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

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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

[graphic: Hurricane Maria, 20SEP2017, via NASA GOES]

Three Things: Was Slow Response to Hurricane Maria Deliberate?

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NB: First, a call to action at the bottom — come back and read this after you’ve read the call. Don’t let last night’s tragedy swamp effective action; Congress continues its work no matter what tragedies befall the rest of us.

Having worked in both site and systems administration with responsibility for business continuity, I can’t help wonder why the post-hurricane response to Puerto Rico’s devastation was so bad — so bad it looks deliberate.

~ 3 ~

As an administrator, I looked ahead a year or more to mitigate both costs and risks to my employer and stakeholders. Budget roof repairs expenses for this year, budget roof replacement capital next year; replace the analog alarm system with digital system, budgeted last year. It’s pretty dull stuff but all it takes is one break-in, or one bad storm, and the losses from damage and business disruption could easily surpass capital and expense budgets combined.

But what of states and territories? State/territory, local and federal governments do what they can within the plodding framework of legislation, regulation, and budgetary requirements and restraints. Sometimes things just can’t be addressed preemptively, like major storms. Fortunately, there’s adequate monitoring to help predict when they will hit and what the likely impact will be, and there’s the awesome power of the largest military in the world to deploy as needed.

We have monitoring like NASA’s GOES satellite imaging, which visually tracked Hurricane Maria from birth to death as a weakened tropical storm.

And NOAA’s Hurricane Center, which makes accurate assessments of timing and strength of a storm’s impact.

Not to mention whatever additional monitoring and reporting the Defense Department had to offer.

We know with certainty the U.S. government was aware from NASA and NOAA reporting that Maria was a Category 5 storm as it approached Puerto Rico. The National Hurricane Center issued 17 reports over four days warning of the storm’s size, strength, and timing of landfall. I can’t imagine government agencies offering any less now than they did under the last administration.

And yet the Trump White House did virtually nothing to prepare for storm response.

You’d think that a guy with experience managing real estate and businesses for continuity would have utilized these best-on-earth notifications to mitigate and recover injury and damage to Puerto Rican Americans and their property. But for some reason this same guy now occupying the White House spent his time harping about NFL players and golfing instead.

~ 2 ~

This tweet thread crossed my timeline last week; I wondered who leaked and why there was so little followup, because the claim it makes is quite serious. (Click to expand the thread in Twitter.)

If this claim is accurate, the Trump White House sat on its tiny mittens and did absolutely nothing to approve a response to a major catastrophe which was expected with a very high degree of certainty to devastate an American territory home to ~3.5 million citizens.

If this happened five days AFTER landfall, was nothing done by the White House BEFORE Maria made landfall?

It’s not as if taking proactive action was difficult, either. I am certain government agencies and the Defense Department were ready to move with plans they’ve had prepared for some time, tweaked for this particular event. All it would take is a simple verbal Yes to proceed.

Or an executive order which we all know this White House can produce like so much facial tissue.

~ 1-a ~

All the monitoring and reporting provided to the White House, from NOAA and NASA to Defense Department, was budgeted and authorized by Congress for the purposes of serving American citizens. The public expects a level of performance for the taxes they pay; monitoring and reporting on weather and risks from weather are but part of their expectations.

American citizens expect and pay for their government to deliver effective and timely response when their domestic tranquility and general welfare are disrupted, whether nation-state or weather- and climate-based threats. They do not expect to be left without clean water, no minimum shelter, no emergency health care, let alone an empty wallet depleted by taxation which paid for common defense they didn’t receive.

Why have Puerto Rican Americans not received the same level of government responsiveness and services their fellow citizens have received post-hurricane Harvey and Irma?

Why can’t we get a straight answer about the White House’s planning in response to Hurricane Maria two to three days after landfall? Is it because the lack of any response is as bad as the lack of preparation — utterly missing, perhaps deliberately so?

At some point this isn’t about the White House and its executive function. It’s about Congress which has failed to ensure the executive knows exactly what is expected of it and what action should be nearly automatic from the executive office.

Oh, but that’s too much legislation, conservatives will say. No — it’s inadequate existing legislation which has incorrectly assumed for too long a competent manager will execute U.S. laws. It’s too many sick, injured, dying, dead Americans in the wake of ineffective governance.

And it’s inadequate action on the part of Congress to tolerate an incompetent executive.

To be concise, more than one branch of government failed Americans.

And those branches now have blood on their hands.

Do something about this before more Americans die. Do more than hold a hearing.

~ 1-b ~

By the way, FEMA’s Brock Long has proven himself an idiot. He should be given the boot.

An under-funded agency could land two rovers successfully on Mars and operate them for years to conduct research, but humanitarian response to a predicted hurricane utilizing the largest standing military on earth is too complicated? Fuck that.

And fuck this guy — I don’t even know who this pasty slack-handed suit is, but he can take his lies and shove them sideways. The storm did NOT cause you and your co-workers to be idiots and liars, boy.

~ 0 ~

Call to Action: Congress continues to work on bills regardless of the tragedy in Las Vegas or the growing catastophic death toll in Puerto Rico. Your efforts helped kill the last ACA repeal attempt formerly known as Graham-Cassidy. These are our next challenges.

CHIP expired at midnight Saturday night. Congress left for the weekend allowing health care funding for 9 million American children to expire. Not much better than President Cheeto going golfing while ignoring Puerto Rico. Call your representatives and demand CHIP funding be addressed immediately. Script for the Wyden-Hatch bipartisan CHIP bill here — note also you may need to call your state officials as well.

Net Neutrality is back on the bubble. FCC chair Ajit Pai has consistently attacked it throughout his brief tenure, sucking up to the telecom industry while ignoring the public’s best interests. Call your representatives and demand net neutrality be assured by voting NO on another five-year term for Pai as chair. Script for your call here. VOTE IS SCHEDULED TODAY — HURRY. Get a leg on this before AT&T persuades the Supreme Court to wade in.

Guns on schedule this week: a bill to approve the sale of gun silencers. Las Vegas’s mass shooting last night should be proof enough that “hearing protection” for shooters is the last thing Congress should worry about. The bill also allows the sale of armor-piercing ammunition. Hell, no. Script for your House rep, and script for your Senators.

A vote to make abortion illegal at 20 weeks on tap tomorrow. No. No freaking way. You may not like abortion, but read this piece — imagine the emotional and physical horror for a woman and her family as she is forced by law to carry a non-viable fetus to term. This decision should be between her, her partner, and her doctor. Make the call.

Congress’ switchboard number is (202) 224-3121. Don’t be like the guy in the White House when you can see action is needed.