Relevant and even prescient commentary on news, politics and the economy.

Book Review, “America’s Bitter Pill

Kip Sullivan and I have had a running dialogue over the last year or so. Kip has been writing for such sites as The Health Care Blog, other blogs and newspaper. I find his knowledge insightful as we discuss what we know and where we are going with healthcare. Today Kip is working on implementing “Health Care For All – Minnesota” and is also developing a 3-year research and public education campaign. If you have questions this is the person to ask them.

This review was written in 2015 and is still relevant in 2020 in terms of how we started to arrive at where we are in healthcare. I have read some of the same complaints he outlines in his dialogue.

America’s Bitter Pill: CBO was Right. The White House and Steven Brill Were Wrong.”

Steven Brill’s latest book, America’s Bitter Pill, is a frustrating mix of excellent history and muddled health policy analysis. The book is a very good addition to the literature on the history of the Affordable Care Act and by far the best reporting I’ve read on the bungled implementation of the federal health insurance exchange. But Brill’s analysis of why the ACA cannot reduce health care costs is naïve and confusing. Brill claims a few smart men on the White House “economic team,” including Peter Orszag and Ezekiel Emanuel, fought hard to push “game-changing” cost-containment into the ACA but were defeated by others who were less interested in cost containment.

That explanation is wrong on two counts:

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USPS Update on Court Cases

Steve Hutkins at Save the Post Office

Another federal court has ruled against the Postal Service. The United States Postal Service is now 0 for 6.

In the case of Richardson v Trump, Judge Emmet Sullivan has ordered a preliminary injunction putting limits on postal operations in the run-up to the election. (Sullivan had also issued a preliminary injunction in Vote Forward v DeJoy.) 

In his Opinion Sullivan writes,

“The Court shall grant Plaintiffs’ request to ‘restore overtime pay’ and to ‘make all late mail deliveries instead of letting mail be delayed or go undelivered.’”

Sullivan stopped short of ordering the Postal Service to returning operations to the status quo as of January 1, which would have meant restoring the 700 sorting machines that have been removed. Sullivan also rejected the plaintiffs’ request that the Court appoint a “special master” to supervise implementation of the Court’s Order.

Late yesterday Judge Victor Marrero issued an order in Jones concerning the Guidance Memorandum the parties have been trying to agree on. The order says,

“The Court is persuaded that the appropriate course is to adopt, in substantial part, the Government’s latest proposal.”

This proposed version of the Memorandum is here.  There are still two areas that need to get worked out. Both involve the wording on extra delivery and collection trips.

Update: The parties in Jones have finally worked out the wording for the Supplemental Guidance Document. You can see it here.

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“Dying In A Leaderless Vacuum”, NEJM

“The New England Journal of Medicine Breaks two centuries of precedent to take an electoral stand,” Medpage Today, Shannon Firth, October 9, 2020

Angry Bear Readers: I am stealing the NEJM’s title as it states all of the issues we are faced with today with the Covid Pandemic. “Dying in a Leaderless Vacuum.” The NEJM is not known for being political. Yet today, the NEJM is taking a stand on what is happening in the United States for the first time in 200 years, with the regard to the lack of leadership by our government during the Covid19 pandemic. I have not included the whole editorial and have only C&Ped two paragraphs which I believe captures much of the argument being made by the NEJM. The entire article is not a long read and I hope and expect you will follow the link to it and read the editorial in entirety.

I have also attached three links to other articles. One is by Internal Medicine Physician and BMJ columnist Abraar Karan, the second is a copy of a letter by renowned epidemiologist William Foege who led the eradication of smallpox and a former CDC Director, and the last is the USA Today article about Foeege letter to Redfield and the events leading up to the letter. Again, all are easy reads in entirety and by taking a few minutes of reading you will be much further ahead of the others around you in information.

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Just Stirring the Pot – Updated

Regeneron Seeks Emergency Approval per trump’s miracle recovery and subsequent endorsement.

Biotech company Regeneron moved Wednesday to apply for emergency approval for an experimental antibody treatment praised by President Trump.

“Subsequent to our discussions with regulatory authorities, we have submitted a request to the U.S. Food and Drug Administration for an Emergency Use Authorization (EUA) for our REGN-COV2 investigational antibody combination for COVID-19.”

And trump? President Donald Trump received the antibody cocktail last Friday along with other drugs under a compassionate use program after becoming sick(?) with the coronavirus. Trump hailed Regeneron’s treatment in a video posted on Twitter Wednesday, saying he would authorize its emergency use and make it available to Americans for free.

Who knew this was a clinical trial of the real drug? What if it was a placebo and he cured himself? If they approve this after all the hoopla over other drugs    .   .   .

Just more deflection from the real issues, the pandemic, himself, etc.

Maybe, we should just follow the money???

A Warning From Michigan

A 4–3 party-line vote and Republican judges on the Michigan Supreme Court invalidated a law that had empowered a historically popular Democratic chief executive to take emergency actions to combat COVID-19. The basis for the decision was an antiquated doctrine that conservatives on the United States Supreme Court have signaled they want to revive.

The Michigan Supreme Court was following the lead of the U.S. Supreme Court. In an opinion last year, Justice Neil Gorsuch wrote a dissent calling for the revival of the nondelegation doctrine. Gorsuch premised his argument on the originalist claim the Framers believed “such delegation of power, in the case emergency powers, would frustrate ‘the system of government ordained by the Constitution’ if Congress could merely announce vague aspirations and then assign others the responsibility of adopting legislation to realize its goals.”

Legislatures aren’t equipped to resolve every question for themselves. Nor are they nimble enough to confront every new challenge as it arises. Sometimes, they need to draw on the executive branch’s expertise and dispatch. And in this case, the Michigan legislature through Gerrymandering has had control of the legislature since 1990. They have the ability to overrule the governor.

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New Healthcare Executive Order

Administration Health Care Executive Order, Health Affairs Blog, Katie Keith, September 2020

Trump believes he took action on Healthcare with an Executive Order protecting people with pre-existing conditions and also by eliminating surprise billing. He did not. 

On September 24, 2020, D.J. Trump issued a health care executive order (EO) focusing on protecting people with preexisting conditions and eliminating surprise medical bills. The Executive Order itself will have little or no immediate effect on healthcare law. Instead of laying out a specific plan or action(s) to take, the EO is detailing the administration’s health policy priorities and general agency directives (such as “giving Americans more choice in healthcare”). The EO’s approach is consistent with the seven-item bulleted list released by the campaign in late August and reiterates the hopes of the constituency for affordable healthcare  minus the detail.

The “release” of this Executive Order and its purpose is to distract and redirect attention away from the nomination of Amy Barrett to SCOTUS and blunting the criticism of President Trump for:

1) moving forward with his nomination so close to the death of Justice Ruth Bader Ginsburg ignoring the precedent established by McConnell on nominations close to an election; and trump’s
2) promising and not delivering a health care plan way ahead of the 2020 election.

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Michelle Obama Speaks . . .

I am one of those losers and suckers who was in the military from 1968 to 1974. As my wife of 49 years would tell you, I came out of the Corp nuts so bad I told her never to get back in bed with me unless you wake me up first. I lost friends like most of us did then. It still bothers me from time to time, I was not there for them. To have this president belittle the loss of them plagues me. They were good people.

This is worth listening to and I hope you take the 24 minutes to listen to Michelle Obama. It is a soothing talk she presents. A special hat tip to Digsby at Hullabaloo for posting it and then inviting everyone to repost it. Michelle Obama “Imagine how it feels . . .
“Imagine how it feels . . .

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How Far Will Repubs Go???

Not a fan of Fox News. This clip of Senator Tom Cotton was easy to install. Briefly and you can listen to the clip, Fox News host Maria Bartiromo states three Repub Senators are fighting COVID-19 infections.

Senator Cotton starts off with thanking Maria for the question and then states “I am doing fine” as if someone asked how he was feeling. This Senator is on the same plane as Ron Johnson for intelligence and which we will address later. Listen to the clip and you will hear and see why (a grinning Cotton), why I am suggesting these people are on the lowest plane for intelligence.

Herr Cotton suggested they can wheel Senators who are sick from Covid on to the Senate floor in order to vote. After all, Dems did such with an ailing 92 year old Senator Byrd who was not contagious. So why not Covid-contagious senators?

Both Lee and Tillis were at the Rose Garden on September 26 when Associate Justice nominee Amy Barrett was introduced by President donald trump and where it is believe many were exposed to Covid.

U.S. Sen. Ron Johnson announced Saturday he tested positive for COVID-19, the results of which came after attending a GOP fundraising event in Ozaukee County on Friday. After being tested, he decided to attend the fund raiser while he waited for the results because he did not have symptoms and the test was supposedly precautionary. Apparently, his chief of staff tested positive. Somehow, Johnson came into contact with his Chief of staff? “Quelle Surprise!” After being exposed to someone who tested positive, one quarantines themselves, something federal guidelines advise.

Oh and Senator Ron Johnson had this to say also:

1. “I’m not in favor of mask mandates, I think that’s up to individuals to be responsible. The jury is out. I think they’re helpful, but it’s certainly not a panacea, it’s not a cure-all.” “Key word here is think.”
2. “I’m not sick, I have no symptoms. I certainly didn’t anticipate testing positive, so there was no reason to quarantine.” No one anticipate a positive result and you do not have symptoms in the beginning to be contagious.

As a precaution, one should stay away from any Republican politicians. Johnson really sets the bar low for ignorance.

Tom Cotton: COVID-infected Senators Will Be ‘Wheeled In’ , Crooks and Liars, David, October 2020

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Is It Ok to Fake Being Healthy???

An Honest QUESTION  .  .  .  

According to the law   .  .  .  .   Is there any difference between a man with AIDS having unprotected sex with someone and not telling his partner about his disease….AND what TRUMP did in New Jersey ???

 

Hat Tip to: HammerHeadSid® at Crooks and Liars, Mike’s Blog Round Up For Sunday, authored last week by Infidel753

trump; “Am I going to die like Chera? Am I?”

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“Free-Exercise Protections”

The court is reversing many of the Civil Rights advances and gains (health care, labor protections, and antidiscrimination in public accommodations, etc.) for LGBTQ, women, etc. on the basis that such protections violates a religion’s practices. In essence legal protections for individuals, workers, etc. seeking to engage in ordinary commercial activity are subordinated to a religious belief. I watched such in action at a County Commission meeting as they passed a resolution to deny the right to abortion and birth control coverage for non-unionized women.

The Weaponization of the Free-Exercise Clause, The Atlantic, Howard Gillman and Erwin Chemernsky, September 2020

Some History:

There was a time when the Constitution’s protection of the “free exercise” of religion was a sort of shield, a protection for religious minorities from the prejudices of the powerful. No longer. The Supreme Court’s conservative majority is in the process of transforming this First Amendment clause into a sword that politically powerful Christian conservatives can use to strike down hard-fought advances in civil rights, especially for LGBTQ individuals and women.

At issue is whether religious believers who object to laws governing matters such as health care, labor protections, and antidiscrimination in public accommodations should have a right to an “exemption” from having to obey those laws. In recent years, religious pharmacists have claimed that they should not be required to fill prescriptions for a legal and authorized medical procedure if that procedure is inconsistent with their beliefs. A court clerk whose religion defined marriage as a union of a man and woman has claimed a free-exercise right to refuse marriage licenses to same-sex couples who have a constitutional right to marry. Religious business owners, such as bakers and florists, who object to same-sex marriage have claimed a right to refuse service to same-sex couples. And employers have successfully asserted a right to deny their workers health-care benefits that they would otherwise be entitled to, such as contraception or abortion counseling.

Providing such religious exemptions has required a dramatic change in the law by the Supreme Court. In 1990, in Employment Division v. Smith, the Supreme Court held that the free-exercise clause of the First Amendment cannot be used as a basis for an exception to a general law, no matter how great the burden on religion, unless the government’s action can be shown to be based on animus to religion. The case involved a claim by Native Americans for a religious exception to an Oregon law prohibiting consumption of peyote.

Justice Antonin Scalia wrote the opinion for the Court ruling against the Native Americans and explained that it would be impossible to provide religious exemptions from civic obligations whenever a person disagreed with the law—there are just too many civic obligations and too many different religious views about those obligations. Also, if the government were to begin down this path, it inevitably would face the impossible task of defining a “religious” belief. Such an approach would force the Court to make intrinsically controversial and discriminatory decisions about which religious views were most deserving of special accommodation and which social values should be considered less important than the favored religious views.

This decision was in line with the approach taken by the Supreme Court, in almost all cases, through American history. Courts long held that the Constitution did not require an exception to general laws on account of religious beliefs—that parents could not deny medical aid to their children, that they could not have them work in violation of child-labor laws, even if the work involved dispensing religious literature, that religious schools could not violate laws against racial discrimination, and that a Jewish Air Force psychologist could not ignore the uniform requirement by wearing a yarmulke.

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September 29, 2020 – 5 Federal Courts Have Ruled Against the USPS

Prof. Steve Hutkins at Save the Post Office adds information on court rulings.

The Postal Service is now 0 and 5 in the eleven lawsuits filed against it as a result of the mail delays caused by the operational changes that went into effect in July. Yesterday two more orders were against the Postal Service.

In Pennsylvania v DeJoy, Judge Gerald McHugh of the Eastern District of Pennsylvania ruled that the Postal Service can’t restrict extra or late trips for mail delivery and can’t prohibit overtime. In Vote Forward v DeJoy, Judge Emmet Sullivan issued his second order against the Postal Service.

Here are the five orders that have been issued in federal courts banning the Postal Service from making the kinds of operational changes that caused delays over the summer:

  • Pennsylvania v DeJoyJudge Gerald A. McHugh, Pennsylvania Eastern District Court (Sept. 28, 2020)
  • Vote Forward v DeJoy, Judge Emmet G. Sullivan, District Of Columbia District Court (Sept. 28, 2020)
  • New York v USPS, Judge Emmet G. Sullivan, District of Columbia District Court (Sept. 27, 2020)
  • Jones v USPS, Judge Victor Marrero, New York Southern District Court (Sept. 25, 2020)
  • Washington v Trump, Judge Stanley A. Bastian, Washington Eastern District Court (Sept. 17, 2020)

As a result of these five preliminary injunctions, the Postal Service has had to walk back all the changes it made over the summer as well as making all sorts of commitments about what it will do to ensure timely delivery of mail ballots. That’s good news for voters and others who depend on the Postal Service for things like their medications.

These five rulings should mean something else as well. The Postmaster General and the Board of Governors have received the strongest of rebukes from four federal judges in five cases representing twenty-four states, several national organizations, and many individuals. This turn of events has to be unprecedented, and it has been a total embarrassment for the Postal Service’s leaders. It won’t happen, but they should be thinking about resigning.

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