Today’s Big Lie

Topping today’s fake news is the Republican mantra that Obamacare is failing and whatever faults their replacement plan may have, nothing can save Obamacare. Cited as evidence is a decrease in the number of insurance companies serving certain states. Aside from the obvious option of the federal government providing coverage as it does in Medicare, which no one mentions, is the quiet Republican sabotage that brought about this situation.

For the last seven years since the Affordable Care Act (aka Obamacare) came into law, Republicans have not only claimed they had a better plan (when they obviously didn’t),  they have worked behind the scenes to gut key elements of the ACA. Now, disingenuously, they act as though they had nothing to do with the problems they cite as evidence of its failure.

If these were decent people, they wouldn’t be able to face themselves in the mirror. But extremists have never let a little basic human decency get in the way of their agenda.

Back in 2015, as the ACA took effect and more people were for the first time able to gain desperately needed medical care, Republicans saw that they would never be able to tear this coverage out of the hands of sick and dying people without suffering political blow-back. So with their midterm election wins giving them legislative authority, they eagerly set about gutting key elements of the ACA in a strategy meant to guarantee its failure.

The law had made provisions for early insurance company losses described in the bill as a ‘risk corridor.’ Expected to decreasingly occur as the bill’s mandatory enrollment requirements gradually built up the number of healthy insured persons, the risk corridor would eventually die off. In the interim, companies were guaranteed government reimbursement to cover such losses.

So in 2015, Senator Marco Rubio led an effort to gut the risk corridor provision. Slipped into a massive spending law late that year, their meddling cut the payments to insurance companies from $2.9 billion to around $400 million. This left insurance companies no choice but to begin withdrawing from low income/high illness states.

Now we hear Rubio, Ryan, et al crowing about how the ACA failed as if they had no hand in that failure.

It’s not that these men want to really hurt their less fortunate brothers. It’s that they worship only two gods—money and so-called conservative values.

As noted in an excellent discussion of the Republican conundrum about health care, “Republicans will not increase the role of government [in health care] for political and ideological reasons” which is why they cannot now or ever develop a plan that is better and cheaper than the ACA.

The conservative agenda is clearly stated as limited government, a healthy culture, and a strong defense. I’ll refrain from ranting about their idea of a healthy culture, code words for “White” and “Christian.”  Sticking to the topic of this post, I’ll point out that “limited government” does not include mandating health care or providing for health care in any way. Worshiping at the feet of so-called ‘free markets,’ conservatives want the sick left to die. If relatives, neighbors or churches don’t help them and they haven’t managed to make enough money to help themselves, then it’s their fault and God’s will that they suffer.

Limited government is a loosely applied term, however. If it comes to invading private homes to rout out pot smokers, conservative lawmakers are all about it. Yet if it comes to corporate polluters lying about profitable chemicals that cause birth defects and cancer, it’s hands off. This means government is limited only when it comes to policing entities that are too big for any citizen or group of citizens to fight alone and unlimited when it comes to bringing the full police powers of the state against individuals who violate conservative cultural norms.

In one tiny example of the absurdity of the health care debate currently underway is the fact that over half of Medicaid recipients are children under the age of six who have developmental disabilities. I blogged about this last week. While seeking to reduce or eliminate Medicaid that serves such children, the Republicans simultaneously are eliminating government oversight of chemical pollution from which many such disabled children arise.

If legislators had the real interests of the American people at heart, they would throw out their replacement plan and the Affordable Care Act and expand Medicare to the entire population. They would remove profiteering insurance companies from the mix. They would instill cost controls on drug companies and medical providers.

After all, if utilities are such a vital need that they deserve government price controls, surely health care is an even greater vital need.

It doesn’t take a genius to figure out that without insurance companies taking a healthy slice of every health care dollar, costs would go down. Or that there’s a screaming need for cost controls when pharmaceutical industry profits routinely equal the profits of banks at nearly 20%, some as high as 40%.

Drug companies are quick to cry how much they need all that money so they can develop new drugs. But reality is that despite investment in new drugs and abusive advertising campaigns, their profits exceed most other industries. With that kind of loose change, it’s no wonder that one of the heaviest contributors to political candidates are drug companies, coming in right after big banks and weapons manufacturers.

World’s largest pharmaceutical firms
Company Total revenue ($bn) R&D spend ($bn) Sales and marketing spend($bn) Profit ($bn) Profit margin (%)
Johnson & Johnson (US) 71.3 8.2 17.5 13.8 19
Novartis (Swiss) 58.8 9.9 14.6 9.2 16
Pfizer (US) 51.6 6.6 11.4 22.0 43
Hoffmann-La Roche (Swiss) 50.3 9.3 9.0 12.0 24
Sanofi (France) 44.4 6.3 9.1 8.5 11
Merck (US) 44.0 7.5 9.5 4.4 10
GSK (UK) 41.4 5.3 9.9 8.5 21
AstraZeneca (UK) 25.7 4.3 7.3 2.6 10
Eli Lilly (US) 23.1 5.5 5.7 4.7 20
AbbVie (US) 18.8 2.9 4.3 4.1 22
Source: GlobalData

In fact, if you take a look at the list of corporate donors to the 2016 campaign, you can pretty much determine the current legislative agenda: more military spending, Wall-Street friendly cabinet members, and no serious effort to provide for the health and well-being of the American people.

 

 

Medicaid and the Chemical Industry

Figure 4: Medicaid is the third largest domestic program in the federal budget.

As of 2002, the majority of Medicaid beneficiaries (54%) were children under the age of six years. Contrary to the popular myth of aging slackers, drug addicts, and welfare queens sucking at the national teat, this majority of Medicaid provides healthcare to children and adolescents with limitation of activity due to chronic health conditions. Their numbers quadrupled from two percent in 1960 to over eight percent in 2012.[1],[2]

This increase parallels the growth in manufacture and use of agricultural chemicals.

One of the fastest growing patient groups covered by Medicaid is children with developmental disabilities. Over the last 12 years, the prevalence of developmental disabilities (DDs) has increased 17.1%—that’s about 1.8 million more children with DDs in 2006–2008 compared to a decade earlier: autism increased 289.5% and ADHD increased 33.0%.

According to a recently released study, children with special health care needs suffer conditions that include

autism, Down syndrome, and other intellectual and developmental disabilities (I/DD); physical disabilities such as cerebral palsy, spina bifida, and muscular dystrophy; mental health needs such as depression and anxiety; and complications arising from premature birth. They may need nursing care to live safely at home with a tracheotomy or feeding tube; attendant care to develop community living skills; medical equipment and supplies; mental health counseling; and/or regular therapies to address developmental delays.[3]

One source puts the annual cost of caring for a child with severe autism at $72,000.

What is happening?

Consider the case of Eva Galindos, a twelve-year-old girl with autism. At age three, she was diagnosed by her pediatrician, but he could not answer the parents’ urgent questions about why this happened to their child. Seeking answers, the Galindos family participated in a study. At the time of Magda Galindos’ pregnancy with Eva, “the family was living in Salida, a small town in central California surrounded by fields of almonds, corn, and peaches. The Galindos could see the planted fields just down the street from their stucco house.” Magda recalled the acrid smell of chemicals sprayed on the fields, very different from the fertilizer odor.

The study revealed that during pregnancy, Magda had been exposed to chlorpyrifos.

In 2014, the first and most comprehensive look at the environmental causes of autism and developmental delay, known as the CHARGE study, found that the nearby application of agricultural pesticides greatly increases the risk of autism.[4] Women who lived less than a mile from fields where chlorpyrifos was sprayed during their second trimesters of pregnancy, as Magda did, had their chances of giving birth to an autistic child more than triple. And it was just one of dozens of recent studies that have linked even small amounts of fetal chlorpyrifos exposure to neurodevelopmental problems, including ADHD, intelligence deficits, and learning difficulties.[5]

The American use of chemicals to eradicate insects both in homes and crops dates back to lead arsenate in 1892, but as early as 900 AD, poisonous arsenic sulfides were used in China.

The search for a substitute [to lead arsenate] commenced in 1919, when it was found that its residues remain in the products despite washing their surfaces. Alternatives were found to be less effective or more toxic to plants and animals, until 1947 when DDT was found. The use of lead arsenate in the US continued until the mid-1960s. It was officially banned as an insecticide on August 1, 1988.[6]

Total global pesticide production and global pesticide imports (1940s-2000) – Tillman et al. (2002)0

DDT (Dichlorodiphenyltrichloroethane) quickly took the place of lead arsenate, even though research as early the 1940s had shown its harmful effects. After Rachel Carson’s expose Silent Spring pointed the finger at DDT for poisoning wildlife and the environment and endangering public health, the chemical was targeted by a growing anti-chemical movement. In 1967, a group of scientists and lawyers founded the Environmental Defense Fund with the specific goal of banning DDT. Despite continuing efforts, DDT is still produced for ‘vector control’ and for agricultural purposes in India, North Korea, and possibly other locations. At least three to four thousand tons of the chemical is produced annually.

Like many chemicals, DDT persists in the environment as well as in tissue of all life forms. Its biological half-life in soil is up to thirty years. Organisms at the top of the food chain suffer greater exposure as the chemical and its major metabolites of DDE and DDD accumulate in animals and plants which are then consumed by other animals.[7] Among its effects, DDT is an endocrine disruptor which can cause cancerous tumors, birth defects, and other developmental disorders.

Specifically, “endocrine disruptors may be associated with the development of learning disabilities, severe attention deficit disorder, cognitive and brain development problems; deformations of the body (including limbs); breast cancer, prostate cancer, thyroid and other cancers; sexual development problems such as feminizing of males or masculinizing effects on females, etc.”[8]

With the ban on DDT, farmers and other chemical consumers turned to chlorpyrifos.

Estimated worldwide annual sales of pesticides 1960 to 1999 in billions of dollars (Herbicides, Insecticides, Fungicides, and others) – Agrios (2005)0Despite the overwhelming evidence that chemicals lead to ever-increasing negative health effects, chemical companies are willing to spend whatever it takes to discredit the evidence in efforts to delay any meaningful regulation of those chemicals. In a lengthy article published January 14, 2017, in The Intercept, an online newsletter, author Sharon Lerner details the efforts of Dow Chemical to protect its lucrative products from EPA regulation.[9] It’s a staggering indictment not only of Dow’s strong-arm tactics but also of the willingness of legislators and government agencies to ignore their duties to American citizens.

Exposure to chemicals which are wreaking havoc on the nation’s children is suffered disproportionately by the poor. Agricultural workers live near fields where chemical sprays drift in through open windows. Inner-city poor live in housing that is routinely sprayed with pesticides despite the presence of children and pregnant women. Long-term exposure plus ingesting food laden with pesticides means that while autism rates among children across the U. S. population is one in 68, for women in poor neighborhoods or near commercial agriculture, the rate of impaired children is one in 21.

Parents such as Magda Galindos can’t afford to move away from the fields where chemicals are sprayed. She also can’t afford to buy organic food, which is often twice as expensive. Her household income and the medical needs of her daughter Eva qualify for state and federal assistance.

Which brings us back to Medicaid.

Figure 1: Type of health insurance among children with special health care needs

Despite compelling and well-documented scientific studies showing the strong link between certain chemicals and a slate of neurodevelopmental disabilities including autism, the EPA has for decades postponed any meaningful action to more strictly regulate (or ban) the culprits. In a recent publication, scientists stated:[10]

In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants—manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered.

This is the tip of a massive iceberg. As reported in a 2016 PBS report on “Science Friday,”

There are more than 80,000 chemicals registered for use today, many of which haven’t been studied for safety by any government agency. But that’s about to change…somewhat. President Obama today signed into law the Frank R. Lautenberg Chemical Safety for the 21st Century Act, named after the late senator who introduced a version of the bill in 2013. This marks the first overhaul in 40 years to the Toxic Substances Control Act of 1976, the nation’s main law governing toxic chemicals.

Absurdly, the law only requires the EPA to test twenty chemicals at a time and each one has a seven-year test deadline before a five-year period during which industry is supposed to comply with any new regulation. At that rate, it will take over a century for all the current chemicals to be tested, all while about 20,000 new chemicals hit the market each year.

New EPA head Scott Pruitt, who voted for the Lautenberg bill, has stated that the law “guarantees protection of the most vulnerable by placing emphasis on the effects of exposure to chemicals on infants, children, pregnant women, workers and the elderly.”[11]

This should be a hopeful note, but even in a best-case scenario where President Trump’s EPA enacts swift meaningful restrictions on chlorpyrifos and other chemicals saturating our soil, air, and waterways, the incidence of fetal exposure and the resultant impairment of so many of our nation’s young will not abate any time soon. These chemicals wash down our rivers and linger in oceans where we harvest seafood. They soak into the walls and floors of our homes, survive in cropland that produces our fruits and vegetables, and become even more concentrated in livestock feeding on those plants.

Since developmentally disabled children form over half the nation’s Medicaid caseload at an estimated cost of about $300 billion (2015), legislators looking to reduce Medicaid expenditures should turn first to the nation’s agrochemical industries. In 2015, for example, Dow AgroSciences reported a full year profit of $962 million. In 2016, even after some losses, the company still enjoyed an $859 million profit.  Monsanto and DuPont reported similar numbers.

Why not impose a 50% tax on such profits? This would yield a modest $1.5 billion toward the Medicaid costs resulting (in part) from their products and serve as a powerful incentive to ensure such products are safe before they’re marketed.

~~~

[1] https://www.nap.edu/read/10537/chapter/4#50

[2] http://www.deseretnews.com/article/865609389/10-common-disabilities-American-children-have.html

[3] http://kff.org/medicaid/issue-brief/medicaid-and-children-with-special-health-care-needs/

[4] https://ehp.niehs.nih.gov/wp-content/uploads/122/10/ehp.1307044.alt.pdf

[5] https://theintercept.com/2017/01/14/dow-chemical-wants-farmers-to-keep-using-a-pesticide-linked-to-autism-and-adhd/

[6] https://en.wikipedia.org/wiki/Lead_hydrogen_arsenate

[7] https://en.wikipedia.org/wiki/Dichlorodiphenyltrichloroethane

[8] https://en.wikipedia.org/wiki/Endocrine_disruptor

[9] See Footnote 5 above

[10] http://thelancet.com/journals/laneur/article/PIIS1474-4422(13)70278-3/abstract

[11] https://www.bna.com/trumps-pick-lead-n73014449061/