Tag Archives: health

Patriotism Betrayed

As Trump rolls out his loony-tunes Cabinet choices, we are beginning to see the irony of “America First.” Rather than even a skewed version of patriotism, Trump is threatening a wholesale retreat from America’s founding ideals and from America’s place in the world.

I won’t waste pixels on his desire to put a science-denying medical conspiracy theorist in charge of the nation’s health, although I will note that–should RFK, Jr. actually make it through the confirmation process–most of the people who will sicken and/or die will be the True Believers in the MAGA base, the same folks who refused to wear masks or get vaccinated against COVID.

RFK, Jr. and his brain worm aren’t the most unbelievable nominees. Others pose an immediate threat to America’s global dominance. A recent essay in the Bulwark addressed the consequences if those nominees’ should take office. With respect to Tulsi Gabbard, the author wrote:

In addition to the problems she will cause American intelligence, her appointment will also send shockwaves through allied intelligence groups.

Because absolutely no one is going to share intel with us once she’s at the top of the org chart.

Instead our allies will cobble together alternative working relationships that do not include America. Without a seat at those tables, decisions will start to be made without consideration of America’s interests.

Eventually those informal working relationships will be codified. And America will be on the outside looking in. Hostage to events with a diminished ability to shape them….

It will also mean that the Pacific nations will have to come to their own arrangements with China. Because if the American public was not willing to shoulder the burden of merely shipping arms to Ukraine, then there is zero chance that we will be willing to go kinetic in the defense of Taiwan.

Tulsi Gabbard–one of Putin’s “useful idiots” and a woman so compromised she couldn’t get a security clearance– at the head of America’s intelligence agencies would be very bad for America, but as the essayist notes, it would be worse if our allies still believed there was a chance America would continue as a guarantor of the global order, only to find that they were mistaken when Putin and Xi acted.

If the Gabbard nomination wasn’t a sufficiently clear sign of America’s retreat from its global obligations and alliances, Trump’s choice for Defense Secretary “sealed the deal” as the saying goes.

Trump has always mistaken acting for reality, and his choice of Pete Hegseth–a television host–confirms his inability to distinguish manner from substance. As the Independent recently reported, not only is Hegseth, a Fox News pundit, massively unqualified, he wants to launch a “frontal assault” against top brass, kick women out of combat, and “implement Donald Trump’s sweeping agenda for the world’s third-largest standing fighting force.”

Hegseth’s nomination, which came as a shock to members of Congress who will ultimately be asked to vote to confirm him, reflects a broader trend among Trump’s Cabinet-level nominations and White House appointments — grievance-fueled loyalists whose disdain for a perceived establishment matches Trump’s wrecking-ball approach to governing and disregard for expertise and experience in a government that tens of millions of Americans depend on.

Since the announcement of Hegseth’s nomination, we have learned that he self-identifies as a Christian Nationalist, sports several White Nationalist tattoos, and has been credibly accused of sexual assault. If confirmed, he will enthusiastically implement Trump’s promises to reimpose a ban on transgender service members, end a policy that covered travel costs for service members seeking abortion care, and gut diversity, equity and inclusion initiatives.

Hegseth is also an out and proud bigot, who spent his college years crusading against diversity and “the homosexual lifestyle,” and suggested in a 2024 book that General Charles Q. Brown Jr., chairman of the Joint Chiefs of staff, and an Air Force fighter pilot with 130 combat flying hours and 40 years of service, only got the job because he is Black. (I’m sure that accusation endeared him to the African-Americans who comprise over 20% of America’s armed forces.)

There are very real issues with U.S. foreign policy. Critics–especially on the Left–point to multiple episodes where American interventions have been highly improper, to put it mildly. Others find fault with current Mideast policies. Americans of all political stripes routinely criticize aspects of the bloated Defense budget.

Correcting past blunders and “right-sizing” the budget, however, require competent leadership, and Trumpworld, from the top down, is thoroughly incompetent. (On the other hand, if the goal of America First is to make America the first country to surrender global influence and abandon its allies, they’ll be great…)

Putin and Xi are undoubtedly cheering….

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Red States, Blue States…

The battles over abortion are highlighting some previously under-appreciated differences between life in Red and Blue states. Those differences include health outcomes as well as economic circumstances..

As Jennifer Rubin summed it up in the Washington Post, 

 If you live in a red state, your risk of getting and dying from covid-19 is higher than in blue states. On average, your life span is shorter, your chance of living in poverty higher, your educational attainment lower and your economic opportunities are reduced relative to blue-state residents.

There are–as Rubin also acknowledges– policies being pursued in Red states that are increasingly persuading people to decamp and live elsewhere:  If they have a choice, “diverse” workers–LGBTQ+ folks, women and members of minority groups with skills needed by high-tech businesses– frequently choose to live in places they find welcoming, or at least safe. (As we saw when Indiana passed RFRA, unlike Republican politicians, local business enterprises understand that they are significantly disadvantaged in unwelcoming states. Low taxes– accompanied by a corresponding lack of public amenities and a poor or mediocre quality of life–simply aren’t enough to attract either new business or the skilled workforces on which those local enterprises depend.)

Red states like Indiana that have participated in the unremitting right-wing attack on public education tend not to produce the educated workforces that appeal to companies looking to relocate. Those disadvantages have produced the significant differences between Red and Blue state economies. As the Brookings Institution has reported,

To be sure, racial and cultural resentment have been the prime factors of the Trump backlash, but it’s also clear that the two parties speak for and to dramatically different segments of the American economy. Where Republican areas of the country rely on lower-skill, lower-productivity “traditional” industries like manufacturing and resource extraction, Democratic, mostly urban districts contain large concentrations of the nation’s higher-skill, higher-tech professional and digital services.

Many of these differences have been apparent for years–and as the Brookings report noted, they have recently been accelerating.  But that’s not all. As Rubin writes,

And then came the abortion bans. Thousands, if not millions, of women of childbearing age might reconsider their residence if they want to avoid the potentially life-threatening bans — or if they simply want to be treated like competent, autonomous adults.

There are signs the reality of forced-birth laws are registering with those most affected. Reuters reports: “The U.S. Supreme Court’s decision in June to overturn the 1973 Roe v. Wade case that legalized abortion nationwide has some students rethinking their higher education plans as states rush to ban or curtail abortion, according to interviews with 20 students and college advisers across the country.” While the evidence is anecdotal at this point, “in the wake of Roe’s overturn, college counselors said abortion has figured prominently in many conversations with clients, with some going as far as nixing their dream schools.”

Lest you be tempted to “pooh pooh” the effect of Dobbs on the college choices of talented young women, I have an example close at hand. My granddaughter–an excellent student–immediately removed Texas’ Rice University–an otherwise highly desirable school– from her list of schools to consider. She’ll attend the University of Chicago, in Illinois, a pro-choice state.

The Times reports that blue-state governors have begun “depicting their abortion rights policies as a business advantage, reinforcing the appeal of the wealthier and more progressive states that many businesses opt to call home in spite of their taxes.

In fact, multiple data points confirm that, among other things, the GOP’s cult ideology decreases life expectancy and keeps many women out of the workplace. It also contributes to the “brain drain” that sends a state’s college graduates to places with more educated populations and a higher quality of life. And if you don’t think any of this really makes a difference in individual life prospects, Brookings will disabuse you of that belief

With their output surging as a result of the big-city tilt of the decade’s “winner-take-most” economy, Democratic districts have seen their median household income soar in a decade—from $54,000 in 2008 to $61,000 in 2018. By contrast, the income level in Republican districts began slightly higher in 2008, but then declined from $55,000 to $53,000.

Underlying these changes have been eye-popping shifts in economic performance. Democratic-voting districts have seen their GDP per seat grow by a third since 2008, from $35.7 billion to $48.5 billion a seat, whereas Republican districts saw their output slightly decline from $33.2 billion to $32.6 billion.

Retrograde public policies have real-world consequences. And those consequences are substantial. Indiana has long suffered the economic and health results of an unhinged and provincial legislature, but it’s about to get much, much worse.

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Double Whammy

A friend from Wisconsin often shares news reported in that state’s media. Most recently, he sent me an article reporting on the troubling results of research into poverty and public health.

Malia Jones is an assistant scientist and social epidemiologist working in Wisconsin. As she notes, her conclusions about increases in poverty despite the economic recovery are consistent with those reached by other scholars.

We didn’t look at explanations for that but other people have, and I think what’s happening is that people at the low end of the economic spectrum are not benefiting from recovery. They’re really being left behind. So inequality is increasing in the face of an expanding economy.

Jones’ work is one more confirmation that, as she says, low-income Americans are being left behind. But her analysis didn’t stop there, and her discussion of both the immediate and long-term implications requires attention.

In short, poor children in America are getting a “double whammy.”

Jones notes that the number of children living in poverty has increased since the Great Recession, and that the existence of children living in poverty is not only a humanitarian issue, but also a critical public health issue. As she points out, exposure to the myriad problems that accompany an impoverished childhood can lead to a lifetime of disability.

It’s those kinds of stressors like housing insecurity, not being sure if there’s going to be food for dinner, living in a crummy neighborhood with violence, those stressors can impair normal brain development.

Impaired brain development often leads to behavioral outcomes; as anyone who has taught in a low-income area can attest, it affects school performance in a variety of ways. Children of poverty often lack the opportunity or means to develop the sorts of skill sets common among middle and higher income students. That, in turn, affects later access to jobs, trapping such children in a cycle of poverty.

Living in poverty also increases the likelihood of poor health. Living in poverty is a major risk factor for obesity, diabetes, hypertension, and even premature death.

It seems unconscionable that the United States would ignore the lifetime health effects of poverty on poor children who are already living in sub-optimal and stressful conditions.  Even the self-satisfied and clueless scolds who insist that poor people just need to work harder can’t hold children responsible for their impoverished situations.  Surely, even the adamant opponents of Obamacare, Medicaid and other efforts to make health care affordable can’t believe that it is either moral or economically reasonable to deprive children of adequate medical attention.

And surely, even self-described fiscal conservatives must realize that the long-term costs of neglecting the most basic needs of poor children are far higher than the costs of timely intervention.

Why is it that American public policy choices so often make me think of the adage: penny wise, pound foolish?

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A Succinct Prescription

One of the things I enjoy about Facebook is my friends’ regular posting of cartoons, pithy sayings and thought-provoking quotations (some real, some highly doubtful…).

This morning, someone posted a photo of a sign held by a member of the “Occupy” movement. The sign enumerated the “demands” of the 99% –healthcare for all, jobs, good public education and a clean environment.

That really doesn’t seem to be too much to expect.

When we ask THE political question–what should government do?–most liberal democracies have answered that government is the collective mechanism we use to provide those things individuals cannot provide alone. Economists call this “market failure,” but the basic idea is that, in order to flourish as individual citizens, we require an infrastructure. To use a local example, individuals buy their own cars, but they need roads on which to drive them, traffic signals to direct them safely, etc. The over-arching question in free societies is always: what should government provide, and what should be left to the private and nonprofit sectors? What can people do for themselves through the market or through voluntary associations, and what must be provided collectively–i.e., “socialized.” (Yes, Tea Party people, that’s what that word means.)

The list on the placard, while not exhaustive, seems pretty reasonable to me. Individuals acting alone cannot protect the environment. Health and education are not consumer goods, they are public goods–and leaving them to the vagaries of the market leads to huge inequities and inefficiencies. As for jobs, I’m one of those throwbacks who thinks we ought to seriously debate the merits of government as the employer of last resort.

Health, jobs, education and clean air and water. What will the ungrateful masses demand next?

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