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Centennial of the Armistice

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Today marks the 100th anniversary of the Armistice that ended World War I, “the War to End All Wars.” Once upon a time, we commemorated this as “Armistice Day.” That changed in 1956 to “Veteran’s Day.” In my mind, this shift was unfortunate — not because there is anything wrong with honoring veterans but because we lost something when we stopped honoring the Armistice. We shifted our focus from the end of the fight to those who fought. Warriors are very often noble. War very often is not. When we celebrate the nobility of the warrior we run the risk of forgetting the ignobility of war.

Wars are often petty, pointless, and avoidable. How many of us can say just exactly what the point of World War I was? If you have a reasonable historical background, you can probably describe the causes. But what the hell were they fighting for? Pride, fear, and greed seem like the main motivators. And, of course, there was a huge “sunk cost” component — once the combatants were engaged and once a significant number of soldiers had died in the fight, it was impossible to give up without having anything to show for the sacrifice.

And the sacrifice was immense. The impersonal savagery of war was laid bare, stripped of its romance. Personal valor counted for little in the face of the industrial machinery of death. (At Verdun, the French and Germans fired 1.4 million tons of steel at each other.) Wave after wave of husbands, sons, fathers, and brothers were sent into what amounted to a meat grinder only to claim a few yards of ground; ground that was soon be lost again as the other side reciprocated. After the assault failed, and the attackers retreated to their trenches, they left behind the bodies of wounded men, pinned down under fire, beyond rescue, dying – the craters in which they lay filling with water, temperatures dropping, their moans and screams filling the air. In the trenches, soldiers had to dig ever lower to bury their dead, had to throw their body waste out into No Man’s Land. The horrors go on and on, and I can’t ever do them justice. I wasn’t there, and they are countless. My prose here is perhaps overwrought, but I don’t think I can do justice to what these soldiers went through. They suffered so much for so little.

The end of fighting, the Armistice, was itself a thing that deserves respect. We should continue respecting it by holding war in disdain. War can be necessary. On the American side, World War II and the Civil War seem like “good” wars. The need for World War I, Korea, Vietnam, and Iraq is much less clear. The soldiers who fight them can be heroic and noble and deserve our gratitude. But we should scorn those who rattle sabers, indulge their pride, and regard war as a primary instrument of policy without concern for the inevitable human suffering.

In Memoriam

by Ewart Alan Mackintosh (killed in action 21 November 1917 aged 24)

(Private D Sutherland killed in action in the German trenches, 16 May 1916, and the others who died.)

So you were David’s father,
And he was your only son,
And the new-cut peats are rotting
And the work is left undone,
Because of an old man weeping,
Just an old man in pain,
For David, his son David,
That will not come again.

Oh, the letters he wrote you,
And I can see them still,
Not a word of the fighting,
But just the sheep on the hill
And how you should get the crops in
Ere the year get stormier,
And the Bosches have got his body,
And I was his officer.

You were only David’s father,
But I had fifty sons
When we went up in the evening
Under the arch of the guns,
And we came back at twilight –
O God! I heard them call
To me for help and pity
That could not help at all.

Oh, never will I forget you,
My men that trusted me,
More my sons than your fathers’,
For they could only see
The little helpless babies
And the young men in their pride.
They could not see you dying,
And hold you while you died.

Happy and young and gallant,
They saw their first-born go,
But not the strong limbs broken
And the beautiful men brought low,
The piteous writhing bodies,
They screamed ‘Don’t leave me, sir’,
For they were only your fathers
But I was your officer.

Porter County’s Terrible, Horrible, No Good, Very Bad (Election) Day

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Michelle Senderhauf, publishing on Medium, has a ground level account of what looks to be a fiasco in the administration of the Porter County elections. From her end, it sounds like a failure in training, preparation, and staffing all around. The reporting from the NWITimes indicates that elections had previously been administered by the Porter County Voter Registration Office. That authority was transferred to the Clerk’s office earlier this year on a 2-1 vote by the County election board. The Clerk is on that board & voted in favor of transferring authority to her office, saying her office could handle the responsibilities. When the election is administered by the registration office, the county clerk, voter registration office, county election board and the local Republican and Democratic Party chairs are involved in the process. The rationale seems to be that putting it all in the hands of the Clerk would streamline things.

According to Senderhauf’s account, training of poll workers took place late or not at all. The proper number of precinct inspectors, judges, and clerks were not present. The ballots were not delivered on time. One precinct was being directed to an improper voting location which did not have the proper ballots for those voters. Absentee ballots were not delivered to the correct locations for counting.

Per the newspaper reports, at about 1:05 a.m. on Wednesday after election day, “there were women sitting on the floor of the rotunda counting absentee and early voting ballots.” Those ballots should have been delivered to the Porter County Administration Center. “The Election Day problems resulted in emergency court hearings and judges’ orders to ensure access to voting and secure the handling of ballots.”

The FBI has been called in by the Porter County Board of Commissioners to investigate. There have been calls for the Clerk, at whom most fingers are pointing, to resign. She apparently lost her bid to become County Auditor.

There are a lot of moving parts in the election process. There are cynical reasons for partisans to blow any hiccup out of proportion, and there is a tendency by well-meaning citizens to be skittish about a process they don’t fully understand and don’t fully trust. (And, to be fair, some of that distrust has been earned — our country has a rich tradition of election fraud). So, I tend to shrug off a lot of the criticism of election day problems. But the failures here sound fairly remarkable and preventable.

FWJG: Endorsement for Donnelly

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It’s no secret that I think Trump is horrible for America. But, I’m not a knee-jerk partisan bomb thrower. I vote for a lot of Republicans though, it must be said, I probably haven’t voted for a Republican to federal office in a general election since Sen. Lugar in 2006. The rise of Newt Gingrich and the impeachment of Clinton kind of soured me on federal Republicans. But in state and particularly local elections, I have historically kind of bounced around. I say this as a probably ineffective way to add credibility to my recommendation that Indiana voters vote for Joe Donnelly. I’m not making this recommendation out of mere tribalism.

I’m prompted to make this post by the Fort Wayne Journal Gazette’s endorsement of Joe Donnelly. The Journal Gazette leans left, so it’s probably no surprise that they endorse Joe. But, their main points, particularly the one on health care, remain valid. Donnelly cast one of the crucial votes against repeal of the ACA. Braun supports AG Hill’s lawsuit seeking to have the courts invalidate ACA protections on pre-existing conditions. (Per the FWJG editorial, “Braun still advocates repeal and has supported a lawsuit filed by Indiana’s Curtis Hill and other Republican attorneys general aimed at ending guaranteed coverage for people with pre-existing conditions.”) The ACA isn’t great, but we saw that after years and years and years of railing against it, Congressional Republicans could only come up with something that was likely to cost more and cover less. (Per the CBO, AHCA would “result in 24 million Americans losing their health insurance while raising premiums for those covered on the individual market.”)

Braun’s party line orthodoxy on health care goes to the larger point that I made on Twitter a few weeks ago shortly after the Donnelly/Braun debate: “I didn’t watch the Senate debate. I do know that Trump is an incessant liar with bad ideas. Joe Donnelly will vote against him sometimes & Mike Braun never will. No need to get into the weeds on this one.” It’s a frequent complaint among my Democratic friends that Sen. Donnelly votes with Trump and against the Democratic party line way too often. (See, e.g., his vote for Gorsuch.) They are either abandoning him or their support is very, very tepid. I get it, but the reality is that we have a two party system, and Indiana is culturally conservative. The choices are between an inconsistent Democrat and a Republican who will always enable Trump. Personally, I tend to think Donnelly is a good guy who more or less tries to do the right thing while remaining politically viable in Indiana. Middle class and working class people stand a better chance under policies he favors than those favored by Braun. And, in any event, for me Braun’s lockstep support of Trump is simply disqualifying.

Update: The South Bend Tribune endorses Donnelly similar reasons.

The Past Rhymes: Anarchist Bombings of 1919

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Today the news is reporting that a lot of people Trump has named as political enemies have been the subject of attempted bombings. In particular, George Soros, the Clintons, and the Obamas received explosive devices that were apparently similar. CNN’s offices were evacuated after what was suspected to be a pipe bomb. An explosive device addressed to Eric Holder was labeled with a return address for Debbie Wasserman Schultz whose return address also appeared on the bomb sent to Soros. A suspicious package addressed to Maxine Waters was intercepted by Capitol Police and New York Governor Andrew Cuomo announced his Manhattan office received a suspicious package.

As the saying goes, the past doesn’t repeat itself, but it rhymes. This rash of murder attempts using bombs is reminiscent of the Anarchist Bombings of 1919. Those bombs were carried out by Italian anarchist followers of Luigi Galleani.

In late April 1919, at least 36 booby trap dynamite-filled bombs were mailed to a cross-section of prominent politicians and appointees, including the Attorney General of the United States, as well as justice officials, newspaper editors and businessmen, including John D. Rockefeller. Among all the bombs addressed to high-level officials, one bomb was notably addressed to the home of a Federal Bureau of Investigation (BOI) field agent once tasked with investigating the Galleanists, Rayme Weston Finch, who in 1918 had arrested two prominent Galleanists while leading a police raid on the offices of their publication Cronaca Sovversiva.
. . .
These bombings fed into the Palmer Raids, the Red Scare of 1919-1920, persecution of immigrants, and contributed mightily to the rise of J. Edgar Hoover and all of the civil rights abuses he stood for.

Some of the bombs at that time were accompanied by a flyer that said:

War, Class war, and you were the first to wage it under the cover of the powerful institutions you call order, in the darkness of your laws. There will have to be bloodshed; we will not dodge; there will have to be murder: we will kill, because it is necessary; there will have to be destruction; we will destroy to rid the world of your tyrannical institutions.

The Palmer Raids were a series of raids to capture and arrest suspected radical leftists, mostly Italian and Eastern European Jewish immigrants (especially those accused of being anarchists and communists), and deport them from the United States. Palmer had told a House Committee sometime earlier that radicals would “on a certain day…rise up and destroy the government at one fell swoop.” A trial run by Palmer was thrown out on First Amendment grounds and he learned to take advantage of “powerful immigration statutes that authorized the deportation of alien anarchists, violent or not.” A young J. Edgar Hoover led the effort, and the raids led to thousands of arrests, many of them legally dubious.

I can’t say what the fall out from today’s bomb attempts will be, but likely nothing good. Opponents of Trump will claim, with justification, that his rhetoric concerning his political opponents is dangerous and condones violence. His supporters who don’t think the violence is justified will likely dismiss the bombs as unrelated to his rhetoric or as a false flag operation. The government can use the attempts as justification for diluting civil liberties and cracking down on disfavored and politically weak groups, be they immigrants or some other undesirable group. Threats of violence will further exacerbate tribal divisions among U.S. citizens, as citizens with differing political opinions increasingly seeing each other as enemies rather than adversaries.

More on the “Balanced Budget” Amendment: Do Unused Appropriations or Money Saved from Prior Years Count Toward Balanced Budget?

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This post is a little technical and is based on questions raised in the comments of my previous post. So, to recap, the Indiana ballot this year will feature a “balanced budget” question which, I assume, will pass because “hey, balanced budget, sounds great!” is about as deeply as the average voter will think about this. We already have a “no debt” requirement in the Indiana Constitution. But, there seems to be a legitimate question as to whether this will disrupt the way Indiana currently runs its budget, even though the current budgetary procedure has steered us clear of debts for a long time now.

The current Article 10, section 5 of the Indiana Constitution says, “No law shall authorize any debt to be contracted, on behalf of the State, except in the following cases: to meet casual deficits in the revenue; to pay the interest on the State Debt; to repel invasion, suppress insurrection, or, if hostilities be threatened, provide for the public defense.” The proposed amendment (pdf) would add language, in part that reads: “The total amount of expense appropriations enacted by the General Assembly for a biennial budget may not exceed the estimated revenue of the State in the biennial budget period.”

The current practice is to account for cash on hand (which is not revenue) and the near certainty that 100% of money appropriated won’t be spent. The budget balances at the end even though estimated revenue is less than appropriations. But, here (as I read it) it says that at the time of enactment, anticipated revenues have to meet or exceed appropriations at the time money is appropriated. So, saving money doesn’t do you any good, and you have to pretend that every dime you appropriate will be spent which is not the case — I think usually there seems to be something on the order of 3-5% of appropriations that aren’t spent and revert to the general fund.

As written, it appears at least arguable that when adopting a budget, the General Assembly can’t account for money saved from prior years or money it can reasonably anticipate not being spent from appropriations.

Amending the Indiana Constitution: What Would You Say . . . Ya Do Here?

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Justin Mack, writing for the Indianapolis Star, has an article on the ballot question to amend the Indiana Constitution this year. The question has to do with requiring a balanced budget, but it’s not at all clear what functional impact, if any, this proposed change would have on the State government. The following is the text of the proposed amendment to Article 10, Section 5 of the Indiana Constitution, the bold text added.

Section 5. (a) No law shall authorize any debt to be contracted, on behalf of the State, except in the following cases: to meet casual deficits in the revenue; to pay the interest on the State Debt; to repel invasion, suppress insurrection, or, if hostilities be threatened, provide for the public defense.

(b) The following definitions apply to this section only for purposes of the limits on the State budget under this section:

(1) “Revenue” means all income received by the state general fund and all other state funds, excluding the proceeds of bonds or other loans.
(2) “Expense” means the ordinary operating costs of State government, including any debt service payments made during the biennial budget period.

(c) The total amount of expense appropriations enacted by the General Assembly for a biennial budget may not exceed the estimated revenue of the State in the biennial budget period.

(d) A State budget enacted by the General Assembly must appropriate money for the State’s prefunded pension funds in the amount necessary to actuarially fund the accrued liability of all such pension funds during the budget period.

(e) If expenses exceed actual revenue received by the State when reconciled at the close of a biennial budget period, the subsequent biennial budget must subtract any shortfall from the projected revenue available for that subsequent biennial budget.

(f) The requirements under subsections (c) and (d) may be suspended if at least two-thirds of the members of the House of Representatives and at least two-thirds of the members of the Senate vote to suspend the requirement.

(g) A court that orders a remedy pursuant to any case or controversy arising under this section may not order any remedies other than a declaratory judgment or such other remedies that are specifically authorized by the General Assembly in a law implementing this section.

The original text in subsection (a) above, I believe, was adopted as part of the 1851 Constitution. The debt provisions would have been important because the fallout from the Indiana Mammoth Internal Improvement Act and the Panic of 1837 was still relatively fresh in peoples’ minds.

By 1840, the disastrous financial consequences of the Panic of 1837 and the Internal Improvement financing was being fully felt in Indiana. The Whigs decided not to nominate Wallace, their sitting governor, and instead nominated Samuel Bigger who had no connection to the Mammoth Internal Improvement Act. The Democratic nominee, Tilghman Howard, had been in the General Assembly at the time of the Act and had voted for it. Bigger claimed to never have supported the Internal Improvement Act. (Given its general popularity at the time, this seems at least somewhat dubious.) Bigger was also aided by the fact that William Henry Harrison was on the ballot as the Whig Presidential candidate. Harrison’s reputation in the state had improved with the rose-colored glasses of hindsight, and he had become something of a folk hero. Despite the state’s financial struggles, the Whigs retained majorities in the legislature, and Bigger defeated Tilghman.

Bigger’s honeymoon didn’t last long. the State’s payment on its debt was double its revenues. The state soon defaulted on payments and, in an effort to come to grips with the situation, the State imposed a massive tax increase (apparently up to a 300% increase in some places). Efforts were made to complete the improvements, the Wabash & Erie in particular, in order to capture revenues from the improvements. However, those efforts did not make a sufficient dent in the debt.

The struggles with that debt continued through the 1840s:

Whitcomb’s first term was devoted to addressing the State’s financial situation. Measures taken during Bigger’s tenure, a somewhat improving economy, and Whitcomb’s cuts to state employee compensation helped improve the state government’s financial outlook. During his term, he advocated for the creation of the Indiana School for the Deaf and a state mental asylum. Both initiatives were successful, but funding would have to wait until further recovery of the state’s financial prospects.

The State had made some recovery on its finances at the time of Whitcomb’s re-election bid, and he defeated Whig Joseph Marshall and Liberty candidate Stephen Stevens. However, despite the improvement on the debt situation, discussions were underway with Charles Butler, a representative of eastern and foreign bondholders to whom Indiana remained indebted. Butler had successfully negotiated a restructuring in Michigan which had similar internal improvement financial problems — also exacerbated by the Panic of 1837 and also involving the sketchy Morris Canal and Banking Company. In 1845, Butler began negotiations. Prior to the legislative session in December of 1845, Morris gave a speech in Terre Haute where he proposed that a tax should be imposed dedicated to partial repayment of the bonds. The bondholders, in turn, would take the Wabash & Erie’s revenues for the other half. He persuaded Governor Whitcomb of his plan and, together, they lobbied local and legislative leaders.

For his part, Butler attempted to scold Indiana for paying local contractors before paying bondholders and cast the State’s debt repayment obligations in moral terms, making much of the “widows and orphans who held Indiana bonds and depended on regular interest payments.” After some rough and tumble debate (one Senator called Butler’s style of writing and thought as “frothy and bombastic”) the legislature passed a bill in early 1847 that provided for payment of half of the bond obligation and traded control and revenues of the Wabash & Erie for the remainder. The debt still consumed about half of the State’s revenues, but it was becoming more manageable.

When Indiana was drafting its Constitution of 1851, it had been wrestling with a disastrous debt situation for more than a decade. The current structure of our Constitution has been sufficient to keep us more or less out of similar disasters for 160+ years. So, what’s the need for this new language? Does it do something that hasn’t been getting done? I don’t know that I even oppose this as a policy matter, but I’m always against mucking around with our Constitution where we don’t have a good handle on the need or the consequences.

This will obviously pass because “balanced budget? Sounds good!” will likely be the general take by voters considering the question. But, for what it’s worth, I think the current language has served us well enough over the years and so I’ll vote “no.”

(Update): When I initially posted this, I had meant to mention that a rule of statutory construction could lead to consequences where maybe none was intended. Let’s say that lawmakers advocating for this provision don’t really want anything to change – they just want to be seen as fiscally conservative.

A basic principle of statutory interpretation is that courts should “give effect, if possible, to every clause and word of a statute, avoiding, if it may be, any construction which implies that the legislature was ignorant of the meaning of the language it employed.” The modern variant is that statutes should be construed “so as to avoid rendering superfluous” any statutory language: “A statute should be construed so that effect is given to all its provisions, so that no part will be inoperative or superfluous, void or insignificant….” A related principle applies to statutory amendments: there is a “general presumption” that, “when Congress alters the words of a statute, it must intend to change the statute’s meaning.”

So, it’s entirely possible that a court interpreting this new language could feel compelled to read this amendment as requiring change of some sort even if legislators didn’t really intent this amendment to have much of a substantive impact on State operations.

State Impact to Stop Updating Its Website

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State Impact Indiana has been a good resource for Indiana education news since 2011. It has announced that it will stop updating its website in favor of having its stories more diffusely spread through NPR and PBS affiliates:

That change has prompted changes with StateImpact. There are no plans to update the project’s website, indianapublicmedia.org/stateimpact. That’s because local NPR and PBS station partners’ websites are home to stories from the Indiana Public Broadcasting team. These in-depth stories will be available on StateImpact’s social media accounts.

That’s a little disappointing. I have StateImpact in my Feedly newsreader. So, when they post a new story, I’d have it there waiting for me when I checked my news feed. I guess I can add a few more NPR and/or PBS sites to my reader — assuming they have RSS feeds. But, I’m afraid those stories will be mixed in with Trump’s outrage of the hour or whatever the hot issue of the day might be. I can also follow the social media feeds, but there I’m at the mercy of Twitter or Facebook’s algorithms. (You don’t have a social media account so much as Twitter or Facebook has an account that you write content for.)

More generally, I’ve been hoping for a return to the use of RSS feeds, the open web, or whatever you want to call it. I don’t know if this is like hoping for a return to a simpler time when everyone wore hats or a realistic anticipation that people will get sick of social media antics.

Stuff Flows Downhill: Inmate Population Edition

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Big hitter, the Lama. Long.

This is a family-friendly blog, so I’ll not say “shit flows downhill” in the headline. Also, I’m a little skittish about using the phrase here at all since it’d be pretty callous to refer to inmates as “shit.” That’s not my intent — rather, I’m referring to the costs of incarceration. Back in 2014, the General Assembly changed the rules so that low level felons would be incarcerated locally, generally in county jails, rather than in state prisons.

According to an AP article:

The state pays jails $35 daily for each of those inmates to cover food and staffing, but the money doesn’t pay for additional jail space. Dozens of Indiana’s 92 counties are studying, actively pursuing or developing expansion plans or are in the midst of building new facilities.

There was also supposedly a plan for the Department of Corrections to evaluate the savings it realized from not having to house these low level felons and the savings would be passed along to the counties to help them pay for the additional burden. But, last I heard (early 2016), the DOC hadn’t identified any savings, despite a 17% reduction in Department of Corrections sentences, amounting to 5,000 fewer inmates. I don’t know if there have been any developments on that front. But, per the AP article, “lawmakers passed a new law earlier this year that tries to address the jail crowding issue, which local officials say has grown since the state sentencing changes took effect in 2014. Counties can now direct a portion of the local income tax rate to go toward correctional and rehabilitation facilities. The legislation requires counties that are building or renovating jails to conduct a feasibility study to examine possible alternatives.”

Reminds me of Caddyshack:

Hey, Lama! Hey, how about a little something, you know, for the effort, you know?”
And he says, “Oh, uh, there won’t be any money, but when you die, on your deathbed, you will receive total consciousness.”
So I got that goin’ for me, which is nice.

So, there won’t be any money, but the General Assembly has given local officials the opportunity to take the heat for passing a tax increase to fund the DOC’s inmate reduction. Not exactly total consciousness, but I suppose it’s something.

Legislative Study Committee Considers Excluding Poverty-Based Situations From Definition of “Neglect”

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I don’t know how serious the consideration is, but the Indiana General Assembly Interim Study Committee on Courts and the Judiciary received a recommendation from the Department of Child Services based on a suggestion from the Child Welfare Policy and Practice Group. (That CWPPG report is worth reading for anyone wanting a deep dive into the subject. The recommendation is to reconsider the statutory definition of “neglect” which is the most common reason for a “Child in Need of Services” (CHINS) case or designation. Specifically, they recommend excluding neglect which is based solely on poverty and limited, one-time lapses in parental judgment. The overarching problem is that Indiana’s DCS is buckling under the strain of its responsibilities.

Inadequate funding is one issue. But there is also a question of whether the system is over-inclusive. Indiana had a 90% increase in children being referred to out-of-home care from 2005 – 2017 (that seems like an odd date range to pick) while neighboring states had between 10% -40%. Indiana also has a comparatively high rate of children being referred to child protection. Only Washington, D.C., West Virginia, and Vermont have higher rates of referrals. (A caution to the reader – I don’t have a great deal of involvement with these types of cases, so I only have a very broad idea of what it means to be referred to out of home care and to be referred to child protection). The study noted that Indiana has significantly more court involvement with these cases than is common nationwide. 72% of child victims in Indiana have court cases pending compared to 29% nationally. So, the question is whether Indiana has a bigger problem or if it is unnecessarily catching families up in a dragnet.

There is a lot to unpack in the CWPPG review and recommendations, and I’ve only skimmed it. But, with respect to the statutory definition of neglect that caught my eye when I started writing this post, the current definition says:

The child’s physical or mental condition is seriously impaired or seriously endangered as a result of the inability, refusal, or neglect of the child’s parent, guardian, or custodian to supply the child with necessary food, clothing, shelter, medical care, education, or supervision.

According to the working group, this is not an uncommon definition, but it notes that other states exclude violations due solely to poverty and occasional lapses in judgment. The proposed definition would define neglect as:

The child’s physical or mental condition is seriously impaired or seriously endangered as a result of the inability, refusal, or neglect of the child’s parent, guardian, or custodian to supply the child with necessary food, clothing, shelter, medical care, education, or supervision, though the parent, guardian, or custodian is financially able to do so, or due to the failure, refusal, or inability of the parent, guardian, or custodian to seek financial or other reasonable means to do so.

I see what they’re trying to do here, but I’d revise the language somewhat. They want to excuse neglect when a parents are trying their best but just can’t provide, but they don’t want to excuse poverty due to sloth. I think they need to incorporate the “solely” concept into the definition, and I think they need to back off a bit on the failure to seek financial means. As currently written, I don’t see an acceptable poverty excuse that actually makes the cut.

But, overall, the general thrust of the idea isn’t too disagreeable. You want to avoid dragging more people into the system than you have to. You want to devote limited resources to where they can do the most good. And you don’t want to criminalize or otherwise diminish parental rights simply because a person is poor. However, where kids are suffering due to poverty, we need to do a better job of providing for them. And, of course, there is the larger problem of the economy being hollowed out and the consequent erosion of the middle class. But, I suppose that’s a bit much to put on the shoulders of DCS.

Unnecessary HIV Transmission in Scott County

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The Lancet has published a study by Gregg Gonsalves and Forrest Crawford finding that earlier implementation of a public health response could have reduced the scale of the HIV outbreak in Scott County. According to the study, the upper bound of undiagnosed HIV infections in Scott County peaked at 126 on January 10, 2015, about two months before Governor Pence declared a public health emergency. The total number of HIV infections was estimated to be 183-184 by August 11, 2015.

Initiation of a response on Jan 1, 2013, could have suppressed the number of infections to 56 or fewer, averting at least 127 infections; whereas an intervention on April 1, 2011, could have reduced the number of infections to ten or fewer, averting at least 173 infections.

Dr. Crawford in a news release summarizing the study said:

Our findings suggest that with earlier action the actual number of infections recorded in Scott County — 215 — might have been brought down to fewer than 56, if the state had acted in 2013, or to fewer than 10 infections, if they had responded to the HCV outbreak in 2010-2011. Instead they cut funding for the last HIV testing provider in the county.

According to a New England Journal of Medicine study, “free HIV testing had not been available in this community since a Planned Parenthood clinic closed in 2013.” Detection could have taken place earlier if there was a better health system in place. Even after the problem was detected, there was resistance to intervention because of moral concerns. Doctors Josiah Rich and Eli Adashi do a good job of explaining the competing policy views:

The tug-of-war in and around NSEPs and syringe access laws is an ideological one. To some, NSEPs condone and encourage drug use, dissuade injection drug users from seeking help, signal governmental acceptance of illegal behavior, perpetuate the cycle of drug crime, contradict law enforcement efforts, and threaten public health and safety. According to Robert Martinez, director of the Office of National Drug Control Policy from March 1991 through January 1993, NSEPs “undercut the credibility of society’s message that drug use is illegal and morally wrong.”4 Framed in this fashion, injection drug use represents a voluntary lifestyle choice by individuals free of behavioral disease. Viewed in this light, NSEPs undermine the “war on drugs” and its attendant drug-control policies. To others, NSEPs constitute patient-centered constructs designed to assist those whom the International Classification of Diseases defines as having “mental and behavioral disorders due to psychoactive substance use.” These patients have a chronic relapsing disease that is amenable to intervention were they not stigmatized, incarcerated, deprived of employment, or kept at arm’s length from medical care. They have been ostracized and marginalized for want of effective outreach.

Ultimately, I think the evidence is on the side of needle exchange programs. Despite what one’s gut reaction might be to the programs, they do more to prevent harm than they do to increase harm. And, ultimately, that’s the moral calculus that policymakers should look at.