Category Archives: public health

Meals On Wheels: Canary in the GOP Coal Mine

The entire “skinny budget,” which somehow manages to keep lots of fat on the Pentagon budget, offered up by the current administration is a mass of mischaracterizations packed into a myriad of outright lies.  The assault on programs like Meals on Wheels is a handle providing a way to understand the totality of the right wing Individualism of the GOP. It’s there, blatantly set forth without excuse, and as emblematic of the Culture of Selfishness as can be imagined.

Cast me not off in the time of old age; forsake me not when my strength faileth. Psalms 71:9

“Trump’s proposed budget completely eliminates the Community Development Block Grant, which provides $3 billion every year for, according to The Washington Post, “targeted projects related to affordable housing, community development and homelessness programs.” Among those is the Meals on Wheels program, which provides meals—and vital human contact—for older, impoverished Americans, many of whom are largely home-bound. According to MOW, one in six American seniors struggles with hunger, and the organization claims it saves the nation about $34 billion a year in medical expenses by decreasing the rate of falls for seniors. The program gets the vast majority of its funding from non-government sources, but the proposal still seems unnecessarily harsh.” [Esquire]

And the rationale for all this would be what, please?

“After a reporter brought up the Meals on Wheels controversy, Mulvaney at first tried to subtly evade the question. But then, as is the wont of this administration, he fell head over glutes explaining that while Meals on Wheels “sounds great,” the administration couldn’t keep wasting money on programs like it that “don’t work.” As in, feeding the elderly apparently isn’t showing strong enough empirical benefits to merit continued federal spending by this White House, which is now deeply wedded to evidence-based policymaking.” [Slate]

There are a couple of things to unpack herein. First, empirical benefits are hard to compile without first establishing a matrix of goals.  Benefits are precisely why the program “sounds good,” the goal is to feed people, and people are being fed in their own homes. In fact some 2.4 million elderly persons are participating in the program at a total cost of $1.4 billion. 500,000 of these are veterans of our Armed Forces. A study in New York City reports that the average age of a participant was 80, meaning the person was likely born around 1937, and if the person is a veteran he or she likely saw service during the Cold War into the Vietnam Era. How goals are framed makes a difference.

If the goal is to provide 2.4 million elderly people one meal per day with a minimum of 625 calories, then we can say it’s working.  If our goal is to be that no elderly Americans go a day without a sustenance level meal for a relatively inactive person, then, no the program has too many people on waiting lists to say it’s an unqualified success.

“The need is growing rapidly, and federal funding has not kept pace. The network is already serving 23 million fewer meals now than in 2005, and waiting lists are mounting in every state. At a time when increased funding is needed, we fear that the millions of seniors who rely on us every day for a nutritious meal, safety check and visit from a volunteer will be left behind.”[MOWAm]

At this point it needs to be said that Federal funding is combined with charitable and individual donations to keep the program literally on its wheels.  Further, the only logical way to pronounce the services a failure is to absurdly assert that because seniors get hungry the next day the program isn’t meeting its goals. However, it’s crucial to take a look at the second feature of GOP rationalization for pure selfishness.

Ultra-right wing conservatives are fond of explaining that services like Meals on Wheels could be better done by local charitable institutions, ignoring the fact that as mentioned above the Federal funding is not the primary source, and IN FACT is supplementary to local charitable funding sources. Catholic leadership, for example, is wary of the implications of the administration’s budget priorities, and Catholic Charities of Southern Nevada is providing some 2,000 daily meals to those on its list. Reducing funding for this single program by one third would have a profound, and profoundly negative, impact on its services.   There are times when the intersection of governance and religious institutions illustrates the point that while private donations are the core, when the need overruns the capacity then it’s time for a little help from friends around the country.  This Cult of Selfishness only works in the ethereal world of ideological fantasies, it doesn’t deliver a meal, even one of a minimum of 625 calories, to a single individual anywhere.

What makes the skinny budget so alarmingly obnoxious is that curtailing funding for Meals on Wheels is merely illustrative of a budget building process based on what the rich want to pay, rather than on what our society needs to be a truly great nation. It is a budget process to Make American Mean Again.

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Filed under health, Politics, privatization, public health, Republicans

GOP Air Balls: ACA Repeal would increase Nevada uninsured by 95%

Trump Favorite Picture This ought to be just a little chilling:

If Republicans go through with their plan to dismantle the Affordable Care Act using a similar model as their failed 2015 Obamacare repeal, the number of uninsured would double, a new report by the Urban Institute report warns. (pdf)  Taking into account the two or so year delay GOP lawmakers say they will include in the repeal bill, the non-partisan think tank estimates that in 2019 the number of uninsured nonelderly people would rise from about 29 million to nearly 59 million.  [TPM]

And the numbers represent what? Answer:

Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees. [UrbanInst. pdf]

Percentages have a way of sounding bland, so some clicking on the Plastic Brain results in approximately 33,040,000 of those people who would lose their health insurance by 2019  being non-Hispanic white people.  47,200,000 would be those without a college education, and thus presumably not in a position to secure the kind of employment providing the resources to find individual health plans.

If the 2015 bill is used as the framework or model, then the Urban Institute projects that there will be 762,000 uninsured individuals in Nevada only 18% of whom would be eligible for assistance; causing a 95% increase in the number of uninsured in Nevada.   Those Nevada politicians who have been denouncing the Affordable Care Act (read Rep. Mark Amodei R-NV2) may want to pause before “taking credit” for creating a 95% increase in the number of Nevadans without health insurance.

It’s important to recall that the Big Lie about the Affordable Care Act is that it is “socialized medicine.”  In reality it’s an Insurance Law. It doesn’t create a nationalized health care system – it merely increases the number of people who have “access” to health care by providing more people with the capability of purchasing health insurance policies.

Senate Democrats have already signaled that should the “Straight Out Of The Gate Repeal and Replace” come from the majority Republicans the GOP can expect no assistance from the Democratic side of the chamber. [TPM]

And, then there’s the politics of the repeal.  If the GOP decides to use the Reconciliation Process (needing only 51 votes for repeal) then Senator Dean Heller (R-NV) raises a question:  “What we are trying to figure out is what the restrictions on reconciliation,” Sen. Dean Heller (R-NV) told TPM. “Does reconciliation allow for a replacement? And it may or may not.” [TPM]

If the process doesn’t allow for “replacement” then the Republicans have chucked the insurance for those with pre-existing medical conditions, insurance coverage for mental health, insurance coverage maternity care, protections from junk insurance policies with maximum limits, and other popular features of the ACA.  They may also be chucking hospitals under the bus.

One private equity spokesperson noted last November, “… hospitals, especially those in rural areas, could be tremendously hard hit if the replacement rolls back the progress made under the ACA to insure patients and incentivize them to get care before their illnesses require emergency room visits or hospitalization.”

Thus, with the lack of any specificity from Republicans about the nature of the “replacement” we could posit some serious problems for the members of the Nevada Rural Hospital Partners – in Winnemucca, Fallon, Battle Mountain, Boulder City, Carson Valley, Ely, Winnemucca, Incline Village, Hawthorne, etc.   A 2016 report for the American Hospital Association provides some general conclusions from which we can contemplate the effect on Nevada’s rural health providers:

”The loss of coverage would have a net impact on hospitals of $165.8 billion  with the restoration of Medicaid DSH reductions; The ACA Medicare reductions are maintained and hospitals will suffer additional losses of $289.5 billion from reductions in their inflation updates; Full restoration of Medicare and Medicaid Disproportionate Share Hospital  (DSH) payment reductions embedded in ACA would amount to $102.9 billion.”  [AHA pdf] 

The technical term for these losses might be “ouch?”   There is a point at which rhetoric meets the road.  It’s all well and good to bellow “Repeal and Replace?” Or, “Get Rid of Socialized Medicine.”  It’s another thing entirely to puzzle out the impact of repeal on all the stakeholders in this issue – the customers and patients, the health care providers, the hospitals and clinics, the insurance companies, and the investors who have an increasing stake in privatized health care in this country.

There are some elements of the Affordable Care Act which could be improved.  However, the Burn the Barn Down political pandering on full display among Republicans isn’t leading to any current and serious discussions of how to make these improvements viable.  And, this is chilling for policy holders, insurance companies, health care providers, hospitals and clinics, and the investors therein.

Perhaps the Pottery Barn rule applies to Republicans: If you break it you own it.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada politics, Politics, public health, Republicans, Rural Nevada

Ladies’ Day: Supreme Court Decision in Texas TRAP law case

Whole Women's Health

The slip opinion is available here in PDF.  Dissents centered on the issue of res judicata, the idea that once a question is litigated it can’t be re-litigated, however the majority ruling says,

“Changed circumstances showing that a constitutional harm is concrete may give rise to a new claim. Abbott rested upon facts and evidence presented before enforcement of the admitting-privileges requirement began, when it was unclear how clinics would be affected. This case rests upon later, concrete factual developments that occurred once enforcement started and a significant number of clinics closed.”

In dissent, Justice Thomas is having none of this —

“This suit is possible only because the Court has allowed abortion clinics and physicians to invoke a putative constitutional right that does not belong to them—a woman’s right to abortion.

Above all, the Court has been especially forgiving of third-party standing criteria for one particular category of cases: those involving the purported substantive due process right of a woman to abort her unborn child.

There are no “insurmountable” obstacles stopping women seeking abortions from asserting their own rights, the plurality admitted. Nor are there jurisdictional barriers.”

Notice, that for Justice Thomas the right to select a medical procedure is “putative,” and “purported.”  Nor should clinics, facilities, and physicians assert the claim that women have the right to obtain services (such as abortions) from them.  By Justice Thomas’s lights the only complaints to the court should come from those women whose rights have been denied.  He pitches the ‘third party litigant’ to the side, as if a union could not seek redress on behalf of its members, or a company should not appeal on behalf of its shareholders?

However, his final point in the list above borrows from the original anti-TRAP argument (‘insurmountable obstacles’) and bluntly tells women “if you want your rights to seek the medical procedures you feel are your right, then please feel free to file a lawsuit.”  Presumably, at your own expense.,

All this fails to answer a simple question:  How do any of the TRAP laws prevent rich women from seeking an abortion – or any other medical procedure for that matter?  They don’t.  And they were never intended to do so.

We should end on a high note, as usual provided by Justice Ginsberg:

Many medical procedures, including childbirth, are far more dangerous to patients, yet are not subject to ambulatory-surgical-center or hospital admitting-privileges requirements.”  (She cites tonsillectomies, colonoscopies, and in office dental surgeries.)  […]

“Given those realities, it is beyond rational belief that H. B. 2 could genuinely protect the health of women, and certain that the law “would simply make it more difficult for them to obtain abortions.”

Game. Set. Match.

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Filed under abortion, public health, women, Women's Issues

Physicians Could Use A Bit Of Healing in Nevada: Opioid Prescription Problems

oxycontin  The Reno Gazette Journal has done a piece of highly recommended reporting – an in-depth account of opioid prescribing in Nevada.

“…a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country.

Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country.

Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydrocodone — nearly three times the rate of New Jersey, which has triple Nevada’s population.”

OC pill There are some important points to take away from the article.  One of the first is that physicians, themselves, have opposed greater oversight of opioid distribution to patients, specifically in regard to SB 459.  One physician testified to the Assembly Committee on Health and Human Services that SB 459 sections 1-12 should be adopted, but the rest of the bill including reporting and medical education requirements should be dropped because it wouldn’t prevent overdoses. [AHHS pdf] Another doctor offering testimony “went there,” comparing the regulation of opioids to Nazi Germany:

“When people come to Las Vegas and need surgery or have chronic conditions and they hear that the climate here is like Nazi Germany in terms of regulations, the tightening of prescription pain medications, and the prosecution of doctors, it has a very chilling effect on these people who need those medications. […] there are folks who have chronic pain. I am an internist and I see this every single day. I sit there arguing with them about cutting their medications down and they start crying and throwing a fit because they need it.”  [AHHS pdf]

He continued:

We pull the DEA reports now and, as a private practitioner with a two- or three-man office, it creates a lot of extra work for my staff and more
documentation. It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that. At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that. [AHHS pdf]

The good news is that the language requiring that a doctor check the prescription drug monitoring database before writing a prescription for a narcotic to a new patient was retained in the bill.  However, the testimony presented should cause some alarm from members of the general public.

OC pill

As the article points out, a state with one third of the population of another probably shouldn’t be prescribing three times the amount of narcotic painkillers.

The argument that the state legislature shouldn’t try to do something to mitigate the problem if the proposal won’t fix the entire problem sounds altogether too analogous to the NRA’s arguments for doing absolutely nothing to prevent guns getting into the hands of felons, fugitives, and domestic batterers.  “If it doesn’t solve the whole problem, then it shouldn’t be done.”  The second piece of testimony is, itself, chilling.

Hyperbole rarely provides productive content in a civic discussion, and Godwin’s Law applies.  Bring up Hitler, and the audience moves along assuming the argument has been abandoned.  Secondly, it’s a bit more than disturbing that a licensed physician would be argued into prescribing medication he or she knows is deleterious or even dangerous for a given patient.

OC pill

No one wants the Hot Potato.  The state pharmacy board doesn’t want to use its database to flag doctors who are over-prescribing narcotics.  Their director: “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physician to be prescribing a ton of narcotics according to his specialty.” [RGJ]  It might be, and then again, it might very well not be. And the Board of Medical Examiners isn’t enthusiastic about clearing out their ranks either:

“It would be inappropriate, and it’s not the intent of the (prescription monitoring program), to find cases to investigate,” said Edward Cousineau, executive director of the Board of Medical Examiners, which licenses medical doctors and investigates malpractice complaints in the state.” [RGJ]

Again, we might ask: Why isn’t it appropriate to weed out physicians who are creating a situation in which Nevada is among the top five states for opioid pushing? Perhaps the next session of Nevada’s Assembled Wisdom will find the intestinal fortitude to (1) require that the Pharmacy Board use its drug monitoring database to look for BOTH doctor shopping patients and pill pushing physicians; and (2) more thoroughly investigate drug overdose deaths. 

OC pill

Kentucky, Tennessee, Texas, and Arizona have enacted such legislation. [RGJ] Nevada should join them.

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Filed under health, Health Care, nevada health, Nevada legislature, Pharmaceuticals, Politics, public health

The SNAP-ping Turtles Attack: Food Stamp Fraud Myths and Legends

Food Stamps

Among the most depressing of the many Republican attacks on people who are the least able to defend themselves are the ones snapping away at the SNAP program, aka Food Stamps.  It’s even more depressing that the attacks are based on myths and urban legends.

The attacks are continuous.  As of April 16, 2016 approximately 41,000 lost access to food assistance as a result of the Walker Administration’s work rules, although his department of Health Services admits it doesn’t track people who find work on their own. [WEAU]  Another 1,000 will lose access to food assistance in West Virginia. [Dpost]  Add yet another 5,000 in Georgia who’ve lost access because of work rule changes. [USAPP] Louisiana hacked off the access for 30,000 in late 2015. [AJA] And, then, of course, there’s the viral display of the lady who took it upon herself to embarrass a fellow human being for using assistance to feed his children.

The tantrum, if true, illustrates the extent to which the myths and urban legends about the food assistance programs have become part of the Republican narrative about food stamps and the people who use them.

One of the more persistent myths is that there is an abundance of food stamp fraud, and the fraud is the result of misuse of the assistance by the recipients.  

First, the food assistance program is actually one of the most efficient and honest programs in government.  And, most of the fraud is on the part of retailers, NOT the customers.

“SNAP fraud has actually been cut by three-quarters over the past 15 years, and the program’s error rate is at an all-time low of less than 3 percent. The introduction of EBT (Electronic Benefit Transfer) cards has dramatically reduced consumer fraud. According to the USDA, the small amount of fraud that continues is usually on the part of retailers, not consumers.” [HC.org]

Even during the last Recession, SNAP problems were miniscule: “SNAP has one of the most rigorous quality control systems of any public benefit program, and despite the recent growth in caseloads, the share of total SNAP payments that represent overpayments, underpayments, or payments to ineligible households reached a record low in fiscal year 2011.” [CPBB]

The USDA, which administers the program has taken notice of the allegations of “waste, fraud, and abuse,” continually leveled at the assistance, and presented a report in 2013:

“The report indicates that the vast majority of trafficking – the illegal sale of SNAP benefits for cash or other ineligible items – occurs in smaller-sized retailers that typically stock fewer healthy foods. Over the last five fiscal years, the number of retailers authorized to participate in SNAP has grown by over 40 percent; small- and medium-sized retailers account for the vast majority of that growth. The rate of trafficking in larger grocery stores and supermarkets—where 82 percent of all benefits were redeemed—remained low at less than 0.5 percent.”  (emphasis added)

More specifically, most of the fraudulent use can be attributed to these small retailers:

“While the overall trafficking rate has remained relatively steady at approximately one cent on the dollar, the report attributes the change in the rate to 1.3 percent primarily to the growth in small- and medium-sized retailers authorized to accept SNAP that may not provide sufficient healthful offerings to recipients. These retailers accounted for 85 percent of all trafficking redemptions. This finding echoes a Government Accountability Office (GAO) report that suggested minimal stocking requirements in SNAP may contribute to corrupt retailers entering the program.” [emphasis added]

However, the lady in the supermarket screaming at the customer, is probably thinking  it’s the food assistance recipient who commits most of the fraud and not the retailer.  She’s likely not concerned that the USDA has initiated rules to sanction 529 retailers, and permanently disqualifying 826 outlets for trafficking in benefits, or falsifying their applications.  Or, that in 2012 the USDA reviewed more than 15,000 stores and permanently disqualified nearly 1,400 for various program violations. She’s also not likely concerned that the USDA has expanded the definitions of fraud to include newer schemes. [USDA]

snapping turtle

Let’s conjecture that the screaming-mimi is associating food assistance with lazy do-nothings who are eating from her hard earned sacred tax dollars. Again, she’s wrong.

Using Nevada (pdf) as an example for the moment, the median income of SNAP recipients in the state was $20,479 per year, or about $1700 per month, and 49% of the households had at least one person working in the previous 12 months; 29% had two or more workers, and only 21.8% had no one working in the previous year.  Why might the person not be working? Try acknowledging that more than 1/2 of SNAP beneficiaries nationally are either children or the elderly. [StoH]  And, no – they are not undocumented individuals: “Undocumented immigrants are not (and never have been) eligible for SNAP benefits. Documented immigrants can only receive SNAP benefits if they have resided within the United States for at least five years (with some exceptions for refugees, children, and individuals receiving asylum).” [StoH]

On a national basis, children account for 44% of food assistance, the elderly and the disabled account for another 20%.  That leaves 36% who are non-elderly, and not disabled, of whom 22% have children to support and feed, and 14% are childless.  [CBPP]

SNAP recipients Those interested in the SNAP statistics for every Congressional District in the nation can find the pdf files here.

Those interested in living in the fact based universe will also find that far from munching on the taxpayer’s dime, every $1 dollar in food assistance generates $1.80 in economic returns to the community. [USDA]

snapping turtle However, we can publicize every FAQ, every article, every report, in the land and there will still be screamers at the Wal-Mart who are convinced that low-life no-gooders mooching on the dole are taking their earnings and wallowing in sin and sloth.  The right wing echo chamber has done a good job of vilifying children, the elderly, the disabled, and the down on their luck to find an excuse to cut spending for at risk citizens. 

snapping turtle

The snapping turtles have also done a good job of associating African Americans with food assistance programs.

“The 2013 data shows, white people are nearly three times less likely than African-Americans to live in poverty; yet, white people claim more food stamps.  According to the data, not only do white people benefit from food stamps, they also benefit from not having politicians and cops target and malign them as lazy, unproductive welfare queens who take advantage of a social safety net. As the chart indicates, racist ideas about welfare have come to overshadow statistical facts that reveal that the face of food stamps is in fact white.” [AnHQ]

There is support for this conclusion  in Nevada statistics.  In Congressional District One 58% of food stamp recipients are white, in Congressional District Two 80.3% are white, in Congressional District Three 66.3% are white, and in Congressional District Four 52.9% are white.  According to the Census Bureau Nevada District 1 has a population of 693,623 of whom 380,587 are white; District 2 has 697,426 residents of whom 580,111 are white; District 3 has a population of 734,973 of whom 499,767 are white; and District 4 has a population of 713,077 of whom 470,799 are white. As much as the popular right wing mythology may want to reinforce the narrative of the Welfare Queen it just doesn’t fit with the statistical reality.

snapping turtle  When statistics don’t fit … try ideological mythology. Food Stamps make you dependent on Government, and dependency is evil incarnate because it is a disincentive to work.  This, flat out, makes no sense at all.  For example, I live in an area with a public water system. Does hooking up to the water system mean that I’m lazy and have no incentive to walk to the spring for the daily bucket? Or, that I should have to dig my own well, and install my own septic tank?  Perhaps this is plausible if I live far enough from my neighbors to put in a septic system, but I don’t so the result would be “my septic tank next to your well.”  Not a pleasant nor hygienic prospect.  Do public roads make me a lazy dependent? Does having a police department make me less independent – should I have to hire my own rent-a-cop?  Maybe in some radical libertarian  landscape no one depends on anyone else, but this is only a fairy tale of dystopian proportions.  Not a land in which any rational soul would want to reside.

snapping turtle

There’s another element not often discussed in polite circles – good old fashioned selfishness.  The trick is to make selfishness acceptable. Perhaps some of the snapping turtles harbor an unhealthy notion that someone out there somewhere is taking money out of their shells, someone who is undeserving of assistance.  I’d be willing to bet that a right wing snapping turtle would never agree that food assistance should be denied to an octogenarian, or to a disabled person, or to a small child, or to a young mother trying to keep food on the table while going to school to complete her education. So, the “undeserving” must be meanly labeled.  They’re Lazy, they’re druggies, they’re people who “have too many children.”  (I’m particularly appalled at the argument which goes: “They” have too many children,” while the next contention is that funding for family planning must be eliminated.)  The line “I saw people at the food bank who are driving better cars than mine,” illustrates the issue.

This example is a visceral reaction – not a questioning skepticism.  Is the vehicle the only asset of any significant value in the entire household?  Does “better” mean newer? If so, then what was traded in to buy it? The comment better illustrates a definition of poverty that would have only the totally destitute ‘deserving’ of assistance, not someone with a functioning vehicle, an air-conditioner, a television set, a refrigerator – as if these consumer items weren’t a necessity in modern American life. Define poverty harshly enough and all manner of selfishness can be justified.

snapping turtle

There’s one myth justifying selfishness we can dismiss. The one that says we should drug test SNAP recipients to see if they’re worthy.  Seven states spent more than one million dollars on drug testing welfare recipients only to discover that there wasn’t a reason to do it in the first place.  Missouri spent $336,297 testing 38,970 recipients to find 48 positive tests. (0.123%) Oklahoma spent $385,872 on tests for 3,342 people and got 297 positives. (11%) Utah’s results were less rational, 9,552 people were tested and 29 were positive. (3.03%) Kansas screened 2,783 persons, with 11 positive results, a 3.95% result costing $40,000. Mississippi tested 3,656 persons and got 2 positive drug tests. Tennessee tested 16,017 people and got 37 positives.  Arizona tested 142,424 persons and got a grand total of 3 positive results. [TP]  Not that it will put much of a chink in the armor of the snapping turtles, but the numbers certainly don’t justify the expense or the rationale for selfishness underlying the testing.

snapping turtle forbidden

I’d like to see the day when (1) Congressman Sludgepump launches his canards about SNAP recipients being lazy moochers, and a reporter asks if he knows the demographics of the recipients in his District, or  when (2) State legislator Gloomcryer decries the possibility of drug use by food stamp beneficiaries and he’s challenged to cite statistics to support his contentions, or when (3) we finally become outraged at the outrageous duplicity and mendacity of the Snapping Turtles. 

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Filed under conservatism, Nevada economy, Nevada politics, public health, Republicans

Nevada Ballot Questions 2016: Number 1 Common Sense Gun Safety

Question One on the November 2016 ballot shouldn’t be there… that is, the issue should have been taken care of by the State Legislature.  It wasn’t, so here we are doing it the hard way. The initiative provides:

“The measure, upon voter approval, would require that an unlicensed person who wishes to sell or transfer a firearm to another person conduct the transfer through a licensed gun dealer who runs a background check. A licensed dealer may charge a “reasonable fee” for his or her service. If the measure is approved, those found to be in violation of the law would be charged with a “gross misdemeanor,” which could result in a $2,000 fine, up to one year in prison, or both, depending on the results of a trial by jury.

The measure exempts certain transfers of firearms from background checks, including transfers between immediate family members and temporary transfers while hunting or for immediate self-defense.

Supporters refer to the measure as The Background Check Initiative.As of 2014, firearms could be sold by individuals via advertisements and at gun shows without requiring purchasers to undergo background checks.” [Ballotpedia]

Ammosexual It didn’t take long for the NRA hysterics to go ballistic.  Look for the Code Words:

“This November, Nevadans will have the opportunity to vote down this unnecessary and unenforceable proposal which Governor Sandoval already vetoed in 2013.  Bloomberg’s NYC propaganda may say this is a gun safety measure, but we all know that this measure has nothing to do with safety or addressing crime and would only impact law-abiding Nevadans.  It’s important that Nevadans stand up for their rights and not let New York City money influence the future of Nevada!”

There they go again.  “Unnecessary and unenforceable,” is an interesting bit of sloganeering, which doesn’t come close to the rational .  We have laws on the books to criminalize robberies – but robberies still take place.  That doesn’t mean that our statutes on robbery are unnecessary because they are “unenforceable.”  And then there’s this:

“The exceptions are incredibly narrow and could turn an otherwise law-abiding person into a criminal, unknowingly.  For example, a firearm can be borrowed to shoot at an established shooting range; however, that same activity away from an established range such as BLM land is not authorized and would constitute an illegal transfer.” [NRA]

Reading comprehension is tricky but the opponents obviously didn’t get the part about “temporary transfers,” so if we’re out hunting and I hand you my gun, this doesn’t constitute a transfer in the legal sense of the initiative.  All this folderol is followed by the usual Faint of Heart Lament “the criminals will ignore it so we can’t do anything.”  Once more,  extrapolating this to its obvious conclusion would pretty much eliminate section 205 of the Nevada Revised Statutes – the ones defining criminal behavior.  We enact statutes like those attempting to curtail credit card fraud, identity theft, and burglary. Thus, we can enact a statute to curtail the unlawful transfers of dangerous firearms.

Straw Man The Straw Man Cometh.  The NRA and ammosexuals argue that the law would be unenforceable without registration, and registration is unconstitutional, un-American, un-holy or whatever.   So, they contend that this is a stalking horse for “gun registration” which leads to “gun confiscation” which leads to the “new world order,” and “tyranny.”

Excuse me while I take a breath.  There is no way to argue an irrational person into rationality.

The Anti-Urbanity Contingent arrives.   It is a “Bloomberg” idea, it comes from New York City. It’s evil?  It’s “New York Values?”  There’s a long and unhealthy anti-urban sentiment that goes back to the popular fiction of the 19th century.  This bit of pure propaganda would have us categorize other New York City inventions as indicative of New York Values, and the Evil City – for example: The Teddy Bear, Mr. Potato Head, Waldorf Salad, and Pizza?  [nyc]  Oh dear, those Teddy Bears might remind children of the story about President Theodore Roosevelt once refusing to shoot a bear because it was tied to a tree. [TRAssoc]

The origin of an idea is immaterial, and relevant only so far as it suggests (but doesn’t prove) some nefarious connections to the irrational fear of something or another.  Nevada statutes are clear about those the state doesn’t want to possess firearms:

Felons. Yes, there are some hysterics who do argue for the “right” of a felon to possess firearms. However, this fringe is fighting against a tide that’s been washing ashore since the 1920s.

Drug Addicts.  I am interested to hear from anyone who believes that a drug addict should be able to upgrade his capacity to steal to support his habit by moving up from burglary to armed robbery.

Fugitives. Again, does the NRA advocate that fugitives, especially those who have graduated to having their pictures up on police bulletin boards and post office displays, have a “right” to possess a firearm?

Adjudicated Mentally Ill.  It seems to me that the cry from the ammosexuals has been that most mass shootings in this country are accomplished by those few who are seriously mentally ill, and constitute a danger to themselves and to the public at large.  

Persons who are unlawfully or illegally in the United States.  I have met a couple of people whose pro-gun enthusiasm is exceeded only by their anti-immigration views.  I wonder if they want “aliens” with guns?

Now, here’s the question: How can we prevent the felons, the fugitives, the drug addicts, the adjudicated mentally ill, and the undocumented from obtaining firearms — IF we don’t adopt a universal system of background checks?  The anti-Question One crowd renders unenforceable the very statutes we rely upon to prevent the dangerous from obtaining the lethal.

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Filed under Gun Issues, Nevada legislature, Nevada politics, public health

Local Water, the EPA: Beyond Goodsprings

Water Faucet EPA

The Reno Gazette Journal reports that there are 23 local water systems in Nevada which are not in compliance with drinking water standards (there are currently 22, but more on that later).  Three local systems listed in the article have lead contamination levels exceeding the lead standard, 15 ppb (parts per billion) as the “action level.”  The public needs this information. However, the agency responsible for establishing the maximum contaminant level (MCL) standards is the whipping boy of choice for the Republican Party.  In short – it really doesn’t do to get up in arms about water or air pollution levels and then call for the abolition of the Environmental Protection Agency.

The regulatory system isn’t all that complicated. The EPA establishes the standards and then it’s up to the states to devise the implementation.  There’s a reason for this. Setting national standards means that states can’t compete in a ‘race to the bottom’ in which some states seek to attract industry by lowering standards until they are in competition to achieve the status of “Worse Than Any Pig Would Ever Consider in a Sty.”  And, potentially damaging everyone else’s air and water in the process.  However, this hasn’t stopped Over-Hyped Demagogue Donald Trump from calling for handing over environmental regulation to the individual states.  [WaPo]

Nor has this made much of an impression on Seven Mountain Dominionist Ted Cruz; “Cruz has called the EPA a “radical” agency that has imposed “illegal” limits on greenhouse gases from power plants. “I think states should press back using every tool they have available,” the Texas senator has said. “We’ve got to rein in a lawless executive that is abusing its power.” [WaPo]

Ohio Governor John Kasich has been critical of the Michigan attempts to address its man-made, GOP inspired, water quality issues in Flint, MI, but hasn’t been on top of the situation with the Sebring, OH water contamination. [TP]

The 2008 Republican national platform was exceptionally mealy-mouthed about environmental protection:

“Our national progress toward cleaner air and water has been a major accomplishment of the American people. By balancing environmental goals with economic growth and job creation, our diverse economy has made possible the investment needed to safeguard natural resources, protect endangered species, and create healthier living conditions. State and local initiatives to clean up contaminated sites — brownfields — have exceeded efforts directed by Washington. That progress can continue if grounded in sound science, long-term planning, and a multiuse approach to resources.”

It’s not likely that much more will come from a 2016 version.   Nor should we expect much in the way of support for addressing the national problems associated with our drinking water systems.  Remember the ASCE’s Report Card on American Infrastructure (2013)?

“At dawn of the 21st century, much of our drinking water infrastructure is nearing the end of its useful life. There are an estimated 240,000 water main breaks per year in the United States. Assuming every pipe would need to be replaced, the cost over the coming decades could reach more than $1 trillion, according to the American Water Works Association (AWWA). The quality of drinking water in the United States remains universally high, however. Even though pipes and mains are frequently more than 100 years old and in need of replacement, outbreaks of disease attributable to drinking water are rare.”

Not to put too fine a point to it, but as a nation we’re running on a Run-to-Ruin system in which local water distributors are functioning with outdated infrastructure while trying to maintain acceptable levels of quality.  Goodsprings Elementary School offers us an example of what can happen given a 1913 building and 21st century water quality standards. [RGJ]  If Goodsprings was an isolated example, then we could address the aging pipes and move on, but it’s not that isolated, nor that uncommon.  Current EPA estimates indicate we are having to replace between 4,000 and 5,000 miles of drinking water mains in this country on an annual basis, and that the annual replacement rate will peak sometime around 2035 with 16,000 and 20,000 miles of aging pipe needing to be replaced each year. [ASCE]

Putting The Public Back In Public Utility

I am going to start with some basic assumptions. First, that a family or person should be able to move to any part of this great land and expect to find clean water running from the faucet.  Secondly, that it is not a good idea to allow individual states to set drinking water standards, since some might find it inconvenient or inexpedient to set scientifically reliable standards in the interest of “development” or “industrialization.”  Such a piece meal approach would put paid to the first basic assumption.   So, if we’re agreed that any person in this country should have a reasonable expectation of clean drinking water then we need national standards.

Some of the standards are easier than others.  Arsenic contamination levels offer an example of a complex problem with some nuanced related issues.  The MCL (maximum contaminant level) for arsenic was lowered in 2001 from 50 ppb to 10 ppb. Public water systems were to be in compliance by January 23, 2006. [EPA] [More information at FAS pdf] The Reno Gazette Journal reports ten Nevada water systems not in compliance.  One, the McDermitt GID has recently been declared in compliance with a current projected annual running average below 10 ppb after the system put in a new central well.

Arsenic enters the drinking water systems one of two ways, either through industrial activity or as a naturally occurring contaminant.  If the system is west of the Rocky Mountains it’s a reasonably good bet that the arsenic is naturally occurring.  It’s probably not too far off the mark to say that if the standard were set at 15 ppb most Nevada water systems would be in compliance, but the standard is 10 and that’s ultimately what matters.

The smaller public water systems have more trouble meeting the standards than the larger ones, as described by the BSDW:  “The smaller systems are the ones that tend to struggle with regaining compliance because they typically have limited financial resources so we have to collectively figure out ways to help that community get back to compliance,” said Jennifer Carr, NDEP deputy administrator. “Larger systems such as TMWA also have more personnel to tackle projects whereas some of our smaller water systems are operated by one person who might be doing another side job.” [RGJ]

And, now we’re down to the gritty part: Where does the money come from to resolve contaminant problems with arsenic? Or, for that matter, other water infrastructure issues?    The State Revolving Fund provides low interest loans for water infrastructure projects in the state; and can in some circumstances offer “forgiven” loans to small public water services.  The “bottom line” is that in 2016 there will be a need for approximately $279 million for arsenic treatment, groundwater treatment, storage tank replacements, metering systems, and distribution lines in Nevada.  And, the worse news, “Not all will be funded.” [KTVN]

The Drinking Water State Revolving Fund was created in 1996 to support water systems and state safe water programs.  “The 51 DWSRF programs function like infrastructure banks by providing low interest loans to eligible recipients for drinking water infrastructure projects. As money is paid back into the state’s revolving loan fund, the state makes new loans to other recipients. These recycled repayments of loan principal and interest earnings allow the state’s DWSRF to “revolve” over time.”  [EPA]   As of 2014 this system had provided $27.9 billion to water suppliers to improve drinking water treatment, improve sources of drinking water, providing safe storage tanks, fixing leaking or aging distribution pipe, and other projects to protect public health. [EPA] The EPA estimates that small public water systems nationwide, those serving populations less than 3,330,  will need approximately $64.5 billion for infrastructure needs. [EPA 5th report pdf]

What was the Republican controlled Congress’s response? They may have avoided a shutdown, but the waters weren’t exactly flowing:

The bill provides $863.2 million for the DWSRF  well below President Obama’s request of $1.186 billion and more than $40 million below the programs FY2015 appropriation.While the figure represents the lowest DWSRF appropriation in several years, it is significantly above the FY16 funding levels originally proposed by the House and Senate Appropriations Committees, each of which would have cut DWSRF funding to below $780 million. [UIM]

What have we learned?

  • The Republican candidates for the presidency show little to no enthusiasm for infrastructure investments in general, and beyond bemoaning the state of Flint’s water system which must be someone’s fault “just not ours,” even less enthusiasm for funding local drinking water improvement projects.
  • The Republicans in Congress were only too happy to cut funding for the best source for local public water companies projects, in the name of “fiscal responsibility” – meaning, one could think, that preserving tax cuts for the rich is preferable to providing clean drinking water to everyone.
  • The infrastructure needs in this country are serious and go well beyond fixing bridges and filling pot-holes.  This, and we’ve not yet reached the peak of distribution line replacement needs coming up in the next 20 years.
  • “Austerity” is a lovely buzz word, and “We’d love to do it but we just can’t afford to” is a fine campaign trail stump speech phrase, but these won’t keep the water coming from the tap clean and safe.  We need to stop thinking of our infrastructure as an expense and begin to consider it for what it is – an investment; an investment in the capacity of our cities and towns to provide basic services so that economic activity can take place.
  • And, NO it isn’t a good idea to abolish the EPA.

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Filed under Appropriations, Congress, conservatism, Economy, EPA, Infrastructure, nevada health, Politics, public health, Water