Two interesting pieces of public health news. The first is good news.
Congress actively is attempting to combat HIV and Hep-C infections by removing asinine restrictions on funding for needle exchanges: (via Vox)
Congress quietly made a huge change to help combat HIV: It effectively lifted the federal funding ban on needle exchange programs, which provide clean needles — meaning syringes that aren’t infected with HIV — to drug users….keeps the federal funding ban on syringes themselves, but ends the ban on all other aspects of the programs — staff, vehicles, gas, rent, and so on. Activists praised the move as an effective end to the ban, since the syringes are a very inexpensive part of needle exchange programs.
Syringes are dirt cheap. The physical syringe costs pennies, while the entire distribution process costs roughly a dollar per syringe according to HarmReduction.org. Federal funding for 97% of the cost of the needle exchange distribution is a big deal, and it should lead to lower HIV and HEP-C new infection rates which should lead to lower long term health care costs.
HarmReduction.org points to a 2005 CDC study that found syringe exchanges cost no more than $12,000 for every HIV infection prevented. At that time, it was estimated a person who acquired HIV would have an incremental life time medical expense associated with their disease of roughly $190,000. Needle exchange has a public health pay-off of almost 1,600%. The CDC study only examined HIV infections averted. If we expand the averted disease universe to include Hep-C (which costs $50,000 to $80,000 for a cure), the return on investment is even higher.
No hedge fund, no super accelerated Alpha investment strategy, no Ponzi scheme can match that return on investment.
And now some bad news. The Flint lead poisoning was preventable and it was preventable at a penny per person per week.
The problem began in April 2014 when Flint switched from Detroit’s water supply to save money and began using water from the Flint River, which has a high salt content.
That corroded the pipes it flowed through and lead from those pipes — which had been undisturbed by Detroit’s less corrosive water — leached into the system.
Marc Edwards, a professor at Virginia Tech who has been testing Flint water, says treatment could have corrected much of the problem early on — for as little as $100 a day [my emphasis]— but officials in the city of 100,000 people didn’t take action….
“In five years, these kids are going to have problems with special education. They’re going to have cognition problems,” Hanna-Attisha said. “Seven to 10 years, they’re going to have behavioral problems.”
That is $35,000 a year to prevent lead poisoning. Paying that much each year for ten years to prevent a single child from being poisoned is a good public investment. The Washington Post had an incredibly depressing but vital article on lead poisoning costs in Baltimore after the Freddy Gray case.
Rose, who can scarcely read or write, calls herself a “lead kid.” Her childhood home, where lead paint chips blanketed her bedsheets like snowflakes, “affected me really bad,” she says. “In everything I do.”…The family had settled a lead-paint lawsuit against one Baltimore slumlord in 2007, granting Rose a monthly check of nearly $1,000, with yearly increases. Those payments were guaranteed for 35 years….Rose sold everything to Access Funding — 420 monthly lead checks between 2017 and 2052. They amounted to a total of nearly $574,000 and had a present value of roughly $338,000….
One 24-year-old lead victim sold nearly $327,000 worth of payments, which had a present value of $179,000, for less than $16,200 — or about 9 cents on the dollar. Another relinquished $256,000 worth of payments, which had a present value of $166,000, for $35,000 — or about 21 cents on the dollar.
Flint will see an extra 160 or more cases of lead poisoning (baseline rate of 2% lead poisoning of children, new rate is 4% or higher. 2010 Census had 8,177 children under Age 5 living in Flint City, Michigan). At $300,000 life time costs (which seems to be the going rate in Baltimore) saving $35,000 will cost society $48 million dollars. That is a negative return on investment of negative 1,371%.
Public health measures (clean water, harm reduction and mitigation etc) have massively higher pay-offs to both society and the individual through harms averted than acute medical care. Avoiding problems tends to be way cheaper and better than treating preventable problems.
Yes, but the cost of treating the water would mean some millionaire might have to pay an extra $25 in taxes, so can’t do that.
It doesn’t seem too far fetched to me that any analysis done prior to switching would have shown the potential consequence. But an analysis also would have cost money.
This is such a bone-simple concept you’d think even Republican voters could get it. All of us kicking in a few bucks a year to provide protection for catastrophic events. But so many people are convinced that any tax levy is cause for another Lexington and Concord revolution. So they pocket an additional $24 in tax “savings,” while their water becomes undrinkable, their schools fall apart around their kids, their roads become impassable. That’s some high-grade freedom right there, that is.
I’m reminded of the story out of Tennessee (?) a couple of years ago. The voters in a rural area voted to de-fund the fire department, which then offered annual subscriptions to residents who wanted firefighters to come out when their homes caught fire. Inevitably, some nitwit who hadn’t paid his assessment had his home catch fire, and he called for assistance. The fire department came out, but only to make sure the fire didn’t spread to other homes that had paid their assessment. They didn’t do squat-ah about the cheapskate’s home, even when he offered to pay his assessment on the spot. I don’t remember exactly what the assessment was, but it wasn’t much compared to the comfort and security of knowing that trained firefighters would respond immediately should your structure catch fire.
Isn’t that just our culture, “Save now, pay later”?
This Flint fuckery shows exactly the problem with modern day let them eat cake Republicanism. They have ruined lives by poisoning the children of Flint. They do these penny pinching pound foolish things so that the super wealthy don’t have to pay taxes to support the city/state/country that has been so good to them. In the end, the penny pinching will cost outrageous amounts of money and will not actually restore the victims to wholeness and health. The super wealthy and the politicians who do their bidding will not suffer any consequences for their greed and idiocy.
Oh and when these kids struggle in school or get into legal trouble etc–these same fuckers will shame them and say they deserved what they got.
Penny wise, pound foolish. Except if you look at where the money goes. If they had spent $35,000 a year on lead abatement, that $300,000 per person of adverse effects money would be going elsewhere: NOT to the prison-industrial complex, NOT to the pharmaceutical-industrial complex, and so on. So more robbing Peter to pay Paul. Regular taxpayers get screwed again, as do the poors and the blahs who had the “lack of initiative” to live in Flint.
What Original Lee said….
Steve in the ATL
When are we going to ban the buying of structured settlements? That practice destroys the entire purpose of the structured settlement.
The effects of lead poisoning in children have largely been confined to the lower classes, tenants in homes that still have 40-year-old lead paint in the interior or residents of housing projects built near lead smelters. But the Flint case will affect all economic strata (to the extent there is still wealth in Flint) because everybody uses the water. That may affect how this issue is perceived.
Seems like this should be prohibited by something. It’s a variant of usury, after all.
Then again, credit card rates (not to mention payday loans) are actual, outright usury, so I suppose nobody really cares.
@Steve in the ATL: I see we had similar thoughts. However, a reasonable (whatever that means) way to convert annuities to lump sums seems reasonable (whatever that means) to me, especially since annuities do the same in reverse.
@gratuitous: IIRC, the yearly payment to the city fire department by the rural residents would have been something $75. $75!!! There was a big dust-up over the firefighters not doing anything but I understood their stance. If they had accepted the payment at the time of the fire, then other people would have tried that. And actually fighting a fire cost more than $75 — that was the cost averaged out over all the residents of the rural county and the city.
Lead abatement has been put out there as one of the reasons the violent crime rate has decreased in the past decades.It will be interesting (in a horrible way) to see what happens to the crime rates around Flint in 16-20 years. Looks like the republicans have handed us another real-life experiment.
@Capri: Probably not a big enough sample (thankfully) as a lot of those kids will not spend their entire life in Flint.
It’s Michigan, Richard……..to paraphrase Chinatown.
I live across the St. Clair River from Michigan, and I swear they are getting more ignorant and angry by the day. I have not read or watched any news programs from Michigan for quite awhile [I still get bits and pieces of news listening to local CBC radio and on the internet] and have recently given up on their sports radio stations due to the bigoted and ill-informed opinions of the fools taking and making the calls.
@MomSense: Agree with you 100%. In “socialist” countries like Canada, I think there is some understanding by the well off that paying a few additional % in income taxes is a small price to pay to keep the overall system the way it is and thus slanted in favour of the successful.
That kind of insight seems to be completely missing in the US. I don’t know if the rich [in general] in your country are just inherently cruel, selfish, and careless of their fellow citizens or your political system is that warped and corrupt.
After rereading what I have written it seems a little harsh, but jeez the stuff that is going on would have been unthinkable twenty-five or so years ago. Why aren’t things getting better?
One other thing to remember about Flint is that its local government was controlled by an “emergency manager” appointed directly by the state. In Michigan, when your local government/ school district becomes insolvent (helped along in many cases by the draconian budget cuts at the state level), the state comes in examines things, then can topple the existing elected local government and appoint an unelected emergency manager to essentially rule as a viceroy. You’ll be completely unsurprised that they’re supposed to balance budgets by tearing up union contracts, gutting pay, laying off employees, slashing pension benefits, selling off public assets, neglecting infrastructure — but not by forcing bondholders to take a haircut.
Now, in some cases, the local elected governments the manager replaced were completely ineffectual, but in some cases it effectively amounts to a state coup. And the emergency managers that come in do not always have the best interest of local citizens in mind.
All too true, sadly. And there’s really no monetary settlement that can make them truly whole, because there’s no way to undo the effect of lead on someone’s brain.
And the worst thing is, they’ve known about this since, when, sometime in 2014? And they hid the evidence, bullshitted that there was nothing to see here,and kept on poisoning those kids.
I can understand their making a disastrous decision out of a combination of ignorance and the desire to save a few bucks. But once they had any hint of elevated lead levels in the water, they could have said to themselves, “this is a horrible thing to do,” and gone back to using Detroit water as quickly as possible. Even if they covered things up then, at least they’d minimized the damage.
But they kept right on going.
Everyone who aided and abetted this policy and who knew about the lead should spend a couple decades in prison. Because that’s what you do to people who poison children.
Is there a difference between being outright cruel, selfish, and careless and just being indifferent? I don’t see the super rich person or corporation (people, my friends) who compartmentalizes reducing their tax burden such that they don’t consider how that affects the larger community as being less cruel or evil than the people who decided to poison the water, cover it up, and continue doing so until overwhelming pressure forced them to stop.
It’s totally evil. It’s such a stark example of evil that it completely overwhelms me. I’m pretty sure actual steam is coming out of my ears.
More than this, this is getting into the larger problem of infrastructure, declining cities (especially in the East Coast and Midwest) and pollution of rivers and water systems.
It would also have required some level of respect for the impartiality and professionalism of the testers and the procedure. Can’t have that alongside the geocentric cosmology, young-earth geology, four element physics and four humour medicine classes, now can we?
@low-tech cyclist: I think it was done deliberately. The only reason to lie about providing corrosion protection is so you can go on poisoning the kids. Especially when you don’t even go back and try to make the lie true.
Anybody want to take bets on what would be happening if some scary Muslims had poisoned a city’s water supply?
And now the plumbing of the entire town has to be replaced because it’s too corroded to be safe to use, even if the water is properly treated now.
@japa21: Oh don’t worry about the millionaires. The fact that people are allowed to purchase the income streams in exchange for pennies on the dollar in a lump sum means it’s not they who will take a hit, it’ll be the public.
Michael Moore is, as one might imagine, on fire over this, and calling for the arrest of the governor.