Across the Great Divide

Shelter Report: Toothless in Gaza.

Paco came in today to brush his teeth.

One of his schticks is to speak in a regional shitkicker accent. So, as he said it, he'd come to the Day Center to brush his tayth.

He still has a full set to brush. Many of our guests are not so fortunate.

Rush is missing his top front teeth back to the canines. Because he's well over six feet, it would be easy for someone to think werewolf as they stare up into the gap. He's also scrawny, hyper and has one white eye with the cornea clouded over. Though he tends to run away from trouble, his appearance tends to provoke people. Last week, a 12-year-old girl punched him in the face and blackened his good eye. 

Toni has no teeth. Her sunken lips and collapsed cheeks brand her as homeless and a possible meth addict. She has a job interview coming up, and I don't know how she'll fare. She's unlikely to land anything that involves public contact. But she will go in there and smile and try to act confident.

I remember David, who was saving his money for new dentures. He'd been a ski instructor, but couldn't get rehired after he lost his teeth.

Jolene's teeth are small and malformed, as if her adult teeth never came in to replace the soft baby teeth.

I'm not even going to start on the decay I've seen.

According to surveys of homeless veterans, dental care was consistently ranked as one of their top three unmet needs, along with long-term permanent housing and childcare, and I have little doubt that finding would hold across the homeless population. Poor oral health can be a barrier to finding employment—both cosmetically and as a contributor to low self-esteem.

Worst of all, the homeless population has the most difficulty reversing the situation. They:

• have worse dental problems
• are about half as likely to have dentures if they are toothless
• are twelve times more likely than people with stable housing to have dental problems
• and are less likely to have access to dental care because they lack money, health insurance (Medicaid coverage for dental care varies by state) and often, a dentist willing to serve them.

Dietary limitations because of their dental condition can further deteriorate overall health. 

You have nice teeth, said Rush.

(For the record, they are a bit coffee-stained, untouched by orthodontia up front and generously crowned in the rear.)

You must have listened to your parents, he said.

Shelter Report: The Doctor Will See You Now.

Nothing scientific about this, but I hear about medical clinics of all sorts — from primary care to specialists — that are seeing lighter than normal patient schedules. My dentist's office called, barely a week after sending a reminder card, to book me for my "preventive cleaning."

Maybe now's a good time to get cancer or have that neck tattoo removed.

Used to be, things slowed at the first of the year when people still had to work down their deductibles. We just passed midyear, so maybe something else is going on.

Employer-paid health plans are getting more expensive, or going away, or the jobs themselves are. That looks like the real health care rationing, although I'm sure someone out there can explain why it's the government's fault.

This week in the preschool there were more runny noses than usual. One girl's mother took her to the ER. She was diagnosed with a cold.

Mom's lucky she has free health care, but I wouldn't recommend doing what she had to do to get it.

Colorado Marijuana Rx Law Causing Pain as Well as Relieving it.

Last week I wrote about local difficulties with enforcing Colorado's medical marijuana law.

Here's a pretty good article that gives an overview of the economic and law enforcement issues related to the law as more people in the valley get into the business.

[The legislator sponsoring a new regulatory bill] knows folks in law enforcement and those selling medical marijuana equally are unhappy with how his bill is shaping up. Dispensaries are afraid the cost of staying in business will be too high; law enforcement is angry they’ll be in business at all.

The city of Grand Junction alone could collect $445,500 in annual sales taxes on medical marijuana sold through the dispensaries.

Medical Weed Operation Leads to Exposing Patient Information.

Colorado is getting its feet wet with medical marijuana, creating some new twists on how drug laws are enforced.

This week in my hometown, authorities were called to an office building near the Census offices where someone observed an unusual smell. More than a thousand marijuana plants were found under grow lights.

But with cultivation being legal based upon the number of patients being supplied by a dispensary, the cops couldn't just confiscate the weed.

They did, however, check to see whether the large number of plants was justified.

Here's where it starts to get sticky.

A search warrant executed Tuesday authorized the seizure of photocopies of patients’ marijuana registry cards, as well as doctors’ recommendations and personal contact information for patients [...]

The judge who signed the warrant did what he had to, I guess, if there was suspicion that the legal growing operation was producing extra weed on the side. But in order to confirm the proportions being grown were legitimate, patient records were opened up to scrutiny.

This is the sort of thing that makes some people afraid of government getting deeper into the health care business, of course, so even if the grower (Sid Squirrel!) is totally on the up and up, this sort of investigation could have repercussions beyond the drug business.

[Disclosure: My brother is a local police commander and the judge is a former classmate. I have not discussed the case with either of them.]

The Cat with Nine Bandages.

The cat has been getting tumors near his vaccination sites (there's fuel for anti-vaccination fire!), and last visit to the vet, he had another one removed.

Before the day was through, one of his stitches had come out.

Now, the way a man would manage this problem — assuming he noticed anything — would be to let nature take its course, which is kind of a proactive-sounding way of doing nothing.

A woman, however, worries that another stitch will come out, and then... Well, all creation could become unraveled.

So a trip to the drug store produced a sort of steri-strip designed to help secure the wound. That seemed just as accessible to a grooming cat as the original stitch, so a band-aid was placed over the strip. The band-aid looked too lickable and was already having trouble adhering to the furry skin, so next came an Ace bandage wrap around the midsection, secured with a piece of packing tape.

Packing tape wasn't really designed as an elastic bandage closure, so next came the cry: Where's the duct tape?

At last, we were approaching male problem-solving territory!

This latest intervention may work, if only because the cat does not want to be ministered to for a sixth time.

I thought about posting a photo, but I want to spare everyone in the family, including the cat, further embarrassment. However, if this continues to be a problem, I may start to get interested after all, now that it is an engineering problem and not a matter of survival of the fit.

Who Benefits from Bachmann's Health Care "Freedom of Choice"?

Minnesota Rep. Michele Bachmann has announced her "bipartisan legislation, H.R. 502, the Health Care Freedom of Choice Act," which

would make medical expenses, including health care premiums, 100% tax-deductible for all individuals.  Under current law, health insurance is tax-free for those who receive it through their employers.  My bill would give this same tax benefit to people who buy their own health insurance or pay for medical care “out-of-pocket.”  This would give all Americans the freedom to purchase the health plan of their choice, to pick their preferred doctors and to make their own medical decisions. 

In the buildup to her rollout, the decidedly non-bipartisan Bachmann said, “We are rejecting politics as usual in Washington D.C. in dealing with this health care issue.”

Apparently, proposing tax cuts as the solution to all that ails us is not politics as usual.

I haven't read the bill, but let's examine her description 100% tax deductibility as giving people freedom to purchase the health plan of their choice.

The context.

The average American family with employer-subsidized health care coverage (earning about $50,000 in household income) pays out about $7,000 per year in its share of premiums and out-of-pocket costs. Employer contributions average nearly $10,000.

The current federal tax system already allows deductibility of medical expenses. You can deduct the amount of your medical and dental expenses that is more than 7.5% of your AGI [Adjusted Gross Income]. For example, if your AGI is $35,000, 7.5% is $2,625. If your family of four paid medical expenses of $7,000, you could deduct $4,375. Filing as the head of the household, you would pay $3,996 in federal income taxes.

So who really benefits from the Bachmann proposal?

The poor? No. They don't save enough to afford insurance.

Taking the example above, the Bachmann bill would lower the family tax bill by $393 — or about 10 percent. That's about enough to pay for one month's premium on a moderately high deductible insurance policy in Minnesota for that family of four.

Claiming higher levels of expenses does not yield any larger relative savings under the Bachmann plan, because the only difference is the tax that's applied to the family's first $2,625 in expenses under the current system.

The real question for lower income households is whether they can come up with the money at all. They are less likely to be covered by employer plans, and they also have less income available to pay regular premiums and out-of-pocket costs. A tax deduction doesn't help the cash flow for people living paycheck to paycheck.

The middle class? They'd see a modest benefit.

The Bachmann proposal would result in an additional $562 in tax savings over the current system — worth a little more than one month's premium for a Medica HSA plan. 

The top earners? You won't be surprised.

1. The top 10 percent of earners — at least those who are employed — are generally covered by health insurance. (In 2006, only 8.5% of those earning $75k+ were uninsured, sompared to 21.1% of those earning $25-50k.)

2. The higher the income, the more likely the insured has a Cadillac plan as part of an executive compensation package.

3. Once you reach top 5 percent of earners or so, your own medical expenses cease being deductible under current tax law. For example, at $200,000 AGI, only your expenses above $15,000 would qualify for deduction.

Someone earning $100,000 and paying the average $7,000 for medical expenses would not be able to deduct any of it. Under Bachmann's bill, they could deduct it all, worth $1,680 in tax savings.

The bottom line?

Wealthier tax payers, who are more likely to be well-covered, do better under the tax portion of the Bachmann plan.

A tax-deduction scheme favors those who pay more taxes. Look at it this way. Someone earning $500,000 who had $35,000 in medical expenses could deduct them all and save $12,250 in taxes. Someone earning $35,000 with the same medical costs would simply be bankrupt.

A tax deduction for all also means less revenue, and less revenue means program cuts. No doubt "Health Care Freedom of Choice" would be used to justify cutting public health care expenditures, which primarily benefit low-income people. 

Some choice.

Don't Look to Rush or to Hawaii to Rate U.S. Healthcare System.

I have been treated to the best health care the world has to offer -- that is right here in the United States. I don't think there is one thing wrong with the American health care system. It is working just fine, just dandy.

– Rush Limbaugh

Limbaugh is quoted after a visit to a Hawaiian hospital that admitted him with severe chest pains... But presumably before he received his EOB from the insurance company.

Drawing conclusions about a system, based on anecdotal experience, is always hazardous, especially when the person doing the drawing is a wealthy celebrity blinkered by ideology.

He does not detail the treatment that was so dandy or whether it actually resolved a medical problem other than transient pain. Most important, he does not say — and probably doesn't know — how much it cost.

My own experience with medicine in the islands is limited, but possibly relevant. In 2003, I accompanied someone experiencing severe abdominal pain to a Maui ER. I'll spare you the details, except to say the problem was likely a ruptured ovarian cyst that was going to resolve itself and apparently did by the time the dose of pain killers wore off. A CT scan and ultrasound revealed nothing — just as in Rush's case — and a laproscopy offered after the patient felt ready to leave was turned down.

However, the patient spent most of the day on a gurney in the ER — without a pillow (they were out of pillows) — for continuing "observation," which meant "lie here by yourself until we can find the specialist to come back and take another look at you."

The charges for this visit, which did not involve an ambulance, room or medical intervention other than fluids, meds and the diagnostic tests, came to $14,000. Fortunately, the costs were picked up by insurance, but because they were out-of-network for the Minnesota-based policy, Medica (and its policy-holders) paid a higher portion of the bill. 

The care was "best" if best means borderline over-provision of services with no adverse outcome. (We'll guess Rush got a pillow.)

Ironically, because Hawaii has an employer mandate and a relatively high number of people with health insurance, its hospital emergency rooms don't provide the level of indigent and outpatient care that burden costs at mainland hospitals.

Most Hawaiians see their regular doctor, use fewer health care services and are admitted to hospitals 26 percent less than the United States average. The ERs can deal with true emergencies, like chest pain, abdominal pain and surf-slammed tourists. In 2007, the state had 34 percent lower ER outpatient visits than the national average.

Other states tried employer-mandated care only to repeal the efforts after employers threatened to move across state lines. Hawaii’s isolation forestalled such threats, and its paternalistic plantation history made employer-provided care an easy fit.

There are perils in drawing conclusions about how a national health care system would work based on one isolated state's experiences — and liberals and conservatives will find the lessons they're looking for.

One thing you already knew, though. Rush Limbaugh isn't telling you the whole story.

Seeing Her Ideas in a New Light.

Mina Bissell will never forget the reception she got from a prominent scientist visiting Lawrence Berkeley National Laboratory, where she worked. She gave him a paper she had just published on the genesis of cancer.

“He took the paper and held it over the wastebasket and said, ‘What do you want me to do with it?’ Then he dropped it in.”

– "Old ideas spur new approaches in cancer fight," New York Times

Interesting piece on new/old thinking about how cancer tumors spread, and how that spread might be arrested by addressing the healthy cells around the tumor.

“Think of it as this kid in a bad neighborhood,” said Dr. Susan Love, a breast cancer surgeon and president of the Dr. Susan Love Research Foundation. “You can take the kid out of the neighborhood and put him in a different environment and he will behave totally differently.”

“It’s exciting,” Dr. Love added. “What it means, if all this environmental stuff is right, is that we should be able to reverse cancer without having to kill cells. This could open up a whole new way of thinking about cancer that would be much less assaultive.”

There's more research to be done, especially since this direction has been largely dismissed by the cancer establishment for decades.

I also can't help but notice that two of the key scientists, whose early papers are now seen a new light, are named Mina and Beatrice.

Vic Chesnutt: No Sweeter Relief.

Holes in his sweater, fluid in his lungs

The experts say there's things

He should've done better

But instead he's just dying young

– Vic Chesnutt, "Dying Young"

The Christmas Day death of singer-songwriter Vic Chesnutt, who had been partially paralyzed since a drunk-driving car crash when he was 18, could be spun as a story about chemical abuse, depression or suicide. But at bottom (see his "When the Bottom Fell Out" below), it's a story about health care in America.

If you have a pre-existing condition that requires ongoing treatment, and are a self-employed musician in employer-based system, you're not likely to be enjoying the "greatest health care system in the world."

He spoke at length December 1st on "Fresh Air" about his struggles with the health care system, and in another interview, he said:

I'm not too eloquent talking about these things. I was making payments, but I can't anymore and I really have no idea what I'm going to do. It seems absurd they can charge this much. When I think about all this, it gets me so furious. I could die tomorrow because of other operations I need that I can't afford. I could die any day now, but I don't want to pay them another nickel.

Back in 1996, a Chesnutt Tribute album called "Sweet Relief II: Gravity of the Situation," helped raise money for his medical bills — and was intended to perhaps goose him out of obscurity so he could make a better living. At the time, he was quoted in a Strib story by Jon Bream about medical insurance for musicians.

"A lot of musicians are living supper to supper" and can't pay for insurance. "It's really scary," said Chesnutt, pop's most prominent paraplegic singer-songwriter. "I was lucky enough: I had a job when I crashed. I was working at Hardee's and at a cotton mill, too. So I'd paid in Social Security for a couple of years and I automatically got Medicaid, which is a great thing. If not, my family would've been starved to death. It would've sucked them dry."

Even thirteen years later, a difficult and obscure artists can't go back to the well for another tribute album. So the greatest outpouring comes too late.

Oh, Little Town of Kettleman: A Christmas Story.

Well, not really. But it is a tale about consumption and the birth of babes in humble surroundings, specifically, Kettleman City, California. It's a tiny, Spanish-speaking farm town three miles from the largest toxic waste dump in the West.

Of 20 children known born here between September 2007 to November 2008, five had a cleft in their palate or lips, according to a health survey by community activists.

[...]

Clefts of the lip or palate routinely occur in fewer than 1-in-800 births in California, according to state health statistics. 

[...]

Owners of the waste facility have offered to fund a health study, but they say there's no evidence linking the dump to the maladies. Other potential culprits are pesticides sprayed on nearby fields, discolored drinking water and exhaust from Interstate 5, the West Coast's major north-south highway, that borders the town.

Ironically, some of the chemical waste in the neighborhood comes from Mexico, where U.S. auto batteries were sent for recycling. When signs of lead poisoning started showing up in communities near that facility, Mexico and the EPA paid to ship some of the waste back to America.

In other words, babies with birth defects and adults with high incidences of cancer and asthma are one result of this American life.

 

Doing it the old-fashioned way.

Down-the-hill method of waste disposal, Colorado (left) and Chinese street life near the local lead plant.

The concentration of waste near people without power or the money to move elsewhere happens all over the world today, but the more usual historic pattern was dumping in place. Whether it was sewage, garbage, or construction debris, the waste byproducts would be distributed more evenly unless the farming, mining or manufacture was done on a large scale.

Even without big dumps that pull in waste from elsewhere, residents in Libby, Montana, inhaled asbestos. Folks in Moab, Utah, still deal with background radiation and leachate from uranium tailings. Rural Louisianans live with toxins and sludge from the oil industry and its partner, petrochemicals. Floridians watch sugar growers pollute the Everglades. West Virginians wheeze and eventually strangle on coal dust.

Kettleman City is just more egregious example.

The company operating the dump may not be blameless, but it is handling the toxic residue of America's production of lead, arsenic, asbestos and PCBs in a location bombarded with agricultural chemicals and vehicle emissions. As a Chemical Waste Management spokeswoman says, "there's a high degree of complexity."

She's right. And as American consumers with big garages and nice, neat backyards, we contribute to it.

[h/t Norwegianity]