The Health of Arkansas

Yesterday, Arkansas Governor Asa Hutchinson beamed as he announced a drop in the number of state residents receiving health insurance through Medicaid.

Today there are fewer Arkansans on Medicaid than when I took office in January 2015, while our state’s population continues to increase. In the last year alone, the rolls have decreased by 117,000 (10%). Because of the reduction in Medicaid enrollment, DHS is now projecting that it will spend roughly half a billion dollars LESS (taxpayer money) on Medicaid in SFY’19 than anticipated in the biennial budget.

Perhaps to some, this is great news. We’re saving money! Woopee! All those freeloaders out there sucking on the government teat are now out in the cold where they belong.

But wait. We’re talking about medical care here, people who are sick or disabled or otherwise unable to obtain health care because they can’t afford to buy insurance. By his own numbers, our governor just celebrated the fact that 117,000 people of Arkansas are no longer able to obtain health care.

Now maybe that’s not exactly true. Maybe some of those folks got well from cancer or liver failure or whatever caused them to qualify for Medicaid. Maybe some of them got great jobs and have insurance now through their employers. Maybe some of them became the sudden beneficiary of their Aunt Tilley’s fabulous estate. Or won the lottery.

Or maybe not.

The reduction might have something to do with the federal government’s deep cut in advertising about how to sign up for health care. Or the federal government’s reduction in the sign-up time period. Or the state’s questionable method of deciding who to remove from the program—the electronic data system currently in use automatically deletes anyone who doesn’t respond to a request for income information. As in, one lost piece of mail. One overlooked letter amid a pile of unpaid bills. One person’s inability to comprehend what is being asked of him as he undergoes chemotherapy.

Last year, the governor looked for all the ways he could reduce the amount of money Arkansas pays for health coverage. As reported in the Arkansas Times in the May 2, 2017, edition, the governor’s goal was to lower the income limits.

As part of the Affordable Care Act, Arkansas expanded Medicaid via a unique policy known as the private option, which uses Medicaid funds to purchase private health insurance plans for low-income Arkansans. The concept was later re-branded as “Arkansas Works” by the governor. The expansion covers adults who make less than 138 percent of the federal poverty level — that’s $16,400 for an individual or $33,600 for a family of four.

The governor’s proposed changes to eligibility remove anyone who makes more than the federal poverty line (that’s $11,880 for an individual or $24,300 for a family of four) from the Arkansas Works program. Only people who make less than the poverty line would qualify going forward. That includes not just the beneficiaries who are covered by private option plans but also those who were deemed medically frail under Arkansas Works (the 10 percent of beneficiaries with the greatest medical needs, who are currently routed to the traditional Medicaid program rather than private option plans).[1]

So just to be clear, any single person earning more than $990 per month or head of household with spouse and two children earning more than $506 per person would no longer qualify for government assistance in gaining health insurance. This hasn’t yet been implemented because the federal government has not yet responded to Gov. Hutchinson’s request for the change. But really, governor?

Even the 138% of poverty level leaves lots of people without access to care. In 2013, 21% of Arkansas adults went without health care because of the cost. Do bragging rights automatically come to Gov. Hutchinson because that number dropped to 15% by 2016? What is 15% anyway, besides a seemingly small number?

The state’s estimated population is 3,004,279. Take away 23.6% of that for people below 18 years of age (non-adults). That leaves 2,295,270 adults. Fifteen percent of that equals 344,290 adults in this state without health care. That’s a lot of friends and neighbors.

In a November 2017 report, the Arkansas Times explained another proposed part of Hutchinson’s Medicaid ‘reform.’

Those between the ages of 18-49 would be required to work 80 hours per month; if they were not working, they would have to participate in job training programs or certain approved volunteer activities. Beneficiaries must be in compliance for nine months out of the year or they would be removed from the program for the duration of the year. Beneficiaries 50 or older would not be subject to the work requirement; exemptions would be available for others who met certain criteria, such as caring for dependent children.[2]

Studies have examined the realities of financial need in the United States and have come up with a set of numbers that reveal just exactly how morally bankrupt is the governor’s reasoning (along with the increasingly evident moral bankruptcy of the entire Republican party).

For a family with two adults and two children, the average cost of living in the United States hovered around $65,000 per year in 2015. The figure excludes discretionary spending on nonessential goods and services, such as leisure, entertainment and luxury items.[3]

To be fair, another source gathering economic data specific to locations gives credit to a lower-than-average cost of living in Arkansas. For a family of four in Little Rock, the average monthly cost is $2876.46. For an individual not paying rent, the monthly cost is estimated at $819.24.[4] However, in the governor’s proposed lower income limit, in neither case is there any ‘leftover’ income adequate to buy health insurance. In case you didn’t notice, the estimated average cost of living for Little Rock is $400 MORE than the cutoff income level for those seeking Medicaid coverage under the governor’s preferred income guidelines.

It’s no secret that Arkansas is one of the unhealthiest states in the nation. We rank 48th. We have higher rates of diabetes, cardiovascular disease, cancer, and general poor health both physically and mentally. In particular, according to a January 1, 2018, report published in the Arkansas Democrat Gazette, from 2013 to 2016, “the percentage [of Arkansans] who reported that their mental health had not been good in 14 of the past 30 days rose from 14.7 to 16.4 [percent.]”

The report I’d like to hear from Gov. Hutchinson would show data about the number of marginally-employed people who have gained better-paying jobs. It would show how many of those suffering mental or physical illness have gained any improvement in their health. I’d like to hear that Arkansas is spending more, not less, on health care not only in direct services but in education—I’m talking about nutrition education, cooking lessons, and everything else humanly possible to teach people how to eat healthy—which, tragically, probably doesn’t include toaster pastries for breakfast.

I’d like to hear the governor talk about how vouchers and private schools won’t be allowed to siphon money away from public schools. I’d like to hear his analysis of how inadequate education leads to poor self-esteem and how a positive self-image is key to a person’s ability to pay attention to diet and exercise. I’d like to hear him talk about how a person who doesn’t feel good either mentally or physically is a prime candidate for substance abuse.

I’d like to hear the governor discuss the abysmal status of substance abuse treatment options in the state, a crushing health care issue that gets short shrift in public discussion. More on that in another blog.

The governor needs to say that fundamentals like good health and proper education make all the difference in how a person participates as a vital member of society or how he/she gains and maintains sufficient employment. He needs to say, again and again, that a person who is well, who has learned how to reason, and who recognizes the responsibility of self-care and citizenship is the kind of person we absolutely must gain a lot more of in this state.

At any cost.

~~~

[1] https://www.arktimes.com/ArkansasBlog/archives/2017/05/02/governors-proposed-cuts-to-medicaid-eligibility-will-increase-costs-for-working-poor-likely-to-increase-uninsured-rate

[2] https://www.arktimes.com/arkansas/state-still-awaiting-federal-approval-on-medicaid-expansion-changes/Content?oid=11322951

[3] Cost of Living https://www.investopedia.com/terms/c/cost-of-living.asp#ixzz53JNGsNLI

[4] https://www.numbeo.com/cost-of-living/in/Little-Rock

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America’s New Greatness

It’s been a crushing year. One after another, hard-won social advancements have been blocked or dismantled in the rush to “Make American Great Again.” But what does that even mean?

Exactly when was America greater? When everyone used outdoor toilets? When women couldn’t work outside the home? When skin color decided who could marry whom, or vote, or eat at a lunch counter?

Is ‘great again’ a worthy goal, the best we should expect? Is the conservative mantra right, that free enterprise and individual liberty “under limited government” was and forever will be the pinnacle of human achievement? If only we could rid ourselves of this ‘big government’ and free ourselves of onerous taxation, would the U.S. of A. become the shining star of the days of yore?

No, no, and no.

Let me explain. At the time of the Founding Fathers, ‘free enterprise’ applied to white male landowners. The constitution ignored the rights of women and non-landowners. Voting rights for Natives or slaves never entered the discussion. The founders conceived of a nation of educated, well-to-do white men who used women, natives, and slaves to meet self-serving goals in creating heirs, seizing ever greater slabs of the continent, and forcing labor from non-whites in order to sustain and increase their wealth.

They weren’t evil men. That’s just how things had always been. No wonder certain white males today would see those as the glory days.

But there’s no lack of free enterprise. Men and women of any class or color routinely open their own businesses. Three out of ten workers in the U. S. are self-employed or are hired by self-employed persons.[1] The ‘small business’ community provides the majority of American jobs.

…large businesses only employ about 38 percent of the private sector workforce while small businesses employ 53 percent of the workforce. In fact, over 99 percent of employing organizations are small businesses and more than 95 percent of these businesses have fewer than 10 employees. The reality is that most Americans are employed by a very small business that has little in common with the tiny sliver of the business demographic represented by corporate America.[2]

The complaint of conservatives is that free enterprise is hindered by big government. They rail against requirements that employers pay into insurance policies that provide medical care for workers injured on the job or that provide health care that meets the employees’ needs. Employers also must pay into Social Security and Medicare funds on a 50-50 basis with the employee’s withheld funds. Employers are required to deduct the appropriate amount of state and federal income tax from employee wages and to deposit this tax into government accounts. Employers also must provide a wage statement at the end of each year (W-2, 1099, etc.).

These requirements annoy the hell out of employers. When I operated my own café, I spent hours working on payroll. I resented spending money on workman’s compensation insurance – I never had an injured employee and all that I paid was money down a hole. But I understood the reason for it. If an employee had become injured, should I expect the government to pay for medical care? Should I personally pay for it? Should the employee be abandoned to pay himself?

These are old problems solved incrementally over a long period of American history back when a majority of legislators worked for the people instead of themselves. We stopped sending disabled or aged persons to poor farms where a pitiful stipend from the state supported them along with the random generosity of wealthy donors who might drop a few crumbs from their tables. We stopped allowing employees to be injured or killed in unsafe workplaces. We required people and their employers to set aside funds for retirement.

Like the Affordable Care Act, social support systems developed by our elected representatives to better provide for the ‘general welfare’ are an evolved safety net for all of us. The simplistic idea that these systems should be dismantled in pursuit of some long-vanished ideal of “free enterprise” fails to recognize all the reasons these systems came into being in the first place. We need them. They serve an important purpose.

‘Individual liberty’ is another often-touted phrase by deconstructionist conservatives. What that concept meant to the founders no longer applies in our current reality. The founders lived on the edge of an unexplored country with such a vast reserve of lands that no one could imagine a time when there weren’t new horizons where young men could ‘go West’ to make their fortunes. Individual liberty was possible only because men gained forty acres or more by simply staking a claim or, in many cases, serving in the military after which they received land grants.[3]

What land is free now? None.

What we took from the Natives was a virgin continent full of natural resources. The lands of Europe had been exploited for over two thousand years and here was a whole new start. Individually and collectively, we harvested those resources while patting ourselves on the back about how smart and industrious we were in building a fabulous new nation. We never considered that sooner or later, the last farmland would be plowed, the last gold nugget would be found, and we would run smack up against the end of the bonanza. We did the same thing here that our forefathers had done in Europe.

Conservatives, enraptured with these myths of a glorious past, believe we can return to times when anyone who wanted to work hard could simply plow his way to success with a mule and a compliant wife. Women, keen for their own ‘individual liberty,’ aren’t so compliant anymore. Farming is no longer a viable path to sufficient livelihood.

Obviously our living standards have changed. No more outdoor toilets or working the fields from dawn to dusk. We’re dependent on electricity and modern medical care and automobiles, all things that as recently as a hundred years ago simply did not factor into the picture for a majority of Americans.

Ever in pursuit of their bankrupt myth, the conservatives’ last gasp is the current grab of political power, attained by selling the myth to those who don’t understand. The conservatives are busy ending food and medical care for the aged, the homeless, and other needy segments of the population. The entire social net crafted over decades is being dismantled in a futile grab for a long-lost past.

The descendants of European colonialism want the glory back. They don’t agree that taking from the rich and giving to the poor is the right approach for modern societies. European nations have already grasped this concept. America today and in the future can never be the America of 1800 or 1900 or even 1950.

Making profit off of sick people or school children is immoral. Just as government regulates utilities, so it must regulate other services required by everyone, including health care and the internet. This is not an appropriate arena for capitalism. Government, not profit-driven capitalists, serves as the most efficient provider for the common welfare –healthcare, affordable housing, education, public transportation, infrastructure like bridges and railways, and a vast network of social services.

Reducing the tax burden for the wealthiest among us accomplishes nothing but the impoverishment of our entire nation. The current imbalance of wealth is clear evidence that the rich should be taxed even more. Expanded social programs should ensure that those at the lowest income levels are brought into counseling, health care, education, and training programs in order to improve their economic status.

We’re a largely urban, multicultural society now, completely different from what the Founding Fathers knew. Just as the founders were right to declare the rights of personal liberty, so were progressives right to end discrimination against minorities, women, and the handicapped and to provide mechanisms by which the damages of such long-term discrimination could be healed. It’s the progressives who have understood that the safety net must be available equally from state to state, a service that only the federal government can ensure.

The personal bankruptcy of a small number of men like Donald Trump and Steve Bannon cannot be allowed to dictate the future of our country. Such men long for a culture where white maleness guarantees ascendancy. Without a white male-dominated social structure, they cannot gain the power they so desperately crave. These are weak men dependent on the subjugation of others for emotional and economic support. They will die off just as the Neanderthal died off.

It’s called failure to evolve.

Here’s a toast to 2018 and the continuing evolution of our great nation.

 

~~~

 

[1] http://www.pewsocialtrends.org/2015/10/22/three-in-ten-u-s-jobs-are-held-by-the-self-employed-and-the-workers-they-hire/

[2] https://www.huffingtonpost.com/kristie-arslan/five-big-myths-about-amer_b_866118.html

[3] Bounties of up to 1,100 acres were granted for Revolutionary War service between 1775 and 1783 and up to 320 acres for the War of 1812 through 1815. Additional free lands went to men fighting in the Mexican War 1846-1848 and in Indian Wars from the 1780s through the 1890s. While outright land grants ended in 1855, Union soldiers who fought in the Civil War received homestead rights along with others meeting certain criteria. Much more on land grants and homestead rights at Wikipedia.

 

The Critical Need for Dental Care

A friend of mine I’ll call Tom is a Vietnam vet. His back is so wrecked he has to take a pain pill before he gets out of bed. He lies there in pain waiting for the drug to kick in. Then he stands in a hot shower until the muscles relax enough for him to walk. For years, he did this each morning before packing up his tools and heading out to work. Now he can’t work.

Jumping out of helicopters into the jungle with a heavy pack did this to Tom’s back. He was a skinny little kid to start with. But his back is not why Tom is in crisis now.

For years, Tom had bad teeth. He finally managed to save up enough to get them pulled but it took more months to save sufficient money to buy dentures. Tom’s down to skin and bones because he couldn’t bear the pain of chewing.

Two years ago, the Veterans Administration Hospital discovered Tom has COPD. Since then, he’s been on oxygen plus inhalers and struggles for each breath. The damage from a lifetime of work as a painting contractor can’t be undone, all those jobs of clearing away old asbestos insulation and sheetrock dust without wearing proper respiration masks. It wasn’t just a matter of not having money for a mask or not wanting the hindrance of something that restricts vision and mobility, although both those things applied. It was even more a matter of not realizing what atomized paint and volatile chemicals could do inside his body.

Now the VA has found that he has a faulty heart valve. Fixing it will be tricky because the vessel adjacent to the faulty valve has an ominous bulge, otherwise known as an aneurysm.

Inhaled particulate aside, how much of Tom’s predicament can be attributed to years of living with bad teeth? Plenty. As it turns out, respiratory disease can be a direct result of poor dental health:

Bacteria from periodontal disease can travel through the bloodstream to the lungs where it can aggravate respiratory systems, especially in patients who already have respiratory problems. A study published in the Journal of Periodontology uncovered a link between gum disease and an increased risk of pneumonia and acute bronchitis.

Or how about dementia, a condition increasingly suspect in Tom’s case?

Tooth loss due to poor dental health is also a risk factor for memory loss and early stage Alzheimer’s disease. One study, published in Behavioral and Brain Functions, found that infections in the gums release inflammatory substances which in turn increase brain inflammation that can cause neuronal (brain cell) death.

The U. S. Surgeon General in 2000 stated: “…oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.” And that’s the tip of an iceberg of ailments including erectile dysfunction and even cancer.

… a study published in Immunity earlier this year also hinted that a bacterium implicated in gum disease, Fusobacterium nucleatum, can reduce the ability of the immune system to recognize and destroy cancer cells.

Veterans theoretically get all their health care needs met. But there’s no veterans’ coverage for dental. Medicare and Medicaid also don’t cover oral health. It’s as if our mouths don’t matter.

In the seventeen years since the surgeon general issued his report clearly outlining the devastating systemic harm caused by poor dental health, nothing has been done to expand dental care to those who need it. Awful images jokingly posted on social media about “Walmartians” invariably include people with horribly decayed teeth. Or no teeth at all.

A 2016 Alternet article, “Why in Heaven’s Name Aren’t Teeth Considered Part of our Health?,” reveals that over 106 million Americans have no dental coverage and that one in four has untreated dental decay.

The social cost is as high or higher than the medical cost. We are immediately disgusted by those with visibly bad teeth. People with rotted teeth have a hard time finding employment and are shunned in social circles. Bad teeth are a marker of the lower classes. As noted by Susan Sered, author of the Alternet article,

The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.

Even before the surgeon general issued his report, common sense told us that decaying teeth sent infection into our bloodstream and compromised our immune system. A steady drip of pus into the body’s blood and lymph systems overwhelms not only the body’s ability to resist infection but also damages otherwise healthy tissue in vital organs.

No wonder Tom has a diseased heart, diseased lungs, and a poor prognosis. He lived with rotten teeth for years. Nobody in the VA stepped up and advised him about this problem. It’s not in their job description.

Likewise, as noted in the Alternet article, the lack of dental coverage in Medicare and Medicaid leaves out large segments of the population most in need of care. It’s estimated that 70% of seniors lack dental care precisely at a time in life when dental problems are most likely to appear.

Except for the random ‘free’ clinic for those qualified (and those lucky enough to live near one and who find their way through the tedious process of discovering where and how such clinics function), those without expensive dental insurance are on their own in addressing this vital and overlooked medical need. Many, like Tom, go without attention to their dental health until they can literally pluck teeth out of their inflamed gums like so many ripe plums.

There’s no excuse for this country to continue to ignore dental health. As one of the fundamental causes underlying so many severe medical conditions, dental disease should rank near the top of conditions covered fully by all insurance programs. In addressing oral health, insurance companies could help prevent or reduce many long-term ailments that cost untold millions and generate incalculable pain and suffering.

There’s no help for Tom. Even after saving enough of his meager pension to purchase dentures, he has continued to decline. It takes all his effort to simply walk across the room. While the VA gropes with surgical options for his heart and keeps him supplied with pain meds and oxygen, Tom lives at home alone without access to Meals on Wheels or other resources that could bring him at least one hot meal a day. He lies in bed watching television, dependent on liquid nutrition drinks and microwaved meals for food. His family chips in when they can, but that’s not a daily meal.

Tom insists he’s not interested in assisted living in the veterans’ home because he’s heard bad things about how people there are treated. He’s also not close enough to death to qualify for hospice. He’s stubborn and proud and thinks he might be able to work again.

This travesty stems largely from the failure of our nation to recognize the insidious creeping harm of poor dental health or the true preventative nature of proper dental care. It’s hardly news that there’s little to no respect for prevention—the lack of understanding about nutrition and poor food preparation skills are a big part of the nation’s mushrooming health care costs, driven in part by the rise of fast food and the barrage of advertisements for unhealthy foods.

“We are what we eat” has never been a more important thought. Especially when we consume bacteria from rotting teeth.

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/