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A journey through a land of extreme poverty: welcome to America

The UNs Philip Alston is an expert on deprivation and he wants to know why 41m Americans are living in poverty. The Guardian joined him on a special two-week mission into the dark heart of the worlds richest nation

Los Angeles, California, 5 December

You got a choice to make, man. You could go straight on to heaven. Or you could turn right, into that.

We are in Los Angeles, in the heart of one of Americas wealthiest cities, and General Dogon, dressed in black, is our tour guide. Alongside him strolls another tall man, grey-haired and sprucely decked out in jeans and suit jacket. Professor Philip Alston is an Australian academic with a formal title: UN special rapporteur on extreme poverty and human rights.

General Dogon, himself a veteran of these Skid Row streets, strides along, stepping over a dead rat without comment and skirting round a body wrapped in a worn orange blanket lying on the sidewalk.

The two men carry on for block after block after block of tatty tents and improvised tarpaulin shelters. Men and women are gathered outside the structures, squatting or sleeping, some in groups, most alone like extras in a low-budget dystopian movie.

We come to an intersection, which is when General Dogon stops and presents his guest with the choice. He points straight ahead to the end of the street, where the glistening skyscrapers of downtown LA rise up in a promise of divine riches.

Heaven.

Then he turns to the right, revealing the black power tattoo on his neck, and leads our gaze back into Skid Row bang in the center of LAs downtown. That way lies 50 blocks of concentrated human humiliation. A nightmare in plain view, in the city of dreams.

Alston turns right.

Philip
Philip Alston in downtown LA. Photograph: Dan Tuffs for the Guardian

So begins a two-week journey into the dark side of the American Dream. The spotlight of the UN monitor, an independent arbiter of human rights standards across the globe, has fallen on this occasion on the US, culminating on Friday with the release of his initial report in Washington.

His fact-finding mission into the richest nation the world has ever known has led him to investigate the tragedy at its core: the 41 million people who officially live in poverty.

Of those, nine million have zero cash income they do not receive a cent in sustenance.

Alstons epic journey has taken him from coast to coast, deprivation to deprivation. Starting in LA and San Francisco, sweeping through the Deep South, traveling on to the colonial stain of Puerto Rico then back to the stricken coal country of West Virginia, he has explored the collateral damage of Americas reliance on private enterprise to the exclusion of public help.

The Guardian had unprecedented access to the UN envoy, following him as he crossed the country, attending all his main stops and witnessing the extreme poverty he is investigating firsthand.

Think of it as payback time. As the UN special rapporteur himself put it: Washington is very keen for me to point out the poverty and human rights failings in other countries. This time Im in the US.

David
David Busch, who is currently homeless on Venice beach, in Los Angeles. Photograph: Dan Tuffs for the Guardian


The tour comes at a critical moment for America and the world. It began on the day that Republicans in the US Senate voted for sweeping tax cuts that will deliver a bonanza for the super wealthy while in time raising taxes on many lower-income families. The changes will exacerbate wealth inequality that is already the most extreme in any industrialized nation, with three men Bill Gates, Jeff Bezos and Warren Buffet owning as much as half of the entire American people.

A few days into the UN visit, Republican leaders took a giant leap further. They announced plans to slash key social programs in what amounts to an assault on the already threadbare welfare state.

Look up! Look at those banks, the cranes, the luxury condos going up, exclaimed General Dogon, who used to be homeless on Skid Row and now works as a local activist with Lacan. Down here, theres nothing. You see the tents back to back, theres no place for folks to go.

California made a suitable starting point for the UN visit. It epitomizes both the vast wealth generated in the tech boom for the 0.001%, and the resulting surge in housing costs that has sent homelessness soaring. Los Angeles, the city with by far the largest population of street dwellers in the country, is grappling with crisis numbers that increased 25% this past year to 55,000.

Ressy Finley, 41, was busy sterilizing the white bucket she uses to slop out in her tent in which she has lived on and off for more than a decade. She keeps her living area, a mass of worn mattresses and blankets and a few motley possessions, as clean as she can in a losing battle against rats and cockroaches. She also endures waves of bed bugs, and has large welts on her shoulder to prove it.

She receives no formal income, and what she makes on recycling bottles and cans is no way enough to afford the average rents of $1,400 a month for a tiny one-bedroom. A friend brings her food every couple of days, the rest of the time she relies on nearby missions.

She cried twice in the course of our short conversation, once when she recalled how her infant son was taken from her arms by social workers because of her drug habit (he is now 14; she has never seen him again). The second time was when she alluded to the sexual abuse that set her as a child on the path towards drugs and homelessness.

Given all that, its remarkable how positive Finley remains. What does she think of the American Dream, the idea that everyone can make it if they try hard enough? She replies instantly: I know Im going to make it.

A 41-year-old woman living on the sidewalk in Skid Row going to make it?

Sure I will, so long as I keep the faith.

What does making it mean to her?

I want to be a writer, a poet, an entrepreneur, a therapist.

Ressy
Ressy Finley, who lives in a tent on 6th Street in Downtown LA. Photograph: Dan Tuffs for the Guardian

Robert Chambers occupies the next patch of sidewalk along from Finleys. Hes created an area around his tent out of wooden pallets, what passes in Skid Row for a cottage garden.

He has a sign up saying Homeless Writers Coalition, the name of a group he runs to give homeless people dignity against what he calls the animalistic aspects of their lives. Hes referring not least to the lack of public bathrooms that forces people to relieve themselves on the streets.

LA authorities have promised to provide more access to toilets, a critical issue given the deadly outbreak of Hepatitis A that began in San Diego and is spreading on the west coast claiming 21 lives mainly through lack of sanitation in homeless encampments. At night local parks and amenities are closed specifically to keep homeless people out.

Skid Row has had the use of nine toilets at night for 1,800 street-faring people. Thats a ratio well below that mandated by the UN in its camps for Syrian refugees.

Its inhuman actually, and eventually in the end you will acquire animalistic psychology, Chambers said.

He has been living on the streets for almost a year, having violated his parole terms for drug possession and in turn being turfed out of his low-cost apartment. Theres no help for him now, he said, no question of making it.

The safety net? It has too many holes in it for me.

Of all the people who crossed paths with the UN monitor, Chambers was the most dismissive of the American Dream. People dont realize its never getting better, theres no recovery for people like us. Im 67, I have a heart condition, I shouldnt be out here. I might not be too much longer.

That was a lot of bad karma to absorb on day one, and it rattled even as seasoned a student of hardship as Alston. As UN special rapporteur, hes reported on dire poverty and its impact on human rights in Saudi Arabia and China among other places. But Skid Row?

I was feeling pretty depressed, he told the Guardian later. The endless drumbeat of horror stories. At a certain point you do wonder what can anyone do about this, let alone me.

And then he took a flight up to San Francisco, to the Tenderloin district where homeless people congregate, and walked into St Boniface church.

What he saw there was an analgesic for his soul.

San Francisco, California, 6 December

The
The Gubbio project at St Boniface in San Francisco. The church opens its doors every weekday at 6am to allow homeless people to rest until 3pm. Photograph: David Levene for the Guardian


About 70 homeless people were quietly sleeping in pews at the back of the church, as they are allowed to do every weekday morning, with worshippers praying harmoniously in front of them. The church welcomes them in as part of the Catholic concept of extending the helping hand.

I found the church surprisingly uplifting, Alston said. It was such a simple scene and such an obvious idea. It struck me Christianity, what the hell is it about if its not this?

It was a rare drop of altruism on the west coast, competing against a sea of hostility. More than 500 anti-homeless laws have been passed in Californian cities in recent years. At a federal level, Ben Carson, the neurosurgeon who Donald Trump appointed US housing secretary, is decimating government spending on affordable housing.

Perhaps the most telling detail: apart from St Boniface and its sister church, no other place of worship in San Francisco welcomes homeless people. In fact, many have begun, even at this season of goodwill, to lock their doors to all comers simply so as to exclude homeless people.

As Tiny Gray-Garcia, herself on the streets, described it to Alston, there is a prevailing attitude that she and her peers have to contend with every day. She called it the violence of looking away.

Coy
Coy Catley, 63, in her homeless box made of cardboard sheets on a sidewalk of Tenderloin, San Francisco. Photograph: Ed Pilkington for the Guardian


That cruel streak the violence of looking away has been a feature of American life since the nations founding. The casting off the yoke of overweening government (the British monarchy) came to be equated in the minds of many Americans with states rights and the individualistic idea of making it on your own a view that is fine for those fortunate enough to do so, less happy if youre born on the wrong side of the tracks.

Countering that has been the conviction that society must protect its own against the vagaries of hunger or unemployment that informed Franklin Roosevelts New Deal and the Great Society of Lyndon Johnson. But in recent times the prevailing winds have blown strongly in the youre on your own, buddy direction. Ronald Reagan set the trend with his 1980s tax cuts, followed by Bill Clinton, whose 1996 decision to scrap welfare payments for low-income families is still punishing millions of Americans.

The cumulative attack has left struggling families, including the 15 million children who are officially in poverty, with dramatically less support than in any other industrialized economy. Now they face perhaps the greatest threat of all.

As Alston himself has written in an essay on Trumps populism and the aggressive challenge it poses to human rights: These are extraordinarily dangerous times. Almost anything seems possible.

Lowndes County, Alabama, 9 December

Aaron
Aaron Thigpen discusses the poor sewage conditions in Butler County. Improper treatment has put the population at risk of diseases long believed to be extinct in the US. Photograph: Bob Miller for the Guardian


Trumps undermining of human rights, combined with the Republican threat to pare back welfare programs next year in order to pay for some of the tax cuts for the rich they are rushing through Congress, will hurt African Americans disproportionately.

Black people are 13% of the US population, but 23% of those officially in poverty and 39% of the homeless.

The racial element of Americas poverty crisis is seen nowhere more clearly than in the Deep South, where the open wounds of slavery continue to bleed. The UN special rapporteur chose as his next stop the Black Belt, the term that originally referred to the rich dark soil that exists in a band across Alabama but over time came to describe its majority African American population.

The link between soil type and demographics was not coincidental. Cotton was found to thrive in this fertile land, and that in turn spawned a trade in slaves to pick the crop. Their descendants still live in the Black Belt, still mired in poverty among the worst in the union.

You can trace the history of Americas shame, from slave times to the present day, in a set of simple graphs. The first shows the cotton-friendly soil of the Black Belt, then the slave population, followed by modern black residence and todays extreme poverty they all occupy the exact same half-moon across Alabama.

There are numerous ways you could parse the present parlous state of Alabamas black community. Perhaps the starkest is the fact that in the Black Belt so many families still have no access to sanitation. Thousands of people continue to live among open sewers of the sort normally associated with the developing world.

The crisis was revealed by the Guardian earlier this year to have led to an ongoing endemic of hookworm, an intestinal parasite that is transmitted through human waste. It is found in Africa and South Asia, but had been assumed eradicated in the US years ago.

Yet here the worm still is, sucking the blood of poor people, in the home state of Trumps US attorney general Jeff Sessions.

A disease of the developing world thriving in the worlds richest country.

The open sewerage problem is especially acute in Lowndes County, a majority black community that was an epicenter of the civil rights movement having been the setting of Martin Luther Kings Selma to Montgomery voting rights march in 1965.

Philp
Philp Alston talks to a resident. Many families in Butler and Lowndes counties choose to live with open sewer systems made from PVC pipe. Photograph: Bob Miller for the Guardian

Despite its proud history, Catherine Flowers estimates that 70% of households in the area either straight pipe their waste directly onto open ground, or have defective septic tanks incapable of dealing with heavy rains.

When her group, Alabama Center for Rural Enterprise (Acre), pressed local authorities to do something about it, officials invested $6m in extending waste treatment systems to primarily white-owned businesses while bypassing overwhelmingly black households.

Thats a glaring example of injustice, Flowers said. People who cannot afford their own systems are left to their own devices while businesses who do have the money are given public services.

Walter, a Lowndes County resident who asked not to give his last name for fear that his water supply would be cut off as a reprisal for speaking out, lives with the daily consequences of such public neglect. You get a good hard rain and it backs up into the house.

Thats a polite way of saying that sewage gurgles up into his kitchen sink, hand basin and bath, filling the house with a sickly-sweet stench.

Given these circumstances, what does he think of the ideology that anyone can make it if they try?

I suppose they could if they had the chance, Walter said. He paused, then added: Folks arent given the chance.

Had he been born white, would his sewerage problems have been fixed by now?

After another pause, he said: Not being racist, but yeah, they would.

Round the back of Walters house the true iniquity of the situation reveals itself. The yard is laced with small channels running from neighboring houses along which dark liquid flows. It congregates in viscous pools directly underneath the mobile home in which Walters son, daughter-in-law and 16-year-old granddaughter live.

It is the ultimate image of the lot of Alabamas impoverished rural black community. As American citizens they are as fully entitled to life, liberty and the pursuit of happiness. Its just that they are surrounded by pools of excrement.

This week, the Black Belt bit back. On Tuesday a new line was added to that simple graphic, showing exactly the same half-moon across Alabama except this time it was not black but blue.

blue belt south

It depicted the army of African American voters who turned out against the odds to send Doug Jones to the US Senate, the first Democrat from Alabama to do so in a generation. It delivered a bloody nose to his opponent, the alleged child molester Roy Moore, and his puppetmasters Steve Bannon and Donald Trump.

It was arguably the most important expression of black political muscle in the region since Kings 1965 march. If the previous entries in the graphic could be labeled soil, slavery and poverty, this one should be captioned empowerment.

Guayama, Puerto Rico, 10 December

So how does Alston view the role of UN rapporteur and his visit? His full report on the US will be released next May before being presented to the UN human rights council in Geneva.

Nobody expects much to come of that: the world body has no teeth with which to enforce good behavior on recalcitrant governments. But Alston hopes that his visit will have an impact by shaming the US into reflecting on its values.

My role is to hold governments to account, he said. If the US administration doesnt want to talk about the right to housing, healthcare or food, then there are still basic human rights standards that have to be met. Its my job to point that out.

Alstons previous investigations into extreme poverty in places like Mauritania pulled no punches. We can expect the same tough love when it comes to his analysis of Puerto Rico, the next stop on his journey into Americas dark side.

Three months after Maria, the devastation wrought by the hurricane has been well documented. It tore 70,000 homes to shreds, brought industry to a standstill and caused a total blackout of the island that continues to cause havoc.

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John McCain had the chance to do the right thing on healthcare. He failed | Lucia Graves

There are many reasons to respect the Arizona senator, but his remarkable stoicism and service cant excuse his yes vote in the Senate

John McCain often gets cast as a truth-teller to Donald Trump, but his voting record says otherwise. And nowhere was that more clear than on Tuesday when, despite his own ill health, when it came to the decision of whether to take other peoples healthcare away, he cast a decisive vote in the wrong direction.

Addressing his fellow lawmakers, McCain called passionately for a return to regular order, and for senators to work constructively across the aisle. Why dont we try the old way of legislating in the Senate, the way our rules and customs encourage us to act, he said in his Tuesday speech. If this process ends in failure, which seems likely, then lets return to regular order!

Though he has often railed against Trump as if he cant actually affect what he is complaining about, McCain isnt a helpless observer hes an influential senator. And on Tuesday, as the country draws closer than ever before to the death of the Affordable Care Act, he was a pivotal one.

Had McCain simply voted no to the question of whether the Senate should begin debate on a repeal or replacement of Obamacare, which squeaked by in the Senate with a vote of 51-50, the chambers leader Mitch McConnell might well have been forced to do the very thing McCain claimed to want: restore the chamber to order.

Instead, McCain, who was recently and tragically diagnosed with an aggressive form of brain cancer, and who returned to DC explicitly to help save the GOP healthcare bill, voted yes.

To put it another way, faced with a rare opportunity to make a real tangible difference, he risked traveling amid failing health to make possible the very thing he decried.

More damningly, he voted yes to take away healthcare from millions of Americans including an untold number of other cancer patients even as he continues to access benefits of the quality care afforded him as a senator, care subsidized by American taxpayers.

Never mind that at this point in time Republicans have little idea what the bill they would replace Obamacare with will contain. Never mind that we have arrived at this point through a secretive process devoid of public hearings, or even that Republicans would have the healthcare of millions of American women dreamed up entirely by men.

Politics appears to have triumphed over logic. Sadly, the politics that won out today are is not even a sort personally dear to John McCain that much was made clear in his floor speech. Its not even his own electoral politics that won out, either; after a tough re-election battle, he wont be up again until 2022, freeing him up as much as electorally possible to act solely with his moral compass as the guide.

Instead, McCain did the very thing he had just railed against, acting out of partisan loyalty.

There are many reasons to respect McCain, a former prisoner of war who endured torture in the five and a half years he spent captive in North Vietnam, and has campaigned against torture by the US. His 2008 campaign against Barack Obama now looks like the very model of civility in the wake of Trump.

But even his remarkable stoicism and service cant excuse what he just did.

The grim reality is that health insurance is of the utmost importance when it comes to surviving cancer, the second leading killer in America after heart disease. Put simply, the uninsured are much more likely to die than those with insurance and sooner.

A recent study in the journal Cancer found the uninsured were 88% more likely to die of testicular cancer than those with insurance. For patients with Medicaid, the number dropped to a 58% greater chance of dying than privately insured patients like McCain.

The study found the same trend held true for patients with glioblastoma, the malignant brain cancer McCain was recently diagnosed with. Its a terribly disease with a median life expectancy with his type of just 15 months, and thats as true for McCain as anyone, but the uninsured still die faster than anyone.

Voting to subject any one of millions of Americans to go to meet such a fate without even the benefit of the best tools medicine has to fight it is cruel, given McCains new-found appreciation of the benefit.

The estimated cost of McCains recent surgery to remove the cancer above his eye is a sum that would bankrupt many Americans, using the Medicare rates for which McCain qualifies.

Theres a way to fix the fact that many Americans under the age of 65 dont have access to any such care: let everyone under it buy in, a scheme for which many on the left have argued. But on Tuesday, McCain helped move the country in precisely the opposite direction.

We still dont know which of several bills Republicans will bring up for a vote, but all of them involve millions of Americans losing the very sort of health insurance upon which McCain depends.

The only question is whether its a matter of 22, 32, or just 15 million people who will lose access. What we can say with confidence is whatever version moves forward, McCains lost more than his good health hes lost his decency.

Read more: https://www.theguardian.com/commentisfree/2017/jul/25/john-mccain-healthcare-senate-vote-republicans

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Trump to rally: GOP senators who oppose health bill ‘will have a lot of problems’

Trump speaks for an hour at campaign-style rally in Youngstown, Ohio, and boasts of accomplishments while pledging once again to build that wall

Donald Trump warned that Republican senators who dont support legislation repealing and replacing Obamacare will have a lot of problems.

Speaking for an hour at a campaign-style rally in Youngstown, Ohio, Trump took a victory lap after the Senate voted to begin debate on legislation to repeal the Affordable Care Act. We are now one step closer to liberating our citizens from this Obamacare nightmare, he said.

Before a raucous crowd in the blue-collar city, Trump went on to warn that any senator who votes against repeal and replace tells America that they are fine with the Obamacare nightmare, and I predict theyll have a lot of problems.

However, Trump spent comparatively little time discussing healthcare. Instead, he returned to familiar themes from his freewheeling presidential campaign, deriding fake news and pledging once again to build that wall on the border between the United States and Mexico. He also returned to familiar boasts about how, with the exception of Abraham Lincoln, he can be more presidential than any president thats ever held this office and taunted protesters, saying about one: Hes going back home to mommy.

He spent much of the rally boasting about his accomplishments since taking office: I think, with few exceptions, no president has done anywhere near what we have done in his first six months.

In particular, Trump dwelled on his efforts to curb illegal immigration and deport undocumented migrants from the United States. Trump claimed that in doing so we are liberating our towns and cities and warned darkly of immigrants in gangs committing crimes.

They dont want to use guns because its too fast and its not painful enough, claimed Trump. So theyll take a young, beautiful girl, 16, 15 and others, and they slice them and dice them with a knife because they want them to go through excruciating pain before they die, and these are the animals that weve been protecting for so long.

Trump though did not address the investigations into Russian interference in the 2016 election or his growing displeasure with Jeff Sessions, the attorney general, for recusing himself from the justice departments investigation into the 2016 campaign.

Read more: https://www.theguardian.com/us-news/2017/jul/25/trump-republicans-healthcare-bill-rally-ohio

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John McCain has been diagnosed with brain cancer, spokesman says

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Statement reveals brain tumor known as glioblastoma was removed along with blood clot above senators right eye during surgery last Friday

John McCain, the Arizona senator and former Republican presidential candidate, has been diagnosed with brain cancer.

A brain tumor known as a glioblastoma was removed from McCain along with a blood clot in a surgery at the Mayo Clinic on Friday, a spokesperson said on Wednesday.

McCains office had only previously announced that the blood clot had been removed from above the 80-year-olds left eye.

The Mayo Clinic said in a statement released by McCains office: The senator and his family are reviewing further treatment options with his Mayo Clinic care team. Treatment options may include a combination of chemotherapy and radiation. The senators doctors say he is recovering from his surgery amazingly well and his underlying health is excellent.

The surgery had forced McCain to stay in Arizona this week and miss votes in the Senate. It had led to a delay in the vote on the Senate Republican bill to repeal and replace the Affordable Care Act (ACA), which was originally scheduled for Monday. Since the delay was announced, a sufficient number of Republican senators came forward to express their opposition to the bill and forced the majority leader, Mitch McConnell, to shelve it and instead try to push a vote on a clean repeal of the ACA.

In a statement, the Arizona senators spokesperson said that in the aftermath of his diagnosis, further consultations with [the] Mayo Clinic care team will indicate when he will return to the United States Senate.

An extended absence would likely make it even more difficult for Republicans to repeal or replace the ACA, popularly known as Obamacare. Senate Republicans have a narrow 52-48 majority and, with the tie-breaking vote of Mike Pence, can only afford to lose two votes if McCain is present. His absence means that two Republican no votes would now sink any legislation if all 48 Democrats are unified in opposition.

McCain, who was re-elected to his sixth term in the Senate in 2016, was the Republican partys presidential nominee in 2008 and finished second to George W Bush in the 2000 GOP presidential primary. Prior to his career in politics, McCain served as an aviator in the US navy, and was held as prisoner of war for five and a half years during the Vietnam war. While being held captive by the north Vietnamese, McCain was repeatedly subjected to torture. He retired as a captain after earning a number of decorations including the Silver Star, the Bronze Star and the Distinguished Flying Cross.

The Arizona senators illness sparked an outpouring of support from both sides of the aisle.

In a statement, Donald Trump said: Senator John McCain has always been a fighter. Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. Get well soon. Trump, who famously set off a political firestorm in 2015 by saying McCain was not a war hero, said earlier in the week of the Arizona senator: We hope John McCain gets better very soon because we miss him. Hes a crusty voice in Washington. Plus we need his vote. And hell be back.

Barack Obama, against whom McCain ran in the 2008 presidential election, tweeted: John McCain is an American hero & one of the bravest fighters Ive ever known. Cancer doesnt know what its up against. Give it hell, John.

Barack Obama (@BarackObama)

John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.

July 20, 2017

A number of McCains colleagues in the Senate also expressed their well wishes. In a statement, Mitch McConnell said: John McCain is a hero to our Conference and a hero to our country. He has never shied from a fight and I know that he will face this challenge with the same extraordinary courage that has characterized his life. The entire Senate familys prayers are with John, Cindy and his family, his staff, and the people of Arizona he represents so well. We all look forward to seeing this American hero again soon.

Outside a meeting of Senate Republicans to discuss healthcare reform on Wednesday night, senator John Hoeven of North Dakota said they had learned of the diagnosis during the meeting.

It was very emotional almost kind of stunned disbelief, Hoeven told reporters. Senator James Lankford, of Oklahoma, then led them in prayer.

Hoeven said the senators had received a message from McCain via South Carolina senator Lindsay Graham, a close friend. The senator told them he was eager to get back and get to work, Hoeven added.

Graham was visibly emotional as he recalled his conversation with McCain when he learned of the diagnosis.

He says, Ive been through worse, Graham told reporters. Five minutes into the call, however, McCain wanted to talk the legislative priories, Graham said.
God knows how this ends, he said. But I do know this: This disease has never had a more worthy opponent.

In a statement, McCains daughter Meghan said: He is a warrior at dusk, one of the greatest Americans of our age, and the worthy heir to his fathers and grandfathers name. But to me, he is something more. He is my strength, my example, my refuge, my confidante, my teacher, my rock, my hero my Dad.

Meghan McCain (@MeghanMcCain)

Statement regarding my father @SenJohnMcCain: pic.twitter.com/SMte9Hkwkq

July 20, 2017

Lauren Gambino contributed to this report.

Read more: https://www.theguardian.com/us-news/2017/jul/19/john-mccain-brain-cancer

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Senate will vote to repeal Obamacare without replacement, after new healthcare bill stumbles

Republican Mitch McConnell calls for vote on clean repeal, after senators Mike Lee and Jerry Moran come out against latest effort to replace Obamacare

Senate majority leader Mitch McConnell has announced that the Senate will vote on a clean repeal of Obamacare without any replacement, after two Republican senators broke ranks to torpedo the current Senate healthcare bill.

Senators Mike Lee of Utah and Jerry Moran of Kansas came out on Monday night in opposition to McConnells Better Care Reconciliation Act (BCRA), the Senate version of the controversial healthcare reform bill that passed the House in May.

Senate Republicans hold a bare 52-48 majority in the Senate and two members of the GOP caucus, the moderate Susan Collins of Maine and the libertarian Rand Paul of Kentucky, already opposed the bill, along with all 48 Democrats. The announcement from Moran and Lee made it impossible for Republicans to muster the 50 votes needed to bring the BCRA bill to the floor.

Instead, McConnell announced late on Monday night that the Senate would vote on a bill to simply repeal Obamacare without any replacement in the coming days.

The Kentucky Republican said in a statement: Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful.

He added that in the coming days the Senate would vote on repealing the Affordable Care Act with a two-year-delay. The Senate passed a similar bill in 2015, which was promptly vetoed by Barack Obama.

McConnells plan echoes a statement made by Donald Trump in a tweet on Monday night, in which the president urged a repeal of Obamacare with any replacement to come in the future.

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in! Trump wrote.

The announcement from Lee and Moran came as Trump was having dinner at the White House with a number of senators who support the bill. Trump talked to several conservatives on the phone over the weekend, including Lee, in an attempt to win their support.

In a tweet, Lee noted that he could not support this version of the bill. Moran used the same language on Twitter. Both voted for a clean repeal of the Affordable Care Act in 2015, albeit with the expectation that it would be vetoed by Obama and not become law.

In an op-ed in The Resurgent, a conservative online publication, Lee cited the fact that the current bill did not incorporate an amendment that he introduced with Ted Cruz to allow insurance companies to offer bare-bones insurance plans. In Lees argument, the mandate that insurance companies cover pre-existing conditions resulted in a hidden tax which meant that middle-class families are being forced to pay billions in higher health insurance premiums to help those with pre-existing conditions.

In a statement, Moran took a slightly different tack. He said: There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it. This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcares rising costs. The Kansas Republican also warned that the current legislation leave[s] the federal government in control of everyday healthcare decisions which Moran said made it more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase.

The announcement came shortly after a Senate vote on the healthcare bill was delayed due to the hospitalization of John McCain. The Arizona senator had a blood clot removed from above his left eye on Friday night and was unable to fly to Washington as a result. On Saturday, McConnell said the Senate would defer consideration of the bill while McCain recovered. A number of other moderate Republican senators have yet to take positions on the bill, most notably Dean Heller of Nevada.

Although a repeal of Obamacare without providing for a immediate replacement has long been popular with conservatives, many other Republicans have been skeptical of this approach because of the potential political cost.

In contrast, McCain said in a statement that Republicans should start the process of passing a health care bill over. Congress must now return to regular order [and] hold hearings, said the Arizona Republican.

In a statement, the Senate Democratic leader, Chuck Schumer, said: This second failure of Trumpcare is proof positive that the core of this bill is unworkable.

He added: Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our healthcare system.

Lauren Gambino contributed reporting

Read more: https://www.theguardian.com/us-news/2017/jul/17/republican-health-bill-senators-oppose-vote

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Journalist under fire for calling it ‘crazy’ not to be disgusted by homeless people

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Prominent Mother Jones writer Kevin Drum says critics deliberately misreading his response to study on peoples reaction to seeing homelessness

A high-profile Mother Jones writer has suggested that it would be crazy not to have a reflexive disgust of homeless people, stirring the anger of those who say he is perpetuating the worst kinds of stereotypes.

Writing on Friday, Kevin Drum was responding to a study which found that some people with a propensity for feeling disgust might experience it when faced with someone living on the street.

Glenn Greenwald reacted by posting photographs of homeless people who have performed altruistic acts alongside a screen shot from Drums story. The two authors of the study, meanwhile, say Drum glossed over subtleties in their work.

outside in america

He seemed to just be endorsing the worst stereotypes without any nuance or without any humanization of these people, said Scott Clifford, one of the authors and an assistant professor of political science at the University of Houston.

Drum said his critics were guilty of deliberately misreading what I wrote.

The authors of the study which is admittedly eyebrow-raising owing to its lexicon set out to untangle a contradiction. Across the country, cities seek to aid homeless people by providing shelters and millions of dollars in funding, while also passing laws against sitting or lying on sidewalks, or restricting where RVs can park, which serve to exclude them.

They examined survey data and focused on a particular feeling that seemed to play a role in perpetuating this paradox: While most of the public wants to help homeless people, they write, sensitivity to disgust drives many of these same people to support policies that facilitate physical distance from homeless people.

Disgust, they propose, might help explain nimbyism in this casea desire among housed people to prevent camps or housing being built in the vicinity of their own homes. And they argue that the media exacerbates disgust with stories that mention disease and unsanitary conditions.

But they do not say that this kind of reaction of reaction is universal: while some people are prone to feeling disgust in the presence of homelessness, others are less likely to.

In his brief response to a summary that the authors published in the Washington Post, Drum said he found their results unsurprising. About half the homeless suffer from a mental illness and a third abuse either alcohol or drugs, he wrote, before commenting how crazy it would be not to not to be disgusted by a population like that.

He finished by suggesting that it was the work of a decent human being to overcome these reflexive feelings and find empathy.

It certainly is the work of of a good human being not to act fully based on immediate reactions, said Maria Foscarinis, executive director of the National Law Center on Homelessness & Poverty. She said the study seems to make sense, though she had some reservations. But she did not agree with Drum, calling the post really over the top and not true to what the paper is saying.

Its just a manifestation of the worst kinds of stereotypes. As a subscriber to this publication, Im really disappointed.

Pete White, head of the Los Angeles Community Action Network, said he thought Drums conclusions risked tarring an entire group of people, as if every houseless person is addicted to drugs and had a mental illness.

Both of the studys authors expressed displeasure. He appears to believe that everyone will in all circumstances feel disgust towards homeless people, said Spencer Piston, the other author and an assistant professor of political science at Boston University. Theres a clear irony here, which is that we argue that the connection between disgust and attitudes about the homeless depend in part on media coverage and the extent to which homeless people are portrayed as disgusting.

In an email, Drum said that he did not think his blogpost was unfaithful to the study. He also pushed back at those condemning him. Please note that I didnt say I was disgusted by the homeless, nor that they are inherently disgusting, he said. Only that, given the nature of the demographic, its not surprising that most people find them disgusting.

Clara Jeffery, the editor-in-chief of Mother Jones, said that the anger was fueled by the terms used in the study and not Drums writing itself. But it is one brief post about a study, she added in her email. Mother Jones has an extensive body of work on the homeless, the housing and mental health and opioid crisis fueling it.

Do you have an experience of homelessness to share with the Guardian? Get in touch

Read more: https://www.theguardian.com/us-news/2017/jul/17/homelessness-kevin-drum-mother-jones-disgust

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Sense of purpose aids sleep, US scientists find

People who felt they had a strong purpose in life suffer from less insomnia and sleep disturbance, says neurologist

The secret to a good nights sleep later in life is having a good reason to get up in the morning, according to US researchers who surveyed people on their sleeping habits and sense of purpose.

People who felt they had a strong purpose in life suffered from less insomnia and sleep disturbances than others and claimed to rest better at night as a result, the study found.

Jason Ong, a neurologist who led the research at Northwestern University in Chicago, said that encouraging people to develop a sense of purpose could help them to keep insomnia at bay without the need for sleeping pills.

More than 800 people aged 60 to 100 took part in the study and answered questions on their sleep quality and motivations in life. To assess their sense of purpose, the participants were asked to rate statements such as: I feel good when I think of what Ive done in the past and what I hope to do in the future.

According to Ong, people who felt their lives had most meaning were less likely to have sleep apnea, a disorder that makes the breathing shallow or occasionally stop, or restless leg syndrome, a condition that compels people to move their legs and which is often worse at night. Those who reported the most purposeful lives had slightly better sleep quality overall, according to the study in the journal Sleep Science and Practice.

Insomnia and some other sleep disorders become more common in old age, but Ong said that the findings were likely to apply to the public more broadly. Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia, he said.

Age UK, a charity, advises people who sleep badly to go to bed and rise at the same time every day; establish a bedtime routine; and cut out caffeine, alcohol and nicotine in the evening. Not eating a heavy meal late at night; avoiding exercise before bed; cutting out daytime naps and banning TVs and computers from the bedroom helps too, they add.

Read more: https://www.theguardian.com/science/2017/jul/10/sense-of-purpose-aids-sleep-us-scientists-find

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John McCain predicts Republican healthcare bill will fail

Unpopular bill further imperilled after senators returned to their states and faced constituents strongly opposed to it

A senior US Republican senator has predicted that the bill to roll back Obamacare would probably fail, adding to growing signs that the bill is in trouble.

My view is that its probably going to be dead, John McCain said on the CBS program Face the Nation.

The Senate bill, which faces unified Democratic opposition, has been further imperilled during a week-long recess where several Republican senators have had to return to their states and face constituents strongly opposed to it. Senators return to Washington on Monday.

The Senate bill keeps much of Obamacare intact but strips away most of its funding. It repeals most Obamacare taxes, overhauls the laws tax credits and ends its Medicaid expansion. It also goes beyond repealing Obamacare by cutting funding for the Medicaid program beginning in 2025.

The White House chief of staff, Reince Priebus, said on Sunday on Fox News that President Donald Trump expected Congress to pass a bill to repeal and replace Obamacare.

The Republican senator Ted Cruz on Sunday said failure to pass the bill was not an option and the Senate effort had to focus on lowering premiums. He pointed to an amendment he offered that is being scored by the nonpartisan Congressional Budget Office, which assesses the impact of legislation.

Cruzs amendment would allow insurers to offer plans that do not comply with Obamacares mandate that they charge sick and healthy people the same rates and that they cover a set of essential health benefits, such as maternity care and prescription drugs, as long as they also offer plans that do comply with the regulations.

The amendment has drawn the support of conservative senators and groups, who say the it will help lower premiums. But moderate Republicans and outside critics say it will erode protections for people with pre-existing conditions and make their insurance unaffordable.

The Senate majority leader, Mitch McConnell, aims to hold a vote on the legislation, which needs the support of at least 50 of the Senates 52 Republicans, before a six-week recess that begins on 29 July.

Yet even McConnell cast doubt on the bills prospects for passage last week.

Speaking at a luncheon in his home state of Kentucky, McConnell said if Congress failed to follow through on a seven-year pledge to repeal Obamacare then it must act to shore up private health insurance markets, comments seen as providing a pathway to a bipartisan deal to fix the health system.

Read more: https://www.theguardian.com/us-news/2017/jul/10/john-mccain-predicts-republican-healthcare-bill-will-fail

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McConnell hints healthcare vote could fall short: ‘I’m a guy with a Rubik’s cube’

Senate majority leader spoke to impasse over key aspects of Republican bill at an event Thursday, but said no action was not an alternative

Senate majority leader Mitch McConnell on Thursday hinted that the Republican effort to repeal the Affordable Care Act (ACA) could fall short as conservatives and moderates in his conference remain at an impasse over key aspects of the bill.

Before leaving Washington for a week-long Fourth of July recess, McConnell delayed a vote on the Republican healthcare bill after it was clear there was not enough support for the plan, which would leave 22 million fewer people without health insurance over the next decade, according to an analysis by the Congressional Budget Office.

If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur, McConnell told constituents at a Rotary Club lunch on Thursday, according to the Associated Press.

No action is not an alternative, he added. Weve got the insurance markets imploding all over the country, including in this state.

McConnells comments were quickly embraced by his Democratic counterpart, Senate minority leader Chuck Schumer.

Its encouraging that Sen McConnell today acknowledged that the issues with the exchanges are fixable, and opened the door to bipartisan solutions to improve our healthcare system, Schumer said in a statement.

As weve said time and time again, Democrats are eager to work with Republicans to stabilize the markets and improve the law. At the top of the list should be ensuring cost-sharing payments are permanent, which will protect healthcare for millions.

McConnell faces a daunting task as he works behind the scenes with senators to craft a bill that bridges the ideological divide within his conference. Moderates, especially those from states that opted to expand Medicaid under the ACA (also known as Obamacare) are wary of scaling back spending on the health insurance program for low-income Americans, and conservatives are irked the plan does not go further to repeal the law.

Im in the position of a guy with a Rubiks cube trying to twist the dial in such a way to get at least 50 members of my conference who can agree to a version of repealing and replacing Obamcare, McConnell told Kentucky voters at a town hall-style event on Thursday, according to NBC. That is a very timely subject that Im grappling with as we speak.

Senate
Senate minority leader Chuck Schumer holds up a photograph of constituents who would be adversely affected by the proposed Republican bill. Photograph: Andrew Harnik/AP

An initial draft of the Senate Republican healthcare plan mirrors the structure of the House bill, which passed in May. The measure would repeal key pieces of the ACA while extracting deep cuts to Medicaid compared to spending under current law.

McConnell has since made changes to the bill, including adding $45bn to combat the opioid epidemic, among other adjustments. The CBO is expected to release another analysis sometime next week, a likely indicator that Senate Republicans will not vote on the plan until later this month.

On Thursday, a handful of senate Republicans echoed McConnells skepticism about whether the party would be able to reach an agreement on health care.

It is precarious, senator Ted Cruz, a conservative of Texas, said on San Antonios KTSA Radio. The majority is so narrow, I dont know if we get it done or not.

Senate Republicans are using a special budget process known as reconciliation to avoid a Democratic filibuster of the repeal plan. To pass the bill, Republicans need support from at least 50 of their 52 members. No Democrats are expected to support a repeal measure. In the case of a tie, vice-president Mike Pence would cast the final vote.

Cruz has offered an amendment that would allow insurance companies to sell non-compliant plans as long as they also offer at least one plan that does meet Obamacare standards. Experts on both sides of the political debate said such an action could devastate insurance markets.

Senator Jerry Moran, a Republican from Kansas who surprised his party when he came out against the bill, told constituents in Palco that healthcare reform is almost impossible to try to solve when youre trying to do it with 51 votes in the United States Senate, in which there is not significant consensus on what the final result ought to be.

As the debate over healthcare rages, Senator Pat Toomey, a Republican of Pennsylvania who supports the bill, suggested during a televised town hall on Wednesday that McConnell was several weeks away from winning enough support for a vote. Asked why Republicans were struggling to fulfill a years-long campaign promise, Toomey offered a candid reply.

Look, I didnt expect Donald Trump to win, he said. I think most of my colleagues didnt, so we didnt expect to be in this situation.

Read more: https://www.theguardian.com/us-news/2017/jul/06/republican-healthcare-bill-mitch-mcconnell-vote-delay

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Activists cry cowardice as Republican senators shut doors to healthcare town halls

Pat Toomeys closed-door talk saw him accused of not having the courage to speak to those affected, while Ted Cruz also faced dissent at his ticket-only event

At a town hall in Pennsylvania on Wednesday night, Republican senator Pat Toomey faced an angry protest over his role in the GOP healthcare bill, while Ted Cruz was heckled over his suggested amendment to the legislation at an event in Texas.

Scores of people gathered outside the ABC27 studio in Harrisburg, Pennsylvania, where Toomey was holding what had been billed as a town hall meeting.

But in reality just eight audience members were allowed into the invite-only event, and their questions had been pre-screened by the news channel.

The closed-door approach did not endear Toomey to the sign-waving protesters outside, who accused the senator of not having courage to speak to people who would be personally affected by the Senate healthcare legislation he helped to write.

Cruz, meanwhile, was heckled at what in theory should have been a safe event; a ticket-only town hall veterans discussion hosted by Concerned Veterans for America a rightwing advocacy group financed by the Koch brothers.

Audience questions for Cruz at the event in McKinney, north of Dallas, had been screened in advance by the CVA, but two audience members went rogue to quiz and interrupt the Texas senator over his proposed tweak to the Senate bill.

The Better Care Reconciliation act, which the Congressional Budget Office says would leave an additional 22m people without healthcare, is currently stuck in the Senate without enough votes to pass. Cruzs amendment would allow insurance companies to sell plans that do not include the Affordable Care Act (ACA)-mandated essential health benefits, in a move he claims would reduce costs.

At the town hall, however, Cruzs adversaries repeatedly shouted him down as he attempted to defend his measure.

When you mandate what every policy has to cover you drive up the cost of insurance, Cruz said, which means fewer people can afford healthcare. The essential health benefits also made people pay for coverage that they dont necessarily want, he said.

Its all fine and good to mandate that everybody get coverage for everything at all times, but what happens in practice is the prices go so high that people are left out in the cold.

Ted
Ted Cruz also faced heckling at a ticket-only town hall event in Texas. Photograph: ddp USA/REX/Shutterstock

Some 1,300 miles to the north east, Toomey was being given a much easier ride from the eight attendees at his town hall. The majority of the questions from that crowd, as well as from small groups of people invited into the studios of three other ABC affiliates in Pennsylvania, focussed on healthcare, but there was no heckling and no follow-up questioning.

Asked about the damaging CBO score, Toomey accused the organization of bias and said that its calculations were based on wildly speculative assumptions that I think are extremely likely to come to pass.

Toomey denied that the process of drafting the bill which has no public hearings had been overly secretive, but was non-committal over whether he supported repealing the ACA without a replacement.

The senator was asked the question twice, both times saying that he believed the scenario was unlikely.

I just dont think there are enough votes in the senate to pass that, Toomey said. I just dont think its going to come to pass.

Meanwhile, outside the studio about a hundred people noisily protested both the senators role in the unpopular healthcare bill and his refusal to hold a truly public event.

We want Toomey to come home on his recess and actually speak with constituents, instead of doing telephone town halls or televised town halls where he doesnt have to interact with the people hes supposed to be representing, said Katey Dyck in a phone interview, who travelled two hours from her home in Fort Washington, just north of Philadelphia, to attend the protest.

Hes dismantling our healthcare system without having the courage to speak to people who would be personally affected.

Dyck travelled to Harrisburg with her two children and two friends, one of whom, Alison Fraser, was arrested after staging a sit-in at Toomeys Washington DC office last week.

There are issues with the ACA. There are things they can do to bring down costs, Fraser said.

But they cant just dismantle this bill that has really done so much to protect people, and make sure people arent discriminated against because of pre-existing conditions.

Also among the protesters was Josh Burkholder, a Democrat who ran unsuccessfully for US congress in Pennsylvanias fourth district last November.

Theyre giving a huge tax break to the 1% here, Burkholder said, also by phone, of the Senate legislation.

Its just awful. Making a giant tax break for the ultra rich while simultaneously pulling the rug out from under the poor of the country is just disgusting.

The majority of Senate Republicans have so far ducked interactions with the public during recess week supposedly a time for elected officials to return to their districts and meet with constituents.

The Washington Post reported that just four GOP senators planned to attend Fourth of July parades, while only three Cruz, Bill Cassidy from Louisiana and Jerry Moran from Kansas are scheduled to hold public town halls.

Cruz and Moran are openly opposed to the Senate bill while Cassidy has said he is concerned and has put forward an alternative to the plan.

Read more: https://www.theguardian.com/us-news/2017/jul/05/pat-toomey-ted-cruz-healthcare-bill-protest

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