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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Coronavirus dashboard for October 9: everybody has to touch the hot stove at least once

Coronavirus dashboard for October 9: everybody has to touch the hot stove at least once

 

Total confirmed US infections: 7,605,218*
Average infections last 7 days: 46,869
Total US deaths: 212,762

*Actual number is probably 5 to 7 million higher, or about 4% of the total US population

Source: COVID Tracking Project

In the last 4 weeks, the average number of new infections has risen again. Here is the breakdown by regions:

Here is the same for deaths:

 

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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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Deniality

Le dénialité est trop cher.

Denial isn’t specific to Americans, though we do seem to be better at it than most. We are now at least 30 years into severe climate change, yet 30-40% of Americans are in denial; assumedly, still looking for, waiting for, a return to normal. Not only are we not going back to the way it was 30 years ago; under the best of scenarios, no one of the next 5 generations will see the weather and climate of 1990 again. Under less than best of scenarios, neither the current generation nor the following 3 generations, will see weather and climate return to those of today. Still we see these professional deniers push and shove their way into any public discussion to argue that we can’t afford to take the necessary steps to halt Climate Change because the changes would be too costly. This lot deliberately tries to lead us to believe that their employers’ sunken costs are somehow our own.

The real cost of our not doing enough 30 years ago is the cost of the damage done during those 30 years plus the cost of doing today what still needs to be done. Putting it off just makes it ever more expensive. Still and yet,we hear politicians, economists and the self-anointed say that we can’t afford to do what we need to be doing about Climate Change. If we don’t, in another 30 years, we will have borne all the added damage that will have been done and be facing a situation where no amount of money will be enough. The cost of Climate Change will always be increasing until Climate Change is reversed. We’re well into shorter periods of doubling for temperature change, the number of wildfires and the acres burned, extended periods of drought, displaced people, … i.e., the price of not doing whatever it takes is doubling; so the price of doing whatever it takes. It is the not doing something about Climate Change that we can’t afford. We simply must stop burning fossil fuels.

—Extending—

Trump, although perhaps better known for his lying, is also a known Climate Change denier. Most of his supporters are in deep denial about Climate Change; many of them support him because of his denial. The Trump presidency itself is a consequence of our collective denial of Climate Change (that and a few or more other things). Since taking office, Trump has taken several actions that increase greenhouse gas emissions; thereby increasing the rate of Climate Change, increasing the damage.

The COVID-19 pandemic itself is an indirect consequence of this denial. Climate Change has severely diminished viable habitats for many species, putting pressure of these species, putting different species in closer proximity. President Trump denied the pandemic; told America that it would go away. It didn’t; it won’t. His is one of the biggest denials by an American president of all times. As a consequence of the pandemic, of Trump’s lying about and public denial of it, and also because of a large segment of the American public’s denial of it; more than 200,000 Americans have died from COVID-19 to date. Most of these deaths could have been avoided. Yet, Trump lies to us about aerosol transmission, susceptibility of children to COVID-19, availability of a vaccine, … These lies themselves are a form of denial; a denial of reality. So, too, the believing of those lies by some thirty-plus percent of Americans. If we had provided masks and imposed obligatory wearing, tested, and did contact tracing, the death toll would have been <30k. The damage to our economy would have been ~ -3% GDP. We know this because of South Korea, Taiwan, Germany, … America’s denial of the COVID-19 pandemic has exacted a very high price. It will keep doing so until: we make the wearing of mask obligatory for close proximity, have rapid result accurate testing, and do effective contact tracing; or, until almost everyone is vaccinated with a highly effective vaccine.

Is our denial inherited? Probably. In our past: The Capitalists lied about capitalism and the people believed them, died early for capitalism by the tens of thousands. Slave owners lied to themselves. Slave owners lied to poor white southerners and those poor white southerners believed them, fought and died for them. More lately, many Americans let Fox News lie to them and tell them what to believe. What are they thinking letting someone tell them what to believe? How could someone let tell them what to think?

America has been in decline for 50 years now, yet a majority of us wait for things to get back to normal. Oh, and by the bye, that was Normal we just passed, the town just before that was called Normal, and, that town straight ahead is called — Normal. Sorry, guess you can’t get to normal from here.

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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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Trump and Socialized Medicine

In economics we have the concept of “revealed preference” that simply states that you do not pay attention to what an individual claims to prefer. Rather, you pay attention to what they actually do.

President Trump just elected to go to Walter Reed National Military Medical Center for treatment of his COVID-19 symptoms. He could have elected to go to any hospital in the country, but he choose to go to the most purely socialist medical center in the country, one owned by the government and all it’s employees are government employees. Just as the military is the purest example of socialism in the US, Walter Reed is the purest example of socialized medicine in the US.

So Trump’s revealed preference is that he prefers socialized medicine to private medical care.

Who knew that deep down he really is a socialist.

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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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Coronavirus dashboard for September 30: a portrait of dismal societal failure

Coronavirus dashboard for September 30: a portrait of dismal societal failure

I hear the WWE staged a helluva mud wrestling cage match last night!

Since we won’t get any economic news until Every Statistic In The World is released tomorrow, in other, more uplifting news, let’s take the most updated look at coronavirus infections in the US.

Total US infections: 7,190,230
Average infections last 7 days: 42,045
Total US deaths: 205,986
Average deaths last 7 days: 743

Source: COVID Tracking Project

A number of weeks back, I looked at how each US State was doing by way of a color coding system based on the global history of the pandemic. Here’s the system:

Deep Red (general alarm out-of-control fire): 200+ infections per million, 5+ deaths per million.
Red (3 alarm fire): 100-200 infections, 2-5 deaths
Orange (2 alarm fire): 60-100 infections, 1-2 deaths
Yellow (1 alarm fire):40-60 infections, 0.5-1 deaths
Blue (smoldering/1 alarm fire): 20-40 infections, 0.2-0.5 deathsGreen (embers): 0-20 infections,  0-0.2 deaths

Here’s how all 50 States, plus DC and Puerto Rico, fit into that paradigm, for infections only.

Deep Red (general alarm out-of-control fire): 200+ infections per million:

14 States (ND, SD, WI, UT, IA, AR, MT, OK, ID, NE, MO, KS, AL)+ Puerto Rico (up from 5 five weeks ago).

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A Look at Drug Pricing 2020, Costs, and Why – “Redux”

I had written on the high cost of pharmaceuticals late 2019, “Another Look at Drug Pricing, Costs, and Why” citing from the World Health Organization, the ICER, JAMA Network, Health Affairs, and my own posts (links below and in text). You will find the some of the same articles cited in new commentary of increased drug costs in the Washington Post, Kaiser Health News, and Medpage Today. It appears the three of them have caught up with Angry Bear’s coverage on the rising costs of pharmaceuticals except we go deeper into this issue. A footnote would have been nice as my information has been out for ~ 1 year now.

The Cost Table (below) lists the most common prescriptions from 2012 through 2017 as detailed in the May 2019 JAMA Network Open’s article “Trends in Prices of Popular Brand-Name Prescription Drugs in the United States” shows  median total costs and percent change in price for 49 high volume brand name drugs over six years. If you care to read it, this JAMA Network Open article is open to anyone.

A Bit of A Summary

This particular table can also be found in another post I wrote; Does Trump Read JAMA Network Open? which reviewed the latest JAMA findings (Trends in Prices of Popular Brand-Name Prescription Drugs in the United States) on pharmaceutical price increases from 2012 to 2017. It is another in a series of articles (by me) which has looked at the rising prices of pharmaceuticals. The World Health Organization (2018) findings cited here reflect on R & D costs for cancer drugs and the amount of time needed to recoup those costs (median of 3 years for $750 million) with an average return of $14. 50 for every $1 invested in R & D for cancer drugs.  For the maximum estimated risk-adjusted cost of R&D (US$2.827 BN), the time to cost recovery was 5 years (range: 2 years; 10 years, n=56).

Click on the JAMA Table: Median Total Cost of Top-Selling Brand-Name Drugs 2012 – 2017 to enlarge and again to magnify if needed.

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