Poorly Educated Poor White Women Dying Young

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From a story in The American Prospect:

Everything about Crystal’s life was ordinary, except for her death. She is one of a demographic—white women who don’t graduate from high school—whose life expectancy has declined dramatically over the past 18 years. These women can now expect to die five years earlier than the generation before them. It is an unheard-of drop for a wealthy country in the age of modern medicine. Throughout history, technological and scientific innovation have put death off longer and longer, but the benefits of those advances have not been shared equally, especially across the race and class divides that characterize 21st–century America. Lack of access to education, medical care, good wages, and healthy food isn’t just leaving the worst-off Americans behind. It’s killing them.

The journal Health Affairs reported the five-year drop in August. The article’s lead author, Jay Olshansky, who studies human longevity at the University of Illinois at Chicago, with a team of researchers looked at death rates for different groups from 1990 to 2008. White men without high-school diplomas had lost three years of life expectancy, but it was the decline for women like Crystal that made the study news. Previous studies had shown that the least-educated whites began dying younger in the 2000s, but only by about a year. Olshansky and his colleagues did something the other studies hadn’t: They isolated high-school dropouts and measured their outcomes instead of lumping them in with high-school graduates who did not go to college.

The last time researchers found a change of this magnitude, Russian men had lost seven years after the fall of the Soviet Union, when they began drinking more and taking on other risky behaviors. Although women generally outlive men in the U.S., such a large decline in the average age of death, from almost 79 to a little more than 73, suggests that an increasing number of women are dying in their twenties, thirties, and forties. “We actually don’t know the exact reasons why it’s happened,” Olshansky says. “I wish we did.”…

Researchers have long known that high-school dropouts like Crystal are unlikely to live as long as people who have gone to college. But why would they be slipping behind the generation before them? James Jackson, a public-health researcher at the University of Michigan, believes it’s because life became more difficult for the least-educated in the 1990s and 2000s. Broad-scale shifts in society increasingly isolate those who don’t finish high school from good jobs, marriageable partners, and healthier communities. “Hope is lowered. If you drop out of school, say, in the last 20 years or so, you just had less hope for ever making it and being anything,” Jackson says. “The opportunities available to you are very different than what they were 20 or 30 years ago. What kind of job are you going to get if you drop out at 16? No job.”

If you were to poll folks here in the Piedmont of North Carolina you would find a lot of people who agree with this premise. We're in the midst of a tectonic shift from a manufacturing-based economy to a knowledge-based economy and there are a lot of people who once made a good living with their high school (or less) education who are now struggling to keep their heads above water. Scary, scary stuff.

 

BCBSNC Affordable Care Plan Rates

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Blue Cross Blue Shield of NC released their premium rates for their various Affordable Care Act plans and while the numbers are very general, which makes it impossible to compare directly to your current plan if you have one, and there's also no way of knowing which subsidies you might qualify for until you can plug your income numbers into the formula. Those subsidies will be significant for some people:

Consumers can purchase the same BCBSNC ACA health plans, and access subsidies, from the Exchange or directly from BCBSNC. BCBSNC’s buy online tool facilitates the transaction for those who qualify for a federal subsidy (consumers purchasing their own coverage with income levels between 100 percent and 400 percent of Federal Poverty Level2). The subsidy impact will be significant for some. For example, a person earning 100 percent of FPL could pay $19.15 per month for a Silver plan.

And then there's this tidbit:

ACA health plans generally offer richer benefits than plans many BCBSNC customers choose today, according to the insurer. In addition to requiring richer benefits, the ACA eliminates the use of gender or health status in setting premiums.

At work we have BCBSNC's Blue Options coverage. It's age-banded so every five years the rates go up pretty significantly – for instance when I turned 45 I cost a lot more to insure than when I was 44 – but when I compare my individual rate with the chart of sample plans on the BCBSNC announcement page I see that my premium is more than a 40 year old's platinum plan, but my coverage (70% of cost) is about the same as the silver plan. This leads me to believe that, all things being equal, my individual coverage might be cheaper under ACA than with Blue Options. 

Another factor working against us at the office is that we have a very small group of three families so we have experienced some very steep increases over the last few years as we each breach those five-year age bands. We've been lucky in that our employer has covered our individual coverage premiums – family/dependent coverage is 100% out of pocket – but the only way to continue that each year has been by increasing co-pays and deductibles, and reducing the percentage of expenses covered from 80% to 70%. If the premiums continue to rise at the 10-30% annual rate we've been seeing the last few years then we're likely going to have to start paying a percentage of premiums out of pocket as well.  Combine those increased costs with access to potential subsidies and all of the sudden those ACA rates look more and more appealing, especially if our employer agrees to raises in lieu of health coverage. 

My prediction? Lots of small employers will decide to forego the headaches of administering a health plan and save some money in the process by prodding their folks to utilize the marketplace. That, of course, is exactly what the marketplace administrators want.

ACA Getting Real

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Despite the noise being made from the lunatic fringe of the Republican party about shutting down the government in an effort to force the defunding of the Affordable Care Act (ACA), the reality we're all facing is that the implementation of the ACA is set to begin in earnest over the next couple of months. For those of us who aren't intimately familiar with the effects that ACA will have on our lives there are now a few resources we can access to try and understand where this law is going to take us. Those resources include:

  • The Nevada Department of Insurance's site dedicated to explaining the ACA and allowing folks to get quotes for the various plans available through the state's exchange/marketplace. Obviously the quotes won't apply to non-residents of Nevada, but the general information is useful to non-residents and the pricing should be someone relevant to other states, especially when it comes to subsidies for lower income individuals and families.
  • The Triad Business Journal has an article about Blue Cross Blue Shield of North Carolina's announcement of its rates this coming Thursday and what we North Carolinians will likely be looking at come the October 1 deadline for insurers to make their rates public.
  • The US Census' site that shows how many uninsured there are in NC by demographics, which is a good indicator of how many people will be eligible for coverage and subsidies under the ACA.

While it's nearly impossible for anyone to predict exactly what's going to happen with the implementation of the ACA, it's becoming increasingly clear that major changes in the health care marketplace are afoot. One thing I personally hope to see is that the NC market for health insurance grows more competitive. We've had what is for all intents and purposes a duopoly in this state for years and it would be great to have more viable, competitive insurers to choose from.

 

Forsyth County’s Most Unique Road

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A fascinating post over at the Forsyth County Public Library North Carolina Room's blog explains why Shattalon Drive is Forsyth County's most unique road name:

“Shattalon” is not a legitimate word, rather, “Shattalon” is a unique word, which means that somebody made it up and it is applicable in only one case, to the road in Forsyth County which bears its name. It appears nowhere else in the world…

At that time, the section of road between Robinhood Road and the Yadkinville highway was usually referred to as Flynt Road, because it led to the Flynt land along the Yadkinville road. But he noted the trend that most roads were being named for the activities that occurred along them. Since there were several dairy farms on his stretch of the road, he envisioned it becoming Jersey Road, or Guernsey Road or something like that. But he was a progressive thinker and wanted his neighborhood to project a more modern aura, with a unique road name that everyone would find pleasing to speak.

There were only  eight households on that three mile stretch of road…Sapp, Hines, Adams, Shields, Barnes, Petree, Cartner and Brown, the last three dairy farmers. So he wrote their names and began thinking. He experimented with combining the letters of their last names to find an appropriate name for the road and came up with a unique word, which was adopted…Shattalon…a unique word

His name was Carl Sapp, born in 1905 to Thomas Jackson and Minnie Norman Sapp in the Mount Tabor community of Forsyth County.

 
1927Forsythmap001

Map indicating the road. Source Forsyth County Public Library North Carolina Room blog.

Saving Money By Not Using Health Insurance

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Wall Street Journal piece found via Freakonomics explains how not using your health insurance can save you some serious bucks:

I explained that just because he had health insurance didn’t mean he had to use it in every situation. After all, when people have a minor fender-bender, they often settle it privately rather than file an insurance claim. Because of the nature of this man’s policy, he could do the same thing for his medical procedure. However, had I been bound by a preferred-provider contract or by Medicare, I wouldn’t have been able to enlighten him….

Most people are unaware that if they don’t use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the “list” price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.

So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a “self-pay” (or uninsured) patient. I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasonable upfront cash price for the outpatient surgical/nursing services. He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance.

 

Tubes

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Elon Musk's proposal for whisking people from point A to point B via pneumatic tubes isn't as revolutionary as you'd think. In fact, a New Yorker built a working prototype in 1867 that apparently thousands of people tried. Below is an excerpt from a blog post that looks at the various uses of pneumatic tubes in the 19th century and here's a link to the Bloomberg article about the working prototype:

Interestingly, a pneumatic tube system in London ended up playing a crucial role during the telegraphy era: Undersea signals originating from the US and making it into the UK didn’t have enough oomph left to make it into noisy London, so the telegraphs were printed out on paper and sent into London via the pneumatic tube system. In addition, like with Paris’ extensive system, there were local tube stations in many neighborhoods into which you placed your cylinder. That cylinder could carry messages of course, but it could also carry small physical items as well, including food and even, according to some recorded cases, proposals plus engagement rings. Kind of like a primitive Amazon Prime operating atop of a steampunk Internet system that could deliver physical items!

A Revival of Compassion, Part II

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Earlier this week I wrote a post that was prompted by Rev. Mike Aiken's letter to the editor that calls into question our elected leaders' compassion for the poor. In that letter he wrote:

Congress continues to debate proposed massive cuts to the food stamp program. As a result of a computer glitch at the N.C. Department of Health and Human Services, the demand for emergency food bags more than doubled overnight. With the decision not to extend unemployment benefits, 12,000 Triad families are facing homelessness. In July, Urban Ministry assisted many of these families with more than $52,000 in direct assistance. The decision of our legislature not to accept federal Medicaid funding that would cover an additional 500,000 North Carolina medically indigent residents was a major factor in the decision to close the HealthServe Medical Clinic at the end of August.

Rev. Aiken is the Executive Director of Greensboro Urban Ministry and thus has an up close and personal view of the effects these cuts in government programs are having. His organization is being stretched thin trying to keep up with the increased need, and his isn't the only one. From an opinion piece in yesterday's Winston-Salem Journal written by David Heinen, director of public policy and advocacy for the NC Center for Nonprofits, and Holly Welch Stubbing, senior vice president and in-house counsel for Foundation for the Carolinas:

Sequestration spending cuts may cause members of Congress to assume nonprofits in our communities will always be able to fill the gaps in providing basic safety net programs. The reality, however, is that the ongoing effects of the recession have placed such a strain on nonprofits that many lack the capacity to take on this added responsibility.

The workload of many nonprofits has increased as the number of North Carolinians living in poverty has jumped to nearly 18 percent. In 2011, 93 percent of North Carolina nonprofits experienced an increased need for services, and 58 percent were unable to meet these needs. Two out of every five nonprofits operated at a deficit last year, and one-third had to cut programs or services.

The main point of Heinen and Stubbing's piece was to stress the importance of state and federal governments fully preserving the deduction for charitable contributions as they work on tax reform. They pointed out the stress being felt by nonprofits is extreme due to the increased demand for their services prompted by a still rough employment situation and a reduction in government aid, and they argued that if states and the federal government were to eliminate or reduce deductions for charitable contributions it would truly put the nonprofits in an even more tenuous position. 

Quite frankly we as a society are currently in the position of having to choose between negative options when it comes to the poor and needy: do we help them via government programs, nonprofit programs or some combination of the two? These are negative options because they are reactionary in nature and do nothing to address the root causes of poverty and hunger. Until we address those root issues – jobs, education, out-of-control health care expenses, etc. – our government/non-profit programs will continue to be needed by too many people instead of serving their proper role as a safety net of last resort for the very unfortunate who have hit rough times due to unforeseen circumstances.  Here's the crucial part though: until we do address and resolve those root problems then we must find away to keep people off the streets and my fear is that the programs we have in place won't be able to do it.

On Publishing

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Dana Blankenhorn has an excellent post on the demise of newspapers as we've known them and the future of publishing in general. Here's the money quote:

Your job, as a publisher, remains what it was in the 19th century. Define a market, aggregate both the buyers and sellers, and stimulate financial transactions between them. Publishing is a market-making proposition, and those who create the best marketplaces win. Every time.

These are still the early innings of the online publishing game. The collapse of newspapers is a gift from above, not a plague. It opens up vast new opportunities for people who have learned their business, publishers and editors both.

 

A Revival of Compassion

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*Note* – The following is a personal opinion and has nothing to do with my employer or any other organization with which I'm involved.

The Rev. Mike Aiken, Executive Director of Greensboro Urban Ministry, wrote this letter to the Greensboro News & Record:

In my nearly 40 years of ministry with the poor, I’ve never seen a more desperate time for those in need! If the Great Recession of the past several years wasn’t enough, our government is retreating from a War on Poverty in the 1960s to a War on the Poor today.

Congress continues to debate proposed massive cuts to the food stamp program. As a result of a computer glitch at the N.C. Department of Health and Human Services, the demand for emergency food bags more than doubled overnight. With the decision not to extend unemployment benefits, 12,000 Triad families are facing homelessness. In July, Urban Ministry assisted many of these families with more than $52,000 in direct assistance. The decision of our legislature not to accept federal Medicaid funding that would cover an additional 500,000 North Carolina medically indigent residents was a major factor in the decision to close the HealthServe Medical Clinic at the end of August.

Who will stand up for the hungry and poor? “Lord, when did we see you hungry or sick?” (Matthew 25). We need a Revival of Compassion in North Carolina!

In a conversation I was having with a friend the other day the topic of the food drive organized by the organization I work for came up. Working on that food drive for the last four years has given me a closer look than many folks get at how the system for feeding the hungry works. The sheer volume of food that flows through the network is mind boggling and when you see that scale of need it doesn't take long to realize that it's not something that can be handled solely by the nonprofits out there. This isn't a guess, it's an observation: with reduced government programs people will go hungry. Not "might", "will." 

That same conversation led me to admit that for the first time in a very long while I'm extremely worried about what's going to happen to our community. This isn't hyperbole or some partisan reaction to current affairs. The cumulative effect of all the factors that Rev. Aiken outlines in his letter are going to have an immediate impact on the lives of thousands of people in our community. The burden of providing a modicum of a safety net will now fall even more heavily on the shoulders of the nonprofit community and many members of that community are facing funding cuts of their own. Unfortunately I truly think you'll start to see a wave of closures of those nonprofits as they collapse from a combination of funding cuts and increased demand. If not outright failures, then a reduction in services in an effort to survive. Either way there will be people going without and that's a tragedy.