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And Nero Fiddled While Rome Burned

Friday, November 20th, 2020

Speaking on CBS this morning, Secretary of Health and Human Services Alex Azar said the delay in allowing President Elect Biden’s transition team to meet with Trump Administration health officials will cause no harm to anyone, because, “The same career professionals there on January 19th will be there on January 21st.” Hmmmm.

Have you ever had the exquisite experience of being part of a team buying a company? If you answered “yes” you know what that involves. Even if, as buyer, you intend to make no operational changes, which, admittedly, is rare, there is a lot to learn as you approach  the sale. Data rooms are complicated. So are the people you’ll be employing. What senior staff will you keep? Who will go? After you execute a Term Sheet, understanding product development, the logistics of distribution and the financial labyrinth will take time, usually more than a few months.

Suppose the company you’re buying is Amazon, the company owned by Jeff Bezos, the richest person in the world. Amazon’s reported operating expenses for the year ending 30 September 2020 were $328.04 billion. Try to wrap your head around how long such a purchase would take and what it would involve. It would be an awesome undertaking.

Now, think of the U.S. government. According to the U.S. Bureau of Economic Analyisis, U.S. expenditures for the 2019 fiscal year, ending 30 June 2020, were $7.3 trillion, a tad larger than Amazon’s operating expenses.

The 2021 budget for Health & Human Services, which runs 184 pages, calls for $1.3 trillion in spending; 1.2 trillion for mandatory programs like Medicare and Medicaid and $94 billion in discretionary spending.

We are engaged in two massive efforts: first, to control the spread of the novel coronavirus, and second, to vaccinate 330 million people as quickly as humanly possible – twice. Atul Gawande, a member of Biden’s Coronavirus Transition Team, in an interview following Azar’s, said roadblocks delaying the baton pass will, not could, cost lives, thousands of them. He said Azar’s claim that no one would be hurt by delaying the transition is “absolutely not true.”

Consider that Pfizer announced this morning that it will file for Emergency Use Authorization for its vaccine today. But the Biden team has had zero conversations with HHS. Not CDC, not FDA, not CMS, not NIH. Not a soul in government.

Meanwhile, back at the White House, Donald Trump remains out of sight, concentrating on manufacturing out-of-this-world conspiracy theories rather than on the job the Electoral College hired him to do in 2016. He’s giving the term “grasping at straws” an entirely new meaning. Nothing is too outlandish. Case in point: His fairy-tail spouting “Personal Lawyer’s” cringe-worthy press conference yesterday. Everything that comes out of Rudy Giuliani’s mouth these days is full of what makes the grass grow green and tall, but people are buying it.

This is sticking a very sharp knife into American Democracy.

According to a new Reuters/Ipsos poll conducted from 13 to 17 November, 55% of Republicans surveyed think Donald Trump “rightfully won” the election, only to have it stolen from him by widespread voter fraud. Only 55% of all adults in the United States surveyed by the poll said they believed the Nov. 3 presidential election was “legitimate and accurate,” and 28% said they thought the election was “the result of illegal voting or election rigging,” which is up 12 points from four years ago. It is unfathomable why so many of our neighbors fixate on the rigged election theme with the intensity of devoted biblical scholars. They have become habituated to believing the rants that spew from Mr. Trump and his sycophant toadies. And in this case, old habits don’t so much as die hard, as they refuse to die at all.

One can only hope Joe Biden and his team, whenever they’re able to begin taking the reins of government, will find a way to clean America’s gaping societal wound and start the healing.

How optimistic about that are you?

Now There Are Two, And Other Thoughts

Monday, November 16th, 2020

The Moderna Vaccine

Moderna’s announcement today that its vaccine candidate, mRNA-1273, is more than 94.5% effective in early trial results is wonderful news. Pfizer’s similar announcement from last week about its vaccine, BNT162b2, (also mRNA-based) gives us great hope that by mid-2021 the U.S. may have vaccinated most of the country’s population.

One advantage Moderna has over Pfizer is that its vaccine does not require “ultra cold storage,” as in minus 103 degrees Fahrenheit. As we wrote here, Pfizer says it has developed specially designed, temperature-controlled shipping packages, using dry ice, to keep its vials at roughly minus 103 below Fahrenheit for up to 10 days. But what happens if the doses are not used in ten days? This is one of the many things that is concerning governors and health care experts who are wrestling with the logistics of large-scale vaccinations.

We won’t know if Pfizer’s and Moderna”s vaccines can really do what it seems they might be able to do until the final results of their trials are known, but there is one thing we won’t know even then: How long will they protect us from the Coronavirus? Although both companies will follow all test subjects for a couple of years, if they each file quickly for and receive Emergency Use Authorization, which is all but guaranteed, they will go to market with about four months of data.

Will this lack of certainty about long-term protection cause people to forego vaccination? Personally, I don’t think so. But there is another possibility.

As we have seen for many months, despite the lack of competent leadership from 1600 Pennsylvania avenue, there are significant segments of the population taking the virus more seriously than others: seniors, those who are health-compromised, and myriad others who have paid attention to the science. It is conceivable these groups will take the vaccine, but refuse to return to any semblance of pre-pandemic life until long-term efficacy is known, and that won’t happen until well into 2022. If this happens, it is likely that masks, remote work, telehealth, and a host of other accommodations we’ve made due to the pandemic are here for quite some time longer.

Speaking of vaccines, here comes China

Flying under the media radar was an article in Foreign Affairs (subscription required) from 5 November by Eyck Freymann and Justin Stebbing. China Is Winning The Vaccine Race: How Beijing Positioned Itself as the Savior of the Developing World is an eye-opening look at China’s herculean effort to rebound from its tragically bungled initial response to COVID-19. From the article:

As a result, the disease spread around the world, crippling economies, killing more than 1.2 million people, and badly damaging Beijing’s image. In 2021, China plans to redeem itself by vaccinating a large chunk of the global population. Although it faces stiff competition from the United States and other Western nations in the race to develop the first vaccine, Beijing is poised to dominate the distribution of vaccines to the developing world—and to reap the strategic benefits of doing so.

Four of the 11 worldwide vaccine candidates are Chinese. The most promising of these, developed by Wuhan-based Sinopharm, is already being given to frontline workers in the United Arab Emirates.

Half the world’s population lives in the developing world, and Donald Trump’s administration, with its America First mantra, has no plans to distribute vaccines to that half of humanity, leaving a wide open door through which China is already walking. Also from the article:

The United States has declined to participate in a World Health Organization (WHO) initiative to deliver two billion vaccine doses to at-risk populations in developing countries, and it has not extended financing to or signed preferential vaccine distribution deals with such countries, as China has done.

While the U.S. will supply vaccines to its own citizenry and sell them to other developed countries, the vast underbelly of humanity will go a-begging. The emerging markets of Asia, Africa, the Middle East, and Latin America can barely afford vaccines, China has seized this opportunity by announcing subsidies and striking loan deals with the eighteen countries where its vaccine candidates are now in Phase Three clinical trials. As far back as May, Chinese President Xi Jinping promised that any successful Chinese vaccine would be used for a “global public good.” Thus far, he has kept that promise.

Throughout the pandemic (and, for that matter, the entire Trump presidency), America has ignored no, stiff armed the half of humanity most in need. This is just another Everest the incoming Biden Administration will have to climb as it tries to undo four years of foreign policy misfeasance, which the Oxford English Dictionary defines as “the wrongful exercise of lawful authority.” Kind of fits, doesn’t it?

Barack Obama returns

President Obama jumped back into the political scene as a force for Joe Biden during the recent campaign. Our first Black president did his part to help rally the African American vote, which proved so consequential in Biden’s victory.

Now, President Obama has written the first book in what will be a multi-book memoir. The Promised Land goes on sale tomorrow. So, he’s begun the book interview marathon, that, in his case, will be widely covered by the media. Case in point Yesterday, he turned up twice on CBS, first with Gayle King on CBS Sunday Morning and second with Scott Pelley on Sixty Minutes.

I’m sure the book is interesting and will sell a gazillion copies, but that’s not what I want to mention here. No, I’d like to end this column with a little story Mr. Obama told at the end of his interview with Ms. King.

Having become a private citizen at 12:01 pm, 20 January 2017, the former president began to reacclimate to private life. For security reasons, he was still prohibited from driving himself. So, as he tells it, there he is in the backseat of some vehicle checking his iPad and being driven somewhere by a Secret Service Officer. Then, the car slows and stops. Since this never happens in a presidential motorcade, he wonders why they stopped. Had something happened? Was there some danger? He looks up and sees the red light. At that moment, another car drives up beside him and he sees children playing in the back seat. As he told Ms. King, “Welcome to private life, Barack.”

Sixty-five days from now, Donald Trump will begin to encounter his own red lights for which he must stop. That will be a reality show worth watching.

 

 

This Is Madness

Friday, November 13th, 2020

Let’s start with the numbers.

Global Cases

Global COVID-19 cases are rising and the rise is accelerating, as documented by the Johns Hopkins Coronavirus Resource Center. There have been nearly 53 million cases around the world, 660 thousand yesterday. There have now been about 1.25 million deaths, and the death rate is also rising.

U.S. Cases

According to the New York Times Latest Map and Case Count, America’s case rate is surging faster than at any time in the pandemic.

Consider these four points from the above chart:

Since the beginning of COVID-19 in the U.S., the health care community has made tremendous gains in treating the disease, that is, in preventing deaths. However, no one yet knows the extent of long-term complications due to contracting the virus. Although COVID-19 primarily affects the lungs, it can damage many other organs as well. This organ damage may increase the risk of long-term health problems. Regardless, deaths are once again rising.

With respect to keeping safe, absolutely nothing has changed since the beginning of the pandemic. Hand washing/sanitizing, social distancing, mask wearing, and testing are, to this day, the only things we can do to control the disease. At some point in the future, perhaps by mid-spring, the vaccine cavalry will come charging over the hill. But until then, we’re on our own. COVID-19 is the enemy, the opposition, and we have to outlast it. Everyone needs to put on the moral cloak of responsibility.

It would be nice if that moral cloak were to become moral leadership from the White House, but the Trump Administration, obscenely obsessed with fighting the will of the majority, has gone AWOL, once again leaving the states to fight the disease by themselves, and most are now fully engaged.

Consider Ohio, where Republican Governor Mike DeWine is doing everything he and his team can to drive home the need for masks, hand washing and social distancing. Case in point: His Department of Health created a compelling video to illustrate the value of social distancing.

One of the most tragic things I have ever observed is going on right now across America. Millions of people have been persuaded the washing, wearing and distancing things are lies meant to steal the soul of the nation in a socialistic, Mephistophelean conspiracy. They believe government is trampling on their “rights.” Meanwhile, many of them get sick, some of them die, and they bring great harm to their neighbors who are trying to do the right thing. This is madness.

Can We Ever Learn From History?

Tuesday, November 10th, 2020

Yesterday was the 82nd anniversary of Kristallnacht, Germany’s Night of Broken Glass.

Two days prior to Kristallnacht, Herschel Grynszpan, a 17-year-old Polish Jew, had assassinated Ernst vom Rath, a young diplomat at the German embassy in Paris, shooting him five times at close range. This gave Hitler and his Minister of Propaganda*, Joseph Goebbels, the excuse they needed to organize a pogrom against Jews in Germany and parts of Austria and Czechoslovakia.

Goebbels told an assembly of National Socialists, “The Führer has decided that … demonstrations should not be prepared or organized by the (Nazi) Party, but insofar as they erupt spontaneously, they are not to be hampered.”

And so, on 9 November 1938, thousands of Nazis and Hitler Youth erupted “spontaneously,” attacking Jewish homes, schools, synagogues and businesses, smashing windows and destroying property. They put everything Jewish to the torch. Firefighters were told to let the fires burn themselves out. Goebbels instructed police to round up as many Jewish young men as possible and cram them into jails.

As far back as 1925 when he wrote his autobiographical Mein Kampf (My Struggle) from jail, Adolph Hitler had made known his anti Semitic intentions. And by 1933 the people of the UK and America knew also, because in that year Mein Kampf was translated into English. Nobody paid attention.

Kristallnacht was Hitler’s first, large scale, organized and overt attack on Jews. Consequently, many historians consider 9 November 1938 the beginning of the Holocaust.

Immediately following the close of the Second World War, social scientists and historians began trying to figure out why so many Germans had, lemminglike, followed, even embraced, hate-filled Hitlerism. The answers are complicated.

Following the First World War, the victors had punished Germany in monumental fashion, both economically and politically. Germans resented this with seething anger. Hitler capitalized on this.

Then there was the Great Depression of the early 1930s, which plunged Germany into even more profound economic chaos. Hitler took advantage of this, also, calling on Germans to throw off the yoke of humiliation. He gave fiery speeches, observed by American and British diplomats, which should have alerted governments to what was coming, but did not.

Hitler  instilled in the German people an us-against-them world view, or Weltanshauung. They would have followed him anywhere, and they did.

A week ago today, more than 70 million Americans voted for Donald Trump. That’s four million more than voted for him in 2016. Although I’m sure perhaps half of them voted out of economic self interest – they like his policies enough to stomach his lies and boorishness – what about the other half, the cheering cult, his own lemminglike followers at his rallies and beyond? As Hitler before him, Trump has sold them the us-against-them Kool Aid, and they have swallowed without questioning and without caring if whatever comes out of their Leader’s mouth is true or not.

As far as I can see, Joe Biden won the presidency and the republican party won the election. Not a single state legislature flipped. Republicans gained seats in the House, and are on the verge of holding on to the Senate. The last time we had a democrat elected president and a republican senate was 1885, 135 years ago, with the presidency of Grover Cleveland.

Donald Trump will eventually leave the White House, but he’s not going away, and neither are his followers or Trumpism. He gets tremendous satisfaction from his Rallies. Can you see him abandoning them? No, he will continue to stoke fear and hatred, just as a certain Austrian wannabe artist did long ago.

If you think 2020 was bad politically, just wait until you get to experience 2021.

Good luck to us all.

* Originally, Goebbels opposed the word propaganda, because in the public usage of the day it connoted – wait for it – Lies!

Shameful Leaders Play Chicken With The Economy Hanging In The Balance

Monday, November 9th, 2020

Today, the Bureau of Labor Statistics announced productivity, output and earnings data for Q3, 2020. This follows its announcement three days ago that the nation’s unemployment rate in October had fallen to 6.9%, the 6th consecutive month it has dropped.

While the drop in the unemployment rate is certainly good news, the long-term unemployed (those jobless for 27 weeks or more) increased by 1.2 million to 3.6 million, accounting for 32.5 percent of the total unemployed. Further, the country has seen only half of the 22 million people who lost jobs due to the pandemic return to the workforce.

Regarding today’s announcement, while productivity and output rose 43.5% and 38.6%, respectively, real earnings, a very important number, dropped 9.1% in Q3.

Most of the relief bills passed earlier in the pandemic have expired, including the $2.2 trillion CARES Act, which provided for additional unemployment benefits of up to $600 a week for many individuals.

The Federal Reserve, led by Chairman Jerome Powell, as well as the nation’s leading economists, have been arguing for months that we need a second relief package. Powell maintains that businesses, cities and states, and the unemployed are in dire need of help. On 6 October, in a speech to the National Association for Business Economics, he said the unemployment rate would be closer to 11% were it not for misclassification of idle workers and for people leaving the workforce. He warned the group that without additional support, the economy could slip into a downward spiral “as weakness feeds on weakness.”

Powell and his colleagues at the Federal Reserve say we need a new relief package NOW, and we need it to be BIG. Personally, I am not optimistic about that. I’m no economist, but I have friends who are, and they are not optimistic, either, at least not in the short term. And, although the 74 million (and increasing) Americans who voted for Joe Biden are happy Donald Trump has been handed his walking papers, we remain a house divided now more than ever. Some of us are euphoric, some in denial, others in despair, still others angry beyond words. It will take time and a lot of compassion for healing to even begin. But time is something many of our neighbors in horrific economic difficulties through no fault of their own simply don’t have.

In the next few days and weeks we’ll discover if our elected leaders can get out of the way of their ego-driven lust for power and display enough moral fiber, presuming they have some, to help the businesses, cities, states, and millions of our fellow citizens who hang by their fingertips over the edge of an economic abyss.

 

One Day More

Monday, November 2nd, 2020

Music is built on mathematics. Together they form humanity’s only universal language. With that in mind, here’s One Day More, the greatest Act One Finale in the history of theatre. Just to set the tone and get your blood moving.

“Tomorrow we’ll discover what our God in heaven has in store.”

No gloom and doom today. Just a thank you to all who have voted and who will vote. We’ll probably wind up with the largest vote count in the history of the country in both raw numbers and as a percentage of population. If Donald Trump has done nothing else, and he sure has done a lot, he’s brought out the vote.

After the dust settles, we’ll get more into that “done a lot” thing.

Stay safe.

Seven Days

Tuesday, October 27th, 2020

A diversion

How about a break from anything having to do with COVID-19 or the election? Would you like that? Then let me tell you a story.

Long ago, in a galaxy far away, a 23-year-old, newly-minted, Infantry 2nd Lieutenant airborne ranger with my name spent two-plus years in a little country in Southeast Asia called Vietnam. I think if Donald Trump had foregone the fake bone spurs and taken his chances over there he might have learned a lot.

But that’s another story, and not the point of this one. Couldn’t help myself.

Three months before rotating home to the U.S., I had been pulled from the field, that is, taken out of the jungle, and given a staff job on Firebase Vegel in northern South Vietnam.

With two months to go, I decided to begin keeping a Short-timer’s Calendar.

My Short-timer’s Calendar consisted of the centerfold of the June, 1971, Playboy magazine. My Battalion Commander, Lt. Colonel  Bulldog Carter (that’s right, Bulldog), and my partner, Buck Kernan (who went on to become a Lieutenant General, like his father before him), marked up the luscious photo into 60 puzzle-like areas numbered from 60 down to one. The trajectory of the progression became increasingly lascivious.

Thereafter we held a nightly, candle-lit ceremony in the bunker occupied by Buck and me.

But before I describe the ceremony, I have to tell you about the Macadamia nuts.

During Vietnam  the army  allowed soldiers a ten-day R&R (Rest and Relaxation) vacation. As a two-year guy I got two of them, which I spent in Honolulu, Hawaii, with my wife, Marilyn. One day, during the second R&R, we went to the PX (Post Exchange) at Scofield Army Barracks to pick up a couple of things. While we were there we bought a large bottle of Macadamia nuts for me to take back to Vietnam. In Vietnam, little things became luxurious delicacies.

Back to the ceremony.

Our bunker had a single bunk bed. There was only one bed, because Buck and I took 12-hour shifts in the Op Center keeping the world safe for democracy. One of us would end his shift, wave to the other and crash into the bed.

Every night, at 2000 hours, 8:00 pm to you, the three of us would gather in the bunker. There was a small table to the side of the bed.  I had pinned the centerfold to the wall above the table. At the appointed hour, I would light two candles and place them on each side of the table under the pin-up. I would open the bottle of Macadamia nuts, which occupied a special spot in the center of the table, and hand each of my comrades one nut, taking one for myself. We would then have a moment of quiet reflection, after which I would, with a red marker purloined from the Op Center, X-out the next descending number on Miss June.

We would then eat the nuts.

We did that all the way down to ONE! On that night, we held a special ceremony, inviting the Battalion XO, the other six staff officers and the Battalion Sgt. Major into the bunker, which became almost as crowded as the stateroom scene in Night at the Opera. We gave everyone a Macadamia nut that night, and, in a service worthy of priestly ordination, I passed the bottle of Macadamia nuts to Buck, who, because he still had six weeks to go, later on would replace my centerfold with his centerfold and continue the tradition. We retired my centerfold to a place of prominence on the side wall of the Op Center, where Bulldog could see it every day all day. Six weeks later, Buck’s would be hung beside it.

The next day, I choppered south, boarded a chartered Pan Am plane with about three-hundred other happy guys and flew home to what we called “the world.”

OK. Break’s over

If it weren’t so stupidly tragic and delusional, one might be forgiven for viewing Donald Trump’s campaign swan song as comical. “We’ve turned the corner.” “It will go away.” “On November 4th, you won’t hear about it anymore.” And the list goes on.

But if you really want to know how we’re doing, there are, actually, reliable places to look. Johns Hopkins Coronavirus Resource Center and the New York Times COVID Tracker, for example.

And now there is this website, which tracks the Rt factor for each state, daily. Rt represents the effective reproduction rate of the virus calculated for each locale. It lets us estimate how many secondary infections are likely to occur from a single infection in a specific area. Values over 1.0 mean we should expect more cases in that area, values under 1.0 mean we should expect fewer. As of today, only one state, Mississippi, of all places, is below 1. You can see what infection rates are like today, two weeks ago, one, two and three months ago. It confirms what all of us, except the aforementioned Mr. Trump, his minions and cult-like followers, know to be true.

If we’ve “turned the corner” it is only to enter Dante’s Ninth Circle of Hell. You remember that one, don’t you? It’s the final, deepest level of hell, reserved for traitors, betrayers and oath-breakers. Up until now, it’s most famous occupant had been Judas Iscariot.

Up until now.

And finally…

Seven days to go.

The number seven comes up a lot in Roman Catholicism. There are seven Cardinal Virtues, called by the church, “Gifts of the Holy Spirit.” They are wisdom, understanding, counsel, fortitude, knowledge, piety, and fear of the Lord.

There are seven Corporal Works of Mercy. They are feed the hungry, shelter the homeless, clothe the naked, visit the sick and imprisoned, bury the dead, and give alms to the poor.

And there are seven Spiritual Works of Mercy. They are instruct, advise, console, comfort, forgive, and bear wrongs patiently.

Judge, now Justice, Amy Coney Barrett is a devout Roman Catholic. I’m sure she is also a very smart person and probably a pretty good lawyer, too.

But for a month now, I’ve been bothered by something about her, and with seven days to go, I’m bothered even more.

For the life of me I cannot get over that, at her super-spreader Rose Garden introduction and follow-on reception in the White House, she did not wear a mask to protect herself and others. I understand everyone else who attended had swallowed the Kool-Aid, but she should have known better. And last night, in the White House Blue Room and outside on its balcony, she was still unmasked.

There are only three possibilities for this behavior.

  1. She doesn’t believe masks protect us and others from the virus, which I don’t believe for a minute;
  2. She is ignorant about masks and doesn’t understand their importance, which I don’t believe for a second;
  3. She was influenced by Trump’s behavior, as well as that of everyone else’s, and just went along to get along.

I’m voting for door #3, and that is a scary thought for our future.

Seven days.

 

 

It’s Been Quite A Week — Here Are Some Things You Might Have Missed

Saturday, October 24th, 2020

From the Department of There’s No Accounting For Stupidity

Since 1980, the population of Idaho has grown from about one million to nearly 1.8 million, considerably outstripping the rate of growth of its neighbors Montana and Wyoming. Over the last 14 days, all three states have seen large spikes in Covid-19 cases, according to the New York Times’s Covid Map and Case Count. And they’re not alone. All the Midwest and Pacific region states are seeing similar surges. Their governors are faced with balancing increased restrictions with the personal freedom inherent in pioneering individualism.

Nowhere did this daunting task become more evident than Thursday in Idaho, a state that has seen a 55% rise in cases in the last two weeks and where, minutes after hearing local hospitals were approaching full capacity necessitating moving patients to Seattle, of all places, the regional health board voted to repeal the local mask mandate.

The regional board, composed of seven appointed members with no requirement to have any medical experience, voted 4-3 to end the mandate. Health District epidemiologist Jeff Lee had just finished describing how the state’s hospitals were becoming “overwhelmed” by the surge in cases. For example, even after doubling up patients in rooms and buying more hospital beds, the hospital in Coeur d’Alene had reached 99% capacity. But, not to worry, it’s just an eight hour, 493 mile ambulance ride from Boise to Seattle.

“We’re facing staff shortages, and we have a lot of physician fatigue. This has been going on for seven months — we’re tired,” Lee said.

He introduced several doctors who testified about the struggle COVID-19 patients face, the burden on hospitals and how masks reduce the spread of the virus. But that didn’t matter to the Board’s majority who just did not see the sense in masks, no matter what the experts said.

To put a period on the “Health” Board’s meeting, member Allen Banks got to the heart of the matter by denying the existence of Covid-19. Lecturing the medical professionals who testified, he said, “Something’s making these people sick, and I’m pretty sure that it’s not coronavirus, so the question that you should be asking is, ‘What’s making them sick?”

That penetrating question came from a gentleman with a Ph.D. in chemistry from the University of Colorado, who for 30 years has worked in medical research in biotechnology and pharmaceutical development.

Dr. Banks would make a wonderful addition to the White House Coronavirus Task Force.

How cold is cold enough?

Have you stopped to consider the logistics of delivering upwards of 200 million doses of a future Covid-19 vaccine? That’s a lot of syringes. If you laid them end to end they would stretch from the North Pole to the South Pole, about 13,000 miles.

And the vaccine would have to be kept cold, very cold. Just how cold you ask? Try minus 103 Fahrenheit. That’s nearly four times colder than your home freezer, colder even than Antarctica in the dead of winter.

This is a complex challenge. For months, manufacturers, federal and state governments, and large health care systems have been quietly planning how to navigate this ultra “cold chain” that stretches from vaccine manufacturers to hospitals, nursing homes, doctors’ offices, and many far-flung clinics. Now that Pfizer has announced it plans to apply for emergency-use authorization designation in late November for its vaccine currently in Phase 3 trials, solving the cold problem becomes more urgent.

The nation’s governors wrote the Trump Administration last Sunday expressing concerns about the supply of ultracold freezers and dry ice — already experiencing shortages. Pfizer says it has developed specially designed, temperature-controlled shipping packages, using dry ice, to keep its vials at roughly minus 103 below Fahrenheit for up to 10 days. But what happens if the doses are not used in ten days? This is what is confounding the governors.

This issue is even more difficult than it appears, because the vaccines of both Pfizer and Moderna, another leading vaccine developer in Phase 3 trials, require two shots within 21 and 28 days, respectively. The situation is eased somewhat, because Moderna’s vaccine, at around minus 4 Fahrenheit, does not require the same ultra-cold storage temperature as Pfizer’s.

Might be a good time to buy stock in a maker of dry ice.

High Deductibles: Another nail in the rural hospital coffin

Since 2010, more than 130 rural hospitals have closed, 15 thus far in 2020. One mostly overlooked reason is the health insurance deductible. Depending on the plan (employer-sponsored, ACA Marketplace, etc.) a family deductible can range from $0 (but the out-of-pockets are huge) to well over $8,000.

Families in rural communities often face deductibles in the $2,000 to $4,000 range. And when family members require hospitalization, it often happens they cannot pay the deductible. Rural hospitals are forced to eat this less than tasty bill, send it to a collections company, or set up a payment plan with the patient. They prefer the payment plan route, but this significantly delays getting the money, and the bill is often reduced because of the patient’s economic circumstances. So, the hospital goes further in the red and its patients go further in debt. The pandemic has only exacerbated this problem.

Just another example of our nation’s dysfunctional health care “system.”

How to get rid of an irritating federal employee

Despite a great swath of the public thinking otherwise, federal employees can be fired, although it is true that this happens rarely. Of the 2.1 million federal employees about 10,000 are terminated annually, according to the Merit Systems Protection Board (MSPB).

Firing a federal worker is similar to what would occur in the private sector, with one twist. In both settings, best practice recommends, and the federal system requires, the three step verbal warning, written warning, termination process. The twist comes after that. Federal employees can appeal to the MSPB, and the appeals can take a long time to adjudicate.

This past week, the Trump administration threw an interesting log on the fire when the President issued an Executive Order stripping long-held civil service protections from employees whose work involves policymaking. This will affect tens of thousands of workers, and will reduce them to being, for all practical purposes, “at will” employees, meaning they can be fired for cause or not for cause at a moment’s notice.

Under this order, federal scientists, attorneys, regulators, public health experts and many others in senior roles would lose rights to due process and in some cases, union representation, at agencies across the government.

These are not politically appointed employees who require confirmation to their positions, whom the president can terminate or have terminated by whim. Rather, they are professionals who serve as a cadre of subject-matter experts for every administration. I will let you consider the possible ramifications of this Executive Order, which to me seem profound. The Order, while not affecting a majority of the government, could upend the foundation of the career workforce by imposing political loyalty tests.

It is possible, with less than two weeks before election day, this may be more symbolic than real, because the Order requires agencies to indicate employees who would be affected by 19 January 2021, a day before the next inauguration. If Joe Biden wins the election he would be unlikely to follow through on the president’s order. But if Donald Trump is re-elected, this tectonic Order will monumentally reshape the federal service.

Think about that. Please.

 

 

 

 

The Attic Door Is Opening

Friday, October 16th, 2020

Today is the 166th birthday of the controversial, but brilliant Irishman and playright Oscar Fingal O’Flahertie Wills Wilde. In his day, the wittiest man in Dublin, or anywhere else for that matter. And it’s the 129th anniversary of the publication of his only novel, The Picture of Dorian Gray. We’ll come back to that in a bit.

Moving to the present, we have 18 days to go, and I know you know what I mean. Eighteen unpredictable, but grueling days until 3 November, the official election day, although the election is well underway with more than 17 million votes already cast across 44 states and the District of Columbia. Democrats have voted early at four times the rate of republicans, most of whom plan on voting in person on the 3rd.

I confess for me it’s hard to focus on anything else, workers’ compensation, for instance. I’ve tried, but I keep getting sucked back into the political black hole.

Because not all states treat early balloting the same, it is highly unlikely we will know the result on the night of the 3rd, but we will certainly know at some point. To get to that point, the parties will face off in a fight to the death. Neither of them will bring a knife to that gunfight. The Supreme Court may step in à la Bush v. Gore. Given recent shenanigans, won’t that be interesting?

Last night during Joe Biden’s Town Hall in Philadelphia, George Stephanopoulos asked the former Vice President what he’d do if he lost. Biden said he’d probably go back to teaching and working at The Biden Institute within the Biden School of Public Policy and Administration at the University of Delaware (he taught constitutional law from 1991 to 2008 – bet you didn’t know that). He said he’d also continue working on the causes he’s advocating during the campaign.

Samantha Guthrie asked the same question of President Trump at his simultaneous, split screen Town Hall in Miami, but couldn’t get a similar rational response that he’d go quietly into that good night. I have the feeling that if the President loses we’re in for Hellzapoppin’.

During his presidency, Donald Trump, who, during the 2016 campaign famously said, “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK?”, has been more teflon-coated than any of your expensive kitchenware. Fiascos that would annihilate Paul Bunyan just bounce off. But since mid-way through the pandemic, things seem to have changed. Recent polling from Reuters/Ipsos shows 59% of likely voters believe he has managed our healthcare horrendoma poorly. And in the last few weeks it’s been one thing after another tarnishing his image. While his followers remain religiously devoted, the rest of the nation seems to be turning on him. At last night’s Town Halls, Biden was calm, thoughtful and engaging with his questioners, going so far as to ask one young man to stay after the Town Hall so they could talk some more. Trump, on the other hand, was, well, Trump, on defense, but in fighting mode, nonetheless.

All of which brings us back to Oscar Wilde and The Picture of Dorian Gray. In the novel, Dorian Gray, a handsome and hedonistic young man, sells his soul à la Faust, but with a twist. A famous artist paints his portrait, which Dorian puts in the attic of his home. Over the years, the young man in the portrait in the attic ages in a gruesome, hideous way, but not Dorian himself, who lives a life of debauchery and cruelty. Finally, in a fit of remorse, he slashes the painting. Servants below hear agonizing cries, rush to the attic and break down the door, only to find an unrecognizable and very dead old man lying in front of the painting, restored to its original beauty.

Donald Trump’s attic door is beginning to crack open.

Like BBs In A Boxcar

Monday, October 12th, 2020
Turning and turning in the widening gyre   
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world….
The best lack all conviction, while the worst   
Are full of passionate intensity.
          The Second Coming, by William Butler Yeats

 

One thing COVID-19 has certainly done is to expose many of the foundational flaws in America’s healthcare house that Jack built, the house that “cannot hold.” From the Trump administration’s helter-skelter response, to the unequal treatment of Blacks and Latinos, to the near total reliance on China for PPE, to the exacerbating plight of rural hospitals, to jaw-dropping surprise bills, to something as granular as the price of insulin, and the list goes on.

To illuminate the dire situation even more, the Kaiser Family Foundation last week published its annual Employer Health Benefits Survey, which showed the average annual premium for a family of four has grown 4% over the last year, more than doubling the rate of inflation, and has now reached $21,342, with worker contributions averaging $5,588. Add in the average deductible of $4,000, along with copays of $40, and employees get their hair-raising, once-a-year healthcare sticker shock.

In 2020, the U.S. is spending 18% of GDP on healthcare, according the Office of the Actuary within the CMS. For years, I’ve been quoting Herb Stein’s Law: “If something cannot go on forever, it will stop.” And for years, I’ve been wrong. This cannot be sustainable, but so far it has been.

A distant second-most-costly-country-in-the-world is Switzerland, at 12.1% (which is what the U.S. spent 30 years ago in 1990). The Swiss, as do many other OECD countries, have a decentralized system similar to ours, a blend of public and private-pay healthcare, with two important differences: First, since 1996, government, wanting to spread the pool, has required the Swiss people to purchase healthcare insurance, similar to the Affordable Care Act’s individual mandate (which Congress eliminated when it passed the Tax Cuts and Jobs Act of 2017, effective 1 January 2019). The result is for more than 20 years the Swiss have nearly 100% participation, but not the U.S.; our rate of the uninsured is going up, not down, made worse, much worse, by job, and consequently health insurance, losses due to the pandemic. Second, government plays a large role in establishing prices, especially for pharmaceuticals.

I think we can say with total certainty that, regardless of what you hear or read, nobody knows what healthcare in America will look like a year from now. If Trump wins reelection and republicans hold the senate, the ACA, or what’s left of it, could find itself buried deep beside Davy Jones’s locker at the bottom of the ocean, and what would come after that? Back to square one. People, our fellow citizens, our friends and relatives with chronic conditions, would once again find themselves walking down the edge of an economic razor blade.

There are four possible outcomes:

  1. Trump wins and republicans hold the senate, as above;
  2. Trump wins and democrats take the senate, resulting in stalemate, but the Trump reality show continues;
  3. Biden wins and democrats take the senate, in which case big changes are coming; and,
  4. Biden wins and republicans hold the senate, resulting in stalemate, but we’re saved from Trump’s histrionics (one hopes).

Options three and four spare us the president’s governing style, which is to say, chaos. For four years we have been subjected to his whipsawing and dangerous administration. His policies, personality and pronouncements seem to bounce around like BBs in a boxcar. Never more so than in the last few weeks. Things change by the hour. Nothing is predictable, except unpredictability.

We are moving inexorably into the winter of our continuing discontent. God help us all.