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Warning: Red States may be Hazardous to your Health

In late September, a Nebraska woman was sentenced to two years in prison for helping her daughter obtain abortion pills. The case was less about abortion than about some bizarre behavior regarding the burial of the fetal remains, but this is still appalling on any number of levels.

Even so, that’s not what piqued my interest. Rather, I was drawn to one curious footnote to the story, and I’ve heard nothing about it since.

Apparently, the judge in the case had ordered the woman to undergo a psychological evaluation prior to sentencing. Presumably, the results might have helped to mitigate her sentence. Which sounds reasonable, perhaps even routine.

But that evaluation never happened. It was, strangely, “cancelled due to lack of funding.”

Huh? A person whose future may have hinged on that evaluation was denied it because the state couldn’t afford it?

How underfunded are we talking? How many other people moving through the Nebraska judicial system haven’t received court-ordered psych-evals? How many might have seen their sentences softened, or even eliminated? If these evals are underfunded in the judicial system, are they likewise underfunded in other state agencies like, say, healthcare or education or law enforcement?

For a decade, the Republicans in control of the Nebraska government refused to sign on to the Medicaid expansion of Obamacare. They happily turned down tens of millions in federal healthcare funding, for reasons that were purely petulant. No black president was gonna tell them who gets and doesn’t get healthcare in their state.

But then, in 2020, the voters pushed back. In a referendum, held at the height of the pandemic, their own constituency forced them to accept the expansion. Even a brainwashed Republican electorate recognized how much health that sort of money could buy.

Still, the state government, in its wingnut wisdom, dragged its feet in the implementation of that expansion. I don’t know how quickly that money might have entered the healthcare mainstream, but you can bet it was slowed down considerably. And you can bet a lot of programs designed to help people remain chronically underfunded to this day.

In today’s red states, that’s a feature, not a bug. Whatever can be done to degrade, demean, and ultimately shorten people’s lives is fair game, and if they have to rig the system to do that, then so be it.

But beyond the cruelty, beyond the lying, beyond the corruption, beyond the willful stupidity, beyond the wanton zombification of their constituents, it’s becoming ever more evident that you have a significantly better chance of dying prematurely in a red state than a blue one.

Studies now show that this irrational refusal to take federal funding is costing thousands of lives each year. And the redder the state, the more threatened you are. 

Nebraska was lucky to have a referendum process that allowed the public to vote against the wishes of their medieval government. Same with Oklahoma and Missouri, where citizens are still fighting their own states over implementation of the expansion they voted for.

As for the ten “un-expanded” states — Texas and Florida most notably — either they have no such referendum mechanism, or they’ve rendered it ineffective. The only way the people of these states can make the expansion happen is to vote out their Republican administrations. Good luck with that — the gerrymandering is as baked-in as the brainwashing.

But with or without the expansion, these states will remain deeply unhealthy. People who live in red states are significantly more likely to die of cancer, heart disease, or diabetes than in blue states. They have disproportionately more “deaths of despair,” from smoking, drugs, gun violence, or from a panoply of alcohol-related diseases, accidents, and suicides.

And then there’s Covid. Look no further than the records of these states during the pandemic. They all knew better, yet they took their cues from Trump, as opposed to science. The mass death of their citizens was of no consequence at best, intentional at worst.

Now, as they incorporate anti-abortion measures into their laws and budgets, they’re turning pregnancy into a potentially lethal crapshoot, where women are unable to terminate even a fetus that’s killing them.

Still, the ideology never sleeps, even as teen pregnancy soars, even as infant mortality skyrockets, even as hospitals and clinics close for lack of funding, even as doctors flee in droves,to more humane places.

Of course, doctors aren’t the only ones leaving. Teachers — upset by the book bans, the racism, the gay-bashing, and the school boards scrutinizing them for heresy — are moving out, as well. Those who remain, those who see the dangers but can’t leave, will be forced to lie low and watch the steady descent into state fascism.

Underfunding is a constant theme here, and it’s by design. Cutting taxes is a religion in these states, and in doing so they starve their own institutions. They renounce personal income taxes, relying instead on regressive sales taxes that fall disproportionately on the poor, and which don’t raise nearly enough revenue.

Red states give the illusion of being pro-business, but in reality low tax rates are their only selling point. They tout these tax rates in trying to attract business, yet they can’t afford the basics of a modern business environment: good schools, decent hospitals, functioning infrastructure, and a reasonably responsible local government. Companies that rely on first-rate talent to do business need to be able to offer that talent a desirable place to live. Only the companies that don’t care about that stuff will fall for the illusion.

So it’s a race to the bottom. Red states compete with each other for who can offer the lowest tax rates. The lower the tax rates, the lower the revenues. The lower the revenues, the bigger the deficits in the state budgets. Those deficits are then used as an excuse to cut services — fire, police, garbage, public maintenance, prisons, etc. — and to ultimately either eliminate those services, or bid them out to private contractors, who then deliver worse service for more money.

The end product of all this administrative malpractice is a life expectancy that’s four and a half years shorter in red states than in blue. That might not sound like much, but in actuarial terms it’s a shocking difference.

In other words, we’re now seeing ample evidence of what we’ve suspected all along: Red states are a great place to die young.



  1. I was talking to a guy from Russia the other day. He reminded me that people will endure incredible hardship in the name of patriotism. They don't question authority. They take a strange form of pride in being able to withstand the suffering.


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