The cost of health care and access to health care still top many Americans’ list of the most urgent problem facing the nation, and rising costs continue to bite into the pocketbooks of both individuals and the government. Tackling that problem was one of the primary reasons behind the passage of Obamacare, both in terms of its cost controls and its subsidies to people buying care on the exchanges. And bringing the picture into further relief, a new Gallup poll released today found that over one in three Americans have put off medical treatment because of concerns with cost — the highest reported numbers in the last decade:

Thirty-two percent of Americans say they have had to put off medical care for themselves or their family in the past year due to the cost — the highest percentage since Gallup started tracking this annually in 2001. The percentage reporting they are putting treatment off is up significantly from the 19% found 12 years ago.

More than half of those with no health insurance say they have had to put off care (55%), as have 30% of those with private health insurance — while 21% of those who have Medicare or Medicaid say the same.

The strikingly low number of people on Medicaid or Medicare who report putting off health care due to costs is in line with an earlier survey by Gallup that found 76 percent of recipients on those programs are satisfied with the cost of their health care, versus just 57 percent of those on private insurance. It’s also consistent with a recent study by the Government Accountability Office, which found Medicaid recipients enjoy virtually identical access to necessary care as those on private insurance — despite concerns that Medicaid’s reimbursement rates to providers are far lower.

The tragic shooting at a school today in Connecticut, the general increase in such mass shootings in the United States, and the silence of policymakers in the face of the problem all hint at a remarkable contradiction in modern American crime: although medical advances ensure that fewer lives are being lost to violence, incidences of such violence are actually increasing.

A recent report in the Wall Street Journal found that serious gunshot and stabbing wounds rose 47 percent over the last decade, even as the number of homicides dropped during the 1990s and then again after 2007:

Emergency-room physicians who treat victims of gunshot and knife attacks say more people survive because of the spread of hospital trauma centers — which specialize in treating severe injuries — the increased use of helicopters to ferry patients, better training of first-responders and lessons gleaned from the battlefields of Iraq and Afghanistan. [...]

After a steady decline through the 1990s, the annual number of homicides zigzagged before resuming a decline in 2007, falling from 16,929 that year to an estimated 14,722 in 2010, according to FBI crime data.

At the same time, medical data and other surveys in the U.S. show a rising number of serious injuries from assaults with guns and knives. The estimated number of people wounded seriously enough by gunshots to require a hospital stay, rather than treatment and release, rose 47% to 30,759 in 2011 from 20,844 in 2001, according to data from the Centers for Disease Control and Prevention’s National Electronic Injury Surveillance System-All Injury Program. The CDC estimates showed the number of people injured in serious stabbings rose to 23,550 from 22,047 over the same period.

Drawing conclusions about causation from those numbers is an inexact science — especially because the process of collecting and classifying information from emergency rooms can be haphazard. “Homicide is the one thing we’re measuring well,” Jens Ludwig, a law professor and the director of the University of Chicago Crime Lab, told the Wall Street Journal. “Everything else is subject to much more uncertainty.”

But other reports also suggest that trauma centers are improving the chance of survival for victims of violent crimes. A New England Journal of Medicine study in 2006 determined that treating patients at trauma centers, rather than regular hospitals, significantly lowered their risk of death.

According to the American Trauma Society, 90 percent of Americans lived within an hour of a trauma center by helicopter or ambulance in 2010. But the propagation of those trauma centers is a costly endeavor. The Trauma Center Association of America, a lobbying group for that sector of the medical industry, estimates that those centers lose $230 million a year providing the uninsured with treatment — and that’s not including the emergency care they provide for their low-income patients, which is also often funded by Medicaid, a federal program that provides far lower reimbursement rates than private insurers.

Details about Friday’s horrific shooting spree at a Connecticut elementary school are still emerging, and it remains unknown whether the suspected shooter suffered from underlying mental health issues. But the fact remains: in America, it’s currently easier for a poor person to get a gun than it is for them to get treatment for mental health issues.

Most murders committed in the United States involve a firearm — particularly handguns. A quick search shows that a typical handgun can be purchased for anywhere between $250 and $500. A .223-caliber semi-automatic rifle — which some reports indicate was the type of firearm used in today’s attack — costs between $700 and $2000. And contrary to the gun lobby’s most ardent hysteria about Barack Obama, gun ownership has actually been rising over the past four years, as has the use of guns in violent crimes.

By comparison, access to mental health services remains spotty, its funding and beneficiary requirements subject to the whims of governments attempting to balance their bloated budgets. People often do not know when they are entitled to preventative care services for mental health, and the people who do often forgo care due to the stigma associated with receiving such care.

And then there’s the cost of more extensive care. According to the National Survey on Drug Use and Health (NSDUH), a mere 7.1 percent of all American adults receive mental health services. Most of these Americans’ care is covered by private insurance, with children, poorer, and more elderly Americans being covered through public insurance programs such as Medicare and Medicaid. An additional ten percent are uninsured. But out-of-pocket costs for both inpatient and outpatient mental health services remain staggeringly high:

Obamacare will require health plans on statewide exchanges to cover mental health services as one of its “essential health benefit” categories. But states ultimately carry most of the discretion when it comes to defining what these services are and how much funding they get, and the coverage won’t help Americans in the absence of active efforts to identify and treat mental health disorders.

The National Alliance on Mental Illness (NAMI) reports that Connecticut’s public mental health system currently provides coverage for less than one in five Connecticut residents with a serious mental health problem. The other four may not be able to afford to pay for those services on their own, particularly since mental health issues tend to disproportionately affect poor people.

Many states do require mental health evaluations and background checks before allowing their residents to purchase a gun. But doing an evaluation isn’t the same thing as actually treating people with ongoing mental health conditions.

Secret video footage of a hog farm in Manitoba, Canada show workers body-slamming piglets into the floor, swinging them into metal posts and kicking them when they can’t stand up. The harrowing video was filmed by an investigator for animal rights group Mercy for Animals Canada, who went undercover at the Puratone farm for three months. Mercy for Animals Canada — a sister organization of the U.S. group by the same name — released the footage Monday, calling for major grocery chains that carry Puratone meat to boycott the pork producer.

As Manitoba officials prepare to inspect and possibly investigate the Puratone facility, however, an “Animal Care Review” panel has dismissed this type of abuse as a standard, “humane” practice. This panel of researchers and scientists was put together by the Center for Food Integrity, an American organization funded by agribusiness giants including Monsanto, the National Pork Producers Council, Pfizer, Cargill and Purdue. The Vancouver Sun reports:

But the Animal Care Review Panel, made up of a University of Manitoba animal sciences professor, an Ontario Veterinary College professor and a research scientist, says [body-slamming piglets is] a humane way to euthanize piglets.

The panel, formed by the Center for Food Integrity, a U.S.-based organization representing farmers, food processors and retailers, said most of what’s in the video is widely acceptable and humane. [...] The footage appears to show pigs bleeding from open wounds in tight metal cages, pregnant pigs with distended, inflamed bellies, and piglets being slammed down on the floor by staff.

Watch it (warning — contains very graphic images):

The Center for Food Integrity is in fact an industry public relations group intended to “build consumer trust and confidence in the contemporary U.S. food system by sharing accurate, balanced information, correcting misinformation, modeling best practices and engaging stakeholders to address issues that are important to consumers.” In a recent example of this “accurate, balanced information,” CFI encourages companies to justify factory farms, where overcrowding and confinement in filthy quarters often breeds disease, by telling consumers that “indoor housing systems protect food animals from bad weather and predators.”

CFI essentially exists to clean up PR messes for Big Ag. In February, an American animal rights group released an undercover video of an Iowa hog farm showing immobilized pigs in tiny crates caked with feces, workers pushing herniated intestines back inside a piglet, and other pigs being fed the intestines from dead pigs. CFI quickly convened a panel to explain the video showed “normally accepted production practices and nothing that could be considered abusive.”

Indeed, these abusive practices do seem to be standard across the industry; in July, yet another undercover video was released by Mercy for Animals at a hog farm in Minnesota documenting the same tiny “gestation” crates found at the Canadian facility. CFI’s panels try to convince consumers that “standard” practice are the same as “humane” practices.

Rather than put effort into reforming systematic cruelty, Big Ag companies prefer to invest in bending the law to suit them. Five states have passed so-called “ag-gag” laws, which criminalize undercover investigations and secret footage inside these facilities. These laws’ sole purpose is to keep consumers from discovering the conditions in which their food is produced.

At an Urban Institute panel on depression and low-income Americans on Thursday, Marla McDaniel of the Center on Labor, Human Services, and Population pointed out that low-income American mothers are “more likely to have severe depression.”

Fortunately, Obamacare’s Medicaid expansion will help offer those low-income mothers the crucial preventative and mental health services they need to treat their clinical depression. Especially considering the economic disparity between those who are affected by depression — and the lack of sufficient treatment options for low-income Americans — states that choose to expand Medicaid under Obamacare will make important strides toward ensuring low-income mothers have the health resources they need:

Eighty two percent of infants living in households with depressed mothers were enrolled in Medicaid or CHIP programs, health care programs for low-income people, according to a separate 2010 report by the Urban Institute about children affected by maternal depression. Of the mothers, at least 40 percent were not receiving any treatment. Outcomes were consistently worse for uninsured families.

Having a lower-income household also affected the type of mental health provider treating the women, according to the draft paper. Ten percent of lower-income mothers visited a psychiatrist and received a prescription to treat their symptoms, about half as many as the higher-income mothers. Seven percent of the low- income mothers received treatment from social workers, compared to 2 percent of higher income women and 5 percent of the uninsured.

But states choosing to participate in the expansion of Medicaid could improve access to the prevention and treatment women need, said Larke Huang, a psychologist and senior adviser at the federal Substance Abuse and Mental Health Services Administration, who was also part of the forum. Medicaid currently covers pregnant women considered “medically needy,” who might not meet income requirements. The coverage continues until six months after they give birth. In states that expand the program, many of those women will now qualify for the program after the six-month period, she said.

In fact, when mothers’ depression goes untreated, it results in significant social costs that extend well beyond the early childhood period. According to Scientific American, depressed mothers are less likely to have a strong cognitive bond with their children or be employed, leading to excess stress in households — and ultimately perpetuating a vicious cycle in which untreated mental health conditions negatively impact the prospects of future generations.

Furthermore, a disproportionate number of Latino and African-American children live in single-mother household, and seven in ten children in such families are in a low-income household. These are communities that are already struggling with the effects of decades of racial and class bias — and a lack of preventative mental health resources only exacerbates that historical gap.

But while Obamacare’s Medicaid expansion could provide some relief to these families, GOP governors in poor states with high uninsurance levels have been refusing to take part in the program. So far, Nevada’s Gov. Brian Sandoval (R) — whose state has a high concentration of poor Hispanics and African Americans — has been the only Republican state official to embrace expanding his state’s Medicaid pool.

The Republican-dominated Ohio Legislature has tried and failed to advance some of the most extreme anti-choice and anti-woman legislation in the country, including a bill to defund Planned Parenthood and the “heartbeat bill” that would have banned abortions as early as six weeks into a pregnancy. Having had little success in the state house, radical anti-choice advocates have found a foothold in the Ohio State Medical Board instead.

On Thursday, the Ohio Senate confirmed Ohio Right To Life President Mike Gonidakis’ appointment to the state Medical Board. Gonidakis is now the second member of the officially nonpartisan board with strong ties to the anti-choice organization, after former Right to Life board member Laurie Elsass. The Medical Board, comprised of 9 doctors and 3 “consumer” positions, manages licensing and regulation of the state’s doctors.

During his 5-year term, Gonidakis will have the power to deny or revoke licenses from Ohio doctors. With no medical expertise, the former ORTL president has made it quite clear that he is willing to distort medical information to fit his agenda. Just a few months ago, he falsely claimed that “not one abortion last year, and the report just came out a few weeks ago, not one abortion was due to rape, incest, or the life of the mothers.” This assertion was disputed by practicing OB-GYNs.

While the board is intended to be purely administrative, other states have also politicized their medical boards. The Virginia Medical Board was pressured into reconsidering their decision to exempt existing abortion clinics from excessively strict regulations meant to shut down these facilities. In Iowa, Gov. Terry Branstad (R-IA) stacked the state medical board with an anti-choice activist and a Catholic priest who had testified on anti-choice legislation. Gonidakis has made it quite clear how he will approach his position; just a few months ago, he claimed falsely that “not one abortion last year…was due to rape, incest or the life of the mothers.”

Gonidakis is just one of Gov. John Kasich’s (R-OH) many politicized appointments during the lame duck session. The governor also appointed Ohio Right to Life board member Marshall Pitchford to a Supreme Court vacancy committee on October 12. Executive Director of NARAL Pro-Choice Ohio Kellie Copeland protested the appointments, saying Kasich’s choices proved he was “playing a more active role in the war on women than Ohioans realize.”

Louisiana Governor Bobby Jindal (R) managed on Friday to do what the rest of his party has been unable to: Listen to public opinion. In a Wall Street Journal op-ed published in Friday’s paper, Jindal advocates for over-the-counter access to birth control, as an “end of birth-control politics.”

The article, prompted by new guidelines on birth control distribution from the American College of Obstetricians and Gynecologists, comes as a surprise from the rabidly anti-abortion Jindal. But it makes sense from a governor who is widely expected to throw his hat into the ring for the 2016 presidential election.

Over-the-counter access to birth control is actually an area where free-market conservatives and pro-choice liberals can agree. Jindal’s argument smacks of conservative ideology, but his logic is respectful of those who believe in a sex-positive, equal access approach to family planning:

Let’s ask the question: Why do women have to go see a doctor before they buy birth control? There are two answers. First, because big government says they should, even though requiring a doctor visit to get a drug that research shows is safe helps drive up health-care costs. Second, because big pharmaceutical companies benefit from it. They know that prices would be driven down if the companies had to compete in the marketplace once their contraceptives were sold over the counter.

So at present we have an odd situation. Thanks to President Obama and the pro-choice lobby, women can buy the morning-after pill over the counter without a prescription, but women cannot buy oral contraceptives over the counter unless they have a prescription. Contraception is a personal matter—the government shouldn’t be in the business of banning it or requiring a woman’s employer to keep tabs on her use of it. If an insurance company or those purchasing insurance want to cover birth control, they should be free to do so. If a consumer wants to buy birth control on her own, she should be free to do so.

Jindal clearly learned some lessons from Mitt Romney’s campaign. Polls show that voters — particularly women — were quick to reject Romney because of his threat he represented to women’s access to the health care they need. So, while this op-ed is rooted in conservative ideology, it simultaneously recognizes that popular opinion in support of easier access to birth control spans across the political spectrum. In fact, studies suggest that providing wider access to affordable birth control, particularly through policies like the Obamacare mandate requiring insurers to provide all birth control methods copay-free, can drastically lower the number of abortions.

If Jindal is truly dedicated to providing women the most effective and affordable methods of birth control, however, he will need to look beyond oral contraceptives. Thanks to Obama’s mandate, IUDs — by far the best method for preventing pregnancy — are now available to a woman at no cost to her. Jindal has offered no similar path to those contraceptive methods by way of the private sector.

Earlier this week, Michigan Gov. Rick Snyder (R) quietly approved anti-union “right-to-work” legislation, signing the bill into law behind closed doors despite widespread protests from unions. But that’s not the only radical piece of legislation the governor is likely to sign during the last few weeks of the lame duck session. Early on Friday morning, HB 5711 — a massive 45-page anti-abortion bill that combines several attacks on women’s reproductive freedom into one measure — passed the Michigan House by a 72-35 vote, and will now be sent straight to Snyder’s desk.

The House first passed HB 5711 in June. But after the state Senate made some slight changes to HB 5711 on Wednesday — removing the provision that would have required doctors to dispose of fetal remains in the same manner that they must handle the disposal of dead bodies, the first proposal of its kind in the nation — the legislation needed to be re-approved by the House. Even without the provision regarding fetal remains, the omnibus bill still seeks to impose a host of new restrictions on women seeking to terminate a pregnancy, doctors who administer abortion services, and women’s health clinics.

The state’s last-minute push to threaten women’s health services is directly contradictory to the message that voters sent in last month’s election. The majority of Michigan residents support legal access to abortion services. And this particular piece of legislation sparked a massive outcry over the summer, culminating in a defiant performance of Eve Ensler’s Vagina Monologues on the steps on the Michigan Capitol building.

Nonetheless, the Detroit Free Press reports that Snyder is expected to sign HB 5711 into law.