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)
Correct about Mississippi being the poorest state in the USA. Here is the list of the poorest and the least poor among us:
Poverty rates were highest in the states of Mississippi (19.58%), Louisiana (18.65%), New Mexico (18.55%), West Virginia (17.10%), Kentucky (16.61%), and Arkansas (16.08%), and they were lowest in the states of New Hampshire (7.42%), Maryland (9.02%), Utah (9.13%), Hawaii (9.26%), and Minnesota (9.33%). (Wikipedia)
Thanks Fern. It’s a helpful list that spurs the question...can someone please explain the process of how those wealthier states actually send money to support the poorer states?
Here's how that works: we pay our federal taxes as a percentage of our income. Minnesota, where I live, has a larger percentage of our population above the poverty level. So, there are more tax dollars flowing from Minnesota to the federal government than in states like Mississippi. When federal programs, created by Congress, distribute funds, those funds are sent out to the States based on the details of the law, often need-based. The needs of the poor in states like Mississippi often mean that more of the funds go to poor states.
Interesting...in light of the Republican idea of giving more rights to the states and cutting federal “socialist” programs, what would happen to those poor states? What if the Republicans get their way...no more redistribution of wealth? (Just wondering if the poorest states are run by republican legislatures?)
Those Republican lawmakers create a class system that keeps poor people down, over generations, and provides opportunities only to people who are in the "right groups," politically-connected, wealthy, white, male, related to the important families.
California and most of the Blue States subsidize the Red States. I think a change is needed: A state gets back no more than it pays into the federal government (natural disasters excluded). 20-25% is taken from all tax revenue to fund the federal government and DOD; the rest returned to the States. Past tTime for the Red States, and their voters, to get the kind of government intervention they want--none
In Va. the first question to any sick person trying to see a doctor, nurse ,or health care person is “ what insurance do you have?”Not , let’s take a look and start to find out why you are sick.
There are blocks in Va. where one provider takes your insurance but in the next zip code they don’t. The insurance companies have “big business of profit only” tied up. It is easier to die than to see a doctor.
Doctors with a true calling to help those suffering could demand of their very exclusive “Union” the AMA that they won’t be controlled like that.
I once wrote to my “ insurance survey” , “I got better care at the gas station, and it was self -serve”!
We are sick because the disease of “ losing hope” has taken over.
Sad, sad, sad because there is no shame!
Go home Mike One Pence, two Pence, three Pence, of total uselessness!
Concierge medical care is a growth industry here in CA. Pay a retainer to a doc and you’ve got all the attention you want. I equate it to owning a share in a private jet and an expensive tropical resort home (ick!).
My family has been very happy Kaiser Permanente members for years. Our doctors treat us with thorough care and genuine kindness without having to deal with the bureaucracy.This should be the model for medical services nationwide.
Marg Mac, Same here in Colorado. Permanente physicians are salaried (denounced as "socialism" by those profit mongers in the FFS world of medical practice), thus they escape the perverse incentives of profit-driven medical care. This was the original HMO model, sadly corrupted once the for-profit insurance companies (KP is non-profit) smelled the sweet odor of boundless riches through the mechanism of ruthless claims denial.
Kaiser recommended amputating my 90 year old father's leg when the pressure ulcers Kaiser Hospital allowed him to get wouldn't heal. "He's already mostly in a wheelchair." UCLA saved his leg. I got Kaiser to pay for UCLA's care, too. Caveat Emptor w/ Kaiser
Citizen 60, as you must know, anecdotes are not the substitute for data. I'm sorry for your 90 yo father's situation. Non-healing leg ulcers are often the result of poor circulation.
I called on hospitals 15 years. I have dozens of hospital pt care horror stories, Kaiser in the Western States has pride of place for the highest number.
It’s most recent is to put the NICU resuscitation station in 1/2 of an “active” labor and delivery room without building a wall in the room. Pt and family in labor got to hear preemie pronounced dead after all the staff and machines behind the curtain tried to save it (SF).
Jean, exactly “It is easier to die than to see a doctor.” And most Mississippi residents living below poverty line would agree. Just ask Dr. Google. And this might be a repeat of Fern’s comprehensive assessment of Mississippi, but never too many times to hear and see the Truth. “Life expectancy at birth in Mississippi is the lowest of all states and has historically been low. As is generally the case in states with low life expectancy, Mississippi struggles with poverty, and residents report relatively unhealthy behaviors. At 19.8 percent, no state has a higher poverty rate. Mississippi also has the largest share of adults who do not exercise, at more than a third of the local adult population.” https://www.clarionledger.com/story/news/2019/02/21/life-expectancy-us-where-does-mississippi-rank/2937070002/
We might like to believe that doctors with 'true calling' have that kind of power. They don't. Corporatocracy really does control everything in our lives. Most of us are not aware of the extent of this.
Deborah, as I was reading Dr Richardson’s post about the Republicans labeling everything the government does for ordinary Americans as socialism, I immediately thought - yeah, they prefer a system much like feudalism, where the people are kept “in their place” to serve and support the wealthy, the feudal lords.
Truman said it best: "Republicans called public power socialism. They called water purification socialism. They called Social Security socialism. Republicans call anything that helps people socialism."
Another of my Truman favorites: "Democrats want to help people who need help. Republicans want to help people who don't need help."
The Republican view of government "socialism" seems very selective--Social Security and Medicare are socialist, but $4.5B in FEMA funds to Florida are not.
I used the term "neo-feudalism" for our neo-liberal system nearly a quarter-century ago. But it was unfair to a system that did at least provide some protection in exchange for provisions and services.
I agree but I think it is important to be very clear what we are dealing with here. The term class warfare raises the hackles of the abusers and brings out the deniers en masse. The powers to be want the people to believe it’s the immigrants or welfare queen or the Democrats or Republicans that we need to fight and bring order and fairness to the masses. When the poster I replied to mentioned that the prison sentence for murder may be significantly less than that for robbery , there is a reason for that. The moneyed powers want to stop any theft of their property, they don’t care if the people kill each other. We need to be looking up at the real criminals, not our neighbors.
Anyway I wholly agree with you on another post, we are one, with similar goals and concerns as most peoples on this Earth. Just that recognition alone would be a great start.
Christine. Thank you. Excellent link. Right now I’m listening to Politics Girl in conversation with American Political journalist, David Corn, discussing one of his books, “American Psychosis: A Historical Investigation of How the Republican Party Went Crazy.” Crazy? “It’s not new, he says. According to David’s research, the insanity currently going on with the GOP is not so much a departure from the norms, as a logical conclusion of an established pattern. Since the 1950’s, the Republicans have knowingly encouraged and exploited extremism, bigotry, and paranoia to retain or gain power. As one review put it, “American Psychosis is a sobering look at the ideological destruction, born of cynicism and opportunism, of a once principled party.”
Please do not insult feudalism, a system that made some allowance for social reciprocity. Even chattel slavery housed and fed its human beasts of burden.
As for religion, people do like to believe that if they're well-off, they're saved; while, moving down to the poorest of the poor, if you can't afford to eat properly or to get medical help, you'll always be free to pray. And rest assured, your betters will always be there, kindly reminding you that you are in their prayers...
You are on an ultra hot roll, Peter. It's a relief for me to read your posts because you are among a number of us who have the words to characterize inhumanity on obedient subjects who have been well schooled on their worthlessness. We know that this isn't only about Mississippi. It's old and new again.
I answered this but think I understand why Substack couldn't handle my comment.
No matter.
Feudal barbarity is indeed succinct, other terms might be even more so, yet nothing in the thesaurus can come close to expressing the depths to which some human beings' perverseness can descend.
Years ago, I was very struck by the words of Saadi Shirazi which, I learned, are inscribed above the entrance to the Hall of Nations in the UN Building. The content resonated deeply for me. The content, but none of the English translations that I found. I know no Farsi, lost contact with Iranian friends long ago... I ought to have contacted a good friend of my son but, to cut a long story short, I read a literal transcription of these lines, together with all the renderings I could find, and put together what is bound to be a variation on Saadi's theme:
*
Men are members of one body
From one essence they were made
If one single member suffers
The whole body feels the pain.
Those who do not feel for others
Are but beasts, and not our brothers.
*
Yes, my rendering is harsh, but while I see the first two lines as well expressing the deep underlying equality of mankind, the last two tell how far men can descend in betraying our Truth.
I wonder if this could be brought to the attention of Rowshan Nemazee or anyone among HCR's readership familiar with Farsi and Iranian poetry... I'd value comments on this.
Also Jackson is one of the most difficult Capitol cities to get to. They have no commercial airport, the closest one is 30 miles away. When I was a traveling consultant I hate being assigned there for that very reason.
Sorry, while Jackson MS is indeed hard to get to and Medgar Wiley Evers [International] Airport doesn't merit the word I've put in brackets, it is only 6 miles out from downtown...
Thank you, my apologies, I was confusing Jackson MS with Jefferson City MO. I did use the Medgar Evers airport in Jackson, It was with Jefferson City MO that I had to use Columbia MO to get to Jefferson City. Unfortunately my mind blurs (too often) because I traveled so much back then.
Fern, how do we hit these numbers home? Billboards? Easily understood graphics? It’s not rocket science. I worked for fifty years and get $2,200 per month. I could not exist without this money, which I earned and paid into from my first job at 18, in 1967. I thank Frances Perkins and Heather for her history, everyday. First thought when I wake up: “Thank you, Frances, for starting Social Security!”
More importantly, how do we get Mississippians to vote out those who refuse to expand Medicaid? Do they—and other citizens—not see the connection b/t those “leaders” who vote for their citizens to die, or remain poor or uneducated—and voting? BTW TN, where I live, has refused to take Medicaid too, three times, once when asked by a Repub governor who even got some tweaks from HHS that should have made it more palatable to a red legislature. And rural hospitals in TN have closed too.
First of all they have to know about Medicaid and or any other government function that is here to help us be a Democracy. Very few people really have the facts about the government agencies and or what they do for us.
Many do not understand SS, Medicare, EPA, IRS.... go through our agencies and ask your community of family and or friends to tell you or describe the purpose of each. Again, the Republicans like dumb. What do you , America , like?
Carole, I live in Vermont, where billboards are prohibited. Thankfully! Only in small older communities are there poles for electricity and telephone, too. Otherwise all lines are underground. It's a beautiful state, and there are modern ways to communicate: SMS, emails, media and marches are a few..
As a psychiatric RN, I spent ~20% of my time making what we called "insurance calls", which mainly consisted of keeping insurance companies from discharging still suicidal patients. What ever agent I spoke to would usually back down when I asked for their name to put on the discharge paperwork, though sometimes one of the psychiatrists would have to call as well. This almost never happened with our medicaid and medicare patients. Tricare was great also.
The reality is a very messy, very inefficient health care insurance system, coupled with very little regulation of prices for health care services has made our system very expensive with poor to middling outcomes. We paid for a brand new Cadillac and got a used Pinto. "Socialized Medicine" could actually realize huge savings for all involved, as all hospitals have to absorb the costs of treating the uninsured.
We became Kaiser members when a family member need mental health services. Long before the ACA made mental health care equal to physical health care, Kaiser treated the brain as it would any other body part, giving mental health patients the care and dignity they deserve.
With our previous coverage, only $25 of the $750 psychiatric initial appointment was eligible for reimbursement. That was an insult and I told the insurance rep that!
If such a large percentage of Mississippi citizens want the Medicaid expansion, why do they keep electing the same-old-same-old politicians to “represent” them?
We have it in Georgia too. Also, Blatant gerrymandering. National elections have shown our overall electorate is pretty much evenly split 50/50. Yet in our statehouse, Democrats have been overwhelmingly sidelined. Shouldn't our state-wide representation also somehow be able to reflect the numbers we put up in national elections? It's trumpeted about that Georgia is a "swing state" and "purple". One look at our state and local representation easily shows this is NOT true. Why the discrepancy, y'all??
Let's look at the numbers of Georgia's representatives. Nationally, in the US Senate, both our Senators are Democrats, elected via statewide elections. Keep that fact in mind, please. When it comes to the 14 districts that send representatives to the US House, the make up is 9 Republicans and 5 Democrats. Also, keep that number in mind.
In the Georgia General Assembly, in the State Senate of 56 Senators, the make-up is 32 Republicans to 23 Democrats (with one vacancy, but it is in a district that is quite red, so add another Senator to the Republican total). In the State House of 180 representatives, the make-up is 98 Republicans to 79 Democrats, with 3 vacancies (not sure right off-hand where those are). In the past election, in the statewide executive branch elections, Governor Kemp won VERY handily over Stacey Abrams, and all the other races--Lt. Governor, Sec'y of State, etc. etc.--were all won by Republicans in races that were not at all close. Again, these were statewide elections. Georgia has 159 counties--a huge total, all things considered--and aside from counties in the cities that are blue (Atlanta metro area of roughly 26 (!) counties, Columbus, Augusta, Savannah, Macon, Athens), in the overwhelming majority of the other counties they are run unanimously by Republicans. In my own corner of the world, pulling a couple of totals out of the hat, in a county of 200,000+ population, in 2020 T***p won by 64,000 to 25,000. In the US Senate runoff in 2022, Walker won by 52,000 to Warnock's 19,000. ALL the government positions in this county are held by Republicans. I'm living in a sea of red. This is true in the overwhelming majority of the remaining red counties in the state, which, considering the rest of Georgia's 159 counties (easily 100+), is a lot.
So, *IF* Georgia were truly a "purple" state, my point is: shouldn't then state and local election results be more reflective of our "purple" status? It is my opinion that the numbers in Georgia show quite clearly there is not a fair and equal representation throughout the rest of the state. The urban vs rural divide in Georgia is extreme and Republicans are using it to their advantage. Yes, nationally, Georgia has shown it has stirrings of becoming "blue/purple", but to me that does not at all reflect who holds the balance of power in this state, and it seems to me that if a state is going to become well and truly "purple" this needs to be shown as being true in the down ballot and local races as well.
Yes, it mostly answers me. The balance of power has to be resolved in your state. There appears to be change occurring. It nay spread if more people support it.
Just pulled up Ballotpedia, my sometimes go to for election info. One point I will make is I lived in Michigan for 27 years and saw the Gerrymandering going on there. Our representatives were mostly Repub and our Senators were Dems (except for one instance) going back till 2000. That we had Dem Senators for so long kind of tells the story of how the state was leaning,
Since 1984, the Repubs had control of the state Senate till just recently. Since 1990, the Repubs had control of the state House. Repubs had the Governorship in 1990, 2000, and 2010. Those years allowed the formation of voting districts in Michigan. Packing and Gerrymandering were the orders of the day. Until 2020. I'll explain.
You can't Gerrymander a national election; but you can mess with the voting rolls just like Kemp and Raffensperger did. National news talked of the tens of thousands or voters being dropped from the voting rolls. I wonder why they would do such?
Now, what happened in Michigan? Why did Michigan realign its voting districts? Katie Fahey, a Michigan resident and political novice posted a message on Facebook two days after the 2016 presidential election. She wanted to take on gerrymandering. She recruited more than 14,000 volunteers to campaign for an amendment to the state’s constitution. It passed with 61% of the vote and created the commission (Guardian).
Now Michigan has a Democratic Governor, House, and Senate populated with such people as Mallory McMorrow. Repubs in my Township appointed me (Dem) to the Planning commission. I pretty much know how the sausage is made in small communities of 25,000.
As you stated, you have two Dem Senators in Congress. That is an achievement and a marker of things changing. You are on the brink of change. I believe what may be needed in Georgia is a Katie Fahey or Mallory McMorrow. Warnock a[[ears to have some grit in him.
I admit I leaped before I thought about this and looked at more of the history of Georgia. If anything Georgia could parallel what Michigan did. Good luck.
I have to compose a letter to the City Council asking them why the submission of a Plat would be acceptable if the streets were all mismarked with different names then the county Plat, the builder unknown, the developer unknown, and you can not find the piece of land? The City Manager already went off on me in a public meeting where I would have been declared "out-of-order if I answered. A part of Roberts Rule of Order . . . I guess that only applies to me.
I took the discussion points to be in the opposite direction. I would have offered up the Secretary of State and the Governor's efforts in purging the voter rolls. Thank you though.
I realize that gerrymandering and voter suppression are widespread and have real impact and consequences.
In this instance however, if the survey data presented are accurate (always a big if) then neither should prevent the Republican and Democratic voters from voting out the reps that refuse to expand Medicaid. Either the survey data are very far off, or access to healthcare is not in the top tier of people’s reasons to vote for or against particular candidates. I suspect it is the latter. I expect that a large percentage of the struggling hospitals and medical practices will close. Then people will be screaming. It is a case of you don’t know what you’ve got till it is gone. Although I also suspect that there are many that would be covered for out patient routine medical care with expansion that do not realize what they have been missing.
No, Heather Chase, HCR is not an anti-Republican American. She is an historian who tells the truth. Facts are what you seem to see as anti-Republican. HCR reports what they do. She also reports what Dems do, and that is not always stellar either.
I agree, Patricia. So let's see: is my accusation of Heather Richardson an insult or a fact? I just wrote her to ask that she send me pieces in which she is not an anti-Republican American. More to the point, please note the following insults from readers of today's post--just today's! Because according to your Rousseau quotation, all these readers are "in the wrong": "the toxic republican vermin"
"Every time I hear the term “States rights” I see slavery and the confederate flag."
"The Repugnants are ignorance and hearsay."
"The greatest danger to this country is the imbecilc, retrograde republican party and climate change."
"I think the Repugnants are even MORE dangerous than climate change...."
"Further proof that the only 'good Republicans' are six feet under."
Hmmmmm? How does your comment stand up in this readership?
Our voting history is supposed to be a private matter unless we ourselves choose to reveal it.
And if you think only people who vote as you do can speak truthfully, you will never know truth, and you certainly won't want to live in a democracy, which needs debate and at least respect for other ideas in order to exist.
Mis/dis information…They aren’t reading Heather, Joyce Vance, Robert Hubbell, etc. Those same-old-politicians lies, Fox News, talk radio, NewsMax, etc are where they get their information. This includes the upper middle class as well as the lower. I live in Texas and I would bet that very few Texans are aware that our Governor declines Medicare Expansion.
You could edit your original comment to reduce confusion, but the positive side is that they have an opportunity to correct someone. Either way, your comment is a public service. It's also true. I know because I live in TX.
Please be careful when describing these medical care programs. MediCARE is the national health insurance program for the elderly and disabled which is part of our FICA contribution with every paycheck. MediCAID is federal money which can be sent to the states to help provide medical care service to the part of the population that meets poverty guidelines. By refusing MediCAID, states are actually punishing the poor.
Jane Myers. Thank you for that very important comment on the terms/language. I liked Deborah Minyard’s comment, realized her “misspeak” and was then relieved to see her correction. An example on how our language can throw us off “into the weeds”
Maybe the poor deserve punishment. They failed at choosing the right ancestors, didn’t they. They could have been born into a wealthy family if they had had more sense.
IMO, stress could well be a health factor to those who have been paying attention to what has transpired over the past few decades. Anger and negativity has to be taking a toll on the health of many who claim to be republicans. When that is manifested through withholding health care social safety nets, and basic decency the lifespans of even more groups are reduced. Just a thought.
Janet, Dick Cheney leaps to mind with his six heart transplants….but supporting policies his entire career to keep medical care to a minimum for most Americans. Stress should kill all those evil Repugnants dismantling our society. I will not shed a tear.
DLM Back in 2012 the surgeon was surprised to find that Dick Cheney had a heart. I wonder whether his personality changed with a ‘new heart.’ I’m humming the song ‘You gotta have heart.’
A good friend of mine is still alive long after his original heart was removed and replaced. You might want to show more compassion for the folks who survive to live longer lives from transplants, despite the occasional stinker like Cheney. Greater still, those that gave their organs did so selflessly, through organ donor cards or notations on their drivers’ licenses, giving the recipients another lease on life. You demean the amazing medical breakthroughs, and the talented surgeons, who extend life for those who survive.
Apropos of my comment is the announcement that Bonnie Raitt has the Grammy Song of the Year nomination for “Just Like That”, a moving and simple tune dealing with just this very subject. Read about the process she came by to craft this wonderful song here:
Janet the Republicans I know are staying insulated from the facts and relying more or less on really old party lines. They seem confused as to who todays republicans even are. Health care is fine as most of them are on Medicare and their retirements are wrapped around social security. As to what is actually driving the economy they are pretty sure the tax cuts are holding the country together. Most agree that they would be unable to pay any more taxes on their limited incomes and they are very confused that democrats want more taxes. Perfect storm.
The proximal and gentle questions for those Republicans fearing loss of income from taxes are: How would their taxes actually increase? Would it be the income taxes - are their social security and other retirement account income considered taxable income? (Am I incorrect that working income is taxed but not passive income, i.e. retirement income?) Or would they pay more taxes through a sales tax of 30%? For instance, if we buy $200 in groceries a week for a year (52 x $200 = $10,400/year), then at 30% taxes (10,400 x .3 is $3,210) we would have to pay $13,520 ($10,400 + $3,120) to get $10,400 in groceries. Not only that, but we would feel it each time we buy anything, for instance $200 in groceries get either $140 in groceries, or pay $260 for groceries. I know arguments are not helpful, but it still feels like calm, thoughtful conversations stand a chance to create change.
Yes, I see your point; as you may know, the idea of passive income is a term from economics, I guess. We could say retirement income, social security money (is that really income?), or income from investments. I do agree with you, we need to speak the language of our audience.
Retirement needs a champion. Social security is well below poverty levels. Most will never see an investment portfolio and many who do will lose in the marketplace. The business community is an uneven jumble of minimalist retirement provision. Here today and gone tomorrow retirement programs seem to work only for those who are employed by one entity for their entire professional career. While certain provisions can be carried forth from employer to employer often there will come an unforeseen blocking provision which jeopardizes even well thought out retirement programs. The rank and file labor market must have a retirement which is unimpeachable rather than ending in a peach tree dish as someone’s experimental failure. We cannot operate under the provision that people who lose retirement deserve what they get. Or people who plan for no retirement deserve what they get. I am going to work myself to death is not an acceptable retirement vehicle. In this respect someone has to be his brothers keeper. Such a dialogue as you propose should be in the shopping cart along side of racism mitigation, gun violence, health care, women's rights, peace on earth ( let’s not pretend we are the nexus ), disarmament, human rights, wilderness preservation, mental health care, homelessness, sustainable energy, environmental protection, educational opportunities, equality, global warming and perhaps we could turn homeland security into an offensive force which destroys the monsters both foreign and domestic who stalk us all relentlessly. Ok, That was a bridge too far. Can we ask for these obtainable objectives? Can we implement them? Who will represent us? Why isn’t this the focus of this particular congress. Personally I am tired of counting MTG’s three toes.
FOR AN OUTSTANDING EXAMPLE OF HOW WHITE SUPREMACY IS ENDAGERING AND ROBBING THE CITIZENS OF JACKSON WHO ARE PREDOMINANTLY BLACK __ read this!
'JACKSON, Miss. (AP) — The Mississippi House voted Thursday to further restrict how the capital city of Jackson, which has struggled with water problems, can spend money from a 1% local sales tax — the latest effort in the Republican-led Legislature to control actions of the Democratic-led city.'
'Jackson voters approved the tax in 2014, with the money designated for roads, bridges, water and sewer. Under House Bill 1168 that passed the House Thursday, all of the money would go toward the city's struggling water system.'
'Jackson lawmakers and other Democrats opposed the plan. They said directing all the 1% sales tax revenue to water would hinder Jackson’s ability to fix heavily damaged roads and bridges, including those pockmarked by potholes deep enough to flatten tires.'
“Our streets will go to the devil,” said Democratic Rep. Earle Banks of Jackson.'
'Jackson has had water problems for years and most of the city lost running water for several days in late August and early September after heavy rainfall exacerbated problems in the main water treatment plant. Parts of Jackson lost water again after a cold snap in December.'
'House Ways and Means Committee Chairman Trey Lamar, a Republican from Senatobia, sponsored the bill. He said ensuring clean, fresh drinking water is a higher priority now than fixing potholes.'
“There is a serious need to spend money on water and sewer in the city of Jackson,” Lamar said.
'Opponents of the bill pointed out that Jackson is set to receive $600 million from the federal government for water system improvements. Lamar said he does not know when the federal money will arrive. He also acknowledged he has not spoken with Ted Henifin, who was appointed by the federal government to oversee improvements to the Jackson water system.'
'Democratic Rep. Robert Johnson of Natchez pointed out that money generated by the 1% sales tax in Jackson is already overseen by a commission with members chosen by the governor, lieutenant governor and House speaker. Critics of that commission say it was created by the majority-white Legislature to curb the power of elected officials in a city that is more than 80% Black.'
'Speaking of Lamar's new proposal, Johnson said: “This is another one of those paternalistic ideas that, 'We’re going to tell y'all what to do because we want to punish you while we're doing it.'”
'House Bill 1168 passed 76-41. The vote was largely along party lines, with support from Republicans and most of the opposition from Democrats.'
'The bill was held for the possibility of more House debate and it eventually would have to go to the Senate for more work.'
'The Republican-controlled state Senate recently passed a bill that would transfer the ownership and management of the Jackson water system to a regional board after the federally-appointed administrator leaves.'
'A bill that awaits House debate would create a new court system in parts of Jackson with appointed rather than elected judges. Jackson Mayor Chokwe Antar Lumumba said the court proposal reminds him of apartheid. He has also sharply criticized the regional water board proposal.'
Copyright 2023 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Thank you, Fern. We should all be speechless. Maybe too many are. Mississippi has been one of or THE poorest state in our nation for years. Forever? It’s obvious its own government keeps the people poor.
HCR makes it clear today that American democracy does not always provide its citizens with what is in their best interests and what repeated polling indicates they want. The Mississippi story about that State’s refusing federal Medicaid dollars extends much further into the nation’s social and economic fabric. For example, HCR points out that ‘the theory behind it also says that the government should also stay out of the business of protecting civil rights, because state governments are the centerpiece of American democracy.’
That is the crux of the problem. State governments are NOT the centerpiece of American democracy. The national government in Washington IS its centerpiece.
The ambiguous Tenth Amendment (‘The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people’) was only one of the many compromises which were made to gain the support of the slaveholding states in 1789 for the new Constitution and is the basis for this misguided theory about what is the ‘centerpiece’ of American democracy, presently adopted by Republicans nationwide.
That is why we had thirteen stars on the American flag in 1789 and fifty today, perpetuating the words of the Tenth Amendment. We should only have one big star on the flag. Just as Republicans ignore the first thirteen words of the Second Amendment (as does the Supreme Court), they choose to ignore the final four words of the Tenth Amendment, ‘or to the people.’
Compromises made for slaveowners in 1789 are not pertinent today and must be remedied because so long as this misused belief in State governments persists, our democracy will rest on wet and shifting sands rather than upon solid rock.
There is no actual ambiguity in either the 2nd or the 10th Amendments, the ambiguity has been introduced, as you note, by the Courts, particularly the Supreme Court and could be cured just as easily either by that Court or by the do-nothing Congress if they chose to perform the tasks for which they were elected. Maybe if we had pictorial coloring books of the Constitution with embedded videos it would help them figure it out.
Fern, this scenario is mind blowing in its stupidity and mystery. But sometimes the simplest answer is the best one?
"Poll: 80% of Mississippians favor Medicaid expansion" - The refusal to accept Federal money is a refusal to save hospitals and therefore save lives. When the river floods and kills, they are quick to accept Federal money and help. Why not for illness?
Perhaps we should look again at the Jackson water problem. I think the brains of the people in this state have been addled by something in the water. Lead? PFAs? Little brain eating worms? Something we haven't identified yet?
How else to explain the utter stupidity of voting for idiots who deny them adequate healthcare? That denies them life itself.
My point is that the voters of Mississippi continually vote against their better interests. They vote for these fools who deny them proper health care. If 80% of them want Medicaid, why don't they vote for it? Why do they put up with such self destructive nonsense?
Maybe their brains have been rendered useless by a pollutant. But I am open to any other explanation.
If any of you are videographers, or documentarians (or know someone who is one), Fern’s last paragraph would make a stunning visual for people to emotionally connect with on a personal level. Losing 4 years of your life, at the tail end of your life. What will you miss out on? Grandchildren being born, grandchildren growing up, being there for your family, for your friends, for your fur babies, passing along your wisdom when it is sought, seeing 1460 more sunrises and sunsets, being in nature for 1460 more days, just being - celebrating, caring, consoling, contributing and making the world a little bit better because you lived 4 more years.
It so happens that, only two days ago I attended a lecture in France on Progress and Regressions in Science. One of the major disappointments mentioned was the entire area of public health throughout the world, entailing—among other things—no improvement in the treatment or control of TB and malaria endemic in 3rd-World countries, variable failures to prevent or tackle Covid and future zoonoses, a massive worldwide increase in obesity, starting in childhood, which spread from the US outwards and has incalculable effects on overall health and healthcare costs, falling life expectancy in several countries, including America... Russia, of course, is a dreadful case, even without the totally absurd war waged by a deranged dictator... Nevertheless, Americans, no matter the state they live in, die younger than people in many other industrialized countries...
Drugs, whether sold over the counter or by criminal cartels, were not mentioned in this context, neither were lead bullets in civilian bodies, both adults and children.
As for social security, in Britain, the Liberal politician David Lloyd George introduced a national retirement pension in 1906 and followed it up in 1911 with the National Insurance Act providing "British workers with insurance against illness and unemployment. All wage-earners had to join his health scheme in which each worker made a weekly contribution, with both the employer and state adding an amount. In return for these payments, free medical attention and medicines were made available, as well as a guaranteed 7-shillings per week unemployment benefit" [https://www.historic-uk.com/HistoryUK/HistoryofBritain/Lloyd-George/] America, of course, had to wait until 1935 and FDR's New Deal (which the Republican Party has been increasingly committed to uprooting on the grounds that it is “socialism”... Of course. A great success in Socialist countries like Switzerland and Japan...
This idea of the Infallible Market God as the great magical economic, social and political panacea is, of course, utter BS, bargain-basement mythology, a bouquet of abstractions designed for the exclusive benefit of non-human entities (regardless of how they have been raised to “personhood” by a corrupted US Supreme Court). Competition and “choice” were supposed to make for greater efficiency in all areas of life and to limit the evils of bureaucracy. In reality, aided and abetted by IT “improvements”, privatized bureaucracy is making the citizen's life (or should I say “the subject's life”) into one long training in masochism. Worse, it has infected public bureaucracy, which no longer aims to serve both citizens and economic actors while keeping a beady eye focused on the spending of taxpayers' money, but is obsessed with exclusive service to those in need of no help. Government bureaucrats once employed understandable language but now spout jargon worthy of Komintern at its worst, the only difference being the equally invalid content. Looking Glass Land nonsense.
In economic terms, the bias has been towards extreme inequality accompanied by cartel monopolies. And everywhere, bureaucracy. But bureaucracy whose sole aim is to maximize institutional and other major investors' quarterly returns—and to hell with all else.
How this heavy, self-serving, IT-aided-and-compounded bureaucracy is supposed to square with, for instance, the provision of all the most basic services, social, health, transport, communications, infrastructural, etc. to the public, I think we have all seen too well by now.
We have seen the Present and no, it doesn't work. As for future prospects provided by the current dispensation, the only promise is… KAPUTT.
The estimable Marx and Engels may have failed to sway this bourgeois from his boring, middle-of-the-road fence-sitting politics... but the world has developed such a wild rightward tilt that views that were deadly dull and conventional in the 1960s are now distinctly Leftie. So, if I end a long life clinging to the left edge of the playing field, also inhabited by too many narcissistic nutcases, it's neither Lenin, Mao nor Gramsci I have to thank for this seeming conversion which is no conversion at all, but Sainted Ronald Reagan, Holy Maggie, and such luminaries as the All-That-Glitters-Coney-Island-Critter that last occupied the White House...
Thank you, Angela and Fern, HCR and all of us here who not only care, but actively work for a more socially and economically equitable future and healthy environment. The picture is crystal clear. I add politically, but truly caring and making a difference is more than political rhetoric. It’s action that at this time is a Democratic party practice. And repubs talk and dismantling of anything that helps people is their action. Citizens who vote repub continue to support a kind of nonviolent resurrection, causing poverty and inequality to continue in this wealthy country where the poor and middle class pay taxes and the wealthy benefit. It should be shocking. To all Voters. Should be.
Fern, thank you for these details. I read the bit about Mississippi with despair. I don't see any of that changing soon, unfortunately. The water problem in Jackson, mentioned below, is also deplorable. I know some of this has to be about race, but it must affect poor white people in Mississippi too. Heath care in this country is a joke, but if we try to fix it, it's that dreaded word, socialism. Once again the Rs prove themselves to be the party of death.
I seem to recall that, a few years ago, people from Iranian health services were providing help and organizational advice to the poorer public hospitals in Mississippi.
I never heard what happened after that, but can't help wondering if ways were not found of putting a stop to such assistance, coming from a country whose regime commonly leads to its being labeled an enemy of the US. Besides being an embarrassment, this interest on the part of benevolent foreigners must have had the undesirable effect of giving poor Mississippians the impression that they merit attention as sentient human beings.
I live in Austin, TX metro area and about once a month there is a post on the social app, Nextdoor Neighbor, that goes something like this: “My wife(husband, father, son, etc) was just diagnosed with _____ (fill in the blank) and looking for help finding insurance to help us pay for surgery/treatment. Any suggestions?” Not only is this heartbreaking, but it should never occur in the richest country in the world, but it does, daily, in the good ‘ol USofA!
Heart breaking? Yes. I would also call it inhumane and essentially criminal. Dozens of other countries with nowhere near the resources of the good Ole US of A... simply don't have that problem. And we spend more than double per capita on something that is broken beyond repair. It's stupid and very cruel.
Thank you, Eileen, for posting this painful, too, common failing of America's exceptionalism. It is OUR STORY. The lives of many Americans, how many? are too dark and too in the dark, and that's what 'it' is all about!
To put it succinctly, the state government opposes the will of 80% of Mississippians on an issue with life or death implications.
That sounds like a firm foundation for a political campaign to me.
If it was 55%, or the issue wasn't a central one like health care, I could understand how Republicans could continue to distract the voting public and remain in power.
But 80%? Hospitals closing and people dying as a result of deliberate government policy decisions?
There should be no issue more important for the vast majority of that 80% of Mississippi voters than the increased likelihood of their preventable death or the preventable death of their loved ones because of intentional decisions made by the party in power against the will of the people.
How do these barbarians keep winning elections? Democrats in Mississippi should be hammering home this point to the exclusion of all others in every election cycle until the voters get the point, realize their stake in the fight, and turn out to vote these scoundrels out of office.
Oh, and the other states, mostly with Republican leadership, who turn down federal money for Medicaid expansion?
You ask 'how do these barbarians keep winning elections?' They do it by campaigning on cultural issues such as the dangers of CRT, of books they object to, of abortions, of someone taking away their guns, of LGBTQ citizens having rights, of vaccinations, of weakening the police, of mixed marriages, of racial, ethnic, or religious groups other than their own taking their place ....
They ignore real issues such as providing health care, climate change, protecting the environment, voting rights, equal opportunity for all, tax policies that give a fair shake to all, and government regulation of things that must be regulated such as the financial marketplace, food, drug and product safety and working conditions.
That's how they keep winning elections. The barbarians cannot be fought on the cultural battlefields of their choice, listed above, which is what they desire. We keep making that mistake.
A pro-choice demonstration never changes the mind of a pro-lifer, or a legislator. They must be defeated by stressing real issues with postitions which are in the interest of most citizens. In Mississippi, they must campaign on the absolute need to particiapate in federal Medicare benefits, and not waste their breath, time and resources on those who oppose taking advantage of them.
Yes, you're absolutely right. Republicans sank the Clinton healthcare plan by changing the debate from the Democrat's wonky policy arguments to the dishonest kitchen table discussions of Harry and Louise (and the misogynistic demonization of Hlilary, but that's another story).
Personalize the issues and you'll win the voters. Unlike the abortion rights movement you mention, the provision of health care is a personal experience that directly affects everyone, all the time, and there's plenty of opportunity to bring the fight to every living room, or kitchen table.
Republicans in eleven states have given Democrats the perfect wedge issue. Ignore the culture wars, and this big thing remains: if you side with Republicans, you'd better hope you don't get sick. Or your kids, or your aging parents. And eleven states is a big enough sample on which to hang a national campaign.
This is a better wedge than Social Security, in which Republicans have already destroyed the confidence of anyone under the age of 50. This is the direct lived experience of every American, literally a matter of life and death for everyone.
From a selfish, personalized point of view, there should be no more important issue to anyone with the power to vote. From an altruistic, help-everyone point of view, or a public health point or view, the same is true.
And Democrats are unambiguously on the right side, and Republicans have given them eleven fat, juicy targets to attack, not counting Congressional races and municipal contests. If we blow this one, we deserve perpetual government by MAGAt, and we will probably get it.
The problem is that Democrats are also politicians, and being such, all of their motivation is not altruistic. An effort should be made to keep this above party identity, and as you point out, health care is an ideal personalized wedge issue (as opposed to the Affordable Care Act, Medicare, and Medicaid individually that can become politicized).
YES! To all you have written, along with the URGENCY of communicating the LIFE and DEATH decisions that are being made for Mississippians by the Governor and state legislators. The case against Mississippi's Republican elected representatives is clear and the foundation for the national campaign exposing the Republican Party's goal to obtain autocratic control over the American people as they have done in Mississippi.
It seems to me the elephant in the room is Tom Perez. Where was he when all this was going on? What happened in Mississippi has been a long standing problem. Democratic leadership has been asleep at the switch.
Eadie, I don't think I understand your comment I agree that Tom Perez didn't do the job. Democrats didn't follow Howard Dean's call to be local everywhere in the country - to grow the party where it wasn't a presence. Mississippi is the poorest state and blood red. In general, I would say that the Democratic Party was the problem but I don't want to call the donkeys 'elephants in the room'.
This was a perfect opportunity for the DNC to expose the hypocrisy and utter disregard of rethuglican leadership for the poorest among us. If you hadn't brought the whole issue in Mississippi to my attention again, I would have continued to ignore one more important reason the democrats are losing the message war.
You would think that the GQP was committing political suicide with this. But there are a couple of other factors. These voters are not the brightest bulbs on the planet. And more importantly, they vote based on emotional cultural warfare issues. Like fetus fables and the national security threat of drag queens.
As you say, they're being brainwashed to vote based on abstract fictions. That's why forcing them to pay attention to reality they can't ignore, like their own and their family's health and the lack of concern their government has for them, should be a winning strategy.
When your child gets the flu or meningitis and can't get hospital treatment, the cultural impact of drag queen story hour gets put in perspective real quick.
You're right about what should be campaign talking points but aren't and, if the Democrats don't update their approach, the status will remain quo or deteriorate.
For the record, 39 states and D.C. did expand Medicaid and 11, including Mississippi did not.
The Governor of Mississippi seems well-versed in the venerable traditions of his state and guided by the spirit that sits firmly ensconced where the heart of his party ought to be. He would surely have inspired Jonathan Swift to write a most memorable panegyric. At a stroke (of inaction), he has found the perfect way to correct those confounded poverty statistics while ensuring that Mississippians will forever vote as they are required to: a new, improved and sanitized approach to lynching, the mass elimination of the undeserving black poor, all without recourse to any of the customary paraphernalia.
’Tis a pity this Elegant Solution seems better to accord with Social Darwinism than with our True Religion, which tells us Darwin lied, wherefore we are enjoin’d in Commination to burn all accursed copies of The Origin of the Species (along with most of the books in our Public Libraries).
Elisabeth, I believe it will come a point when Republicans will not be able to withstand the powers of a Nature enraged by climate change. But I see your perspective, too: Republicans are dangerously PRECIPITATING the conditions that lead to that point—with consequences for all humanity.
With climate change we are playing with forces so thoroughly beyond our control if we push them far enough, and even now, and crucial to our survival. So that's the biggest threat. Meanwhile, follow the money. It's just nuts the degree (above and beyond the ordinary) we have allowed "the theory embraced by members of both parties between 1933 and 1981" to be replaced with Gilded Age plutocracy and corruption. It is mad the degree to which we now accept as normal, the press reports as normal, that wealthy lobbies routinely get to overrule the public will, and that we routinely vote for people who accept that. Even Democrats, more than is honorable or democratic, but the Republican Party is completely bought and paid for, and their response to Liz Cheney and Adam Kinzinger shows where decency gets you in today's "GOP".
Pence pretends to be so worried about passing debt to our grandchildren yet denies climate change and how that will profoundly affect those grandchildren.
The greatest danger in my mind is people not standing up to the willful ignorance driving the Republican Party. Calling them names only fuels their resolve to do even worse things. Only by looking them in the eye, calling them out and making them defend the defenseless with put a stop to their sh*t.
They go hand and hand. Climate change will not skip over a state that denies Medicare to its citizens, allows unlimited gun carry, censors public school history lessons, scapegoats persons who exhibit a non pathological minority variant of the human condition, or in short--lest this list go on for pages--threatens the vengeance of a violent God made in their own image, I.e. bullying, petty, selfish, temperamental, full of fire and smoke that signifies nothing.
So, Pence and you other Republicans, how are we doing? Do you give a _ _ _ _?
'U.S. has lowest life expectancy among its peers.
KAISER FAMILY FOUNDATION'
'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.
Chris Hayes did a piece on this topic tonight. The statistics are mind-boggling and soul-crushing. We have a for-profit system of healthcare that is only serving to put us six feet under sooner than most of the rest of the world's developed nations. Our courts are making decisions that will lower our life expectancy. And government, like that of Mississippi, that displays a callousness found only in this, the most well-armed nation on earth.
The media pushes processed food as quick, easy and everything except nutritious. So, people tend to buy overpriced packaged food products that are popular (as shown constantly on mainstream media), causing obesity. Children and young adults need to learn (perhaps in school?) nutrition, as real food is a big key to life expectancy.
There’s truth to that, but the media also pushes the Mediterranean diet as the key to why Italians have such longevity, without attributing any of that longevity to universal health care.
OMG! You are soooo right. Earlier this week, a box of "food" was delivered to our apartment building to the wrong address. It sat there for a day until my husband retrieved it out of curiosity. There was no return address, no phone number, no way of reporting the misdelivery and the address on the box was across town. We opened it, discovered it was packed in fake "ice", and figured we'd taste it. 🤮 Horrible! The sodium and fat content was through the roof, it was basically the same ingredients remixed into different servings of "food", the "fresh" vegetables had no taste (even the onion), on and on. We ended up throwing the premixed packages of ooze down the disposal and tossing the packaging in the trash - non-recyclable plastic and coated cardboard containers. We'll skip down the street to our farmers market this morning with glee.
P.S. At happy hour yesterday, my (still) teaching buddies and I (I'm retired) were reminiscing about our hand-made wholesomely delicious school lunches. And no waste.
Fern, you are a wonder. When I moved from NYC to MA in 2000, I was stunned by the sheer amount of seriously obese people in the supermarket. In NYC nearly everyone walks to get food and other supplies whereas here it’s with cars and adding to pollution. However, where ever I look or read, almost no where is obesity mentioned in relation to addictions. And, you’re correct: the leading often underlying cause of death is obesity.
I continue to admire your comments to Heather’s amazing newsletters.
Samm, you provoked a blush. Thank you. In addition to learning a good deal from HCR about America and democracy, including her relative calmness, absolute steadiness, synthesis of material, supportive spirit and more; the caring and sharing of info as well as the company of subscribers, I am prompted by this setup to learn more through research. In challenging and, too, frequently, terrible times, LFAA offers a very worthwhile perch for learning and activism. I'm grateful. Cheers, Samm.
He survives the way most politicians do, “socialism” for selfish, worthless, cruel and ignorant bureaucrats. Most could not hold down assistant manager jobs at fast food restaurants. Yet, they give themselves paid healthcare, generous pensions funded by hard working taxpayers, endless hoardes of cash and lifestyle perks from wealthy donors, paid leave and vacations .and short work weeks.
It is the gop creed, “socialism” for me and carbon driven climate change, unsafe drinking water, pollution and polluted air, unsafe food, destruction of animal species, and easy access to weapons of death for you.
That is how Pence and his useless, morally corrupt cronies survive.
Seems to be all about the fame and fortune and power greediness. I have long proposed we diminish the goodie bag and increase the work ethic. Our good politicians are out here nearly exhausted trying to be who we need them to be. As for Pence, he looks like he was beaten as a child and then dropped on his head. Why he entered politics is so that his congregation could get rid of him.
He’s flowing the dark path of the irredeemably self-interested. It’s all about pandering for votes – for power - nothing more, nothing less.
There is no ‘’vision’’ for the future of America in the Republican party; theirs is a deep dive to the bottom for its inaptly named leaders, who live in a moral and intellectual vacuum. They spout bullshit day and night – BS being defined as language the truth or falsity of which is of no concern – to woo the base.
Pence, Trump, DeSantis and McCarthy make George Wallace and Strom Thurmond look almost virtuous in comparison.
Exactly this, well said. I think it makes it even worse. They know it’s BS, and they do it anyway because it’s their path to power, full speed ahead and damn the torpedoes. The torpedoes being reality, democracy, climate change, health care, gun violence, inequality, you name it.
Pence survives because he's a groveling little piss ant. He chants the GOP buzzwords. Socialism, babies, abortion, less government, guns, you know, BS for the poorly educated masses.
“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”!
As the middle class departs the guillotine class will have no choice but to accommodate the totalitarian class. The elites haven’t really thought it through too good.
"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".
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.
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.
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?
Sharon, we're in deeper s*** than that in MO. Actually, the attempt by the Gov and Leg to starve Medicaid expansion has failed because (think) the superior court--step up from the circuit--forced the issue. But the rollout is of course going like molasses. In 2021, the DHHS suspended the need to reapply every year for Medicaid and the rolls expanded hugely. But now that suspension has passed and so there is a steamroller heading toward people who are on Medicaid--a steamroller made of time wasting paperwork. NPR has been reporting faithfully about this. Other problems in MO and KS: highest rates of maternal mortality; lowest rates of per-child education spending; lowest wages for school teachers; highest doctor-to-patient ratios (especially in rural KS and MO) . . . I could go on. I am very fortunate to live in KC because, with a bevy of medical schools and other health care education programs all over the place, we have what I think of as "east coast" health care here (that would be the northeast and middle, not the south!). And because of all those students running around, the philanthropic wings of all these medical schools are quite active in the community. And still our prenatal and obstetric systems suck--not because of the doctors but because of not having enough of them. Especially an issue for Black women.
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.
"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.
Well said, sir. The history of policing in the US and the application of policing today is not something for the "thin blue line" to be proud of. You can paint "to protect and to serve" on all the cars of your fleet, but the only thing being protected is property, there is no "duty" to put yourself in harm's way, and the ability to articulate your fear of injury in "tense, rapidly evolving, and uncertain circumstances" is a license to kill people that are "dangerous".
And sadly, this arrived in my email a few minutes ago. The purpose of a cartel is to prevent meaningful change, and our two parties with their first-past-the-post voting representation system is serving as a very effective cartel against redefining the role of policing.
That is a good read. I know that training in the "Warrior Mindset" has taken full hold of law enforcement, and a chief who suggested more of a "Guardian Mindset" was vilified.
The Warrior Mindset presumes one is training to eliminate an enemy. Police training that encourage that naturally identify "the enemy" as the citizens, which is the farthest thing from any role to "serve and protect." Such training produces othering, which is a marking of groups as inferiors. The granting of "qualified immunity" creates an extremely dangerous caste system in which the group marked as inferiors is the citizens. These "others" must obey the law, even if they must be compelled to obey unjust laws by force. It creates a superior caste that is above the law and thus above those they other.
I 'm not convinced that such othering by police officers differs that much from ruling class othering by our political parties' elites, who seem to view common citizens as inferiors. It's OK to kill, rob, deceive, and disrespect citizens in both cases. One simply is privileged to do it directly with violence and civil forfeiture if one identifies with a police caste employed by and responsible to the ruling class rather than to citizens. The ruling class does it in more subtle ways by allowing deprivation of life, liberty, and dignity by those with the resources and influence to persist in being predators of citizens for profit.
And just released today. Worth a listen. Did mine while putting in some workout time on an indoor bike. As an investigative journalist and film maker, Michael has the expertise to produce this particular monologue like no one else on Substack.
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.
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.
@J L, You might be aware that renowned economist Paul Krugman, for some time, has portrayed much of Republican dogma as “zombies,” ideas “that should have been killed by contrary evidence, but instead keep shambling along, eating people’s brains.” One such example is that tax cuts for wealthy earners generate prosperity and, thus, pay for themselves.
I would note that you might be interested in Krugman’s latest book Arguing With Zombies, which is a compilation of zombie ideas he has, over the years, in his NYT columns, deconstructed owing to their not having a shred of serious evidence to support them.
"tax cuts for wealthy earners generate prosperity and, thus, pay for themselves and HOW in the HELL are we going to PAY for it???!!! Deficit! Deficit! Austerity! Austerity!"
@J L, You’re right that an indoctrinated people “incessantly”fed on partisan propaganda are disinclined to put up a fight or to ask questions and be skeptical.
I try to avoid cynical, but skeptical is the other half of open mindedness, as (in my opinion) a true skeptic is skeptical of absolute negation as well as absolute belief. That said there are certainly a range of degrees of confidence. I would not put a gun to my head and pull the trigger to see if "positive thinking" would let me survive. I don't believe in Sasquatch, but hold out a particle of possibility that perhaps there is something of that nature there. It's just that absolute knowledge of any sort depends on the powers of a human nervous system, and while I am confident in "the thing in itself" I can never entirely get out of my own way.
Indoctrinated people fight plenty, but fight to preserve whatever illusion they are invested in. And it can be argued that human reality is in fact an illusion, or at least a representation, but we have our senses and our ability to think to keep it remarkably accurate. Wards of mental hospitals show what happens when reality-checking ability is way off, but who among us has never been fooled?
I think we preserve or hone our edge when we question everything. Who would have guessed that space-time is demonstrably elastic, but Einstein had the temerity to question the unquestionable, over a century ago? Who would dare to think that kings are naked?
@J L, I apologize that a busier-than-usual schedule has prevented me from replying in a timely manner to your thought provoking comment. Truthfully, your openness brings to mind the increasing number of states intent on taking over ideological control of education and of speech itself. The idea of questioning being driven from classrooms, from newsrooms, and the like is synonymous, in my view, with Orwell’s 1984 totalitarian society, wherein there will be no thought as we understand it now.
The part of Romeo and Juliet practically no one talks about occurs after the death of the lovers in which both feuding families and "the Prince" who had some regulatory authority commiserate over the tragedy, and and their own self-centered folly. It's only a story, but I see examples of real people who live to regret their own hubris.
I have regretted (and no doubt will come to regret) my own narcissistic follys . I think it can be easily argued that hubris is and always has been humanity's worst enemy. I believe we can work on dropping the self-centered pretenses and think more about what's provably real before it really comes around to bite us, (as it is already doing to many).
Or even the present, much less testable evidence considered of a probable or desirable future. Just where are current "trends" taking us and where is it that we really want to go?
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!
It's a good rant; no apology needed. The 2A people scare the living daylights out of me. They are in no way, shape, or form part of a "well regulated militia". But by gum, they can take their guns to the grocery store to repel boarders, should the opportunity present itself. Or leave it on the coffee table so their child can shoot their friend, playing with it.
Don’t be sorry! You wrote a wonderful post! I’m not deep enough into my coffee yet, but it’s downright revolting how votes in red states are being completely disregarded with the courts blessing. PA made a huge shift in 2022, it can be done. We can shut this down. Voting is all we have at this point. Vote them all out!
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.
Those kinds of studies need to be done. Medicare is also under attack: the sharks (for-profit insurance companies like United Healthcare) smell blood in the water (large amounts of government cash) and are doing all they can to move us to 'Medicare Advantage'. Do not underestimate their callousness and greed. We'll continue to pay more for healthcare while the rest of the developed world moves to single-payer (government-run) plans that will continue to raise their life expectancies. We'll keep ours on the downward slope by producing and buying more assault rifles.
Medicare Advantage is doing a great job of selling people a bill of goods. They have all kinds of incentives like able to buy gear with their insurance plan. Wait until you have a medical emergency and need care by specialist who is out of network good luck.
My Medicare Advantage Plan allows me to see any doctor accepting Medicare, works overseas when I travel, and I still get free health club memberships through the Silver Sneakers program. Max out of pocket for non-drug costs is $3000/ year. So, not all Advantage plans are the same. I do pay extra, but overall less than what I paid for health insurance before retirement.
It costs you more ... you just don't see it. For example, they are known to "upcode" ... go to your doctor for a headache and they bill the government for a brain tumor. Or deny treatment.
My dad was on a Medicare Advantage plan,which served him well as he was healthy and remained on NO meds until he passed away at 97. When I questioned some of the billing codes ( one was for chronic kidney disease) I was told as he was elderly, it was an automatic code !
Not surprising, as renal insufficiency is virtually universal in seniors. One would hope that as we age, our doctors all run routine blood work, and if they notice something, they let us know. That being said, besides whatever means you take to stay healthy (exercise, healthy diet, etc) you need to also LOOK at your own blood tests and compare them to prior ones. As seniors, watch your BUN and Creatinine levels as these are the kidney function tests of your blood Chemistry profile.
If you Google, there are many websites that help you understand what the tests are and what the tests mean, HOWEVER, many if not most blood tests cannot be considered by themselves, it is the greater overall picture that the physician looks at.
Mr. Helfand, I am simply passing on what I have read, certainly not describing YOUR experience. Glad you are checking what has been billed in your name.
I am 66, I chose traditional Medicare. I have an older sister whose husband had had extensive skin cancers, literally had his 3 rebuilt 3 times. They have had issues with coverage under Medicare Advantage. I wish I could give you the exact issues but I don't recall. They are Chicago residents and have access to top healthcare from multiple locations. (Although the way healthcare systems are gobbling each other up, I feel like we're headed to one healthcare system).
I wonder if people in rural areas have problems with Medicare Advantage and finding in-network specialists within a reasonable driving distance.?
Continuing that thought, after working in several major medical centers within the Chgo area: as a senior, I choose to NOT move more than a 20-30 minute drive from a hospital that can administer TPA. I performed the clotting tests on blood samples of stroke victims--these samples were either drawn in the ambulance or as the patient walked in the door and literally RUN to the lab. We were to turn these around within 20 minutes of being received, which was not easy. We'd get notification that one was coming and had to hold loading any other specimens on the machinery to keep it open--keep in mind that we had many, many critical patients in this facility whose waiting blood tests results were the determining factor of how much/what drug they needed right now.
I had to CALL the doctor with the results, not wait to enter them in the computer and have someone access them on the other end. Every.single.minute mattered.
Given after 60 minutes from onset of stroke, the TPA is actually dangerous.
My brother is in rural Maine, he has MA and with the limited # of doctors, there is no difference in coverage of MA vs. regular Medicare. MA is cheaper. For Rural America, there is no medical competition - if you are lucky you have 1 hospital that you can get to in a reasonable amount of time.
Absolutely. Insurance companies are for profit . Our Medicare healthcare dollars go to insurance companies. There is something very wrong with this picture.
“ By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.”
Unfortunately I don’t have a NY times subscription. I think it is important for people to know how our Medicare dollars are going to for profit insurance companies. They have sold us a bill of goods which benefits the for profit insurance companies. I would love to fully understand how Medicare dollars pay money to insurance companies. I would think the money would go to providing healthcare.
I dunno, my mom had Medicare advantage, for which she did not pay any extra premiums, and it fully covered stroke and cancer treatment. It was pretty great. She did have some out of pocket costs for prescriptions, but it wasn’t much. Paid vision and dental out of pocket but a good plan overall.
Is United Health Care in with this mix, or is it different? When I closed out of this Letter I noticed an email from Pro Publica; I think this may be the link:
I read this article since before retiring, among other things, I managed employee benefits. Yes, this is about United Healthcare denying (and misleading) this poor man.
The (conservative) Brookings Institude published an analysis way back in 1997 They are pro-privatization, yet they conclude that to transition from public to privatized Social Security, massive increases in public spending are needed to pay ongoing Social Security obligations as younger workers pay less into the public system and more into the privatized system. In other words, a successful privatization scheme will raise Federal debt by trillions over decades. So, if present day Republicans are honest, they would say that we must increase the deficit for decades as they decrease future liabilities. They would also say that a massive government intervention in the financial system will be needed to protect naive workers from investing badly. In other words, they would bring the US closer to a socialized system.
Actually,, if the Republicsns are willing to spend what it takes to protect workers - ensuring current recipients get what they're promised while transitioning younger workers to 401K-like systems, the plan should actually work. Democrats might sign on to a decades-long commitment to protect all retirees and also protect all current and future workers.
If Republicans can be honest. If public discourse is patient, civilized, and open. If pugs fly, too. (Or pigs, but that typo made me smile. Briefly)
Anyway, an excerpt from that Brookings study:
"Transition to a Private System
The United States cannot immediately scrap its public retirement system and replace it with a private system. At the end of 1996, more than 43½ million Americans were collecting benefits under Social Security. About 1.6 million workers began to collect new retirement benefits during the year, and another 600,000 were awarded new disability pensions. Even if the country adopted a private system for young workers, people who are already retired or planning to retire within the next few years would continue to receive Social Security checks for several decades. Public funds must be appropriated to pay for these pensions, regardless of the system established for workers who will retire in the distant future.
The need to pay for the pensions of people who are already retired or near retirement age poses a challenge to all plans for privatizing Social Security. Money must be found for existing pension liabilities at the same time workers will be asked to contribute to a new type of private pension account. Because active workers will be required to finance pensions for retired workers and old workers nearing retirement, they may resent the obligation to pay for their own retirement pensions through contributions to new private accounts.
Some privatization plans would fund new retirement accounts by diverting a small part of the present payroll tax into private retirement accounts. In 1996, OASDI benefit payments exceeded Social Security tax revenues by $30 billion, or 1 percent of taxable earnings (see box 1). Thus, 1 percent of the 12.4 percent payroll tax could be invested in individual retirement accounts while still leaving enough taxes to pay for current pension payments. This source of financing for private accounts will not last forever, however. Even if workers under age 40 are completely excluded from collecting Social Security pensions, benefit payments will exceed Social Security taxes by around 2015 (see figure 1). Thus the strategy of diverting a small part of Social Security taxes can work only if current benefits are scaled back. In addition, workers must contribute much more than 1 percent of their wages if they hope to accumulate enough private savings to enjoy a comfortable retirement.
More ambitious privatization plans would divert half or more of the present Social Security payroll tax into private retirement accounts and slash Social Security payments available to young workers (for example, those under age forty-five). These plans would require borrowing or new federal taxes to pay for existing Social Security liabilities. The diversion of payroll taxes would starve the Social Security system of revenue, forcing the program to run huge deficits. To cover these deficits Congress would be forced to raise taxes or borrow funds. The need for extra taxes or borrowing would eventually shrink as pensioners collecting Social Security were replaced by pensioners who received benefits from the new private accounts, but this process would not be complete for several decades. In the interim, the federal government would need to impose extra taxes (temporarily replacing most of the lost Social Security taxes) or sell a large amount of additional public debt."
What would retirement even look like for American workers who constantly change employers? Employers who come and go? Employers who routinely fire employees before too much seniority is built up. Employers who rely entirely on social security. Trying to work your way through all these and other shape shifters seems almost imperiling the future of any retirement. There may be a model that can be achieved but until then the genius of Frances to this day has no equal in keeping the wolf from the door.
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.
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.
Very interesting perspective!!! I live within a 5 mile radius of 3 large hospitals. I have seen some of what you mention.
You mention the shortages of people to care for patients. Over the years, I worked with many immigrants who provided care. Cutting off the immigrants is an argument for another time, but we need those people.
I relate to the shortages, as I retired from the lab after 40+ years. We started having staffing issues back in the 80s as HIV scared many people away from working with blood. CSI shows boosted for a bit, but I had a number of students who were he profession of the modern medical lab really came about thanks to the invention of the Coulter Counter in 1953, which was probably the first "lab" machine. (Modern medicine simply would not exist without the laboratory. As a med tech, I am biased, but it is true.) As I entered my 50s, the ASCP realized that the average age of techs was increasing, but they were unsuccessful in recruiting sufficient students to enter the field. The labs I worked in are now finding it almost impossible to find certified techs, they are hiring students with Biology or Chem degrees. This does not mean these people are stupid at all, but they simply require a lot of OTJ training that is very difficult to provide.
used to grit my teeth at the stories of "lab error" when in actuality, lab tests are as good as the sample you are given. We were trained as to what/why samples were acceptable. Example being, (more than once) I received a sample which had a platelet count that did not fit the patient condition, obviously there had been a clot. I called to request a new sample as this was clotted and was told by an RN that there was "no way it's clotted, I took off that clot myself!". This was someone who should have known! What does the average Bio major learn about blood tests?
This is going to be a huge problem as you can only automate so far.
Any not medical person whose read this far as I know I went off topic, a piece of advice. If you are conscious and thus able to do so when having any lab tests done, INSIST that you see the samples and make sure it is YOUR name on the tube or container. Especially if you have a common name.
I should also comment that this was unusual for nurses to say that they pulled out a clot, though it did happen more than once. The last hospital that I worked with had the VP of Nursing work closely with one of the upper lab managers. They both took nursing and lab working together a priority. I have the highest regard for 99.99% of nurses.
I think you must live very close to me, I’m in Upper Arlington.
One thing that has always confused me is that we Americans are so utterly convinced that our way is the best way, and we don’t look at other countries’ solutions to these same problems. I’ve sought medical care, both for myself and for my children, in Italy. Not only in a big city, but also on a remote island. Absolutely top notch care, zero charge - but very bare bones buildings. No fancy rooms, no fountains, no bells and whistles. The same is true for Italian schools. Plain buildings, but outstanding education, and not because the teachers are better. They aren’t. But they have a national curriculum and a different method of funding public education which is more equitable, and there are very few private schools. It works. My youngest did second grade in Italy, and by the end of that year, he was a full year ahead of his American peers. In second grade! And they don’t even have kindergarten.
Thank you. NYT had an excellent article regarding this about a month ago. I have homes in two underserved communities. The struggle for care is real. Most healthcare requires a 2 hour drive for anything other than a GP and wait times for appointments are ridiculous. “‘Dem hospitals sure are purty tho”.
I recently stopped working for a large hospital system that was crying poverty and 100,000,000 $ debt. A friend showed me several single spaced pages of the hospital administrators, each pulling in salaries from $300k up to $800k. The hospital is closing community primary care practices and consolidating them in a building quite far away from these communities.
The idea of excess administrators is to have top down control of every aspect of practice, operations and clinical, in order to control the bottom line. This leaves very little influence by the clinicians and staffs in the field to improve the system. I have become quite disheartened recently, after 50 plus years of primary care practice.
Phil, thank you for this excellent perspective. I have long felt that compensation to front line medical providers is woefully inadequate. In my rural area finding a GP is very hard and most rely on NP’s to provide initial care/treatment (they usually great btw). IMHO medical care institutions should be non-profit—but solvent (having cash reserves, putting money back into improving treatment option & employee pay/benefits, etc)….BUT all those employed should be compensated with a decent wage (ie; make a living, not a killing). Having retired after 40+ years on staff at a small CA State Univ (now a Cal Poly), I watched colleges (not just mine) become “Club Ed” with lots of bells & whistles (“fun” stuff) instead of investing in better pay/benefits for the programs & educators, and the bloating of the upper administrative level….how many executive VP’s does a college need?
I appreciate your explanation of the situation. Again it highlights that the answers lie somewhere we are kept from getting to. Having a reasonable, informed decision about this with a credible chance of the solutions being implemented, is equal to me winning the PowerBall.
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)
I believe Mississippi is the poorest state in the country (and also the most fervently religious).
Meanwhile, I believe Jackson, Mississippi is still in the throes of a water crisis, in addition to the deplorable state of its hospitals.
The cruelty displayed by the governor and legislature is feudal in its barbarity.
Correct about Mississippi being the poorest state in the USA. Here is the list of the poorest and the least poor among us:
Poverty rates were highest in the states of Mississippi (19.58%), Louisiana (18.65%), New Mexico (18.55%), West Virginia (17.10%), Kentucky (16.61%), and Arkansas (16.08%), and they were lowest in the states of New Hampshire (7.42%), Maryland (9.02%), Utah (9.13%), Hawaii (9.26%), and Minnesota (9.33%). (Wikipedia)
What’s the Alabama state motto? Thank God for Mississippi.
Alabama: Making Georgia Look Better
60 counties in Georgia have no access to pediatric care. 8 rural hospitals have been allowed to close. 🤬
Exactly. Take Atlanta out of Georgia and we'd be Mississippi.
Just got to keep on keepin' on.
Thanks Fern. It’s a helpful list that spurs the question...can someone please explain the process of how those wealthier states actually send money to support the poorer states?
Here's how that works: we pay our federal taxes as a percentage of our income. Minnesota, where I live, has a larger percentage of our population above the poverty level. So, there are more tax dollars flowing from Minnesota to the federal government than in states like Mississippi. When federal programs, created by Congress, distribute funds, those funds are sent out to the States based on the details of the law, often need-based. The needs of the poor in states like Mississippi often mean that more of the funds go to poor states.
Interesting...in light of the Republican idea of giving more rights to the states and cutting federal “socialist” programs, what would happen to those poor states? What if the Republicans get their way...no more redistribution of wealth? (Just wondering if the poorest states are run by republican legislatures?)
Be careful what you wish for?
Those Republican lawmakers create a class system that keeps poor people down, over generations, and provides opportunities only to people who are in the "right groups," politically-connected, wealthy, white, male, related to the important families.
California and most of the Blue States subsidize the Red States. I think a change is needed: A state gets back no more than it pays into the federal government (natural disasters excluded). 20-25% is taken from all tax revenue to fund the federal government and DOD; the rest returned to the States. Past tTime for the Red States, and their voters, to get the kind of government intervention they want--none
well... if those of us in Red states actually had any say, that might be fair.
In Va. the first question to any sick person trying to see a doctor, nurse ,or health care person is “ what insurance do you have?”Not , let’s take a look and start to find out why you are sick.
There are blocks in Va. where one provider takes your insurance but in the next zip code they don’t. The insurance companies have “big business of profit only” tied up. It is easier to die than to see a doctor.
Doctors with a true calling to help those suffering could demand of their very exclusive “Union” the AMA that they won’t be controlled like that.
I once wrote to my “ insurance survey” , “I got better care at the gas station, and it was self -serve”!
We are sick because the disease of “ losing hope” has taken over.
Sad, sad, sad because there is no shame!
Go home Mike One Pence, two Pence, three Pence, of total uselessness!
And Mike Pence trying to stay relative is good for a laugh, but really, who pays him to give speeches? And who would want to listen to this dullard?
Concierge medical care is a growth industry here in CA. Pay a retainer to a doc and you’ve got all the attention you want. I equate it to owning a share in a private jet and an expensive tropical resort home (ick!).
My family has been very happy Kaiser Permanente members for years. Our doctors treat us with thorough care and genuine kindness without having to deal with the bureaucracy.This should be the model for medical services nationwide.
Marg Mac, Same here in Colorado. Permanente physicians are salaried (denounced as "socialism" by those profit mongers in the FFS world of medical practice), thus they escape the perverse incentives of profit-driven medical care. This was the original HMO model, sadly corrupted once the for-profit insurance companies (KP is non-profit) smelled the sweet odor of boundless riches through the mechanism of ruthless claims denial.
Kaiser recommended amputating my 90 year old father's leg when the pressure ulcers Kaiser Hospital allowed him to get wouldn't heal. "He's already mostly in a wheelchair." UCLA saved his leg. I got Kaiser to pay for UCLA's care, too. Caveat Emptor w/ Kaiser
Citizen 60, as you must know, anecdotes are not the substitute for data. I'm sorry for your 90 yo father's situation. Non-healing leg ulcers are often the result of poor circulation.
I called on hospitals 15 years. I have dozens of hospital pt care horror stories, Kaiser in the Western States has pride of place for the highest number.
It’s most recent is to put the NICU resuscitation station in 1/2 of an “active” labor and delivery room without building a wall in the room. Pt and family in labor got to hear preemie pronounced dead after all the staff and machines behind the curtain tried to save it (SF).
Jean, exactly “It is easier to die than to see a doctor.” And most Mississippi residents living below poverty line would agree. Just ask Dr. Google. And this might be a repeat of Fern’s comprehensive assessment of Mississippi, but never too many times to hear and see the Truth. “Life expectancy at birth in Mississippi is the lowest of all states and has historically been low. As is generally the case in states with low life expectancy, Mississippi struggles with poverty, and residents report relatively unhealthy behaviors. At 19.8 percent, no state has a higher poverty rate. Mississippi also has the largest share of adults who do not exercise, at more than a third of the local adult population.” https://www.clarionledger.com/story/news/2019/02/21/life-expectancy-us-where-does-mississippi-rank/2937070002/
We might like to believe that doctors with 'true calling' have that kind of power. They don't. Corporatocracy really does control everything in our lives. Most of us are not aware of the extent of this.
Deborah, as I was reading Dr Richardson’s post about the Republicans labeling everything the government does for ordinary Americans as socialism, I immediately thought - yeah, they prefer a system much like feudalism, where the people are kept “in their place” to serve and support the wealthy, the feudal lords.
Truman said it best: "Republicans called public power socialism. They called water purification socialism. They called Social Security socialism. Republicans call anything that helps people socialism."
Another of my Truman favorites: "Democrats want to help people who need help. Republicans want to help people who don't need help."
The Republican view of government "socialism" seems very selective--Social Security and Medicare are socialist, but $4.5B in FEMA funds to Florida are not.
I used the term "neo-feudalism" for our neo-liberal system nearly a quarter-century ago. But it was unfair to a system that did at least provide some protection in exchange for provisions and services.
Today, it's all take and no give.
It’s calked class warfare.
Call this childish idiocy what you like, I suspect that baboons, wolves and wild dogs know better.
I agree but I think it is important to be very clear what we are dealing with here. The term class warfare raises the hackles of the abusers and brings out the deniers en masse. The powers to be want the people to believe it’s the immigrants or welfare queen or the Democrats or Republicans that we need to fight and bring order and fairness to the masses. When the poster I replied to mentioned that the prison sentence for murder may be significantly less than that for robbery , there is a reason for that. The moneyed powers want to stop any theft of their property, they don’t care if the people kill each other. We need to be looking up at the real criminals, not our neighbors.
Anyway I wholly agree with you on another post, we are one, with similar goals and concerns as most peoples on this Earth. Just that recognition alone would be a great start.
There are Red States that do not received more from the federal government than they contribute. to it.
T'aint class warefare to ask each state to be revenue neutral; to not just be takers.
Deborah, so beautifully said: yes barbaric….
Also near the bottom in health outcomes.
Talk about cruelty. We are living amongst it everywhere.
Politics Girl….Leigh McGowan
https://youtu.be/b_Fo2uygdUw
🗽
Christine. Thank you. Excellent link. Right now I’m listening to Politics Girl in conversation with American Political journalist, David Corn, discussing one of his books, “American Psychosis: A Historical Investigation of How the Republican Party Went Crazy.” Crazy? “It’s not new, he says. According to David’s research, the insanity currently going on with the GOP is not so much a departure from the norms, as a logical conclusion of an established pattern. Since the 1950’s, the Republicans have knowingly encouraged and exploited extremism, bigotry, and paranoia to retain or gain power. As one review put it, “American Psychosis is a sobering look at the ideological destruction, born of cynicism and opportunism, of a once principled party.”
Please do not insult feudalism, a system that made some allowance for social reciprocity. Even chattel slavery housed and fed its human beasts of burden.
As for religion, people do like to believe that if they're well-off, they're saved; while, moving down to the poorest of the poor, if you can't afford to eat properly or to get medical help, you'll always be free to pray. And rest assured, your betters will always be there, kindly reminding you that you are in their prayers...
You are on an ultra hot roll, Peter. It's a relief for me to read your posts because you are among a number of us who have the words to characterize inhumanity on obedient subjects who have been well schooled on their worthlessness. We know that this isn't only about Mississippi. It's old and new again.
Nina Simone: Mississippi Goddam
https://www.youtube.com/watch?v=LJ25-U3jNWM&list=RDLJ25-U3jNWM&start_radio=1&rv=LJ25-U3jNWM
Thank you so much, Fern. Here’s Lyrics of Nina Simone’s song, a piece of history. Click link for all. It’s still the truth.
“The name of this tune is Mississippi Goddam
And I mean every word of it
Alabama's gotten me so upset
Tennessee made me lose my rest
And everybody knows about Mississippi Goddam
Alabama's gotten me so upset
Tennessee made me lose my rest
And everybody knows about Mississippi Goddam
Can't you see it
Can't you feel it
It's all in the air”
https://www.google.com/search?q=nina+simone+mississippi+god+damn+lyrics&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari
Feudal barbarity is succinct!
I answered this but think I understand why Substack couldn't handle my comment.
No matter.
Feudal barbarity is indeed succinct, other terms might be even more so, yet nothing in the thesaurus can come close to expressing the depths to which some human beings' perverseness can descend.
Years ago, I was very struck by the words of Saadi Shirazi which, I learned, are inscribed above the entrance to the Hall of Nations in the UN Building. The content resonated deeply for me. The content, but none of the English translations that I found. I know no Farsi, lost contact with Iranian friends long ago... I ought to have contacted a good friend of my son but, to cut a long story short, I read a literal transcription of these lines, together with all the renderings I could find, and put together what is bound to be a variation on Saadi's theme:
*
Men are members of one body
From one essence they were made
If one single member suffers
The whole body feels the pain.
Those who do not feel for others
Are but beasts, and not our brothers.
*
Yes, my rendering is harsh, but while I see the first two lines as well expressing the deep underlying equality of mankind, the last two tell how far men can descend in betraying our Truth.
I wonder if this could be brought to the attention of Rowshan Nemazee or anyone among HCR's readership familiar with Farsi and Iranian poetry... I'd value comments on this.
Also Jackson is one of the most difficult Capitol cities to get to. They have no commercial airport, the closest one is 30 miles away. When I was a traveling consultant I hate being assigned there for that very reason.
Sorry, while Jackson MS is indeed hard to get to and Medgar Wiley Evers [International] Airport doesn't merit the word I've put in brackets, it is only 6 miles out from downtown...
Thank you, my apologies, I was confusing Jackson MS with Jefferson City MO. I did use the Medgar Evers airport in Jackson, It was with Jefferson City MO that I had to use Columbia MO to get to Jefferson City. Unfortunately my mind blurs (too often) because I traveled so much back then.
Fern, how do we hit these numbers home? Billboards? Easily understood graphics? It’s not rocket science. I worked for fifty years and get $2,200 per month. I could not exist without this money, which I earned and paid into from my first job at 18, in 1967. I thank Frances Perkins and Heather for her history, everyday. First thought when I wake up: “Thank you, Frances, for starting Social Security!”
More importantly, how do we get Mississippians to vote out those who refuse to expand Medicaid? Do they—and other citizens—not see the connection b/t those “leaders” who vote for their citizens to die, or remain poor or uneducated—and voting? BTW TN, where I live, has refused to take Medicaid too, three times, once when asked by a Repub governor who even got some tweaks from HHS that should have made it more palatable to a red legislature. And rural hospitals in TN have closed too.
Voter suppression in Mississippi?
First of all they have to know about Medicaid and or any other government function that is here to help us be a Democracy. Very few people really have the facts about the government agencies and or what they do for us.
Many do not understand SS, Medicare, EPA, IRS.... go through our agencies and ask your community of family and or friends to tell you or describe the purpose of each. Again, the Republicans like dumb. What do you , America , like?
maybe. or maybe they are so tired, sick, hungry, homeless, and under educated that the gerrymandering doesn't even matter now?
I want billboards to be used more effectively for these messages. EVERYONE sees them and reads them.
My husband and I have this conversation a lot--electronic changeable billboards.
Yes, a very worthwhile idea. Make it simple, and quotable!
Something to the effect of:
Today’s Republicans prefer breadlines to a decent minimum wage and shanty towns to decent rural hospitals.
Carole, I live in Vermont, where billboards are prohibited. Thankfully! Only in small older communities are there poles for electricity and telephone, too. Otherwise all lines are underground. It's a beautiful state, and there are modern ways to communicate: SMS, emails, media and marches are a few..
As a psychiatric RN, I spent ~20% of my time making what we called "insurance calls", which mainly consisted of keeping insurance companies from discharging still suicidal patients. What ever agent I spoke to would usually back down when I asked for their name to put on the discharge paperwork, though sometimes one of the psychiatrists would have to call as well. This almost never happened with our medicaid and medicare patients. Tricare was great also.
The reality is a very messy, very inefficient health care insurance system, coupled with very little regulation of prices for health care services has made our system very expensive with poor to middling outcomes. We paid for a brand new Cadillac and got a used Pinto. "Socialized Medicine" could actually realize huge savings for all involved, as all hospitals have to absorb the costs of treating the uninsured.
Well said Steve and very well done to point out that there is a difference between health care and health care insurance.
Been saying that for years, and almost NO ONE understands the distinction between HEALTH CARE & HEALTH CARE INSURANCE!!!
As with other sited issues, it continues to be about the $$$ and not the health of the patient
We became Kaiser members when a family member need mental health services. Long before the ACA made mental health care equal to physical health care, Kaiser treated the brain as it would any other body part, giving mental health patients the care and dignity they deserve.
With our previous coverage, only $25 of the $750 psychiatric initial appointment was eligible for reimbursement. That was an insult and I told the insurance rep that!
If such a large percentage of Mississippi citizens want the Medicaid expansion, why do they keep electing the same-old-same-old politicians to “represent” them?
Voter suppression
We have it in Georgia too. Also, Blatant gerrymandering. National elections have shown our overall electorate is pretty much evenly split 50/50. Yet in our statehouse, Democrats have been overwhelmingly sidelined. Shouldn't our state-wide representation also somehow be able to reflect the numbers we put up in national elections? It's trumpeted about that Georgia is a "swing state" and "purple". One look at our state and local representation easily shows this is NOT true. Why the discrepancy, y'all??
same here in Texass ... gerrymandering and very effective voter suppression that takes many different forms.
Bruce:
I am not a, or your research assistant. Do you have some numbers to support your contention Georgia is not purple? A citation works also.
(Thanks to BK below...)
Let's look at the numbers of Georgia's representatives. Nationally, in the US Senate, both our Senators are Democrats, elected via statewide elections. Keep that fact in mind, please. When it comes to the 14 districts that send representatives to the US House, the make up is 9 Republicans and 5 Democrats. Also, keep that number in mind.
In the Georgia General Assembly, in the State Senate of 56 Senators, the make-up is 32 Republicans to 23 Democrats (with one vacancy, but it is in a district that is quite red, so add another Senator to the Republican total). In the State House of 180 representatives, the make-up is 98 Republicans to 79 Democrats, with 3 vacancies (not sure right off-hand where those are). In the past election, in the statewide executive branch elections, Governor Kemp won VERY handily over Stacey Abrams, and all the other races--Lt. Governor, Sec'y of State, etc. etc.--were all won by Republicans in races that were not at all close. Again, these were statewide elections. Georgia has 159 counties--a huge total, all things considered--and aside from counties in the cities that are blue (Atlanta metro area of roughly 26 (!) counties, Columbus, Augusta, Savannah, Macon, Athens), in the overwhelming majority of the other counties they are run unanimously by Republicans. In my own corner of the world, pulling a couple of totals out of the hat, in a county of 200,000+ population, in 2020 T***p won by 64,000 to 25,000. In the US Senate runoff in 2022, Walker won by 52,000 to Warnock's 19,000. ALL the government positions in this county are held by Republicans. I'm living in a sea of red. This is true in the overwhelming majority of the remaining red counties in the state, which, considering the rest of Georgia's 159 counties (easily 100+), is a lot.
So, *IF* Georgia were truly a "purple" state, my point is: shouldn't then state and local election results be more reflective of our "purple" status? It is my opinion that the numbers in Georgia show quite clearly there is not a fair and equal representation throughout the rest of the state. The urban vs rural divide in Georgia is extreme and Republicans are using it to their advantage. Yes, nationally, Georgia has shown it has stirrings of becoming "blue/purple", but to me that does not at all reflect who holds the balance of power in this state, and it seems to me that if a state is going to become well and truly "purple" this needs to be shown as being true in the down ballot and local races as well.
Does this answer your question?
Yes, it mostly answers me. The balance of power has to be resolved in your state. There appears to be change occurring. It nay spread if more people support it.
Just pulled up Ballotpedia, my sometimes go to for election info. One point I will make is I lived in Michigan for 27 years and saw the Gerrymandering going on there. Our representatives were mostly Repub and our Senators were Dems (except for one instance) going back till 2000. That we had Dem Senators for so long kind of tells the story of how the state was leaning,
Since 1984, the Repubs had control of the state Senate till just recently. Since 1990, the Repubs had control of the state House. Repubs had the Governorship in 1990, 2000, and 2010. Those years allowed the formation of voting districts in Michigan. Packing and Gerrymandering were the orders of the day. Until 2020. I'll explain.
You can't Gerrymander a national election; but you can mess with the voting rolls just like Kemp and Raffensperger did. National news talked of the tens of thousands or voters being dropped from the voting rolls. I wonder why they would do such?
Now, what happened in Michigan? Why did Michigan realign its voting districts? Katie Fahey, a Michigan resident and political novice posted a message on Facebook two days after the 2016 presidential election. She wanted to take on gerrymandering. She recruited more than 14,000 volunteers to campaign for an amendment to the state’s constitution. It passed with 61% of the vote and created the commission (Guardian).
Now Michigan has a Democratic Governor, House, and Senate populated with such people as Mallory McMorrow. Repubs in my Township appointed me (Dem) to the Planning commission. I pretty much know how the sausage is made in small communities of 25,000.
As you stated, you have two Dem Senators in Congress. That is an achievement and a marker of things changing. You are on the brink of change. I believe what may be needed in Georgia is a Katie Fahey or Mallory McMorrow. Warnock a[[ears to have some grit in him.
I admit I leaped before I thought about this and looked at more of the history of Georgia. If anything Georgia could parallel what Michigan did. Good luck.
I have to compose a letter to the City Council asking them why the submission of a Plat would be acceptable if the streets were all mismarked with different names then the county Plat, the builder unknown, the developer unknown, and you can not find the piece of land? The City Manager already went off on me in a public meeting where I would have been declared "out-of-order if I answered. A part of Roberts Rule of Order . . . I guess that only applies to me.
BK:
I took the discussion points to be in the opposite direction. I would have offered up the Secretary of State and the Governor's efforts in purging the voter rolls. Thank you though.
I realize that gerrymandering and voter suppression are widespread and have real impact and consequences.
In this instance however, if the survey data presented are accurate (always a big if) then neither should prevent the Republican and Democratic voters from voting out the reps that refuse to expand Medicaid. Either the survey data are very far off, or access to healthcare is not in the top tier of people’s reasons to vote for or against particular candidates. I suspect it is the latter. I expect that a large percentage of the struggling hospitals and medical practices will close. Then people will be screaming. It is a case of you don’t know what you’ve got till it is gone. Although I also suspect that there are many that would be covered for out patient routine medical care with expansion that do not realize what they have been missing.
Life expectancy in these states will plummet.
Is this the whole truth?
Marj:
You could ask for proof in the form of citations. Or provide the whole proof.
Of course not. Heather Cox Richardson is not simply an American, she is an "anti-Republican American."
No, Heather Chase, HCR is not an anti-Republican American. She is an historian who tells the truth. Facts are what you seem to see as anti-Republican. HCR reports what they do. She also reports what Dems do, and that is not always stellar either.
So far, I have seen no truth about Democrats, but as you will note in the comment I just made, I hope she will prove me wrong.
As versus "an anti American Republican"?
Ah, there we go. Partisanship. I'm not a Republican, by the way, Bridget, but I do know that many Republicans are not anti-American.
Insults are the arguments employed by those who are in the wrong.
Jean-Jacques Rousseau
I agree, Patricia. So let's see: is my accusation of Heather Richardson an insult or a fact? I just wrote her to ask that she send me pieces in which she is not an anti-Republican American. More to the point, please note the following insults from readers of today's post--just today's! Because according to your Rousseau quotation, all these readers are "in the wrong": "the toxic republican vermin"
"Every time I hear the term “States rights” I see slavery and the confederate flag."
"The Repugnants are ignorance and hearsay."
"The greatest danger to this country is the imbecilc, retrograde republican party and climate change."
"I think the Repugnants are even MORE dangerous than climate change...."
"Further proof that the only 'good Republicans' are six feet under."
Hmmmmm? How does your comment stand up in this readership?
Um not sure you are aware of Prof Richardson voting history.
Our voting history is supposed to be a private matter unless we ourselves choose to reveal it.
And if you think only people who vote as you do can speak truthfully, you will never know truth, and you certainly won't want to live in a democracy, which needs debate and at least respect for other ideas in order to exist.
Nope, I'm not.
I am not necessarily interested in her voting history. I'm interested in her history history.
😉
Mis/dis information…They aren’t reading Heather, Joyce Vance, Robert Hubbell, etc. Those same-old-politicians lies, Fox News, talk radio, NewsMax, etc are where they get their information. This includes the upper middle class as well as the lower. I live in Texas and I would bet that very few Texans are aware that our Governor declines Medicare Expansion.
I meant Medicaid….
You could edit your original comment to reduce confusion, but the positive side is that they have an opportunity to correct someone. Either way, your comment is a public service. It's also true. I know because I live in TX.
Please be careful when describing these medical care programs. MediCARE is the national health insurance program for the elderly and disabled which is part of our FICA contribution with every paycheck. MediCAID is federal money which can be sent to the states to help provide medical care service to the part of the population that meets poverty guidelines. By refusing MediCAID, states are actually punishing the poor.
By refusing medicaid, R states are causing my insurance rates to be higher. Such decisions punish everyone.
Jane Myers. Thank you for that very important comment on the terms/language. I liked Deborah Minyard’s comment, realized her “misspeak” and was then relieved to see her correction. An example on how our language can throw us off “into the weeds”
Maybe the poor deserve punishment. They failed at choosing the right ancestors, didn’t they. They could have been born into a wealthy family if they had had more sense.
Is it not the job of the few Texans that do know the gov declines Medicare to share info?
To deaf ears. My brother is active in Dem politics in TX and spits so hard in frustration that his teeth hurt.
MEDICAID
MEDICAID
Now that's the question!! How to promote the truth so voters can make decisions that will benefit them!
Voter suppression .
Like I say unsmart voters.
I would say deliberately uneducated so they can be easily manipulated. Remember, Mississippi also ranks at the bottom in education.
Think gerrymandering and voter suppression!
IMO, stress could well be a health factor to those who have been paying attention to what has transpired over the past few decades. Anger and negativity has to be taking a toll on the health of many who claim to be republicans. When that is manifested through withholding health care social safety nets, and basic decency the lifespans of even more groups are reduced. Just a thought.
Janet, Dick Cheney leaps to mind with his six heart transplants….but supporting policies his entire career to keep medical care to a minimum for most Americans. Stress should kill all those evil Repugnants dismantling our society. I will not shed a tear.
Cheney had one heart transplant in 2012 after a series of heart attacks prior to the transplant. He did not have six heart transplants.
DLM Back in 2012 the surgeon was surprised to find that Dick Cheney had a heart. I wonder whether his personality changed with a ‘new heart.’ I’m humming the song ‘You gotta have heart.’
Transplants or heart operations?
Who were the poor saps who "donated" their hearts?
A good friend of mine is still alive long after his original heart was removed and replaced. You might want to show more compassion for the folks who survive to live longer lives from transplants, despite the occasional stinker like Cheney. Greater still, those that gave their organs did so selflessly, through organ donor cards or notations on their drivers’ licenses, giving the recipients another lease on life. You demean the amazing medical breakthroughs, and the talented surgeons, who extend life for those who survive.
Apropos of my comment is the announcement that Bonnie Raitt has the Grammy Song of the Year nomination for “Just Like That”, a moving and simple tune dealing with just this very subject. Read about the process she came by to craft this wonderful song here:
https://www.nytimes.com/2023/01/31/arts/music/bonnie-raitt-grammys-just-like-that.html
Peace & Love in these troubled times. Be safe; stay well.
Motorcycle riders. Actually accidents of all kinds but motorcycle are high on the list.
Yes. My GP refers to motorcycle riders (like myself) as 'organ donors'.
There is only one 'sap'.
Janet the Republicans I know are staying insulated from the facts and relying more or less on really old party lines. They seem confused as to who todays republicans even are. Health care is fine as most of them are on Medicare and their retirements are wrapped around social security. As to what is actually driving the economy they are pretty sure the tax cuts are holding the country together. Most agree that they would be unable to pay any more taxes on their limited incomes and they are very confused that democrats want more taxes. Perfect storm.
Propaganda works
in the Big Think newsletter there is a great article entitled "The Theory of Stupidity." Very thought provoking.
The proximal and gentle questions for those Republicans fearing loss of income from taxes are: How would their taxes actually increase? Would it be the income taxes - are their social security and other retirement account income considered taxable income? (Am I incorrect that working income is taxed but not passive income, i.e. retirement income?) Or would they pay more taxes through a sales tax of 30%? For instance, if we buy $200 in groceries a week for a year (52 x $200 = $10,400/year), then at 30% taxes (10,400 x .3 is $3,210) we would have to pay $13,520 ($10,400 + $3,120) to get $10,400 in groceries. Not only that, but we would feel it each time we buy anything, for instance $200 in groceries get either $140 in groceries, or pay $260 for groceries. I know arguments are not helpful, but it still feels like calm, thoughtful conversations stand a chance to create change.
I hear you Edward but I would lose them at “ passive income.”
Yes, I see your point; as you may know, the idea of passive income is a term from economics, I guess. We could say retirement income, social security money (is that really income?), or income from investments. I do agree with you, we need to speak the language of our audience.
Retirement needs a champion. Social security is well below poverty levels. Most will never see an investment portfolio and many who do will lose in the marketplace. The business community is an uneven jumble of minimalist retirement provision. Here today and gone tomorrow retirement programs seem to work only for those who are employed by one entity for their entire professional career. While certain provisions can be carried forth from employer to employer often there will come an unforeseen blocking provision which jeopardizes even well thought out retirement programs. The rank and file labor market must have a retirement which is unimpeachable rather than ending in a peach tree dish as someone’s experimental failure. We cannot operate under the provision that people who lose retirement deserve what they get. Or people who plan for no retirement deserve what they get. I am going to work myself to death is not an acceptable retirement vehicle. In this respect someone has to be his brothers keeper. Such a dialogue as you propose should be in the shopping cart along side of racism mitigation, gun violence, health care, women's rights, peace on earth ( let’s not pretend we are the nexus ), disarmament, human rights, wilderness preservation, mental health care, homelessness, sustainable energy, environmental protection, educational opportunities, equality, global warming and perhaps we could turn homeland security into an offensive force which destroys the monsters both foreign and domestic who stalk us all relentlessly. Ok, That was a bridge too far. Can we ask for these obtainable objectives? Can we implement them? Who will represent us? Why isn’t this the focus of this particular congress. Personally I am tired of counting MTG’s three toes.
Not to mention the stress Republicans have caused for the rest of us.
That is what I meant …. The repugs are creating stress for the rest of us while their stupidity and evil insulates them!
FOR AN OUTSTANDING EXAMPLE OF HOW WHITE SUPREMACY IS ENDAGERING AND ROBBING THE CITIZENS OF JACKSON WHO ARE PREDOMINANTLY BLACK __ read this!
'JACKSON, Miss. (AP) — The Mississippi House voted Thursday to further restrict how the capital city of Jackson, which has struggled with water problems, can spend money from a 1% local sales tax — the latest effort in the Republican-led Legislature to control actions of the Democratic-led city.'
'Jackson voters approved the tax in 2014, with the money designated for roads, bridges, water and sewer. Under House Bill 1168 that passed the House Thursday, all of the money would go toward the city's struggling water system.'
'Jackson lawmakers and other Democrats opposed the plan. They said directing all the 1% sales tax revenue to water would hinder Jackson’s ability to fix heavily damaged roads and bridges, including those pockmarked by potholes deep enough to flatten tires.'
“Our streets will go to the devil,” said Democratic Rep. Earle Banks of Jackson.'
'Jackson has had water problems for years and most of the city lost running water for several days in late August and early September after heavy rainfall exacerbated problems in the main water treatment plant. Parts of Jackson lost water again after a cold snap in December.'
'House Ways and Means Committee Chairman Trey Lamar, a Republican from Senatobia, sponsored the bill. He said ensuring clean, fresh drinking water is a higher priority now than fixing potholes.'
“There is a serious need to spend money on water and sewer in the city of Jackson,” Lamar said.
'Opponents of the bill pointed out that Jackson is set to receive $600 million from the federal government for water system improvements. Lamar said he does not know when the federal money will arrive. He also acknowledged he has not spoken with Ted Henifin, who was appointed by the federal government to oversee improvements to the Jackson water system.'
'Democratic Rep. Robert Johnson of Natchez pointed out that money generated by the 1% sales tax in Jackson is already overseen by a commission with members chosen by the governor, lieutenant governor and House speaker. Critics of that commission say it was created by the majority-white Legislature to curb the power of elected officials in a city that is more than 80% Black.'
'Speaking of Lamar's new proposal, Johnson said: “This is another one of those paternalistic ideas that, 'We’re going to tell y'all what to do because we want to punish you while we're doing it.'”
'House Bill 1168 passed 76-41. The vote was largely along party lines, with support from Republicans and most of the opposition from Democrats.'
'The bill was held for the possibility of more House debate and it eventually would have to go to the Senate for more work.'
'The Republican-controlled state Senate recently passed a bill that would transfer the ownership and management of the Jackson water system to a regional board after the federally-appointed administrator leaves.'
'A bill that awaits House debate would create a new court system in parts of Jackson with appointed rather than elected judges. Jackson Mayor Chokwe Antar Lumumba said the court proposal reminds him of apartheid. He has also sharply criticized the regional water board proposal.'
Copyright 2023 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Tags: Mississippi, Associated Press, politics
Thank you, Fern. We should all be speechless. Maybe too many are. Mississippi has been one of or THE poorest state in our nation for years. Forever? It’s obvious its own government keeps the people poor.
Thanks Fern.
HCR makes it clear today that American democracy does not always provide its citizens with what is in their best interests and what repeated polling indicates they want. The Mississippi story about that State’s refusing federal Medicaid dollars extends much further into the nation’s social and economic fabric. For example, HCR points out that ‘the theory behind it also says that the government should also stay out of the business of protecting civil rights, because state governments are the centerpiece of American democracy.’
That is the crux of the problem. State governments are NOT the centerpiece of American democracy. The national government in Washington IS its centerpiece.
The ambiguous Tenth Amendment (‘The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people’) was only one of the many compromises which were made to gain the support of the slaveholding states in 1789 for the new Constitution and is the basis for this misguided theory about what is the ‘centerpiece’ of American democracy, presently adopted by Republicans nationwide.
That is why we had thirteen stars on the American flag in 1789 and fifty today, perpetuating the words of the Tenth Amendment. We should only have one big star on the flag. Just as Republicans ignore the first thirteen words of the Second Amendment (as does the Supreme Court), they choose to ignore the final four words of the Tenth Amendment, ‘or to the people.’
Compromises made for slaveowners in 1789 are not pertinent today and must be remedied because so long as this misused belief in State governments persists, our democracy will rest on wet and shifting sands rather than upon solid rock.
There is no actual ambiguity in either the 2nd or the 10th Amendments, the ambiguity has been introduced, as you note, by the Courts, particularly the Supreme Court and could be cured just as easily either by that Court or by the do-nothing Congress if they chose to perform the tasks for which they were elected. Maybe if we had pictorial coloring books of the Constitution with embedded videos it would help them figure it out.
Unless those who are intent on banning books got to them first.
Fern, this scenario is mind blowing in its stupidity and mystery. But sometimes the simplest answer is the best one?
"Poll: 80% of Mississippians favor Medicaid expansion" - The refusal to accept Federal money is a refusal to save hospitals and therefore save lives. When the river floods and kills, they are quick to accept Federal money and help. Why not for illness?
Perhaps we should look again at the Jackson water problem. I think the brains of the people in this state have been addled by something in the water. Lead? PFAs? Little brain eating worms? Something we haven't identified yet?
How else to explain the utter stupidity of voting for idiots who deny them adequate healthcare? That denies them life itself.
Bill, I'm not sure I understand your reply. It is the state legislators and governor in Mississippi who have rejected all bills to expand Medicaid.
THE FOLLOWING EIGHT STATES IN THE USA HAVE NOT ADOPTED EXPANSION OF MEDICAID:
Florida
Georgia
Kansas
Mississippi
North Carolina
South Carolina
Wisconsin
Wyoming.
My point is that the voters of Mississippi continually vote against their better interests. They vote for these fools who deny them proper health care. If 80% of them want Medicaid, why don't they vote for it? Why do they put up with such self destructive nonsense?
Maybe their brains have been rendered useless by a pollutant. But I am open to any other explanation.
Happy to have spurred your emphatic opinion of bamboozled voters, some of whom might not like it any other way.
Fern, do you know if Mississippi provides its legislators with healthcare insurance?
https://thefga.org/wp-content/uploads/2021/05/Mississippi-Not-Take-Bait-Medicaid-Expansion.pdf
If any of you are videographers, or documentarians (or know someone who is one), Fern’s last paragraph would make a stunning visual for people to emotionally connect with on a personal level. Losing 4 years of your life, at the tail end of your life. What will you miss out on? Grandchildren being born, grandchildren growing up, being there for your family, for your friends, for your fur babies, passing along your wisdom when it is sought, seeing 1460 more sunrises and sunsets, being in nature for 1460 more days, just being - celebrating, caring, consoling, contributing and making the world a little bit better because you lived 4 more years.
Thank you Fern.
Congratulations on making this extrapolation.
It so happens that, only two days ago I attended a lecture in France on Progress and Regressions in Science. One of the major disappointments mentioned was the entire area of public health throughout the world, entailing—among other things—no improvement in the treatment or control of TB and malaria endemic in 3rd-World countries, variable failures to prevent or tackle Covid and future zoonoses, a massive worldwide increase in obesity, starting in childhood, which spread from the US outwards and has incalculable effects on overall health and healthcare costs, falling life expectancy in several countries, including America... Russia, of course, is a dreadful case, even without the totally absurd war waged by a deranged dictator... Nevertheless, Americans, no matter the state they live in, die younger than people in many other industrialized countries...
Drugs, whether sold over the counter or by criminal cartels, were not mentioned in this context, neither were lead bullets in civilian bodies, both adults and children.
As for social security, in Britain, the Liberal politician David Lloyd George introduced a national retirement pension in 1906 and followed it up in 1911 with the National Insurance Act providing "British workers with insurance against illness and unemployment. All wage-earners had to join his health scheme in which each worker made a weekly contribution, with both the employer and state adding an amount. In return for these payments, free medical attention and medicines were made available, as well as a guaranteed 7-shillings per week unemployment benefit" [https://www.historic-uk.com/HistoryUK/HistoryofBritain/Lloyd-George/] America, of course, had to wait until 1935 and FDR's New Deal (which the Republican Party has been increasingly committed to uprooting on the grounds that it is “socialism”... Of course. A great success in Socialist countries like Switzerland and Japan...
This idea of the Infallible Market God as the great magical economic, social and political panacea is, of course, utter BS, bargain-basement mythology, a bouquet of abstractions designed for the exclusive benefit of non-human entities (regardless of how they have been raised to “personhood” by a corrupted US Supreme Court). Competition and “choice” were supposed to make for greater efficiency in all areas of life and to limit the evils of bureaucracy. In reality, aided and abetted by IT “improvements”, privatized bureaucracy is making the citizen's life (or should I say “the subject's life”) into one long training in masochism. Worse, it has infected public bureaucracy, which no longer aims to serve both citizens and economic actors while keeping a beady eye focused on the spending of taxpayers' money, but is obsessed with exclusive service to those in need of no help. Government bureaucrats once employed understandable language but now spout jargon worthy of Komintern at its worst, the only difference being the equally invalid content. Looking Glass Land nonsense.
In economic terms, the bias has been towards extreme inequality accompanied by cartel monopolies. And everywhere, bureaucracy. But bureaucracy whose sole aim is to maximize institutional and other major investors' quarterly returns—and to hell with all else.
How this heavy, self-serving, IT-aided-and-compounded bureaucracy is supposed to square with, for instance, the provision of all the most basic services, social, health, transport, communications, infrastructural, etc. to the public, I think we have all seen too well by now.
We have seen the Present and no, it doesn't work. As for future prospects provided by the current dispensation, the only promise is… KAPUTT.
The estimable Marx and Engels may have failed to sway this bourgeois from his boring, middle-of-the-road fence-sitting politics... but the world has developed such a wild rightward tilt that views that were deadly dull and conventional in the 1960s are now distinctly Leftie. So, if I end a long life clinging to the left edge of the playing field, also inhabited by too many narcissistic nutcases, it's neither Lenin, Mao nor Gramsci I have to thank for this seeming conversion which is no conversion at all, but Sainted Ronald Reagan, Holy Maggie, and such luminaries as the All-That-Glitters-Coney-Island-Critter that last occupied the White House...
Peter, 'All-That-Glitters-Coney-Island-Critter' is 18 carat, so superior to the original.
Come, any epithet's a cinch when faced with that kind of Goldilocks...
Thank you, Angela and Fern, HCR and all of us here who not only care, but actively work for a more socially and economically equitable future and healthy environment. The picture is crystal clear. I add politically, but truly caring and making a difference is more than political rhetoric. It’s action that at this time is a Democratic party practice. And repubs talk and dismantling of anything that helps people is their action. Citizens who vote repub continue to support a kind of nonviolent resurrection, causing poverty and inequality to continue in this wealthy country where the poor and middle class pay taxes and the wealthy benefit. It should be shocking. To all Voters. Should be.
You're the one with precious scenes from the years and moments in our lives. Thank you, Angela.
Fern, thank you for these details. I read the bit about Mississippi with despair. I don't see any of that changing soon, unfortunately. The water problem in Jackson, mentioned below, is also deplorable. I know some of this has to be about race, but it must affect poor white people in Mississippi too. Heath care in this country is a joke, but if we try to fix it, it's that dreaded word, socialism. Once again the Rs prove themselves to be the party of death.
I seem to recall that, a few years ago, people from Iranian health services were providing help and organizational advice to the poorer public hospitals in Mississippi.
I never heard what happened after that, but can't help wondering if ways were not found of putting a stop to such assistance, coming from a country whose regime commonly leads to its being labeled an enemy of the US. Besides being an embarrassment, this interest on the part of benevolent foreigners must have had the undesirable effect of giving poor Mississippians the impression that they merit attention as sentient human beings.
Interesting. I hadn't heard about this.
Get healthcare out of the greedy hands of corporations!
The other thing that strikes me and I hate to say this maybe corp/gov want certain populations to die off!
If the populations aren't White, collette, you may have made a strong point not to be dismissed.
I live in Austin, TX metro area and about once a month there is a post on the social app, Nextdoor Neighbor, that goes something like this: “My wife(husband, father, son, etc) was just diagnosed with _____ (fill in the blank) and looking for help finding insurance to help us pay for surgery/treatment. Any suggestions?” Not only is this heartbreaking, but it should never occur in the richest country in the world, but it does, daily, in the good ‘ol USofA!
Heart breaking? Yes. I would also call it inhumane and essentially criminal. Dozens of other countries with nowhere near the resources of the good Ole US of A... simply don't have that problem. And we spend more than double per capita on something that is broken beyond repair. It's stupid and very cruel.
Thank you, Eileen, for posting this painful, too, common failing of America's exceptionalism. It is OUR STORY. The lives of many Americans, how many? are too dark and too in the dark, and that's what 'it' is all about!
Sounds just like the good ol' 1950s in too many parts of the world...
To put it succinctly, the state government opposes the will of 80% of Mississippians on an issue with life or death implications.
That sounds like a firm foundation for a political campaign to me.
If it was 55%, or the issue wasn't a central one like health care, I could understand how Republicans could continue to distract the voting public and remain in power.
But 80%? Hospitals closing and people dying as a result of deliberate government policy decisions?
There should be no issue more important for the vast majority of that 80% of Mississippi voters than the increased likelihood of their preventable death or the preventable death of their loved ones because of intentional decisions made by the party in power against the will of the people.
How do these barbarians keep winning elections? Democrats in Mississippi should be hammering home this point to the exclusion of all others in every election cycle until the voters get the point, realize their stake in the fight, and turn out to vote these scoundrels out of office.
Oh, and the other states, mostly with Republican leadership, who turn down federal money for Medicaid expansion?
Sounds like that campaign should be national.
You ask 'how do these barbarians keep winning elections?' They do it by campaigning on cultural issues such as the dangers of CRT, of books they object to, of abortions, of someone taking away their guns, of LGBTQ citizens having rights, of vaccinations, of weakening the police, of mixed marriages, of racial, ethnic, or religious groups other than their own taking their place ....
They ignore real issues such as providing health care, climate change, protecting the environment, voting rights, equal opportunity for all, tax policies that give a fair shake to all, and government regulation of things that must be regulated such as the financial marketplace, food, drug and product safety and working conditions.
That's how they keep winning elections. The barbarians cannot be fought on the cultural battlefields of their choice, listed above, which is what they desire. We keep making that mistake.
A pro-choice demonstration never changes the mind of a pro-lifer, or a legislator. They must be defeated by stressing real issues with postitions which are in the interest of most citizens. In Mississippi, they must campaign on the absolute need to particiapate in federal Medicare benefits, and not waste their breath, time and resources on those who oppose taking advantage of them.
Yes, you're absolutely right. Republicans sank the Clinton healthcare plan by changing the debate from the Democrat's wonky policy arguments to the dishonest kitchen table discussions of Harry and Louise (and the misogynistic demonization of Hlilary, but that's another story).
Personalize the issues and you'll win the voters. Unlike the abortion rights movement you mention, the provision of health care is a personal experience that directly affects everyone, all the time, and there's plenty of opportunity to bring the fight to every living room, or kitchen table.
Republicans in eleven states have given Democrats the perfect wedge issue. Ignore the culture wars, and this big thing remains: if you side with Republicans, you'd better hope you don't get sick. Or your kids, or your aging parents. And eleven states is a big enough sample on which to hang a national campaign.
This is a better wedge than Social Security, in which Republicans have already destroyed the confidence of anyone under the age of 50. This is the direct lived experience of every American, literally a matter of life and death for everyone.
From a selfish, personalized point of view, there should be no more important issue to anyone with the power to vote. From an altruistic, help-everyone point of view, or a public health point or view, the same is true.
And Democrats are unambiguously on the right side, and Republicans have given them eleven fat, juicy targets to attack, not counting Congressional races and municipal contests. If we blow this one, we deserve perpetual government by MAGAt, and we will probably get it.
Game on.
The problem is that Democrats are also politicians, and being such, all of their motivation is not altruistic. An effort should be made to keep this above party identity, and as you point out, health care is an ideal personalized wedge issue (as opposed to the Affordable Care Act, Medicare, and Medicaid individually that can become politicized).
YES! To all you have written, along with the URGENCY of communicating the LIFE and DEATH decisions that are being made for Mississippians by the Governor and state legislators. The case against Mississippi's Republican elected representatives is clear and the foundation for the national campaign exposing the Republican Party's goal to obtain autocratic control over the American people as they have done in Mississippi.
It seems to me the elephant in the room is Tom Perez. Where was he when all this was going on? What happened in Mississippi has been a long standing problem. Democratic leadership has been asleep at the switch.
Eadie, I don't think I understand your comment I agree that Tom Perez didn't do the job. Democrats didn't follow Howard Dean's call to be local everywhere in the country - to grow the party where it wasn't a presence. Mississippi is the poorest state and blood red. In general, I would say that the Democratic Party was the problem but I don't want to call the donkeys 'elephants in the room'.
This was a perfect opportunity for the DNC to expose the hypocrisy and utter disregard of rethuglican leadership for the poorest among us. If you hadn't brought the whole issue in Mississippi to my attention again, I would have continued to ignore one more important reason the democrats are losing the message war.
You would think that the GQP was committing political suicide with this. But there are a couple of other factors. These voters are not the brightest bulbs on the planet. And more importantly, they vote based on emotional cultural warfare issues. Like fetus fables and the national security threat of drag queens.
As you say, they're being brainwashed to vote based on abstract fictions. That's why forcing them to pay attention to reality they can't ignore, like their own and their family's health and the lack of concern their government has for them, should be a winning strategy.
When your child gets the flu or meningitis and can't get hospital treatment, the cultural impact of drag queen story hour gets put in perspective real quick.
You're right about what should be campaign talking points but aren't and, if the Democrats don't update their approach, the status will remain quo or deteriorate.
For the record, 39 states and D.C. did expand Medicaid and 11, including Mississippi did not.
What I can't figure out is that they are literally killing off their base. Don't they get that?
Besides the fact that hospitals provide a lot of jobs!
The Governor of Mississippi seems well-versed in the venerable traditions of his state and guided by the spirit that sits firmly ensconced where the heart of his party ought to be. He would surely have inspired Jonathan Swift to write a most memorable panegyric. At a stroke (of inaction), he has found the perfect way to correct those confounded poverty statistics while ensuring that Mississippians will forever vote as they are required to: a new, improved and sanitized approach to lynching, the mass elimination of the undeserving black poor, all without recourse to any of the customary paraphernalia.
’Tis a pity this Elegant Solution seems better to accord with Social Darwinism than with our True Religion, which tells us Darwin lied, wherefore we are enjoin’d in Commination to burn all accursed copies of The Origin of the Species (along with most of the books in our Public Libraries).
well said
Just don't ask your average Mississippian to comprehend it.
yes, indeed
The greatest danger to this country is the imbecilc, retrograde republican party and climate change.
Deborah, that’s two things. I think the Repugnants are even MORE dangerous than climate change....
Elisabeth, I believe it will come a point when Republicans will not be able to withstand the powers of a Nature enraged by climate change. But I see your perspective, too: Republicans are dangerously PRECIPITATING the conditions that lead to that point—with consequences for all humanity.
You're right, I should have written "two dangers."
However, as destructive as "the Repugnants" are, climate has the ability to sweep everything before it away.
With climate change we are playing with forces so thoroughly beyond our control if we push them far enough, and even now, and crucial to our survival. So that's the biggest threat. Meanwhile, follow the money. It's just nuts the degree (above and beyond the ordinary) we have allowed "the theory embraced by members of both parties between 1933 and 1981" to be replaced with Gilded Age plutocracy and corruption. It is mad the degree to which we now accept as normal, the press reports as normal, that wealthy lobbies routinely get to overrule the public will, and that we routinely vote for people who accept that. Even Democrats, more than is honorable or democratic, but the Republican Party is completely bought and paid for, and their response to Liz Cheney and Adam Kinzinger shows where decency gets you in today's "GOP".
Most people live detached from Nature these days and don't realize this truth. Fixing the RepubliCONs won't fix the planet.
Pence pretends to be so worried about passing debt to our grandchildren yet denies climate change and how that will profoundly affect those grandchildren.
I'm sure that part of his solution includes more tax cuts for the wealthy. First things first.
Never forget which over-populated, petroleum-using, capitalistic species caused climate change---
Yes. Climate change is science. The Repugnants are ignorance and hearsay.
Or ignorance & heresy.
What do you know about climate change? Prey tell? It’s an economy thing;) Here is an interview with the author of the GND. https://news.yahoo.com/aoc-chief-staff-admits-green-124408358.html
The greatest danger in my mind is people not standing up to the willful ignorance driving the Republican Party. Calling them names only fuels their resolve to do even worse things. Only by looking them in the eye, calling them out and making them defend the defenseless with put a stop to their sh*t.
They’ve achieved critical mass in terms of shamelessness. They’re aware, they just don’t care
It has not so far.
They go hand and hand. Climate change will not skip over a state that denies Medicare to its citizens, allows unlimited gun carry, censors public school history lessons, scapegoats persons who exhibit a non pathological minority variant of the human condition, or in short--lest this list go on for pages--threatens the vengeance of a violent God made in their own image, I.e. bullying, petty, selfish, temperamental, full of fire and smoke that signifies nothing.
MEDICAID
Thanks!
Preach it, sister.
Charlie, I am a licensed lay preacher in the Episcopal Church as it were. Probably preaching to the choir here.
and that WAR
I blame the unsmart voters that voted them in office.
So, Pence and you other Republicans, how are we doing? Do you give a _ _ _ _?
'U.S. has lowest life expectancy among its peers.
KAISER FAMILY FOUNDATION'
'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.
https://www.forbes.com/sites/joshuacohen/2023/01/01/the-number-one-health-story-from-2022-is-the-troubling-decline-in-life-expectancy/
Chris Hayes did a piece on this topic tonight. The statistics are mind-boggling and soul-crushing. We have a for-profit system of healthcare that is only serving to put us six feet under sooner than most of the rest of the world's developed nations. Our courts are making decisions that will lower our life expectancy. And government, like that of Mississippi, that displays a callousness found only in this, the most well-armed nation on earth.
This is not 'new'. I saw Chris' piece, good job. Why hasn't this been headlined? It is the 'Life and Death Story of America!'
Thank you for this Fern.
The media pushes processed food as quick, easy and everything except nutritious. So, people tend to buy overpriced packaged food products that are popular (as shown constantly on mainstream media), causing obesity. Children and young adults need to learn (perhaps in school?) nutrition, as real food is a big key to life expectancy.
There’s truth to that, but the media also pushes the Mediterranean diet as the key to why Italians have such longevity, without attributing any of that longevity to universal health care.
OMG! You are soooo right. Earlier this week, a box of "food" was delivered to our apartment building to the wrong address. It sat there for a day until my husband retrieved it out of curiosity. There was no return address, no phone number, no way of reporting the misdelivery and the address on the box was across town. We opened it, discovered it was packed in fake "ice", and figured we'd taste it. 🤮 Horrible! The sodium and fat content was through the roof, it was basically the same ingredients remixed into different servings of "food", the "fresh" vegetables had no taste (even the onion), on and on. We ended up throwing the premixed packages of ooze down the disposal and tossing the packaging in the trash - non-recyclable plastic and coated cardboard containers. We'll skip down the street to our farmers market this morning with glee.
P.S. At happy hour yesterday, my (still) teaching buddies and I (I'm retired) were reminiscing about our hand-made wholesomely delicious school lunches. And no waste.
Thank you Fern. You are amazing!
Fern, you are a wonder. When I moved from NYC to MA in 2000, I was stunned by the sheer amount of seriously obese people in the supermarket. In NYC nearly everyone walks to get food and other supplies whereas here it’s with cars and adding to pollution. However, where ever I look or read, almost no where is obesity mentioned in relation to addictions. And, you’re correct: the leading often underlying cause of death is obesity.
I continue to admire your comments to Heather’s amazing newsletters.
Thank you!
Samm, you provoked a blush. Thank you. In addition to learning a good deal from HCR about America and democracy, including her relative calmness, absolute steadiness, synthesis of material, supportive spirit and more; the caring and sharing of info as well as the company of subscribers, I am prompted by this setup to learn more through research. In challenging and, too, frequently, terrible times, LFAA offers a very worthwhile perch for learning and activism. I'm grateful. Cheers, Samm.
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.
He survives the way most politicians do, “socialism” for selfish, worthless, cruel and ignorant bureaucrats. Most could not hold down assistant manager jobs at fast food restaurants. Yet, they give themselves paid healthcare, generous pensions funded by hard working taxpayers, endless hoardes of cash and lifestyle perks from wealthy donors, paid leave and vacations .and short work weeks.
It is the gop creed, “socialism” for me and carbon driven climate change, unsafe drinking water, pollution and polluted air, unsafe food, destruction of animal species, and easy access to weapons of death for you.
That is how Pence and his useless, morally corrupt cronies survive.
And many become millionaires via their gifts and insider tips. The gift givers are running the government.
Seems to be all about the fame and fortune and power greediness. I have long proposed we diminish the goodie bag and increase the work ethic. Our good politicians are out here nearly exhausted trying to be who we need them to be. As for Pence, he looks like he was beaten as a child and then dropped on his head. Why he entered politics is so that his congregation could get rid of him.
I don’t for one minute think he believes it.
He’s flowing the dark path of the irredeemably self-interested. It’s all about pandering for votes – for power - nothing more, nothing less.
There is no ‘’vision’’ for the future of America in the Republican party; theirs is a deep dive to the bottom for its inaptly named leaders, who live in a moral and intellectual vacuum. They spout bullshit day and night – BS being defined as language the truth or falsity of which is of no concern – to woo the base.
Pence, Trump, DeSantis and McCarthy make George Wallace and Strom Thurmond look almost virtuous in comparison.
Exactly this, well said. I think it makes it even worse. They know it’s BS, and they do it anyway because it’s their path to power, full speed ahead and damn the torpedoes. The torpedoes being reality, democracy, climate change, health care, gun violence, inequality, you name it.
Pence survives because he's a groveling little piss ant. He chants the GOP buzzwords. Socialism, babies, abortion, less government, guns, you know, BS for the poorly educated masses.
“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”!
As the middle class departs the guillotine class will have no choice but to accommodate the totalitarian class. The elites haven’t really thought it through too good.
you think that's not our current situation?
I think Suz-an that humanities capacity to suffer is larger than the desire to see others fall through the same cracks.
"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".
Tried it before, they will try it again. And they slobber at the thought of “free money.”
Exactly
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.
And DeSantis is planning a wild west unrestricted gun show in Florida, this the Republican standin for Trump.
Were they ever more humanitarian? They have become monitized.
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.
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?
Sharon, we're in deeper s*** than that in MO. Actually, the attempt by the Gov and Leg to starve Medicaid expansion has failed because (think) the superior court--step up from the circuit--forced the issue. But the rollout is of course going like molasses. In 2021, the DHHS suspended the need to reapply every year for Medicaid and the rolls expanded hugely. But now that suspension has passed and so there is a steamroller heading toward people who are on Medicaid--a steamroller made of time wasting paperwork. NPR has been reporting faithfully about this. Other problems in MO and KS: highest rates of maternal mortality; lowest rates of per-child education spending; lowest wages for school teachers; highest doctor-to-patient ratios (especially in rural KS and MO) . . . I could go on. I am very fortunate to live in KC because, with a bevy of medical schools and other health care education programs all over the place, we have what I think of as "east coast" health care here (that would be the northeast and middle, not the south!). And because of all those students running around, the philanthropic wings of all these medical schools are quite active in the community. And still our prenatal and obstetric systems suck--not because of the doctors but because of not having enough of them. Especially an issue for Black women.
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.
Well said, sir. The history of policing in the US and the application of policing today is not something for the "thin blue line" to be proud of. You can paint "to protect and to serve" on all the cars of your fleet, but the only thing being protected is property, there is no "duty" to put yourself in harm's way, and the ability to articulate your fear of injury in "tense, rapidly evolving, and uncertain circumstances" is a license to kill people that are "dangerous".
And sadly, this arrived in my email a few minutes ago. The purpose of a cartel is to prevent meaningful change, and our two parties with their first-past-the-post voting representation system is serving as a very effective cartel against redefining the role of policing.
https://nymag.com/intelligencer/2023/01/tyre-nichols-and-the-end-of-police-reform.html
That is a good read. I know that training in the "Warrior Mindset" has taken full hold of law enforcement, and a chief who suggested more of a "Guardian Mindset" was vilified.
The Warrior Mindset presumes one is training to eliminate an enemy. Police training that encourage that naturally identify "the enemy" as the citizens, which is the farthest thing from any role to "serve and protect." Such training produces othering, which is a marking of groups as inferiors. The granting of "qualified immunity" creates an extremely dangerous caste system in which the group marked as inferiors is the citizens. These "others" must obey the law, even if they must be compelled to obey unjust laws by force. It creates a superior caste that is above the law and thus above those they other.
I 'm not convinced that such othering by police officers differs that much from ruling class othering by our political parties' elites, who seem to view common citizens as inferiors. It's OK to kill, rob, deceive, and disrespect citizens in both cases. One simply is privileged to do it directly with violence and civil forfeiture if one identifies with a police caste employed by and responsible to the ruling class rather than to citizens. The ruling class does it in more subtle ways by allowing deprivation of life, liberty, and dignity by those with the resources and influence to persist in being predators of citizens for profit.
And just released today. Worth a listen. Did mine while putting in some workout time on an indoor bike. As an investigative journalist and film maker, Michael has the expertise to produce this particular monologue like no one else on Substack.
https://www.michaelmoore.com/p/the-execution-of-tyre-nichols#details
I LIKE this post !!! Lots of supporting links and a unique point of view. well done.
❗️ ❗️ ❗️
Thanks for this reckoning, Ed.
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.
Bingo.
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.
@J L, You might be aware that renowned economist Paul Krugman, for some time, has portrayed much of Republican dogma as “zombies,” ideas “that should have been killed by contrary evidence, but instead keep shambling along, eating people’s brains.” One such example is that tax cuts for wealthy earners generate prosperity and, thus, pay for themselves.
I would note that you might be interested in Krugman’s latest book Arguing With Zombies, which is a compilation of zombie ideas he has, over the years, in his NYT columns, deconstructed owing to their not having a shred of serious evidence to support them.
Reaganomics:
"tax cuts for wealthy earners generate prosperity and, thus, pay for themselves and HOW in the HELL are we going to PAY for it???!!! Deficit! Deficit! Austerity! Austerity!"
@J L, Regrettably, when partisans listen only to each other and pursue unsubstantiated policies, the results invariably are devastating.
And the unwary take them seriously
Cult dynamics and incessant big lies. History shows us it works. Destructive malware for critical thinking, so yes, "zombie" to that extent.
And yes, Krugman is one of the better economic thinkers out there.
@J L, You’re right that an indoctrinated people “incessantly”fed on partisan propaganda are disinclined to put up a fight or to ask questions and be skeptical.
I try to avoid cynical, but skeptical is the other half of open mindedness, as (in my opinion) a true skeptic is skeptical of absolute negation as well as absolute belief. That said there are certainly a range of degrees of confidence. I would not put a gun to my head and pull the trigger to see if "positive thinking" would let me survive. I don't believe in Sasquatch, but hold out a particle of possibility that perhaps there is something of that nature there. It's just that absolute knowledge of any sort depends on the powers of a human nervous system, and while I am confident in "the thing in itself" I can never entirely get out of my own way.
Indoctrinated people fight plenty, but fight to preserve whatever illusion they are invested in. And it can be argued that human reality is in fact an illusion, or at least a representation, but we have our senses and our ability to think to keep it remarkably accurate. Wards of mental hospitals show what happens when reality-checking ability is way off, but who among us has never been fooled?
I think we preserve or hone our edge when we question everything. Who would have guessed that space-time is demonstrably elastic, but Einstein had the temerity to question the unquestionable, over a century ago? Who would dare to think that kings are naked?
@J L, I apologize that a busier-than-usual schedule has prevented me from replying in a timely manner to your thought provoking comment. Truthfully, your openness brings to mind the increasing number of states intent on taking over ideological control of education and of speech itself. The idea of questioning being driven from classrooms, from newsrooms, and the like is synonymous, in my view, with Orwell’s 1984 totalitarian society, wherein there will be no thought as we understand it now.
Thank you for interjecting some practical philosophy.
We need to have our minds jogged quite often... to wake us up... or at least to know when we're dreaming.
The part of Romeo and Juliet practically no one talks about occurs after the death of the lovers in which both feuding families and "the Prince" who had some regulatory authority commiserate over the tragedy, and and their own self-centered folly. It's only a story, but I see examples of real people who live to regret their own hubris.
I have regretted (and no doubt will come to regret) my own narcissistic follys . I think it can be easily argued that hubris is and always has been humanity's worst enemy. I believe we can work on dropping the self-centered pretenses and think more about what's provably real before it really comes around to bite us, (as it is already doing to many).
Thanks for "Arguing With Zombies," Barbara.
My pleasure, Jeff. In my view, Krugman does a brilliant job of delivering the truth.
A couple of days ago Meta (Facebook) announce $40 Billion stock buy back. Gotta question their definition of “trickle”
That's the "torrent" part.
We have not listened to the past…
Or even the present, much less testable evidence considered of a probable or desirable future. Just where are current "trends" taking us and where is it that we really want to go?
Hear Hear !!! Nice Rant.
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!
Christopher, I like this : Republican tax cuts = Socialism for the rich
It's a good rant; no apology needed. The 2A people scare the living daylights out of me. They are in no way, shape, or form part of a "well regulated militia". But by gum, they can take their guns to the grocery store to repel boarders, should the opportunity present itself. Or leave it on the coffee table so their child can shoot their friend, playing with it.
Thanks for that reference to the Vidal/Buckley debate
Good rant!
Don’t be sorry! You wrote a wonderful post! I’m not deep enough into my coffee yet, but it’s downright revolting how votes in red states are being completely disregarded with the courts blessing. PA made a huge shift in 2022, it can be done. We can shut this down. Voting is all we have at this point. Vote them all out!
The phrase “race to the bottom” comes to mind
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.
Those kinds of studies need to be done. Medicare is also under attack: the sharks (for-profit insurance companies like United Healthcare) smell blood in the water (large amounts of government cash) and are doing all they can to move us to 'Medicare Advantage'. Do not underestimate their callousness and greed. We'll continue to pay more for healthcare while the rest of the developed world moves to single-payer (government-run) plans that will continue to raise their life expectancies. We'll keep ours on the downward slope by producing and buying more assault rifles.
Medicare Advantage is doing a great job of selling people a bill of goods. They have all kinds of incentives like able to buy gear with their insurance plan. Wait until you have a medical emergency and need care by specialist who is out of network good luck.
My Medicare Advantage Plan allows me to see any doctor accepting Medicare, works overseas when I travel, and I still get free health club memberships through the Silver Sneakers program. Max out of pocket for non-drug costs is $3000/ year. So, not all Advantage plans are the same. I do pay extra, but overall less than what I paid for health insurance before retirement.
It costs you more ... you just don't see it. For example, they are known to "upcode" ... go to your doctor for a headache and they bill the government for a brain tumor. Or deny treatment.
A couple of links:
https://americanprospect.bluelena.io/index.php?action=social&chash=6c1da886822c67822bcf3679d04369fa.1421&s=65473cdb9b65940d8971d2bbc5f9189d
https://prospect.org/health/dark-history-of-medicare-privatization/
My dad was on a Medicare Advantage plan,which served him well as he was healthy and remained on NO meds until he passed away at 97. When I questioned some of the billing codes ( one was for chronic kidney disease) I was told as he was elderly, it was an automatic code !
Not surprising, as renal insufficiency is virtually universal in seniors. One would hope that as we age, our doctors all run routine blood work, and if they notice something, they let us know. That being said, besides whatever means you take to stay healthy (exercise, healthy diet, etc) you need to also LOOK at your own blood tests and compare them to prior ones. As seniors, watch your BUN and Creatinine levels as these are the kidney function tests of your blood Chemistry profile.
If you Google, there are many websites that help you understand what the tests are and what the tests mean, HOWEVER, many if not most blood tests cannot be considered by themselves, it is the greater overall picture that the physician looks at.
Yes, I'm sure that happens. But i check all my bills and that hasn't happened with the medical providers I've used so far.
Be careful when trying to tell people ehat they really experienced unless you know first hand.
Mr. Helfand, I am simply passing on what I have read, certainly not describing YOUR experience. Glad you are checking what has been billed in your name.
Try this one:
https://hartmannreport.com/p/the-latest-for-profit-advantage-assault
I am 66, I chose traditional Medicare. I have an older sister whose husband had had extensive skin cancers, literally had his 3 rebuilt 3 times. They have had issues with coverage under Medicare Advantage. I wish I could give you the exact issues but I don't recall. They are Chicago residents and have access to top healthcare from multiple locations. (Although the way healthcare systems are gobbling each other up, I feel like we're headed to one healthcare system).
I wonder if people in rural areas have problems with Medicare Advantage and finding in-network specialists within a reasonable driving distance.?
Continuing that thought, after working in several major medical centers within the Chgo area: as a senior, I choose to NOT move more than a 20-30 minute drive from a hospital that can administer TPA. I performed the clotting tests on blood samples of stroke victims--these samples were either drawn in the ambulance or as the patient walked in the door and literally RUN to the lab. We were to turn these around within 20 minutes of being received, which was not easy. We'd get notification that one was coming and had to hold loading any other specimens on the machinery to keep it open--keep in mind that we had many, many critical patients in this facility whose waiting blood tests results were the determining factor of how much/what drug they needed right now.
I had to CALL the doctor with the results, not wait to enter them in the computer and have someone access them on the other end. Every.single.minute mattered.
Given after 60 minutes from onset of stroke, the TPA is actually dangerous.
Sorry for the digression here.
My brother is in rural Maine, he has MA and with the limited # of doctors, there is no difference in coverage of MA vs. regular Medicare. MA is cheaper. For Rural America, there is no medical competition - if you are lucky you have 1 hospital that you can get to in a reasonable amount of time.
I have a MA plan I’m very happy with.
And somewhere between the money paid by the governmet for Medicare, and the money available for you, your insurance company has found its profit.
Absolutely. Insurance companies are for profit . Our Medicare healthcare dollars go to insurance companies. There is something very wrong with this picture.
The government does pay private insurance companies, intermediaries, to manage Medicare claims. There is no Medicare claims office.
“ By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.”
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html?
Unfortunately I don’t have a NY times subscription. I think it is important for people to know how our Medicare dollars are going to for profit insurance companies. They have sold us a bill of goods which benefits the for profit insurance companies. I would love to fully understand how Medicare dollars pay money to insurance companies. I would think the money would go to providing healthcare.
I dunno, my mom had Medicare advantage, for which she did not pay any extra premiums, and it fully covered stroke and cancer treatment. It was pretty great. She did have some out of pocket costs for prescriptions, but it wasn’t much. Paid vision and dental out of pocket but a good plan overall.
Is United Health Care in with this mix, or is it different? When I closed out of this Letter I noticed an email from Pro Publica; I think this may be the link:
https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
I read this article since before retiring, among other things, I managed employee benefits. Yes, this is about United Healthcare denying (and misleading) this poor man.
The (conservative) Brookings Institude published an analysis way back in 1997 They are pro-privatization, yet they conclude that to transition from public to privatized Social Security, massive increases in public spending are needed to pay ongoing Social Security obligations as younger workers pay less into the public system and more into the privatized system. In other words, a successful privatization scheme will raise Federal debt by trillions over decades. So, if present day Republicans are honest, they would say that we must increase the deficit for decades as they decrease future liabilities. They would also say that a massive government intervention in the financial system will be needed to protect naive workers from investing badly. In other words, they would bring the US closer to a socialized system.
Actually,, if the Republicsns are willing to spend what it takes to protect workers - ensuring current recipients get what they're promised while transitioning younger workers to 401K-like systems, the plan should actually work. Democrats might sign on to a decades-long commitment to protect all retirees and also protect all current and future workers.
If Republicans can be honest. If public discourse is patient, civilized, and open. If pugs fly, too. (Or pigs, but that typo made me smile. Briefly)
Anyway, an excerpt from that Brookings study:
"Transition to a Private System
The United States cannot immediately scrap its public retirement system and replace it with a private system. At the end of 1996, more than 43½ million Americans were collecting benefits under Social Security. About 1.6 million workers began to collect new retirement benefits during the year, and another 600,000 were awarded new disability pensions. Even if the country adopted a private system for young workers, people who are already retired or planning to retire within the next few years would continue to receive Social Security checks for several decades. Public funds must be appropriated to pay for these pensions, regardless of the system established for workers who will retire in the distant future.
The need to pay for the pensions of people who are already retired or near retirement age poses a challenge to all plans for privatizing Social Security. Money must be found for existing pension liabilities at the same time workers will be asked to contribute to a new type of private pension account. Because active workers will be required to finance pensions for retired workers and old workers nearing retirement, they may resent the obligation to pay for their own retirement pensions through contributions to new private accounts.
Some privatization plans would fund new retirement accounts by diverting a small part of the present payroll tax into private retirement accounts. In 1996, OASDI benefit payments exceeded Social Security tax revenues by $30 billion, or 1 percent of taxable earnings (see box 1). Thus, 1 percent of the 12.4 percent payroll tax could be invested in individual retirement accounts while still leaving enough taxes to pay for current pension payments. This source of financing for private accounts will not last forever, however. Even if workers under age 40 are completely excluded from collecting Social Security pensions, benefit payments will exceed Social Security taxes by around 2015 (see figure 1). Thus the strategy of diverting a small part of Social Security taxes can work only if current benefits are scaled back. In addition, workers must contribute much more than 1 percent of their wages if they hope to accumulate enough private savings to enjoy a comfortable retirement.
More ambitious privatization plans would divert half or more of the present Social Security payroll tax into private retirement accounts and slash Social Security payments available to young workers (for example, those under age forty-five). These plans would require borrowing or new federal taxes to pay for existing Social Security liabilities. The diversion of payroll taxes would starve the Social Security system of revenue, forcing the program to run huge deficits. To cover these deficits Congress would be forced to raise taxes or borrow funds. The need for extra taxes or borrowing would eventually shrink as pensioners collecting Social Security were replaced by pensioners who received benefits from the new private accounts, but this process would not be complete for several decades. In the interim, the federal government would need to impose extra taxes (temporarily replacing most of the lost Social Security taxes) or sell a large amount of additional public debt."
Yea, verily, if Republicans can be honest. (sigh).
What would retirement even look like for American workers who constantly change employers? Employers who come and go? Employers who routinely fire employees before too much seniority is built up. Employers who rely entirely on social security. Trying to work your way through all these and other shape shifters seems almost imperiling the future of any retirement. There may be a model that can be achieved but until then the genius of Frances to this day has no equal in keeping the wolf from the door.
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.
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:
https://www.dropbox.com/s/c4uajap3t4kcar8/administrator%20growth%20to%202019.png?dl=0
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.
Very interesting perspective!!! I live within a 5 mile radius of 3 large hospitals. I have seen some of what you mention.
You mention the shortages of people to care for patients. Over the years, I worked with many immigrants who provided care. Cutting off the immigrants is an argument for another time, but we need those people.
I relate to the shortages, as I retired from the lab after 40+ years. We started having staffing issues back in the 80s as HIV scared many people away from working with blood. CSI shows boosted for a bit, but I had a number of students who were he profession of the modern medical lab really came about thanks to the invention of the Coulter Counter in 1953, which was probably the first "lab" machine. (Modern medicine simply would not exist without the laboratory. As a med tech, I am biased, but it is true.) As I entered my 50s, the ASCP realized that the average age of techs was increasing, but they were unsuccessful in recruiting sufficient students to enter the field. The labs I worked in are now finding it almost impossible to find certified techs, they are hiring students with Biology or Chem degrees. This does not mean these people are stupid at all, but they simply require a lot of OTJ training that is very difficult to provide.
used to grit my teeth at the stories of "lab error" when in actuality, lab tests are as good as the sample you are given. We were trained as to what/why samples were acceptable. Example being, (more than once) I received a sample which had a platelet count that did not fit the patient condition, obviously there had been a clot. I called to request a new sample as this was clotted and was told by an RN that there was "no way it's clotted, I took off that clot myself!". This was someone who should have known! What does the average Bio major learn about blood tests?
This is going to be a huge problem as you can only automate so far.
Any not medical person whose read this far as I know I went off topic, a piece of advice. If you are conscious and thus able to do so when having any lab tests done, INSIST that you see the samples and make sure it is YOUR name on the tube or container. Especially if you have a common name.
I should also comment that this was unusual for nurses to say that they pulled out a clot, though it did happen more than once. The last hospital that I worked with had the VP of Nursing work closely with one of the upper lab managers. They both took nursing and lab working together a priority. I have the highest regard for 99.99% of nurses.
I think you must live very close to me, I’m in Upper Arlington.
One thing that has always confused me is that we Americans are so utterly convinced that our way is the best way, and we don’t look at other countries’ solutions to these same problems. I’ve sought medical care, both for myself and for my children, in Italy. Not only in a big city, but also on a remote island. Absolutely top notch care, zero charge - but very bare bones buildings. No fancy rooms, no fountains, no bells and whistles. The same is true for Italian schools. Plain buildings, but outstanding education, and not because the teachers are better. They aren’t. But they have a national curriculum and a different method of funding public education which is more equitable, and there are very few private schools. It works. My youngest did second grade in Italy, and by the end of that year, he was a full year ahead of his American peers. In second grade! And they don’t even have kindergarten.
Yep - Worthington. Though - in the winter, we are in South Carolina.
We used to live in Worthington! And lucky you, it’s very cold here this morning.
Thank you. NYT had an excellent article regarding this about a month ago. I have homes in two underserved communities. The struggle for care is real. Most healthcare requires a 2 hour drive for anything other than a GP and wait times for appointments are ridiculous. “‘Dem hospitals sure are purty tho”.
I recently stopped working for a large hospital system that was crying poverty and 100,000,000 $ debt. A friend showed me several single spaced pages of the hospital administrators, each pulling in salaries from $300k up to $800k. The hospital is closing community primary care practices and consolidating them in a building quite far away from these communities.
The idea of excess administrators is to have top down control of every aspect of practice, operations and clinical, in order to control the bottom line. This leaves very little influence by the clinicians and staffs in the field to improve the system. I have become quite disheartened recently, after 50 plus years of primary care practice.
Wow. These behemoths are killing healthcare.
Phil, thank you for this excellent perspective. I have long felt that compensation to front line medical providers is woefully inadequate. In my rural area finding a GP is very hard and most rely on NP’s to provide initial care/treatment (they usually great btw). IMHO medical care institutions should be non-profit—but solvent (having cash reserves, putting money back into improving treatment option & employee pay/benefits, etc)….BUT all those employed should be compensated with a decent wage (ie; make a living, not a killing). Having retired after 40+ years on staff at a small CA State Univ (now a Cal Poly), I watched colleges (not just mine) become “Club Ed” with lots of bells & whistles (“fun” stuff) instead of investing in better pay/benefits for the programs & educators, and the bloating of the upper administrative level….how many executive VP’s does a college need?
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I appreciate your explanation of the situation. Again it highlights that the answers lie somewhere we are kept from getting to. Having a reasonable, informed decision about this with a credible chance of the solutions being implemented, is equal to me winning the PowerBall.