Murphy’s Law: H.R. 2646 and Mental Health Services

Bill Yes, the Republicans have been diverting attention from the regulation of firearms in America by switching to speaking of mental health; and yes, there’s a bill in the House (HR 2646) which seeks to address some of the issues raised by mass shootings.  However, it’s not “gone anywhere” fast; and, it’s not a particularly good bill.

The title is nice, “Helping Families in Mental Health Crisis Act of 2015” – some of the provisions are helpful, others may very well not be.  The bill does provide for more sharing of information concerning a person who has gotten treatment for mental health problems. Section 401 allows for caregivers to receive information about diagnoses, treatment plans, appointment scheduling, medications and medication related instructions, but not any personal psychotherapy notes. This sharing is intended to protect the health, safety, or welfare of the individual or the general public. Caregivers would also have access to educational records in Section 402.  There’s a fine line here. On one hand sharing information could (and possibly should) enable the caregivers involved to have a better understanding of the person’s condition and treatment plan. On the other there’s an element of concern about how much information is shared with whom – especially since mentally ill individuals are 11 times more likely to be victims of criminal acts than to perpetrate them.  [MHA]

Assisted, Involuntary, Mandatory?

Then there’s the questionable use of the English language in the term “Assisted Outpatient Treatment.”  It sounds like it would have the emphasis on “outpatient,” but the word that should be emphasized is “assisted,” as in assisted by the courts.  “Assisted outpatient treatment (AOT) is court-ordered treatment (including medication) for individuals with severe mental illness who meet strict legal criteria, e.g., they have a history of medication noncompliance. Typically, violation of the court-ordered conditions can result in the individual being hospitalized for further treatment.” [TAC]  There are studies which indicate the AOT plans in 45 states do help relieve some of the stress on caregivers, and often result in a reduction of hospitalization.  Thus, what we’re really talking about here is mandatory outpatient treatment.  Whatever we call it, “assisted,” “mandatory,” or “involuntary” before jumping to any conclusions we might want to determine if “it” works.

The efficacy depends on how we measure success.  If the criteria include  re-arrest rates, program costs, or crime rates, then the AOT plan appears successful in general societal and economic terms. [TAC] On the cautionary side, the Phelan Study (NYC 2010) included ‘184 people who were in AOT and compared them to a control group recently discharged from a psychiatric hospital and were attending the same outpatient facilities as the AOT group. Both groups experienced similar reductions in psychotic symptoms.’  “The AOT group members were four times less likely to report an incident of serious violent behavior than those in the control group,” which would be good news indeed, except that the AOT wasn’t the sole factor.  The Duke Mental Health Study (Swanson 2000) found “improved outcomes and reduced violence was associated with simply more frequent service visits over an extended period of time (6 months or more).” [PsychCen]  In short, time and treatment were the most significant factors.

And now we’re left with a question:  Is the success of the AOT programs correlated to the coercion element, or is the success of the program correlated to the extension of the treatment services over time?  If the latter, then we’d expect to be allocating more funding to the treatment services necessary.  Another question raised might well be on what basis are we justifying our political decisions concerning the implementation and funding for AOTs?  Are we successful if we reduce policing costs? Institutionalization costs? Or do we measure success in terms of the mental health of the patient?  There is, most likely, a place for AOT in our mental health care system, how much emphasis we want to place on it is a political decision.

Politicians and Policy

“On June 4, Congressman Tim Murphy introduced legislation (HR 2646) designed to dismantle the federal mental health authority – the Substance Abuse and Mental Health Services Administration (SAMHSA) – which has successfully promoted recovery and community inclusion for individuals with serious behavioral health conditions for 25 years, as called for by President Bush’s New Freedom Commission on Mental Health. The bill would replace SAMHSA with a new Office headed by a politically appointed government official, controlled by Congress ….” [MHA]

This is the point at which the two familiar bugbears of politics emerge: Congressional Control and Funding.

“Threats of sequestration in 2013 had a significant impact on people’s ability to access mental health services and programs, including children’s mental health services, suicide prevention programs, homeless outreach programs, substance abuse treatment programs, housing and employment assistance, health research, and virtually every type of public mental health support. The Substance Abuse and Mental Health Services Administration (SAMHSA) claimed it alone would be cutting $168 million from its 2013 spending, including a reduction of $83.1 million in grants for substance abuse treatment programs.” [Forbes]

What hasn’t been cut in Congressional appropriations for mental health care support for the states isn’t faring all that well in the FY 2015 budget.  Sometimes it seems that “block grant” simply means a way to pile the money together and then cut the whole stack.  For example, in FY 2013 the Community Mental Health Services Block Grant program received a total of $437 million, in FY 2014 the figure increased to $484 million, but in FY 2015 the final number is $483 million.  One provision in H.R. 2646 would allow only medical professionals with certain academic credentials to evaluate block grant requests – which sounds very “professional” except when we consider that some substance abuse and alternative programs may be very successful, but aren’t necessarily conducted with the imprimatur of currently medically credentialed individuals – critics have charged that this is a perfect way to “ossify” the field of mental health care and substance abuse treatment.

There is an alternative bill in Congress which does not eliminate SAMHSA, and which shares many of the provisions of H.R. 2646, is S. 1945.  A comparison of the two bills is available here in pdf format.  Whether the administrative situation is changed or not, unless the funding for the programs is enhanced, or at least made equal to the inflation rate, it may not matter much who is administering a smaller portion of an already diminishing pie.

It’s The Money Stupid

Enforced treatment, coerced treatment, “assisted” treatment, or whatever we may chose to call it without addressing the need for “time and treatment;” combined with Congressional micro-management, Presidential politics; and, an underfunded by a block grant system, doesn’t seem like the best approach to addressing mental health services in this country.

First, we need to get some perspective.  If SAMSHA has focused on alcohol and drug abuse it’s probably because as of 2013 we had 17.3 million Americans who were categorized as “alcohol dependent,” and some 24.6 million who had used illicit drugs in the previous month before the 2013 survey. [DAgov]  By contrast, government figures estimate approximately 10 million adult Americans with serious mental illnesses. [NIMH]  The focus issue is only important IF we’ve decided we can afford to address one problem or the other, but not both. Focus isn’t an issue if we decide that we can do two things at once and proceed to tackle both.

Secondly, there most likely is a valid social use for mandatory treatment especially for those who cannot or will not voluntarily cooperate with evidently necessary treatment plans, and whose behavior is such that the individual presents, in the hackneyed phrase, a danger to himself or others.  Further, while patient privacy is a legitimate concern, it should not infringe on the needs of caregivers and others with whom a seriously mentally ill comes in contact.   (While we’re on this topic – why not consider additional funding for local police and law enforcement agencies to allow training in dealing with the mentally ill?  If the motto is “Protect and Serve,” then might not allowing police officers to receive limited but significant information about a patient serve to improve their interaction with him or her.)

Third, it doesn’t make sense to argue for increased institutionalization, on a short or long term basis, if there are inadequate facilities available.  For example, in 2010 Nevada had 302 beds for the mentally ill, which is calculated to be approximately 25% of the total need. [TAC] [see also LVRJ 2013] If part of the solution is AOT, and the coercion element is hospitalization, then the hospital beds need to be available.

Therefore, if we are truly interested in making life safer for the general public (witness: mass shootings by mentally ill individuals) and safer for the mentally ill (who are 11 times more likely to be the victims of crimes), then it should behoove us to consider allocating some resources toward creating a system in which (1) there are adequate and easily accessible mental health care facilities and services, (2) there is adequate funding for mental health care services so that these facilities are maintained and expanded as needed, and (3) we are not overly focused on Silver Bullet Solutions, but willing to advance and develop a spectrum of mental health care services which include a wide range of treatment options.

There are some good portions of both H.R. 2646 and S. 1945, and some definite limitations and foibles exposed in each.  What neither bill manages successfully is to fully fund the mental health care needs of Americans in the 21st century.

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Filed under Health Care, Mental Health

One Great Distraction: Guns, GOP, and Mental Health

blood money The GOP response to gun violence in America is getting tiresome, and no diversion or distraction more so than when its members cite “mental health” as a topic for discussion.

The Republican Party really shouldn’t get anywhere near this distraction, not with their record on making mental health care available to American citizens. [AmerBlg]   It doesn’t do to blather on about Guns and Mental Health in one breath and then take 50+ votes to repeal the Affordable Care Act in the next.

Before the passage of the Affordable Care Act about 1/3rd of those who did have health insurance in the individual market had no coverage for substance use disorder to services, and 1/5th had no coverage for mental health services, including outpatient therapy, and inpatient crisis intervention and stabilization.  Additionally, even when a person did have coverage there was no guarantee mental health services would be covered comparably to medical and surgical care.   The situation in the small group market was a bit better, coverage for substance abuse and mental health services was more common, but many states did not have “parity” laws requiring comparable coverage with medical and surgical treatment.  Then, there were those 47.5 million Americans who didn’t have any health insurance, and the 25% of uninsured adults who have a mental health condition, a substance abuse problem, or both. [ASPE]

After the passage of the Affordable Care Act mental health and substance abuse are categories covered as part of the package of Essential Health Benefits.  With the finalization of rules as of January 1, 2014 consumers buying health insurance policies can be confident that the health plan will cover mental health services, and importantly, that there will be parity for mental health and substance abuse treatment coverage. [ASPE]

And what was the Republican reaction?  “Repeal.. Repeal.. Repeal…” at least 50+ times. [WaPo]  

January 8, 2011:  There was a mass shooting in Tucson, AZ  six were killed, eleven others wounded including a member of Congress, Rep. Gabby Giffords.   January 19, 2011: The House votes to repeal the Affordable Care Act.  On February 19, 2011 the House passed an FY 2011 continuing appropriations bill with several amendments to “severely limit” the implementation of the Affordable Care Act. The measure passed with no Democratic support.  Further votes were taken to carve up and diminish the provisions of the Affordable Care Act on March 3, 2011, April 13, 2011, and April 14, 2011.  On April 14, 2011 a House resolution advised the Senate to defund all mandatory and discretionary spending associated with the Affordable Care Act.  April 15, 2011 the Republican controlled House passed its version of the budget repealing and defunding the Affordable Care Act.  During the four months after the Tucson Shooting the Republican controlled Congress spent much of its time trying to defund, limit, or outright repeal the law requiring health insurance companies to include mental health services as an “Essential Benefit” and on par with coverage for medical and surgical treatment.  And, they weren’t finished.  Republicans tried to gut the Affordable Care Act provisions on May 3, 2011; May 4, 2011May 24, 2011; and on August 1, 2011 the Budget Control Act cut some mandatory and discretionary funding tied to the Affordable Care Act.

October 12, 2011:  Eight people were killed and another critically wounded by a shooter in Seal Beach, California.  Ironically, on October 13, 2011 the House passed the “Protect Life Act” preventing any funding from be applied to abortion procedures.  More Congressional incursions were made on the Affordable Care Act on November 16, 2011, December 13, 2011, and December 16, 2011.  On February 1, 2012 Congress voted to repeal a long term care insurance program (CLASS).  February 17, 2012 the House voted to cut funding for Louisiana’s Medicaid program by $2.5 billion, and cut $11.6 billion including $5 billion from the Public Prevention and Health Fund.  The cut to the Medicaid program was significant because Medicaid is the insurance provider for low income people, some of whom might be in need of substance abuse or mental health care treatment.  On March 29, 2012 the House version of the FY 2013 budget called for repealing and defunding the Affordable Care Act.

April 2, 2012:  A former student at Oakland’s Oikos University opened fire in a classroom, seven were killed and three wounded.  The House attacked the Affordable Care Act again on April 27, 2012, and more significantly voted on May 10, 2012 to replace the automatic budget cuts to the Defense Department by defunding and repealing portions of the Affordable Care Act. June 7, 2012 the House voted to repeal the medical device tax, and limit the reimbursements for over the counter medications.  On July 11, 2012 the House voted to repeal the Affordable Care Act.

July 20, 2012: 12 people were killed and another 58 were injured in the shooting at the Aurora, Colorado movie theater.  Yet again, opponents of gun safety regulations noted that the shooting was the result of mental illness.

August 8, 2012: A shooter gunned down six people and injured three others at a Sikh Temple in Oak Creek, WI.

September 28, 2012: Six were killed and two injured in a workplace shooting in Minneapolis, MN.

October 21, 2012:  Three died and four were injured in a shooting in Brookfield, WI.

December 14, 2012:  Newtown, CT; 27 died including 20 first grade children. On December 20, 2012 the House voted once more to replace discretionary spending cuts enacted as part of sequestration by defunding and repealing several provisions of the Affordable Care Act.  On January 1, 2013 the “fiscal cliff deal” passed the House including the repeal of the CLASS Act and cutting funds for the Consumer Operated and Oriented Plan. 

On May 16, 2013 the House voted to repeal the entire Affordable Care Act. 

June 7, 2013: Five people were killed in a shooting incident in Santa Monica, CA which ended on the campus of Santa Monica College.  On July 17, 2013 the House voted to delay the implementation of the Affordable Care Act for employers by one year.  Also on July 17, 2013, the House voted to delay the implementation of the individual mandate.  On August 2, 2013 the House voted to prevent the IRS from implementing or enforcing any portion of the Affordable Care Act.

September 16, 2013:  12 were killed and 3 injured in a shooting at the Washington, DC Naval Yard.  On September 20, 2013 the House voted to approve a short term FY 2014 continuing resolution in which the Affordable Care Act was fully defunded, including the prohibition of all discretionary and mandatory spending, and rescinding all of its unobligated balances.  On September 29, 2013 the House voted again to repeal the medical device tax, and to delay the implementation of the Affordable Care Act by another year.  September 30, 2013, the House voted to delay the individual mandate, an action which would effectively render the law inoperable.

Votes were taken in the House on October 17, 2013; November 15, 2013; January 10, 2014; January 16, 2014, March 5, 2014 to weaken the enforcement of the Affordable Care Act.  More such votes were taken on March 11, 2014; March 12, 2014; and, March 14, 2014. [LAT]

April 2, 2014: Three were killed, sixteen injured in Fort Hood, TX, scene of a previous shooting in 2009.

On January 28, 2015 Rep. Bradley Byrne (R-AL) introduced H.R 596, a bill to repeal the Affordable Care Act.  The measure passed the House on February 3, 2015. [RC 58]*

May 23, 2015: Six dead, seven wounded in Isla Vista, CA. June 18, 2015: Nine dead at the Emanuel AME Church, Charleston, SC.  October 1, 2015: Nine dead, nine injured in Roseburg, OR.   Meanwhile, the Huffington Post asked Senators what might be done about the carnage:

“If there’s one issue that these senators wanted to talk about when asked about gun violence, it was the mental health component. Nearly all of those who were interviewed said their attention is on that aspect of the problem, instead of on gun laws.

“What I’ve been focused on, and I think it very much relates to, unfortunately, too many of these mass shootings, is improving our early intervention mental health system,” said Sen. Kelly Ayotte (R-N.H.). “Hopefully we can take some immediate action and find common ground.” [HuffPo]

Improving our “early intervention mental health system?”   What appears to be more than slightly inane (if not outright insane)  is to believe that repealing the Affordable Care Act — such that we cannot assure health insurance coverage for substance abuse and mental health problems, on par with coverage for medical and surgical treatment – is going to augment our attempts at “early intervention,” – or for that matter, for intervention at any stage.

Unless, and until, the Republicans are willing to stop trying to repeal the law that requires mental health treatment coverage as part of an Essential Benefit package, and stop attempting to repeal the provisions saying that the coverage must be on par with other medical and surgical treatment benefits, the noise about “doing something about mental health” is just that – a distracting noise.

Unless, and until, the Republicans are willing to put legislation into the hopper (and bring it to the floor for a vote) increasing (1) federal support for mental health care services, and (2)  increasing the number of low income people in the Medicaid program who have access to expanded coverage, then they’ll have to pardon those who say the “mental health” rhetoric is a hollow, shallow, attempt to distract the nation from any serious and substantive discussion of gun violence as a public health issue.

References: Congressional Research Service, “Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act, July 8, 2015. (pdf) Los Angeles Times, Deadliest Shooting Rampages, October 1, 2015.  Washington Post, House has voted 54 times in four years on Obamacare,” March 21, 2014.  AmericaBlog, “Republicans are using mental health as an excuse to do nothing about gun violence.” October 6, 2015.  International Business Times, “Republicans’ Mass Shooting Response Focuses Not On Gun Control But On Mental Health Reform,: October 5, 2015.  Huffington Post, “Despite Mass shootings, Republicans won’t touch gun laws,” October 6, 2015.

*Nevada Representatives Amodei, Hardy, and Heck, voted in favor of H.R. 596.  Representative Titus voted no.

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Filed under H.R. 1591, Mental Health, Nevada politics, Politics, public health

Could we get off their backs? A Rant in several pieces

Teens

I’m going to read about one more piece on “Kids These Days!” and start yanking at my ever-thinning gray hair.  Here’s why:

There’s this argument that the modern social media technology is making them less empathetic.  Less empathetic than what?  Whom?  Than those kids who volunteer to make homeless youngsters’ life a little easier at a D.C. shelter?  Or, the ones who help out at their local library? Or, maybe it’s just the big kid who encourages the little one to join a pickup basketball game?  Sometimes it’s the big issues that count, like teens involved in the prevention of bullying, sometimes it’s the little ones like making sure the little guy gets to take at least one shot.  At any rate they’re all measurably more empathetic than the last lament I heard from an oldster about “they just have kids and then expect everyone else to pay for them.”

We can all figure out who “they” are, it just takes a total lack of empathy to disregard their humanity.

We’re going to hell in a hand basket…just listen to their music. I would, but I’m not all that much into bass. And, besides I still like listening to that music that was going to send us all to perdition a generation or so ago. You know, the stuff with the rolling hips, swinging skirts, rolled arm T-shirts, and steady back beat – that was supposed to be catering to our instincts to dive into the back seat and do …. whatever.   But, but, but, …

THEY are plugged into their headphones and ear-buds!  And, precisely which generation was it that paid close attention to much around them during their adolescent years?  It must have been the one before they put doors on rooms.

Some of them are listening to someone because there are teen groups advocating tolerance, promoting Gay-Straight Alliances, and working for the preservation of voting rights.  Frankly, it’s not the kids who scare me; it’s the elders who pine for the days when they could pat Janie on the butt down at the garage and not get called out for it.  It’s the grumpy goof who who has to “think” before he uses the N-word, previously a much loved epithet in his limited vocabulary. It’s the older person who having gotten through college when tax money supported those institutions now believes that spending money on someone else’s kid is a “waste of taxpayer dollars.”

But mostly, it’s just a tired whine diluted by eons of overuse.

“My grandpa notes the world’s worn cogs
And says we’re going to the dogs.
His grandpa in his house of logs
Said things were going to the dogs.
His grandpa in the Flemish bogs
Said things were going to the dogs.
His grandpa in his hairy togs
Said things were going to the dogs.
But this is what I wish to state:
The dogs have had an awful wait.” [Ask]

Finis.  Meanwhile,  I’ll place my bets on the kids in Michigan who decided to build their own airplane from scratch, and the Texas youngster who created his own digital clock, and all the other ones handing out meals, and clothing, and pamphlets…

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Blood Money and Nevada Politicians

blood money Indeed, it’s time to “politicize” the gun violence issue in this nation; and, it should be done in this election cycle.   The top “gun rights” advocacy groups in terms of money spent on candidates are: (1) The National Rifle Association, which spent $952,252 during the 2013-14 season; (2) Safari Club International, which spent $694,640 during the same period; (3) Gun Owners of America, $270,157; (4) National Shooting Sports Foundation, $169,250; (5) The Ohio Gun Collectors Association, $35,500; and, (6) The Dallas Safari Club, $9,250.  [OpenSecrets]  And now – Who has been collecting some of this money in Nevada?

Contributions from all cycles to date as reported by the Center for Responsive Politics show:

Senator Dean Heller (R-NV) $101,565

Representative Joe Heck (R-NV) $31,415

Representative Mark Amodei (R-NV) $25,765

Representative Cresent Hardy (R-NV) $1,000*

During his 2012 election campaign Senator Heller was presumably pleased to have five contributions from the Safari Club International totaling $6,000. [FEC]   FEC records show more recent money coming into the Cresent Hardy* (R-NV4) campaign from pro-gun sources: there was a $1,000 contribution from the National Rifle Association Political Victory Fund on June 19, 2015, and a $2,000 contribution from Safari Club International on June 30, 2015. [FEC]

Representative Mark Amodei (R-NV2) collected $2,000 from the Safari Club International (6/22/15) thus far in the 2016-2016 season; he collected $2,500 from the National Rifle Association on 9/15/14, $1,000 from the National Shooting Sports Foundation (9/22/14), and $1,000 from Safari Club International on 6/21/13.  The gun lobby was generous to Representative Amodei in the 2011-2012 season as well, with three contributions (8/1/2011) (12/20/2011) (7/27/2012) totaling $4,000 from the National Rifle Association.  Then, he received four more contributions from Safari Club International for $1,000 (8/9/2011) another $1,000 (3/19/2012), a boost of $2,000 (2/4/2012) and yet another $1,000 late in the season (9/8/2012).

Counting

While the politicians were collecting contributions from the pro-gun organizations, the CDC reported 16,121 homicides in the US in 2013 of which 11,208 were attributable to firearms. [CDC] As of 2011, the CDC reported, there were 41,149 suicides in this country, of which 21,175 were attributable to firearms. [CDC]  Worse still, we’re not even sure exactly how many children we’re losing every year to gun violence. [WaPo] [NYT] As close as we can infer is that between 2007 and 2011 an average of 62 children under the age of 14 were accidentally shot and killed each year. This is probably, as the Post pointed out, an undercount. [ERorg.]  The politicians collect more contributions, and the count rises.

Counting is important because the gun violence argument is becoming entangled in the differentiation between causation and correlation.  Gun fetishists will be delighted to find that FactCheck is criticizing one of the President’s recent comments about gun regulation and death rates as not being one of causation. No one appears to be disputing the correlations.  What’s interesting is that the original comment, “states with the most gun laws tend to have the fewest gun deaths” doesn’t seem to imply a causal relationship (or even a near perfect positive correlation of .98)  Perhaps for the purists, he might have expressed it as: “There appears to be a correlation between the efforts of a state to enact and enforce gun safety legislation and a lower overall gun violence death rate.”

Additionally, as the FactChecker points out counting suicides and accidental gun deaths is problematic because we lack a standard reporting system, an issue which muddies the clarity of statistics on accidents involving children as described in the links above.  Accurate information (data collection as in “counting” as accurately as possible) would also allow us to treat gun violence as a public health issue.  [Gupta CNN]

Counting and Will Power

If we go by the numbers, none of us can avoid the No. 1 cause of death until we reach 44 years of age – the heart disease and cancer causation kicks in. Unintentional injury is the leading cause for those aged 1-44.  However, when we look at the second leading cause of death in those between the ages of 15-35 it’s suicide, and the third leading cause is homicide.  [CDC]  Surely, if we have these kinds of statistics before us we can observe a public health issue of the first water.

Consider for a moment: Tuberculosis, Pneumonia, and Gastrointestinal infections were leading causes of death in 1900; in 2010 the leading causes were heart disease and cancer. [I09]  We treated TB, Pneumonia, and gastrointestinal infections as public health problems, studied causes, promoted research to find preventative measures and cures, and made a political decision that we would address these three killers with the funding and resources to defeat them.  However, as long as the merchants of lethal weapons continue to pay off politicians, and dispute even the most common sense elements of a potential solution, and won’t even consider funding basic research … our public health problem will persist as a matter of ill-advised political policy.

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Filed under Gun Issues

I’m Tired: Of Defeatist Gun Glorifiers.

Blood splatter Another week another mass shooting, and yet another round of the old tired clichéd talking points from the defeatist – demoralized – ammosexuals. 

#1.  “Oregon has strict gun safety laws and the incident happened in Oregon, therefore gun laws don’t work.” No matter how many times another state or municipality is inserted into this framework it’s still the southbound product of a northbound bull.    Not sure? Go to this report of a study of the subject.

#2.The shooter was a ___________”  Another dropping of “product.”  I don’t care if the shooter was a bright green aubergine striped believer in the Great Pumpkin.  The shooter was able to secure lethal firepower all too easily and the entities which allowed him to do so are not held accountable in any meaningful way.

#3.It’s the parent’s responsibility to instruct and acculturate their children.”  Yes, and too many have decided on instructing children in the use of firearms without teaching the elements of responsibility thereof and  have begat another generation, some members of which think using a firearm is a way to vent, rage, and settle domestic disputes.  Again – more bull “product.”

#4.  “Banning guns leaves citizens unprotected.”  More male bovine “product.”  Really? Unprotected from what? Criminals? A gun in the home is more likely to be used in a crime, an accident, or a suicide than it will be to protect the Castle.  Need some real information? Try here.

#5.The shooter was mentally ill.”  This piece of “product” usually comes up when the shooter is a white male.  (Other shooters are Black (thugs), Muslim (terrorists) or if brownish (Un-American.)  So, I ask, what was a mentally ill individual doing with a lethal weapon?  Did a parent allow access? Did a store fail to run a background check? Did a private seller not perform due diligence?  Did the state legislature decide that only those who have been adjudicated mentally ill would be precluded from obtaining lethal weapons?

Ok, enough of the NRA publicity points, enough southbound product of northbound bulls.  We can, and should, make every effort to make our country safer.  We will never achieve perfection, but if we listen to the demoralizing, defeatist ammosexuals we’ll never even try.  We can do something:

  • Require universal background checks for firearm purchases. All firearm purchases.
  • Legislate to limit the practice of straw purchases of firearms.
  • Legislate to limit the amount of purchases.  One gun per month seems reasonable.  A person would have every right to purchase guns, just not all at once.
  • Limit the magazine capacity. 
  • Ban the sale of assault rifles.  Soldiers need them, civilians don’t.
  • Keep firearms out of the hands of domestic abusers and stalkers.
  • Fund and assist scientific studies into the causation and effects of gun violence.
  • Repeal liability immunity for gun manufacturers, in short make them as responsible for their product and any other manufacturers.
  • Enact safe storage laws.
  • Pledge to vote against any politician supported by the NRA, the Shooting Sports Foundation, Gun Owners of America, or any other manufacturing lobby promoting the sales of lethal weapons in this country.

If the defeatist, demoralizing, gun enthusiasts want to keep spouting their talking points, want to keep making excuses for doing nothing – fine, however I’m tired of their defeatism, their demoralization, their ranting, and their irrationality.  We cannot achieve perfection, but we can certainly do something to make this country and its citizens safer.

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Fiorina, Lucent, and Lucidity

Fiorina 1 Nevada Republican Party Chair, Michael McDonald, was pleased to post that Carly Fiorina won the National Federation of Republican Women’s straw poll at their convention in Phoenix, AZ last month. [NVGOP]  Gathering 27% to the Hair-Do’s 20% – if that’s to be called a ‘win’ in the sorting of the occupants in the GOP 2016 Clown Car.  There’s another way to sort the candidates, especially those who claim that business acumen is an automatic qualifier for political office. 

Those pundits who have labeled Fiorina “Snarly Failure-ina” are usually referring to her unfortunate tenure – and subsequent Golden Parachuted Escape therefrom – at Hewlett Packard.  However, it’s instructive to go back a bit and start with AT&T.

Twenty years ago AT&T began the process of selling off one of its core assets, the equipment manufacturing division, including Bell Labs the originator of the transistor and a ‘preeminent research outfit.’  The idea was that as a separate entity the equipment division could compete with AT&T competitors and sell its products to flashy outfits like Sprint, Winstar, and PathNet telecom networks.   Fiorina’s star ascended as the head of the group selling gear to “service provider networks.” [Fortune]

The Big Deal in which AT&T spun off Lucent was not without some chickens which would come home to roost later.  There were several clues at the time which projected problems: (1) Lucent was valued at $15 billion at the time of the IPO, but a $21 billion value had been bruited about only a week earlier; (2) its major competitors were Siemens (Germany), Alcatel (France), and Motorola. (3) AT&T loaded the company with $3.8 billion in debt; (4) there were restructuring costs tied to planned major layoffs and Lucent reported a loss of $867 million for 1995 on revenue of $21.4 billion, down from a profit of $482 million and revenue of $19.7 billion for the year before. [LATimes]  And then there was this warning:

Lucent also faces a maturing U.S. market for telecommunications switches. It is making an aggressive push into faster-growing markets in Asia and elsewhere, but it faces tough competition from companies like Alcatel that have long had a powerful international presence. [LATimes]

A bit of history is in order:

“At that time, telecommunications equipment companies had entered a period of unprecedented — and as it would later emerge, unsustainable — growth. Congress had passed a law making it easier for new companies to compete with local phone companies, which had long been de facto monopolies. Households and businesses first connecting to the new-fangled Internet added phone lines and equipment and services, creating a gold rush to build up new network capacity around the world.” [Recode]

For “gold rush” read “financing” for the Qwests and WorldComs and other providers  which had laid far more fiber optic cable and installed way too much capacity, well beyond the needs of the potential customers.  What to do in the service of selling telecommunication switches in a “mature” market – one which was at least saturated if not in the flood zone?

Fiorina administered the practice of “vendor financing” to keep revenues up. There’s nothing necessarily nefarious about this – it was a standard business practice in which Lucent required suppliers to arrange or provide “long term financing for them as a condition to obtaining or bidding on infrastructure projects.” [recode]  When the deals were good, such as the $2.3 billion extended to Sprint, they were very good. But then… there were others of much more questionable obligations. 

It was reported in October 1998 that Lucent and WinStar entered into a $2 billion five year “network pact.” That $2 billion from Lucent was supposed to allow WinStar to expand on an international basis. [IntNews]  The deal didn’t last any five years, it only lasted until WinStar declared bankruptcy in 2001, and sued Lucent for $10 billion claiming that the firm broke its vendor financing agreement. [CompW]  By the time WinStar went under, Fiorina was ensconced at Hewlett-Packard.  WinStar wasn’t the only disaster.

There was also PathNet, a vendor financing deal which made even less sense.  PathNet at least had the sense to notice that first tier cities were all but awash in telecommunications equipment in 1999, so they were going to focus on second and third tier cities for their networks. To this end they secured $2.1 billion from Lucent in vendor financing in February 1999.  [FOonline]  This amount to a company which reported less than $2 million in annual revenue. [recode]  Even using the most generous estimates the company had barely $100 million in equity; it was juggling $385 million in junk bonds at 12.25% interest, and the added $440 million in loans from Lucent only served to jack up the company’s leverage to 8:1. Even higher as they drew more of the loan? [Fortune]

Fiorina has pushed back on the notion she was happy with these short term, dubious deals, however, there’s another side: Lucent at one point predicted annual growth of 17%-22% annually. (1997) [Fortune]  Now, what’s not for Wall Street to love about a 17% annual growth rate? Fiorina may not have been over the moon about the vendor financing deals, but she was determined to rack up big sales. [Fortune]  PathNet filed for bankruptcy in April 2001.

An SEC filing just after Fiorina left Lucent revealed a $7 billion in loan commitments to customers, Lucent dispensing some $1.6 billion. [Fortune]  Why would this be important?  For starters, think Bubble. What the highly questionable home mortgages were to the Housing Bubble, those vendor loans were to the Tech Bubble.  At one point Lucent shares dropped to >$1, and in 2006 the company merged with Alcatel. [Fortune]

So, what do we know?  Fiorina’s tenure at AT&T/Lucent wasn’t much more than that of the Super-Saleswoman who predicted high growth rates and revenues based on vendor financing deals, deals which collapsed as the saturated market finally emerged from behind the curtain of financial manipulation. This isn’t business vision, it isn’t even lucidity – it is merely chasing a fast buck.

References and Recommended Reading:  Linda Rosencrance, “Winstar files for bankruptcy, sues Lucent for $10 billion, Computerworld, April 18, 2001. Staff Report, “AT&T Spinoff Lucent Makes Historic IPO,” Los Angeles Times, April 4, 1996. Scott Woolley, “Carly Fiorina’s troubling telecom past,” Fortune, October 15, 2010. Arik Hesseldahl, “Time to revisit Carly Fiorina’s business record before HP?…” Recode, August 30, 2015.  Jeffrey Sonnenfeld, “Why I still think Fiorina was a terrible CEO,” Politico, September 20, 2015.  Glenn Kessler, “Carly Fiorina’s misleading claims about her business record, Washington Post, May 8, 2015.  Andrew Ross Sorkin, “The influence of Fiorina at Lucent, in hindsight,” New York Times, September 21, 2015. Julie Bort, “Yale Professor on Carly Fiorina’s business record: She destroyed half the wealth of her investors yet still earned almost $100 million,” Business Insider, September 16, 2015.

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Filed under Economy, Politics

Dean Heller’s Immoderate Vote

Heller Goo1

Once again, Nevada junior Senator Dean Heller gets stretched out into Immoderate territory in Senate votes this week.  On September 22, 2015 Senator Heller voted in favor of the unscientific and pretty thoroughly politicized “Pain Capable…” forced birth bill (H.R. 36) [roll call 268]

Senator Dianne Feinstein (D-CA) explained the opposition to the bill by noting it is  (1) unconstitutional because it bans abortion procedures before a fetus is medically considered viable and it does not include exceptions for a situation in which a woman’s health in endangered – both elements contradict Roe v. Wade and other precedents.  [RealityCK]

Senator Susan Collins (R-ME) added: “Do we really want to make a criminal out of a physician who is trying to prevent a woman with preeclampsia from suffering damage to her kidneys or liver, or having a stroke or seizures?” said Sen. Susan Collins (R-ME). “Do we want the threat of prison for a doctor who knows that his pregnant patient needs chemotherapy or radiation treatments?” [RealityCK]

For those unfamiliar with lady parts and how they function (which unfortunately seems to include a majority of Republican men in Congress) let’s note that preeclampsia generally occurs after 20 weeks, and one of the first signs is an increase in the woman’s blood pressure.  There is one and only one cure for preeclampsia – the delivery of the fetus. [MayoClinic]  The decisions made by the woman and her physician are going to be really tough at this point. 

The delivery has to happen before damage to the kidneys or liver becomes permanent – or fatal.  What happens to the fetus is problematic.  The usual assumption of viability in the U.S. is 24 weeks of gestational age.  Less than that gestational age and the fetus will likely not be physically mature enough to survive into the neo-natal period and achieve the capacity to be an independent human being. [NCBI]  However, there is another factor which isn’t biological.  The technology must be available to sustain the fetus delivered this early.  For example, even in developed western European countries such as Portugal the age of assumed viability is higher than in the U.S. [NIH]

What makes Senator Heller’s position so radical is his vote to criminalize the efforts of a physician who is confronted with preeclampsia in a pregnant woman after 20 weeks into the pregnancy – when the condition most often appears – and his assumption that all pregnant women and their physicians have access to the kind of neo-natal technology associated with a neo-natal intensive care unit.  And, not just any neo-natal care unit, in cases of extremely pre-mature infants we’re talking about Level III care capacity.

Now scroll through the Nursing Institute of Nevada list of hospitals and their technical and staff capabilities.  Two list Level II nursery care, six list Level III facilities – and they are all located in either the Las Vegas or Reno area.  Treating preeclampsia outside one of Nevada’s two metropolitan areas requires all the emergency training and equipment for the most extreme emergencies.

As if the situation weren’t complicated enough, preeclampsia’s early symptoms – headaches, nausea, plus aches and pains are all things that happen in a normal pregnancy.  However, when the headaches are severe, there’s blurred vision. severe abdominal pain,  and  shortness of breath – it’s time for the emergency room. [MayoClinic]   The condition occurs in about 5%-8% of all pregnancies, and can appear at any time during pregnancy, delivery, and up to six weeks post-partum, although it most frequently happens in the final trimester. [PreecOrg]

It would be very useful if more Republican men knew that a pregnancy involves more than having a wife who reacts to certain smells, and  has trouble with shoe laces, in addition to the general knowledge that it’s a good idea to keep the gas tank filled in the family wagon.

The radical forced-birth crowd in the U.S. Senate seems not to understand that their anti-abortion grandstanding has implications in the real world in which not all pregnancies are trouble free, not all women and infants have immediate access to the very latest technology and medical expertise, and not all complications in pregnancies take place conveniently before some artificially established gestational age.  It’s too bad Senator Heller has joined this herd.

Recommended reading for Republican men: “Frequently Asked Questions,” Preeclampsia Foundation. “Familial Occurrence of Preeclampsia,” National Institutes of Health, NCBI. “Late Pregnancy Complications,” Patient.Info. “Preeclampsia,” Mayo Clinic. “Medline Plus: Preeclampsia,” NLM, NIH. “Preeclampsia,” WebMD.

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Filed under Health Care, Heller, Nevada politics, Politics, Republicans, Women's Issues