Thursday, July 5, 2018

Suicide in Rural America

With the tragic celebrity suicides of Kate Spade and Anthony Bourdain, the subject of suicide is again part of the national dialogue. It’s a shame that it takes a celebrity victim (such as from suicide or a drug overdose) to finally call our attention to serious issues like this. Maybe better late than never?

At about the same time that these suicides occurred, the Center for Disease Control and Prevention (CDC) released a study showing that the US suicide rate increased about 25% from 1999 to 2016. This in itself is pretty disturbing. But while the 25% is a lot, it’s much worse than it looks!  For you see, the 25% is just an average across the country.  While some states were lower than the 25% figure, some were higher - much higher. The map below shows a number of states in the 38-58% increase range. The dubious champions were North Dakota (57.6%) followed by New Hampshire and Vermont (48%) and South Dakota close behind (44.5%). There were also a significant number in the 31-37% range. Although Nevada is shown as a slight decrease, its suicide rate was already high to begin with.

There were obviously a number of causes for the 25% overall increase. But with some of the states far above the overall average, those causes were a whole lot worse in those states.  But why? The answers would explain a lot.

So what do the states with the highest suicide rate increase have in common? It looks like these are states with a lot of rural areas.  Furthermore, the states with the worst numbers are not only rural but very sparsely settled. Indeed, the rural areas have fallen on especially hard times. And that is the subject to be investigated here.

Our lifestyles of increasing social isolation are a problem in many places. It is generally agreed that increasing social isolation can lead to trouble in the form of depression and at its worst can lead to suicide. Where people used to get together in groups to interact face to face, communication is now much more through Emails and text messages between our computers and smartphones.  Who hasn’t seen a group of teenagers gather together in a group but instead of talking, will bury their faces in their smartphones texting each other.

Sparsely populated areas will always face special challenges from social isolation whether it’s in the US or elsewhere.  However, there are trends in the US that are making things worse.  With jobs such as in mining, paper mills, and textiles disappearing, new generations of young educated people are leaving the rural areas for the cities which have many more career opportunities, The result is a hollowed out population of mostly elderly who in many cases have difficulty getting around.

The loss of various industries can lead to troubles that are greater than just job loss. Losing one’s livelihood can be crushing, not just financially but from a mental health standpoint. For all too many of us, our jobs are a part of our identity and a way we contribute to society. Once thrown on the proverbial scrap heap, it’s all too easy to conclude we are worthless which can lead to depression (which from personal experience I know all too well) and perhaps ultimately, suicide if help doesn’t come along in time.

But while these losses due to industries moving are fairly well known, less well known is that American farmers are killing themselves in record numbers.  In some states, the farmer suicide rate is even higher than the rate for veterans.

In fairness, farmer suicides are not unique to America.

The US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally: an Australian farmer dies by suicide every four days; in the UK, one farmer a week takes his or her own life; in France, one farmer dies by suicide every two days; in India, more than 270,000 farmers have died by suicide since 1995.

It is well established that severe financial stress can be a trigger to suicide. Farmers’ financial well being often depends on factors beyond their control such as weather and politics.  They have had struggles for years from the reduced prices for the commodities that they sell. Now this situation has been greatly exacerbated by a deliberate decision by the Trump administration to ignite a trade war.

Since April, duties the U.S. has levied on goods from China, Mexico, Canada and the European Union have sparked retaliatory tariffs and trade threats, targeting American farm goods from pork to cheese to apples.
Disquiet among farmers grew in June as crop prices fell thanks to benevolent U.S. weather and additional duties expected from China on products like soybeans, for which it is the U.S.’s top customer. The total value of this year’s U.S. corn, soybean and wheat crops dropped about $13 billion, or 10%, in June, said Chris Hurt, an agricultural economist at Purdue University. On Monday, U.S. soybean prices continued their downward spiral, heading toward the lowest level in a decade.
And once these various countries find other sources for their agricultural food needs these markets may be lost for the foreseeable future.  Mental health resources can help these farmers to cope with the possibility of economic ruin. But...

Mental health resources while sometimes strained in the city can be next to unavailable in rural outlying areas.  And for those without insurance, it’s even worse. And with the opioid epidemic spreading to rural America, sources for treating addiction are often few and far between.

Medical and dental care are problematic as well. Doctors are not attracted to impoverished areas.  Rural America has too few dentists along with few jobs to create paying patients. And as icing on the cake, rural states especially out west under Republican control do not have access to Medicaid because their governors rejected this part of Obamacare.

There have been a number of philanthropic efforts to provide medical and dental care to rural America. Most notable is Remote Area Medical which was founded by Stan Brock to take care of medical needs in the Third World. But after he saw the sorry shape that rural America was in, he decided America was where he was needed most. But he can’t be everywhere. Getting sick and not hot having access to medical care can put a terrible strain on a person.

So can poverty. In the cities, help is often available from organizations that can rely on donations from relatively affluent people. In a rural town where often everybody is poor there is no such help.

And finally, rural areas in general but especially the states in the sparsely populated heartland have a culture where gun ownership is almost universal.  While we all mourn the homicides that often command so much of the news, a lot more US gun deaths are due to suicides rather than homicides.

In the United States, access to firearms is associated with an increased risk of completed suicide. A 1992 case-control study in the New England Journal of Medicine showed an association between estimated household firearm ownership and suicide rates, finding that individuals living in a home where firearms are present are more likely to commit suicide than those individuals who do not own firearms, by a factor of 3 or 4.

So while all of the social isolation and other social problems in rural America may drive people to contemplate suicide, a gun as a handy and lethal way to accomplish the act makes it more likely to happen.
David Hemenway, professor of health policy at Harvard University's School of Public Health, and director of the Harvard Injury Control Research Center and the Harvard Youth Violence Prevention Center, stated:
Differences in overall suicide rates across cities, states and regions in the United States are best explained not by differences in mental health, suicide ideation, or even suicide attempts, but by availability of firearms. Many suicides are impulsive, and the urge to die fades away. Firearms are a swift and lethal method of suicide with a high case-fatality rate.
So we must now ask the question - can anything be done about all of this?  In my humble opinion there is good news and bad news. The good news is that there are solutions to try and address this tragic situation.  The bad news is that at least most of the solutions require money - mainly federal money since many of these states are already strained for resources because of their ideological addiction to tax cuts.  Furthermore, these admittedly liberal solutions would most likely be treated with scorn by these people who need help the most. But nothing is stopping me from making suggestions.

The quickest way to stop the bleeding would be for America to provide universal health coverage, including dental and mental health - just like in the rest of the industrialized world. Philanthropic efforts such as the aforementioned Remote Area Medical along with The Health Wagon are greatly appreciated but are far from a solution. Indeed, many of the patients seen have suffered irreversible damage to their health, A number of them were too far gone to save. In spite of the right-wing rhetoric on Obamacare "death panels" the true death panels are the Republican governors of states who refused the Medicaid expansion part of Obamacare for their citizens for reasons that amount to little more than spite. In addition, the lack of patients with insurance to pay for medical services has led to the closing of hospitals in a number of rural communities, thus depriving them of emergency room care within practical distances. I know - single-payer universal health insurance is little more than a liberal pipe dream with Republicans controlling all the levers of power. But extending the Medicaid expansion to the states without it would be a great help in the meantime - like what recently happened in Virginia.

Help in creating and expanding community centers in small rural towns would help to fight the loneliness often encountered there. Having a place for people to gather in places like this would promote more of a sense of belonging which would in turn discourage suicide. We finance senior community centers in the city where I live.  Why not do the same for rural America?

As for bettering the economic prospects for rural America, there are no easy answers. Attracting prospective employers to a place that has poor medical care and indeed, might not even have a hospital would appear to be hopeless. But our president instilling false hope in the return of lost coal mining jobs is little more than cruel and manipulative. On the other hand, not all industries are contracting. For example, there are more jobs to be had in renewable sources of energy such as solar and wind which are better suited for remote areas. Although the Great Plains has by far the most abundant wind supply, new technology in the way of taller wind turbines may indeed make wind power viable in all 50 states!  The Tennessee Valley Authority was born in 1933 under FDR to provide economic relief to parts of Appalachia, primarily by hydroelectric power.  It is encouraging that they are at least slowly starting to branch out into solar and wind power.

Another issue that is near and dear to liberals like myself is gun control. Just focusing on the area of suicide for now, a study has shown that background checks and waiting periods for gun purchases are associated with lower rates of suicide. Of course not all suicides are by guns. But it stands to reason that not making guns so readily available would save some lives.

Finally, it can be instructive to study countries that have a lower suicide rate to see what they do differently.  Let’s take three bordering countries - Canada, the United States, and Mexico. According to this chart from the World Population Review listing suicides per 100,000, the US ranked 43rd with 14.3 suicides per 100k with Canada close behind at 46th with 12.3 suicides per 100k. Then there is Mexico coming in at 143rd place with only 5 suicides per 100k. What makes this even more remarkable is the crushing amount of extreme poverty in Mexico where according to Wikipedia some 35% of Mexico’s population is living on less than $5.50 a day (compared to only 1 or 2% in the other 2 countries). Clearly financial distress can lead to suicide but why is Mexico an exception here? Here’s a likely explanation: Mexico is known for its close family culture.

Every culture has a unique set of values, traditions and norms. The general culture of Mexican families has a strong foundation in unity. As with any culture, family life is as much individualistic as it is communal.

So while many Mexicans suffer through the same problems coping with poverty, family members have their back so they don’t have to suffer alone unlike many Americans especially in those remote rural locations.

Yes, we do need to invest the resources to fix our shattered safety net. But we must also remember that as humans we have a need to connect to others and to belong. This means reaching out to each other and remembering that we are all in this together. Yes, there will still be suffering. But unlike some others who were not as fortunate, we will want to live to tell about it!

Sunday, March 25, 2018

Is Our Democracy in Crisis?

At first blush, asking whether our democracy is in crisis comes across as negative thinking. But sometimes, there are just those symptoms that grab our attention. For example, if someone sitting next to us started to cough, sneeze, and shiver it would only be natural to ask if that person was feeling well.
When it comes to our democracy, many of us have seen symptoms of something wrong and have questioned its health. Usually, these are just temporary disorders that resolve themselves. After all, our democracy which is protected by our Constitution is a strong one. But to believe it is indestructible may just be a little too much false security.
Many democracies around the world have died or are going in that direction. The reader is encouraged to check out this interesting and informative study done by Freedom House.
Democracy faced its most serious crisis in decades in 2017…
Seventy-one countries suffered net declines in political rights and civil liberties, with only 35 registering gains. This marked the 12th consecutive year of decline in global freedom.
The United States retreated from its traditional role as both a champion and an exemplar of democracy amid an accelerating decline in American political rights and civil liberties.
So what are those symptoms we are seeing that are causing us to question the health of our democracy? Here is an admittedly subjective but by no means exhaustive list.

Especially since the infamous Citizens United Supreme Court decision, big money from often unidentified sources is gaining an ever increasing stranglehold on our electoral process. It has been argued that the ability to give money to candidates is an exercise of free speech. But when candidates accept disproportionally large money donations from various commercial or political interests, it’s not much of a stretch to assume that big donors are calling the shots instead of the voters. Here is just one example. In a recent Quinnipiac Poll an astonishing 97% support background checks for all buyers. With this amount of universal support, it should be a slam dunk for Congress to pass this. But because the National Rifle Association funds so many candidates, the general voters' desires are mostly being ignored.
In a democracy with free and fair elections, a bedrock principle is whoever gets the most votes wins. Not necessarily with the Electoral College which goes back to the original ratifying of the Constitution. Twice in the last 16 years, we have had a president elected with a minority of votes. And it almost happened again in 2004. In essence, some votes count while others don’t. That’s not a real democracy!
There have been many forms of voter suppression over the years. Voter ID laws are the latest. While it all seems legitimate, there is a lot of red tape for people like out of state resident college students and those without driver’s licenses – who by and large tend to vote Democratic. Why do just about all the requests for stricter Voter ID laws come from Republicans? Because it provides them an unfair tactical advantage as openly admitted here.
Gerrymandering has been employed by both Democrats and Republicans through the years. It is about politicians redrawing electoral districts to benefit their own party. In effect, it’s about politicians picking their voters instead of the other way around true to the principles of democracies. The results can be incumbent candidates who are impossible to remove because their parties have unassailable majorities in their redrawn districts. Fortunately, judiciaries are now starting to strike back against this undemocratic practice like recently in Pennsylvania.
Our intelligence community has determined without a doubt that Russia led by President Vladimir Putin made a full assault on our democracy by tampering with our presidential election in favor of Trump and against Hillary Clinton. While we will never know for sure whether this tipped the election in Trump’s favor, with his razor-thin margin of victory, it is entirely possible!  Even worse, we know that Russia intends to tamper with our upcoming 2018 and 2020 elections! The integrity of these elections and our democracy will be greatly in question unless we are able to stop this tampering. Thus far, there has been little effort to do so especially with Trump having been in denial of the tampering.
But perhaps the most egregious sin against our democracy was the stealing of a Supreme Court Justice pick from Democratic President Barack Obama. Although Supreme Court Justices have a lifetime term if they want it, the Constitution as part of its system of checks and balances grants the sitting president the right to choose the Justice subject to the Senate’s approval. When Justice Antonin Scalia died suddenly, President Obama's replacement pick was stonewalled by the Republican majority Senate in hopes that the Republicans would win the upcoming presidential election. When Donald Trump scored his upset victory, he got to install his choice with approval of that same Republican majority Senate on a strictly party line vote. This added insult to injury since Trump was elected while losing the popular vote.
It has been asserted by many going back to Thomas Jefferson that an informed electorate is vital to a strong, functional democracy. This is quite intuitive. Elections are about choices. It stands to reason that without informed choices, the freedom to choose is not necessarily beneficial for a democracy. At its worst, really bad choices can lead to the end of democracies. Retired Supreme Court Justice David Souter had dire warnings in this video which I urge the reader to watch.
There were a number of points he made. But the last one made a particular impression on me. In essence, he said that if the electorate is not aware of the causes of problems that have not been addressed, it is all too easy for a demagogue to ask for (and receive) total power to solve these problems. How prescient! It was less than a month after this talk that a demagogue who said that for all the problems he claimed America to have, they could be fixed “only by me” after which he was given the keys to the government to run with it.
Which brings us to the 500 pound gorilla in the room in the way of President Donald Trump who has far more authoritarian tendencies than any president in our nation’s history. I can outline all the reasons why but can I once again refer the reader to this outstanding video lecture by liberal economist and professor, Robert Reich?
Interestingly, this video which had a number of scary warnings about the authoritarian nature of Trump was produced shortly before his inauguration. Now a little over a year later, I think everything he said was spot on! I urge the reader to watch this video to see if you agree.
Of all of his authoritarian tendencies, the one that is perhaps most disturbing is his relentless turning of truth upside down to where it is presented in the form that was labelled as “alternative facts”.  Meanwhile, any questioning the media had of his version of the truth was brushed aside as “fake news”. The notable exception in Trump’s mind is Fox News which caters to him unconditionally. It has been derided by its detractors as being the closest thing to state-run media America has. Here is a rather amusing video of Fox News in action. And just to make things worse, Trump is now filling a number of his positions in his staff with sycophants, many of them former Fox News commentators. The result will be fewer and fewer restrictions on the impulses of this erratic president.
So we finally return to the question posted in the title. Whether we truly are in crisis is a matter of opinion. But it is a fact that Russia is doing everything possible to undermine our democracy by their meddling in our elections. A democracy is truly in crisis if its citizens begin to seriously question whether we have fair and free elections. We must stop Russia at all costs!
In addition, the media has a special duty to call out Trump to hold his feet to the fire as much as possible. Perhaps our best hope lies in Special Counsel Robert Mueller who is investigating Trump and his staff for possible money laundering and/or illegal collusion with the Russians during the recent presidential election. But as his dragnet comes closer to Trump, there is always the fear that he will fire Mueller which if it happens will almost certainly put us in crisis mode.
Our democracy has survived through a number of mortal threats to it, most notably the Civil War and World War II and to a lesser degree, Watergate. If it survived crises like these, surely we have little to worry about, right? Maybe not! I would like to offer this quotation by Robert Hutchins:
The death of democracy is not likely to be an assassination from ambush. It will be a slow extinction from apathy, indifference, and undernourishment.
I think Hutchins nailed it! Overall, Americans have indeed exhibited a lot of apathy and indifference over our political system. We have one of the lowest voter turnout percentages among democracies in the world. All too many people are just indifferent about the vital political issues of the day. Yes, they are understandably more concerned with work and family. Politics is more for political junkies like me but not for them. The result is a democracy that is running on autopilot. While this may be OK for much of the time, we may veer off course and if we aren’t keeping an eye on things, we may at least stray far off course or at worst – crash!
But I’m going to end this decidedly negative essay on a positive note. The shocking upset victory by Donald Trump and the resulting chaos that followed has served as a major wake-up call for many Americans. Many are now taking to the streets to say that they’re mad as hell! But more importantly, they are registering their dissatisfaction at the ballot box, most recently in the special election in Pennsylvania's 18th congressional district where the Democrat Conor Lamb scored an upset victory in an area so heavily gerrymandered that Donald Trump won this district by over 20 points and the Democrats in previous elections here didn’t even bother to field a candidate!
History has shown that the party of an unpopular president (like Trump) suffers major losses in midterm elections like the one coming up this November. Many Republicans in Congress have seen the writing on the wall and have announced their upcoming retirements from office.
Republicans now control all three branches of our federal government. Political prognosticators are predicting with some confidence that the Democrats will at least retake the House in 2018 which will provide some vitally needed balance of power in Washington until the next election in 2020. But November is a ways off and anything can happen in the meantime!
Let’s not delude ourselves into thinking a single election is going to fix all of the considerable problems our democracy is going through. It would be a step in the right direction, though. If enough of us care to make a difference, then the tide will turn to our elected leaders serving the interests of its citizens and not the other way around. Now that’s what a real democracy is all about!

Friday, December 15, 2017

Still the Party of Big Business and Big Money

Back in a March posting, I wrote that if we were given the exercise of trying to describe the Republican Party in only one sentence, this would be my response:
The raison d’être of the Republican Party is to look out for the interests of big business and big money.
I also called them the Party of Cruel and labelled them as sociopaths.  Even as an admitted liberal partisan, I try to step back and look to see whether my rhetoric is hitting home or is simply over the top. The argument can be made by some that the two major parties both want the same things to serve us all but just want to accomplish them in different ways.
But with the Republican tax cut bills that have recently passed the House and Senate, this naïve argument is being blown up to smithereens!
Of course, tax cuts favoring the wealthy have been part of the Republican playbook going back to Ronald Reagan. The claim has always been that this giveaway to the wealthy results in a 'trickle down' effect that benefits those who are lower in the economic food chain. But this promised trickle down effect has always been proven to be an illusion. The rich keep their gains and the government suffers a shortfall in tax receipts. Then to address the resulting deficits, Republicans then demand cuts in social programs such as food stamps, Social Security, and Medicare. Rinse, repeat.
With this present version, they are at it again. To justify a proposal to cut the corporate tax rate from 35% to 20%, we are told by President Trump and others that the resulting corporate tax savings will result in more hiring and an average wage boost of $4,000.
If you’re going to tell a lie, tell the big lie! Corporations have a fiduciary responsibility to their shareholders to maximize profits. In the past, they have always taken the money and used it for stock buybacks and/or increasing the dividends they pay out to their stockholders. This is good for the corporations and their wealthy investors, but does nothing for the average worker.
In addition, the different bills propose to either significantly cut or eliminate all estate taxes which benefits only the very richest families in America – like not coincidentally, the Trumps. But Republicans love their rich people and don’t seem to care about anybody else.  For example, we have this tone deaf quote from Iowa Republican Senator Chuck Grassley.
"I think not having the estate tax recognizes the people that are investing as opposed to those that are just spending every darn penny they have, whether it's on booze or women or movies."
But what makes this round of tax cuts especially egregious is that tax increases on the middle and lower classes are being proposed to help finance this giveaway to corporations and the wealthy! Even so, this is still being peddled as a middle class tax cut – another example of the big lie! The details behind how the House and Senate bills were put together are a bit too involved to include here. But the interested reader can check this link to learn more.
And just as bad, mainstream economists who have crunched the numbers are forecasting an additional $1 trillion will be added to the US national debt over the next 10 years!
All of this is from a party of proclaimed deficit hawks. For example, some of the more extreme members of Congress would not even agree to relief funds for Hurricane Sandy unless an offsetting budget cut was found elsewhere. A more recent example is the Children's Health Insurance Program (CHIP) which is still awaiting funding because according to Republican Senator Orrin Hatch "we don't have any money anymore."
As to the real reason for the proposed tax cuts, some Republicans unafraid of being voted out by people who don’t know any better have actually admitted that this is all about a payback to their donors.
And with confidence that the tax cut bill will soon pass, there is already talk about cutting welfare, Medicare, and Medicaid spending. Told you so!
House Speaker Paul D. Ryan (R-Wis.) said Wednesday that congressional Republicans will aim next year to reduce spending on both federal health care and anti-poverty programs, citing the need to reduce America's deficit. 
“We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” 
This takes incredible balls. Think about it! Ryan and his fellow Republicans want to give corporations and the wealthy a huge tax cut which will explode the deficit on the backs of the middle and lower classes. And then he wants to cut programs that benefit these middle and lower class people to try and address this same deficit he just created!  For those who are still unconvinced that tax cuts do little more than explode deficits, Kansas served as a “real live experiment” in conservative governance where Republican Gov. Sam Brownback got to cut taxes to his heart’s content just to prove the validity of his right-wing ideology.  The result was little or no growth along with a huge shortfall in tax receipts to the point where Kansas was no longer able to properly fund their public education system. Unlike the federal government, state governments cannot resort to deficit financing so the Republican legislature had no choice but to raise taxes by overriding a veto by Brownback.,
The tax cut legislation still hasn’t made it to the finish line at the President’s desk for signing into law. The House and Senate versions that were passed have some significant differences that are being reconciled so a single bill can be passed again by the House and Senate to be signed into law by the president.
One thing for sure is that the revote in the Senate will again be extremely close. The result may be influenced by the special Senate election on December 12 in Alabama won by Democrat Doug Jones. As is well known, the Republican candidate was Roy Moore, a blatant bigot who has been accused of molesting a number of teenage girls, including a 14 year old while he was in his 30s. While some supporters claim to be unsure of the charges, others who say they believe the charges still supported Moore because his vote in Congress is more important than worrying about sending an accused pedophile to Congress. That’s sociopathic if you ask me!
Recent events have only accelerated Republican efforts to frantically pass this bill. First, with the surprise election win by Jones, the Senate wants to vote on this bill before he is sworn in which would decrease the Republican razor-thin majority there. Secondly, as more details of the tax cut bill are revealed, it is becoming ever more unpopular with the American public, the most recent polls showing only about a 29% approval rating. Earlier this year when Congress was voting on a repeal of Obamacare, many Republicans received a rude reception from angry constituents back home afraid of losing their health insurance. Well, those protests are back! And helping to drive these same protesters is a sneaky provision in the bill to eliminate the individual mandate in Obamacare to recover some of the money given out as part of the tax cuts. Without this requirement for everybody to have health insurance, the stability of the insurance exchanges could be extremely compromised which could have some big effects which may possibly turn out to be a deal breaker for some moderate Republicans.
The Congressional Budget Office (CBO) estimated that repealing the mandate would result in 13 million fewer people being covered by health insurance and would cause insurance companies to raise premiums by 10 percent a year.
You don’t have to believe a liberal like me to see that the Republican Party has become morally bankrupt. Just check out this growing list of Republican politicians and pundits who have either turned on their party and/or President Trump.  
I will close with this recent sample of some of the vitriol coming from many conservative commentators, The G.O.P. is Rotting by David Brooks.
Today’s tax cuts have no bipartisan support. They have no intellectual grounding, no body of supporting evidence. They do not respond to the central crisis of our time. They have no vision of the common good, except that Republican donors should get more money and Democratic donors should have less.
The rot afflicting the G.O.P. is comprehensive — moral, intellectual, political and reputational. More and more former Republicans wake up every day and realize: “I’m homeless. I’m politically homeless.”