the two parties on this are rigidly adhered to over the last many years- Republicans - "we need to get government out, and have a free market approach to medical care" and Democrats - "Government is the solution" Are BOTH wrong.

The government control of prices through medicare in the past 40 years has absolutely destroyed primary care. Physicians' fees - which now stand at roughly 10-15% of the health care bill, have been the usual target. To the point that physicians were being paid below what it cost to deliver care, they became insolvent, and many had to become employees of the big hospitals. There is now a crisis-level physician shortage in large part because for 30 years, the government has controlled (through funding of residency positions) the supply of physicians. More stupid blind cutting of costs with no nuanced understanding of the consequences.

Meanwhile hospitals were largely immune to the cost cutting. Witness this years fee structure from CMS which cut physicians a further 4.5% but raised hospital payments 4.3%. The hospital system I worked in in Columbus Ohio is an example. In 2017, the reserve fund was $3.6 billion, and in 2022 it had increased to $6.7 billion. This is during a period in which the system built one hospital and bought another, and suffered setbacks due to the pandemic. Yet its cash reserves still nearly doubled in 5 years. For context, OhioHealth’s cash reserves are greater than the gross domestic product of 55 of the world’s nations. In 2020 and 2021, OhioHealth received a pandemic bailout of $209 million, that it obviously didn't need. It made a nice profit during the pandemic year without the "bailout"

The hospitals in Mississippi you reference may be in trouble. Many rural hospitals are, even while the large chains become insanely rich. Nevertheless, knowing hospital administrations as I do, I would say they are no more trustworthy than is Putin. I would not believe their claims of poverty. I have recently seen Cleveland Clinic sound the alarm because they claim they lost 200 million dollars last year. A quick look at their public information reveals that they, too have multiple billions in cash, more than OhioHealth. In 2020 - CCF (cleveland clinic foundation) had $12.9 billion in cash equivalents and investments . In 2021, that was $14.8 Billion, an increase of $2.9 billion in one year. Now, if they are being truthful (not a given) and they lost $0.2 billion in 2022, they are still $2.7 billion ahead of 2020.

Lesson - don't take the hospital's cries for help at face value.

If you look at the "system" in Columbus, (scare quotes because this is NOT a system in the sense that the parts do NOT work together) you see three major hospital systems competing, but they do not compete on price, they compete on luxury. Each one's hospitals are palaces in comparison to the hospitals in any other country. Soaring lobbies with beautiful water features. Patient rooms far more luxurious that those patient's rooms at home. They each have had massive building projects through the past 20 years and currently. Within about 7 miles of my home, I have three hospitals each with its own (cardiology, Oncology, Orthopedic, Neurology) Center of Excellence!!! They build duplicative mini-hospitals in the corridors leading to the expensive neighborhoods in suburban areas. This makes no sense. This "competition" only drives costs up. Yet, patients cannot see an actual physician many times, and must accept treatment by a nurse. This is a massive albatross of a failing system.

This is what the ACA has allowed. Big hospital systems, big pharma were essentially carved out and protected by the Democratic legislation. Democrats!!! Who are supposed to protect the little guy-patients.

So - over the years I have learned that neither big business hospital systems nor government (which is the biggest business of all, of course) is the solution.


Neither the Republicans nor the Democrats present a serious solution, they each present ideological talking points, both of which fail in actual practice.

Any real solution that might fix the system would have to dismantle the massive hospital systems which have grown so large, rich and influential that it is politically not feasible to replace them.

Any politician with a real solution would have to deal in the dirty details of a major change, and our system of elections now rewards politicians who don't do this, but only function at the level of 4 sentence sound bites. Any real solution in Columbus would have to include the merger of 3 big systems, so that duplicative services and buildings would be shut down. That seems impossible in an environment where the survival of each management team is predicated on showing an increase in profits every quarter, and these management teams fight to the death to ensure their survival over their competitors 5 miles away. Incidentally, we have witnessed a massive growth in administrative overhead, compared to those actually delivering care, in the past 30 years. See this graph:


Sadly, I think that the change that is necessary will only come after a serious crisis in medical care, and we are approaching that. Now, even well insured can't afford the care. Now, there are developing shortages of people to care for patients. Now, there are shortages of critical medicines. NONE of this was the case 40 years ago. This is the product of 40 years of government + Big Business running medicine with more profits as the end goal.

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