"The South still lags" and Other Fun Facts

Note: I have rewritten this first paragraph since I first published this post. Saturday, Nov. 21, 2009
This post is not about me. It's about what's sorry about the South, where more than six generations of my ancestors have lived. I've found myself defending the South lately, first in a conversation while on vacation, with a woman in northern California; then in response to a blog post by Kevin Drum, whose blog I read often; then to a friend who was describing what some of her friends in California say or wonder about the South. But today I'm complaining, too, about the inequities of the South.

Take salaries, for example. Over ten years ago, I taught part-time at a community college in Duluth, Minnesota. My pay? $3500 per course per quarter. Fifteen years later, adjuncts at the community college here in Georgia where I tutor part-time make $2100 per course per semester. Adjuncts at the community college in Killeen, Texas, made $1550 per course per semester when I was teaching there in 2004-2007. I have taught full-time at universities, and when I was full-time, I was a voice for adjuncts and their pay. But my voice didn't make a difference.

And now, just a few minutes ago, I read that the United Health Foundation has published its results on the healthiest and unhealthiest states in the United States. Big surprise what states are the unhealthiest. The bottom 12?

• Texas
• Arkansas
• Kentucky
• West Virginia
• Georgia
• Tennesee
• Nevada
• South Carolina
• Louisiana
• Alabama
• Oklahoma
• Mississippi

The healthiest state in the country? Vermont. Oh, and guess what, health care has something to do with that:

[E]very pediatrician in Vermont accepts Medicaid and the benefits extend to families who earn up to 300% of the poverty line.

The New England states evidently should be the role model for slacker states:

New England in general sets a benchmark for the country, the report found. All six New England states are in the top 10. These states have favorable demographics and an excellent public health infrastructure, including a large number of doctors per capita.

Eight of the ten states on the bottom of the rankings list are in the South:

In general, residents of these states are more likely to be smokers or to be obese, the report found. They also have worse health insurance coverage, fewer physicians per capita and live in areas with high violent crime and more child poverty.

Oh, and the article does report that 96% of Vermonters are Caucasian and "that health outcomes can be worse for racial and ethnic populations as well as those with lower incomes and education levels."

I read this article and couldn't help but make connections with this book I'm reading now: Slavery by Another Name: The Re-Enslavement of Black Americans from the Civil War to World War II.  Why does the South lag? Because the rest of the country tends to give up on the South--or what might stand in as a signifier of today's South. After the Civil War, the intransigent racism of the South led to laws that essentially re-enslaved African-Americans. How did the North respond? Well, eventually by giving up on the South until the South rose up again in the form of--no, not Johnny Reb, but the likes of Martin Luther King, Jr. and all those other heroes of the Civil Rights Movement. In 1896, Plessy v. Ferguson  "legitimized the contemptuous attitudes of whites," especially those whites who held power in the South, and that "new consensus

marked an extraordinary turning point in the political evolution of the nation. Thousands of northern whites had fought not because of their fondness or empathy for African Americans but because the principles of the Declaration of Independence coupled with American compulsion with honesty demanded it. The abandonment of that principle, and embrace of an obviously false mythology of citizenship for black Americans, brought an end to the concept that abstract notions of governance by law and morality could always be reconciled with reality. It marked a new level of unvarnished modern cynicism in American political dialogue. And it established a pattern over the ensuing years in which almost any rationalization was sufficient to excuse the most severe abuses of African Americans. (Blackmon, p. 110-111)

I see this same betrayal today in our political discourse--oh, please, don't think I'm equating health care with the enslavement of millions of African-Americans. This is a comparison, not an equation. But just note the many politicians--not all of whom are from the South!-- who claim that we have the best healthcare system in the world. Who claim that every citizen has adequate health care. These are the voices of today's metaphorical South--it's not necessarily a region but a state of mind, a state of mind that condemns a vast portion of the nation's citizens to poor resources because of its slavish faithfulness to an ideology.

Other findings that represent this "separate but equal" myth? How about how uninsured and insured people are treated when seeking emergency care?

Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study.
The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable. ("Uninsured ER patients twice as likely to die", Associated Press, 16 Nov., 2009; posted on MSNBC.com)

Or how about this fun fact, that there are more hungry Americans today than there have been "since the government has been keeping track," as reported in The Washington Post :

The data show that dependable access to adequate food has especially deteriorated among families with children. In 2008, nearly 17 million children, or 22.5 percent, lived in households in which food at times was scarce -- 4 million children more than the year before. And the number of youngsters who sometimes were outright hungry rose from nearly 700,000 to almost 1.1 million. ("American's Economic Pains Bring Hunger Pains," Amy Goldstein, The Washington Post, 17 November 2009.

And earlier this week I read how,  in "its analysis of health care legislation,"  Goldman Sachs "concluded that, as far as the bottom line for insurance companies is concerned, the best thing to do is nothing." Do nothing, and stocks rise for stockholders in insurance companies: "The study's authors advise that if no reform is passed, earnings per share would grow an estimated ten percent from 2010 through 2019, and the value of the stock would rise an estimated 59 percent during that time period."  Hurray for rich bastard stockholders! Tough shit for all those millions of Americans who can't get adequate healthcare.

Something is seriously wrong in this country when over a million of Americans go hungry, many millions can't get adequate healthcare, many other millions can't change jobs because they are afraid of losing health care, and millions of workers do not receive pay commensurate with their skills and abilities.

Fun quiz: How many Southern politicians are supporting health care reform and sponsoring bills to decrease hunger and to provide workers with more rights? How do those numbers compare with politicians from other regions of the country?

Health Care Reform--Polling doctors

The New England Journal of Medicine has posted the results of a health care reform poll focusing on doctors' opinions: "Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion". The initial poll was sent to a random sample of 5,157 U.S. doctors (some excluded from the original list of 6,000 because of their being in training or their practicing medicine outside U.S. territories). The doctors were divided into four groups:

• primary care physicians,
• medical subspecialists, neurologists, and psychiatrists
• surgical specialists and subspecialists, and
• other specialties

The physicians were asked which of three options for expanding health care they preferred:

• "public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans;
• private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan.
• or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare."

Of the total number of doctors polled, 43.2% of doctors responded:

• 62.9% supported the public and private option
• 27.3% supported offering private options only
• 9.6% supported offering only a public option.

Interestingly, of the four categories of physicians, primary care doctors most supported the public and private option. Also,

Overall, 58.3% of respondents supported an expansion of Medicare to Americans between the ages of 55 and 64 years. This support was consistent across all four specialty groups, with proportions in favor ranging from 55.6% to 62.4%.

So, as in the wider American public, a majority of doctors favor expanding insurance coverage by providing access through both public and private options. Just saying.

Go to the article (link above) for graphs and such. For further discussion of this poll and others, go to "Listen to Your Doctors," by Harold Pollack, posted at The New Republic, 15 September 2009.

Health Care Costs

Updates below

Conservatives I know--and these are the Fox-News adherents--always bring up predictable issues when we argue politics. In a recent discussion, one family member seemed to suggest that health care costs would be significantly lowered by tort reform. It's amazing to me why this person, a blue-collar worker all his life, worries so much about medical malpractice. The class of people who seem to concern him most are folks who make five or six times what he made working in a carbon black plant. Because I love him--okay, he's my dad--I usually drop the issue when the discussion becomes too contentious or when he changes the subject to another hot-button issue, a familiar technique: chase another rabbit when the first one looks like it's going to become dinner for another fox. I try to bolster my arguments with facts, but facts just don't stick with many people; too often we ingest "facts" that are watered down--or dissolved completely--and served up with a toxic salsa of paranoia, fear, and self-refential world view.

But because I am at heart an optimist who thinks that perhaps people can change their minds when confronted with facts, carefully gathered details, and thoughtful observations, here are some facts about health care and medical malpractice, courtesy of Health Affairs: The Policy Journal of the Health Sphere (with a h/t to Matthew Yglesias and Ezra Klein for the link):

• Yes, more Americans sue their doctors than citizens in the UK and in Canada. However, "[t]wo-thirds of the U.S. claims were dropped, dismissed, or found in favor of the defendant; in one-third, plaintiffs received compensation after a settlement or judgment." Here is a table comparing the "Malpractice Claims and Payments in Four Countries, 2001."
• What about the legal costs of defending those malpractice suits?

  Legal costs are estimated to average $27,000 per claim in the United States, which adds approximately $1.4 billion in costs to the $4.4 billion paid in settlements and judgments.23 The costs of underwriting insurance against malpractice claims are estimated at an additional 12 percent, or $700 million.24 The cost of defending U.S. malpractice claims, including awards, legal costs, and underwriting costs, was an estimated $6.5 billion in 2001—0.46 percent of total health spending.

• Look at that last line in the quote above: "The cost of defending U.S. malpractice claims" is less than 1/2 of 1 percent of total health care spending in this country.

Malpractice claims do not add significantly to overall health care costs. The writers conclude that malpractice litigation is a growing problem--and it probably should be addressed. However, the claim that health care costs in this country would be significantly reduced by tort reform just does not hold up under the facts. Once again: The cost of defending malpractice claims in the United States comes out to be less than 1/2 of 1 percent of total health care spending in this country.

Can we then, please, turn to a more thoughtful, fact-supported discussion of significant ways to reduce health care costs in this country?

Source:
Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner and Hugh R. Waters. "Health Spending In The United States And The Rest Of The Industrialized World." Health Affairs, 24, no. 4 (2005): 903-914. 13 Sept. 2009. http://content.healthaffairs.org/cgi/content/full/24/4/903

Updates, more sources:For another discussion of healthcare costs and medical malpractice, see Maggie Mahar's blog, Healthbeat, and these posts: "Medical Malpractice: Fiction, Facts, and the Future; Part I and "Medical Malpractice: Fiction, Facts, and the Future; Part II.

See, also, Atul Gawande's article, "The Cost Conundrum," in The New Yorker.

Phil Gingrey Encourages Gun-totin'

When Chris Matthews asked Phil Gingrey (R-GA) if he believed that people should bring guns to town hall meetings where health care is being discussed, Gingrey replied, "I would think that they should exercise their rights under the 2nd Amendment." Gingrey essentially is encouraging people to take guns to town meetings, to meetings where folks have already been worked up into hysterical fear by lying politicians and media faces. Folks who carry guns to those meetings didn't just casually strap on their weapons when they dressed in the morning; they deliberately holstered-up when they prepared to attend a meeting in which they disagreed with the speaker. They are visually communicating the idea that if the speaker says something they don't like, they have force on their side: a deadly weapon. Even if they don't intend to use that weapon, their message is clear. And it's clear to those who might be so fearful or so mentally unstable that they indeed might use deadly force.

People like Phil Gingrey are helping to establish an atmosphere of intimidation and potential violence in public discourse. In a country where four presidents and several popular leaders have been assassinated (and others have faced would-be assassins), it seems insane to me that people are encouraging gun-toting to political rallies. That Gingrey understands the potential violence is revealed in his own words when he laughs and says he has nothing to fear because he gets standing ovations at his town hall meetings:

I've already had five town hall meetings. I have six more planned. I don't plan on wearing a bullet proof vest. In fact, I usually get standing ovations when I come into these meetings, so I have no fear.

So my question for Phil Gingrey is this: If you didn't get standing ovations at your town hall meetings and if you were, instead, faced with people shouting angrily at you, would you then fear for your life if you saw those same folks toting guns?

Rachel Maddow addressed the issue of gun-toting at political events in an with interview Joseph Petro, who served for twenty-three years as a special agent and who authored the book, Standing Next to History: An Agent's Life Inside the Secret Service. She asked Petro how the Secret Service deals with ordinary citizens, not police or security officers, who show up armed at a political rally where the president is present. She referred to an AP report about how a dozen such armed folk showed up at a recent event with President Barack Obama. "Well, that's not something the Secret Service often encounters," Petro responded. He went on to say the following:

But I think this is less a Secret Service issue and more an issue for all of us. [What] you said a few days ago that the possibility of American politics turning to violence or to terrorism at the fringes is not all that theoretical. I would argue that the vitriolic political rhetoric we're hearing, some from seemingly responsible people, is stimulating a lot of these foolish stunts, and they're not very helpful. And I think they're dangerous, actually. And I think they're dangerous for two reasons. One is: it's hard enough to protect the president. The Secret Service and the local police are being distracted from that duty, to keep our president safe. And I think the second reason may be even more serious, is the fact that it could incite or encourage one of those individuals at the fringe that you mention from doing something really dangerous and perhaps violent against the president or some other person .... Maybe the politicians should look at lowering some of the rhetoric to try to create a more positive atmosphere. (Joseph Petro, Rachel Maddow Show)

Angry mobs, inflammatory political atmosphere, and gun-toting citizens....even at open events with President Barack Obama. If anything happens to my president, people like Phil Gingrey will have a lot to answer for.

See Also:

David Sirota, "What it Means to Wear a Gun in Public," posted in Salon, 22 Aug 2009.

What's Up with This?

Watching the clips of the screaming middle-aged and old white people (people my age) at town hall meetings, I am just astonished at these folks who are being encouraged to act so stupidly and disrespectfully. Howls from mobs never convinced me of the rightness of something: in fact, just the opposite. Will there be lynch mobs next?

I went to the website of one of those organizations that is encouraging people to disrupt town hall meetings. A link on that website led to this picture of old white dudes showing some attitude: (Old white dudes wanting to "kick some liberal ass"). Well, one can find idiocy in any group or movement. But the more I see of those heckling people on television, the less I want to have to do with anyone associated with the movement, even folks who might have legitimate gripes.

At Slate, Timothy Noah lists links for keeping up with the health care debate.