Tag Archives: medical care

What They’re Breaking

Those of us who are aware of the “shock and awe” assault on America’s governance–and even those of us who are trying not to focus on the details of that assault–tend to shudder over our recognition that the Trump/Musk tantrum is doing immense damage. But few of us possess either the knowledge or the fortitude to enumerate what these know-nothing zealots are destroying.

In a recent Substack Letter, Paul Krugman provided a partial enumeration. He began by noting the difference between breaking ‘things” and breaking government processes.

“Move fast and break things” is sometimes an OK approach if the things in question are just hardware, which can be replaced. But what if the object that experiences “rapid unscheduled disassembly” is something whose continued functioning is crucial to people’s lives — say, something like the U.S. government?

As he points out, the (very) young techies Musk has sent into government agencies (Krugman dubs them “Muskenjugends”) share three characteristics:

First, they all seem to be extreme right-wing ideologues: whenever journalists investigate the social media trail of one of Musk’s operatives, what they find is horrifying. For example, Marko Elez, who had access to the Treasury Department’s central payments system, had in the recent past advocated racism and eugenics.

Second, they don’t know anything about the government agencies they’re supposedly going to make more efficient. That’s understandable. The federal government has around 2 million workers, many — I would say the vast majority — performing important public services, in a huge variety of fields. You can’t parachute into a government agency and expect to know in a matter of days which if any programs and employees are dispensable.

But the third characteristic of the Muskenjugend is that, like Musk himself, they’re arrogant. They believe that they can parachute into agencies and quickly identify what should be cut.

The Muskenjugend attack is compromising important–even essential–government operations. In their haste to “trim” the fedeeral workforce, Trump officials fired more than 300 staffers at the National Nuclear Security Administration, “apparently unaware that this agency oversees America’s nukes.”

The next day, realizing the enormity of the error, the agency tried to reinstate those workers — but was having trouble getting in touch, because the terminated workers had already been locked out of their government email accounts.

The administration also fired 3400 workers at the National Forest Service, which plays a critical role in fighting forest fires, and has mandated large layoffs at the Centers for Disease Control and Prevention (just as alarms are escalating about the potential for a bird flu pandemic.)  The CDC has been pressured to withhold reports, so Krugman notes that we might remain unaware of the next pandemic until it’s well underway.

Large layoffs have also decimated the Department of Health and Human Services. According to CBS, those layoffs have included half the officers of the Epidemic Intelligence Service, who play a critical role in identifying public health threats. There have also been layoffs at the FDA, which monitors the safety of food additives and medical devices.

And according to the union, despite an uptick in air disasters, several hundred workers have been fired at the Federal Aviation Administration.

The list goes on. But peering through the details, the overall strategy is clear: Musk and his minions decided to summarily fire as many federal workers as they could without making any effort to find out what these workers do and whether it’s important.

It’s easy to criticise the growth of government in the abstract. It is a lot harder to explain why government should not be making sure our foods are safe to eat and our aircraft safe to fly, among the many other functions that must be performed collectively in modern societies. It’s easy to point to excesses of red tape, to find fault with systems that seem faulty or have become obsolete. It is much harder to identify and correct the flaws while taking care to maintain essential safeguards.

It seems all too likely that Americans are about to learn the real costs of austerity theater. Many of the suddenly laid off workers were providing essential services. Nor should we underestimate the demoralization the vindictive layoffs have created even among those workers who still have their jobs (so far.)

So when we experience our next wave of devastating forest fires, when significant numbers of Americans begin dying from preventable diseases and faulty medical devices, remember: These disasters will be partly the fault of arrogant, ignorant men who decided to smash up a reasonably functional government.

And don’t get me started on the effects our “Nazification” and bowing to Putin while betraying Ukraine is having on America’s global stature…

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Puncturing The “Pro-Life” Myth

I assume there are sincere people (mostly, but not exclusively, male) who bought into the myth that prohibiting abortions was all about “saving babies.” In the wake of actual bans, the incredible dishonesty of that assertion has become harder to ignore. 

The avowed “pro life” activists have been conspicuously silent about the fact that– In the wake of the Dobbs decision–in states like Indiana that have stringent bans, women have died or suffered extreme medical consequences in greater numbers than before. While most women already knew that the purported “pro life” concerns about “life” didn’t extend to the lives of women, those activists have been equally silent about the sharp rise in infant mortality. As the linked report shows, in the year and a half following the Supreme Court Dobbs decision, hundreds more infants died than usual in the United States. The vast majority of those infants had congenital anomalies, or birth defects, and it is likely that a number of those babies experienced painful deaths.

The refusal of ideologues to understand that abortion availability is an essential part of healthcare has meant that women suffering miscarriages have been denied adequate and timely treatment, and that pregnant women who very much want to carry their babies to term are having difficulty finding an ob/gyn to provide prenatal care and deliver those infants. The state’s abortion ban has led to a decline in OBGYN residency applications–a decline likely to worsen the already alarming shortage of maternal care providers. A patient in Northern Indiana died last year from an ectopic pregnancy because there was no ob-gyn to treat her.

None of which seems to bother the “pro life” Micah Beckwiths of the world.

Now, it turns out that the medical consequences of these bans–their very negative effect on actual lives–extends far beyond reproductive medicine. According to the Indiana Capital Chronicle, the bans are also interfering with the diagnosis and treatment of breast cancer. In the wake of Dobbs and state bans, finding a local provider for breast screenings has become far more difficult. Planned Parenthood clinics that used to provide those screenings have closed and staff shortages at other sites have increased as medical personnel leave states with bans.  The remaining health care providers are overwhelmed.

One in 3 oncology fellows surveyed by the American Society of Clinical Oncology says abortion restrictions hurt cancer care, and more than half of fellows said they are likely to consider the impact of abortion restrictions on care when deciding where to practice. Although many states like Indiana allow exceptions when the termination of a pregnancy is necessary to protect the life of the pregnant patient, the rules on how to apply these exceptions are unclear. In Ohio, two cancer patients were denied treatment until terminating their pregnancies under the state’s 6-week ban, forcing them to seek care out of state. As these bans persist, more Hoosiers will face similar situations—many of which may go unseen.

Early detection through routine screenings plays a critical role in improving survival rates, as 1 in 8 women in the U.S. will develop breast cancer in their lifetime. But when health centers are forced to close, those lifesaving screenings disappear too.

How “pro life” are the pious ideologues who talk endlessly about the “pre-born” but refuse to acknowledge the profoundly negative outcomes of these bans for the lives of already-born women? 

Excuse my cynicism, but I remain convinced that the real motive for these bans is the patriarchal belief that women should be returned to a submissive social status. Increasing efforts by GOP politicians to restrict access to birth control give the game away.

With the advent of the pill, women were–for the first time– able to manage their fertility and plan their families. Women were able to enter the workforce, able to participate with men in the broader civic and political society. As Morton Marcus and I documented in From Property to Partner, reproductive choice has been far and away the most important element of women’s liberation. 

Initially, perhaps some people were convinced that the “pro life” movement really was about keeping wicked and “ungodly” women from “killing babies.” Now that we have irrefutable evidence that, thanks to these bans, more babies and more women are dying, it will be interesting to see how many of those people revise their opinions. 

I’m not holding my breath, because for the great majority of those “pro life” warriors, it was never about life. It was about male dominance and faux religion.

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California Dreaming…

Yesterday’s post, and a number of the comments that followed, acknowledged the importance of health insurance to the social safety net, and lamented the resistance of Congressional Republicans to maintenance–let alone extension– of current coverage.

Fortunately, Washington isn’t the only game in town.

With the collapse of anything remotely resembling governance coming from Washington, D.C., California has become the de facto adult in the room. Those of us appalled at Trump’s retreat from environmental protections, for example, take comfort in the fact that California, with its huge and important markets, is insisting upon fuel-efficient cars and other environmentally-sensitive measures.

In healthcare, apparently, California is also proposing to go where Congress won’t.

In the face of the GOP assault on the Affordable Care Act and Medicaid, California is preparing to vote on a statewide single-payer plan. Californians currently spend about $370 billion annually in a typical, insurance-dominated system that leaves 40 percent of the state’s  population uninsured or underinsured. The single-payer measure is working its way through the legislature, and a fiscal analysis was presented to lawmakers and the public last week by the bill’s sponsor and the California Nurses Association.

The analysis was done by a team led by Robert Pollin, the co-director of the Political Economy Research Institute at the University of Massachusetts and a former UC Riverside faculty member. At a Sacramento press conference, he explained how a single-payer system would enable all Californians to be completely covered. That includes 3.7 million currently uninsured residents and another 12 million who are underinsured, meaning they cannot afford their policy’s co-pays and deductibles.

The universal coverage would be paid for by combining all government healthcare subsidies, which accounts for about 70 percent of California’s current spending, and by two proposed tax increases: a 2.3 percent gross receipt taxes on businesses (which kicks in after the first $2 million in earnings and which exempts small businesses); and a 2.3 percent increase in the sales tax, with exemptions for necessities such as food, housing, utilities, and other services.

Those combined revenue streams would raise an estimated $400 billion annually to pay for universal coverage under a single-payer system.

Assuming the law passes, California will actually spend less than it currently does on healthcare, and the average middle-class family will see out-of-pocket costs fall by 9 percent.

Most businesses will also save money, Pollin explained, because they will no longer be paying for their employees’ health care. Even with the proposed gross receipts tax exempting the first $2 million, typical California businesses employing 10 to 19 people would see costs fall by 13.8 percent, he said. Businesses employing 20 to 99 people would see costs fall by 6.8 percent, he said. Businesses employing up to 500 would see costs fall by 5.7 percent, and the 500-plus businesses would see costs fall by 0.6 percent.

The law would establish a system paying hospitals and providers what they are currently paid under the federal Medicare program. That’s about 22 percent less than what private insurers pay. The new system would also negotiate bulk purchases of drugs, and it would achieve the same sort of administrative efficiencies of scale that Medicare has achieved. Medicare’s overhead, as I’ve indicated previously, runs around 3%, while overhead for private insurers (who must market their policies and pay their top management competitive private sector salaries) runs between 22-25%.

As I write this, the measure is not a “done deal.” But a similar bill passed a few years ago, only to be vetoed by then-Governor Schwarzenegger. Assuming passage of the pending measure, it is likely that Governor Jerry Brown will sign it.

California has a bit over 12% of the U.S. population. If it passes single-payer, it will be a game-changer. (Already, New York’s legislature has begun discussing a similar approach.)

This could get very interesting. I’m gaining a new appreciation for federalism.

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