Vice President Mike Pence had made it clear he thinks little of Charles Darwin, having thoroughly dissed evolution as “just a theory.” Once again, Pence finds himself on the wrong railroad track of history. And the light at the end of his tunnel ​— ​once again ​— ​is the oncoming train of Donald J. Trump, his boss. There’s no immediate record of Trump expounding on evolution, but given that he’s embraced “survival of the fittest” with all the ardor of a boa constrictor in heat, one can only assume he’s a big fan. As always with Trump, an unmistakable element of perversity is involved.

I say this because Trump ​— ​as has been widely reported ​— ​won biggest in communities with the highest death rates among white voters. This demographic cohort in the United States is unique among all westernized industrial democracies: Its members have experienced an actual decline in life expectancy. In fact, this life expectancy decline emerged as the single most reliable indicator of Trump support, even more than political party affiliation. In other words, more dead white people, more Trump votes. Typically, victorious politicians seek to curry favor by rewarding friends and punishing enemies. Trump ​— ​strikingly counterintuitively, and yes, even boldly ​— ​is doing the exact opposite.

In a morbid way, this makes sense. If Death by Despair ​— ​opioid addiction, suicide, gun deaths, and alcohol poisoning ​— ​got Trump to the dance, he can stay in the cha-cha line by feeding that despair. Based on the fine print of the repeal-and-replace health-care bill that Trump is trying to ram down the throat of a reluctant Congress this week, that’s exactly what he’s doing. Even with last-minute changes to make the bill more palatable, the Republican health-care alternative will harshly punish the rural white communities that overwhelmingly supported Trump while simultaneously rewarding younger, affluent voters who overwhelmingly voted for Hillary Clinton. Trump is doing this mayhem by making private insurance more expensive for older whites, hacking their subsidies, and pushing them off the expanded public-health-insurance ledge that’s proved to be the single-most-effective element of the Affordable Care Act by far. Feed the despair.

By cannibalizing expanded Medicaid coverage to the tune of $880 billion, Trump and the Republicans can justify massive tax cuts for a group who needs them the least, the very wealthy and reasonably healthy. Depending on whose numbers you use, $275 billion in these tax cuts will benefit the top 5 percent of income earners. Two-thirds of the cuts will go to the top 20 percent, and 40 percent of the proceeds will line the pockets of the now famous One Percent. For their sacrifice, those who already have a lot will get to have more. On any normal planet, this would be sufficient to make even robber barons blush, and the proposal would have been DOA. Instead, it remains on life support as House Speaker Paul Ryan gives new meaning to the expression “a pig in a poke.” At some point, real people will die. Others will wish they had.

Again, this makes sense under a perverse Darwinian logic. America spends $3.1 trillion a year on health care ​— ​more than $9,000 a year per man, woman, and child. That’s screamingly more than any other nation on the planet; 70 percent of which goes to 10 percent of the population in hopes of prolonging their last six months of life. If our expenditures are high, life expectancies are decidedly not. By that metric, we’re lucky to hover in the middle of the pack among comparable nations. Rather than reform what is an impossibly complex system and focus more on health and less on sickness ​— ​as the Affordable Care Act sought ​— ​Trump and the Republicans have seized upon a much bolder solution: Cut costs by making health care accessible to those who need it least ​— ​the young, healthy, and rich.

In Santa Barbara, push is coming to shove in ways both obvious and not so obvious. Since Obamacare was passed, roughly 1,000 people have signed up for drug-addiction treatment with the County of Santa Barbara. Of these, 30 percent have opioid addictions. Many of these can be regarded as the “able-bodied” individuals some Republicans insist shouldn’t qualify for re-imbursement. In a similar vein, Obamacare has enabled the Santa Barbara Neighborhood Clinics to screen 7,000 of its patients for opioid-addiction issues. Of those, it appears 1,000 need serious help. The clinics provide primary care to about 20,000 low-income, working people, many of whom are Spanish-speaking immigrants. Before Obamacare, 35 percent of the clinics’ customers were uninsured, meaning they paid what they could, typically $42 for a basic visit. Those visits cost $170 to provide. Under Obamacare, the number of self-paying visits has dropped to 22 percent. That’s helped give the clinics a degree of financial stability that long eluded them. Maybe you don’t use the clinics so don’t care. If they disappeared overnight, there’d be 50 more patients a day choking up the Cottage Emergency Room. Absolutely everyone would feel that.

The clinics will also be hurt by Trump’s decision to cut all funding to the Community Development Block Grant program ​— ​which has funded low-income assistance services for 42 years. That’s because four of the five county government entities receiving block grants use a portion of their funds to keep those clinics afloat. It’s no secret the clinics serve large numbers of immigrants. Since Trump unleashed the hounds of mass deportation, the number of patients visiting the neighborhood clinics has dramatically dropped. Some sick people too afraid to get medical help will get better. But most just get sicker. Sooner or later, sick people end up in the Emergency Room. If you think that doesn’t affect you, think again. No one outruns Charles Darwin. Not even Mike Pence.  ​


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