Today's Post-Midterm Message: Health Inequity Can Kill You

<Word Cloud:

University of New South Wales Sydney School Of Medicine>

<i.>

I feel like I've been leveled by a bulldozer. For the past week, Squawker and I have been flattened by some kind of monster flu bug, that's become one of those grim winter traditions: "Welcome to this, buddy!" At least The Squawker and I have been spared what my sister just endured -- the chronic diarrhea and puking bouts that often accompany with these bugs.

However, though I'm mostly over the sniffling/snorting phase, I'm struggling with back pain, which has migrated from my right side, to the center to my left side. Which is rather terribly inconvenient, as our Brit cousins might say, when one is spending a great deal of time under the covers. Or sitting to do a post, like this one. It is what is, so I'll just have to carry on.

Still, in light of the flurry of interest in my last post ("Today's Midterm Message: Life Is Not A Pre-Existing Condition"), I thought it made sense to follow up with a related topic: health inequity. Put bluntly, where you live can literally determine how long you live. Or how soon you die.

That's the thesis of Dr. David Ansell, of Rush University Medical Center (Chicago, IL), who's spent 30 years studying how racism and social inequity impact life expectancy -- one of the simplest, barest metrics of human existence. I stumbled on his YouTube presentation, and his work, while letting my fingers do the Googling (so to speak).

Ansell's presentation, "How Inequity Kills: Health Systems And Health Inequity" (September 27, Lake Michigan College, Benton Harbor, MI) is linked below in its entirety. I haven't seen it in full yet, but what I have caught is pretty disturbing, as you might imagine. Simply stated, the gaps between rich and poor -- which, one might argue, have grown into canyons, if not outright chass -- are also revealing themselves in who lives, and who dies. A lot of this information is deeply disturbing; as Ansell says at the beginning, "I always tell people, 'Wait till the end to clap. You may not like what I say.'"

The venue where Ansell spoke is a case in point. Life expectancy in Southwest Michigan's Twin Cities -- better-off, white St. Joseph, MI -- is 19 years longer than in its largely African-American, poorer neighbor, Benton Harbor. Put another way, you can bank on living to 86 or 87 in St. Joseph, and its equally lilly white neighbor, Stevensville;. However, if you live in Benton Harbor, 67 is the average life expectancy. Across the board, the gap between rich and poor is 15 years nationwide.

Ansell calls this phenomenon "the death gap," which is driven by access to healthcare, as well as structural racism that's often built into policymaking, particularly at the local level -- where the gaps are most glaring, he asserts. Those phenomenons have led to death gaps between rich and poor of four (Ireland), eight (Great Britain) and 30 years (Michigan). "Now, every developed country has a gap, but no country has a gap like the United States," he says.

<UNSW World Cloud, Revisited:

The Reckoner>

<ii.>

Of course, such concerns are hardly new. People have bandied them about endlessly since the 1980s, when "trickle down" economics and flat wages became, with rather few resceptions, deeply embedded instruments of public policy. However, all this wealth only seemed to flow largely in one direction, to an inner ring of elite overdogs, who wasted little time finding the best representatives that money could buy.

And they're not shy about the privileged cocoons they inhabit. Far from it, as this ever-so-tasteful anecdote from Business Insider's November 12017 interview with billionaire Sean Parker suggests: 

"So ... I'm going to be like 160 and I'm going to be part of this, like, class of immortal overlords. [Laughter] Because, you know the [Warren Buffett] expression about compound interest. ... Give us billionaires an extra hundred years and you'll know what ... wealth disparity looks like."

Sensitive, isn't he? With more than a whiff of moral bankruptcy to boot. If Satan does exist, and he's up for crafting a special air-conditioned room -- well, I've got a fair idea of his first candidate. Let's leave it at that. You can read the whole nauseating business for yourself below. Enough said there.

Even so, it's interesting that Facebook's first president has a qualm or two about letting his kiddos consume the offerings of a social media conglomerate that hungers 24/7 to exploit their time and attention ("God only knows what it's doing to our children's brains"). 

Guess that makes him a trifle hypocritical, too, so...well, once you finish selling your soul, you may well as tick all the wrong boxes, right? It's like Jays Potato Chips: you can't stop with just one (sellout), right?

Of course, there's a school of thought that suggests we're silly to get so upset. Sean Parker only spouts publicly what people like him intone, mantra-like, behind closed doors, and hey, who cares? He's only a billionaire, so why would anybody believe him, anyway? No harm, no foul. It's all good, right?

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But here's the problem with that logic. As Ansell's presentation clear, if we don't undo all those corrosive practices that shorten an average person's life -- whether it's credit checks to get a job, or restricting their living spaces to the neighborhoods, or making insurance conditional, at best -- we'll slide ever further back into the pre-New Deal dark ages. Or, as Ansell observers, "What we tolerate, we promote. So, if you tolerate unsafe conditions, we're promoting unsafe conditions."

You can assign whatever metrics to the problem you wish. One nugget that stands out from the Business Insider article is this one: in 2016, annual healthcare costs reached $10,345 per person. Plugging that back into Ansell's Twin Cities example, that figure chews up about 3 percent and 54 percent, respectively, of a person's average income in St. Joseph ($34,985), and Benton Harbor ($18,962).

Granted, Michigan was one of the few Republican-led states to expand Medicaid to its most vulnerable citizens, though time will tell how many actually keep their coverage, once those long-threatened work requirements kick in. In the end, though, it's fair to say that healthcare issues are often a question of numbers. Review the above statistics, again, if you wish, and watch Ansell's presentation. Then ask yourself: "Who really comes out ahead here?" If that doesn't rally people after the Democrats' midterm successes, nothing will. --The Reckoner

Links To Go (Hurry, Hurry, 

Before Your Medicaid Evaporates):
(Cut 'n' paste in your browser, if needed):

Business Insider

Dr. David Ansell:

How Inequality Kills:

Health Systems & Health Equity:

https://www.youtube.com/watch?v=3uMCy9j8ubU

Ex-Facebook President 

And Billionaire Sean Parker Reveals...

https://www.businessinsider.com/ex-facebook-president-sean-parker-billionaire-advantage-better-healthcare-2017-11

Trumpcare Demise Takeaways (& Guest Cartoon: The Highwayman)

<The Highwayman: "Christmas For The People">

Trumpcare is dead, for now.  As we saw last month, on live TV, John McCain's (R-AZ) dramatic "thumbs" down gesture on the Senate floor finally scuttled his party's effort to strip millions of their dearly-won health insurance -- whether they owed it to the Affordable Care Act itself, or living in a Medicaid expansion state (like me). The bats have been forced back into the abyss, leaving Trumpcare to join the love bead, the Nehru jacket, the pet rock, and the Sears cocktail dress in the Hall of Historical Japes. 

Fittingly, for me, the so-called "skinny repeal" psycho circus (July 27-28) coincided with a medical procedure -- like Trump's election, when I underwent an emergency tooth extraction the morning after, as I've already written here:

https://ramennoodlenation.blogspot.com/2016/12/lifes-little-injustices-take-ix-month.html

The night before the skinny repeal psychodrama unfolded, I underwent a vascular procedure that had eluded me for a decade, due to my uninsured status. Basically, I needed to close a vein or two. It wasn't life-threatening, but the doctor told me that -- had I waited much longer -- I'd surely start feeling worse, since  blood had been pooling in my legs, and feet...not snaking back up to the groin, as Nature intended.

So I laid down on the table, and got the job done. I didn't feel any pain, aside from a half-dozen pokes of the doctor's needle. Naturally, my inner thigh felt a little tender afterwards, but all that's ebbed away as I sit here writing. Needless to say, I feel better than I've felt in ages. And it didn't cost me a dime (at least, I haven't seen a bill yet).

However, without my Medicaid card's surprise appearance in my mailbox a couple months ago, my surgery would never have happened. I can't even count, over the last decade, how many workarounds I investigated...from applying for charity care via the local hospital, to the GoFundMe route, and selling off everything I owned. Among other options.

That being said, the warped course that the health debate took -- from the House Republicans' equally ill-starred effort, to the various Senate alternatives cobbled together in those secret meetings, and "working" lunch breaks -- should spike any notions of the "adults in the room" restraining Trump and his ultra-right acolytes. Look no further than veteran shapeshifters like  Lindsay Graham (D=SC), who breathlessly denounced the "skinny repeal" effort for the TV cameras...only to vote for it hours later.

We heard equally tortured volleys of verbal gymnastics from so-called moderate GOPers like Shelly Moore Capito (WV), Dean Heller (NV), and Rob Portman (OH), who offered varying reservations about Trumpcare's impact on hospitals and vulnerable constituencies, like people with disabilities...only to cave in, as Graham did, and join their fellow "adults" in sending "skinny repeal" down the conveyor belt with a hearty shove. 

Heller's example is especially pathetic, as we watched him zig (first, opposing the Senate's original Better Reconciliation Act as "bad for Nevada," then agreeing to allow to debate on it), and finally, zag (with a few more scripted verbal reservations)...before his knees buckled, and he, too, joined the "adults" on their skinny repeal stampede.

Heller's attempt to play every possible end against the middle smacks of General Friedrich Fromm's actions, as portrayed in Valkyrie. For those who don't know their war history, Fromm is the guy who declined to take part in the July 20, 1944 bomb plot against Adolf Hitler, but held out the possibility of joining the conspirators later...but only after getting proof of the dictator's demise. 

Confronted with the opposite outcome, Fromm hurriedly moved to execute the ringleaders, an act that didn't fool his Nazi paymasters. He, too, wound up executed in March 1945 (having been stripped of his military status the previous -- though, out of deference to it, Hitler allowed him to be shot, rather than being slowly strangled from a loop of piano wire -- lucky guy, eh?). 

Senator Heller hasn't seen the movie, I guess.

If nothing else, the near-success of all this frenetic backroom maneuvering is testimony to the siren song of groupthink -- although, funnily enough, it didn't sway Senators Susan Collins (ME), or Lisa Murkowski (AK), who staked out their opposition from the beginning, and -- unlike their tin-eared, tone-deaf colleagues -- showed signs of actually doing their homework, and listening to their residentes' concerns.

Time will tell whether the political will exists to fix the Affordable Care Act's well-documented warts (which Collins and Murkowski repeatedly pointed out, to anyone who cared to listen).. However, the failure of Trumpcare also proves that the resistance to it -- and whatever equally ill-thought-out initiatives fly off the president's desk -- is alive and well. Without so many millions of us taking the time -- whether it involved marching, picketing, or trying to track down a fugitive Senator or Congressman, ducking their constituents -- we might already have been bemoaning our return to the Dark Ages (as in, 20 to 50 million newly uninsured Americans, depending on which estimate you believed).

I will remember both those nights -- my procedure, and the collapse of Trumpcare -- as long as I live and breathe. I couldn't help but feel emotional after the impact of McCain's gesture sunk in. I'd been working late, as usual, which meant I kept the TV on. Due to the camera angles CNN was using, however, what happened wasn't immediately clear. Of course, the meaning quickly became clear enough, especially after the networks replayed that footage --- which prompted me to tell people: "This is why we do this. This is why we fight so hard to change things."

Of course, plenty of other fights loom ahead. But, for me, the biggest takeaways come down to two points: first, the system worked, for a change. A bad idea remained a bad idea, and stayed on the cutting room floor. The second is an expression attributed to Abraham Lincoln, one that Democratic House Minority Leader Nancy Pelosi liked to quote when the GOP cranked up the first of its zombie healthcare bills last spring: "Public sentiment is everything." If you want to explain why Trumpcare tanked, I couldn't think of a better epitaph.. --The Reckoner

Guest Cartoon: The Highwayman: "The Future Of Trumpcare"

This cartoon reminds me of a line from a Graham Parker song: "I have seen the future of rock, and it sucks." Well, substitute "Trumpcare" for the r-word, and I think you'll be able to see where The Highwayman was coming from on this cartoon...and it may be closer than you think...if they get their way. If. If. If. --The Reckoner

Benefits Back On The Chopping Block: Now Is Not The Time To Sit On The Fence

<"The ice age is comin', the sun's zooming in:
Engines stop running, the wheat is growing thin...>

<i.>

They've done it again. The Republican ideologues in the House of Representatives...who couldn't agree on the finer details of screwing the poor (and their low- to moderate-income peers)...jump-started their innocuously-titled monstrosity, the American Health Care Act (AHCA), in all its ghasty glory, by a 217-213 vote today. As expected, the measure passed along party lines, with 29 Republicans voting no, and no Democrats voting for it. The political football back to the Senate, where the math hasn't changed: you still need 60 votes, including eight Democrats, to actually pass this so-called piece of legislation. We'll see how well that scenario plays out.

However, I'm not going to spend time rehashing the ugliness of the AHCA, which is almost stupefying, in terms of who it rewards (the already insanely wealthy) and punishes (seniors,  via the "age tax" that insurers imposed before the Affordable Care Act (ACA); the poor, via the attempted conversion of Medicaid into a block grant program, or the imposition of high-risk pools, which failed spectacularly in states that tried them iduring the pre-ACA era). You can read the links below to see how the screw will bore through your back. Trust me -- no matter who does the analyzing, it's not a pretty picture.

Nor will I revisit the familiar pro and con arguments about the ACA's impact on the average person. Obviously, major issues that need correcting -- starting with the sky-high deductibles ($6,000 and $12,000? who were they kidding?), and double-digit rate increases that stoked resentments against the law. Now that people realize what they might lose, support for the ACA has shot up. If the Democrats ever regain majority control, they'll need to address these issues -- but that's another discussion for another day. If the law vanishes, that discussion is academic.

There's something downright surreal about the House's race to strip so many millions of what coverage they've gained since the ACA passed in 2010. Somewhere in his special little air-conditioned room in Hell, the late, discredited East German Communist leader, Erich Honecker, is high-fiving his equally grimy colleagues, as they observe the anticsnow going on in Washington: "Ja, ja, see? I told you so! I told you so!"

No, today, as we hold our breath, once again -- I'm going to focus on the people who, even now, after all the picketing and protesting, keep saying things like, Give him (Trump) a chance." "He doesn't really mean what he says." "He probably won't finish out his term." "It doesn't matter, and it doesn't affect me." "Whatever he does, we can overturn it at some other time." To all of those excuses, I offer a simple rejoinder: Now is not the time to sit on the fence, and here's why.

<I think we've all seen this movie before...>

<ii.>

Maybe you voted for Trump, thinking he really is some kind of  populist, waiting to tap his inner Bernie Sanders? There's a classic saying in business that past behavior is the best predictor of future behavior. Granted, Herr Trump zigzags constantly, but the few proposals that he's tried to advance --the AHCA, the massive social services cuts envisioned in his so-called budget, or the proposed tax cuts that would, effectively, soak the rich dreams to unimaginable new heights -- hail from the ultra-right playbook. Yet he's trying to jam all these things down our throats,with an approval rating that hovers somewhere in the low 40s. I don't feel like keeping quiet as he rolls out these evil science experiments. And neither should anybody else.

Maybe you take Trump for the latest clown who'll limp out of Washington with his tail between his legs, without any substantive achievements? Perhaps, but he can still wreak plenty of havoc by default. The best chance to check him  -- the 2018 midterm elections -- is a gut-wrenching 18 months away. Unless we lay the groundwork now, the Democratic dreams of recapturing one (or both) Houses of Congress will amount to no more than that. Ask the rivals who watched Trump stumble in Iowa last year, only to see him walk off with the nomination. Ask them what happens when you don't take a looming threat seriously.

Maybe you're unwilling to stand up, because Trump won't survive the impeachment process, and you somehow won't be affected? Impeaching Trump leaves us vulnerable to his equally batshit crazy VP, Mike Pence -- the same "compassionate conservative" who also presided over massive public health cuts as governor of Indiana. Putting someone like him at the top of the pyramid doesn't buy us relief; protest does, at least some degree, if only because it serve as a rude interruption of Trump's and Pence's narcissisitic fantasies ("Who cares what the media claims? They love me!"). And don't think you'll slip under the radar somehow. How many employers will continue offering the same kind of insurance -- or, for that matter, any kind of insurance -- if the AHCA actually becomes law?

Maybe you're counting on someone else to speak their mind, because you think the damage can be undone later? That scenario only becomes probable if Democrats capture the U.S. House and Senate, which nobody in their wildest dreams is floating right now (Most of the smart money is focused on regaining the former body). Part of the reason we're in this fix is because everybody waited for someone else to do the right thing. The progressives waited for the Democratic establishment to hear them out. Didn't happen. The voters returned the House to GOP control, hoping for relief from ACA premiums. Didn't happen. Trump's rivals, then Hillary Clinton, waited for him to stumble, and commit political hara-kiri. DIdn't happen. 

See where that logic gets us? No matter what rationalization you choose, the result is the same, as the British abolitionist William Wilberforce once observed: "Having heard all of this you may choose to look the other way but you can never again say you did not know." No matter what happens with the House vote today, whatever protesting we do must continue, and we must continue to drive home the message. Now is not the time to sit on the fence. --The Reckoner

Links To Go (Hurry, Before
They Yank The Coverage Rug For Good):
Center For American Progress:
The Upton Amendment To The ACA
Repeal Bill Will Have Almost No Effect:
https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/

Huffington Post: Jimmy Kimmel's Humanity
Underscores GOP's Heartlessness Toward The Poor:
http://www.huffingtonpost.com/entry/jimmy-kimmel-mo-brooks_us_590882a9e4b05c397682861c

Los Angeles Times: All The Horrific Details
Of The GOP's New Obamacare Bill: A Handy Guide:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-repeal-20170504-story.html

Los Angeles Times: Seven Ways
The GOP's Obamacare Repeal Bill
Would Wreck Your Healthcare:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-gop-healthcare-20170314-story.html

Los Angeles Times: The GOP Isn't Replacing
All Of Obamacare -- Just the Parts That Work:
http://www.latimes.com/opinion/editorials/la-ed-gop-obamacare-replacement-plan-20170306-story.html

Life's Little Injustices (Take X): A Month Of Pain Pills Costs $100

<Those troublesome little Colcrys 
tablets, up close and personal>

I'll always remember Election Day 2016 for a different reason: the emergency tooth extraction that I endured, the morning after millions of Americans mourned the now all too real nightmare of Donald Trump clawing his way to the presidency.  The need to take out this right rear tooth didn't surprise me, because it had bothered me for several months. By Election Week, the situation had escalated to on-again/off-again pain and throbbing, to the point of putting an ice pack over my cheek (so I could get whatever passed for sleep).

Thankfully, our town has a clinic that serves the low-income and uninsured -- blokes like me, in other words. The only catch? According to their rules, I had to come as an emergency walk-in, since I hadn't used their dental services in so long. However, once I dragged my carcass down there, the waiting around -- and the inevitable paperwork blizzard that accompanied it -- took longer than the procedure. I arrived at 8:07 a.m., By 9:45 a.m., I was ready to go home. Not bad, in the scheme of things.

This clinic also has a pharmacy, which is good, since -- if you're on being charged on a sliding fee scale, like me -- you can theoretically save money on your drugs. I say "theoretically," because this isn't possible in every case.  I paid $22.30 for the dentist's prescriptions, including $10.30, for Tramadol -- to deal with post-procedural pain that, thankfully, never materialized -- and $12 for Ibuprofen (of the 800-milligram super-duper variety). Good show, I told myself. Now, you'll have a stockpile for the next toothache.

I decided to stock up on my gout medications, while I was at it. I'd spent much of October -- and early November -- battling two different attacks that hit  my right ankle and right knee. Both kept me virtually immobilized, and confined to bed, for a couple weeks. As a result, I had to visit the clinic, which gave me a steroid shot for the pain. However, since I was broke at the time, I had to put off getting the drugs that I needed -- until my toothache forced that issue, and prompted my return.

That meant I needed Colcrys and Indomethecin, to deal with the pain and swelling, respectively, and Allopurinol, which you take to prevent future gout attacks. The pharmacy tech reckoned that the Allopurinol and Indomethecin would cost about $22, based on my sliding fee status. "Okay, so far, so good," I said. Between The Squawker and myself, we could come up with that sum. "Now, what about the Colcrys, then?"

"That's gonna be a bit more expensive..." The pharmacy tech knitted her brows together, and punched the relevant keys on the cash register. "Yeah, that's gonna be $100, for 30 of them -- $98.92, with tax."

"Wow," I said, "at that price, they'd better do the job, right? There's no substitute for this one, I take it?"

"I don't see one, offhand. I can leave the doctor a note..."

"Tell you what," I suggested. "I'll take three of them, to get out of the pain today, and come back for the rest."

"Sounds good. Just let us know when you come back," the tech responded. "You should try to get Medicaid -- we have a lot of those patients here, and they typically don't pay anything. Or not very much."

"Right," I said. "I'll look into that."

And so, I went on my way, having plunked down $22.30 for the dental prescriptions, $22 for the gout pills that seemed halfway affordable, and $9 for the Colcrys, to zero out the pain I'm feeling today. Who cares about tomorrow, or even next week?

Like millions of Americans, I'm not in a position to care about such things, because a) I haven't been insured for a decade, so b) the traditional medical infrastructure isn't obliged to deal with me, which means c) without places like this clinic, I'd slide between the cracks completely.

Health care is already maddening enough -- something the Affordable Care Act, however well-intentioned or ill-conceived it is, depending on who you ask, did nothing to halt. However, as so many savvy commentators have already observed, it's about to get a lot worse under Trump, whose minions will spend a lot of time repeating two bromides, over and over again, to people in my position:

"Sure, it sucks. You're on your own."

"You don't like it? 

Well, you just can get rich!"

I suspect we'll hear these mantras a lot in the Trump era, because he and his cohorts will never have to depend on the crappy health care options they expect those below them to live under -- and therein lies the problem. --The Reckoner

<Twenty years of household bills, all neatly filed away for a rainy day -- and yes, most of them are medical ones.>