Small minds, and POOF, a S.Dakota science institution is gone

South Dakota State University - Geospatial Sciences Center of ExcellenceSmall minds, insular thinking.  It’s an infection that’s spread across the United States in the last several years, and one victim of the “disease” is the death of one of the most successful science programs of its kind in the entire world.

In 2016, Barry Dunn became president of South Dakota State University. One thing he did when arriving was review the state of the “Geospatial Sciences Center of Excellence” (GSCE)…a truly WORLD-renown science center established in 2005 to develop and apply remote sensing and other geospatial data for research and education purposes. Some of the biggest names in the field were lured to South Dakota State.  In the last 13 years, Mike Wimberly…Matt Hansen…David Roy…Geoffrey Hennebry…Mark Cochrane…all were key parts of GSCE and its development.  Over the last 13 years, they’ve had a massive impact on the field, applying remote sensing data and analysis techniques to applications that include understanding disease vectors and risks of West Nile virus…helping to establish and use the next generation of satellite sensors…mapping fire extent and severity…mapping changes in our ever-declining grassland ecosystems…and many, many more.

Students from all over the world moved to South Dakota, of all places, to work with such a wonderful collection of researchers.  The research impact has been enormous.  The reputation is sterling.  The senior scientists at GSCE brought in huge amounts of external research dollars. It has been, by all logical measures, a raging success.

It’s now decimated. During his review process, Barry Dunn in his infinite wisdom decreed SDSU GSCE wasn’t of any benefit to South Dakota, partially because 1) it didn’t do all its work IN South Dakota, and 2) it didn’t have enough South Dakota students. So, they cut $1 million in core funding. They effectively gave the research leads a 25% pay cut.  The result of the drop of support?  For the next semester that starts in a few weeks, literally NONE of the GSCE Senior Scientists will remain.  That’s right…ALL have decided enough is enough, and all are moving on to greener pastures. A science center like no other, one South Dakota could put up against ANY similar science center in the world…and it’s gone belly up, thanks to new “leadership” at South Dakota State.

Small minds, insular thinking…what the hell has happened in this country? Doing work that’s WORLD-renown and applied in all continents is deemed a NEGATIVE, because they didn’t do all their work in South Dakota? Too many foreign students is a “problem”?  It’s a problem that’s certainly not limited to SDSU, GSCE, or South Dakota.  To me it all falls under the same kind of anti-intellectualism, anti-“expert”, anti-SCIENCE paradigm that seems to have infected America.

A South Dakota institution is gone after far too short a time, all thanks to tiny little minds with a lack of vision and appreciation for the bigger picture.

Birds Under Systemic Attack in the U.S. Under Trump

Young Whooping Crane - Grus americana

A researcher at the Patuxent Wildlife Research Center in Maryland, dressed in white garb designed to emulate an adult Whooping Crane, and a young, 2-month old Whooping Crane “colt”.  Researchers only interact with the young while wearing such outfits, to avoid any human imprinting on the young.  Patuxent has played a vital role in conserving Whooping Cranes and bringing them back from the edge of extinction. Thanks to the GOP and this administration, the entire Whooping Crane program and its minuscule $1.5 million cost is being eliminated.

There are around 600 Whooping Cranes in the world, with about 30% of those in captivity. Of the few hundred birds in the wild, most breed near Wood Buffalo National Park in Alberta, while a smaller and more recently established breeding population is found in central Wisconsin. The species has become reestablished in the wild only due to strong conservation measures and to the diligent and long-term efforts of captive breeding and reintroduction programs such as the 51-year year effort at Patuxent Wildlife Research Center in Maryland. When the program started in 1966, only 42 Whooping Cranes were left. The dedicated efforts of Patuxent scientists were vital for bringing the species back from the edge of extinction.

In 2016, Patuxent scientists developed a plan that would wind down their captive breeding program, with a plan to end the program in another 10 to 15 years.  Thanks to the Trump administration, that program is now in the process of being disbanded immediately.  In a multi-TRILLION dollar federal budget, the $1.5 million U.S. Geological Survey budget for the Whooping Crane program was a minuscule drop in the bucket.  But with a GOP political ideology that’s focused on corporate profit and short-term financial gain over ANY environmental concern, the death of the USGS’s Whooping Crane program is just one small part of a sinister, death-by-a-thousand-cuts to wildlife conservation in the United States.

The proposed cuts in both the proposed fiscal year 2018 and 2019 Trump budgets are more a declaration of war on the environment than they are a sound, fiscally responsible means of streamlining federal programs. The Ecosystems mission area of the USGS is responsible for an array of wildlife research and management programs: The Trump budget proposes a 30% cut in those programs for the coming fiscal year.  Many programs are slated for complete elimination, including the popular Cooperative Research Units, a network of an onsite USGS presence on academic campuses across the US.  Designed to foster local cooperative research on wildlife issues, the entire $25 million budget for the Coop units for 2019 is likely to be eliminated. The Climate and Land Use program is being forced to change its name to “Land Resources”, with nearly ALL climate-related research eliminated (as well as much of the landscape research).  Eliminating even the WORD “climate” is a common theme in proposed budgets across ALL Federal agencies. The “Energy and Minerals” Mission Area is the one USGS mission that maintains most of its funding, but the proposed changes are startling in scope.  While funding would remain stable or even increase for mineral resource exploitation, the entire “Environmental Health” program, designed to assess potential environmental consequences of resource extraction on Federal lands, is slated to be eliminated.  In other words…we want to exploit the Federal lands that YOU AND I own, but we don’t want to even look at the environmental consequences of that exploitation.

Other agencies in the Department of Interior are also slated for severe cuts, including cuts to the US Fish and Wildlife Service, the Bureau of Land Management, and the National Park Service. The GOP goal is to transition the primary focus of DOI to the exploitation of our natural resources, with environmental concern and conservation efforts being severely curtailed.  The Endangered Species Act, originally championed under the GOP and the Nixon Administration, is similarly under attack, with multiple efforts in Congress underway to undermine the law.

600 Whooping Cranes on the planet.  600 birds, found in only two concentrated breeding areas, and thus extremely susceptible to some disturbance or disease event, yet while the GOP attempts to raise our military spending by a ridiculous $70-80 BILLION a year, they have the gall to point to the $1.5 million Whooping Crane cost as a “luxury” that our Nation can’t afford.  Not to mention a trillion-dollar tax cut for corporations and the rich at a time when corporate profits are at record levels.

There’s so many disgusting things happening in Washington right now that it’s hard to stay on top of all the latest headlines.  Russia-gate, potential impeachment, obvious racism and bigotry emanating from the president himself (no, this president doesn’t get a capital “p”), mass killings and gun control issues…it’s overwhelming.  Conservation stories such as these are having a hard time getting any play in the mainstream press.  With the damage that’s being done RIGHT NOW, it will likely take decades for us to recover, after what’s shaping up to be four years of continuous and widespread attacks on our Nation’s wild resources, and the long-established programs designed to protect and manage them.

I just hope birds like the Whooping Crane can weather the storm until Americans come to their damned senses.

Hearing Neil deGrasse Tyson — Science in today’s world

Neil deGrasse Tyson - Sioux Falls, SD

Neil deGrasse Tyson, speaking at the Boe Forum at Augustana University in Sioux Falls. All science related of course, getting sidetracked on some amusing other issues at times, but a great speech. My biggest takeaway…the need to restore humanity’s sense of wonder about the universe (and our own world).

We had the GREAT pleasure last night to hear Neil deGrasse Tyson speak at the “Boe Forum” at Augustana University in Sioux Falls.The Boe Forum on Public Affairs was founded in 1995, with a goal “to provide access to individuals who can address events, issues or problems of worldwide or national concern and of broad public interest.”  They’ve certainly had some wonderful speakers (and some less wonderful speakers…think Newt Gingrich and Rudy Guiliani) over the years. They’ve managed to draw some very big names, including Colin Powell, Mikhail Gorbachev, George H.W. Bush, Al Gore, Desmond Tutu, Vicente Fox, Sandra Day O’Connor, Pervez Musharraf, and Madeline Albright. Augustana University has just opened their new “Froiland Science Complex”, and said they wanted a “moonshot” science speaker to coincide with opening of that science center.  They certainly succeeded by managing to draw Neil deGrasse Tyson to Sioux Falls.

Tyson ended up talking for two hours, and while my son was getting a wee bit antsy towards the end, I must say that it was a very engaging, surprisingly funny, and interesting talk that kept me very engaged the entire time. There were a few things that surprised me a bit, things I disagreed with.  Given today’s political climate and how it’s affecting science, I was hoping for more content on the intersection of the two, but overall it was a terrific talk.  Some of the takeaways for me:

1968 – 1972 – Birth of the Environmental Movement — The highlight of the talk to me was a section where he specifically talked about the period of 1968 to 1972 and the profound effect it had on humanity and our country.  Apollo 8 was the first mission to orbit the moon, in 1968. As they rounded the moon, astronaut William Anders took the iconic “EarthRise” photo (bottom of this post), looking across the moon’s surface back at Earth.  The next year we landed on the moon. As Tyson noted, these events totally changed humanity and how we view our own planet.  Some very simple observations noted how little we understood our earth up to that point.  He showed a photo from Star Trek, of the Enterprise orbiting the Earth. Their depiction of Earth had the continents, the oceans…but no clouds!  Tyson gave other examples of artwork and even scientific renderings of Earth up to that point, and none of them portrayed the clouds that are always present! The sense of wonder during the space race, the first looks at our planet from space…it changed how we viewed our planet.  In the period from 1968 to 1972, you thus ended up with the establishment of the first Earth Day. The Environmental Protection Agency was founded.  The National Oceanic and Atmospheric Administration was founded.  We started cleaning up our air, our water.  We noticed the massive decline in our national symbol, the Bald Eagle, and banned DDT to save the species (a resounding success!).  The Endangered Species Act was founded in 1973.  This period STARTED the environmental movement.

Reinvigorating interest in science — The take-home point from the examination of the 1968-1972 period?  All that sense of wonder…that feeling that our Earth is a special place…that’s GONE, or at least incredibly diminished right now. Many people today simply can’t see past their own short-term guilty pleasures to even THINK about the future.  At the end of Tyson’s talk, he had a question-and-answer period. One of the questions was related to these points, and how we can get back to those days of the 1960s and 1970s where environmental conservation, where caring about our planet, really was part of the American consciousness. The answer from Tyson wasn’t related to politics, it wasn’t related to things like the March for Science coming up on April 22nd, it wasn’t related to need for better PR.  No, the answer was much more basic, and was rooted in k-12 education. We just don’t value science as much as we should in those formative years. As Tyson stated, what’s going to end up giving us a kick in the butt isn’t just a change in k-12 education, but a realization that we’re losing our economic competitiveness.  With education driven not by national-scale policy but local and state policy, the States that embrace science and technological innovation, starting in k-12, are the ones that will be competitive for industries that drive our economy. Given how much of a focus their is in this country right now on economics, money, and growth, the cynical side of me believes that it will be economic competitiveness that will end up re-igniting the interest and science and innovation, rather than any pure desire to invest in science for science’s sake.

Star Trek depiction of Earth

Prior to the famed “EarthRise” photo from 1968 and our landing on the moon a year later, humanity had little awareness of how to even portray our Earth. As Tyson noted, up until the late 1960s and the space race, this was a typical depiction of Earth (from the original Star Trek) series. Continents…check! Water…check!! Atmosphere, clouds, and weather…something’s missing! The space race had a profound impact on the way humanity viewed our own planet

Intersection of Science, Culture, and Politics — Speaking of the March on Science on April 22nd, one of the questions he received was about scientists and their role in activities such as this. Overall for the night, he really avoided politics, although there were a few timely, light jabs thrown in.  When the audience member asked this question, I thought we might finally hear his thoughts on the impact of politics on science right now. He did touch on that intersection, but it was different than I was expecting. He’s an educator, some may view him as an entertainer, but at his heart, he’s a scientist through-and-through.  His answer began by saying he was on the fence, that in his own mind, he’s still trying to decide how scientists should react in this kind of political environment.  But for the March itself, he said what he really hoped was that such an event wouldn’t be necessary.  As he hammered home all night long, science isn’t political.  Science provides its own truths, as as he stated, it doesn’t really give a damn what you think about it, what your personal, cultural, or political beliefs are.  In short, you can tell that what he’d like to have happen is that the science would speak for itself, that the knowledge and understanding we produce would stand on its own, and that humanity would return to a time where we’d base our decisions on that knowledge.  You can tell he’s struggling a bit with the issue, and is likely as bewildered as many of the rest of us as to how truth, how fact, are being ignored in the face of cultural, political, and ideological attacks. He definitely didn’t seem to have a clear answer on how scientists respond.

Human ego and science — Tyson ended his talk with a theme similar to his discussion of the 1968-1972 period, and its effect on humanity.  He talked about the “Pale Blue Dot” images, the first from Voyager One in 1990, where the instrument looked backed towards Earth and took an image representing our planet as tiny, pale blue dot in a sea of stars and emptiness.  The Cassini satellite studying Saturn provided a similar view more recently, with a 2013 image that shows Earth as a tiny blue dot hiding in the shadows below the foreground image of Saturn and its rings. The end of the talk itself was a reading of material from Carl Sagan, from his 1994 book “Pale Blue Dot”.  The following summarizes that material (a bit revised, from a talk Sagan gave that year):

We succeeded in taking that picture, and, if you look at it, you see a dot. That’s here. That’s home. That’s us. On it, everyone you ever heard of, every human being who ever lived, lived out their lives. The aggregate of all our joys and sufferings, thousands of confident religions, ideologies and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilizations, every king and peasant, every young couple in love, every hopeful child, every mother and father, every inventor and explorer, every teacher of morals, every corrupt politician, every superstar, every supreme leader, every saint and sinner in the history of our species, lived there – on a mote of dust, suspended in a sunbeam.

 

The Earth is a very small stage in a vast cosmic arena. Think of the rivers of blood spilled by all those generals and emperors so that in glory and in triumph they could become the momentary masters of a fraction of a dot. Think of the endless cruelties visited by the inhabitants of one corner of the dot on scarcely distinguishable inhabitants of some other corner of the dot. How frequent their misunderstandings, how eager they are to kill one another, how fervent their hatreds. Our posturings, our imagined self-importance, the delusion that we have some privileged position in the universe, are challenged by this point of pale light.

 

To my mind, there is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly and compassionately with one another and to preserve and cherish that pale blue dot, the only home we’ve ever known.

"Pale Blue Dot", Cassini

‘Version 2″ of the Pale Blue Dot photo, if you will. This is from the Cassini spacecraft orbiting Saturn, looking back at Earth (the small dot in the bottom right).

Religion and Science — Tyson touched on topics related to the Sagan reference all night long. In the overall scheme of the universe, we’re insignificant. We’re not “special”.  At one point he listed the 5 most common elements in the Universe.  He then listed the most common elements in a human body. The list is identical, with the exception of helium (given it’s pretty much non-reactive, it doesn’t form elements found in the human body).  The point he makes…we’re just “stardust”, made up of the same common elements found throughout the universe.  On a night when he would occasionally brush up against the edge of talking in depth about the intersection of culture, politics, and science, but never really dive into the deep end of that pool, this may have been the most “controversial” part of the talk (particularly given that the talk was at a University associated with the Evangelical Lutheran Church, and was speaking in very “red” South Dakota). When touching on politics or culture, you can tell he tries very hard to avoid offending anyone, and he barely mentioned religion.  But as I listened to this part of the discussion, I did wonder what some of the more religious people in the room were thinking.  We’re not “special“.  We’re almost certainly not alone in the Universe, given that we’re made up of the same material as is found throughout the rest of the Universe. We live in a country, however, where a huge swath of the population is unable to separate the science, even the empirical world staring them in the face, from their religion.  In the end its a personal ideology that ends up driving the behavior and interactions of so many Americans, science (and reality!) be damned.  Overall for the night, in what would be interpreted to be a tough cultural and political setting for a science purist like Tyson, he did a great job walking the fine line of informing, without offending.

If you ever get a chance to see Tyson speak, it’s well worth your time.  He’s a wonderful speaker, with a rare ability for a scientist…he knows how to connect with people.

Apollo 8, William Anders' "Earthrise"

The iconic “Earthrise” photo, taken by Apollo 8 astronaut William Anders on Christmas Eve, 1968.

Visiting a Muslim country, facing your “fear”

Terry - United Arab Emirates

A much younger version of myself, still hanging on to my old heavy-metal days and the long flowing hair. I couldn’t have looked, or acted, more differently than the local population when I spent a month in the United Arab Emirates. It didn’t matter. I was always treated with respect and warmth. People are people. We all want the same things in life.

20 years ago today I landed in Abu Dhabi, in the United Arab Emirates, to do a month’s worth of work in a cooperative exchange with the UAE government. I was young(er), had long flowing hair about a foot long in the back, and had never been overseas before. I was probably the definition of a hippie, obnoxious, clueless American overseas.

During my trip I also visited Oman, Saudi Arabia, and Qatar, all countries that are overwhelmingly Muslim. Despite looking and acting MUCH different than the locals, I was treated with kindness, respect, and warmth throughout my trip. The people I dealt with were wonderful, warm, funny…in other words, they were normal human beings trying to live out their lives the best way they knew how. Not once did I feel threatened. Not once did I feel scared. At every opportunity, when I needed help making my way through a day in a strange land, a helping hand was offered.

These are the same people being targeted over the last month. These are the people so many Americans are scared of. They’re not criminals. They’re not terrorists. They’re people who may look a little different than you, may believe in different things than you. They want the same things you want in life…family…health…and happiness.

Put a human face on those you may be suspicious of. Put yourself in THEIR shoes. You may find you have a hell of a lot more in common than you realize.

Abu Dhabi - 7 EmiratesRub Al Khali Desert - United Arab EmiratesUnited Arab Emirates - CamelRub Al Khali Desert - United Arab Emirates

Why “Alex” > “Olivia” > “Nate” — Health care in America

Three Happy Children

Three happy children, “Alex’, “Olivia”, and “Nate”, living in a world where Alex will receive better health care than Olivia, and Nate will receive the worst health care of all 3, all because of their socioeconomic status.

We’re two weeks into a new Congress that smells blood in the water.  Other than a flurry of legislation designed to limit transparency and ethics oversight (always a great sign when that’s their first thought when they arrive in Washington), the major focus has been the dismantlement of Obamacare (the Affordable Care Act, ACA).  What is abundantly clear is that those voting to “repeal and replace” the ACA, without having ANY idea of what they might eventually replace it with, are oblivious to the impacts of the law on real Americans.  What follows is a NOT so hypothetical story of three children, “Alex”, “Olivia”, and “Nate”, and what health care policy in the United States means to them.

Alex, Olivia, and Nate are all young teenagers or pre-teens.  Each has Type-1 diabetes, the auto-immune version where their own misguided immune system has attacked and destroyed the islet cells in their pancreas’ that make insulin.  For the rest of their lives, they will be dependent upon insulin injections.  It’s a life fraught with risk. If you don’t control your blood sugars well, you’ll have frequent hyperglycemia events (high blood sugar). Over time, that will contribute to kidney disease, eye disease, cardio-pulmonary disease, and peripheral nerve damage. If you’re extremely vigilant and try to control your blood sugars very tightly, you’re more likely to have hypoglycemic events (low blood sugar), a dangerous condition that can cause seizure, coma, and even death.  Long-term blood sugar control is measured with a patient’s “A1C”, a hemoglobin-based measure from your blood.  A “normal” A1C is less than 6.5. The higher a diabetic’s A1C is, the worse their long-term blood sugar control, and the higher their risk for complications.

There’s little doubt the ACA is a god-send to Type-1 diabetics like these Alex, Olivia, and Nate.  No longer can they be refused insurance coverage for their pre-existing condition.  Diabetes is an expensive, life-long disease, but thanks to the ACA, they will no longer be subject to lifetime maximum payouts from insurance companies.  For parents helping them transition to an adult life and the responsibility for their own health insurance, the ACA allows parents to cover children on their insurance until they turn 26.  Things are much better with the ACA, but even with the ACA, we’ve got a long way to go in providing equitable health care in the United States.  With that as background, here is the not-so-hypothetical story of Alex, Olivia, and Nate and their battle with Type-1 diabetes…and the American health care system.

“Alex”

Alex is a young teenager who was diagnosed with Type-1 diabetes at a very young age.  His family would be considered  upper-middle class. Alex’s family has a very good, comprehensive health care plan, with insurance provided through one of Alex’s parents. Alex has had access to some of the best care a young diabetic can have. For over 10 years, Alex has had an insulin pump, a small device that holds a reservoir of insulin.  His pump automatically provides a steady stream of insulin all day long (the “basal” insulin), just as the body normally does, to try to keep blood sugars stable. His pump also makes it easy to administer insulin at meals.  He simply estimates how many carbs he’s eating, enters that number in the pump, and the pump provides the proper amount of insulin required to process the sugars in that meal. Alex checks his blood sugar very often (8-10 times a day), but was still occasionally experiencing both hyperglycemic and hypoglycemic events.  In addition to his pump, his family pursued a “continuous glucose sensor” (CGM), another medical device that automatically checks his blood sugars every 5 minutes.  The CGM even has a cell phone app, where his parents are alerted on their cell phones if his blood sugars need attention. He no longer faces the dangerous “nighttime lows”, a hypoglycemic event that may occur at night when a patient is asleep and less able to respond. If Alex’s blood sugars start to drop anywhere close to dangerous levels, an alarm will alert both him and his parents that action is needed.  Alex’s A1C levels have typically been right around 7.0, just a bit above that of a “normal” person.  With the new CGM, it’s likely that will go down even further.  Alex’s care is expensive.  The insulin pump and the CGM both costs thousands of dollars, as do the yearly supplies that support those devices.  Along with the costs of insulin, doctor visits each month, and other supplies, Alex’s health care costs without insurance would be in the 10s of thousands of dollars per year.  Even with what’s considered quite good insurance, his parents pay a lot out of pocket each year for the pump, CGM, and supplies. They can afford it, however, and Alex’s long-term prognosis and risk of complications is much lower than Olivia’s or Nate’s.

“Olivia”

Olivia is a pre-teen who has had diabetes for about 5 years.  Her family would be considered middle-class, perhaps lower middle class. Olivia’s family has a health care option through a parent’s employer, with coverage that isn’t nearly as good as what is provided by Alex’s insurance. Olivia’s family would like a better insurance plan, but their income is high enough that they’re not eligible for subsidies under the ACA that might enable them to “shop around” and find better insurance.  Olivia’s insurer covers only part of the costs of an insulin pump, and does not cover costs for a CGM.  Olivia’s family cannot afford the out-of-pocket costs that would be required to get an insulin pump, so Olivia does not have an insulin pump, or a CGM.  Her insulin control relies on frequent injections, with a daily “long-acting” insulin that is meant to mimic the basal insulin (the steady, day-long drip) provided by Alex’s pump, and “short-acting” insulin that is given with every meal.  Olivia doesn’t like needles, but as a young diabetic, she’s learned to tolerate them. Olivia knows Alex, and marvels at his pump, which frees Alex from the 4-6 daily injections that Olivia gets.  Olivia checks her blood sugar as frequently as Alex, 8-10 times per day, which helps keep her blood sugars under control.  She can respond when blood sugars are low or high, but it means another injection (for high blood sugars).  Without a CGM, she’s more subject to unnoticed hypoglycemic or hyperglycemic events.  Unlike Alex, who “feels” when his blood sugar is low, Olivia has no such physical feelings or warning signs when her blood sugars go low.  She recently was hospitalized after a severe, nighttime hypoglycemic event, when extremely low blood sugar results in seizure and a short period of unconciousness.  With her diligence in checking blood sugars, however, those events are minimized. Her A1C is significantly higher than Alex’s, usually around 8.0 to 8.5.  Compared to Alex, she’s thus not only at risk of unnoticed high or low blood sugar events, she’s also more likely to develop longer-term complications such as heart disease, kidney failure, or eye disease.

“Nate”

Nate is a teenager who was diagnosed with diabetes about 10 years ago.  He lives in a single-family home, a good home with a very loving mother, but paying the bills is a struggle.  The only health insurance available to Nate’s family prior to the ACA was a “catastrophic care” policy with very high deductibles and much poorer coverage than either Alex or Olivia receive.   After Nate was diagnosed, the economic struggles meant pinching pennies on health care. It even meant pinching pennies on the administration of insulin. At difficult times, Nate’s family would avoid carbohydrate-laden meals, in order to save money on the amount of insulin needed to treat Nate. Visits to the endocrinologist were few and far between, as Nate’s mother couldn’t afford them.  Nate’s blood sugar control was very poor prior to the ACA, with A1C’s typically over 10.  Under the ACA, subsidies are available, including both tax credits and cost sharing subsidies, that ensure a plan on the ACA marketplace can’t cost more than 9.5% of a family’s income. After the ACA, Nate’s mother enrolled in a marketplace plan and obtained a health care plan that was much better than the poor health care option provided through her employer.  However, Nate’s insurance is similar to Olivia’s, in that only partial costs of an insulin pump would be covered, and a CGM is not covered.  Nate’s mother cannot come close to paying the out-of-pocket costs that would be required for an insulin pump. Nate relies on shots much like Olivia does.  Nate’s mother is extremely thankful for the availability of ACA coverage, as without it, even the cost of insulin would have been very difficult for her to pay under her employer’s poor, catastrophic coverage insurance.  However, the family still struggles with everyday costs, including costs of health care. With the only available, affordable ACA plan, coverage is worse than either Olivia’s or Alex’s.  Nate’s situation has improved, but his family is still forced to make extremely difficult healthcare decisions, regarding both health care and other, every-day expenses.  With another sibling with asthma and other problems, covering health expenses is difficult even with the ACA and tax credits.  Visits to the doctor are fewer for Nate’s family than for Olivia’s and Alex’s. Blood sugar control has improved for Nate with the better insurance from the ACA, particularly as the family doesn’t feel the need to “scrimp” on insulin, yet Nate still has A1C levels that approach 10 at times.  Nate is at substantially higher risk of long-term complications than either Alex or Olivia.

Comparing Alex, Olivia, and Nate

Alex > Olivia > Nate.  That’s the situation in today’s health care system, where your level of care is directly related to your ability to pay.  With Type-1 diabetes, blood sugar control is LIFE.  There are tools available that assist a Type-1 diabetic in maintaining blood sugar control, but those tools are of no use if a family can’t afford them.

In all likelihood…Alex will outlive Olivia.  Olivia will outlive Nate.  It’s as simple as that, when blood sugar control is the key to a long, happy life for a diabetic.  Particularly a type-1.  It has NOTHING to do with the love of a family, or the desire to keep blood sugars under control.  The parents of Alex, Olivia, and Nate all love their children very much, and would do anything to keep them as healthy as possible.  It simply boils down to economics. Even if insurance provides some access to advanced treatment options, that’s useless if the family can’t afford co-payments or other fees required to get those advanced options.

The ACA is far from perfect, but also a much, much better situation than we had prior to the ACA. The ACA is a step in the right direction, but more is needed. Instead, we’re heading backwards.  The split between the “haves” and the “have nots” has never been more evident in the United States, and as the not-so-hypothetical case of Alex, Olivia, and Nate shows, that divide is also still clearly evident in how we dispense our health care.

Well we are “South” Dakota…

Confederate Flag

A new flag at a house on my way home! My guess is it’s been a month since I’ve been by, so this is something that’s popped up since the election. THIS is the kind of behavior that I guess is now normalized, thanks to our election of an openly bigoted pig of a man as President.

I work at a facility that’s outside of Sioux Falls in the middle of nowhere, which gives me the somewhat unique opportunity to drive gravel roads to and from work if I so wish.  I have several different roads I can take, but today took a gravel road I haven’t taken for probably a month.  I found a new feature on the road!  Joe White Trash Redneck decided to add a second flag to his flag pole…a Confederate Flag.

We ARE “South” Dakota I guess, and unlike those liberal heathens up in North Dakota, there are clearly many of South Dakotans that still harbor old-time convictions.  Who am I kidding…there are white trash rednecks like this all over the country, and lily-white South Dakota is no exception.  The difference is that unlike the South, here we wrap our bigotry and racism in good ol’ fashioned Midwestern “niceness”.

I’ve lived in Nebraska or South Dakota nearly all my life, save for a couple of years spent in Washington D.C. just after college.  I know what people are like, and I’ve always known the “nice Midwesterner” label was a farce.  People are people, and I certainly didn’t notice any difference in “niceness” in D.C. vs. here.  People certainly drive like assholes EVERYWHERE, whether you’re on the jam-packed freeways around D.C. or on the roads around Sioux Falls!  Any pride South Dakotans or other Midwesterners may take in their civility melts away quickly when you peek just under the surface.  Conservative values that dominate here are remarkably similar to conservative values in the deep South, where people may wrap themselves in a cloak of piety and religious belief, but that cloak is simply a cover for some very deep-rooted bigotry and racism.

Is it good or bad that the Trump election normalizes this kind of behavior?  What does it say that a house I’ve passed countless times in the past 23 years never had a Confederate flag flying, yet within a month of Trump being elected, it proudly flies next to the American flag?

Insecure white (trash/redneck/losers) have certainly gotten payback after 8 years of a (gasp!) black president, and with the choice of Trump, people are seemingly becoming much less shy about showing their true colors.

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