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“Doesn’t Mississippi Have More Pressing Concerns?”: Fattest, Poorest, Sickest State In America Rails Against LGBT People

A portrait of Mississippi.

It has a lower percentage of high school graduates than almost any other state. It has an unemployment rate higher than almost any other state.

Mississippi’s fourth-graders perform more poorly than any other children in the country in math. Also in reading. Its smoking rates are among the highest in the country. Along with West Virginia, it is the fattest state in the Union. It has the highest poverty rate and the lowest life expectancy.

Small wonder 24/7 Wall Street, a content provider for Yahoo!, Time and USA Today, among others, has dubbed Mississippi the “worst state to live in.”

All of which provides a certain pungent context for what happened last week as Gov. Phil Bryant signed into law a bill legalizing discrimination against LGBT people. It is dubbed the “Protecting Freedom of Conscience from Government Discrimination Act,” which is a cynical lie. The only thing it protects is those doing the discriminating.

You want to refuse to rent to a lesbian couple? You’re covered.

You want to refuse to hire a transgendered woman? Go for it.

You want to force your gay adopted son to undergo so-called conversion therapy? No problem.

You want to kick an adulterous heterosexual out of your hardware store? Yep, the law says you can even do that.

Indeed, it says that any gay, transgendered or adulterous individual whose behavior offends the “sincerely held religious beliefs or moral convictions” of a person, for-profit business, government employee or religious organization can be refused service.

As if your sexual orientation or marital status were the business of the cashier ringing up your groceries or the barber trimming your hair.

It is worth nothing that similar laws have been propounded in other states — Georgia, Indiana, Arkansas — only to be turned back under threat of boycott by Fortune 500 companies and professional sports teams doing business there. “The worst state to live in,” was immune to that kind of pressure because it has no such teams or businesses.

You’d think that would tell them something. You’d think it would suggest to Mississippi that it has more pressing concerns than salving the hurt feelings of some putative Christian who doesn’t want to bake a cake for Lester and Steve.

But addressing those concerns would require serious thought, sustained effort, foresight, creativity and courage. It is easier just to scapegoat the gays.

So the fattest, poorest, sickest state in the Union rails against LGBT people and adulterers and never mind that if every last one of them pulled up stakes tomorrow, Mississippi would still be the fattest, poorest, sickest state in the Union.

The point is not that such bigotry would be impossible in places that are healthier or wealthier. The point is not that such places are immune to it. Rather, the point is simply this: Isn’t it interesting how reliably social division works as a distraction from things that ought to matter more?

After all, Mississippi just passed a law that 80 percent of its eighth-graders would struggle to read.

If they graduate, those young people will look for work in a state with an unemployment rate significantly higher than the national average. But if one of those kids does manage to find work at the local doughnut shop say, she will — until the law is struck down, at least — have the satisfaction of refusing service to some gay man, secure in the knowledge that the state that failed to educate her or give her a fighting chance in a complex world, now has her back.

One feels sorrier for her than for the gay man. Her life will be hemmed by the fact of living it in a state that fights the future, that teaches her to deflect and distract, not resolve and engage.

The gay man can buy doughnuts anywhere.

 

By: Leonard Pitts, Jr., Columnist for The Miami Herald; The National Memo, April 10, 2016

April 12, 2016 Posted by | Discrimination, LGBT, Mississippi, Phil Bryant | , , , , , , , , | 1 Comment

“Ideology Standing In The Way”: How To Get Sicker, Die Sooner, And Pay More For It

It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.

The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.

The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.

That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.

The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.

We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).

The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.

If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.

How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.

Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.

And this, dear readers, is how you get to be last place in the developed world.

 

By: Jill Lawrence, The National Memo, September 24, 2015

September 25, 2015 Posted by | Affordable Care Act, Health Care Costs, Medicaid Expansion, Uninsured | , , , , , , , | 1 Comment

“Race, Class And Neglect”: Baltimore, And America, Don’t Have To Be As Unjust As They Are

Every time you’re tempted to say that America is moving forward on race — that prejudice is no longer as important as it used to be — along comes an atrocity to puncture your complacency. Almost everyone realizes, I hope, that the Freddie Gray affair wasn’t an isolated incident, that it’s unique only to the extent that for once there seems to be a real possibility that justice may be done.

And the riots in Baltimore, destructive as they are, have served at least one useful purpose: drawing attention to the grotesque inequalities that poison the lives of too many Americans.

Yet I do worry that the centrality of race and racism to this particular story may convey the false impression that debilitating poverty and alienation from society are uniquely black experiences. In fact, much though by no means all of the horror one sees in Baltimore and many other places is really about class, about the devastating effects of extreme and rising inequality.

Take, for example, issues of health and mortality. Many people have pointed out that there are a number of black neighborhoods in Baltimore where life expectancy compares unfavorably with impoverished Third World nations. But what’s really striking on a national basis is the way class disparities in death rates have been soaring even among whites.

Most notably, mortality among white women has increased sharply since the 1990s, with the rise surely concentrated among the poor and poorly educated; life expectancy among less educated whites has been falling at rates reminiscent of the collapse of life expectancy in post-Communist Russia.

And yes, these excess deaths are the result of inequality and lack of opportunity, even in those cases where their direct cause lies in self-destructive behavior. Overuse of prescription drugs, smoking, and obesity account for a lot of early deaths, but there’s a reason such behaviors are so widespread, and that reason has to do with an economy that leaves tens of millions behind.

It has been disheartening to see some commentators still writing as if poverty were simply a matter of values, as if the poor just mysteriously make bad choices and all would be well if they adopted middle-class values. Maybe, just maybe, that was a sustainable argument four decades ago, but at this point it should be obvious that middle-class values only flourish in an economy that offers middle-class jobs.

The great sociologist William Julius Wilson argued long ago that widely-decried social changes among blacks, like the decline of traditional families, were actually caused by the disappearance of well-paying jobs in inner cities. His argument contained an implicit prediction: if other racial groups were to face a similar loss of job opportunity, their behavior would change in similar ways.

And so it has proved. Lagging wages — actually declining in real terms for half of working men — and work instability have been followed by sharp declines in marriage, rising births out of wedlock, and more.

As Isabel Sawhill of the Brookings Institution writes: “Blacks have faced, and will continue to face, unique challenges. But when we look for the reasons why less skilled blacks are failing to marry and join the middle class, it is largely for the same reasons that marriage and a middle-class lifestyle is eluding a growing number of whites as well.”

So it is, as I said, disheartening still to see commentators suggesting that the poor are causing their own poverty, and could easily escape if only they acted like members of the upper middle class.

And it’s also disheartening to see commentators still purveying another debunked myth, that we’ve spent vast sums fighting poverty to no avail (because of values, you see.)

In reality, federal spending on means-tested programs other than Medicaid has fluctuated between 1 and 2 percent of G.D.P. for decades, going up in recessions and down in recoveries. That’s not a lot of money — it’s far less than other advanced countries spend — and not all of it goes to families below the poverty line.

Despite this, measures that correct well-known flaws in the statistics show that we have made some real progress against poverty. And we would make a lot more progress if we were even a fraction as generous toward the needy as we imagine ourselves to be.

The point is that there is no excuse for fatalism as we contemplate the evils of poverty in America. Shrugging your shoulders as you attribute it all to values is an act of malign neglect. The poor don’t need lectures on morality, they need more resources — which we can afford to provide — and better economic opportunities, which we can also afford to provide through everything from training and subsidies to higher minimum wages. Baltimore, and America, don’t have to be as unjust as they are.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, May 4, 2015

May 5, 2015 Posted by | Baltimore, Economic Inequality, Poverty | , , , , , , , , , | Leave a comment

“Expanding Social Security”: The Fiscal Scolds Driving The Cut-Social-Security Orthodoxy Have Deservedly Lost Credibility

For many years there has been one overwhelming rule for people who wanted to be considered serious inside the Beltway. It was this: You must declare your willingness to cut Social Security in the name of “entitlement reform.” It wasn’t really about the numbers, which never supported the notion that Social Security faced an acute crisis. It was instead a sort of declaration of identity, a way to show that you were an establishment guy, willing to impose pain (on other people, as usual) in the name of fiscal responsibility.

But a funny thing has happened in the past year or so. Suddenly, we’re hearing open discussion of the idea that Social Security should be expanded, not cut. Talk of Social Security expansion has even reached the Senate, with Tom Harkin introducing legislation that would increase benefits. A few days ago Senator Elizabeth Warren gave a stirring floor speech making the case for expanded benefits.

Where is this coming from? One answer is that the fiscal scolds driving the cut-Social-Security orthodoxy have, deservedly, lost a lot of credibility over the past few years. (Giving the ludicrous Paul Ryan an award for fiscal responsibility? And where’s my debt crisis?) Beyond that, America’s overall retirement system is in big trouble. There’s just one part of that system that’s working well: Social Security. And this suggests that we should make that program stronger, not weaker.

Before I get there, however, let me briefly take on two bad arguments for cutting Social Security that you still hear a lot.

One is that we should raise the retirement age — currently 66, and scheduled to rise to 67 — because people are living longer. This sounds plausible until you look at exactly who is living longer. The rise in life expectancy, it turns out, is overwhelmingly a story about affluent, well-educated Americans. Those with lower incomes and less education have, at best, seen hardly any rise in life expectancy at age 65; in fact, those with less education have seen their life expectancy decline.

So this common argument amounts, in effect, to the notion that we can’t let janitors retire because lawyers are living longer. And lower-income Americans, in case you haven’t noticed, are the people who need Social Security most.

The other argument is that seniors are doing just fine. Hey, their poverty rate is only 9 percent.

There are two big problems here. First, there are well-known flaws with the official poverty measure, and these flaws almost surely lead to serious understatement of elderly poverty. In an attempt to provide a more realistic picture, the Census Bureau now regularly releases a supplemental measure that most experts consider superior — and this measure puts senior poverty at 14.8 percent, close to the rate for younger adults.

Furthermore, the elderly poverty rate is highly likely to rise sharply in the future, as the failure of America’s private pension system takes its toll.

When you look at today’s older Americans, you are in large part looking at the legacy of an economy that is no more. Many workers used to have defined-benefit retirement plans, plans in which their employers guaranteed a steady income after retirement. And a fair number of seniors (like my father, until he passed away a few months ago) are still collecting benefits from such plans.

Today, however, workers who have any retirement plan at all generally have defined-contribution plans — basically, 401(k)’s — in which employers put money into a tax-sheltered account that’s supposed to end up big enough to retire on. The trouble is that at this point it’s clear that the shift to 401(k)’s was a gigantic failure. Employers took advantage of the switch to surreptitiously cut benefits; investment returns have been far lower than workers were told to expect; and, to be fair, many people haven’t managed their money wisely.

As a result, we’re looking at a looming retirement crisis, with tens of millions of Americans facing a sharp decline in living standards at the end of their working lives. For many, the only thing protecting them from abject penury will be Social Security. Aren’t you glad we didn’t privatize the program?

So there’s a strong case for expanding, not contracting, Social Security. Yes, this would cost money, and it would require additional taxes — a suggestion that will horrify the fiscal scolds, who have been insisting that if we raise taxes at all, the proceeds must go to deficit reduction, not to making our lives better. But the fiscal scolds have been wrong about everything, and it’s time to start thinking outside their box.

Realistically, Social Security expansion won’t happen anytime soon. But it’s an idea that deserves to be on the table — and it’s a very good sign that it finally is.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, November 22, 2013

November 23, 2013 Posted by | Social Security | , , , , , , , , | 4 Comments

“Life, Death And Deficits”: There Is No Good Case For Denying Older Americans Access To Medicare And Social Security

America’s political landscape is infested with many zombie ideas — beliefs about policy that have been repeatedly refuted with evidence and analysis but refuse to die. The most prominent zombie is the insistence that low taxes on rich people are the key to prosperity. But there are others.

And right now the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare. Even some Democrats — including, according to reports, the president — have seemed susceptible to this argument. But it’s a cruel, foolish idea — cruel in the case of Social Security, foolish in the case of Medicare — and we shouldn’t let it eat our brains.

First of all, you need to understand that while life expectancy at birth has gone up a lot, that’s not relevant to this issue; what matters is life expectancy for those at or near retirement age. When, to take one example, Alan Simpson — the co-chairman of President Obama’s deficit commission — declared that Social Security was “never intended as a retirement program” because life expectancy when it was founded was only 63, he was displaying his ignorance. Even in 1940, Americans who made it to age 65 generally had many years left.

Now, life expectancy at age 65 has risen, too. But the rise has been very uneven since the 1970s, with only the relatively affluent and well-educated seeing large gains. Bear in mind, too, that the full retirement age has already gone up to 66 and is scheduled to rise to 67 under current law.

This means that any further rise in the retirement age would be a harsh blow to Americans in the bottom half of the income distribution, who aren’t living much longer, and who, in many cases, have jobs requiring physical effort that’s difficult even for healthy seniors. And these are precisely the people who depend most on Social Security.

So any rise in the Social Security retirement age would, as I said, be cruel, hurting the most vulnerable Americans. And this cruelty would be gratuitous: While the United States does have a long-run budget problem, Social Security is not a major factor in that problem.

Medicare, on the other hand, is a big budget problem. But raising the eligibility age, which means forcing seniors to seek private insurance, is no way to deal with that problem.

It’s true that thanks to Obamacare, seniors should actually be able to get insurance even without Medicare. (Although, what happens if a number of states block the expansion of Medicaid that’s a crucial piece of the program?) But let’s be clear: Government insurance via Medicare is better and more cost-effective than private insurance.

You might ask why, in that case, health reform didn’t just extend Medicare to everyone, as opposed to setting up a system that continues to rely on private insurers. The answer, of course, is political realism. Given the power of the insurance industry, the Obama administration had to keep that industry in the loop. But the fact that Medicare for all may have been politically out of reach is no reason to push millions of Americans out of a good system into a worse one.

What would happen if we raised the Medicare eligibility age? The federal government would save only a small amount of money, because younger seniors are relatively healthy and hence low-cost. Meanwhile, however, those seniors would face sharply higher out-of-pocket costs. How could this trade-off be considered good policy?

The bottom line is that raising the age of eligibility for either Social Security benefits or Medicare would be destructive, making Americans’ lives worse without contributing in any significant way to deficit reduction. Democrats, in particular, who even consider either alternative need to ask themselves what on earth they think they’re doing.

But what, ask the deficit scolds, do people like me propose doing about rising spending? The answer is to do what every other advanced country does, and make a serious effort to rein in health care costs. Give Medicare the ability to bargain over drug prices. Let the Independent Payment Advisory Board, created as part of Obamacare to help Medicare control costs, do its job instead of crying “death panels.” (And isn’t it odd that the same people who demagogue attempts to help Medicare save money are eager to throw millions of people out of the program altogether?) We know that we have a health care system with skewed incentives and bloated costs, so why don’t we try to fix it?

What we know for sure is that there is no good case for denying older Americans access to the programs they count on. This should be a red line in any budget negotiations, and we can only hope that Mr. Obama doesn’t betray his supporters by crossing it.

By: Paul Krugman, Op-Ed Columnist, The New York Times, November 15, 2012

November 19, 2012 Posted by | Politics | , , , , , , , , | 2 Comments

   

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