ANOTHER YEAR WITHOUT MEDICAID EXPANSION AND THE BODY COUNT GROWS: Since 2014, in a mean-spirited display of antipathy and partisan spite toward former President Barack Obama, legislative leaders forced a ban on Medicaid expansion. They continue to ignore the pressing needs and look for excuses to avoid doing the responsible thing. North Carolina remains one of just 11 states yet to expand Medicaid since the federal government agreed to assume almost all the cost. Since the 2014 ban on Medicaid expansion, the state has left more than $40 billion in federal funding in Washington. Meanwhile federal taxes being paid by North Carolinians are helping pay for Medicaid expansion in Arkansas, Louisiana, Utah, Indiana and most recently, South Dakota – all overwhelmingly Republican states. The money is just one “cost.” For North Carolina families it has meant: 4,240 to 15,200 deaths of loved ones who weren’t able to get the lifesaving care they needed. 110.458 women haven’t been able to get breast cancer screening mammograms. 236,500 diabetics have gone without medication. 118,000 jobs, that would have been created because of the infusion of federal funds, have gone wanting. Meanwhile, health care costs are skyrocketing. I recently had a CT scan that was critical in determining I did not have any cancerous growths, and it fell into the gap between two limited benefit plans I carry through my job. $5,300 may be a drop in the bucket for some, but for the rest of us, it's crippling. Fix this now, dammit.
WE NEED MORE PRIMARY CARE PHYSICIANS: Primary care physicians choose this specialty vital to patients’ health, but not necessarily to their own. Fewer than 1 in 4 new doctors make this their path. Those who do so value the personal relationships with patients and genuinely believe this is the best approach to improve overall health. I began my remarks by sounding a common note, namely that healthcare costs are too high. With barely four percent of the world’s population our country spends almost half of the $8 trillion world healthcare expenditure. In 1970, the U.S. spent 6 percent of our gross domestic product on healthcare. CMS says today that is 19.7 percent…20 cents out of every dollar of economic output. The per capita cost of healthcare is estimated to be $11,945, more than twice as much as the average industrialized nation. And some 64 percent of those surveyed said they avoided or delayed medical care because of costs. he Robert Graham Center in Washington reports that North Carolina has almost 6,000 primary care physicians (2010 numbers) or about 1 family doc for each 1,633 people, well above the national average of 1 to 1,463 people. Our state set a goal to get closer to the national average, however population growth and they greying of our state makes this a stretch. The Graham Center further projects that our state will need another 1,885 – a 31 percent increase – primary care physicians by 2030. Of the 25 percent of new docs choosing family medicine, even fewer choose to start or join practices in rural areas of our state, where people are poorer, less healthy and more dependent on Medicaid and Medicare. Patient loads are often greater, fewer support services (like Pharmacies) are available and physician spousal employment opportunities are fewer. Adding a family physician to a rural community provides more benefits than just lowering healthcare costs and improving health outcomes. It is a morale boost that can attract new businesses and residents. The Sheps Center for Healthcare Services Research at UNC reports that between 1990 and 2020 there were 334 documented rural hospital closures in 44 states. North Carolina witnessed 11 such closures since 2005 and at least five more are teetering. Expanding Medicaid would be a critical first step in preserving those rural hospitals. As far as primary care Docs, we need to give more support to Physician's Assistants and Nurse Practioners, freeing them from the professional bondage of working under (and billing under) MDs.
CONGRESS MUST ACT ON DACA: Oscar Miranda Tapia came to Elon University as a Golden Door Scholar. Since graduation, he has completed a service-year fellowship in Alamance County, earned his master’s in education from Harvard University, and helped launch an Elon program to support first-generation college students. Today, he’s in a doctoral program at N.C. State University and co-author of a forthcoming book on college student success. Tony Solis, Davidson College Class of 2019, is a first-generation college student who has lived in the U.S. since age 6. A passionate advocate for education, he helped Davidson recruit and support talented students regardless of their finances, taught math in Washington, D.C. for Teach for America, and developed online curricula in math and Spanish. He’s now a graduate student at Princeton University’s School of Public and International Affairs. Oscar and Tony are two of the more than 800,000 U.S. residents, including 22,000 in North Carolina, who have benefited from Deferred Action for Childhood Arrivals (DACA) status. During our tenures at Davidson and Elon, we got to know these extraordinary young people. As educators and proud Americans who believe in the promise of this country, we urgently support a common-sense policy to ensure that this pool of talent — which this country badly needs to retain — no longer remains at risk. It’s the smart and moral thing to do. Given recent court rulings that endanger the future of DACA, we are united in calling on North Carolina’s congressional delegation to secure Dreamers’ futures in the U.S. Congress by passing bipartisan legislation before the end of the year that includes a legislative solution for Dreamers. As recent polls remind us, Americans across the political spectrum strongly support Congress delivering a bipartisan immigration fix this year that includes permanent status for immigrant populations, such as Dreamers and farm workers, paired with border security measures. Time is running out. I don't see the upcoming Republican majority in the U.S. House supporting this, much less championing the effort. They probably won't even bring it to the floor for a vote, which is both disingenuous and cowardly. Prove me wrong. Please.
A PAINFUL GOODBYE TO LEONARD PITTS: Well, as Carol Burnett used to say, I’m so glad we had this time together. I’ve written about 1.6 million words as a columnist. This 600 or so will be the last. I’m retiring for a few reasons. One is that, while I’ve managed to squeeze out four novels between column deadlines, my dream was always to write books full time. I turned 65 in October, so if not now, when? Another reason is that a column, for me, at least, is an act of emotional investment — and I’m emotionally exhausted. They say you know when it’s time. That’s true. And it is. Thank you, readers, for your loyalty and for every word of encouragement and constructive criticism along the way. Tomorrow, I will wake up for the first time in 46 years without a deadline to meet. It’s going to feel strange. I’ve always considered this podium a great privilege: Everyone has an opinion, after all, but precious few get to have their voices magnified — much less be paid for it. I tried to use that privilege to sound alarms about human rights, democracy, gun violence, the misinformation crisis and more. The fight on all those fronts goes on. Nothing ends here, except my access to this megaphone. I’ll be teaching and, of course, writing novels from now on. Which is fine. I’ve said pretty much all I had to say. Except for this: Isn’t it amazing how fast the years go? Turns out, time doesn’t really care if you’re having fun; it flies, regardless. Again, Carol Burnett said it well. “Seems we just get started and before you know it, comes the time we have to say, so long.” Good night, everybody. You will be missed, Leonard. You didn't just tell us what we were doing wrong, you told us how to do things better. Not sure who (if anyone) will be able to fill those shoes.
ORIGINALISM IS BUNK. LIBERAL LAWYERS SHOULDN'T FALL FOR IT: Originalism, the belief that the meaning of the Constitution was fixed at the time it was adopted, is the legal theory that dominates the thinking of this conservative Supreme Court. Not all of the conservative justices are committed originalists. I count four of the six — all but Chief Justice John G. Roberts Jr. and perhaps Samuel A. Alito Jr., who describes himself as a “practical originalist.” But they have all written or joined originalist rulings. Given that reality, liberals can’t lightly dismiss conservatives’ insistence that the Constitution should be interpreted based strictly on the original meaning of its text. In the current circumstances, liberal advocates appearing before the court would be remiss not to make an originalist case. But there’s also little evidence, at least in the highest-profile cases, that it will do them much good. When originalist arguments favor a result the conservative justices dislike, they’re content to ignore them, or to cherry-pick competing originalist interpretations that comport with their underlying inclinations. Originalism doesn’t serve to constrain but to justify. This is not a fair fight — or an honest one. Because originalism purports to freeze our understanding of the Constitution as written at the end of the 18th century or amended in the second half of the 19th, it is skewed to a cramped reading of the document, unleavened by modern science and sensibilities. Why should we understand — much less accept — the constitutional meaning as fixed at a time when women lacked the right to vote, when recently enslaved Black people attended segregated schools, when the economy was agrarian, and when the notion of gay rights was unthinkable? Originalism sounds both obvious and alluring. Of course, the text of any document must be the starting point for understanding it; that has always been an important part of the legal method, and no one is suggesting that it be abandoned. Of course, judges should do their best not to act, as conservatives might say, like “legislators in robes.” But originalism trends almost inexorably right. As Justice William J. Brennan Jr. explained in a 1985 speech responding to Meese, originalism “in effect establishes a presumption of resolving textual ambiguities against the claim of constitutional right.” Which is precisely why it was taken up by Meese and company. “They embraced originalism because it was conservative,” said Michael Waldman, president and chief executive of the Brennan Center for Justice and author of a forthcoming book on the court. “They didn’t embrace conservatism because it was originalist.” To be honest, I believe the Founding Fathers would be disappointed in us for giving so much credence to their intent. And not only in cases where we misread their intent, but all of it. The Constitution evolved a great deal during its conception, prompting immediate amendments. They gave us the tools and examples to make it a living document, and we should acknowledge their tacit admission they were not perfect.
LETTERS TO THE EDITOR
MELANIE WALKER: TEACHER PERFORMANCE PAY IS A BAD IDEA: At a time when teachers are leaving the profession in droves due to overwork, underpay, feeling undervalued and burnt-out, the roll-out of a pilot program that rewards high state test scores is another slap in the face, as well as being fraught with pitfalls. Who would want to work in an under-performing school or with a difficult student population? Some disciplines, such as elective classes, have no state tests. Today, classes can have 35 to 50 students. The stress and workload are enormous. Being in the profession for 30 years, I know firsthand that teachers are mostly a selfless and dedicated lot who perform miracles every day and cater not only to the educational needs of the child but the emotional and social needs as well — being counselors, psychologists, cheerleaders, coaches and mentors. They deserve our validation, respect and a professional salary. This is the exact opposite of the "squeaky wheel" approach, dedicating resources where they are least needed. And it will widen the gap between economic classes, the last thing we should be doing.
ANN WINSTEAD: NC NEEDS TO BETTER REGULATE POULTRY FARMS: The reporting in the series on Big Poultry from the Charlotte Observer and News & Observer has exposed serious flaws in the system, and this has been going on for far too long. Even South Carolina requires large poultry farms to have permits and inspections — and the locations aren’t kept secret like they are in North Carolina. We know these facilities are producing waste and pollution that gets into the air and drinking water sources and is harming the health of North Carolinians. So why are these big companies allowed to operate like it’s the Wild West? It’s past time for our elected officials to put reasonable measures in place to keep our communities clean and safe. I'm not holding my breath waiting for NC Republicans to step up on this problem, because they don't see it as a problem. Elections matter, and NC's rural voters need to start paying closer attention.
CELIA DICKERSON: NC'S MENTAL HEALTH CARE IS ATROCIOUS: The Dec. 1 article about the poor service for children with mental health news stirred bitter memories of trying to navigate treatment for a grandchild. As I sat in the Brynn Marr waiting room for a frustrating session with a social worker, I saw the pain and shock on the faces of other families. All the treatment center offered us was respite from the stress of trying to care for a child who was a danger to himself and his family. Families are at the mercy of a wasteful system of outsourced care. Until 2000, North Carolina had a caring network of local and state-funded mental health centers. The current policy of treating mental health care as a commodity to be held at arms’ length and managed by out-of-state for-profits is a travesty. We are overpaying for a worthless product for our vulnerable citizens. We are wasting tax dollars and keeping a class of citizens from being active and productive members of society. The outsourcing of mental health has failed miserably in our state, but the bean counters are just fine with it. Again, don't expect Republicans to do anything that might jeopardize their annual tax-cutting extravaganza, which is the only thing they know how to do.
Just not feeling it this year...
Somebody at work asked me what my "plans" were for Christmas. Plans? I don't even have "a" plan, much less a plurality. It seems like Black Friday was yesterday, and I haven't even attempted any Shopping. I don't have a tree this year, not even one of those little tabletop ones.
What do I want for Christmas? Peace on Earth, and maybe a Starbucks gift card.
As sad as this is going to sound, Christmas is for children. Little children, who have yet to become jaded over our Capitalist Materialistic Society (CMS). I can vaguely recall those memories, waking at oh-dark-thirty and impatiently waiting for the entire family to assemble around the tree for the product consumption to begin, the steady march of brand names across the carpet, to each individual's pile of booty.
Okay, sorry about that. I let Evil Steve have unfettered access to the keyboard for a few minutes, and that was a mistake.
Christmas is whatever you make it. It can be a joyous occasion, where you reaffirm your love for family and friends, and give them gifts they probably wouldn't buy for themselves. But most of all it is a special time set aside to be together, however briefly, in an era where everybody's schedule seems to conflict. An excused absence from the rat race, where shoes are not necessary (but keep your socks on, please, nobody wants to see that), and smiles are not forced but come naturally.
Take the time to enjoy the holiday, folks. You've earned it.
Merry Christmas from the Great Dismal Swamp
It can always be worse!
PS. Jane and I are having a quick getaway to Suffolk VA for our 35th wedding anniversary. It is the jumping off spot for GDS.
Swamps are cool.
I got lost in the Big Muddy swamp during a night land navigation course. As I was walking, my feet started to splash. So I stopped and took the red filter off my flashlight (ruined my night vision, but it was apparently not working anyway) and looked around. Water as far as I could see. Took a reading with my compass, and headed to where dry ground should have been. Didn't work.
So I strung up my hammock between two trees and slept on it. When the sun came up I saw the dry ground about 40 feet away.
There's probably a lesson in there somewhere, but it flew...under my feet? ;)
Have fun. Be nice. Do good.
Your $5,300 CT scan
Meanwhile, health care costs are skyrocketing. I recently had a CT scan that was critical in determining I did not have any cancerous growths, and it fell into the gap between two limited benefit plans I carry through my job. $5,300 may be a drop in the bucket for some, but for the rest of us, it's crippling. Fix this now, dammit.
Well, obviously, the NC GOP controlled legislature intended for you to use that big tax cut they gave you a few years ago for this. Remember that much-hyped tax cut, signed by McCrory, to much fanfare?
I remember it. And, if your tax cut was anything like mine, you could use ten years of it to just about pay off your CT scan.
Yeah, I didn't even notice it
Of course I didn't have a six (or seven) figure income, so it wasn't really meant for me anyway.