[Photo by Piron Guillaume via Unsplash]

Another Kind of Recovery: Post-Maria Puerto Rico and Health Care Critical Infrastructure

I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.

Pay Now and Pay Later: What Losing CHIP means to America

 

Let me tell you something you (most probably) secretly believe, secret even from yourself,  because you are an American: poor and sick children aren’t going to amount to anything. This is true whether you’re a Republican or a Democrat. The two sides will argue it’s for completely different reasons, but the conclusion is the same. We all know that poor and sick children aren’t going to live lives of note or interest.Nevertheless, we all want to be good people, and that’s why CHIP has bipartisan support. CHIP is the Children’s Health Insurance Program, originally SCHIP, a Clinton-era expansion of social security specifically for children who were too poor to get insurance, but not able to be covered by Medicaid.

CHIP’s Congressional authorization expired in September. The program is slowly running out of money, with just under nine million children potentially facing life without access to healthcare.

Americans talk a lot about the cost of healthcare. The cost of not providing healthcare to children in a world with failing environmental protections and failing schools is impossible to calculate. It is very high, it lasts lifetimes and generations.

I am taking breaks as I write this. My neck and shoulders are making typing hard, and I am coughing up a yellow sputum, very much the same as I have been coughing up since I was a child, and I will have to see the doctor soon about it. I am an active 44-year-old woman, lifelong non-smoker, with a healthy BMI who has been receiving healthcare in Europe for the last three years. But for my life before my 40s, I was mostly an uninsured low-income American, born and raised in Los Angeles.

I was an active child and an avid dancer. When I became a teen I slowed down a bit, there were times when I would cough and cough for weeks, sometimes coughing up little solid and foul smelling lumps of material from my lungs. I threw up involuntarily a lot when I exercised. I didn’t talk about it much, there didn’t seem to be any point.

I dealt with mental health issues, which were treated by the school district. That treatment was not only substandard, but deleterious, always pushing poor children to see themselves as the source of their troubles, even at times when the troubles were obviously medical in nature. Everything was always in our heads, everything, even throwing up involuntarily and migraine headaches were something I was doing to myself.

Los Angeles in the 1980s was a time of intensive personal responsibility and very poor air quality. It was the Reagan years, and we were all self-reliant cowboys. There was always a cadre of depression-era grandparents around, calling themselves the Greatest Generation, and telling us that no matter what happened we had it easy and our complaints were just whining. The drug war was at fever pitch, and the world was made up of Good Guys and Bad Guys, and you sure as shit did not want to be one of the Bad Guys. And the air that I grew up in was so bad you could live next to a mountain range and not know it for months.

CHIP was created in 1997. The Clintons were pushing the nation towards centrism, the air in LA was getting cleaned up, and I was 24 — far past the age where it could have helped me.

I was used to making due by then anyway. Poor kids aren’t allowed to be sick, it’s a moral failing, and I’d learned to compensate and sneak to get what I could. But still, even after some kind of insurance became available, it was never because we deserved it. As children we’re burdens on the struggling poor. As students and eventual adults, we’re no better. We’re making it up, we’re lazy, we’re difficult, we cost too much and are worth far, far too little. The political debate has never been about letting us find our potential, for we have none. The debate has been about whether it’s more moral to help us or let us die quietly.

Of the 9 million kids insured on CHIP 3 million are, like me, chronically ill. Not all of them would die without medical treatment, I’m sure they could move on, scarred, struggling to survive, out of childhood and any realistic chance of being cared for. I know how it feels to be one of those children. I try to be a generous and caring person and see all of humanity as my family, but there is a part of me that really doesn’t care what those children decide to do to the rest of you. You have it coming.

Being uninsured when you’re a chronically sick child isn’t just the lack of care. It’s the constant and unrelenting sense that you are not valued, not desired by your society. It is the rejection of your ability to live itself, the feeling that you can never be more than lice on the body politic. Any self-esteem you can grab back from the way society treats you comes with a hate so dark it makes ISIS look like a summer camp.

But the truth is these children mostly won’t do anything. They’ll wander desperately through life, looking for hope, going to the ER for rescue inhalers, and trying to score many kinds of drugs to dull the pain both physical and mental. Some will escape up the socio-economic ladder, but they’ll hide where they came from because you think we’re all worthless. That’s what I did for years. Statistically, we’ll die younger than you, probably uninsured, in a hospital. The commentary on our lives won’t be: What have we done? How did we fail these fellow humans so terribly? What have we lost in creativity and talent? Instead the political story of our lives will be: This causes healthcare costs to rise.

There are sick children all over the world. There is only one country that blames them for making healthcare costs rise because we won’t give them care as children.

CHIP passed in 1997. In 1998, I got my first employer healthcare. The diagnoses started rolling in. Migraines, Irritable Bowel Syndrome, Major Depressive disorder. GERD with Barrett’s Esophagus. It wasn’t caused by weight, but because my esophagus doesn’t close. It just doesn’t. Weird, huh!? That would have been handy to know sooner.

That diagnosis wasn’t a surprise, as least not after I understood the context. I tended to throw up if I bent over too far. I was a high school gymnast, and even back then the contents of my stomach would regularly come out of my nose on the uneven parallels. My coach would send me home sometimes, but no one ever suggested I see a doctor. It was in my head, I was doing it to myself somehow, being a burden on everyone.

After the ’98 round of medical diagnoses and treatment, I came back and yelled at my mother for never believing me. I cried, I apologized later. She’d been a child herself when I was born, and she was trusting authorities who were telling her I was broken, and so was she. She apologized too, we cried and screamed and stomped off and hugged and cried some more.

This is how we cope. To try to think about this not personally, to see it as part of politics and society and an economic plan is too big and too painful to contemplate. Even now, it makes my throat tighten and a wave of nausea pass through me. It is so evil.

The diagnoses kept coming in the new century, and I became ineligible for any kind of insurance that wasn’t employer-based. EDS Hypermobility type, Cervical Dystonia, PTSD. The last one I crowdfunded to pay for, the old-fashioned way. I passed the hat amongst my friends and raised the money to pay the PTSD therapist. It was a difficult and sometimes humiliating decision, but it was the right one. I emerged from my therapy not fixed, but healing. I had tools I hadn’t had before. I went back to work. My friends had passed up dinners and presents and special things to help me get that therapy, but it worked.

GoFundMe brags about raising $5 billion in crowdfunding for medical care in America. Of course there’s more than that over the years; families that sell their houses for each other, friends that skip vacations to give the people they love a chance at life. Leonard Pitts wrote rather viciously about a conservative man trying to raise money to retain his sense of sight. This man was politically unworthy, socially irresponsible, and medically suspect; he smoked and owned a house. How could he ask for help? This is America, and even the people who believe in universal healthcare balk at care for those they deem Unworthy. We don’t even know how to imagine a system that just cares for people because they are people.

It’s been two years, and I hope that man is not blind, and I hope his loved ones haven’t suffered too much. Between people who love each other, there is no better use of these little monetary tokens to express love than paying so they may live and live well.

From an economic perspective, it’s a disaster. Every meal and trip skipped to pay for medical expenses slows down the stimulus that money could provide. The medical payments funnel money into the upper echelons of society where is slows down, sits, and ossifies. It is a disaster in every way.

But Congress is full of good people who are the somebodies who think of the children, and so CHIP is bipartisan. But it’s so expensive, and it’s hard for Congress to find the ~$14b it will cost. When it comes to funding stupid planes perfect for types of wars that don’t exist anymore, Congress has no problem finding the budget to switch from the disastrously stupid F-22 fighter (>$70b) to the next stupendously expensive F-35 fighter (>$400b for R&D). The F-22 finally saw action in two countries several years after being discontinued: against ISIS in Syria, and the Taliban in Afghanistan, both military forces more known for fighting out of the back of pick-up trucks than dogfighting with jets. More money goes to the federal employee travel budget than goes to CHIP. (According to Hatch and Coburn) More money goes to the black budget devoted to spying on everything and everyone on the net than goes to CHIP, but most of Congress probably doesn’t know how much more, it’s a secret. Congress can even find billions to make stupid fucking pennies no one wants.

A sick kid doesn’t realize the money that could help them is going to something as stupid as fighter jets no one needs or black budgets that may be straight-up illegally spying. But they do know that they’re a burden, they know that the world doesn’t want them. It makes them sad and angry, and everyone around them scrambles to find billions of dollars in spare change to take care of the people they love because Congress is so bad at finding things.

When you don’t treat the minds and bodies of children, it isn’t just those children who are affected. Something as simple as getting check-ups, interceding on basic problems early, and making mental and sexual health resources easy to access can stop a lifetime of expensive and heart-rending problems that weigh down families and communities and echo through generations.

Programs like CHIP, or universal healthcare as provided in Europe, are not about handing things to the worthless poor. They are about the epidemiology of the whole of society. Treating your neighbor’s kid now is about not having to treat them later, and not living with the consequences of their illness in your environment or tax expenditures. It is choosing to not live in a society of desperation and constant quiet anger. Programs like CHIP, and the proposal for Medicare For All, are fundamentally selfish, just a long-sighted form of selfishness that Americans are kind of bad at.

Without a program like CHIP, we are in the position of hoping parents bring their children into the ER for routine needs, jacking up our healthcare costs to ever more ridiculous heights, because the alternative is somehow much, much, worse. Untreated children don’t just infect other children with their diseases, they drag down schools, divert the resources of their families, increase crime and even lower property values. They spend so much time struggle to find their own worth, they deny the world their talents. If you don’t want to treat poor sick children, you might be better off going all Sparta on us and throwing us off cliffs than just letting us struggle along in society.

By the way, Sparta was a terrible place to live, despite what you’ve seen in 300. It was miserable and authoritarian and full of legally-required slavery and child rape and never really developed or got better. The Persian Empire, and even Athens, were better societies on every count, including military. Sparta wasn’t good at infrastructure and tended to steal what they did have. Infrastructure is what makes society nice to live in, and worth the bother. This is a fact Americans used to get; we like our highways and dams and standing armies and power lines, but apparently the water’s edge is schools, pollution, healthcare and paying taxes. Those are, for some reason, not infrastructure.

I never accepted my worthlessness, I never stopped fighting. I also never shot anyone or became a drug addict. I did a lot of sketchy things to get medical care. I’ve taken a lot of other people’s leftover drugs, and coordinated with other people to pass around drugs and advice from medical professionals who may have never known where it was going, and probably didn’t want to. And I rebelled and rejected society, sometimes violently, so that I could do worthwhile things not in keeping with my station in life.

Now I live in a place that provides me care. I haven’t had to prove my economic worth, which is good because it’s likely I never will. But now, after my expenses, I still have a little money left over. And every Saturday morning after food shopping, I go get myself a good cappuccino in the city center, and sit for a while enjoying the light, watching people go by, and little children chase dogs and birds. I’m not in paradise, there are plenty of problems here, like everywhere. But none of them are sick children hiding the yellow sputum they cough up from their parents because no one can afford a fucking inhaler.


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.


Some of my sources were:
https://www.kff.org (many articles, it’s a treasure trove of information)
8.9 million children enrolled, cost is around $14 billion. 35 million children are enrolled in CHIP or Medicaid or both.

https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-care-crisis-is-a-gold-mine-for-crowdfunding
https://www.vox.com/2017/12/3/16730496/orrin-hatch-chip-tax-bill

More information on children on Medicaid: https://www.medicaid.gov/chip/downloads/fy-2016-childrens-enrollment-report.pdf

Three Things: Non-Nuclear Proliferation

The entire social media universe has been panicking over Fearless Leader’s whacked-out statement on North Korea at the end of his bigly speech yesterday on opioids. His hyperbole was on par with his decades of hawkishness about nuclear weapons, so both unsurprising while infuriating.

What I want to know: did he say what he did to distract from the Trump-Russia investigation underway, and/or did he say what he did roughly 30 minutes before the stock market closed for somebody’s benefit? I’d love to know who might have been short selling yesterday afternoon and this morning after his recent petulant tweet hyping the stock market’s record highs. Things don’t look good today, either, in spite of calming noises from Secretary of Exxon Tillerson.

[source: Google Finance]

Whatever. Let’s look at some non-nuclear matters.

~ 3 ~

The New York Times’ op-ed, Our Broken Economy, trended yesterday morning on Twitter and is still making waves today. It’s a pretty good read with compelling charts, if not very deep. Morons across the internet have misinterpreted what it tells us, which is that income has stagnated or fallen for the majority of the U.S. while the income of the uppermost 1% to .01% has skyrocketed in less than a decade. Loss of leverage in wage negotiations due to union busting and the skyrocketing cost of secondary education have held back the lower 80%.

What has most recently ‘weaponized’ the growth of income, while destroying any illusion of the American dream? In my opinion, three things contributed the most:

— the loss of Glass-Steagall Act and the subsequent unmooring of the financial industry from risk-reducing practices which siloed capital;

Citizens United, which exacerbated the trend toward regulatory capture;

— the financial crash of 2008 and the subsequent loss of wealth for the lower 80% in terms of savings, investments, and property ownership.

But a fourth, rapidly growing factor is making difference and may also be exploding as an unintended consequence of legislation passed in 2007 requiring a larger percentage of margin on commodities trading. Algorithmic trading, conducted out of sight, skimming from every trade, on stocks rather than on commodities and at inhuman speed and scale, has increased unearned wealth but only for the very wealthiest.

Matt Bruenig says we must confront capital. Yes, but I think the appeal to do so is based in fairness, a universal ethic. A system which distorts pricing by not allocating true and full costs of the commons consumed to products and services  sold is unfair. It is not a ‘free market’ and certainly not a fair when the playing field isn’t level and not every business pays for what it consumes of the commons.

And it’s not fair when businesses deliberately suppress wages below workers’ real cost of living. That’s slavery. We don’t need charts to tell us something is wrong when the prevailing wage won’t provide meager shelter and food.

~ 2 ~

The effect of Michigan’s criminal state government on Flint doesn’t remain in Flint. More than 70 new cases of Legionnaires disease have been reported in southeastern Michigan; this time the state’s health authorities have been prompt about reporting them, unlike the shoddy reporting around cases 2-3 years ago directly related to the water in Flint.

I will bet good money many of these new cases have a link to Flint since the water system has still not been completely replaced.

Eclectablog reminds us Flint’s Water Crisis is now at Day 678 and the city has yet to be made whole though Michigan’s Gov. Rick Snyder admitted he knew that Flint’s drinking water was poisoned with lead. There are still Flint residents who cannot drink their tap water without the use of a water filter.

Given the outbreak of Legionnaires disease, I wonder how many more Michiganders may actually sicken and die because of Rick Snyder’s handling of Flint’s financial emergency and the water system.

~ 1 ~

You might already have read about the lawsuit filed against Disney for its failure to protect children’s privacy; I know Marcy tweeted about it. More than 40 applications Disney developed and sold collect information without consent about the kids using them, putting them at risk, in violation of the Children’s Online Privacy Protection Act (COPPA).

But here’s what really bugs me about this on top of the privacy problems: Disney not only had a history with violating COPPA; the government went after them in 2011 and 2014 for problems with Playdom and MarvelKids. Disney must have known competitors Mattel and VTech had problems with their network-enabled electronic toys breaching children’s privacy circa November 2015. Why did Disney fail to remediate their 43 applications more than 18 months ago when both Mattel and VTech were under fire?

Disclosure: I own Disney stock. And yes, I’m thinking shareholders should be pissed off about this failure to disclose a material risk in financial reports BEFORE parents filed a lawsuit.

~ 0 ~

That’s it for now. See you tomorrow if we haven’t already been fried to a crisp. This is an open thread – treat each other nicely.

The Jetzon’s Self Driving Auto Car Drone Aint Here Yet

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History shows again and again
How nature points out the folly of men.

Yeah, truer words never spoken. Even if in relation to Godzilla. And you can apply that to the relentlessly ballyhooed “autonomous driving automobiles”.

Seriously, this stuff is Henny Youngman type of slapsick comedy. It ain’t happening.

Okay, I am cribbing from Atrios, but dammit, what the hell do you think us conspiracy propagators are supposed to do??

I’m just saying these cars won’t ever (in our lifetimes – sure, eventually the singularity might arrive) really work as hyped and certainly don’t deserve all of the press they’re getting. I also don’t think that even if they did work they’d be a big improvement for all (some) of the reasons people think they will be, but those are more debatable issues which I rarely bother to debate because the fact is the things aren’t going to work. Okay, I’ll define “work.” Basically, you have to be able to tune out 100% over 90% of the time. I’ll even allow for a “last mile” kind of “time for you to drive” thing as long as the rest of the time you can kick back and read your book or whatever. Because if you have to pay attention but usually not doing anything, what’s the point? It’s just better cruise control. A neat feature for some, but nothing more than that.

Ya. I am sure that all of you out there driving their Tesla 3’s will squawk [oh, wait, they are not out yet!]. As I am sure all of you on the waiting list for Tesla 3’s [good luck with that!] that is already years behind technical and production capability at Tesla are oh so defensive of the giant Elon Musk dream. Surely the dream will catch up to reality, it must!

Also, the supertrains between Los Angeles and San Francisco (okay, forget the “cheaper” stuff, that was a joke!) and between New York and Washington DC are totally gonna be ready to roll after New Year’s Eve.

When the candidates talk about their totally awesome “infrastructure and jobs” proposals, maybe ask what the hell they are talking about. Because it is probably bullshit. Hold them to it.

Blumenthal, Booker Point to Unsuccessful Attack for Call for TSA in Trains

Richard Blumenthal and Cory Booker are using a thwarted attack on a train in Paris as reason to call for more TSA presence in trains.

Sens. Richard Blumenthal (D-Conn.) and Cory Booker (D-N.J.) are urging the TSA to “to implement security and safety improvements … to our country’s public transportation and passenger rail systems” that the duo said were “mandated by Congress in 2007 but still not implemented.”

“This effort comes on the heels of an attempted terrorist attack on a Paris-bound train last week in which three Americans successfully subdued the attacker,” Blumenthal’s office said in a statement previewing an appearance by the Connecticut senator at Hartford’s Union Station.

That’ll fix Amtrak’s woes: to make taking the train as humiliating and time-consuming as flying.

As it happens, DHS’ Inspector General is looking at what TSA is doing for Amtrak security right now.

Screen Shot 2015-08-25 at 3.11.18 PM

So the Senators might wait until that is done.

More interesting, however, the National Transportation Safety Board still hasn’t solved the May 12 derailment in Philadelphia that killed 8 and wounded 200. Last we heard, NTSB was asking, again, for trains (both freight and passenger) to be equipped with the kind of recording equipment that would help determine the cause of accidents.

Call me crazy, but passengers stand at least a decent chance of thwarting a gun attack on a train. Not so something wrong with the train itself.

Maybe we should work on fixing the trains themselves — and while we’re at it the infrastructure. Only then should prioritizing this kind of policing take precedence.

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