Can Obamacare Be Saved?

The Republican plan, as I understand it, is to pass a law repealing Obamacare as soon as the next Congress is called into session. However, sniveling weasels that Republicans are, the law won’t go into immediate effect. They’ll put the end date sometime after the 2018 midterms, of course.

The latest is that Republicans will repeal Obamacare right away in January using a process called budget reconciliation, which lets them repeal budgetary items with just 51 votes in the Senate. Then, Republicans will enact a self-imposed deadline roughly three years from now before they have to pass a replacement plan. How much of the existing Obamacare elements will limp along until then remains unclear, and whether you can repeal some but not all of Obamacare without causing it to collapse is a big open question.

But such a scenario also creates a self-imposed crisis that Republicans hope will pressure Democrats into coming to the negotiating table down the road. This is where clarity is crucial. Three years from now, it’s not the Democrats’ crisis. It’s a Republican one. There is no health care cliff, Obamacare doomsday, congressional-health-care-death-spiral apocalypse unless Republicans create one by repealing Obamacare without a replacement plan.

And they’ve never been able to come up with a replacement plan. Time and time again they claim to have done so, but that plan always falls apart under scrutiny, forcing them to come up with another replacement plan.

The biggest bite to any Republican so-called plan always is that they can’t cover people with pre-existing conditions without either a mandate for everyone to buy insurance (which, of course, in their minds is Evil) or without putting uninsurable people into high-risk pools, which have been tried in several states and just plain don’t work.

And if they eliminate the mandate but keep the pre-existing condition requirement, the costs of policies would more than skyrocket. It would set the health insurance industry into chaos. See “Why Keeping Only the Popular Parts of Obamacare Won’t Work.”

But the real bite is that the guy Trump wants to head Health and Human Services is a five-alarm whackjob. In his perfect world, only young, healthy people (and the very rich) would have insurance and the rest of us would just be required to suffer and die.

Rep. Tom Price (R-GA), President-elect Donald Trump’s pick for health and human services secretary, already has a plan for how to abolish Obamacare. …

…Price will arrive at HHS with a clear blueprint for what comes next. He is the author of the Empowering Patients First Act, one of the most thorough and detailed proposals to repeal and replace Obamacare. …

… It would replace the law with a plan that does more to benefit the young, healthy, and rich — and disadvantages the sick, old, and poor. Price’s plan provides significantly less help to those with preexisting conditions than other Republican proposals, particularly the replacement plan offered by House Speaker Paul Ryan (R-WI).

The biggest cut to the poor in Price’s plan is the full repeal of the Medicaid expansion, a program that currently covers millions of low-income Americans, which Price replaces with, well, nothing.

I caught a few seconds of Paul Ryan’s interview on 60 Minutes yesterday, before I was able to change the channel. Ryan assured America that Obamacare would be replaced by “Patient-centered healthcare that gets everybody access to affordable healthcare coverage, so that they can buy whatever they want to buy.” And I want a pony, too.

But now the Republicans will have to put up or shut up, and they can’t do it. Whatever they do is going to hurt a lot of people.

So they’ll make a big show out of repealing Obamacare, except most likely it will still be in effect — mandate and all — for the next three years or so. But it’s possible enough of the whackjobs — like Tom Price — will insist on taking it apart sooner, which will cause widespread disaster and lots of suffering.

Stuck With the Bill

Seems to me the Epipen scandal pretty much exemplifies most of what’s wrong with America. Consider:

The Epipen is epinephrine inside  a fancy delivery system.  According to Raw Story, the delivery system was developed by the military on the taxpayers’ dime.  If this is true, one wonders how the pharmaceutical corporation Mylan got an exclusive patent on the thing. If taxpayers developed it, why isn’t it in public domain?

For that matter, EpiPen has been on the market since 1977. Why hasn’t anyone else come up with a competitive product? The only alternative, as I understand it, is to get a vial of epinephrine and a syringe and inject it the old-fashioned way. That might not be practical for some people with extreme allergies that might strike at any time, especially for children.

Epipen’s list price soared to $608 per pack, from about $100 in 2007. Of that, the corporate vampire squid Mylan makes $274. The rest goes to wholesalers, insurance companies, retailers and “pharmacy benefit managers,” whoever they are. Sounds like a whole lot o’ gouging going on.

Note that Mylan has made no significant changes to the Epipen for years. They raised prices, mostly over the past three years, because they expected a generic competitor to come on the market next year, but in fact the FDA did not approve the competitor. So Mylan still has a monopoly.

And there’s this: “For years, Mylan Pharmaceuticals has been selling the devices to schools at a discounted price, giving them a break from rising costs. But the program also prohibited schools from buying competitors’ devices — a provision that experts say may have violated antitrust law.”

And there’s this: “While Mylan was jacking up the price of the pens over the last nine years, making them nearly unaffordable for many patients, the company’s CEO, Heather Bresch, saw her total compensation package go from around $2.5 million when she was the company president to just shy of $19 million in 2015. ”

To add insult to injury, a couple of years ago Mylan re-incorporated in the Netherlands to save itself from paying U.S. taxes, but it’s still mostly located in the U.S.

In most civilized countries this sort of thing doesn’t happen because governments exercise price controls on medicines and medical technology. Companies can make a profit, but only so much profit.  People have been buying Epipen packs for about $100 in Canada, I understand.  Here, as you probably know, Medicare is prohibited by federal law from negotiating lower prices with pharmaceutical companies. Because it’s all about the profits.

More Lives That Matter

The United States has among the highest rates of infant and maternal mortality in the developed world. Worse, according to official statistics, the rate of maternal mortality in the U.S. has shot up in recent years, even as the rate is going down just about everywhere else

(Maternal mortality rate refers to the number of women who die as a result of pregnancy and childbirth per 100,000 pregnancies/births. Infant mortality rate refers to the number of infants per 1,000 births who die between birth and their first birthday.)

Maternal mortality has jumped from 7.2 in 1987 to 18.5 in 2013; I understand the U.S. is roughly tied with Iran and Hungary in the maternal mortality department. And keep in mind that those numbers are averages; some states are not that bad, and some are worse.

However, a recent article in Scientific American argues that the maternal mortality rate really isn’t going up; it’s always been that bad, and we just didn’t know it.

Until relatively recently most states relied on a death certificate form that was created in 1989. A newer version of the form, released in 2003, added a dedicated question asking whether the person who died was currently or recently pregnant—effectively creating a flag for capturing maternal mortality. Specifically, this recently introduced question asks if the woman was pregnant within the past year, at the time of death or within 42 days of death.

The addition of this question means that the apparent increase in maternal mortality in the U.S. “is almost certainly not a real increase. It’s better detection from the new certificates,” says Robert Anderson, chief of the Mortality Statistics Branch with the CDC’s National Center for Health Statistics. “The numbers are going up but it’s most likely not because women are more likely to die,” he contends.

In other words, maybe the problem isn’t getting worse; it’s just that the way we used to collect data camouflaged how bad things were before. That’s so … not a relief. However, other researchers quoted in the same article think there is an increase that can’t be entirely accounted for by the change in data collection.


One aspect of maternal mortality that has not changed over the years is the extent to which it varies by race. The risk of maternal mortality has remained about three to four times higher among black women than white women during the past six decades. Since 1999 maternal mortality has climbed among both black and white women—potentially due to those changes in death certificates and also how deaths are now coded in the U.S. using the ICD-10. Yet even with the cross-race increases in deaths related to pregnancy, in 2007 the maternal mortality rate for black women was still nearly three times higher than the rate for white women.

Researchers have shown that black women are not inherently more likely to have underlying pregnancy complications. Indeed, one national study that looked at five major common causes of maternal death and injury that collectively account for more than a quarter of all pregnancy-related deaths found that black women did not have a significantly higher prevalence than white women of those conditions—preeclampsia, eclampsia, obstetric hemorrhage, placental abruption and placenta previa. Yet black women were two to three times more likely to die than white women with the same complication.

Increased poverty and stress are an obvious reason why black mothers are at increased risk, IMO, but the medical science guys who look at this stuff aren’t persuaded that’s the entire story.

Whatever the cause, the data tell us that a lot of women die in the U.S. who would have lived had they gone through pregnancy and childbirth in any of about 50 other countries, including Estonia and Qatar. And a disproportionate number of those women are African American, and nobody knows why.

There are huge differences from state to state, for that matter. Maine has a maternal mortality rate of 1.2, according to data aggregated from the Center for Disease Control. Michigan has a rate of 21.0. The District of Columbia is even worse — 38.2. We’re in Third World territory with that number.

Similarly, the United States lags behind most of the developed world in infant mortality, and a disproportionate number of those infants also are African American. Conservatives for years have dismissed the data with claims that these are mere reporting anomalies. If an extremely premature infant dies immediately after birth, for example, it’s usually counted in the infant mortality data in the U.S. but would not be counted as such in some other countries.

An article in the Washington Post from September, 2014 blows that argument out of the water

Despite healthcare spending levels that are significantly higher than any other country in the world, a baby born in the U.S. is less likely to see his first birthday than one born in Hungary, Poland or Slovakia. Or in Belarus. Or in Cuba, for that matter. …

… One factor, according to the paper: “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries. Since survival before 22 weeks or under 500 grams is very rare, categorizing these births as live births will inflate reported infant mortality rates (which are reported as a share of live births).”

Oster and her colleagues found that this reporting difference accounts for up to 40 percent of the U.S. infant mortality disadvantage relative to Austria and Finland. This is somewhat heartening.

But what about that other 60 percent?

“Most striking,” they write, “the US has similar neonatal mortality but a substantial disadvantage in postneonatal mortality” compared to Austria and Finland. In other words, mortality rates among infants in their first days and weeks of life are similar across all three countries. But as infants get older, a mortality gap opens between the U.S. and the other countries, and widens considerably.

See the chart in the article. We’re not losing newborns as much as we are losing infants from one to 12 months old, and the gap widens as the infants get older. It appears many babies are dying in the U.S. who would have lived if they’d been born in Finland. And the biggest factor seems to be income; in the U.S., babies born into poor families die a lot more often than babies born into wealthy families. There also are big discrepancies from one state to another.

The U.S. rate of 6.1 infant deaths per 1,000 live births masks considerable state-level variation. If Alabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings. Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain.

Needless to say, a disproportionate number of those poor families are African American. I couldn’t find raw numbers, so I don’t know how many African American women and babies die what must be preventable deaths in the U.S. every year. Maybe someone else can find that number. I don’t know how many White, Native American, Asian American and Latina women and their babies die, either. In 2013 about 800 women of all races died of complications of pregnancy and childbirth in the U.S., and if you have the data and can do math better than I can perhaps you can figure it out. I found no raw numbers of babies who die before their first birthday, just the rates.

The bottom line, though, is that access to health care, including reproductive health care, is a life and death issue for American women. And our lack of attention to this problem is a national disgrace. Yet instead of addressing it we’ve been manipulated into a phony controversy about Planned Parenthood. Really disgusting.

King v. Burwell Update

The Story Thus Far: The Supremes are expected to hand down a decision in King v. Burwell this month or the next.  If the Court sides with the plaintiffs, the subsidies for health insurance purchased through exchanges would be eliminated in 34 states, causing about 7.5 million people to lose coverage on the spot. The decision could bring about the catastrophic failure of the ACA.

Republicans are angry with the White House for not creating a “Plan B” to make some provision for the 7.5 million. Of course, if Republicans in Congress gave a hoo-haw about the 7.5 million, it would be the easiest thing in the world to simply amend the ACA to make it clear the law will provide subsidies to all states whether they created their own exchanges or not. The House has managed to vote to repeal Obamacare more than 50 times already, after all; they could divert their attention to a simple fix.

There is an ongoing debate whether a decision to strike down exchange subsidies would hurt Dems or Republicans worse. In a sane world it ought to hurt Republicans, but many have pointed out that voters in the affected states probably don’t know doo-doo from doughnuts — else they wouldn’t be saddled with a bunch of loser wingnuts in state government — and would blame Democrats when their premiums are jacked up.

Anyway, the White House position is that any justice who votes to end exchange subsidies would be a political flunky and damnfool idiot, and they’re banking on at least five justices not being damnfool idiots. We’ll see. But the White House is making no plans.

Republicans are making typical Republican-type plans, which means they are trotting out hazy concepts that won’t work but can’t come up with anything concrete. Jonathan Cohn explains the problem:

Republican leaders in Congress have been promising to craft a detailed Affordable Care Act alternative ever since President Barack Obama signed the law in March 2010. But while Republicans have found time to vote on repealing the health care law more than 50 times — and have worked hard, as they did on Tuesday, to pass modifications that would benefit powerful special interests like the medical device industry — they’ve yet to move a single Obamacare alternative through committee and to the floor. Nor has any committee with relevant jurisdiction held even a single hearing on how to handle the aftermath of a potential Supreme Court ruling that wipes out tax credits in two-thirds of the states.

(For a thorough and thoroughly amusing chronicle of past GOP promises to craft Affordable Care Act alternatives, see the summaries from HuffPost’s Jason Linkinsand Jeffrey Young.)

Republicans’ history of promising and then not delivering comprehensive health care legislation — a history, after all, that goes back decades — hints at a deep, fundamental disagreement with the entire idea. Republicans will talk up the importance of helping people with pre-existing conditions or providing financial assistance to people for whom insurance is too expensive. But creating a truly universal coverage system — in which everybody has access, regardless of income or health — requires taking steps that many conservatives simply can’t abide.

Specifically, universal coverage requires some combination of regulation, taxes and redistribution (from healthy to sick, and from rich to poor) that Republicans tend to find economically destructive, morally noxious or both. That’s true of wholly nationalized, single-payer systems like you find in France or Taiwan. It’s true of universal schemes of regulated private insurance, like they have in the Netherlands, Singapore and Switzerland. It’s even true of programs in the U.S. that have existed for a long time — not just Medicare but also, to some extent, employer-sponsored insurance.

But rather than admit that they cannot come up with a comprehensive health care plan that will actually work, they engage in a sort of legislation theater in which they toss out talking points about Health Savings Accounts (which only work for relatively healthy people with lots of disposable income who need tax shelters) or propose providing subsidies in exchange for killing the mandate (which would cause private insurance companies to pull out of the exchanges). Some of them are still talking about high-risk pools, which have been tried and which consume tax dollars the way a black hole obliterates matter.

But at the state level, some officials are beginning to panic.

Tonight the Wall Street Journal has a fascinating look something we may soon hear a lot more about in a very rushed and chaotic fashion. Last month, an outfit called the Milbank Memorial Fund (as best I can tell a relatively non-ideological foundation focused on health care policy) held a secret one day meeting in Chicago for officials from states who may suddenly find their citizens cut off from Obamacare health care insurance subsidies because of the new GOP challenge to the law.

The verdict. Basically that they’re screwed.

This doesn’t necessarily mean that the Republican legislators in those states are likely to do a damn thing, even if there were a damn thing they could do. However, there’s talk that some state governors might find some work-around that would allow the subsidies to continue, like declare that their exchange is a state exchange, dammit, even if the federal government created it. Maybe they could set up some shell site interface to the federal exchange and call it a state exchange. Whatever.

All I can say right now is that I’m glad I live in New York, which has its own exchange.

The Further Adventures of Gov. Sam Brownback

Adding to the rolling disaster that is Kansas, Gov. Brownback somehow decided that raising taxes on HMOs would be just the thing to close the state’s budget gap. This is not going well.

According to The Wichita Eagle, leaders at Aetna are warning lawmakers that if Brownback’s proposal goes into effect the healthcare company would be hit with $12 million in additional taxes and add $206 to an average HMO insurance policy holder’s bill. Brownback’s proposal is currently awaiting approval in a House-Senate conference committee.

Seriously, what was he thinking?

Specifically, Brownback is looking to raise a “privilege fee” on annual HMO premiums which is currently at 1 percent. Brownback wants to raise it to 5.5 percent in order to bring in $136 million in new revenues. The $136 million would then be used to replace $80 million in state funds currently going to Medicaid, according to the Eagle. Kansas officials argue that the tax has to go to all HMO companies that offer Medicaid through Kansas’s KanCare program.

And yes, of course Brownback refused to expand Medicaid through the ACA, which would have taken care of the Medicaid problem without Kansas citizens haven’t to suffer for it. Why would we expect anything else?

On Monday, new Kansas revenue estimates projected a $400 million deficit for the 2016 fiscal year. That deficit is projected to grow to near $500 million if lawmakers don’t pass new insurance taxes.

“Conservatives” seem to think that if they can find some magic formula regarding taxes and budgets that costs will just go away. But some costs don’t go away. You can manage them stupidly or smartly, but they aren’t going away, and shifting who has to pay for stuff is not making the cost go away.

Elsewhere: Be sure to read “I am a cook in the US Senate but I still need food stamps to feed my children” and “Conservative Republicans Alone on Global Warming’s Timing.”

Does the GOP Fear the Fallout from King v. Burwell? (Updated)

SCOTUS will hear the King v. Burwell case on March 4. This is the case in which it is alleged that states that did not set up their own exchanges under the Affordable Care Act cannot offer federal subsidies to people buying insurance through the federal exchange. The New York Times editorial board says of this,

On Wednesday, the Supreme Court will hear oral arguments in one of the most anticipated cases of the term: King v. Burwell, a marvel of reverse-engineered legal absurdity that, if successful, will tear a huge hole in the Affordable Care Act and eliminate health insurance for millions of lower-income Americans — exactly the opposite of what the law was passed to do.

Even an idiot ought to be able to understand that the primary point of the exchanges is to facilitate people buying individual health policies that can be subsidized. I suspect even some Republicans realize this.

The suit is based on one ambiguously worded sentence in the ACA. In a subsection of the law dealing with tax credits, the ACA describes exchanges “established by the states.” The authors of the bill say this was a vestige of the original assumption that the states would set up their own exchanges. It wasn’t anticipated that so many would refuse to do so. But the Burwell challenge hangs on  those four words — established by the states.

The challengers did not innocently happen upon these words; they went all out in search of anything that might be used to gut the law they had failed to kill off once before, on constitutional grounds, in 2012. Soon after the law passed in 2010, Michael Greve, then chairman of the Competitive Enterprise Institute, which is helping to finance the current suit, said, “This bastard has to be killed as a matter of political hygiene. I do not care how this is done, whether it’s dismembered, whether we drive a stake through its heart, whether we tar and feather it and drive it out of town, whether we strangle it.”

After the challengers found the four-word “glitch,” as they initially called it, they worked backward to fabricate a story that would make it sound intentional. Congress, they claimed, sought to induce states to establish exchanges by threatening a loss of subsidies if they did not. (Not coincidentally, the challengers also traveled state to state urging officials not to set up exchanges, thus helping to create the very “crisis” they now decry.) Of course, if Congress intended to introduce a suicide clause into a major piece of federal legislation, it would have shouted it from the mountaintops and not hidden it in a short phrase deep inside a sub-sub-subsection of the law. So it is no surprise that no one involved in passing or interpreting the law — not state or federal lawmakers, not health care journalists covering it at the time, not even the four justices who dissented in the 2012 decision that upheld the Affordable Care Act — thought that the subsidies would not be available on federal exchanges.

So, the purpose of Burwell is to kill Obamacare, and if SCOTUS decides for the plaintiffs, it might very well succeed. The Kaiser Family Foundation estimates that if the states without their own exchanges lose subsidies, 13,402,890 Americans who ought to be insured by 2016 will lose out. And the entire law could quickly unravel for everyone, as the health insurance industry is thrown into chaos. I understand roughly 9 million people would lose their insurance almost immediately.

The immediate fallout from a decision for the ACA challengers would, therefore, be chaos and devastation, and the long-term consequences potentially even worse. The ripple affect could impact just about everybody, and probably not in a good way.

 This past week Republicans in Congress seemed almost frantic in demanding the Obama Administration reveal their “Plan B” to the world. What will they do to save the ACA if the subsidies are struck down in so many states? And the Administration has said, over and over, there is no Plan B. If the subsidies are lost, there’s not a whole lot that can be done to salvage anything.

But rightie media are not accepting this. The Administration is hiding Plan B. HHS denies it is preparing Plan B. The Administration won’t say it is preparing Plan B. (Actually, it plainly says there isn’t one and none are in the works.) But there must be a Plan B! How could there not be a Plan B? Of course there is a Plan B, and congressional Republicans demand to know what it is.

Smart money says all this posturing is trying to signal the Court that the actual fallout of a decision for the challengers wouldn’t really be that bad; the Administration has a Plan B! Also, when the dominoes start crashing and people find themselves cut off from health care again, they are prepared to point to the White House — See? They should have had a Plan B. It’s their fault.

Republicans also have proposed a Plan B, although no one who knows anything about health care insurance thinks it will work. And a whopping majority — 64 percent — of Americans think that if SCOTUS rules against the subsidies, Congress immediately should step up and reinstate them. Which Republicans in Congress have no intention of doing.

Which makes me think that at least a few Republicans are genuinely nervous that a ruling in their favor could bite them, hard. Deep down, a few of the less demented among them may really want the White House to jump in with a Plan B and save their butts.

Update: Here’s something interesting — a GOP senator is proposing that if the subsidies are struck down, Congress should extend them for 18 months.

The loss of subsidies for millions of people would also put the Obama administration on the offense for the first time to protect its signature healthcare law.

A White House crusade against the GOP would mean a firestorm of accusations that the party is taking away care and endangering lives  – building up for the 2016 election.

To avoid that situation, some Republicans are floating a stopgap that would keep the subsidies in place temporarily.

Sen. Ben Sasse (R-Neb.) promised this week that he would introduce legislation that creates a “temporary model to protect those harmed by ObamaCare” in which people could still receive financial help for their healthcare costs for 18 months after a court decision.

Startin’ to sweat a bit there, dude?

Senate Finance Committee Chairman Orrin Hatch (R-Utah) hinted at a similar proposal earlier in the week, promising “a short-term solution” until a Republican can enter the White House.

By some coincidence, 18 months from the likely date of the decision — end of June, 2015 — would possibly take us just past the 2016 elections.

More Elusive Than Bigfoot

The King v. Burwell case, to be argued in front of the SCOTUS in March, was deliberately crafted to take down the Affordable Care Act. So why is it the crafters couldn’t find better plaintiffs? Jeffrey Toobin writes,

The case is based on the claim that the Obama Administration policy of allowing those who received tax subsidies to buy insurance on the federal exchanges—which cover the thirty-four states that don’t have state-run exchanges—violates the terms of the Affordable Care Act itself. If the plaintiffs succeed in making their case, eight million people are estimated to lose their health insurance, and the A.C.A. itself could subsequently unravel.

But the King case, like any case, can only proceed if the plaintiffs have standing—that is, if they can claim an “injury in fact” from the Obamacare law. Thanks to two recent, excellent pieces of journalism, in Mother Jones and the Wall Street Journal, we now know a great deal about the four plaintiffs. Two are veterans of the Armed Forces and can receive health care through the Department of Veterans Affairs; accordingly, they have no reason to seek the tax subsidies under the law. The other two plaintiffs may make too little money to qualify for the tax subsidies, and, furthermore, one who claimed to be a Virginia resident listed a motel that prohibits long-term stays as her address. In short, the provisions of the Affordable Care Act in question in King v. Burwell may be irrelevant to all four plaintiffs—which would mean that they lack standing to challenge it.

Toobin says that conservative justices for many years have dismissed various challenges from liberals on the grounds that the plaintiffs did not demonstrate the law posed an “injury in fact” on them, and thus they lacked standing.

During the George H. W. Bush Administration, a coalition of environmental and conservation groups sued to stop new federal regulations that limited the application of a section of the Endangered Species Act. Chief Justice Roberts, then the Deputy Solicitor General, persuaded the Supreme Court to throw out the case because the plaintiffs would not suffer direct harm from the new regulations and lacked standing to bring the case. In Lujan v. Defenders of Wildlife, the court held that a “generally available grievance about government—claiming only harm to his and every citizen’s interest in proper application of the Constitution and laws, and seeking relief that no more directly and tangibly benefits him than it does the public at large—does not state an Article III case or controversy.”

I understand they don’t hear cases brought by spotted owls, either. A pity.

The Administration’s lawyers didn’t bring up the issue of standing in their brief, which means they either were asleep at the switch or they’d rather not have the case dismissed in a way that would allow the Right to try again.

This also begs the question of why the Right can’t find better plaintiffs. I occasionally read posts or comments from someone who has a legitimate-sounding story of being worse off because of Obamacare, but somehow the examples the Right chooses to feature never stand up to scrutiny.

Inaction and Consequences

There are measles epidemics breaking out around the country, and plenty of people are plenty mad at anti-vaxxers who have weakened our herd immunity and allowed this to happen by not getting their kids immunized. Apparently upscale crunchy suburban parenting requires abstention from vaccines, or else one is a bad parent allowing toxins into children’s bodies. These are college educated people who have persuaded themselves that the risks of the vaccines are greater than the risks from the diseases. I understanding not feeling warm and fuzzy toward the pharmaceutical industry, but this is ridiculous.

I ran into a guy the other day raving about vaccines being a violation of personal sovereignty. To which I thought, how did we get to be such a nation of whiny hothouse orchids that vaccinations are a violation of personal sovereignty? I can understand the small number of people with genuine religious objections, but most anti-vaxxers are objecting on pseudo-science grounds. The long-discredited link between vaccines and autism is still believed, and the link is still being promoted on a lot of websites. Plus there are new scientifically unsupported theories about how the number of vaccines kids are getting is overloading their immune systems, or something.

If vaccines were a brand new thing this fear might be more understandable, but if you’re alive today you probably were vaccinated as a child. Not counting the original, primitive smallpox vaccine of the 1790s — which really was risky — people have been getting vaccinated for all kinds of diseases since the late 19th century. The U.S. issued regulations of recommended vaccine schedules for children and adults in the 1940s. It must have been a state program, but in the 1950s in my public elementary school, the school nurse from time to time lined up everyone in class in alphabetical order and give us our shots right there in school. Nobody was excused.  When I enrolled my kids in public school in the 1980s I had to send their immunization record to the school.

However, after all these years, a substantial number of people have decided that immunizations are (choose as many as apply) a government plot, a scam by the pharmaceutical industry, a threat to our health that for some reason nobody but some celebrities on teevee take seriously, or a harbinger of the One World Order, This is just weird.

Health fads aren’t new at all, but fads about diets have gotten so prevalent they’ve spawned a new term — orthorexia. Suddenly gluten is bad. Suddenly people have to de-tox. Like we didn’t have livers for that. Not that I’m exactly a role model of sensible eating, but I do run into people who are absolutely obsessed with only eating certain foods from a few trusted, and out of the way, sources. It’s like anything sold in a chain grocery store might cause sudden death.

My working theory for at least some of this craziness is that food and health fads have taken the place of religion for some people as a means for protecting themselves and their loved ones for the scary things out there. Prayer has been replaced by colon cleanses.

The measles outbreaks also reminds us that the things we do, or don’t do, really do affect other people in myriad ways. We can go around pretending that our personal choices are just our business, but it’s not always that simple.