With the presidential election still a year away, Wall Street is starting its normal analysis that if a democrat is elected it will cause a devastating stock market crash.  One would think that after all these years of such claims being proven dead wrong that the street would finally give up on it. In the post WWII era from Truman to Obama it is 70 years and each party has had bad candidates in office for half that time.  Truman was only President for seven years and five months so the Democrats only had 35.4 years in office while the Republicans had 36 years in office.  Over these years the average annual S&P 500 gains was 15.9% for Democrats and 6.6% for Republicans. If you look at the actual returns, you would think if anything; Wall Street analyst would be warning about the dangers of a Republican President for the stock market.

Because the chart is already so cluttered I left Truman and Ike off.  But it seem so obvious that the record shows that it is Republican Presidents that investors should fear.  Just to clearly show that stock market gains have been more that double under Democrats versus Republicans I’ve also presented the data in a table.

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Median total costs Table for the most common prescriptions of each of the 49 high-volume brand-name drugs from 2012 through 2017 as detailed in JAMA Network Open’s “Trends in Prices of Popular Brand-Name Prescription Drugs in the United States” 2019.”

A Bit of A Summary: This particular table relates back to a 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 which have looked at the rising prices of pharmaceuticals. The World Health Organization (2018) findings reflected 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 – 2917 to enlarge and again to magnify if needed.

Taken “From the Trends in Prices of Popular Brand-Name Prescription Drugs in the United States” findings, substantial cost increases among these drugs was near universal, with a 76% median cost increase from January 2012 through December 2017, and almost all drugs (48 [98%]) displaying regular annual or biannual price increases. Of the 36 drugs available since 2012, 28 (78%) have seen an increase in insurer and out-of-pocket costs by more than 50%, and 16 (44%) have more than doubled in price. Insulins (ie, Novolog, Humalog, and Lantus) and tumor necrosis factor inhibitors (ie, Humira and Enbrel) demonstrated highly correlated price increases, coinciding with some of the largest increase in drug costs. Relative price changes did not differ between drugs that entered the market in the past 3 to 6 years (2012 – 2017)  and those having been on the market longer (number of drugs, 13 vs 36; median, 29% increase from January 2015 through December 2017; P = .81) nor between drugs with or without a Food and Drug Administration – approved therapeutic equivalent (number of drugs, 17 vs 32; median, 79% vs 73%; P = .21). Changes in prices paid were highly correlated with third-party estimates of changes in drug net prices (ρ = 0.55; P = 3.8 × 10−5), suggesting that the current rebate system, which incentivizes high list prices and greater reliance on rebates, increases overall costs.

The ICER Report (Unsupported Price Increase Report) compared the percentage increases in the  Wholesale Acquisition Cost (WAC – second Column)  to the increase in the Medical Care Consumer Price Index (CPI) over the same period and excluded those drugs with a WAC increase less than 7.32% or two times the increase in Medical Care CPI over the same period. The medical care CPI is one of eight major components of the CPI recorded and reported by the US Bureau of Labor Statistics .

CPI for Medical consists of medical care services (professional services, hospital and related services, and health insurance) and medical care commodities (medical drugs, equipment, and supplies). ICER using overall Medical CPI and not a lone services or commodity related one or subcomponent(s) of either or each was to reflect increases in drug prices relative to inflation in the overall price of medical care. The 77 drugs shown in the ICER Table 2.2 had an increase in Wholesale Acquisition Cost (WAC) greater than 7.32% over  the two-year period (4th quarter 2016 – 4th quarter 2018). The remaining 23 drugs were excluded from further analysis even though they may have been greater than one times CPI.

The ICER Table 2.3 depicting 9 drugs of the 77 shows  the percentage change in net price (Column 3) over the two-year period from the fourth quarter of 2016 to the fourth quarter of 2018, and the and the increase in drug spending during calendar years 2017 and 2018 and the 4th column depicts net revenue after discounts, rebates, concessions to wholesalers and distributors, and patient assistance programs same as Table 2.2 in the report. Only the ICER Table 2.3 is shown here (JAMA chart above).

The first seven drugs under assessment did not display evidence meeting the criteria accepted evidence grading system called GRADE. As a result, the seven are reported as having price increases “unsupported by new clinical evidence.” GRADE is a method used by systematic reviewers and guideline developers to assess the quality of evidence and decide whether to recommend and intervention.  GRADE differs from other appraisal tools for three reasons: (i) because it separates quality of evidence and strength of recommendation, (ii) the quality of evidence assessed for each outcome, and (iii) observational studies can be ‘upgraded’ if they meet certain criteria.

So What Does All of This Mean?

Other reports recognize similar. Healthcare costs are increasing at a much higher rate than inflation, enough so, JAMA is reporting patented pharmaceutical price increases to be 50% to 100% between 2007 and 2014, as are the generic versions, and those introduced during 2007 and 2014 have seen similar sizeable increase. The exhibited JAMA report details the increases.

The ICER report goes a bit further and establishes a benchmark of increase at twice Medical CPI and whether a price increase greater than the benchmark can be justified by the result of significant value brought to the market to account for the increase. At greater than a generous twice Medical CPI, the top nine drugs exceeded this benchmark and after investigation,  did not bring significant value to the market place following the 4 significant values claimed by pharmaceutical companies. This analysis was completed on  9 of 77 drugs having price increases greater than twice Medical CPI. Seven of the nine drugs were shown to have price increases for which additional value could not be substantiated. The remaining two had evidence of clinical value which could not be examined at this time. Then there is the balance of the 77 drugs which have had price increases greater also. Legit or not?

Remember, the ICER is the organization which justifies pricing for many of the new drugs coming to the market place.

The World Health Organization Report reviews the costs of R & D for Cancer Drugs which pharmaceutical companies blame as a the major factor for higher prices over the life of their patents. The WHO document reports the R & D costs are recouped in a median 3 to 5 years for R & D investments of $750 million to $2.8 Bn. Drug patents are significantly long than the recovery. Rent taking . . .

This is just pharma alone and I did not look at hospitals, clinics or hospital supplies. Briefly, “Health Affairs – Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14″ reports  inpatient care at hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent while physician prices grew 6 percent. Both this report and Kocher and Berwick’s “While Considering Medicare For All: Policies For Making Health Care In The United States Better: Health Affairs” point to increases in hospital care as the leading cause of increased healthcare insurance premiums.

The emphasis by politicians has been on the pricing of drugs without looking at the supply chain and the PBM’s influence on it; without looking at the costs of R & D, the return from sales revenue and how quickly those costs are recovered; and without looking at the exclusivity granted drugs through patents that allow the ability to increase pricing without a returning benefit clinically, socially, to the system, and most of all to the patient. The emphasis by government should be a review of drug costs to establish a fair market value/price. I do not see a foundation being established for the setting of pricing.

Trends in Prices of Popular Brand-Name Prescription Drugs in the United States, JAMA Network Open, Nathan E. Wineinger; Yunyue Zhang; Eric J. Topol, May 2019

Unsupported Price Increase Report, Institute for Clinical and Economic Review; David M. Rind, Foluso Agboola, Varun M. Kumar, Eric Borrelli, Steven D. Pearson; October 2019

Technical Report, Pricing of cancer medicines and its impacts; World Health Organization; 2019

While Considering Medicare For All: Policies For Making Health Care In The United States Better; Health Affairs; Kocher and Berwick; 2019

“Health Affairs – Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14;” Health Affairs; Zack Cooper, Stuart Craig, Martin Gaynor, Nir J. Harish, Harlan M. Krumholz, and John Van Reenen; 2019

Run75441 (Bill H)

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An introduction to Save the Post Office and Steve Hutkins. I am not quite sure how I got to Steve; but, I do remember chatting with Mark Jamison who also wrote at Save the Post Office and posting his words up at Angry Bear (Asking the Wrong Questions: Reflections on Amazon, the Post Office, and the Greater Good earlier this year. Mark and I still exchange emails and I owe him a trip out to western North Carolina. Steve is the blog owner, a Prof. of Literature teaching “place studies” at the Gallatin School of New York University. Prof. Steve Hutkins has been writing about the Post Office for at least a decade and the attempts of government, UPS, Fedex, etc. to close it down or limit its operations.

“Save The Post Office” has been writing about the last 5 cent increase in First-Class mail earlier this year.

Back in January 2019, the Postal Service raised the price of a First-Class stamp from 50 to 55 cents. Postal watchdog Douglas Carlson filed a petition with the U.S. Court of Appeals for the District of Columbia Circuit (aka the DC Circuit) challenging the Postal Regulatory Commission’s decision to approve this rate hike.

Carlson argued that in approving the rate hike on Forever stamps the Commission had failed to consider the statutory pricing factors and objectives in the Postal Accountability and Enhancement Act (PAEA) and the public comments questioning this increase. He also argued that the Commission did not reasonably explain its decision. Therefore, he claimed, the Commission’s decision was arbitrary and capricious.

Today the court issued a ruling granting Carlson’s petition and vacating the PRC’s approval of the rate increase on First Class postage. (The court’s opinion is here; the order vacating the PRC ruling is here.)

It’s not clear what will happen next. The PRC could file a petition for a hearing en banc, meaning that it will ask the entire DC Circuit to review the case, as opposed to the three-judge panel that issued today’s ruling. Apparently anticipating such a possibility, the DC Circuit today also issued an order “that the Clerk withhold issuance of the mandate herein until seven days after disposition of any timely petition for rehearing or petition for rehearing en banc.”

If such a petition is not granted, the PRC could even appeal to the Supreme Court. (After the DC Circuit ruled against UPS on an unrelated case involving postal rates, UPS took both of those steps, to no avail.)

In the meantime, we don’t know what impacts today’s ruling will have on the rate hike, which has been in effect since January.

Under the PAEA, the Postal Service has the right to request its next inflation-based rate increase this fall, with an effective date in January 2020. How the next increase will interact with today’s court decision is also unclear.

Past the leap is the section of a court determination that reviews the main issues in the case:

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Since Major Provisions of Affordable Care Act Took Effect

Key Findings:

• The number of uninsured children in the United States increased by more than 400,000 between 2016 and 2018 bringing the total to over 4 million uninsured children in the nation.

• These coverage losses are widespread with 15 states showing statistically significant increases in the number and/or rate of uninsured children (Alabama, Arizona, Florida, Georgia, Idaho, Illinois, Indiana, Missouri, Montana, North Carolina, Ohio, Tennessee, Texas, Utah, West Virginia), and only one state (North Dakota) moving in the right direction.

• Loss of coverage is most pronounced for white children and Latino children (some of which may fall into both categories), young children under age 6, and children in low- and moderate- income families who earn between 138 percent and 250 percent of poverty.

• States not expanding Medicaid to parents and other adults under the Affordable Care Act have seen increases in their rate of uninsured children three times as large as states that have expanded Medicaid.

Causes of Decreased Coverage

The Georgetown Health Policy Institute (full report) details in its report the following factors have contributed to the erosion in children’s health coverage: efforts to repeal the Affordable Care Act and cut Medicaid; an intentional delay by the Republican administration to fund the Children’s Health Insurance Program (2017); the elimination of the individual mandate penalty (2019); cuts to enrollment outreach and advertising pre-ACA enrollment; inadequate oversight by the federal government of state Medicaid programs which create more red tape barriers; and an administration enacted, climate of fear of deportation and intentional confusion for immigrant families discouraging them from enrolling eligible children in Medicaid or CHIP (2016).

The Republican party has made it a goal to repeal the ACA as passed by Barack Obama and Democrats early on in its administration. Under President Trump, the Republicans have done everything possible to deny healthcare coverage to legal immigrants and their families, the poor, and those who are marginalized. The full report includes a series of charts which pictorially represents the issues briefly cited here. It also includes a state by state analysis of the uninsured. It should come as no surprise, the South has 52% of the total uninsured children with Texas have 21.5% of the total uninsured children in the nation.

The Number of Uninsured Children Is On the Rise,” October 2019, Georgetown Health Policy Institute, Joan Alker and Lauren Roygardner

Families looking for information on how to enroll their children in Medicaid or CHIP should call 877-KIDS-NOW or visit insurekidsnow.gov

Run75441 (Bill H)

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Today we have a commentary  by Student Loan Justice Organization Founder Alan Collinge with support from an Angry Bear editor.

Alan:

A key Republican Education Department official and Trump Appointee, A. Wayne Johnson, recently resigned his position at the Department and later made a radical call for student loan cancellation. Johnson noted the lending system was “fundamentally broken” and called for loan cancellation for all loan holders up to $50,000. He also called for a tax credit of the same amount for those who have already repaid their loans. Interestingly, Johnson’s plan sounds very similar- and even more generous- than what presidential candidate Elizabeth Warren is proposing.

The proposal is strong stuff coming from a Republican and his comments could indicate the problem is far worse than the Department of Education has said publicly on student loans. He noted that he came to this conclusion after having a “firsthand look” at defaults, which we already know are running at about 40% for 2004 borrowers, who had borrowed a third of what is being borrowed currently. One can only wonder how bad the internal projections are for more recent students.

Johnson is to be applauded for calling out this big-government lending monstrosity, and even, perhaps, for his call to get the government out of the lending business altogether. In the absence of both bankruptcy protections and statutes of limitations, the Department of Education has become one of the largest lenders on earth and a viciously predatory one at that. In his commentary, Johnson is correct in pointing out the various forgiveness programs run by the Department are failing badly.

Editor Comment:

Dependent upon which manner of accounting is used, student loans can be considered to be profitable or unprofitable. Using the Federal Credit Reform Act (FCRA) accounting methodology, student loans are profitable. Regardless, student loans have no escape unless one dies or becomes disabled. Student Loan Bankruptcy was effectively thwarted by Senator Joe Biden’s efforts since the nineties. If in default, the government will garnish wages, Social Security, and whatever else they can in order to get back their funds.

Others such as Jason Delisle of New America advocate using the Fair Market Value methodology of accounting to assess the risk of default for student loans. Delisle claims the interest rate of a student loan should be set at 12% as there is risk and yearly losses with making low interest rate student loans that do not cover risk of default which is not assessed in the beginning.

Disputing Jason Delisle’s commentary; Malcolm Harris pointed out on Twitter, it’s worth noting that the CBO’s fair-value accounting analysis finds no subsidy for PLUS loans and unsubsidized Stafford loans, but a big one for subsidized Stafford loans, where rates are rising. Overall, there’s a negative subsidy – profit. That’s a way the government could be making a profit even under other accounting specifications, though obviously skeptics like Delisle dispute that.

Outside of student loans, a student could walk into a car dealership, purchase a $30,000+ automobile, which is about the cost of an education, have little down payment and maybe a second signature, and both people could still escape through declaring bankruptcy. This is something major businesses and people such as President Trump have been doing for decades without having wages and benefits garnished for a lifetime.

Alan:

Some of the $50+ billion the Department books in profit every year is being used to fund unrelated social programs. In 1965, President Lyndon B. Johnson declared that these loans would be “free of interest.” The former should not be the case and the later has not happened.

However previously, there were problems with Warren’s plan of student loan relief and these have not gone away under Johnson’s current proposal.

For example: while it is clear that the default rate is screaming upwards and this is crushing many borrowers, many are doing fine, and there is no particularly good reason to cancel their debt. Conversely, there are many borrowers who owe far more than $50,000, who have seen their debt explode with penalties, fees, and interest, such that writing them down by $50,000 really wouldn’t make much of a dent. So this “one-size-fits-all” approach makes little sense. And at an estimated $925 billion, it’s expensive.

Editor Comment:

What is clear to me is people complaining “what about.” Those who paid their loans have little  idea of what has been happening in the student loan industry which is profit driven. There are any number of stories being told of hucksters signing up students into for profit schools which sadly go bankrupt or steer students into course curriculums which will not lead to employment in a job to which they were trained. The system protects the servicer and the loan originator until that loan is paid off.

Does it make sense for people to be entrapped in a loan which can not be paid off thereby keeping them as an economic burden rather than a productive, taxpaying member of society? What about-isms and false equivalencies offers no solution other than indenture.

Alan:

Also, any cancellation program would be administered by the Department of Education, which has a well-documented history of bungling such programs, as Johnson rightly points out. For example, of the roughly 40,000 people who thought they were getting cancellation this year through the Public Service Loan Forgiveness Program, fewer than 100 (less than 1%) actually will. Similarly, a whopping 57% of people in the Income Based Repayment Program (IBR) were disqualified for administrative reasons. So the borrowers are cruelly left owing far more than had they never tried!

The Department of Education cannot be trusted to administer yet another loan cancellation program. As they have done before, they will surely find ways to disqualify the vast majority of borrowers so that the agency captures the wealth rather than those who it was intended.

Editor Comment:

The Department of Education has always been troublesome in administering programs impacting students. The public service program has been haphazardly run and has left many who have paid back loans over ten years in service to the nation without forgiveness of part or the rest of their loan. The current Secretary of Education is a ditz who did not understand the training leading to gainful employment rule was for both nonprofit and for-profit schools and not just about for-profits as she claimed. I too would look for someone else to administer programs given the circumstance.

Alan:

A more efficient solution to this problem is simply returning standard bankruptcy protections to these loans. The Founders called for uniform bankruptcy laws ahead of the power to raise an army, and declare war, and this lending system proves their wisdom. Borrowers must have bankruptcy on their side in order for the lending system to be fair. It is only with this threat that the lenders will act with a modicum of good faith.

Bankruptcy is also a far less expensive solution. While there would be an unavoidable spike in filings initially, bankruptcy scholar Robert Lawless estimated that in the “steady-state,” annual discharges would come to less than $3 Billion per year. Even if it turned out to be double or triple this rate, that is still far less than the proposal in question. Not to mention, no tax hikes would be required. This could be achieved by simply repealing the one line of federal code that exempts student loans.

There is legislation in Congress that would achieve this: HR. 2648, a bipartisan bill, and its Senate companion, S. 1414. Alternatively, President Trump could simply direct the Department of Education to stop opposing student loan borrowers in court. Either way, we would get a much more efficient and well suited outcome.

And the Founders? They would agree with returning bankruptcy capability for student loans.

Alan Collinge is Founder of StudentLoanJustice.Org, and author of The Student Loan Scam (Beacon Press)

Angry Bear: Thank you Alan  .  .  .

Run75441 (Bill H)

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David Axelrod interviewing former Senator Harry Reid on the Axe Files

There is too much going on with Trump and I believe he is purposely doing much of this as a distraction and also to antagonize Democrats. Abandoning the Kurds certainly draws a response from Democrats and most of the Republicans remain silent on things they know to be wrong. For some reason I believe he is setting the stage for something else to occur. If we as Democrats are wrong, all of our actions will reflect poorly on us and for sure he will make fun of our failures.

Reid — a savvy political operator whose moves reshaped Senate procedures such as the elimination of filibusters for most nominations by president, were criticized by Republicans during his time in Congress. Reid in the Axelrod interview acknowledged, Trump’s strategy in discrediting Democrats leading the impeachment inquiry into his actions with Ukraine.

Reid: I don’t think he is an intellectual powerhouse; but, he is basically a very, very smart man. Any argument he involves himself in and no matter what the subject, it is on his terms. You’re always arguing against him. He never, never, is willing to debate an issue on terms that aren’t his.

When asked how he would advise a candidate running against Trump, Reid warned,

Reid: Anyone that thinks Trump’s going to be beaten easily will have another thing coming.

The “evidence is very clear” that Trump was withholding foreign aid as leverage to pressure Ukraine, on a July phone call, to investigate former Vice President Joe Biden. Trump has denied any wrongdoing and has claimed the foreign aid was withheld so European allies could contribute their fair share. Democrats have accused Trump of a quid pro quo and abusing his power of office.

Reid: All you have to do is have a basic understanding of what the law in America: You can not do what he did and go unpunished.

Trump’s modus operandi has been to deflect on the accusations and make light of them publicly to his followers uses he stumbles into the truth in his words. There is no heart in the Republican party to denounce his transgressions even though they know he is wrong.

I see this in Michigan with the blaming of Democrats for issues with the state roads, schools, Detroit, etc. Except, an exception Michigan Republicans do not acknowledge, they the Republicans have had control of the state Senate since 1992, the state House 2/3rds of the time since 1992, the Governorship 2 of 3 times up till now, and a trifecta twice during the time period 1992 – 2018. Republicans control the legislature now. Typical argument:

“common sense doesn’t need to be documented. It’s very easy to blame everything on Democrats. Mainly because they’re guilty.”

“Sorry, your version of common sense can not alter the reality of what took place.”

It is a distortion of the facts on a national stage which has tickled down to the states and blathered on social media by Republican trolls.

And the politicians in Congress? The politicians are too interested in keeping their jobs as senators and congressional representatives to acknowledge the facts or tell the truth. And Democrats are too quick to jump on Trump’s transgressions and provide entertainment for Trump. He is playing the Democrats and laughing as he has the backing of his followers at the state level similar to the mini-conversation I had who denies reality, and those supporters in the Senate. He knows Democrats are toothless.

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The ICER (Institute for Clinical and Economic Review)

Is an independent and non-partisan research organization. Its purpose is to evaluate the clinical and economic value of prescription drugs, medical tests, and health care and health care delivery innovations. ICER conducts rigorous analyses of all clinical data with key stakeholders to include patients, doctors, life science companies, private insurers, and the government and translate the evidence into policy decisions that lead to a more effective, efficient, and just health care system.

As explained by their site information, ICER is known as the nation’s independent watchdog on drug pricing. It’s drug assessment reports include a full analysis of how well each new drug works and the resulting “clinical value, quality of life, benefit to the health-care system and society” used to establish a price. Using the drug assessment report, a “value-based price benchmark” is established  reflecting how each drug should be priced addressing all four factors. Reports also evaluate the potential short-term budget impact of new drugs to alert policymakers to situations when short-term costs may strain health system budgets and lead to restrictions on patient access. Ensuring objectivity in its work, all ICER reports are produced with funding from non-profit foundations and other sources that are free of conflicts of interest from the life science industry or insurers.

What I have seen in the past is the ICER establishing pricing for new drugs taking into consideration these factors; “the patient’s quality of life, and the resulting benefits to the health-care system, and society.” This is the first time I am seeing the ICER looking at price increases and determining whether the value delivered substantiates a price increase. By the numbers: Here are the drugs (and manufacturers) highlighted in a recent ICER’s report, with the increase in net spending attributable to each drug’s price increase, and citing the increases could not be justified by the value delivered.

The figures reflect the dollars Americans spent on drug copays and other out-of-pocket costs in addition to the higher amounts people paid through health insurance premiums and taxes.

Past the leap is an explanation on how the ICER reached its conclusions for the nine drugs and the limitations to this findings.

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August JOLTS report: nearly all employment measures now neutral

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Interesting stuff from the One Handed Economist

“The road to dictatorship is depressingly predictable. Once power is stolen, the problem is to keep it. Anyone who might develop a separate power base must be struck down. Eradicate rivals, rule through force and fear. Trust no one, particularly family, friends and the army. Keep everyone on their toes with random executions, unpredictable policy changes and imaginative public tortures. So far, so historic. It could be a Shakespeare play. What distinguishes modern tyranny, Dikötter argues, is the cult of personality. Total control of the information space keeps the modern dictator in power.” Via New Statesman.

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This is news: Jane Fonda Arrested While Protesting in D.C.

Not particularly a news outlet (Hollywood Reporter – Ryan Parker reporting) I would read but, they have it out front and center in reporting on Ms. Fonda protesting about “the industries that are destroying our planet for profit.”

“I will be on the Capitol every Friday, rain or shine, inspired and emboldened by the incredible movement our youth have created. I can no longer stand by and let our elected officials ignore – and even worse – empower – the industries that are destroying our planet for profit. We can not continue to stand for this,”

It is not the first time Ms. Fonda has been taken into custody. She did protest the Vietnam war and taken into custody. Today Ms. Fonda was arrested with 15 other people for protesting in front of The White House. The protest focused on the lack of action by this administration, big business, and the overall nation on the overall inaction to climate change. Claiming to be “emboldened by the incredible movement our youth have created,” She has moved to Washington to be near the epicenter of the fight for climate change.

Maybe others will follow . . .

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