Category: Health Care

Saturday Soother – March 11, 2023

The Daily Escape:

Sunset, Santa Elena Canyon, Big Bend NP, TX – March 2023 photo by Rick A. Ludwig. Cliff on left is in Mexico, the one on the right is in US. The Rio Grande is in the middle.

Signs that we’re starting to think about the 2024 election are everywhere. Wrongo wants to connect a few dots regarding Biden’s recent efforts to move the Democratic Party more to the middle on crime and immigration while staying left on financing the country’s social and military needs.

Biden proposed a budget to reduce the deficit, protect Medicare and Social Security, and raise taxes on wealthy individuals and corporations. From the NYT:

“In a speech in Philadelphia on Thursday, Mr. Biden said that his budget was designed to ‘lift the burden on hard working Americans’ and drew sharp contrasts with the proposals that Republicans have offered, which the president argued would threaten the nation’s social safety net programs and benefit the rich.”

This contrasts with Biden’s right-leaning position on the recent DC crime bill. Since DC is controlled by the Congress, it’s legislation can be vetoed by the US Senate. Also from the NYT:

“The Senate…voted overwhelmingly to block a new District of Columbia criminal code that reduces mandatory minimum sentences for some violent offenses, with Democrats bowing to Republican pressure to take a hard line on crime in a move that underscored the rising political potency of the issue ahead of the 2024 elections.”

By an 81-to-14 vote, with 31 Democrats voting with the Republicans, the Senate passed the Republican-written measure to undo the District’s law. It now goes to Biden, who after initially opposing it abruptly changed course and said he would sign it.

So, Biden’s tacking left on spending but to the center-right on crime. He’s making a series of calculated moves to position his Party to compete successfully in 2024. Still, it’s disappointing that Biden and 31 Democrats joined with the Right to deny DC residents the right to govern their own city.

But this shouldn’t be surprising. Last year, Biden and the Democrats turned their backs on labor during their contract battle with the railroads.

Here’s Nick Catoggio in the Dispatch: (Brackets by Wrongo)

“[Biden has]…begun to tiptoe toward the center lately on another major Democratic liability, immigration…..Centrist analysts…have warned Biden and his Party that their political viability depends on escaping the…“cultural bubble” in which an unsecured border is treated as a civic good.”

And last week Biden changed his immigration policy. He’s requiring asylum seekers to seek refuge in nations they pass through rather than waiting to do so in the US.

These new policies bring Biden closer to public opinion. Among Democrats, a plurality want to see the number of asylum applicants increased rather than reduced. Among the overall public, it’s the opposite. Biden is tilting toward the latter.

Biden wants to be seen as strong on crime. Democrats walk a fine line of being against crime but not wanting to wholly support the police. Doing that would risk looking anti-Black in cities that are so important to their political success. Dems support compassionate justice and not retributive justice, so they get tied up in knots when violent crime increases, which is rising in America. The problem of course is that the descriptor “violent” isn’t consistently applied.

Biden’s idea is to try to win more votes from people who are not fanatic MAGA types. That means picking off White suburban voters, Asian voters and Hispanic and Black voters, all of whom are concerned about crime.

Tom Sullivan points out that while the moderate-to-conservative White population is in slow decline, their votes remain significant, and that Democrats shouldn’t ignore them over the next two years:

“Sadly, Democrats often do. Campaigning in concentrated urban areas that tend to vote your way is simply easier and more cost-effective. What it means for largely rural states like North Carolina is that while it remains possible to elect a Democrat like Roy Cooper as governor, Democrats’ urban focus bequeaths him a Republican-dominated legislature…”

Sullivan says the Democrats need to start acting like the big-tent party that they used to be.

And that’s what Biden is attempting to do.

Time to say “enough” to war-gaming the 2024 election. It’s time for our Saturday Soother. The daffodils have sprung through the snow, a sure sign of spring. We turn back the clocks tomorrow night, another win for those who hate dark days.

So, it’s time to take a few minutes to center yourself. Start by sitting in a comfy chair and watch and listen to Lili Boulanger’s “D’un matin de Printemps” (On a spring morning). She wrote this piece in 1917 when she was 23. Boulanger battled bronchial pneumonia throughout her short life, dying a year later at age 24. Here, it is played by the Seattle Symphony conducted by Cristian Măcelaru.

Listen and think about her writing this during the darkest days of her life:

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What To Do About Social Security and Medicare

The Daily Escape:

Lupine and poppies, near Glendale, AZ – March 2023 photo by Marion Cart

From Joe Perticone:

“Social Security and Medicare are headed for insolvency—that’s just a mathematical, demographic fact. But when it comes to addressing the problem, there’s virtually nothing the two parties actually agree on. For years, Republicans have waffled between proposing cuts and kicking the can down the road.”

Republicans are correct that Social Security (SS) and Medicare (M) are marching toward insolvency. But they trip over their own feet with their proposals to save them. Republicans are wrong to think they can solve the solvency questions without raising taxes. Once the Republicans take taxes off the table, they’re left without any real solutions to propose.

The Biden administration has done a good job in pre-emptively going after Republican’s ideas about cuts in Social Security and Medicare benefits. The result is that the GOP is squabbling between themselves and scrambling to come up with a plan they could take to the public.

It’s not just the federal debt that should be discussed. Dr. Donald Berwick head of Medicare and Medicaid during the Obama administration wrote in JAMA: (emphasis by Wrongo):

“A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10,000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.”

The WaPo explains why people who live in the American South have bad credit scores. It turns out that neither race nor poverty were the deciding factors. It was medical debt:

“Of the 100 counties with the highest share of adults struggling to pay their medical debt, 92 are in the South, and the other eight are in neighboring Oklahoma and Missouri…”

But why the South? Yes, as a region, it’s unhealthy. But there are several Northeastern states where residents struggle with chronic health conditions but have good credit. One thing that stands out is the lack of Medicaid:

“…a recent analysis in the Journal of the American Medical Association…found that medical debt became more concentrated in lower-income communities in states that did not expand Medicaid after key provisions of the Affordable Care Act took effect in 2014.”

So bad health and bad credit are because of Republican governors’ refusal to expand Medicaid to cover more poor people. Leave it to the south to show a MAGA future for all of us: undereducated, unhealthy, and neck-deep in debt.

More from WaPo:

“In states that immediately expanded Medicaid, medical debt was slashed nearly in half between 2013 and 2020. In states that didn’t expand Medicaid, medical debt fell just 10%, the JAMA team found. And in low-income communities in those states, debt levels actually rose.”

It’s probably not a surprise that deep medical indebtedness isn’t a threat in any other developed nation on earth. It isn’t a surprise that health care in the US costs nearly twice as much as care in any other developed nation, while US health status and longevity lag far behind.

Legislating in the US is always a process. That means Congress labors to find incremental gains they dress up as reforms. The 1983 deal struck by Reagan and Democratic Speaker Tip O’Neill is considered to be one of the great bipartisan compromises. It combined benefit cuts with revenue increases to put Social Security back on a sound financial footing that has lasted for decades.

This time, getting rid of the income cap on the SS tax would help to keep it funded for an additional 35 years. At that point the Baby Boom demographic bulge will be over, and a different set of reforms can be proposed.

Medicare is the second largest program in the federal budget, equaling 10% of the total. Medicare spending is also a major driver of long-term federal spending and is projected to rise from 4% of GDP in FY 2021 to about 6% in FY 2052 due to the retirement of the Baby Boom generation and the continuing rapid growth of per capita healthcare costs:

Medicaid accounts for another 9%. But it’s also the largest source of federal revenues for state budgets. As a result of the federal dollar matching structure, Medicaid has a unique role in state budgets as both an expenditure item and a source of revenue.

Over the next few years, we’re going to need to come up with solutions to the problem of what to do about growing health care costs that are (along with lower tax revenues from recent Republican tax cuts) driving our ever larger US budget deficits.

Both sides are going to have to compromise. There’s no way we’re going to balance the budget in 10 years (or ever) unless we talk about increasing revenues while slowing the growth in the costs of health care that our entitlement programs cover.

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Monday Wake Up Call – February 20, 2023

The Daily Escape:

Oatman, AZ on Route 66 – February 2023 photo by Laurel Anne Lindsay

Some of you may have heard about a study called “The Hidden Tribes of America” by the group More in Common. It’s trying to understand the forces driving political polarization in America today. They classify the American electorate into seven distinct groups, they call “Tribes”.

But their key conclusion is that most people don’t belong on the far left or far right: (brackets by Wrongo)

“
the largest group that we uncovered in our research has so far been largely overlooked. It is a group of Americans we call the Exhausted Majority…representing a two-thirds majority of Americans, who aren’t part of the Wings….most members of the Exhausted Majority aren’t [simply] political centrists or moderates. On specific issues, their views range across the spectrum.”

More:

“But while they hold a variety of views, the members of the Exhausted Majority are also united in important ways: They are fed up with the polarization plaguing American government and society
.. [they] are so frustrated with the bitter polarization of our politics that many have checked out completely
.. they aren’t ideologues who dismiss as evil or ignorant the people who don’t share their exact political views. They want to talk and to find a path forward.

This chart from the study graphically illustrates the seven tribal groups of the American populace. As you can see, there is a left-wing group that is about 8% of the US population. And there are two right-wing groups that equal about 25% of Americans. That leaves four groups in what the authors call the “Exhausted Majority”. They are 67% of the American populace.

Here are some demographic characteristics of the seven groups:

  • Progressive Activists: younger, highly engaged, secular, cosmopolitan, angry.
  • Traditional Liberals: older, retired, open to compromise, rational, cautious.
  • Passive Liberals: unhappy, insecure, distrustful, disillusioned.
  • Politically Disengaged: young, low income, distrustful, detached, patriotic,
  • Moderates: engaged, civic-minded, middle-of-the-road, pessimistic, Protestant.
  • Traditional Conservatives: religious, middle class, patriotic, moralistic.
  • Devoted Conservatives: white, retired, highly engaged, uncompromising,

Wrongo identifies as one of the Traditional Liberals, their description rings true.

The authors say that in their research, this tribal membership predicted differences in Americans’ views on various political issues better than demographic, ideological, and partisan groupings. You can read or download the whole study here.

An “Exhausted Majority” may be a positive political development. Wrongo spends nearly every day thinking that there are just two opposing camps. And that they each view each other with fear and loathing, refusing to listen to anything that doesn’t fit their existing narrative. As we’re entering the next presidential campaign, it’s good to know that Wrongo’s view of our polarization might be well, wrong.

Is the “Exhausted Majority” merely a new response to our dysfunctional politics? Wrongo isn’t alone in thinking that what’s wrong with our country will take decades to overcome. Faced with that, people start to look for quick fixes, or a way to stop listening to the wrangling. And you don’t have to be unaligned with either Party to share this sense of exasperation.

The people described in the “Exhausted Majority” are similar. It’s also true that for most people, politics isn’t the be-all-end-all of their lives. They’d prefer that the business of government didn’t require their involvement. They’re trying to get their kids educated, and to keep them safe. They prefer to see political compromise happen without needing to be involved.

But if you can walk away from politics when it frustrates you, then you’re in the lucky minority:

  • There are large numbers of parents who have discovered that their child is addicted to opioids.
  • There are many people who had lost their health insurance when they were laid off.
  • Many sent their daughter to college in the South only to learn that she no longer has any reproductive rights.
  • Many are worried that books are being taken from public school libraries.
  • Some fear that they may lose the right to vote.

These people can’t simply throw up their hands and walk away. Only political action will help them. We all know that the political radicals are irredeemable. We also know they make the most noise, but they’re a minority.

The fed-up people on both sides and in the middle have to find a way to take the country back from the radicals, instead of allowing ourselves to be herded into existing opposing camps.

Time to wake up America! We can’t simply drop out. There’s too much at stake. Democrats need to find candidates and a message that can motivate an additional 5%-15% of the “Exhausted Majority” to vote with them. To help you wake up, watch, and listen to the RedMolly band play a very nice cover of Richard Thompson’s “Vincent Black Lightning 1952”. It’s a surprise how beautifully it adapts to a bluegrass idiom, and the dobro work makes it:

“Vincent Black Lightning” is one of the most perfect songs ever written. We saw Thompson perform it live at Tanglewood last summer.

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Monday Wake Up Call – February 6, 2023

The Daily Escape:

Sea smoke, South Portland, ME looking towards Portland Head light – February 2023 photo by Benjamin Williamson Photography

On Saturday, Wrongo and Ms. Right went to a dinner party with friends and two generations of family. The after dinner talk turned to how quite a few of the kids and grandkids weren’t planning on having children.

We tossed around ideas about why they were unlikely to procreate, and somethings stood out. First, they see climate change as an existential threat that society is unwilling to solve, even though the technology already exists. Why bring a kid into that?

Second, society seems broken. Our group meant that we face simultaneous crises, layered on top of each other.  This situation involving simultaneous global challenges, for which we have few solutions, is called Polycrisis.

And a crisis in one global system can spill over into other global systems. They interact with each another so that each new crisis worsens the overall harm. The Polycrisis environment weakens every individual’s sense of security and their place in the world.

One impact that seems related to the simultaneous climate, health, economic and geopolitical challenges are the effects on children. The needs for special education and special services for the very young has never been greater in America. It’s forcing big changes in public school budgets across the country.

No one is really sure why this is happening.

Wrongo isn’t proposing a solution, just suggesting we need to think more about how the problems of declining birth rates, coupled with the growing issues our young children are facing, might be interrelated.

Noah Smith an economist, has an interesting newsletter about how we define community:

“In the past, our communities were primarily horizontal — they were simply the people we lived close to….Increasingly, though, new technology has enabled us to construct communities that I’ve decided to call vertical — groups of people united by identities, interests, and values rather than by physical proximity.”

Smith says that in the past few decades, Americans became disengaged from their local communities, hunkering down in their houses, and failing to interact with the people around them. That led to a well-documented decline in Americans’ participation in civic organizations, local clubs, etc. Our neighbors can also be stifling and/or repressive because they impose uncomfortable community norms on us.

We’ve always had Smith’s vertical communities: “the Jewish community”, “the LGBT community”, and many others. But in the past, an identity grouping wasn’t a true community. We all have identities that connect us with faraway people — other Irishmen, other Taylor Swift fans.

Prior to the internet, we couldn’t have much contact with them. These loose vertical communities weren’t efficient ways to exchange ideas. Before email, text and streaming video, getting the word out was very slow, and our horizontal communities would decide whether what we wanted to share was worthwhile.

Now, we’re no longer isolated. The internet brought us a world of human interaction: social media feeds, chat apps, and so on. Suddenly we’re surrounded by people through their words, their pictures, and their videos.

Now we organize much of our human interaction around virtual vertical communities. Former occasional connections became Facebook groups, subreddits and personal networks on Twitter. And like our small towns back in the day, vertical communities use social ostracism to punish those who deviate from consensus norms.

But vertical communities can’t provide things like public education, national defense, courts of law, property rights, product standards, and infrastructure that we all depend on.

These require a government to administer them. And governments are organized horizontally; mostly defined by lines on maps. But what if we socialize, cooperate, and fall in love with the people from our vertical community? What if we grow apart from the people next door and the relationship is irreparable?

We see this every day in America when citizens go to a PTA meeting and discover a bunch of strangers saying things that they despise.

Wrongo isn’t saying that vertical communities are another enemy. But they can and do exacerbate the polycrisis by making truth harder to see. And by making effective action more difficult.

If you doubt this, remember how powerful the anti-vaxx vertical was at the height of the Covid pandemic. Today’s vertical communities are strong enough to keep our government from getting much of anything done. How can we work together with neighbors when we share few common bonds?

America today is a predatory society. We predate on politics, ideas, values, and culture. Biden’s trying to change this, but can he succeed? How many of us are trying to help? Changing a society that’s this broken, one that’s moving deeper into vertical communities will be a very heavy lift.

Time to wake up America! What can we do to maintain what Lincoln in his first inaugural address said:

“We are not enemies, but friends. We must not be enemies. Though passion may have strained, it must not break our bonds of affection.”

To help you wake up, listen and watch the Nitty Gritty Dirt Band’s 2022 cover of Bob Dylan’s “I Shall Be Released” with Larkin Poe (Rebecca Lovell and Megan Lovell) on vocals and a fabulous slide guitar solo:

Sample of Lyrics:

Standing next to me in this lonely crowd
Is a man who swears he’s not to blame
All day long I hear him shout so loud
Just crying out that he was framed

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Monday Wake Up Call – January 9, 2023

The Daily Escape:

Kennebunk, ME – January 2023 photo by Eric Storm Photography

Buried in the McCarthy debacle last week was some good news on the abortion front. From the NYT:

“For the first time, retail pharmacies, from corner drugstores to major chains like CVS and Walgreens, will be allowed to offer abortion pills in the United States under a regulatory change made Tuesday by the Food and Drug Administration.”

The online magazine STAT asked an interesting question: (emphasis by Wrongo)

“When the Food and Drug Administration lifted some — but not all — of its restrictions on an abortion pill this week, it raised questions about why these rules were there in the first place. Mifepristone, the drug in question, has been used by over 3.7 million Americans to end early pregnancies since its approval in 2000, is more than 97% effective, tends to have only mild side effects such as cramping, with severe ones occurring in fewer than 0.5% of patients. So why was it on a list of prescription drugs requiring extra precautions and red tape, alongside opioid painkillers?”

More from STAT:

“Many reproductive rights advocates celebrated the change. But to others, the agency hadn’t gone far enough. Having the drug on a list of medicines that require a risk mitigation strategy gives the false impression that it’s dangerous, they argue. To them, it should be treated like any other pharmaceutical that’s been proven safe and effective.”

That might help to ensure greater access at a time when some states have banned it.

Mifepristone pills are already used for more than half of pregnancy terminations in the US. There has been growing demand for them since the Dobbs decision by the Supreme Court overturning Roe v Wade, the 50-year old federal right to abortion.

With Conservative states moving quickly to ban or sharply restrict abortion, these pills have become the focus of political and legal battles, all of which can influence whether an individual pharmacy will dispense the medication.

The availability of mifepristone through pharmacies will probably vary depending upon location. Deep Red areas will probably have fewer pharmacies willing to dispense it – a combination of more pharmacists exercising their right to substitute their morality for a woman’s, and a fear by the pharmacy of negative consequences ranging from boycotts to fire bombings.

Abortion pills are only a small percentage of any pharmacy’s sales, but they could have a big impact on its public profile. Such calculations will influence a pharmacy’s decision, as will the fact that in about half of the US states, abortion bans or restrictions would make it illegal or very difficult for pharmacies to provide abortion pills.

So, yes, this is a positive development, but it won’t be a panacea: Some Republican-allied group will soon start a court battle to try to reverse the FDA’s policy. Eventually, it will come before the six Christian justices on the Supreme Court. This is a battle for civil rights. It needs to be fought on every level from local to federal, and every incremental victory matters.

We can’t let what may happen down the road prevent us from celebrating a win. The Republicans and the Conservative movement aren’t omnipotent gods. We still live in a world where working, fighting, and voting can make a difference.

Consider this: The Republican’s House majority is due to just 6,670 votes out of 107 million cast, says Inside Elections, a nonpartisan publication. That means every vote cast in 2022 mattered. And if a few more in the right places had been cast, it could have made a generational difference.

Time to wake up America! Every year that American women can continue to access abortion, (chemical or otherwise) matters. Every effort to stem the tide of the many actions that are threatening our civil liberties matter. All of this says we still have the power to change America for the better.

To help you wake up, listen to John Mayer perform his 2006 Grammy-winning hit, “Waiting on the World to Change” from his third studio album, Continuum. The song is kind of an apologia for Gen Y’s well-documented apathy, but even that has changed quite a bit in the 17 years since it was written:

Sample of lyrics:

Me and all my friends
We’re all misunderstood
They say we stand for nothing and
There’s no way we ever could
Now we see everything that’s going wrong
With the world and those who lead it
We just feel like we don’t have the means
To rise above and beat it

[Chorus] And we’re still waiting (Waiting)
Waiting on the world to change
We keep on waiting (Waiting)
Waiting on the world to change
One day our generation Is gonna rule the population
So we keep on waiting (Waiting)
Waiting on the world to change

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Monday Wake Up Call, Abortion Editon – July 18, 2022

The Daily Escape:

Barn with cotton candy clouds, Allegre, KY – July 2022 photo by Fuller Perspective Photography

The Supreme Court’s overturning of Roe has opened a Pandora’s Box of ethical and legal issues. The infamous story about the pregnant 10 year-old Ohio rape victim who was forced to travel to Indiana to receive an abortion is the best example. It was reported in the Indianapolis Star on July 1.

After the Dobbs decision, Ohio Governor Mike DeWine (R) had issued an executive order putting in force a 2019 law that had banned nearly all abortions after six weeks of pregnancy. The 10-year-old was reportedly six weeks and three days pregnant.

Then we saw a Right-wing smear campaign:

  • A WSJ editorial called the Indianapolis Star’s report a “fanciful tale“, and claimed that there is “no evidence the girl exists.”
  • Tucker Carlson said that the story of the 10-year-old girl who had to travel to Indiana to get an abortion was “not true.”
  • Ohio Attorney General Dave Yost said in an interview with USA Today, that the story was likely a “fabrication.”
  • The New York Post, which, like Fox News and the WSJ, is owned by Rupert Murdoch, published an opinion piece by law professor Jonathan Turley under the headline “Activist tale of 10-year-old rape victim’s abortion looks like a lie.”

All of those shouts and murmurs soon disappeared when a 27-year-old man from Columbus, Ohio, Gershon Fuentes, was arrested and charged with impregnating the 10-year-old Ohio girl. Apparently, Fuentes “confessed to raping the child on at least two occasions.”

Subsequently,  the WSJ recanted and published a different editorial correcting the record. Why would they accuse the Star of fabricating a story? From Judd Legum: (emphasis by Wrongo)

“There is a reason why so many people, particularly on the right, were eager to push the idea that Bernard’s story was a lie. If they acknowledged the story was true they would have to answer this question: Do you believe that a 10-year-old rape victim should be forced to give birth?”

By the way, Covid appears to have increased early-onset puberty around the world. Getting your period “early” now means when you’re younger than 8. People who think a pregnant 10-year-old strains credulity should bear this in mind.

The Nieman Lab, a Harvard-based group focused on journalism on the Internet, took the WaPo’s Glenn Kessler, author of their “Fact Checker” column to task for not checking his facts about the Star’s reporting. One of Kessler’s so-called “facts” was: (brackets by Wrongo)

“An abortion by a 10-year-old is pretty rare,” Kessler notes…..[but] The Columbus Dispatch reported that in 2020, 52 people under the age of 15 received an abortion in Ohio.”

Your mileage may vary, but if one under-15-year-old gets an abortion every week in Ohio, it can’t be thought of as “pretty rare”. The press needs to wise up and get the data before diving headfirst to a conclusion.

There are other ways the Dobbs decision will impact lives. Unsure doctors in Texas are already turning away ectopic pregnancies, fearing legal liability. According to The Lily (a WaPo newsletter):

“…a South Texas woman diagnosed with an ectopic pregnancy was refused an abortion by her doctor…..she was advised to seek help out of state.”

Under the unclear Texas law, a doctor who removes an ectopic pregnancy that is not actively causing the patient to bleed to death may face legal consequences.

It doesn’t end there. The laws surrounding in vitro fertilization (IVF) could also be facing threats of lawsuits even though these women aren’t seeking abortions. Slate reports:

“Fertilizing eggs in a Petri dish often results in extra embryos, which are usually frozen….Leftover embryos are frequently discarded or donated to research….In some abortion-restrictive states, this may no longer be possible. Louisiana defines “a viable in vitro fertilized human ovum” as a “juridical person which shall not be intentionally destroyed,” and at least five states have introduced bills establishing fetal personhood.”

States probably won’t ban IVF outright, but as some countries have done, they may limit the number of embryos that can be created in an effort to prevent embryo destruction. All of this would make IVF far more difficult and expensive than it is, and it could possibly reduce the number of IVF clinics in those states.

This is the tip of the iceberg of the issues women will have post-Dobbs. Technology will always be ahead of our laws and ethics. Just as will some men’s (and religions’) need to control women.

Time to wake up America! Elect a filibuster-proof Senate this fall. To help you wake up listen to Willie Nile, perform his ode to Covid, “The Day the Earth Stood Still”:

Sample lyric (that could be about the end of Roe instead of Covid)

So if you feel some heartache
And if you feel some pain
And if you see some lonely soul
Standing in the pouring rain
Offer up some kindness
Compassion if you will
And remember well the way it was
The day the earth stood still

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Saturday Soother – June 18, 2022

The Daily Escape:

Rainy morning, with Vista House at Crown Point in right foreground, Columbia River Gorge, WA – June 2022 photo by David Leahy Photography

Wrongo has written before about the crushing burden of consumer debt in the US. Medical debt is an American disgrace, and Noam Levey, Kaiser Health News (KHN) Senior Correspondent has written an excellent piece about it. He says that 100 million people in America, some 41% of adults, owe some level of debt to healthcare providers.

But most studies don’t reveal the actual extent of the debt because much of it appears as credit card balances, loans from family, or payment plans arranged with hospitals and other medical providers. To calculate the true extent and burden of this debt, KHN partnered with NPR, and the Kaiser Family Foundation (KFF) to conduct a nationwide poll designed to capture not just bills patients couldn’t afford, but other forms of borrowing used to pay for health care.

The results are contained in the KFF Health Care Debt Survey. The KFF poll found that half of US adults don’t have the cash to cover an unexpected $500 health care bill. As a result, many simply don’t pay their medical bills. The flood of unpaid bills has made medical debt the most common form of consumer debt in America.

Over the past five years, more than half of US adults report they’ve gone into debt because of medical or dental bills. Moreover, a quarter of adults with health care debt owe more than $5,000, and about 20% with any amount of debt said they don’t expect to ever pay it off.

Debt incurred for health care is forcing many families to cut spending on food and other essentials. The poll also found that millions are being driven from their homes or into bankruptcy:

So, if 100 million people were in debt and 17% declared bankruptcy or lost their home, that’s 17 million people! The KFF poll found that the debt is also preventing Americans from saving for retirement, investing in their children’s educations, or buying a home. And debt from health care is nearly twice as common for adults under 30 as for those 65 and older. And that age cohort is supposed to be much healthier than the elderly.

Perversely, about 1 in 7 people with medical debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills. An even greater share (two-thirds) have put off care that they, or a family member need because of the cost.

Hospitals are among the culprits. They are capitalizing on their patients’ inability to pay. Hospitals and other medical providers are pushing millions of patients who can’t afford to pay into credit cards and other loans. These are high interest rate loans, carrying rates that top 29%, according to research firm IBISWorld.

This collections business is fed by hospitals, including public university systems and nonprofits granted tax breaks to serve their communities, who sell the outstanding debt to collections companies.

Welcome to the best country on earth, (maybe) one that doesn’t have the best health care system (and certainly one without  health insurance for all). We have a system which shackles 100 million people to medical debt while at the click of a computer mouse, we send $billions in armaments overseas before those same dollars are recycled into the coffers of our Military-Industrial complex.

That’s all for this week. It’s time for our Saturday Soother, when we take a break from the J6 public hearings and whether Ginni Thomas was another Trumpist plotter. Let’s focus on calming ourselves for whatever insults are coming next week.

Here at the Mansion of Wrong, we’re engaged in an air conditioning project, adding more central air to our home. Hey, we’re aware of the crummy stock market, and the rampant inflation, but consume we must.

To help you clear your head on this warm weekend, grab a seat outdoors and brew up a cup of Supernatural coffee ($18.45/12 oz.) by Lee, MA’s own Barrington Coffee Roasting Company. This espresso is said to have flavors of Concord grape, dark chocolate, plum and tangle berry pie!

Wrongo has no idea what tangle berries look like, much less what they taste like.

Now, put on your wireless headphones and listen to the “Adagio for Oboe, Cello, Organ and Strings”, also known as “Elevazione” or “All’Elevazione” by Domenico Zipoli.

Zipoli was an Italian Jesuit priest who lived much of his life in what is now Argentina. He studied with Scarlatti, became a Jesuit, worked as a missionary, and died in 1726 in Argentina at age 38. If fate had granted Zipoli another 20 to 25 years, he might be regarded today as a major composer. Here it’s performed in 2015 by the Collegia Musica Chiemgau conducted by Elke Burkert :

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Monday Wake Up Call – January 31, 2022

The Daily Escape:

Mount Saint Nicholas, Glacier NP, MT – January 2022 photo by Jack Bell Photography

Anyone else thinking that our national party bus is about to stall out in the slow lane on America’s Boulevard of Broken Dreams?

Here’s an under-the-radar story: In 2020, the Trump administration hatched a plan to gradually transition traditional Medicare over to private firms. It’s called Direct Contracting (DC) and is operated by Direct Contracting Entities (DCEs). Currently, there are 53 of them in Phase One of an experimental program operated by the Centers for Medicare and Medicaid Services (CMS).

Under the program, the DCEs receive a fixed amount of money annually to cover care for each traditional Medicare enrollee whose primary care doctor (or group) has signed up with that DCE. The DCEs must pay for all of the care of those people assigned to them. To date, the CMS has auto-assigned hundreds of thousands of people to DCEs.

Since no one on Medicare has voluntarily signed up to work with a DCE, it’s unlikely they know of, nor understand what’s happening. And the CMS doesn’t require DCEs to tell people that they have the right to opt-out.

The idea behind DCEs is to shift a portion of the financial risk of the elderly’s medical care away from traditional Medicare by capping the payments to a third party that’s responsible to pay for it. This is the latest in many efforts by CMS and Congress to control the rising costs of healthcare.

Wrongo and Ms. Right have recently noticed a blizzard of direct mail offers to convert our traditional Medicare to an all-in insurance program. It’s probable that some of these are from DCEs.

The anticipated advantage of the DCE experiment is that Medicare’s out-of-pocket costs will be capped. The DCEs contract with CMS is for an agreed-upon annual payment. They have to pay for care and also make a profit based on that fixed revenue amount from the government. In addition to the normal profits from providing services, DCEs can keep as much as 40% of the money they don’t spend on care.

But there’s no such thing as a free lunch, and it seems to Wrongo that this creates yet another financial incentive to deny otherwise necessary treatments. It’s possible that the DCEs could pay doctors to steer patients away from specialty care. This means that someone enrolled in a DCE has reason to worry that their primary care doctor might limit their access to more costly care.

Direct contracting is supposed to be a pilot program, yet Medicare has no plans to limit the number of people it enrolls in these new plans. Instead, Medicare has announced plans to enroll 100% of traditional Medicare members into DCE-like programs by 2030.

Congress did not authorize the wholesale overhaul of traditional Medicare, so why is this happening? And so far, the Biden administration appears to be willing to continue playing Trump’s cards.

Many of the DCEs are owned by Private Equity (PE) firms. It doesn’t take a chess master to see that the PE firms will ultimately sell out to the insurance industry. And it wouldn’t be a big leap from that to fully privatize Medicare.

Time to wake up America! Did we elect Biden to privatize Medicare? The word “privatize” should scare the hell out of Americans. But unfortunately they’ve been fooled into believing that by some magic miracle of economics, it’s to their benefit.

To help you wake up, today we spend a few minutes with Neil Young. Wrongo appreciates Neil Young saying he wanted his music removed from Spotify if Joe Rogan is allowed to continue spewing his anti-Vaxx trash there.

This was an easy business decision for Spotify. They picked the popular podcaster Rogan with the $100 million-plus exclusive deal, over the cranky 76-year-old rocker whose last gold album was nearly two decades ago. Someone who hasn’t been on the Billboard charts since 1982.

Joni Mitchell and Dave Grohl have now said they will follow Young in leaving Spotify.

Let’s watch and listen to Neil Young playing “Hey Hey, My My” at Farm Aid in Champaign, Illinois on September, 1985. Young is a co-founder and board member of Farm Aid, along with Willie Nelson and John Mellencamp:

Neil won’t burn out or fade away.

Sample Lyric:
Out of the blue
and into the black
You pay for this,
but they give you that
And once you’re gone,
you can’t come back
When you’re out of the blue
and into the black.

“You pay for this, and they give you that”. Listen up Medicare!

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Young Americans Are Suffering

The Daily Escape:

View from Franconia Notch, NH – November 29, 2021 photo by Mel Elam. Looks cold.

There’s plenty of Covid news. We’re concerned about the new Omicron variant while we’re also seeing another surge of the Delta variant around the country. It’s important to remember that half of what you’re reading about Omicron now, and for the next several weeks, is going to be wrong or mistaken.

The problem is that we can’t be sure which half is wrong.

It’s troubling how prevalent Long Covid has become. The NIH reported on an Italian study that found 87% of people recovered and discharged from hospitals showed at least one symptom even 60 days after release. The commonly reported problems were fatigue (53.1%), worsened quality of life (44.1%), shortness of breath (43.4%), joint pain, (27.3%) and chest pain (21.7%).

One symptom of Long Covid that wasn’t reported is emotional distress. This is particularly evident in younger Americans. The just-released Fall 2021 Harvard Youth Poll, surveyed 2,109 Americans aged 18-29, between October 26 and November 8. In addition to their usual questions about politics, they also asked these young Americans about their mental health and Covid. They found that half of them say they’re a different person because of Covid. Here are the results:

Overall, 51% of 18-29-year-olds say that Covid has changed them. What’s particularly striking is that 61% of young women say they’re different now than they were before Covid. Contrast that with men in the survey, just 40% of whom said that they have changed.

While the survey can’t tell us exactly how they’ve changed, there’s some insight because 51% also say that Covid had a negative impact on their life. And there wasn’t a partisan divide: 51% of Democrats, 51% of Republicans, and 52% of independents said that Covid impacted them negatively.

There’s something worse going on though. These kids are a mess mentally. More than half (51%) report  that several times in the last two weeks they felt down, depressed, and hopeless, while 25% have had thoughts of self-harm.

In addition to the majority of youth who express depressive symptoms, and the 25% who express thoughts of self-harm, the study also found that a significant number show traits associated with generalized anxiety disorder:

  • 38% of young Americans report feeling nervous, anxious, or on edge in the last two weeks
  • 36% have been worrying too much about different things
  • 32% have been easily annoyed or irritable
  • 30% have had trouble relaxing
  • 22% report feeling afraid, as if something awful might happen
  • 20% have not been able to stop or control worrying
  • 16% have been so restless that it is hard to sit still

The causes of these emotional problems are diverse. The respondents listed the following as their top five reasons for worry: School or work (34%), personal relationships (29%), self-image (27%), economic concerns (25%), and Covid (24%).

But Covid can easily be seen as the primary driver behind all of these issues. The pandemic brought fear of losing one’s own life or that of an older loved one. The lockdowns impacted school and work, with people having to use technology as a work around for face to face interaction. People were cut off from friends and family. Dating died. Retail businesses that primarily hire the young closed, or sharply reduced their staffing, causing historic job losses and reduced paychecks.

The CDC reported in 2020, that from 2007 to 2018, the suicide rate among persons aged 10–24 had increased 57.4%. Let’s hope that isn’t what will happen to this cohort going forward.

Wrongo and Ms. Right have 12 grandchildren. Ten are between 18-29. A few graduated from high school, college, and grad school during the pandemic. And some of those graduates seem stuck in bad grooves, unable to land the jobs they wanted, or in some cases, a job at all.

They seem to swing between two poles, either feeling unqualified for the job they want, or being unwilling to settle for the jobs they are offered. A few grandchildren with college degrees say they are unqualified for even entry-level positions in their field of study.

These kids broadly represent what the kids in the Harvard study say about changes in their lives during Covid. Young Americans must really hate what we’ve done to them.

Their sense of despair is a common theme in other polling of American adults. But the deep unhappiness and pessimism displayed in the Harvard poll was a startling turn in an age group that might be expected to have more optimism, given that they are at such an early stage of their adult lives.

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We’d Better Build Back

The Daily Escape:

Sunset, Herring Cove, Provincetown MA – October 18, 2021, photo by Karen Riddett

“Men must either govern or be governed.”   ̶  Elihu Root, 1912 Nobel Peace Prize Winner

Wrongo has never cared for Biden’s “Build Back Better” slogan. He prefers “We’d Better Build Back.” The focus should be on what could happen if we remain on the track favored by Sens. Manchin and McConnell, along with McConnell’s Republican colleagues.

We’d better build back from the wreckage of the Trump presidency. We’d better build back from the wreckage caused by Congressional inaction for the past 20+ years.

Wrongo is currently reading “Wildland, The Making of America’s Fury” by Evan Osnos, journalist at the New Yorker. Osnos says in the Prologue, (pg. 13) that September 11, 2001, and January 6, 2021, were two cataclysmic events in American history, and that the intervening 20 years was: (emphasis by Wrongo)

“…a period in which Americans lost their vision for the common good, the capacity to see the union as larger than the sum of its parts. A century and a half after the Civil War, America was again a cloven nation. It’s stability was foundering on fundamental tensions over the balance between individual freedom and the protection of others, over the reckoning with injustice, and over a basic test of any political society: Whose life matters?”

Umair Haque makes the importance of building back clear in a way that only someone living abroad can:

“America has the rich world’s lowest quality of life, by a long way — after all, Americans will die 5–10 years younger than Spaniards or Germans, but even that understates the issue. It is uniquely a dismal life: nowhere else do we see opioid epidemics, kids massacring one another at schools, having “active shooter drills…”

Haque points out that the fundamentals of a decent life: A living wage, universal access to healthcare, affordable education and housing, and a secure retirement are no longer within reach for the average American.

That’s why we’d better build back.

Step one is to deal with the threats to democracy. We will soon know if the Democrats can actually rouse themselves from their Republican-lite slumbers to pass the Freedom to Vote Act to help get this done.

Step two is to pass the Build Back Better Act, Biden’s social spending bill. It’s now clear that the bill will need to shrink in order to pass. And like the House and Senate, America doesn’t agree on which of its big-ticket items are most important, but shrinkage is on the agenda.

The bill has remained popular in the polls. One thing that’s clear from public surveys: People want to pay for the bill by taxing the rich.

A Vox and Data for Progress poll, conducted between October 8-12, found that 71% of voters support raising taxes on the wealthiest 2% of Americans to pay for the bill. Eighty-six percent of Democrats and 50% of Republicans back that idea. Other tax provisions that could be included in the bill, like tax increases on corporations and capital gains, were supported by more than 65%. Increasing corporate taxes is Wrongo’s preferred policy approach to raising revenues.

Vitally important to the job of building a better country is the proposed new spending on health care, long-term care, childcare, and clean-energy jobs. These ideas are supported by 63% of voters in the poll.

The wisdom of the framers has given us an unrepresentative Senate. That unrepresentative Senate has given us the filibuster, which can be changed, but apparently not by our current Democratic Senators.

And despite its popularity, Biden’s social spending bill won’t be passed in its present form until Joe Manchin and Krysten Sinema get what they want removed from it. A real question is whether we have moderate Democrats or just mediocre Democrats who are willing to kill democracy as we know it for some phony principle.

But you can bet it’s not just Manchin and Sinema. There are at least 8-10 other Democratic Senators with substantial bases of wealthy contributors who feel the same pressures and are perfectly happy to have the whole package scaled down, delayed, and possibly killed.

This brings us to step three. Elect better Senators, but how? We were taught in school that in a democratic republic, you get the politicians that the voters (or at least those people who are allowed to vote) want.

This means we need better voters.

How do we get them? It’s hard to know how to do that, except you know, PASS THE FREEDOM TO VOTE ACT!

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