Death for fun and profits

538 has a good write up on the changing patterns of causes of death in the United States. There is one part I want to pull out:

Mortality due to substance abuse has increased in Appalachia by more than 1,000 percent since 1980….

The linked study has a great set of customizable maps. For substance abuse, it shows the southern most counties of West Virginia being one of the epicenters of substance abuse deaths in the country.

And now I want to focus on the specific from the West Virginia Gazette:

Rural and poor, Mingo County has the fourth-highest prescription opioid death rate of any county in the United States.

The trail also weaves through Wyoming County, where shipments of OxyContin have doubled, and the county’s overdose death rate leads the nation. One mom-and-pop pharmacy in Oceana received 600 times as many oxycodone pills as the Rite Aid drugstore just eight blocks away…

Cardinal Health saw its hydrocodone shipments to Logan County increase six-fold over three years. AmerisourceBergen’s oxycodone sales to Greenbrier County soared from 292,000 pills to 1.2 million pills a year. And McKesson saturated Mingo County with more hydrocodone pills in one year — 3.3 million — than it supplied over five other consecutive years combined…
At the height of pill shipments to West Virginia, there were other warning signs the prescription opioid epidemic was growing.

Drug wholesalers were shipping a declining number of oxycodone pills in 5 milligram doses — the drug’s lowest and most common strength — and more of the painkillers in stronger formulations….Between 2007 and 2012, the number of 30-milligram OxyContin tablets increased six-fold, the supply of 15-milligram pills tripled and 10-milligram oxycodone nearly doubled, the DEA records sent to Morrisey’s office show.

This is a complete system failure. There were good actors. It seems like WalMart from the story was doing a good job of actually telling abusers and addicts “no” as they were not filling high dosage prescriptions nor passing out an inordinate number of pills. But there are enough cracks in the system for unscrupulous prescribers, unscrupulous distributors who were solely responsible to pump up next quarters’ stock price, and usually small and locally owned pharamcies to pass a quasi-legal product out in droves without concern about how many people it was killing and how many lives it was disrupting and ruining.

I don’t know how to fix this problem. I just know it is a problem and it needs to be fixed.

Blue State solutions

Two valued community members raised good points yesterday in comments:

Raven Onthill:

the blue states can build their own plans. Romneycare might be the model, and some states might try something else; perhaps some sort of single payer system. I suppose they will pretty much have to.

And Martin:

There’s an opportunity now in California, however. The 6th largest economy on earth and 1/6 of the US economy. Dems have supermajorities in both chambers and have the governorship. We’ve twice passed single-payer and Brown has indicated he’d support it if the finances work out. If there is going to be a widespread national privatization effort, CA now has renewed incentive to make it go. Yes, its hella complicated as Richard has noted, but CA also has the most actively managed exchange in the country, one of the most competitive health care marketplaces in the country, and some of the best health policy folks around Kaiser Family Foundation.

The big problem with both of these cases is that state healthcare policy will interact with federal healthcare policy. That means some type of waiver will be needed. That could be a major blockage.

However, the core point is very strong and very valid. Blue states if they want to take care of their own citizens while allowing the Red States to race to the bottom can do so. If there are massive high income tax cuts, there will be fiscal space from high income Blue state taxpayers to fund local social insurance programs. California has the size and the expertise to make a go at something that could work. My bet is that they would go multi-payer in a tightly regulated market and build from the fairly successful Covered California exchanges with higher subsidies and tweaked eligibility but that is a guess purely informed by speculation before my first cup of coffee.

The next big challenge is getting traditional Blue States with super majorities in the Legislature back to Trifectas by retaking governorships so experimentation can move forward with motivated stakeholders. But that is a discussion for a different day.

If You Don’t Know Who The Patsy At The Table Is, Dear Trumpkins…’s you:

Again and again, President-elect Donald Trump presented himself as the coal miners’ candidate. During the campaign, he promised to bring coal back into the economy, and jobs back into struggling Appalachian towns.

But now some in coal country are worried that instead of helping, Trump’s first actions will deprive miners — and their widows and children — of the compensation they can receive if they are disabled by respiratory problems linked to breathing coal mine dust.

That’s because buried in the Affordable Care Act are three sentences that made it much easier to access these benefits. If Trump repeals Obamacare — as he vowed to do before the election — and does not keep that section on the books, the miners will be back to where they were in 2009, when it was exceedingly difficult to be awarded compensation for “black lung” disease.


This is by no means a done deal, given that at least some coal-country legislators (Joe Manchin, for one) have declared their support for retaining this in whatever comes out of the health care catastrophe the GOP is determined to commit.  But McConnell is, as usual, mum on the matter, and if I were a coal mining family depending on the pittance they do get (top payment for a miner with three dependents: $1,289/month), I’d be getting ready not for hard times — they’re already here — but worse.

[update: obligatory post soundtrack]

The key change the ACA implemented in black lung cases was to shift the burden of proof: instead of a miner having to prove that the work caused the disease, under the new rules,

If a miner has spent 15 years or more underground and can prove respiratory disability, then it is presumed to be black lung related to mine work, unless the company can prove otherwise.

This wasn’t a case of free money all around. As reporter Eric Boodman writes,  “In 2009, 19 percent of claims for black lung benefits were successful; in 2015, that percentage had jumped to 28.” That’s a big jump — but hardly evidence that the black lung compensation process is a wild government grab of beleaguered coal company assets.

Those companies hate the rule, with a spokesman telling Boodman that it’s created “a supplemental pension program” rather than the compensation for occupational disease, which is as fine a bit of high priced turd polishing as I’ve seen in a while.

TL:DR?  Think of this as Mencken’s rule in action:

Democracy is the theory that the common people know what they want, and deserve to get it good and hard.

Trump voters in coal country — West Virginia, Pennsylvania, Ohio, Kentucky — were promised their country back.

What will they receive?

The shaft, deeper and darker than any hole miners have dug in the hunt for what will continue to kill them where they stand.

Image: Léonard Defrance, Coal Mining, before 1805.

Late Night Open Thread: The Revanchists’ (Temporary) Revenge

While the more-Leftist-than-thou “progressives” — including their latest high-profile figurehead — are high-fiving each other in happy anticipation of potential public-outrage gigs over the next four years, at least some people are beginning to push back on the BUT WHITE WORKING CLASS HAS ALL THE SADS!!! meme so beloved of Very Serious Pundits. From the NYTimes, Robert P. Jones on “The Rage of White, Christian America“:

Between Barack Obama’s 2008 election and 2016, America has transformed from being a majority white Christian nation (54 percent) to a minority white Christian nation (43 percent).

But on Election Day, paradoxically, this anxious minority swarmed to the polls to elect as president the candidate who promised to “make America great again” and warned that he was its “last chance” to turn back the tide of cultural and economic change…

The choice before the country was starkly clear. Donald J. Trump’s Republican Party looked back wistfully to a monochromatic vision of 1950s America, while the major party fronting the first female presidential candidate celebrated the pluralistic future of 2050, when the Census Bureau first projected the United States would become a majority nonwhite nation.

My organization’s American Values Survey, released a few weeks before the election, found deep divides in the country on this issue. Americans are nearly evenly divided on whether American culture and way of life have changed for worse (51 percent) or better (48 percent) since the 1950s. Roughly two-thirds (66 percent) of Democrats say American culture has generally changed for the better since the 1950s, while roughly two-thirds (68 percent) of Republicans say American society and way of life have changed for the worse…

Message to ‘Tha Heartland’ and all its defenders, honest or (mostly) otherwise: 1963 is over. It is never coming back.

Thoughtful article (which started as a tweetstorm) from Patrick Thornton — “I’m a Coastal Elite From the Midwest: The Real Bubble is Rural America“:

… My home county in Ohio is 97 percent white. It, like a lot of other very unrepresentative counties, went heavily for Donald Trump.

My high school had about 950 students. Two were Asian. One was Hispanic. Zero were Muslim. All the teachers were white. My high school had more convicted sexual predator teachers than minority teachers. That’s a rural American story.

In many of these areas, the only Muslims you see are in movies like “American Sniper.” (I knew zero Muslims before going to college in another state.) You never see gay couples or even interracial ones. Much of rural and exurban American is a time capsule to America’s past.

And on Tuesday, Nov. 8, 2016, they dug it up…
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Late Night Horrorshow Open Thread: What News of Maine’s “Human Bowling Jacket” Governor?

I have a mild case of the spindizzies, and it’s making me even crankier than usual. But I’m still about 80 IQ points and some head trauma away from “cranky like Paul LePage.”

I will also point out, for any Purity Ponies lurking, that LePage is what happens when the “True Progressive” becomes the enemy of the “at least he’s not Paul LePage” mere Democratic machine candidate.

To quote Mr. Charles P. Pierce, Paul LePage always brings dignity to the office.”

GOTV optimization

This evening, my wife and I were door knocked for the first time this election cycle. A very earnest paid canvasser from a union backed entity asked us half a dozen questions, got our contact information and engaged in small chit chat. He stayed on our porch for ten minutes as a nasty but brief squall ripped through the neighborhood and took down a pair of branches from the walnut tree across the street. As we were talking, I mentioned that I had been a data geek for a similar 527 organization a while back. I understood that this was an initial data canvas and not a mobilization nor a persuasion canvas. Neither my wife nor I need persuasion nor mobilization. We have not missed an election in ten years, and the latest either of us have voted is three hours and seventeen minutes after the polls opened (this year as I was working from home and had to get the kids to school and coffee in me before casting a ballot for Hillary Clinton).

Any resources devoted to either persuade or mobilize my wife or I are wasted resources. We’re going to vote, and we’re going to vote for the most plausibly electable liberal that we can whenever we can. And this is a problem that calls for a solution. We’re going to get hit up with at least four different liberal GOTV ground campaigns (Clinton, joint/coordinated Federal and State Dem victory campaign, an environmental organization and a union backed 527 that we just talked to). Each of these groups will call us, they will mail us, and they will door knock us. If we only answer ten canvassers at the door this fall, I will be surprised. All of that effort is wasted effort that should be deployed on either getting a sure liberal but unsure voter out to vote, or a sure voter but squishy persuasion target out to vote for Democrats.

Is there a solution where my wife and I can register with a data vendor to say that we are 100% sure of voting and we are non-persuadable in the general election cycle so send resources three doors down to the new couple that moved into the neighborhood from out of state and have just registered to vote for the first time? If that is a third party entity, then both the campaigns that are allowed to coordinate with candidates and independent entities can buy the same cleansing lists to clean and narrow their actual target universe.

Reminder: Mike Pence Is Every Bit As Dangerous As Donald Trump

There are two wings in the modern Republican party: the “I Got Mine, Fvck You” (‘business’) clan, represented this presidential year by Donald Trump; and the “We Hate All the Same People You Hate” (‘religious’) group, now ably seconded by Mike Pence. Of course the overlap between the two is large — the main difference between Trump’s career and Pence’s is that when Pence threw other peoples’ money around, he was to some degree subject to the wrath of his victims, the voters. (Despite his best efforts to keep them from hearing about it.) He’s also, per Think Progress, a longtime shill for the tobacco industry. Truly the Swiss army knife of RWNJs!

From Jezebel‘s political sub-blog The Slot, “Get to Know Mike Pence and All of the Very Bad Legislation He’s Signed”:

Pence is a bit of a darling among anti-choice groups. As a member of Congress, Pence sponsored a 2007 bill to defund Planned Parenthood, the first of its kind, the legislation set off a now nearly decade old congressional battle to defund the organization. Pence reintroduced the legislation multiple times until he left the House in 2011. “Let the abortion providers provide for themselves,” Pence told Politico in 2007. “I’d like to continue to be a persistent, respectful voice for the sanctity of life.”

It was a template and an indicator of how he would treat women’s health as governor of Indiana. As governor, Pence signed virtually every anti-choice bill that was put on his desk, including HB 1337, an omnibus abortion bill that a federal court blocked from taking effect in June of this year.

Pence described the law “a comprehensive pro-life measure that affirms the value of all human life.” In reality, it is a deeply invasive law lacking both empathy and reason (unsurprising, perhaps, from the state that jailed Purvi Patel). HB 1337 bans women from seeking abortions based on race, gender or fetal anomaly; it also mandates that women be required to bury or cremate the fetus post-termination. In addition, it required that abortion doctors have admitting privileges in order to practice, a restriction that the Supreme Court recently struck down in Whole Woman’s Health vs. Hellerstedt

In 2015, Pence also signed the Religious Freedom Restoration Act (RFRA). The controversial law prohibits the passage of state laws that “substantially burden” the religious beliefs of individuals. According to the Associated Press, the definition of an “individual” originally included churches and religious institutions, as well as businesses and other entities (RIP Memories Pizza who played themselves all the way to closing).

The law and its passage were a mess. LGBTQ activists argued that the bill would effectively allow business owners to discriminate and deny customers service if they were LGBTQ (or merely if the owner of the business perceived them to be). After numerous companies and organizations, including Angie’s List and the NCAA, announced that they would boycott the state, the Indiana legislature amended the bill, clarifying that it could not be used to discriminate against LGTBQ people.

Pence handled the passage of the bill poorly. He acknowledged that the bill was discriminatory, yet signed it anyway and, in the process, lost quite a bit of cash for Indiana businesses…

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