Browsing the blog archivesfor the day Thursday, September 13th, 2007.

Mind the Gap

Family Issues, Health Care

Fascinating information from Eesha Pandit at Reproductive Health Reality Check:

The Alabama Department of Public Health released a report that shows a link between birth outcomes and health insurance, as reported by the Decatur Daily. The report, by the department’s Center for Health Statistics, examined birth certificates for 60,262 live births, and among other things:

    ▪ Infants born in Alabama in 2005 were more than three times likely to die in the first year if their mothers paid for their deliveries out-of-pocket than those with private health insurance;
    ▪ Infants in deliveries covered by Medicaid were 40% more likely to have low birth-weights and 60% more likely to die than infants with private insurance;
    ▪ White women were more likely to have private health insurance than minority women;
    ▪ Medicaid covered deliveries for nearly four out of every five births among teenage girls and 40% of births involving women ages 20 to 34;
    ▪ Private insurance covered nearly 80% of births among women ages 35 and older; and
    ▪ Nearly all women with private insurance received prenatal care within the first trimester, compared with 74.7% of women with Medicaid.

Now whether Medicaid has merely become a marker for things like education, age, race and economic status, is up to debate. What is clear, though, is the fact that these factors do indeed affect access to reproductive healthcare, and that Medicaid is not a sufficient solution for social inequities.

The simple-minded might read this as an endorsement of private health insurance over “government” health care. In April, Erik Eckholm wrote in the New York Times about a rise in the deaths of babies born to poor and mostly black mothers in southern states — Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Focusing mostly on Mississippi, Eckholm said Medicaid patients had a difficult time finding and getting to providers.

But social workers say that the motivation of poor women is not so simply described, and it can be affected by cuts in social programs and a dearth of transportation as well as low self esteem.

“If you didn’t have a car and had to go 60 miles to see a doctor, would you go very often?” said Ramona Beardain, director of Delta Health Partners. The group runs a federally financed program, Healthy Start, that sends social workers and nurses to counsel pregnant teenagers and new mothers in seven counties of the Delta. “If they’re in school they miss the day; if they’re working they don’t get paid,” Ms. Beardain said. …

…In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.

As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.

“The philosophy was to reduce the rolls and our activities were contrary to that policy,” she said.

The outcomes described by Eesha Pandit at Reproductive Health Reality Check speak loudly and clearly — babies born to women who are cut off from decent health care are at greater risk. Eckhold continues,

Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average.

Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)

That racial discrepancy has a lot to do with why the overall infant mortality rate in the United States is high compared to other industrial first-world nations. Eesha Pandit writes,

In a report from Save the Children released this May, entitled State of the World’s Children, 125 nations were ranked according to 10 gauges of well-being — six for mothers and four for children — including objective measures such as lifetime mortality risk for mothers and infant mortality rate and subjective measures such as the political status of women. Among industrialized nations, the US was second to last (ranked only above Latvia).

See also:Haley Barbour, Baby Killer,” “At Least We Beat Latvia.”

Infant mortality in the U.S. has been relatively high for many years. Yet most Americans either don’t know this or dismiss the statistics as fake. We do have The Best Health Care System in the World™, after all.

It’s true that some of the problem with our infant mortality rates can be attributed to different standards in what’s considered a live birth. In a small percentage of births, a birth that would count as a live birth by U.S. medical standards would be considered a stillbirth in other countries, and thus would not count as an infant mortality. But my understanding is that when these births are taken into account, the U.S. doesn’t move up much. What’s really cranking up the death rates of U.S. babies is the high infant mortality rate among the poor, especially the poor and black, in the United States.

There are also significant differences in infant mortality rates among the states. According to a recent release from the Center for Disease Control:

Three years of data (2002-2004) were combined to get specific estimates of infant mortality rates by state, race and Hispanic origin. For the three-year period there were significant differences in infant mortality rates by state, ranging from a rate of 10.32 [per 1,000 births] in Mississippi to 4.68 in Vermont. For infants of non-Hispanic black mothers, rates ranged from 17.57 in Wisconsin to 8.75 in Minnesota. For infants of non-Hispanic white mothers, the infant mortality rate ranged from 7.67 in West Virginia to 3.80 in New Jersey.

As I wrote here, American hospitals generally provide excellent care for newborns. But too many American babies are born prematurely, or with low birth weight or other preventable problems. And many of these problems can be traced to a lack of basic prenatal care.

Today UNICEF declared that the rate of child mortality worldwide has dropped considerably. Happy news. A table showing rates by country 1960-2005 shows a slight drop in deaths of children under 5 in the U.S. also. But all of the western European nations on the list have lower rates, as do Australia, Canada, Cyprus, the Czech Republic, Japan, South Korea, New Zealand, Singapore, and Slovenia. Shit, people, we don’t even beat Slovenia.

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I Don’t Want to Do This

Bush Administration, Iraq War

I’m liveblogging this turkey. I haven’t read the advance speech release. I want to be surprised.

Iraq is surviving for its survival, he says. Well, who the hell’s fault is that? Petraeus and Crocker say the surge is working. The goal of the surge is to provide security. Our success in meeting these objectives allows us to bring some troops home, he says. That and the fact that we’re running out of troops.

He’s bragging about Anbar province again. He’s not mentioning the death of Sheikh Abdul Sattar Abu Risha.

Oh, sorry, he’s mentioning Sheikh Abdul Sattar Abu Risha now, although not by name.

Anbar Anbar Anbar Anbar.

He’s trying ver hard to look sincere. So far I haven’t seen him smile at inappropriate times.

Got this in email:

* This year is worse than last year for U.S. troops – more were killed every month this year compared to the same month last year. See
* Independent investigations by the Associated Press and Los Angeles Times showed sectarian violence is up–not down as Petraeus and Bush have claimed. Bush and Petraeus claim violence in Iraq is down, with 960 civilians dead in August. But AP found 1,809 killed in August, up from 1,760 in July. LA Times found similar numbers, with August worse than July and June.
* As the Washington Post reports, experts “accuse the military of cherry-picking positive indicators” — such as only counting the deaths of people shot in the back, not in the front.
* A USA Today-Gallup poll shows 53% of Americans don’t trust Petraeus to deliver an independent and objective report.

He’s not saying shit we didn’t already know.

He said that people who saw Iraq as central to American security and those who want the troops home have been at odds. Not to He didn’t mention those who realize Iraq is not central to American security.

He still wants a free Iraq. I want a free America.

Now he’s speaking to Congress and asking for their support for Petraeus’s recommendations.

He said freedom is not free. Now I know I have to take a drink.

There’s a dog show on Animal Planet.

Oh good, it’s over.

Jack Reed is giving the Dem response. I don’t think Reed was the best choice. I would have liked to see Jim Webb again.

Reed is making good points, though.

I’m watching on MSNBC, so Olbermann and Matthews are doing post-game. Matthews says Bush said there are 36 other countries fighting in Iraq. I missed that. That’s hallucinatory.

Matthews: Bush said we are kicking ass. If we’re kicking ass, how come there’s no government coming together. No mention of why we should be fighting; just the dangers of leaving.

Olbermann: Nothing like making a bad self-fulfilling prophecy work for you.

Howard Fineman: The president talked about a permanent presence in Iraq.

Pat Buchanan is on saying that the President did what he needed to do, which is what he is paid to say.

Olbermann: The changes in Anbar didn’t have anything to do with the surge.

Rachel Maddow: People in Anbar no longer fear being beheaded. Instead, they fear being blown up.

Olbermann said Bush was supposed to be restrained in his certitude. Was he?

Joe Biden: Both Petraeus and Crocker acknowledged there was no political movement. By the President’s own standards this whole thing has been a failure. He’s just trying to keep the soldiers there for the next administration. Bizarre.

Biden says the speech was an insult the American people.

Matthews: We’re given a picture of a nation that is an ally fighting for its life against al Qaeda. No mention of the insurgence. When you meet with the President, does he live in this world?

Biden, short version: No.

Mike Huckabee is on speaking the GOP party line. And I’m missing a good CSI rerun on ABC for this. Appreciate it.

Here’s John Edwards’s response:

Here’s the rebuttal from the Center from American Progress:

Discuss, if you feel up to it.

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Edwards Buys Ad to Rebut Bush

Democratic Party, News Media

John Edwards has bought two minutes of air time on MSNBC, scheduled to air after Bush’s 15-minute televised speech from the White House at 9 p.m. EDT. Full story here.

I’d like to see a lot more of this, a la Ross Perot’s thirty minute spots he did in 1992, but of course this takes buckets of money. If you would like to help Edwards pay for this, he would like to hear from you. I wish I had TIVO – it’ll be interesting to see if Edwards’ vaunted rhetorical skills on a two minute national platform can shift the debate.

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The Dying Horse

Iraq War, Republican Party

Ryan Grim writes a post for The Politico titled “‘Betray Us’ ad unites GOP, distracts Dems“:

To judge from the wall-to-wall coverage of’s full-page ad in the New York Times Monday, the liberal group strolled to the 18th hole up by two strokes, pulled out its driver and shanked one deep into the woods.

Wow, that sounds like a disaster for the Dems. But wait …

The solidifying beltway consensus is that the ad, which refers to General David Petraeus as “General Betray Us,” was a blunder of the highest order, uniting Republicans and distracting Democrats at a time the party could instead be pressing for an end to the war.

Yes, Virginia, there are two Americas — inside the Beltway, and everywhere else. Outside of blog aficionados, Rush’s dittoheads and the zombies who watch Faux News, did “everywhere else” even notice?

Still, the Right is flogging the dying horse as hard as it can, because at the moment it’s all they’ve got. They can’t attack the Dems for wanting a quicker withdrawal from Iraq, or for being opposed to President Bush’s Iraq policies, because the public is overwhelmingly on the Dems’ side. So they are working as hard as they can to whip up public outrage over the “betray us” ad, attempting to turn it into a weapon of mass destraction.

Right before the midterm elections last year righties tried to turn a badly phrased joke by John Kerry into a national scandal that would tilt the elections in their favor. As former Republican congressman Dick Armey explained on MSNBC’s Hardball (October 31, 2006), “You misconstrue what somebody said. You isolate a statement, you lend your interpretation to it and then feign moral outrage.”

In that case, the feigned moral outrage seems to have persuaded John Kerry not to attempt another presidential run. But Dems won the midterms, anyway.

Steve M:

Rupert Murdoch’s New York Post — which, during Giuliani’s mayoralty, served as City Hall’s second press office — is parroting remarks Rudy is making about Hillary Clinton’s response to the Petraeus dog-and-pony show. Giuliani and the Post are working in tandem to sustain the dissipating outrage about the MoveOn ad, and are desperately trying to tie it to Hillary.

A bit of the Post editorial that Steve quotes —

Clinton not only couldn’t bring herself to criticize it [the Moveon ad], she also attacked Petraeus’ honesty: “The reports that you provide to us really require the willing suspension of disbelief,” she huffed to the general Tuesday

Giuliani, by contrast, had it exactly right.

He called the MoveOn ad “one of the more disgusting things that has happened in American politics.”

Added America’s Mayor: “The failure of the Democratic candidates to really condemn that, given how much money spends on behalf of Democratic candidates, is unfortunate.”

See how it works — so much as criticizing General Petraeus is an outrage. It wouldn’t surprise me of Bush’s speechwriters work an oblique reference to the Moveon ad into tonight’s speech.

Perhaps no one should tell Rudy what other people have said

In sharp contrast to the lionisation of Gen. David Petraeus by members of the U.S. Congress during his testimony this week, Petraeus’s superior, Admiral William Fallon, chief of the Central Command (CENTCOM), derided Petraeus as a sycophant during their first meeting in Baghdad last March, according to Pentagon sources familiar with reports of the meeting.

Fallon told Petraeus that he considered him to be “an ass-kissing little chickenshit” and added, “I hate people like that”, the sources say. That remark reportedly came after Petraeus began the meeting by making remarks that Fallon interpreted as trying to ingratiate himself with a superior.

I predict the Right will continue to feign outrage over the Moveon ad for another week or so, which is about the time it will take for them to realize the horse is dead and nobody cares.

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