For profit health care: A glimpse at how corporate deceit really works

This story is told in this 30 minute podcast. A transcript of the interview is also at that link. It is a story about corporate business tactics and attendant "public relations" (company propaganda) that CIGNA, a big health care company, routinely employed to keep profit margins high while maintaining a caring public image. Presumably, CIGNA, and all other for profit health care companies still use these tactics to keep costs as low as possible.

By now, it should be clear to everyone that for-profit health care companies operate with an intractable conflict of interest. Specifically, they make more money when insured people do not get health care services. Therefore, in capitalism like with any other company, CIGNA did its best to deny paying for health care services as best it could. The podcast interviews a former senior public relations executive, Wendell Potter[1], who worked for CIGNA. Once Potter accidentally came to realize what he was involved in helping CIGNA do to its customers, his conscience kicked in and he had to get out. 

According to Potter, everything he did was legal, but often misleading. The corporate deceit he helped instill in people led to some bad health care choices by patients and to some preventable patient deaths. His job was to make CIGNA look caring and honest to the public, while maximizing profit by being uncaring and dishonest. 

One episode involved CIGNA dragging its feet about deciding to pay for a teenage girl's liver transplant after she developed leukemia. The company did not want to pay for the transplant so it delayed making a decision. The company delayed so long that the girl's liver had deteriorated to the point that the transplant was considered experimental and therefore not covered by the insurance policy. Bad publicity arose from this case, so CIGNA decided to pay for the transplant even though it was no longer covered. The girl died before she could get her new liver.

Other parts of the interview discuss other sleaze tactics that health care insurance companies routinely employ to avoid paying for health care services. Most civilized industrialized countries have had the common sense to take profit out of their mainstream health care systems. The inherent conflict of interest simply cannot be made to go away any other way. 

Ruthless public relations

Unlike those countries, the US is not civilized. We operate with a capitalist for-profit system. Americans are told they get the best health care in the world. We are not told that we do not necessarily get the best health care in the world. We are also not told that we pay more for health care than any other country in the world. And, we are also not told by the American health care insurance industry that tens of millions of Americans either have no insurance coverage or, they have coverage in theory but cannot actually afford to pay for the deductibles from their "cheap," minimal coverage insurance policies to get payment. Many of them rely on free medical services when, where and if they can get it. Thus, even though Americans pay more than any other country with universal health care systems, we still have tens of millions who are not in the system and get little or no care unless they can afford it on their own.

If memory serves, estimates of deaths from lack of health care in the US before Obamacare ranged from ~20,000/year to ~45,000/year. Not sure what it is these days. That's another fact that the health care insurance industry prefers to not talk about. In capitalism, uninsured people need to pull themselves up by their bootstraps and either get over whatever it is that ails them or drop dead. There's no room in capitalism for any profit-impairing sentiment.

Profit and opacity

This insurance industry loves opacity. For example, people cannot do cost comparisons. Also, when people sign up for Part C of Medicare (Medicare "Advantage" plans -- the advantage is to the insurance companies, not the taxpayers), the insurance industry is brought into the picture and the government moves out. The government pays the companies to handle Medicare and we all know what that means, i.e., the conflict of interest is baaaack! Part of the deal with Part C is that the insurance company negotiated and/or bribed our corrupt federal government into keeping the profits from Part C that the companies make. One estimate is that Part C is worth tens of billions/year, which is why we are constantly bombarded with TV ads trying to coax people out of regular Medicare and into private sector Part C. 

Questions: Would it be better to leave US health care as a mostly for-profit system, or do what other countries with universal health care systems do and socialize it to mostly or completely get rid of the conflict of interest? Is it even politically possible to socialize medicine in the US? Do you like being deceived and lied to about health care, or does that not happen in the US? Is the US health care system corrupt and opaque, or merely just doing what for-profit companies do, e.g., maximizing profits while minimizing transparency?

Footnote: 

1. Potter used to run a cute little website called the Potter Report. It looks to have been abandoned. There he reported on the fun and games of the industry he used to work for. For example, this is part of the last post of March 14, 2019:

Months after advising the Democratic Party to abandon the idea of “Medicare for All,” a former U.S. senator has been hired by a lobbying firm whose clients are leading the fight against changes to the nation’s health care system. Akin Gump Strauss Hauer & Feld LLP, a Washington, D.C.-based law and lobbying firm, announced on Wednesday that former Sen. Joe Donnelly is joining the firm as a partner and will be counseling clients in the health care and financial industries.

In August 2020 at a different site, Potter wrote this:

In my prior life as an insurance executive, it was my job to deceive Americans about their health care. I misled people to protect profits. In fact, one of my major objectives, as a corporate propagandist, was to do my part to “enhance shareholder value.” That work contributed directly to a climate in which fewer people are insured, which has shaped our nation’s struggle against the coronavirus, a condition that we can fight only if everyone is willing and able to get medical treatment. Had spokesmen like me not been paid to obscure important truths about the differences between the U.S. and Canadian health-care systems, tens of thousands of Americans who have died during the pandemic might still be alive.

On a task force for the industry’s biggest trade association, America’s Health Insurance Plans (AHIP), we talked about how we might make health-care systems in Canada, France, Britain and even Cuba look just as bad as ours. We enlisted APCO Worldwide, a giant PR firm. Agents there worked with AHIP to put together a binder of laminated talking points for company flacks like me to use in news releases and statements to reporters. 

I spent much of that year as an industry spokesman, my last after 20 years in the business, spreading AHIP’s “information” to journalists and lawmakers to create the impression that our health-care system was far superior to Canada’s, which we wanted people to believe was on the verge of collapse. The campaign worked. Stories began to appear in the press that cast the Canadian system in a negative light. And when Democrats began writing what would become the Affordable Care Act in early 2009, they gave no serious consideration to a publicly financed system like Canada’s. We succeeded so wildly at defining that idea as radical that Sen. Max Baucus (D-Mont.), then chair of the Senate Finance Committee, had single-payer supporters ejected from a hearing. 

While it’s true that Canadians sometimes have to wait weeks or months for elective procedures (knee replacements are often cited), the truth is that they do not have to wait at all for the vast majority of medical services. And, contrary to another myth I used to peddle — that Canadian doctors are flocking to the United States — there are more doctors per 1,000 people in Canada than here. Canadians see their doctors an average of 6.8 times a year, compared with just four times a year in this country.  

Then there’s quality of care. By numerous measures, it is better in Canada. Some examples: Canada has far lower rates than the United States of hospitalizations from preventable causes like diabetes (almost twice as common here) and hypertension (more than eight times as common). And even though Canada spends less than half what we do per capita on health care, life expectancy there is 82 years, compared with 78.6 years in the United States.

 

The insurance industry loved Obamacare --

if it didn't there would have been no Obamacare

The 1921 battle of Blair Mountain

The Blair Mountain battle was a labor vs coal mine owner conflict that occurred August 25 to September 2, 1921 in West Virginia. It was the largest labor uprising in US history. About 100 miners were murdered and many more were arrested. Local law enforcement, mine owner mercenaries and federal troops crushed the miners fighting for decent work conditions. The United Mine Workers union saw major declines in membership, but long-term publicity led to some improvements in working conditions. 

What enraged and scared the bejesus out of capitalist mine owners was the union of poor whites, blacks and immigrants who rose together to protest barbaric work conditions.

Because the miners lost, the historical story was told by the victors. The winner's story was a pack of lies told by coal companies and the co-opted, craven mainstream media of the time. The winners portrayed the uprising as a caused by miners who were portrayed as products of an ignorant, moonshine-drunken culture, not the vicious capitalist industrial autocracy of the time. 

A 17-minute NPR broadcast discussed this toxic capitalist-inspired and capitalist lied-about event. 

A Blair Mountain miner with his gun 

Wikipedia comments: 

In the short term the battle was an overwhelming victory for coal industry owners and management. UMW [United Mine Workers] membership plummeted from more than 50,000 miners to approximately 10,000 over the next several years, and it was not until 1935 – following the Great Depression and the beginning of the New Deal under President Franklin Delano Roosevelt – that the UMW fully organized in southern West Virginia.

This union defeat had major implications for the UMWA as a whole. After World War I, as the coal industry began to collapse, union mining was no longer financially sustainable. Because of the defeat in West Virginia, the union was also undermined in Pennsylvania and Kentucky. By the end of 1925, Illinois was the only remaining unionized state that could compete with them in terms of soft coal production.

Once union mining became financially unsustainable, non-union mining had to replace it. In the old days, workers always got the shaft when economic forces and capitalism dictated it. That is just how raw capitalism run by human beings worked and still works to the extent modern society will tolerate it.

Question: What is best, unregulated, brass knuckles capitalism backed by force imposed by private and public armies, reasonably regulated capitalism, socialism, or some combination of two or more of those, e.g., significantly or mostly socialized medicine with a reasonably regulated electronics sector?

Armed Blair Mountain miners surrendering to federal troops

Eugene V. Debs: A journey from capitalist reformer to socialist

US Army vs. unarmed striking workers

The NPR program Throughline broadcast a 64 minute episode, American Socialist, about Eugene V. Debs (1855-1926). Debs was a restless mind. Among other things, he worked in the railroad industry and then as a city clerk for Terre Haute Indiana and a state legislator before becoming a political activist. Debs had an understanding of and sympathy for regular people and their plights. Many workers worked 14-16 hours/day, 6 or 7 days a week. The work was often crushing.

In the early days there were no worker protections or labor unions. Workers were routinely injured, killed or their health broke due to overwork. In some places there were company towns and when economic times turned bad, workers were not paid enough to pay for rent and food. That kept them in constantly increasing debt to the company. In bad times, companies cut worker pay so that the impacts on the flow of wealth to owners and shareholders was minimized. There was serious poverty in cities like East St. Louis, where starving men, women and children begging for food roamed some of the streets, presumably streets where they were allowed to roam.  

Debs quit the railroad in East St. Louis after a friend was crushed to death by a locomotive. He moved back to Terre Haute and determined he would do what he could to improve working conditions for railroad workers. That's when he ran for city clerk and was elected. While he was a clerk for Terre Haute, he tended to not impose fines on prostitutes because fines were not imposed on their customers. After two terms there, he was elected to the Indiana state general assembly. 

In the state legislature, Debs introduced a bill that would hold Railroad companies liable for the deaths and injuries of their workers. The state House passed his bill, but Indiana Senate gutted it by removing enforcement measures. This experience led Debs to lose faith in the political process. It began his transition from a capitalist who wanted meaningful reform to a socialist. Debs left politics and moved on to labor organizing and writing articles for newspapers. Early on he argued for capitalist reform.

Debs became disillusioned because labor groups that were forming were fragmented and often competed against each other. The biggest union, the AFL led by Sam Gompers was exclusive, women and racial minorities were mostly excluded. Debs believed there was more strength in labor unity than in fragmentation based on worker skill level, race and sex. Debs then founded the American Railway Union (ARU), which attempted to unite railway workers nationwide. Debs tried and almost succeeded in getting the ARU to accept black workers, particularly the black porters who worked for the Pullman rail car company. That close failure might has altered the course of labor history in the US. Without the porters, the ARU had to resort to tactics that eventually led to the breaking of the union.

One of the program's two hosts and co-founders, Rund Abdelfatah, commented on the issue of divided labor: "When we allow ourselves to be pitted against each other, we gut our own chances of success."

Debs was sort of imprisoned (a 'soft' house arrest) for leading a strike against the railroads. At this time he could have all kinds of visitors, and socialists approached Debs to try to recruit him. Debs' logic included his observation that the Republican Party was the party of the big capitalists, while the Democratic Party was the party of the little capitalists, leaving no party on the side of the workers. Debs resisted socialism a couple years more, but eventually accepted that it was the only realistic alternative to the two-party system of his time.

Debs later ran for president 5 times, once from prison. In 1897, he founded the Social Democracy Party of America based on the remnants of the old ARU. He was vilified by some as an anarchist and others as a dictator. His speeches against Woodrow Wilson arguing resistance to the World War I military draft landed him in jail under the Sedition Act. Wilson called Debs "a traitor to his country."[1] Debs argued strenuously that the American people had no say in making war. He saw World War I as a rich man's pursuit using the blood of the people as a consumable in the effort to make money for themselves.

Debs and the American socialist movement scared the bejesus out of hard core capitalists. They used their own private militias, state and local police and the US Army to fight against and murder striking workers. But over time, some of the more astute and less rigidly ideological among the elites realized that some worker concessions would be needed or things might really get out of hand and actual socialism could rise in America. Things like the 40 hour work week, some worker protection laws, and the beginning of a social safety net eventually came into being. The capitalists opposed it all, but over time they were forced to civilize themselves at least enough to co-opt the socialists by making some concessions and keeping workers as divided among themselves as possible. All of that continues to this day. 

Capitalist tactics have not changed. Capitalism has one and only one universal or nearly universal moral imperative, profit without social conscience, despite some recent squeaks to the contrary.[2] Maximize profit, minimize risk, externalize worker and environmental damage as much as possible, whenever possible by any means possible, legal or not. That's the capitalist moral mindset. It does not look to be merely amoral.

Personal observations and comments

For what it's worth, this broadcast really resonated personally. The mental journey that Debs went through from capitalist reformer to socialist (presumably also with some capitalism reformation) is akin to a mindset reassessment I'm going through now. The corrosive moral rot of capitalism's constant assertion that it is just business and amoral, is pure deceit. It's a Big Lie. The moral rot inherent in unregulated capitalism is a significant source of the degradation of American democracy, civil liberties and the rule of law. To me, unregulated capitalism is inherently demagogic and autocratic-plutocratic. In my opinion, the high stakes political fight we are in now is a continuation of the fight that Debs engaged in long ago.

That fight is corrupt, autocratic, Christian nationalist Republican Party demagoguery fighting hard and dirty for power and wealth concentrated among the chosen elites against a fragmented, divided and distracted urge for democracy with less demagoguery fighting for more distributed power and wealth.

Regarding socialism, capitalists always paint it as a failed ideology and point to the worst of the worst examples. The ideology has never dominated in America, so how it would work here is an open question. Capitalists also always vilify European socialism, but (i) they never mention the fact that many European countries have populations that are happier than Americans, and/or (ii) they downplay happiness as something not important.

 

Questions: 

1. Is it reasonably accurate to boil current American politics mostly down to a fight between forces that want authoritarianism with power and wealth concentrated among the elites against forces that want democracy and civil liberties with power and wealth more distributed among the masses? 

2. Is it correct to argue that unregulated capitalism is (i) often or usually inherently immoral and/or (ii) inherently anti-democratic and pro-authoritarian? 

3. Does American public education do a great, good, mediocre, bad or God awful job of teaching children the sordid, violent history of American labor and the role of heavily vilified, slandered and lied about people like Debs?

Footnotes: 

1. For context, President Wilson mounted a massive federal government propaganda campaign manned by over 150,000 people to deceive and con the American people. The goal was con mostly reluctant Americans into supporting World War I and volunteering to fight in that mindless, hideous slaughter. The tactics that Wilson's "Committee on Public Information" (1917–1919), used included vicious propaganda. One favorite tactic included the still-popular modern tactic of tarring people who oppose war as traitors. Does that sound familiar and contemporary? It should because it is. 

Looking back one can now reasonably ask, was the real traitor to the American people Wilson or Debs? 

2. Nobel prize laureate Milton Friedman publicly argued that CEOs with a social conscience were subversive because they tended to be damaging to profit. 

Sixteen Tons - Tennessee Ernie Ford 

Some people say a man is made outta mud

A poor man's made outta muscle and blood

Muscle and blood and skin and bones

A mind that's a-weak and a back that's strong

You load 16 tons, what do you get?

Another day older and deeper in debt

St. Peter, don't you call me 'cause I can't go

I owe my soul to the company store

I was born one mornin' when the sun didn't shine

I picked up my shovel and I walked to the mine

I loaded 16 tons of number nine coal

And the straw boss said, "Well, a-bless my soul"

You load 16 tons, what do you get?

Another day older and deeper in debt

St. Peter, don't you call me 'cause I can't go

I owe my soul to the company store

etc.

Who is Dave Daubenmire?

 

Controversial former coach Dave Daubenmire talks about ‘lusty’ Trump rally

https://www.nydailynews.com/news/national/ny-coach-dave-daubenmire-trump-masculine-20200921-yvchlmoowje33azd3l2i4etxau-story.html

Dave Daubenmire is a man so obsessed with a domineering vision of masculinity that he encourages bullying, particularly when it is directed at homosexuals.  Further, he argues that not allowing Christians to bully gays is a form of bullying, and that this is only one of many reasons America has been "sissified." 

https://www.change.org/p/lakewood-local-school-district-hebron-oh-do-not-hire-dave-daubenmire

Dave Daubenmire’s $100 Million Plan to Fund His Right-Wing Culture War

Radical religious-right activist Dave Daubenmire has teamed up with anti-vaccine conspiracy theorist Sherri Tenpenny to launch a new organization called The Christian Revolution that is designed to be a funding mechanism to support right-wing activists and causes around the country.

Plus more Dave videos for you to enjoy:

https://www.rightwingwatch.org/post/dave-daubenmires-100-million-plan-to-fund-his-right-wing-culture-war/

Vicious fascist Republican attacks are tearing democracy to pieces

Fascist Republican Party (FRP) hate and anti-democratic poison is oozing deeper and deeper into American society. American democracy, elections and the rule of law are all under a deadly serious attack. The Hill writes:

The toxic acrimony of national politics is seeping down to the local level — and the consequences look ever more ominous.

In recent weeks, school board meetings across the country have descended into screaming matches, often over mask mandates.

Meanwhile, election workers are still reckoning with the forces unleashed in last year’s presidential election — and the fear in some states that new laws mean they could be sued or harassed by partisans in the future.

In many places there is fear — fear for the safety of the low- and mid-level officials who do the unglamorous work that keeps democracy knitted together; and fear for what happens if they decide it’s just not worth it.

Monica Furey Peloso is the president of the board of education for Cheyenne Mountain School District in Colorado.

On Monday, a meeting open to the public became disruptive after anti-mask advocates — many of whom Peloso believes do not live in her district — turned up to harangue the board members for requiring masks for all students.

After the public comment period was over, the board went to a small meeting room to conduct the rest of their business. Irate crowd-members gathered in a courtyard outside, Peloso said.

“A lot of people were chanting and banging on the windows and the door of that little room,” Peloso told this column. “A lot of the people who were facing in at us weren’t even from our district, which was really frustrating.”

The week before, roughly 1,600 miles away, a meeting of the Spotsylvania County School Board in Virginia had to be abandoned — after 13 minutes, according to the local newspaper, The Free Lance-Star — after the crowd became “unruly.”

The school board chair in that case, Dawn Shelley, told this column via email that the behavior she is witnessing from adults is “teaching their children that they can do whatever they want, no matter the consequences. I am worried for our country.”

Shelley also expressed concern that school boards and other local institutions will become less representative of their communities and instead will be taken over by political zealots.

“My concern is not that people won't step up to the plate,” she said. “My concern is that people who don't care, are power hungry, or have a personal agenda will be the ones getting their names on ballots.

Disruptive scenes have been reported across the nation as the politicization of the pandemic deepens.

Eleven people were charged for disrupting a school board meeting in Salt Lake City in May; an aspiring Republican politician in Pennsylvania said within the past two weeks that he intended “going in with 20 strong men” to oust his local board; a meeting in Michigan descended into uproar after one parent responded to a comment about mask mandates with a Nazi salute.

But the anger and incivility isn’t just being seen around school boards — and it can’t be wholly attributed to the prolonged stresses of the pandemic either.

American politics has been becoming more venomous for at least a couple of decades. The factors driving that are numerous and complex. They include the self-reinforcing power of social media, the decline of community institutions, and the willingness of cable news outlets to stoke outrage for ratings.

Then there is former President Trump, both a symptom and an accelerant of the nation’s polarization.

Trump climbed to power by harnessing populist anger at political and media elites. He lost that power only after fomenting a violent uprising, which resulted in him becoming the first president in history to be twice impeached.

The currents that tug at American public life don’t begin and end with Trump — and their negative impact isn’t felt only by his nationally-known targets like Speaker Nancy Pelosi (D-Calif.) or Rep. Alexandria Ocasio-Cortez (D-N.Y.).

Rural Ware County in southeast Georgia briefly became a flashpoint in the wake of the 2020 election when Trump allies alleged voting machines had “switched” votes from Trump to President Biden.

In fact, the 37 votes at issue had been miscounted due to human error. The mistake had been spotted and swiftly resolved.

But the supervisor of elections in the county, Carlos Nelson, is still living with the consequences. His office’s efforts to recruit new election workers for future elections are struggling. He told this column the county is at about 60 percent of where it should be in terms of staffing.

He also related how people who worked on the county’s elections in 2020 had told him about being harassed in grocery stores or while otherwise going about their business.

“People were making snide remarks — ‘we know y’all stealing votes’ and that kind of stuff,” he said.

Those experiences are all the more frustrating given that the workers in question are hardly signing up for glamor or lavish remuneration.

“When a poll worker works from 6 o’clock a.m to 8 o’clock p.m., and you get $125 a day, you are only doing it because of civic duty, because they want to be involved in the process. They are not doing it for the money,” said Nelson.

State-level politicians are also feeling the strain.

Michigan Secretary of State Jocelyn Benson rose to national prominence for reasons she would have preferred to avoid last December.

A mob gathered outside Benson's home on a Saturday evening, chanting through megaphones in protest about the state’s election result. Some of the protestors were armed. Benson was inside with her four-year-old son, the family having just finished putting up Christmas decorations.

In a phone interview Friday, Benson said she was still on the receiving end of some unpleasant exchanges.

“The encounters have changed in type, I would say. They have shifted back online; it has diminished a bit in rancor. But at the same time the constant state of apprehension has remained,” she said.

Benson serves in a state where there are also ongoing criminal proceedings against a group of men who allegedly plotted to kidnap Gov. Gretchen Whitmer (D). One defendant who pleaded guilty in that case was sentenced to more than six years in prison late last month.

In Benson's own situation, the stress of the current political moment takes a toll.

“It has created, really, a sense of a new normal where you are consistently on-edge and consistently aware of the simmering threats,” Benson said. “Sometimes they are more flagrant, sometimes they are more in front of you than others — but there is always a constant recognition of threats.”

Benson asserted that, even in the worst days, she did not wonder whether the costs had become just too high to serve in public office, however. She recalled that she had begun her career working on voting rights in Montgomery, Ala. — and she viewed the attempt to overturn the 2020 election in a similar light.

But as Benson looks at events in other states, not just her own, she wonders where the country is headed. She expresses optimism — but she is blunt about the price to be paid if well-intentioned people turn away in the face of intimidation.

She said that only days ago she addressed a group of election clerks and that “70 percent of my remarks were probably just me saying ‘Thank you.’”

The work was so important, she added, “because if people give up and walk away and don’t stand on the frontlines — whether it’s a bridge in Selma or whether it’s working an election — our democracy will wither on the vine.”

This is more evidence of a sustained FRP attack on democracy, elections, the rule of law, civil liberties and manners and respect. FRP hate is fomented by an endless torrent of well-funded, intentionally divisive lies, deceit, irrational emotional manipulation and crackpot motivated reasoning. Poll data from July indicates support for democracy is declining among Republicans and their conception of patriotism has morphed into support for the FRP's 1/6 coup attempt.

 

Poll data from last January indicates that significant numbers of Americans are worried about domestic threats to our way of life and democracy. 

Questions: Is it unreasonable to believe that American democracy is under gravely seriously attack from the FRP, and/or from some somewhere else? Are American extremists on the left more threatening than extremists on the right?

Adverse climate change impacts on some rural towns

Context

One of the factors that led to our ex-president, Lyin' Donnie, to win the Electoral College in 2016 was a sense of fear and unease in many rural areas. Voter concern was about the long-standing stagnant job and wage situation. Changes in agriculture practices including efficient megafarms slowly decreased the number of farm jobs and who much income they generated. Some small rural towns slowly withered away.

In the 1970s, the Soviet government did an economic analysis and concluded that some small rural towns and villages would be economically viable for the foreseeable future, while others would not. The USSR kept supporting economically viable rural areas and left the rest to slowly wither away and eventually disappear. In forest areas, villages slowly returned to a natural state and wolves roamed around in what was left of dying villages as their populations slowly dropped to zero. A 2013 New York Times article, The Russia Left Behind, described dying villages and towns on the road from Moscow to St. Petersburg (discussed here in 2019). 

Eight miles west of the M10 [Moscow to St. Petersburg highway] lies 

the village of Pochinok, Russia, one of hundreds of disappearing settlements. 

The wilderness is closing in around Nina and Vladimir Kolesnikova and their children.

Ludmila and her grandson Maxim at her sister Nina’s house in Pochinok. 

Nina’s family is the last in her village in an area where 

towns are becoming villages and villages are becoming forest.

At that time I became aware of adverse economic influences on rural areas. Ever since, the concept has stuck with me. More recently, a 2016 essay by Kevin Williamson published in The Nation launched a scathing attack on economically dying rural areas in America. Last March I discussed Williamson's essay here, which included this blistering condemnation of people whining about rural decline and what to do about it:

The truth about these dysfunctional, downscale communities is that they deserve to die. Economically, they are negative assets. Morally, they are indefensible. Forget all your cheap theatrical Bruce Springsteen crap. Forget your sanctimony about struggling Rust Belt factory towns and your conspiracy theories about the wily Orientals stealing our jobs. Forget your goddamned gypsum, and, if he has a problem with that, forget Ed Burke, too. The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles. Donald Trump’s speeches make them feel good. So does OxyContin. What they need isn’t analgesics, literal or political. They need real opportunity, which means that they need real change, which means that they need U-Haul.

Williamson was clearly saying, get a U-Haul, get out of town and go where economic opportunity lies because your economic situation is not tenable. Williamson got a major blast of criticism for his bluntness, but his logic still seems worthy of consideration.

Similar rural decline is being seen in some rural areas of Canada.

The climate change angle

Today, the New York Times raised another issue relevant to the matter of adverse economic forces in some rural areas. The NYT writes:

FAIR BLUFF, N.C. — It’s been almost five years since Hurricane Matthew flooded this small town on the coastal plain of North Carolina. But somehow, the damage keeps getting worse.

The storm submerged Main Street in four feet of water, destroyed the town hall, the police and fire departments, and flooded almost a quarter of its homes. After two weeks underwater, the roads buckled. The school and grocery store shut, then didn’t reopen. When Hurricane Florence submerged the same ground two years later, in 2018, there was little left to destroy.

Climate shocks are pushing small rural communities like Fair Bluff, many of which were already struggling economically, to the brink of insolvency. Rather than bouncing back, places hit repeatedly by hurricanes, floods and wildfires are unraveling: residents and employers leave, the tax base shrinks and it becomes even harder to fund basic services.

Damage in downtown Fair Bluff, NC. The town cannot 

afford to buy ruined buildings and tear them down.

That downward spiral now threatens low-income communities in the path this week of Hurricane Ida and those hit by the recent flooding in Tennessee — hamlets regularly pummeled by storms that are growing more frequent and destructive because of climate change.

Their gradual collapse means more than just the loss of identity, history and community. The damage can haunt those who leave, since they often can’t sell their old homes at a price that allows them to buy something comparable in a safer place. And it threatens to disrupt neighboring towns and cities as the new arrivals push up demand for housing.

The federal government has struggled to respond, often taking years to provide disaster funds. And those programs sometimes work at cross purposes, paying some people to rebuild while paying their neighbors to leave.

Fair Bluff is small-town idyllic, nestled among fields of corn and tobacco near the South Carolina border, shielded from the Lumber River by a narrow bank of tupelo gum, river birch and bald cypress trees. But its main road offers a sobering glimpse of what climate change could mean for communities that can’t defend themselves.

On a recent afternoon, the sidewalks were empty and the storefronts abandoned, their interiors smashed up and littered with trash, doors ajar. The roof of one building had collapsed, a battered American flag stuck in the debris; inside other buildings were ransacked shelves, plastic containers full of Christmas decorations, an upside-down tricycle. Speakers on a Methodist church played recorded hymns for no one.

Some stores were strewn with cleaning supplies and half-full garbage bags, as if shopkeepers had first tried to fix the flood damage before giving up.

“If you look at what the folks here called downtown, really the only business that came back was the U.S. Post Office,” said Mr. Leonard, who splits his time between Fair Bluff and four other towns, none of which can afford a full-time employee on their own.

Stephen Potter, the Seven Springs, NC, mayor. “Long-term, we’re not going 

to be able to stay financially solvent on just our tax base alone,” he said. “Now, what happens when we have another catastrophic flood? I don’t know. I really don’t want to be the mayor that presides over the death of Seven Springs.” 

The NYT article goes on to describe other small towns that climate change, e.g., repeated floods, has made barely economically viable or unviable. Once a town gets too small, it no longer has a tax base sufficient to maintain itself. So, it slowly spirals into non-existence as residents die or move away and businesses go out of business.

Questions: Should the federal government intervene to try to save economically unviable towns, or is that too much like Sisyphus trying to push a boulder up a hill but never able to do it? In other words, can one ever successfully fight against economic forces that are implacably arrayed against success? Should the US do what the Russians started doing decades ago?