Many people living in the 'Diabetes Belt' are plagued with medical debt
text.npr.org
text.npr.org
https://features.propublica.org/diabetes-amputations/black-a...
Another link if you are skeptical there is a racial issue: page 12 of https://data.dartmouthatlas.org/downloads/reports/Diabetes_r.... Among Medicare beneficiaries with diabetes, black people are still way more likely to have a leg amputated.
A doctor who grew up in the heyday of eugenics could still be practicing medicine into the 70s. We literally gave black people syphilis behind their backs, and now we wonder why they are vaccine shy. We spent over two centuries with at least half the country openly espousing as policy that black people were a lesser race and the south screamed from the hills that it was God's intention that white people control black people.
The children of these people were still politically relevant recently.
OTOH, if the "unnecessary" there just means "not satisfying the platonically correct cost/benefit analysis", and there's still some net benefit to the patient, and the government program didn't ask the dentists to use such CBA, then I wouldn't consider that abusive.
(I can imagine Frontline being equally outraged at dentists denying government-subsidized dental care on grounds of failing the platonic CBA too...)
A society cannot be run on expecting people to resist the powerful incentives set up for them.
You can see this effect in every aspect of government operations.
I haven't seen this episode and so don't know what qualifies as "major dental work." However, as someone who has had government dental insurance, I wanted to chime in with a possibly irrelevant anecdote.
This dental insurance covered few things, one of which was having teeth pulled. When I was having major pain and other issues with a molar, the only covered treatment was to have the tooth pulled. Anything else would have to be paid 100% out of my own pocket. So the only viable option for most people in my situation would have been to have the tooth pulled, which certainly seems like "unnecessary major dental work on poor people", through no fault of the dentist.
Frontline Dollars and Dentists season 2012 episode 13
and see for yourself.
Who benefits in these 10 states that have still failed to expand Medicaid? What is the upside, to either the populations of these states or the politicians who run these states and make those decisions? Because the downsides are obvious and seem to directly harm a lot of people.
The people who run on this as a component of their platform.
I don’t know about gerrymandering. In the most recent Texas house election (Texas being one of the major ACA holdouts) republicans won a 12-point seat margin with a 7-point popular vote margin. The governor, which is elected by statewide popular vote, won by an 11 point margin. In the 2022 Tennessee House elections, meanwhile, republicans won 75% of seats with 70% of the popular vote, which is as lopsided as some heavily skewed states like California and New York. (At a certain point, winning more seats than popular votes isn’t due to gerrymandering but just normal population distribution effects.)
I suspect the real issue is that, in red states, the democrats tend to be low propensity and younger voters. In Tennessee, Trump beat Biden by 24 points. But the GOP beat democrats by almost 50 points in the popular vote in the 2022 Tennessee House elections.
I find it perfectly fine to earn 8 time as much as my artist best friend does as long as we are in a market-based system. What bothers me is that I do not pay enough taxes, and could pay even less by declaring my donations.
Segregationists closed public pools and defunded public schools, rather than share with black people. Hurting poor whites as much as poor blacks.
Of course they'd also gut the social safety net.
But that's not the reason I usually see expressed. It usually comes expressed like this:
“The health care industrial complex made up of hospitals, medical device manufacturers and pharmaceutical companies are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging.”
“We must reform Medicaid and double down on pursuing common-sense policy reforms to unleash innovation and increase access that can all lead to lowering costs,” Zander said.
https://www.jacksonville.com/story/news/politics/state/2020/...
I'm afraid I don't entirely understand what that means.
https://www.bostonreview.net/articles/jonathan-m-metzl-dying...
> Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act and the related expansion of Medicaid coverage. Had Trevor lived a thirty-nine-minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky adopted the ACA and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms.
> Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”
> At the most basic level, Trevor died of the toxic effects of liver damage caused by hepatitis C. Yet Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma that, as he made abundantly clear, aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and nonwhite others. Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.
(I am not endorsing these policies, just explaining some of the reasoning behind them.)
>>Federal government only puts in part of the funding
Via the issuance of debt.
Also, even if it’s true that blue states may bear the brunt of taxes, inflation hits everyone equally.
Things like federal mortgage subsidies probably cause more inflation in less affluent regions where housing is less competitive than they do in affluent regions (where the competitors for housing aren't particularly pricing their offers to the largest payment they can afford).
No happy ending. One of the brothers died just before I moved away, of an obesity and diabetes related illness.
Interesting tale. Mostly a question of junk food and portion sizes.
I live in one of these Diabetes Belt counties. I'd like to add another aspect to the "cultural problem", which is that the median person here eats absolutely horrendously and doesn't exercise at all.
> we'd rather give you bad food
I'd like to believe that people have the agency of choosing what they eat.
They do, but they need to know how to eat a healthy diet. I don't know about you, but I've never once seen a commercial about eating whole foods with vegetables. I am however bombarded on a daily basis with adds for fried chicken and burgers. Some people just don't have the access and education.
- Eating a varied healthy diet is a lot more expensive than eating a varied unhealthy diet (if you can eat kale, rice, and beans all day then good for you but most can't)
- We're creatures of habit, if we grow up eating unhealthy we are more likely to continue to as adults. Eating healthy for most people requires cooking for yourself, many never learn this skill or see their parents putting daily effort into meals when they are children.
- Lack of public education around the topic, lack funding for free healthy lunches for school children
I had a friend when I was in school who had the most messed up disgusting teeth I'd ever seen. He had dental insurance, a decent job, decent pay. Turns out he never grew up learning that you're supposed to brush your teeth regularly so he just never made a habit out of it.
Eating healthy is not more expensive. Potatoes, rice, beans, carrots, etc. are all inexpensive. I was in the store today, and a can of Nalley chili with meat and beans is $2.19. It's more than enough for a meal.
I also buy whatever's on sale, including the day older steak which is around half off. A half gallon of milk is $1.99.
Or are they eating shit, because eating shit is the path of least resistance, and median person travels down the path of least resistance, and if you set up your society such that the path of least resistance results in horrible outcomes, you're going to get horrible outcomes?
Sometimes not:
That effects healthcare profits though, so incentives aren't exactly aligned.
The book points out both genuinely bad actors (e.g. companies that pay kickbacks to medical staff for pushing patients into unnecessary helicopter rides) and also problems that happen due to the design of the system, despite the best intentions of individual actors.
[0] https://www.amazon.com/Price-We-Pay-American-Care/dp/1635574...