Thursday, January 18, 2018

Starve the Beast

There were the best of times there were the worst of times and sometimes it is hard to tell the difference when you are poor in America.

The last sentence in the essay reprinted below the question is posed:  Would their deaths cause America to be greater?   In a word, yes.

We have tried slavery, we have tried laws to repress and segregate, we have tried mass incarceration and we have tried Police killings and still yet the poor and the faces of color survive it all.  So let's find ways to kill them by enabling them to do it on their own.  Ask yourself about the violence in communities of color, the health problems, the lack of housing, the lack of education and the opportunities to move across class lines.  Just take away the ladder and there is nothing to climb as  that is the best way to rid yourself of a problem by ignoring it and giving it nothing to fuel itself. Is that not the best way to starve a cold and in turn feed a fever?  And irony that we are in the middle of a huge flu pandemic and little respect for science, for health care and in turn money dedicated to research and development of affordable treatments for basic diseases that plague the world.  Well there is  no money in curing a cold. 

I have made no secret of my loathing of Nashville and Tennessee.  From its Politics to its Religion I have little to anything good to say about either.  And as my Mother used to say, "If you can't say anything good about anyone say nothing at all." Well thankfully she is dead and that is not the first advice of hers I have ignored.  But many will die in the wake of the policies and practices that exist here in Tennessee. 

The rules here are surreal full of contradiction and full of bullshit.   And now we have the red states firmly large and in charge.  The next morality clause will not be about cupcakes and not baking them for those not one's kind but to treat and care for them.  Here in Tennessee it is legal for a mental health provider to decline to care or treat one whose lifestyle they do not approve.   LGBQT folks are pretty free to still use the bathroom of their choice but get counseling no.  And now the move to extend this to medical care is coming.

I also want to point out that we were a State that refused expansion of Medicaid and the health care and opioid crisis in this state is at crisis level.   The fight to keep the local City Hospital open as it runs into the red annually has turned into major policy fights that smack of racism as anything here from transit to a closing of a Y is fought over regardless of the facts that show the community is not using the services, it is the last thing that the black community want is another thing taken from them.  It is an endless circle jerk here over all policy as one community is sure that this is fiscally solvent position based on economics and another is sure it is all race based.  So no the issues over race here will never be resolved.  As I have said many many times it is economics here that matter the color of the residents is only secondary.   But this is a great way to find ways to further marginalize those who are both poor and of color.

This is the current policy proposal with regards to Medicare/Medicaid the federally funded health plans that will enable practitioners to deny a patient based on the practitioners moral beliefs.   This will in turn w lead to people getting turned away if the Physician/Practitioner does not "like" them.  Remember the City Clerk in Kentucky and the Marriage licenses, the Cake Baker in Colorado or Oregon?  This is not sweet in the least.

 I want to recall that I was  one who had the cops show up at their door four days after a hostile Dentist office meeting means that one more reasoning to get this shit done cannot come soon enough.  When I have to defend myself for shooting my mouth (not a gun)  or my life choices and decisions (not being married and not going to Church)  to get dental work we have some real problems that have little to do with health and care.   To that I go, "Who the fuck ares who I fuck?"  I can understand a discussion about safe sex, pregnancy prevention and other issues surrounding a sexually active lifestyle but when it crosses over to judgment and refusal to treat I question why one is in  the field of medicine.   Money?  Well that too.

But we live in different times. While the red wing states eschew Government overreach they also want to control all aspects of life and in turn are sure that be restricting the use of drugs, alcohol, sex and any and all secular activities other than sports America will be great again. No, we will be a Theocracy like Iran with the Christian equivalent of Sharia Law.  I feel it and a I fear it.   I see the conformity and duplicity that exists here in Tennessee in ways that should be a warning to those who are oblivious.   I get it I really do.  Do you?

When you make decisions based on morality you are making ones based in emotions.  They are beliefs not thoughts based on rationality, critical thinking and the ability to evaluate facts as they prevent themselves in order to come to a decision based on reasoning.  This is what I see in the schools, Children who are incapable of said thought processing and that was planned by design and one look at Betsy DeVos should confirm that this is what they want for the rest of the country.  Do you?

Welcome to the death panels.  Remember that threat with Obamacare. Well Trump care is way more deadly. The Moral Minority is back just not the majority they once were and they are calling the shots and they are great shots.

Making Medicaid a Tool for Moral Education May Let Some Die

Eduardo Porter
The New York Times
Economic Scene
Jan 16 2018

Apparently the plan to Make America Great Again will let some Americans die.

Kentucky rushed last week to become the first of the nation’s 50 states to impose a work requirement on recipients of Medicaid. Under the state’s HEALTH plan, most able-bodied 19-to-64-year-olds — excluding the pregnant, the medically frail and some others — will have to work, get job training or perform community service for at least 20 hours a week to qualify for coverage, starting in July.

They will have to pay for it, too — a premium starting at $1 per month for families living on up to one-quarter of the federal poverty line, or about $400 a month for a family of three (such families exist, apparently) and rising to $15 for those who manage to stay above the poverty threshold.

The initiative is, of course, not about saving the state money by pushing poor people off the insurance rolls. It is providing moral education. In the words of Gov. Matt Bevin, the HEALTH plan will free Kentuckians from the “dead-end entitlement trap” and give them “a path forward and upward” so they can fend for themselves.

But the fact remains that the plan is expected to reduce Medicaid spending by $2.4 billion over five years. Roughly half of the 350,000 able-bodied Medicaid beneficiaries in Kentucky currently do not meet the work requirements, by the government’s estimates, and could lose their benefits. Five years from now, the Bevin administration calculates, the change will have culled some 100,000 people from the rolls.

Kentucky won’t be the last. Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin have already submitted their own similar proposals. Barring legal challenges, the Trump administration is eager to let them do it. Millions of Americans stand at risk of losing their health care. Many — the most fragile, the least great — could die as a result.

Mr. Bevin might care to glance south over the border. In 2005, Tennessee removed 170,000 people — almost one in 10 Medicaid beneficiaries in the state, mainly working-age adults without children — from its Medicaid program to save money. They didn’t do well.

The cuts didn’t just eat into poor Tennesseans’ finances. One study found that childless adults in Tennessee — especially the least educated — started delaying or forgoing visits to the doctor. They reported suffering more days in bad health and incapacitated. And they recorded more visits to hospital emergency rooms, which are required by law to care for all comers, regardless of their ability to pay.

Delayed care can kill. Breast cancer is the second-leading cause of cancer death among women. One of eight American women will get it. Detecting it early is critical. Specifically, the five-year relative survival rate for localized breast cancer is 98.5 percent when detected early, but only 25 percent when detected at a distant stage. Waiting for 60 days or longer to get treatment raises the risk of dying of breast cancer over five years by 85 percent.

Another study from Tennessee found that losing access to Medicaid led to delays in diagnosis, so more breast cancers were caught at a later stage. Women who lived in low-income ZIP codes were 3.3 percentage points more likely to receive a diagnosis of late-stage cancer than women living in high-income ZIP codes.

“We are ready to show America how this can and will be done,” Mr. Bevin said at a news conference in Frankfort. And yet Kentucky’s approach to Medicaid draws from a well-worn playbook, one from which both Republicans and Democrats have drawn to trim the social safety net over the years.

Kentucky was an eager participant in the last big so-called entitlement reform, visited upon the nation’s poor just over two decades ago. Under that 1996 program directed at welfare benefits, the entitlement to federal assistance was replaced by a hodgepodge of programs managed by the states and financed by a fixed dollop of federal cash. Work requirements became the norm. And people got less help.

The number of families in poverty in Kentucky has budged little since then, declining to 116,000 from 132,000. But the number of families getting cash assistance has fallen by two-thirds. Today, the Temporary Assistance for Needy Families program covers only one of five poor families in the state. For a single mother with two children, it provides $262 a month — a third less than it did two decades ago, adjusted for inflation.

And Kentucky is hardly the stingiest state. In 15 states, antipoverty cash benefits reach fewer than 10 percent of the families with children in poverty. In all of them, the change was sold as a way to encourage poor Americans to get off their backsides, get a job and prosper on their own — free of the clutches of the welfare state. Yet though it pushed many poor families into employment, it failed at mitigating their distress: Rarely do such families’ breadwinners earn enough to move out of poverty.

The problem with the latest twist in Republicans’ effort to pare the social safety net is that removing the poor’s health insurance may not just make their life more difficult.

It might kill them.

It is well known by now that health insurance saves lives. A review of recent research in the Annals of Internal Medicine concluded that the odds of dying for non-elderly adults are between 3 and 41 percent higher for the uninsured than for the insured.

Work by Katherine Baicker, now at the University of Chicago, with Benjamin Sommers and Arnold Epstein at Harvard found that Medicaid expansions in the past significantly reduced mortality. Their research, they concluded, “suggests that 176 additional adults would need to be covered by Medicaid in order to prevent one death per year.”

It doesn’t take a leap of imagination to figure out what might happen if 100,000 people were to lose their coverage.

As Lawrence H. Summers, once President Barack Obama’s top economic adviser, noted about the Republican tax cut passed in December, thousands would die if the tax bill were to cut the health insurance of 13 million people, as the nonpartisan Congressional Budget Office has estimated.

These would be mostly lower-income Americans. Maybe they would be people from Kentucky — the state with the most cancer deaths and the most preventable hospitalizations, 45th out of 50 in the incidence of diabetes and 47th in terms of heart disease.

Would their deaths cause America to be greater?

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