Tag Archives: red states

OK, Let’s Talk About Mental Health

It’s so predictable. And maddening. After each horrific mass shooting, Republicans pandering to the NRA insist that the problem isn’t guns–it’s mental health.

The most obvious response is equally predictable (albeit far more intellectually honest):  these attacks are vanishingly rare in countries where there are similar proportions of  mentally ill citizens but far fewer guns.

Mental health professionals will also point out that the great majority of people diagnosed with a mental health problem are not violent, so pointing to an undifferentiated “mental health” crisis is simply an effort to distract from the role played by virtually unrestricted gun ownership.

I personally agree with a New Republic headline:“The Main Mental Health Issue in This Country Is in the Republican Party.”

That said, I also agree that, overall, America does a very poor job of diagnosing and treating mental illness. So if we were to ignore the immense hypocrisy of the Republicans who only respond to these massacres by advocating an increase in resources devoted to mental health, we might welcome their sudden attention to that scarcity and their apparently heartfelt efforts to address it. (Snark alert: If you believe those efforts are really heartfelt, I have some swampland in Florida to sell you…)

The linked article from the New Republic looked at the existing patchwork of state funding for mental health diagnosis and treatment.

Before you click, just hazard a guess: Of the top 10 states, how many are red? Likewise, how many of the bottom 10 are red? And where do you imagine Texas ranks?

If you don’t feel like floating down that rabbit hole, I’ll save you the trouble. The top 10 states are: Maine, Pennsylvania, Arizona, New York, New Jersey, New Hampshire, Montana, Vermont, California, Maryland. One red state in the bunch (yes, Arizona is borderline, but it went Democratic in 2020). The bottom 10, from forty-first to fiftieth, are: Florida, Wyoming, North Dakota, Delaware, Louisiana, Oklahoma, Kentucky, Idaho, West Virginia, Arkansas. One blue state.

And Texas—where that lying death cultist of a governor vows to attack the scourge of mental illness with a zeal unmatched since Wayne LaPierre took his last trip to Zegna—just misses the bottom 10, in fortieth place. I doubt I even need to point out (although for the record I will) that Greg Abbott and the state’s Republicans have been cutting mental health funding, by more than $200 million over the last two years.

The article noted that there has been one –and only one–major expansion of mental health spending and insurance coverage in recent American history–and it was part of the Affordable Care Act., aka Obamacare. According to a Commonwealth Fund report, the ACA’s impact on the country’s mental health has been salutary, particularly in states that accepted Medicaid funding.

And we all know how the GOP has reacted to that particular expansion of access to healthcare, including mental healthcare.

The GOP then spent years trying to repeal and “replace” it. Trump also wanted it repealed. So the sole major expansion of mental health coverage in this century was contained in a bill whose passage every Republican in Washington opposed and on which most Republican governors have refused to participate in the state-level implementation. Come to think of it, probably the sole reason the red state of Montana ranks in the top 10 on mental health spending is that the state took the Medicaid expansion money under former Democratic Governor Steve Bullock.

Republicans are not going to expand mental health funding. Mental health care is for sissies and liberals. The only thing they’re going to expand is access to guns. We know this because recent history tells us so. Last week in Vox, Zack Beauchamp posted a shocking but not surprising report on academic studies of legislative responses at the state level to mass shootings. The finding? The norm in this country has been that mass shootings have been used by state legislatures and governors as an excuse to loosen gun laws, not tighten them. This is our country.

We have a mental health problem, all right– but it’s primarily among Republican legislators.

 

A Cold Civil War

Back in high school when most of us studied the Civil War (usually briefly and superficially), it was hard to get our heads around the extent to which Americans held wildly different world-views. I remember my own inability to understand how so many Southerners (and not a few Northerners) fervently believed their skin color entitled them to own another human being.

At the time of the Civil War, a majority of people willing to defend the institution of slavery lived below the Mason-Dixon Line, a geographic reality that made it possible to take up arms against those who disagreed. Today, most of the divisions we face lack that geographic clarity. Although it’s true that we have Red States and Blue States, we also have bright blue cities in those Red States, and Blue States have pockets of rural Red voters. So our current Civil War–and I don’t think that is too strong a descriptor–is a “Cold War,” being fought primarily with propaganda, but threatening to erupt into assaults like the January 6th insurrection.

Most readers of this blog are well aware of the recent speech given by former General Michael Flynn, at an event for QAnon believers that featured other representatives of LaLaLand like Texas Representative Louis Gohmert.

As the New York Times reported,

Michael T. Flynn, a former national security adviser, suggested that a military coup was needed in the United States during a Memorial Day weekend conference organized by adherents of the QAnon conspiracy theory, drawing criticism from political scientists, veterans, Democrats and a handful of prominent Republicans.

I don’t know how many of the Southerners who ultimately took up arms in America’s first Civil War actually believed in the core precepts of slavery and “the White Man’s burden,” but thanks to advances in polling and survey research, we have a fairly accurate understanding of the percentage of our fellow-Americans who claim to believe QAnon nonsense.

A recent poll by the Public Religion Research Institute and the Interfaith Youth Core found that 14 percent of Americans, including about one in four Republicans, believed in three central tenets of the QAnon conspiracy theory: that the United States is being run by a cabal of Satanist pedophiles, that “American patriots may have to resort to violence” to get rid of that cabal, and that a “storm” will soon “restore the rightful leaders.”

In a robust democracy, fourteen percent of the population can be bat-shit crazy without endangering the Union–but we don’t have a robust democracy. As over one hundred political science scholars recently wrote, the attacks on voting underway in several states are transforming democratic decision-making into “political systems that no longer meet the minimum conditions for free and fair elections.” The scholars warn that “our entire democracy is now at risk.”

Ezra Klein recently reminded readers that Democrats face an unforgiving context:

Their coalition leans young, urban and diverse, while America’s turnout patterns and electoral geography favor the old, rural and white. According to FiveThirtyEight, Republicans hold a 3.5 point advantage in the Electoral College, a 5-point advantage in the Senate and a 2-point advantage in the House. Even after winning many more votes than Republicans in 2018 and 2020, they are at a 50-50 split in the Senate, and a bare 4-seat majority in the House. Odds are that they will lose the House and possibly the Senate in 2022.

This is the fundamental asymmetry of American politics right now: To hold national power, Democrats need to win voters who are right-of-center; Republicans do not need to win voters who are left-of-center. Even worse, Republicans control the election laws and redistricting processes in 23 states, while Democrats control 15. The ongoing effort by Texas Republicans to tilt the voting laws in their favor, even as national Republicans stonewall the For The People Act and the John Lewis Voting Rights Act, is testament to the consequences of that imbalance.

This is how a Cold Civil War is conducted. Although there may be scattered bloodshed a la January 6th, the actual battles–the coups favored by crackpots like Flynn and Gohmert and numerous other Republicans– are taking place in state-level legislative bodies where the will of the majority has been neutered by gerrymandering and on media platforms where facts are twisted or sacrificed to feed the appetites–and generate the rage– of angry  old White guys. 

What is really terrifying is the likelihood that this current iteration of Civil War will be won or lost with most Americans totally unaware that it is even being fought….

 

For Goodness Sakes, Indiana!

A couple of years ago, Indiana geniuses came up with the motto “Honest to goodness, Indiana!” After reading this scorching–and utterly accurate–description of what passes for governing in my state, I think that motto should be “For goodness sakes, Indiana!”

The article by Aaron Wren in Governing  magazine looked at the traditional Red state tactics that brought disaster to Kansas and failed to improve economies in Red states generally. When Wren focused on Indiana, he laid out the state’s current status and the roots of our declining wellbeing.

Or look at Indiana. It has had Republican governors since 2005 and full Republican control of the state for over a decade. Its leadership loves to boast that its growth rate in population and jobs beats surrounding states, but that’s a low hurdle to jump. In reality, most of Indiana is stagnating or declining. Over half of the state’s counties are losing population, and the forecast for the prime working age population is grim: Virtually the entire state is projected to have a declining workforce in coming years. Indiana’s per capita income is only 86.2 percent of the national average, and that’s lower than it was when the GOP took over the governorship and the Legislature. Under Republican management, the state started out poor and got even poorer.

Why these poor results in states with the full panoply of red state best practices? It’s because the entire philosophy of governance in Kansas, Indiana and quite a few other Republican states is based on a fundamentally mistaken view of progress. Rather than investing to build up the skills and enhance the well-being of their citizens, they engaged in a race down to the bottom as a strategy to attract corporations.

Wren doesn’t simply make an assertion–he provides examples.

When local media reported on the horrific situations faced by many local renters, Indianapolis responded by passing an ordinance that required landlords to provide tenants with a list of their rights– including the right to have “functional plumbing, safe wiring and heat in the winter.” Indiana’s legislature just overturned that ordinance, as part of the legislature’s ongoing refusal to respect local control, and–as Wren says–at the behest of the property owners’ lobby.

Indiana is a great place to be a slumlord, but not such a good place to be a citizen who rents.

The article points out that this example is just one of many.  The state’s nursing home industry has so many negatives, it has become, Wren says, “a giant scam.” He recounts how hospitals in the state used ownership of nursing facilities to overbill Medicare and siphon over a billion dollars from those homes. The money was used to fund building projects and generous salaries for hospital executives. Meanwhile, Indiana ranks 48th in nursing home staffing, and more than 20 percent of nursing home patients with COVID died (the national rate is 13 percent).

How did our legislature respond? It passed a bill providing expansive immunity from liability for nursing homes and other businesses.

In addition to overturning tenant protections, Indiana has flirted with canceling a transit expansion in Indianapolis that has been supported overwhelmingly by the voters, and gutted a bill that would have required employers to provide basic accommodations to pregnant women. (Expectant mothers can now ask for accommodations, but employers don’t have to actually provide any). Perusing the list of bills working their way through the state Legislature, it’s hard to see much that could even plausibly make a material improvement in the life of Hoosier citizens.

Wren points out that the most important factor in attracting high-wage employers is the availability of a skilled labor force – talent. What he doesn’t mention is the Indiana legislature’s continuing assault on public education, and the negative effects of that assault on efforts to produce a skilled labor force. Instead, the Republicans who have dominated state government continue to siphon dollars from public schools in favor of private, mostly religious schools via the nation’s largest voucher program.

Aaron Wren is no bleeding-heart liberal. When he lived in Indianapolis, I knew him slightly, and followed his observations on local governance. He was pro-business in the better sense of that term, supportive of governance that created a business-friendly environment, but highly critical of the crony capitalism that continues to characterize Republican politics in Indiana.

So long as Indiana’s gerrymandered districts continue to weight rural votes over urban ones, we will continue to rank among the bottom of states in numerous categories, and we’ll continue to have what the late Harrison Ullmann called “the world’s worst legislature.”

For goodness sakes, Indiana!

Red States, Blue States…And Death Rates

The other day, during a political discussion (these days, pretty much every discussion gets political) my youngest son wondered aloud whether it had been a mistake to win the Civil War. The red states of the South have been an economic drag on the blue states for a long time–they send significantly fewer dollars to Washington than they receive courtesy of blue state largesse.

My son was being flip, but his characterization of Red and Blue states wasn’t far off. As Paul Krugman wrote in a recent column in the New York Times, “the political divide is also, increasingly, an economic divide.”

Democratic-leaning areas used to look similar to Republican-leaning areas in terms of productivity, income and education. But they have been rapidly diverging, with blue areas getting more productive, richer and better educated. In the close presidential election of 2000, counties that supported Al Gore over George W. Bush accounted for only a little over half the nation’s economic output. In the close election of 2016, counties that supported Hillary Clinton accounted for 64 percent of output, almost twice the share of Trump country.

Evidently, however, we don’t just live in different economies–lately, we also die differently.

Back in the Bush years I used to encounter people who insisted that the United States had the world’s longest life expectancy. They hadn’t looked at the data, they just assumed that America was No. 1 on everything. Even then it wasn’t true: U.S. life expectancy has been below that of other advanced countries for a long time.

The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.

What I haven’t seen emphasized is the divergence in life expectancy within the United States and its close correlation with political orientation. True, a recent Times article on the phenomenon noted that life expectancy in coastal metropolitan areas is still rising about as fast as life expectancy in other advanced countries. But the regional divide goes deeper than that.

It turns out that the “death divide” Krugman is addressing is closely correlated with political orientation.

I looked at states that voted for Donald Trump versus states that voted for Clinton in 2016, and calculated average life expectancy weighted by their 2016 population. In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country. At this point, blue-state residents can expect to live more than four years longer than their red-state counterparts.

There are a number of possible explanations: blue states expanded Medicaid while most red states didn’t, for example. The gap in educational levels is probably implicated as well; better-educated people tend to be healthier than the less educated, for a number of reasons.

Krugman also notes differences in behavior and lifestyle that affect mortality. (Although obesity has dramatically increased all across America, obesity rates are significantly higher in red states.)

Krugman references–and debunks–conservative explanations for the death divide:

Conservative figures like William Barr, the attorney general, look at rising mortality in America and attribute it to the collapse of traditional values — a collapse they attribute, in turn, to the evil machinations of “militant secularists.” The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”

But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy. And even within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.

Although he doesn’t mention it, I’d also be interested in seeing a comparison of gun deaths in Red and Blue states.

Actually, conservatives like Barr inadvertently make a point: culture and values matter. Just not the way they think.