Social Safety Net – The Wrongologist

Crime: Perception vs. Reality

The Daily Escape:

Saguaros and poppies, Catalina SP, Tucson, AZ – March 2024 photo by Paul J Van Helden

From Jeff Asher, a crime analyst based in New Orleans:

“Murder plummeted in the United States in 2023, likely at one of the fastest rates of decline ever recorded. What’s more, every type of Uniform Crime Report Part I crime with the exception of auto theft is likely down a considerable amount this year relative to last year according to newly reported data through September from the FBI.”

We all knew that crime rates skyrocketed between the mid-1960s and the late 1980s. Then they went into a slow 35-year decline. Now, homicide, violent crime, and property crime rates have returned to what they were prior to the latest 20-year increase. This means that if you’re under 55, crime rates have been falling for most of your adult life.

But America perceives that crime rates are high. A Gallup poll released last November found 77% of Americans believed there was more crime in America than the year before. And 63% felt there was either a “very” or “extremely” serious crime problem — the highest in the poll’s history going back to 2000.

Wrongo doesn’t truly believe the polls since Pew revealed that 12% of people under 30 and 24% of Hispanic people who opt into online polls claim they have a license to operate a nuclear submarine, but here’s a chart:

(This is based on Gallup’s annual Crime survey, conducted Oct. 2023)

The question is, why the disconnect? NPR quoted Jeff Asher:

“There’s never been a news story that said, ‘There were no robberies yesterday, nobody really shoplifted at Walgreens….Especially with murder, there’s no doubt that it is falling at [a] really fast pace right now.’”

One theory you might have is that since the Covid pandemic caused social disorder, dysfunction in our government, and all sorts of problems, including that spike in crime, you might expect crime to remain high even after the country went back to work and school.

Another theory is that when people say “crime“, they don’t exclusively mean “people breaking the law“. Instead maybe they mean “behavior which upsets me“. For example, when the Philadelphia DA tries to focus on eliminating bail for simple drug arrests, while opposing police corruption, he’s said to be soft on crime. Then Republicans (and Trump) tried to impeach him, saying that they’re being “tough on crime” and crime remains a politicized news story.

Another theory is that the narrative around homeless people drives perception of crime. The idea that “homeless people have been violent“, or simply that “homeless people live near me and I don’t want any shelters built nearby,” strengthens the perception that crime is everywhere. For people who feel that way, the statement “Crime is a big problem” is equivalent to the statement “I always see homeless people when I go into town”.

This may explain why crime rates “near me” are perceived to be substantially lower than how national crime is perceived. Few of the homeless are encamped in their suburbs.

If you look back on the 1980s, there were a large number of visible homeless people in Washington DC, and Reagan dismissed them as “homeless by choice“. Today, there are plenty of homeless people on the streets in every city. It’s important to remember that when St. Reagan was governor of California, he released mental patients onto the streets.

This was part of “deinstitutionalization”: The emptying of state psychiatric hospitals that began in the 1950s. As hospitals were shut down, patients were discharged with no place to get psychiatric care. They ended up on the streets, some eventually committing crimes that got them arrested.

In 1963, JFK signed the Mental Retardation Facilities and Community Health Centers Construction Act. (It turned out to be the last bill Kennedy would sign.) The law was designed to replace “custodial mental institutions” with community mental health centers, thus allowing patients to live—and get psychiatric care—in their communities.

However, a sufficient number of community mental health centers were never built.

In 1965, Medicaid accelerated the shift from inpatient to outpatient care: One key part of the Medicaid legislation stipulated that the federal government would not pay for inpatient care in psychiatric hospitals. This further pushed states to move patients out of their state facilities.

That’s when homeless people began to be visible to most of us.

Later, in the 1970s, Nixon declared a war on drugs, setting the stage for tough-on-crime policies. Laws, like mandatory minimum sentences for possession and other drug-related crimes, disproportionately affected people of color and pushed incarceration rates to record levels. Between 1972 and 2009, America’s prison population grew by 700%.

The homeless get blamed for the bad behavior of a small minority of their group. But since an awful lot of the dysfunctional are homeless because their families or friends couldn’t cope with their behavior, it’s logical that the general public would also find their behavior a problem.

And it’s more than just the homeless. In Wrongo’s small Connecticut town, long-time residents resent people who have moved in recently. They are appalled by the occasional drug arrest or stolen car that was left unlocked in a driveway.

This scales up to people in our town bellowing about CHICAGO!!!! Or LA or Portland, OR. They see the far enemy as young Black/Hispanic men in certain zip codes destroying each other. And just possibly turning their attention to our tight, white community here in the Litchfield Hills.

It’s a good thing that overall crime and especially violent crime rates are much lower than they were 30 years ago. But we’re still faced with the overriding perception that people see their families at greater risk now.

This has spilled over into how parents treat their children. NO parent today would allow their kids to get on a bike and roam miles from home. Everything is monitored. If you ask why, the near-universal response is: “It just isn’t safe out there. Not like it used to be.”

Used to be? Most kids were tooling around on their bikes Goonies-style during the 1980s, when crime nationwide was at its peak.

People just seem hell bent on seeing the world as a massively scary place, one filled with predators.

There are major political implications, when data aren’t facts, when truths are lies.

State Of The Union Speech Mop-Up

The Daily Escape:

Morrow Bay, CA – March 2024 photo by Slocoastpix

(This is most likely the only column this week, as Wrongo is working on an outside project.)

Today let’s cover a few disparate topics that are about clean-up from the Biden State of the Union address. The Hollywood Reporter reports on Biden’s viewership ratings with this headline:

“The 2024 State of the Union address drew a larger TV audience than the 2023 address.”

Biden’s speech averaged 32.23 million viewers across 14 broadcast and cable outlets, almost 5 million more viewers than the 2023 State of the Union. Viewership rose on all of the largest outlets by about 18%. More:

“The vast majority of viewers — 28.47 million — watched the State of the Union on the big four broadcast networks (ABC, CBS, Fox and NBC) and the three largest cable news outlets (CNN, Fox News and MSNBC). All seven outlets drew a bigger audience than they did for last year’s address.”

So much for viewer apathy. One big surprise to Wrongo is that Fox News led with 5.84 million viewers, beating out the 5.24 million for ABC, which had the largest viewership among the broadcast networks. NBC’s 4.47 million viewers finished third, followed by MSNBC at 4.43 million, (its largest audience ever for a State of the Union).

Why would Fox have more viewers when their network demographics skew far more to the Right than the others? Did they tune in hoping to see a Biden senior moment?

Second, Sen. Katie Britt (R-Jesus) lied in her rebuttal for the GOP.

Third, Umir Haque’s newsletter, the issue has some good insights that Wrongo hasn’t seen elsewhere. About leadership: (emphasis, parenthesis and brackets by Wrongo)

“We recently discussed the difference between occupying a leadership position—and being accepted as a leader. This Biden’s been hid[den] away by the Democratic machine….Those roaring, electrified [people attending the speech)? Those surging positivity ratings? That’s…going from merely occupying the position, to being accepted as a leader.”

“Biden quietly proposed something very much like a new America. A new American social contract. The ideas came so fast and furious that they were almost easy to miss, sandwiched between philosophy and persuasion.”

“…most State of the Unions aren’t like that. They’re pretty boring because Presidents tout their accomplishments. They’re backwards looking…sort of performance reviews….This one really was…profoundly different.”

Haque who lives in the UK, says that the ideas Biden put forth, are very popular in Europe:

Taxing billionaires, which is part of a new movement, arising mostly in Europe, to reduce inequality, by having a global tax on the ultra-rich.
Taxing executive compensation on salaries over $1 million by making them no longer tax deductible. This is also linked to recent moves by European nations to make economies more equal again.
Giving home buyers tax credits. This is a first step towards fixing America’s badly broken housing market…..many European nations are trying to fix that through incentives like this.
Lowering drug prices. One of Biden’s most revolutionary policy ideas was to let the government negotiate prices for many more drugs—this is a big deal, because of course Americans are ripped off incredibly badly by their version of “healthcare.” This would bring the US in line with other Western nations.

More: (brackets by Wrongo)

“if you read between the lines….Biden [is] recognizing how badly broken many aspects of the American social contract [are] —healthcare, housing, inequality, salaries, taxes—and how all that adds up to an incredibly precarious life even [if you are] at or above the median [income].”

“Taxing billionaires, limiting salaries, intervening in broken markets, giving people actual support—none of these are ideas we associate in the slightest with…American politics. They’re the stuff of social democracy, and Biden’s setting out a sort of lightweight…social democratic vision. It’s not quite one fully, but what it does…is begin to put America on the path to becoming one, like the rest of the Western world.”

This sets a clear distinction between the Parties in 2024. Democrats since Bill Clinton have not had a clear definition of what they stand for: What do they stand for? What’s their overarching idea? Are they after a just society, and a good life for all Americans?

This theory of the good life, the just society, and how they’re linked now has Biden championing a politics that isn’t simply another version of “life’s about winners and losers”. Haque thinks this is an incredibly important evolution in US politics.

Will Biden’s move leftward bring enough votes to win in November? We have to hope it will. Conservative Republican Peter Wehner in the NYT reminds us that there’s just 34 weeks to the election:

“The next 34 weeks are among the more consequential in the life of this nation. Mr. Trump was a clear danger in 2016; he’s much more of a danger now. The former president is more vengeful, more bitter and more unstable than he was, which is saying something…..He’s already shown he’ll overturn an election, support a violent insurrection and even allow his vice president to be hanged. There’s nothing he won’t do. It’s up to the rest of us to keep him from doing it.”

It’s time on this Monday morning, to wake up America! IF he gets to run the country, Trump will act like a juvenile delinquent, flipping over as many of the cafeteria lunch tables as he can. In a nutshell, that’s his MAGA platform. And like the Zombie Apocalypse come to life, sooner or later all Republicans who hold public office will endorse him.

The rest of us have to put aside our ideological differences and support Biden. To help you wake up watch and listen to The Clash perform “(White Man) in Hammersmith Palais” from their 1979 album “The Clash”. This is far from their best, but it’s on point for today’s column:

This song is from a time when the youth began to realize that sticking together was actually a better idea than allowing themselves to be divided. That has to come back.

Sample Lyric:

White youth, black youth
Better find another solution
Why not phone up Robin Hood
And ask him for some wealth distribution

Wake Up To Monday’s Hot Links

The Daily Escape:

Cypress trees, Lake Verritt, LA – November 2023 photo by Rick Berk Photography. Note the egret in the background.

For today’s Wake Up Call, we return to a staple of yesteryear, some hot links that caught Wrongo’s eye over the past few days.

Wrongo isn’t happy with how the Ukraine War has slipped from the consciousness of America’s media and thereby, from our view. Saturday’s WSJ offered an intriguing idea with its column, “Does the West Have a Double Standard for Ukraine and Gaza?” (free link). The article makes two excellent points. First, how these two wars have divided the world. Here’s a view of the division:

From the WSJ: (emphasis by Wrongo)

“Outrage and political mobilization have become subordinated to geopolitical allegiances—a selective empathy that often treats ordinary Ukrainians, Palestinians and Israelis as pawns in a larger ideological battle within Western societies and between the West and rivals such as China and Russia.”

Second, the article concludes by saying that the main difference between the two wars is that the Israeli-Palestinian conflict, with all its complexities, lacks the moral clarity of the Ukrainian resistance to Russia. They quote British lawmaker Alex Sobel:

“There is no moral justification for the Russian invasion. Zero. It’s just about Russian imperialism….But in Israel and Palestine, it’s about the fact that there are two peoples on a very small amount of land, and political and military elites on both sides are unwilling to settle for what’s on offer.”

Yes, America may have the moral high ground in both cases, and views can differ on how both wars are being waged. But as the article says in its second paragraph:

“The Russian invasion of Ukraine in February 2022 was unprovoked, while Israel sent troops into Gaza because of a mass slaughter of Israeli civilians…”.

Make of the article what you will, but it’s important to think through why you (like Biden) think both wars are morally equivalent.

Link #2 is apropos of the COP28 conference now underway in Dubai. Grist Magazine has an article: “Where could millions of EV batteries retire? Solar farms.” As solar energy expands, it’s becoming more common to use batteries to store the power as it’s generated and transmit it through the grid later. One new idea is to source that battery back up at least in part from used electric vehicle batteries:

“Electric vehicle batteries are typically replaced when they reach 70 to 80% of their capacity, largely because the range they provide at that point begins to dwindle. Almost all of the critical materials inside them, including lithium, nickel, and cobalt, are reusable. A growing domestic recycling industry, supported by billions of dollars in loans from the Energy Department and incentives in the Inflation Reduction Act, is being built to prepare for what will one day be tens of millions of retired EV battery packs.”

“Before they are disassembled…studies show that around three quarters of decommissioned packs are suitable for a second life as stationary storage.”

Apparently there are already at least 3 gigawatt-hours of decommissioned EV battery packs sitting around in the US that could be deployed, and that the volume of them being removed from cars is doubling every two years.

Link #3 also shows the impact of the Inflation Reduction Act. Wolf Richter writes that:

“In October, $18.5 billion were plowed into construction of manufacturing plants in the US ($246 billion annualized), up by 73% from a year ago, by 136% from two years ago, and by 166% from October 2019.”

“The US is the second largest manufacturing country by output, behind China and has a greater share of global production than the next three countries combined, Germany, Japan, and India.”

All of this construction spending will take time to turn into production. When these new plants are up and running and producing at scale, manufacturing’s share of US GDP will rise. And much of the new construction is happening in fly-over America, which can use the help.

Finding factory workers in sufficient numbers to support the new capacity will be a key. America has energy in abundance and has robotic manufacturing. So pulling production from overseas with fewer workers needed will be a giant plus for the US.

Link #4 is a downer. Civic Science says in this week’s 3 things to know column, that “Nearly 3 in 10 Americans say they have had to forgo seeing a doctor in the past year due to costs.” Here’s their chart”:

Civic Science says that 12% of US adults have had to miss or make a late payment on medical bills in the last 90 days, a two percentage point increase over September 2022.

A far larger percentage of Americans – 27% of the general population and about 30% of respondents under 55 years old or with an annual household income under $100,000 – report they could not go to a doctor in the past 12 months because they could not afford the cost. Gen Z adults and households making between $25K-$50K are more likely to have held off seeing a doctor due to cost (34% and 31% respectively).

We all know that medical costs have continued to rise and that medical debt is the leading cause of personal bankruptcy in the US. If Congress was really interested in helping provide for the general welfare, they would deal with this out of control problem.

Time to wake up America! There’s plenty going on that isn’t getting visibility in the mainstream media or on social media. You have to cast your net widely to be on top of the good and bad happening in the US.

To help you wake up, we turn to Shane MacGowan, frontman for the Irish group the Pogues who died last week. He left behind a body of work that merged traditional Irish music and punk rock. He wrote many songs that could easily be mistaken for traditional Irish tunes including this one, which was also used as the music for wakes by the Baltimore Police Department in the great, great HBO series, “The Wire“. Here’s “The Body Of An American” from their 1986 album, “Poguetry in Motion”:

RIP Shane.

Suicides Hit A Record

The Daily Escape:

San Juan river cuts through monocline ridge, UT – November 2023 drone photo by Hilary Bralove. It is believed by many that the Navajo people based their rug and basket weaving patterns on what they saw in these geologic formations.

The temporary truce in the Israel/Hamas war is over. Reprobate Congresscritter George Santos (R-NY) was ousted from the House, and former Supreme Court Justice Sandra Day O’Connor died. She was the swing vote in the Bush v. Gore case that stopped the Florida recount and handed the 2000 presidential election to GW Bush. This was the first time that Republicans realized that if they controlled the Court, they could fix elections.

But on a pretty Saturday in southern New England, let’s turn our attention to a news article that hasn’t gotten much interest. From the issue, we learn that:

“More people died from suicide in the United States last year than any other year on record, dating to at least 1941, according to provisional data from the US Centers for Disease Control and Prevention.”

They quote the Kaiser Family Foundation who measure the suicide deaths per 100,000 of population: (brackets by Wrongo)

“Suicide deaths are increasing fastest among people of color, younger individuals, and people who live in rural areas. Between 2011 and 2021, suicide death rates increased substantially among people of color, with the highest increase among AIAN people [American Indian and Alaska Native people] (70% increase, from 16.5 to 28.1 per 100,000), followed by Black (58% increase, from 5.5 to 8.7 per 100,000), and Hispanic (39% increase, 5.7 to 7.9 per 100,000) people….The suicide death rate also increased in adolescents (48% increase, from 4.4 to 6.5 per 100,000) and young adults (39% increase, from 13.0 to 18.1 per 100,000) between 2011 and 2021….”

Suicide rates are up by nearly 50% in adolescents over the last decade, while suicides among Black people are up by almost 60%. These aren’t trends, they’re explosive changes. What we’re seeing in the data is our world in chaos.

Wrongo often says that American life has fallen apart over the past 30 years. People struggle to pay their bills; many do that by accumulating debt. For some, that struggle turns them to embrace demagogues, people who scapegoat innocents, or promise to take their rights away, robbing them of their personhood.

When we see suicide rising particularly among groups who struggle the most for their existence, it says that something has gone terribly wrong with the American model. And in the suicide statistics, there is confirmation that our nearly Darwinian model is what’s wrong. Adolescents and minorities aren’t committing suicide at these rates because they can’t get therapy, but because they feel as if there’s little or no future for them. Sadly, they are told by many pundits and politicians that everything’s fine.

Perhaps this partially explains why Biden seems to be doing so badly in polls of young voters.

As one of the commenters at the issue says:

“It shouldn’t be ‘The pursuit of happiness’ it should be ‘The amelioration of misery’. Being free to pursue happiness when there isn’t enough…left to go around doesn’t do ‘We the people’ any good.”

So, it’s time to forget about Santos, Kissinger and Hamas for a few minutes. Tune in to your Saturday Soother, where we try to get distance from the news for long enough to be able to handle whatever’s coming next.

Here on the Fields of Wrong, we’ve completed our fall clean-up and now it’s on to putting up the deer fencing that protects the bushes around the Mansion. The tree is up and illuminated, and the first members of our family are coming to see it today.

While it’s a beautiful day in the northeast, it makes sense for you to stay indoors for now. Start by brewing up a mug of “The Antidote” coffee ($19.50/12oz.) from Apocalypse Coffee in Melbourne, FL. Now grab a comfy chair by a south facing window and watch and listen to Schubert’s “Serenade”. Written two years before his death, it’s a perfect example of the melancholic music Schubert was so well known for:

Democrats Need New Messaging

The Daily Escape:

Cholla Cactus at sunrise, Joshua Tree NP – November 2023 photo by Michelle Strong

Yesterday’s column described how confusing current polling data is with less than a year to go before the 2024 presidential election. We can easily overdose on polls, but in general, they seem to be pointing toward a very difficult re-election for Biden.

At the risk of contributing to the OD, here’s another example of terrible poll for Biden. It comes from Democratic stalwarts Democracy Corps, run by James Carville and Stanley Greenberg:

“President Biden trails Donald Trump by 5 points in the battleground states and loses at least another point when we include the independent candidates who get 17% of the vote. Biden is trying to win these states where three quarters believe the country is on the wrong track and 48% say, “I will never vote for Biden.”

What to make of all this? Wrongo thinks it’s time to take a different approach to the Democrat’s messaging. Let’s start with a quick look at the NYT’s David Leonhardt’s new book, “Ours Was the Shining Future”. Leonhardt’s most striking contention is based on a study of census and income tax data by the Harvard economist Raj Chetty: Where once the great majority of Americans could hope to earn more than their parents, now only half are likely to. From The Atlantic:

“Of Americans born in 1940, 92% went on to earn more than their parents; among those born in 1980, just 50% did. Over the course of a few decades, the chances of achieving the American dream went from a near-guarantee to a coin flip.”

As we said yesterday, the American Dream is fading. Leonhardt says that the Democrats have largely abandoned fighting for basic economic improvements for the working class. Some of the defining progressive triumphs of the 20th century, from labor victories by unions and Social Security under FDR to the Great Society programs of LBJ, were milestones in securing a voting majority. More from The Atlantic:

“Ronald Reagan took office promising to restore growth by paring back government, slashing taxes on the rich and corporations…gutting business regulations and antitrust enforcement. The idea…was that a rising tide would lift all boats. Instead, inequality soared while living standards stagnated and life expectancy fell behind…peer countries.”

Today, a child born in Norway or the UK has a far better chance of out-earning their parents than one born in the US. More context from The Atlantic: (emphasis by Wrongo)

“From the 1930s until the late ’60s, Democrats dominated national politics. They used their power to pass…progressive legislation that transformed the American economy. But their coalition, which included southern Dixiecrats as well as northern liberals, fractured after…Johnson signed the Civil Rights Act of 1964 and the Voting Rights Act of 1965. Richard Nixon’s “southern strategy” exploited that rift and changed the electoral map. Since then, no Democratic presidential candidate has won a majority of the white vote.”

The Atlantic makes another great point: (emphasis by Wrongo)

“The civil-rights revolution also changed white Americans’ economic attitudes. In 1956, 65% of white people said they believed the government ought to guarantee a job to anyone who wanted one and to provide a minimum standard of living. By 1964, that number had sunk to 35%.”

America’s mid-century economy could have created growth and equality, but racial suppression and racial progress led to where we remain today.

Leonhardt argues that what Thomas Piketty called the “Brahmin left” must stop demonizing working-class people who do not share its views on cultural issues such as abortion, immigration, affirmative action and patriotism. From Leonhardt:

“A less self-righteous and more tolerant left could build what successfully increased access to the American Dream in the past: a broad grass-roots movement focused on core economic issues such as strengthening unions, improving wages and working conditions, raising corporate taxes, and decreasing corporate concentration.”

Can the Dems adapt both their priorities and messaging to meet people where they are today?

The priorities must change first. What would it take to establish the right priorities for the future? Stripping away the wedge issues that confuse and divide us, America’s priorities should be Health, Education, Retirement and Environment (“HERE”). It’s an acronym that sells itself: “Vote Here”.

(hat tip to friend of the blog, Rene S. for the HERE concept.)

Wrongo hears from young family members and others that all of the HERE elements are causing very real concerns. Affordable health care coverage still falls short. Regarding education, college costs barely seem to be worth shouldering the huge debt burdens that come with it.

Most young people think that they have no real way to save for retirement early in their careers when there’s the most bang for the buck. They also feel that Social Security won’t be there for them. From the NYT:

“In a Nationwide Retirement Institute survey, 45% of adults younger than 27 said they didn’t believe they would receive any money from the program.”

Today, only about 10% of Americans working in the private sector participate in a defined-benefit pension plan, while roughly 50% contribute to 401(k)-type, defined-contribution plans.

Finally, people today feel that their elders have created an existential environmental threat that will be tossed into their laps. A problem for which there may not be a solution.

As Leonhardt argues, these HERE problems should have always been priorities for Democrats. But for decades, the Party hasn’t been willing to pay today’s political price for a long term gain in voter loyalty. That is, until Biden started working on them in 2020.

But every media outlet continues to harp on inflation and the national debt. Much of what would be helpful in creating a HERE focus as a priority for Democrats depends at least somewhat on government spending. No one can argue that our national debt is high. It is arguable whether it can safely go higher or if it must be reigned in at current levels.

To help you think about that, we collected $4.5 trillion in taxes in 2022, down half a $trillion vs. what we collected in 2021. Estimates are that the Trump tax cuts cost about $350 billion in lost revenue/year.

Looking at tax collections as a percentage of GDP, it’s less than 17% in the US, well below our historical average of 19.5%. There are arguments to keep taxes low, but if you compare the US percentage to other nations, Germany has a ratio of 24%, while the UK’s is 27% and Australia’s is 30%.

If we raised our tax revenue to 24% of GDP, which is where Germany is now, we would eliminate the US deficit.

There’s a great deal of tension in the electorate between perception and reality. And it’s not caused by partisanship: Democrats and independents are also exhibiting a disconnect, too.

Democrats have to return to being the party of FDR and LBJ. They need to adopt the HERE priorities and build programs around them.

How Can America Handle The Costs Of Elder Care?

The Daily Escape:

The start of US Highway 6, outside of Bishop, CA – September 2023 photo by Steve Wolfe

(There will be no Saturday Soother this week. Wrongo is on the road.)

Millions of older Americans from the Silent Generation and the Baby Boomers are facing a dilemma as they “age in place.” They must figure out how to pay for increasingly complex medical care. The NYT quotes Richard W. Johnson, director of the program on retirement policy at the Urban Institute:

“People are exposed to the possibility of depleting almost all their wealth….”

The prospect of dying broke is an imminent threat for the Boomers. About 10,000 of them turn 65 every day between now and 2030. They’re expecting to live into their 80s and 90s at the same time as the price tag for long-term care (LTC) is exploding. Currently LTC expense is outpacing inflation and approaching a half-trillion dollars a year, according to federal researchers.

By 2050, the population of Americans 65 and older is projected to increase by more than 50% to 86 million. The number of people 85 or older will nearly triple to 19 million. The Times has a chart of how many of those who need long-term care will die broke:

Some older Americans have prepared for this possible future by purchasing LTC insurance back when it was still affordable. Since then they’ve paid the monthly premiums, even as those premiums continued to rise. But this isn’t the norm. Many adults have no plan at all or assume that Medicare, which kicks in at age 65, will cover their health costs. But Medicare doesn’t cover the kind of long-term daily care, whether in the home or in a full-time nursing facility, that millions of elderly Americans require.

For that, you either pay out-of-pocket or you spend down your assets until you have less than $2,000 in assets in order to qualify for Medicaid. Remember that Medicaid provides health care, including home health care, to more than 80 million low-income Americans.

And even if you qualify, the waiting list for home care assistance for those on Medicaid tops 800,000 people and has an average wait time of more than three years.

Here is a snapshot of how long-term care is paid for in the US:

Governments provide 71.4% of the total. The largest non-government source is people who pay out-of-pocket, and private insurance is becoming increasingly expensive. More from the NYT:

“The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home. But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.”

That has led them to enter assisted-living centers run by for-profit companies and private equity funds. The NYT says that about 850,000 people aged 65 or older now live in these facilities and when in them, they are largely ineligible for federal funds. Some facilities provide only basics like help getting dressed and taking medication while others offer luxury amenities like day trips, gourmet meals, and spas.

In either case, the bills can be staggering. More:

“Half of the nation’s assisted-living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.”

Home care is costly, too. According to Genworth, agencies charge about $27 an hour for a home health aide. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.

It’s worse for people with dementia because they need more services. The number who are developing dementia has soared, as have their needs. Five million to seven million Americans over age 65 have dementia, and that’s expected to grow to nearly 12 million by 2040.

The financial threat posed by dementia also weighs heavily on adult children who in many cases become guardians of aged parents. The Times included this chart:

The reality is that families go broke either caring for, or finding care for their loved ones. The alternative: Women in the family give up their lives and jobs to care for their family members instead, which worsens the gender wage gap.

The NYT article makes it clear that older Americans receive far less government support than their peers in other countries. The “why” question is easily answered: It’s a combination of the concerted effort for any public support to be demonized as “welfare”. It’s also partly the result of our failed experiment with long term care insurance. The politicians’ idea was that “the market” would take care of it, so government help for retirees could be limited to Medicaid-paid nursing homes.

But, the LTC insurance industry has largely imploded. Insurers had little experience with the product and grossly overestimated the lapse rates. If a policyholder stops paying, the insurer gets to keep the money and use it to provide services to everyone remaining in the pool. The surprise was that very few people stopped paying. A second miscalculation was that people who held these policies were living longer than forecasted. Longer life equaled higher and larger payouts (insurers also benefit when customers die before they’ve used up all the policy benefits).

A final factor is the rising levels of dementia described above.

And since demand for support outside of family members exceeds the supply of beds, nursing homes and assisted living facilities that aren’t terrible want residents to join during the independent living phase (which requires very little care, so those fees subsidize intensive nursing home care). Many of these facilities require a $400,000-$500,000 buy-in, which may not be refundable at death, even if the resident is current on their monthly fees.

There’s got to be a better way. Medicaid can’t be the only option to pay for LTC. Congress needs to establish a better system for middle-class Americans to finance LTC.

How we handle the growing costs of long-term care is just another reminder that we get LITTLE for our tax dollars beyond a giant military. Americans are responsible for their own medical care, childcare, college tuition, retirement and nursing home care. Some or all of which are provided in other rich countries.

This is a loudly ticking time bomb, and the demographics of the problem won’t change for decades. And yet, the Republicans seem bent on making it worse. They’re actively trying to bring about their dream of privatizing Social Security and Medicare.

Wake up America! We have real problems to solve.

Biden’s Plan To Cut Drug Prices

The Daily Escape:

Mars on left, Earth on right – image by alofeed

The Biden administration released its list of 10 prescription medicines that will be subject to the first-ever price negotiations by Medicare. This is a big deal because Medicare covers 66 million older Americans, people who routinely take very expensive drugs.

Until recently it was illegal for Medicare to negotiate prices with drug companies. But the Inflation Reduction Act (IRA), passed last August, gives Medicare that power. It also forces companies to pay a rebate to Medicare if their drug prices rise faster than inflation. The Congressional Budget Office estimates that price-capping measures will reduce Medicare expenses (and the federal deficit) by $96 billion by 2031.

The list includes drugs for diabetes, arthritis, and Crohn’s disease, and could sharply lower medical costs for patients. Reuters says that the US Centers for Medicare & Medicaid Services (CMS) spent $50.5 billion between June 1, 2022 and May 31, 2023 on these 10 drugs. That was about 20% of the total cost of drugs in the Medicare prescription drug program known as Part D.

The WaPo had an opinion piece by David Goldhill, CEO of SesameCare.com, a digital marketplace for discounted health services: (brackets and emphasis by Wrongo)

“The pharmaceutical industry earns almost 50% of its worldwide revenue here [the US], as do medical information-technology firms. [Medical] Device makers earn 40% of their money in the US. And this understates things, because US revenue is generated from higher prices, so margins are greater. If the US accounts for half of a company’s revenue, it probably contributes at least 75% of its profits.”

This has always been the business plan for Big Pharma: Make your money in the US and take whatever scraps of profit you can get in other markets.

That market subsidy is paid by American taxpayers generally (through the funding of Medicare) and by US pill-takers specifically when they pay higher co-pay prices for the drugs that help with their chronic conditions. The Economist points out that prescription medicines in America cost two to three times more on average than in other wealthy countries:

The blue dots are the price paid in the US for brand name drugs. The grey dots are prices paid in the various countries for all US drugs sold in those countries. The comparison of brand name to generics shows how much greater the cost is to an American. It also follows that US patients’ out-of-pocket expenses, (the slice of drug costs not covered by insurance), are among the highest in the world.

It’s understandable why Biden’s move to start negotiations on some of the most expensive drugs has been fiercely opposed by the pharmaceutical industry. Essentially, high US drugs costs underwrite what amounts to a subsidy for buyers of the same drug sold when it’s outside the US.

Many of the Big Pharma have jumped on the legal bandwagon, challenging price-setting provisions in the IRA. More from the Economist:

“Since the law’s passage over 50 companies have blamed the IRA in earnings calls for clouding their prospects.”

A quick primer on drugs. Most medicines are either small-molecule drugs or large-molecule drugs. The former are the kind of pills that line our medicine cabinets. Large-molecule drugs, (also called biologics), are more complex and must be injected. The IRA grants biologics 13 years of pricing freedom after a drug is approved, while small-molecule drugs get only nine years post-approval before they must face Medicare’s bean counters. The industry estimates that small-molecule brands could lose between 25% and 40% in overall revenue due to the earlier cap on prices.

PhRMA, the pharma Industry’s lobbyist argues (and Republicans back them) that high US prices reflect the high cost of drug development. The pharmaceutical manufacturers are, of course, suing to stop the price negotiations. They say that allowing the government to negotiate lower bulk prices for drugs will stifle innovation, and will cut funds for research.

One thing that Big Pharma wants to avoid showing us is that they rely on smaller, more agile biotech firms for ideas. Between 2015 and 2021, 65% of the 138 new drugs launched by Big Pharma originated mostly from smaller firms. So, while innovation isn’t totally gone from the big firms, what they’re mostly doing is marketing the intellectual property of small pharmaceutical firms.

It didn’t take long for Republicans to jump on the decision to allow Medicare to negotiate drug prices. From Politico:

“Piggybacking on the pharmaceutical industry’s strategy, Republicans are working to persuade Americans that the Biden plan will stifle innovation and lead to price controls.”

Politico quotes Joel White, a Republican health care strategist:

“The price control is a huge departure from where we have been as a country….It gets politicians and bureaucrats right into your medicine cabinet.”

Politico says that the GOP effort to reframe the drug price debate may hurt them, since they plan largely to run on inflation, while the Biden plan will lower drug prices. Also they quote a new poll from the Kaiser Family Foundation (KFF) that shows 58% of independent voters trust Democrats to lower drug costs compared with 39% of Republicans.

Our politicians and pundits have bleated at us for years about being an “exceptional nation” – but what we really are is exceptionally gullible. As long as the large healthcare and pharmaceutical companies insist on standing between American consumers and their health needs, maximizing their profit will always come first.

We also continue to elect leaders who lobby for keeping corporations unleashed so that they can make as much profit as possible, while saying that the “market” will decide where the public good is prioritized. This keeps us hopelessly mired in a grossly expensive, and often ineffective healthcare system.

We continue to let ourselves be convinced by corporations and our politicians that reforming healthcare is impossible. That the solutions and methodologies used by other developed nations are substandard, and/or somehow immoral.

The Hill reported that the 14 leading US drug companies paid out more in stock buybacks and dividends from 2016 to 2020 than they spent on research and development. Those firms spent $577 billion from 2016 to 2020 on stock buybacks and dividends, $56 billion more than the $521 billion they spent on R&D. So, it’s oblivious how Big Pharma could easily fund their R&D with lower drugs prices.

It is also useful to remember that America has more healthcare billionaires AND healthcare bankruptcies than any other country. Those two things are inextricably linked.

As long as the pharmaceutical companies can maximize profits by buying politicians rather than by charging higher prices in other countries – the American people are the ones who will continue to get screwed.

Rural Hospitals Are No Longer Providing Maternity Care

The Daily Escape:

Perseid meteor shower, from Mt. Evans, CO – August 13, 2023 photo by Paul Blais Photography

Welcome to our Saturday Soother, but first, Wrongo intends to spin you up before eventually letting you slow down.

There’s a crisis in rural healthcare in America. Rural hospitals are closing at a rapid rate. Our county (Litchfield) in Connecticut has one of three remaining hospitals that are designated as rural in the state (Sharon Hospital).

A problem for rural hospitals is that many are closing down their labor and delivery services in order to try and remain economically viable. WSHU, a CT-based NPR affiliate, has covered the impact of these closures to Connecticut. They quote Peiyin Hung, a researcher on maternal and rural health at the University of South Carolina:

“My team has been tracking nationwide, hospital-based obstetric unit closures since 2008 up to 2022,…. Almost 300 hospitals closed their OB units.”

WSHU points out that more than 60% of those closures were in rural areas. Why are so many hospital groups moving away from delivering babies in rural locations?

WSHU quotes Dr. Robert Roose, chief medical officer at Johnson Memorial, a hospital in rural Stafford Springs, CT that closed its obstetric unit. He said that it’s a safety issue. Hospitals with fewer than 200 deliveries a year, like Johnson Memorial, are considered low-volume birthing centers:

“There is a clear and critically important correlation between volume and quality of services provided when it pertains to labor and delivery and maternity care…”.

Three years ago, Hartford HealthCare’s Windham Hospital in Willimantic, CT stopped delivering babies, citing the same concern.

Also, malpractice insurance rates go up for low birth-volume hospitals because insurers feel the risk is higher if doctors aren’t getting sufficient practice with birthing. Hung says another problem is the level of reimbursement:

“Medicaid…pays half as much on average [as] private insurance pays for labor and delivery across the country”.

That’s important because about four in 10 of all Connecticut deliveries are covered by Medicaid. Simply put, delivering babies doesn’t pencil out for many rural hospitals.

There are other factors: Rural America’s demographics skew older. Young families in general prefer living in the suburbs or exurban areas. Couple that with America’s lower birth rate and rural hospitals really can’t maintain the birthing volume they need to remain economically viable.

The Center for Healthcare Quality and Payment Reform, (CHQPR) a Pittsburg-based health policy group published “A Crisis in Rural Maternity Care in the United States” which shows the problem:

“Fewer than half (45%) of the rural hospitals in the US currently offer labor and delivery services, and in 9 states, less than one-third do. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies”.

“Hundreds of additional communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing….More than 1/3 of the rural hospitals that still have labor & delivery services have been losing money on patient services, so their ability to continue delivering maternity care is at risk.”

CHQPR reports that more than half of small rural maternity care hospitals lost money in 2021-22.

They suggest that a primary reason rural hospitals are losing money is that private insurance plans pay them less than what it costs to deliver many of the services they offer patients, not only maternity care. They point out that while rural hospitals are losing money on uninsured patients and Medicaid patients, the losses from private payers have the biggest impact on their overall profit margins.

CHQPR suggests that a potential solution is to require that health insurance payments actually cover the cost of rural maternity care. With more than 40% of births (on average) in rural communities paid for by private health plans, having the private insurers pay more would help keep rural maternity care viable:

“Payment amounts must be higher in communities that have difficulty attracting staff, and payments must also be higher in communities with smaller numbers of births to ensure that revenues cover the fixed costs.”

This means that the fee-for-service model isn’t working in low-volume hospitals. Rural hospitals are only paid when they actually provide a service, but a small hospital has proportionally higher overheads than larger hospitals, since they must be staffed and ready to deliver a baby at all times, even if there are no deliveries at all. Read CHQPR’s report “A Better Way to Pay Rural Hospitals”.

Back to Connecticut, Sharon Hospital has proposed closing its labor and delivery unit. There will be a public hearing to consider the closure later this year. But Sharon is about an hour from its affiliated hospital (Danbury Hospital) that has a fully-staffed labor and delivery facility. Sharon may actually be closer to two other unaffiliated hospitals in New York state than it is to its own parent facility.

It’s now time for our Saturday Soother. Litchfield County is having beautiful weather this weekend. We’re taking advantage of it by going to a live Baroque music concert, and possibly heading off to the annual fair in a local town.

To help you relax and zone out from all of the Trump indictment analysis, grab a chair outside in the shade and watch and listen to “Gortoz a Ran” (I’m Waiting) sung by Denez Prigent and Lisa Gerrard. The language in the song is Breton, spoken in Brittany, France. It is closely related to Cornish and Welsh, and all three are Celtic tongues. When the Angles, Saxons and Jutes invaded Britain in the fifth century (400-500 AD), many of the Britons in Cornwall, Devon, and the West Country fled across the English Channel to France. Because of the influx of Britons, the region became known as Brittany.

Most of the images in the video are of Scotland, England, Wales, and Brittany. Lisa Gerrard isn’t singing in any language; she’s just vocalizing. The Uilleann pipes, an Irish instrument, are heard at 3:50:

Lyrics: English Translation

I was waiting, waiting for a long time
In the dark shadow of grey towers
In the dark shadow of grey towers

In the dark shadow of rain towers
You will see me waiting forever
You will see me waiting forever

One day it will come back
Over the lands, over the seas

The blue wind will return
And take back with it my wounded heart

I will be pulled away by its breath
Far away in the stream, wherever it wishes

Wherever it wishes, far away from this world
Between the sea and the stars

The song describes waiting, possibly forever: Aren’t we all waiting? What are we waiting for? For whom are we waiting? Happy Saturday!

The Problems With Childcare

The Daily Escape:

Sunset with Cosmos flowers, Blue Ridge Mountains, Franklin, NC – August 2023 photo by Amy Barr

Monday’s Wake Up Call is that we’re in the middle of a childcare crisis, one that dates back to WWII. Daycare costs too much, daycare workers don’t earn enough, and many daycares don’t make money and are going out of business.

Today, anyone who has tried shopping for day care knows that it’s a tough marketplace. Care.com, an online platform where people can hire housekeepers, pet caretakers, nannies, and more, publishes a yearly Cost of Care Report to help US families understand the cost of childcare. Their June 2023 report found that on average, US parents spend 27% of their household income on childcare expenses:

“Households with children make up 40% of the total US population. And with a national family median household income of $91K, child care costs for the typical American family are even more staggering:

– 45% of families earning less than $100K annually will spend more than $18,000 on childcare in 2023, amounting to 18% of their household income (HHI).

-43% of families earning less than $75K will spend more than $18,000, amounting to 24% of their HHI.

-39% of families earning less than $50K per year will spend more than $18,000, amounting to a whopping 36% of their HHI.”

And increasingly, economists are saying that more women would be working if childcare was available. From Axios:

“In a research note about Friday’s jobs report, the chief economist at consulting firm RSM US did something surprising: Instead of talking about rate hikes or soft landings, he made the case for universal child care.”

Axios quotes RSM’s Joe Brusuelas:

“Childcare for kids under the age of 5 is increasingly an issue for more mainstream economists who are concerned about the prospect of long-term labor shortages in the US. Universal childcare is the most realistic way to help expand the labor force at a time when the economy needs workers the most,”

“The US needs more workers, and there are more women sitting on the sidelines of the labor market than men.

-Right now, close to 86% of working-age men are employed compared with 75% of women. That’s a record for women, but it’s also far below the rates for men — there’s room to grow.

-Substantial childcare investments, like those proposed in the now defunct Build Back Better bill, could increase mothers’ employment by 7 percentage points, with bigger jumps for low-income families, according to estimates in an NBER paper published last year.”

The underlying problem is the economics of childcare. First, it’s difficult to get information about childcare costs either online or over the phone: Daycares often only share their prices after you have visited their facilities. And many daycares have waitlists stretching from six months to a year.

Economists say that long waitlists are a classic sign that something’s wrong with that particular marketplace. In this case, waitlists indicate that daycare prices are too low. But parents say that the price for daycare is actually too high. NPR reports that the median price in daycare for an infant in a large county in the U.S. is $17,000 a year. Also, more than 60% of families can’t afford the full cost of quality day care.

Meanwhile, daycare owners can barely afford to stay open. NPR interviewed a daycare provider in Iowa who said that salaries are 83% of their monthly budget:

“Five percent goes to their loan payment. 4% is operating expenses, cleaning supplies, snow removal, play kitchens, things like that. Three percent is utilities. Another 3% goes to groceries….And 2% is for their insurance and their building insurance and worker’s comp.”

Along with labor, that equals 100%, meaning the center makes no profit. It’s probable that the daycare owner’s pay is in the 83% labor total, but still it means zero profit. The Iowa daycare pays its staff between $12 to $15 an hour, while the local Chick-Fil-A advertises $16.75/hour to start. The Iowa daycare has a census of 72 kids, which requires 25 staff.

Daycares are required by law to hire a ratio of staff/per child, a higher number than other low-wage industries, like fast foods need. In fast food, labor is about 25% of the total costs, and the volume of sales is in the tens of thousands, not the 72 kids that a wage increase would effect in the Iowa daycare.

Since labor costs are such a high percentage of total costs in daycare, increasing wages means prices paid by families of children in daycare have to rise drastically to cover the higher costs. Wrongo did a back of the envelope calculation for the Iowa center. If their base pay was $12/hour and it was raised to $15, the average monthly charge for one of the 72 children already in daycare would increase by $360/month, or about 47%!

The broken system is made worse in the US because we don’t have long maternity and paternity leaves.

Funding for childcare that was put in place during the pandemic is set to run out in September. Once we hit that “childcare cliff,” 3.2 million children will lose federal funding. More centers will either have to raise prices, cut staff or shut their doors.

Universal childcare has a tortured history in the US. During World War II, women replaced men in the domestic workforce. But who would take care of the children? The US government answered by enacting the Lanham Act, the first and only universal child care program in American history. An estimated 550,000 to 600,000 children received care through these facilities, which cost parents 50 to 75 cents per child, per day. The program ended in 1946.

Nixon vetoed a universal childcare bill in 1971 that would have created federally-funded public childcare centers across the US because Conservatives argued that the bill was communist and that it would be the end of the American family. A group called Iowans for Moral Education asked “Whose Children? Yours or the State’s?”

Time to wake up America! If you don’t want society to help take care of kids, you’re an asshole no matter what reason you give for being against funding. These kids didn’t ask to be here and they have done nothing to deserve not having societal support. If you think you can make America great again by making it harder to take care of kids, you’re wrong.

To help you wake up, watch and listen to a scene from the 2003 film “Daddy Daycare”. In this scene, Charlie (Eddie Murphy) and Kim (Regina King) try to find a good preschool for their son Ben, but it turns out to be impossible. Life’s still like this 20 years later:

Saturday Soother – May 6, 2023

The Daily Escape:

Mt. Adams sunrise with orchards in bloom, WA – May 2023 photo by Mitch Schreiber Photography

(Wrongo and Ms. Right give a group hug to family member Bob W. His mother has a grave health crisis. We’re thinking of you Bob.)

There’s a book called “A Terrible Country” written in 2018 by Keith Gessen. It’s about life in Russia a few years before Russia became a pariah in Europe. But the title could easily describe the US in 2023. If you doubt that, maybe you aren’t aware of the video of a NYC subway rider choking a homeless man to death last week. The video lasts for four minutes.

The NYT describes the video:

“The homeless man, Jordan Neely, is seen writhing, trying to get free from the arms and legs of the other subway riders who are pinning him down. As the minutes tick by early Monday afternoon on a northbound F train in Manhattan, Mr. Neely visibly weakens as the arm wrapped around his neck stays tight.”

After he stops moving, the riders hold him down for about another 50 seconds. Neely was later pronounced dead at a nearby hospital. Jordan Neely was homeless. He was a Michael Jackson impersonator. Neely’s race (Black) and that of his killer (White) are a depressingly familiar story. What’s different is that his assailant wasn’t a cop and didn’t use a gun.

What’s also familiar is that the assailant has not been charged by the NYPD.

What’s also disturbing is that the subway car held bystanders most of whom remained bystanders, watching a former Marine choke the life out of Neely for (apparently) behaving erratically.

After the fact, we learned that Neely had more than 40 arrests including an open warrant for punching a 67 old woman. No one should portray him as simply a misunderstood soul. But did he deserve to die in that subway car?

If you’ve been paying attention, you know that there’s been news nearly every day about Americans being killed over mundane, mostly non-threatening actions, or for being in the wrong place at the wrong time.

The NYT’s Roxanne Gay:

“We are at something of an impasse. The list of things that can get you killed in public is expanding every single day. Whether it’s mass shootings or police brutality or random acts of violence, it only takes running into one scared man to have the worst and likely last day of your life. We can’t even agree on right and wrong anymore.”

How did the country get this way? Why is there so much fear and paranoia about the “other”? Why do select elements of our society cultivate this fear by marketing it?

Neely’s killing is partly an outcome of the relentless political rhetoric that has contributed to the public’s false beliefs about actual crime levels in America’s cities. And NYC’s Mayor and NY’s Governor wouldn’t even condemn the killer. Elizabeth Bruenig writes in The Atlantic:

“This process, through which mundane uncomfortable situations are transformed into terrifying ordeals by…incidents of random gun violence…is one means by which a healthy community becomes a violent society. Nobody looks forward to encountering people behaving erratically on the subway…but killing a mentally ill man on a train….represents the loss of a peaceful commons, the absence of compassion, and the overwhelming fear we have come to accept in our culture of violence. This is the country we have become.”

Yep, we’ve become a terrible country. Back to Roxanne Gay:

“There is no patience for simple mistakes or room for addressing how bigotry colors even the most innocuous interactions. There is no regard for due process. People who deem themselves judge, jury and executioner walk among us, and we have no real way of knowing when they will turn on us.”

And on Thursday, four of the Proud Boys, among paranoia’s finest, were convicted of committing vigilante justice against our democracy. Let’s leave the final words to Gay, who says we’ve become:

“…a people without empathy, without any respect for the sanctity of life unless it’s our own…”

Or fetuses.

Time for Wrongo to wash up after digging in this cultural dirt. It’s time for our Saturday Soother where we try to forget about whose drones hit the Kremlin, and try to center ourselves before another demanding week begins,

Here at the Mansion of Wrong, Wrongo and Ms. Right are spending the weekend in NYC seeing two musicals.

But as a public service to the rest of you, grab a seat outdoors on what looks like a beautiful day in the northeast. Now watch and listen to Erzsébet Pozsgai play the first movement of “Spring” from the “Four Seasons” by Antonio Vivaldi on solo violin, live in Budapest in 2013:

The Wrongologist

Geopolitics, Power and Political Economy

Category: Social Safety Net