Archive for the ‘Misc.’ Category

Where Do We Go From Here?

Monday, May 9th, 2022

VI

We end this opinion where we began. Abortion presents a profound moral question. The Constitution does not prohibit the citizens of each State from regulating or prohibiting abortion. Roe and Casey arrogated that authority. We now overrule those decisions and return that authority to the people and their elected representatives. ‘The judgment of the Fifth Circuit is reversed, and the case is remanded for further proceedings consistent with this opinion.

It is so ordered.

Thus ends the 1st Draft of Justice Samuel Alito’s opinion for the court majority overturning Roe and Casey, the two Supreme Court rulings that made abortion legal in America.

Alito’s ruling lays bare what happens when courts are forced to decide on the constitutionality of laws that intersect with morality, societal culture, religion, historical and legal precedent, privacy, and control—specifically, a woman’s right of control over her own body.

Regardless of what you feel about abortion, you will not find even a hint of what Alito feels about it in his 67-page ruling, followed by Appendices in which he lists, in chronological order, the laws that every state passed prohibiting abortion, going back to Missouri’s in 1827, and ending with Mississippi’s in 1952. What you will find is the utter destruction of the arguments behind the Roe and Casey rulings. I think Justice Alito resents what he believes to be the inadequacies, the just plain wrong thinking he finds in Roe and Casey. One could be forgiven for believing he thinks those decisions were less like Supreme Court deliberations and more like a couple of the weekly meetings of the Mickey Mouse Club. Frankly, I cannot wait to read the dissents I know are coming.

The coming fight

The official ruling won’t appear for a month or two, and it may differ from Alito’s draft in minor or major ways, but we are already seeing the beginnings of the warfare to come, the torching of an anti-abortion organization’s office and the picketing and protests outside the homes of Supreme Court Justices, for example. This is a galvanizing issue that only exacerbates the political divide in our country. There will be protests and marches and the probability of violence is not remote. Anger sits in the air. Moreover, there are deep psychological wounds. The women I have talked with who support abortion’s legality are emotionally crushed. Their sense of devastation and betrayal is palpable and profound.

What is all the more galling for these and other women is discovering that the fight they thought they had won 49 years ago, is now lost. Women who were in their 20s in January, 1973, breathed then a collective sigh of relief. Now, those women and their daughters feel gut-punched.

And that ain’t all.

According to the Guttmacher Institute, 23 states already have laws that could be used to restrict the legal status of abortion. That includes the 13 states with Trigger Laws that will drop like the Hammer of Thor when the official ruling arrives.

There are no two ways about it: we are in for a bumpy ride. This will likely be a major issue in the upcoming midterm elections, and if Republicans win and take control of both houses of Congress, it is probable they will move to pass  legislation outlawing abortion nation-wide (and some say contraception and gay marriage, too—Alito’s ruling leaves the door open for those, even though he says the Supremes are only ruling on abortion. Still…). President Biden will veto that, and there will not be enough votes to override his veto. But if all this happens followed by a Republican victory in 2024’s presidential election, the Biden guardrail will be removed. Emigration to Canada will soar.

Going back to the future of the pre-1973s will bring some dire consequences.

Current research demonstrates:

  • By the second year after a nation-wide ban on abortions, pregnancy-related deaths, known as maternal mortality, would increase by 21% overall:
  • Among non-Hispanic Black woman, this percentage would increase by 33%;
  • In a 1976 article, researchers from the Center for Disease Control examined national abortion data from the three years surrounding the Roe ruling and estimated that the number of illegal procedures in the country plummeted from around 130,000 to 17,000 between 1972 and 1974. That will change;
  • On the other hand, a 2020 study published in The Lancet found that in countries where abortion was restricted, the proportion of unintended pregnancies ending in abortion had increased, and the unintended pregnancy rates were higher than in countries where abortion was broadly legal.

I have total certainty the abortion debate, peaceful or otherwise, will not end anytime soon. Feelings about abortion are deeply held beliefs for most people, and, as has been demonstrated since humanity first stood upright, deeply held beliefs seldom, if ever, change.

An admittedly naive suggestion

First, let me state the obvious. Abortion happens when an unintended pregnancy occurs. Unintended pregnancies occur when education is lacking, wrong, or just plain non-existent, and when contraceptives are not used by either the man or the woman. Both of these—education and contraceptive use, which are two sides of the same coin—are hit-or-miss issues throughout American culture.

But they don’t have to be.

It is unfortunate, indeed, that, in many areas well-intentioned, but misguided, parents, officials, and legislators seek to eliminate, or at least dumb-down, Comprehensive Sex Education (CSE) in our public and private school systems. A 2018 UNESCO study “identified 22 relevant systematic reviews, more than 70 potentially relevant randomized controlled trials and a significant amount of non-trial information from 65 publications and online resources,” and found that “sexuality education —in or out of schools —does not increase sexual activity, sexual risk-taking behaviour or STI/HIV infection rates.” And it “reduces unintended pregnancy.”

Education works, and it can significantly reduce the need for abortions if coupled with a systemic nation-wide program that provides easy—even free—access to contraceptives. To succeed, this must not be a one-off, public affairs program. It’s too important for that. The states, as well as the federal government, would need to advocate, and do so forcefully, to change current behavior. Yes, there would still be unintended pregnancies, but shouldn’t everyone’s goal be to reduce those to a minimum? This would result in fewer illegal abortions and less maternal mortality.

For example, today, only 65% of women and a third of men regularly employ contraception. The vast majority of women prefer the pill, with LARCs (Long Acting Reversible Contraceptives) following behind. The point is, there is a 35% opportunity among women, the people who become pregnant and sometimes must resort to abortions.

If, as now seems nearly certain, Roe is overruled, what are our options? We can do nothing, and revisit back alleys and coat-hangers, or we can do everything in our power to reverse that course through Comprehensive Sex Education and universal contraception.

The bleak future is not reality, not yet, anyway. Given our society, there may be little chance of changing the future that now seems ordained, but there are things we can do to mitigate the potentially terrible results of the Alito ruling if we have the strength to fully embrace them.

Women, and women alone, should have the right to decide when, and if, they have children.

 

Important Items You Might Have Missed This Week

Friday, April 8th, 2022

Let’s ban some books!

During the summer of my 15th year, my father walked into our very Roman Catholic home to find me reading a paperback book on the couch in our living room. “What are you reading, Tommy?” he said. So, I showed him the book I was well into. It was Henry Miller’s The Tropic of Cancer. Whereupon, Dad became somewhat apoplectic, and rushed into the kitchen where my mother was starting to cook supper. “Mary, do you know what your son is reading?” he said. “Of course,” my mother replied. “I gave it to him.”

Tropic of Cancer is an autobiographical novel by Henry Miller, published in France in 1934 and, because of censorship, not published in the United States until 1961. And it is racy, indeed. It is also superbly well-written and compelling as it takes the reader on a tour of Miller’s mind as he lived a hedonistic life in the Paris of his youth.

My mother knew a book would never hurt me. People could and would, but not books. And I’m happy to say she eventually convinced my father of the value of that proposition.

I bring this up, because yesterday Pen America released a deeply researched report, Banned in the USA, addressing what it calls the “Index”* of books banned in the U.S. from 1 July 2021 through 31 March 2022. That’s just nine months.

It may flabbergast you to learn that during those nine months the Index lists 1,586 book bans that have occurred in 86 school districts in 26 states. These districts represent 2,899 schools with a combined enrollment of over 2 million students.

Mom would have disapproved.

I was somewhat disappointed I could not write about the banning of Ray Bradbury’s masterpiece Fahrenheit 451. The irony of writing about banning a book about a society that bans and burns books would have appealed to me. However, that book is not on Pen America’s Index (perhaps the book banners aren’t very well read). The irony will have to wait. Henry Miller’s Tropic of Cancer didn’t make the Index, either. I guess hedonism from 88 years ago is fine now, or maybe the book is just too old to worry about anymore. But four of Margaret Atwood’s books are on the list, including The Handmaid’s Tale.  That’s a pity.

Some highlights from the Pen America report:

  • These bans have targeted 1,145 unique book titles by 874 different authors, 198 illustrators, and 9 translators, impacting the literary, scholarly, and creative work of 1,081 people altogether.
  • Texas led the country with the most bans at 713; followed by Pennsylvania (456); Florida (204); Oklahoma (43); Kansas (30); and Tennessee (16).
  • Processes aimed to uphold the First Amendment in the context of school book challenges are not being followed. Of bans in the Index, 98% involve departures from best practice guidelines for how school authorities may remove books; most bans and restrictions have occurred without proper written forms, review committees, or transparency. While school boards and administrators do have some discretion over library and instructional materials, there are safeguards and best practices meant to protect students’ First Amendment rights that are being widely abrogated.

Among titles in the index:

  • 467 titles (41%) included protagonists or prominent secondary characters who were people of color;
  • 247 titles (22%) directly address issues of race and racism
  • 379 titles (33%) explicitly address LGBTQ+ themes, or have protagonists or prominent secondary characters who are LGBTQ+
  • 184 titles (16%) are history books or biographies. 107 have explicit or prominent themes related to rights and activism (9%).
  • 42 children’s books were censored, including biographies of Rosa Parks, Martin Luther King Jr., Ruby Bridges, Duke Ellington, Katherine Johnson, Neil deGrasse Tyson, Cesar Chavez, Sonia Sotomayor, Nelson Mandela, and Malala Yousafzai.
  • The majority of the books targeted have been works of fiction, however 28% are non-fiction and include history books, analytical and/or personal essays, and children’s reference and informational works.

*The “Index” of Prohibited Books, Index Librorum Prohibitorum, established in 1557 by Pope Paul IV, was a list of books Roman Catholics were prohibited from reading on pain of excommunication. The books were prohibited because they contained material considered dangerous or contrary to faith, morals, or the teaching of the Church. I’m not sure if Pen America intended this relationship, but I’ll assume the authors did.

What actions are companies doing business in Russia taking in response to Putin’s invasion?

Yesterday, in an important New York Time op-ed, Jeffrey Sonnenfeld, the Lester Crown professor of management practice at the Yale School of Management, who has studied corporate social responsibility for 45 years, and Steven Tian, research director at the Yale Chief Executive Leadership Institute, pointed out that in the late 1980s roughly 200 American companies withdrew from South Africa, partly in protest against its apartheid system. These actions helped topple the racist regime.

With that in mind Sonnenfeld, Tian and their Yale team have made a deep dive into how companies doing business in and with Russia are responding to the inhumane invasion of Ukraine. After completing their analysis they have placed businesses in one of five categories based on their response to the war. They say, “Consumers should know whether the companies that make their food, clothes and goods are fully committed to ending Mr. Putin’s atrocities.”

Many of the companies they examine are household names. The 162 companies that have chosen to stay have offered a number of excuses, which I find lack any compelling rationale. Sonnenfeld and Tian urge consumers to pressure by boycott. Personally, I have decided the Acer corporation will not be among the brands I consider for my next computer.

Brief comment

Yesterday’s confirmation of Ketanji Brown Jackson to replace Justice Stephen Breyer on the Supreme Court was everything I predicted it would be in yesterday’s Letter From The Berkshires, but a putting-a-period-on-it is in order.

Republicans, continuing to display an abysmal lack of grace and dignity, abruptly walked out of the senate chamber immediately following the Vice President’s announcing the vote. The video of them all rushing for the door as Mitt Romney stood in their midst applauding and looking slightly bewildered as they almost ran him down was disgraceful. The spectacle made a mockery of a place where great Americans, many of them Republicans, once stood.

 

Last Week Today: Mr. & Mrs. Thomas, Cory Booker’s Sermon, And The Loss Of A Titan

Saturday, March 26th, 2022

Last week was a crazy week in America. Trying to sum it up requires leaving out much. This column is a bit long, but its tragedy is there was not enough space to wax eloquent about the NCAA Basketball Tournament. Go Peacocks!

At home with the Thomases

Supreme Court Justice Clarence Thomas and his wife Ginni have made more news in the last week than either of them has in the last ten years.

First, the Justice was admitted to hospital a week ago for an infection with flu-like symptoms (which were not Covid-19). In and of itself this was big news, especially with the backdrop of this week’s Senate Judiciary Committee hearings on the nomination of Judge Ketanji Brown Jackson to fill the soon-to-be-vacated seat of Stephen Breyer. Thomas was released on Friday, and is apparently healthy again, which makes many people happy and many others not so much.

Next, the Supreme Court released an 8 to1 decision on Thursday in which Justice Thomas spent 23 pages of a 60 page ruling in a dissent involving a condemned man in Texas who filed a motion to have his pastor present, “laying on hands” as he prayed over him in the death chamber. Twenty-three pages of “No.”

Finally, on Thursday night there was the bombshell story broken by the Washington Post’s Bob Woodward and Robert Costa of Ginni Thomas’s involvement in the attempts to overthrow the results of the presidential election to keep Donald Trump in power.

Trump’s Chief of Staff Mark Meadows had turned over a trove of emails and texts to the House Select Committee investigating the January 6th insurrection (Meadows has since stopped cooperating with the Committee). Among the texts were 29 back and forths between him  and Ginni Thomas — 21 sent by her, eight by him. Typical of the lot was this one from Thomas:

“Help This Great President stand firm, Mark!!!…You are the leader, with him, who is standing for America’s constitutional governance at the precipice. The majority knows Biden and the Left is attempting the greatest Heist of our History.”

In her texts, Mrs. Thomas was disparaging of Vice President Mike Pence (“We are living through what feels like the end of America. Most of us are disgusted with the VP…”) and complimentary of Sidney Powell, the attorney who promoted incendiary and unsupported claims about the election, and who led the “stop the steal” legal team, along with with Rudy Giuliani, Trump’s personal attorney, and John Eastman, the lawyer who wrote the eight-point plan by which he asserted Republicans could keep Trump in power. Of Powell, Mrs. Thomas wrote she should be “the lead and the face” of the battle. Thomas wrote, “Sounds like Sidney and her team are getting inundated with evidence of fraud. Make a plan. Release the Kraken and save us from the left taking America down.”

This story will develop further in the coming days; there is no way it couldn’t. It cannot prove anything but awkward for Justice Thomas, especially when one considers that the Supreme Court will, as it already has, inevitably hear cases stemming from the insurrection. Thus far, Thomas has refused to recuse himself from these cases. Continuing that refusal would be saying to the American public, as well as to his Supreme Court fellow Justices, that, while he may have had knowledge of his wife’s intimate involvement with the attempt to overturn the election and keep Trump in power, they did not discuss it in any husband and wife interplay and her profoundly strong views about the election never influenced his thoroughly impartial decisions.

Perhaps. Mrs. Thomas recently told the Free Beacon,“But we have our own separate careers, and our own ideas and opinions too. Clarence doesn’t discuss his work with me, and I don’t involve him in my work.”

Right. Perhaps.

Cory Booker’s paean

As any rational person knew it would, this week’s Senate Judiciary Committee hearings on the nomination of Judge Ketanji Brown Jackson to the Supreme Court had some predictable moments. We knew that certain Republican senators on the committee would take the national TV spotlight as an opportunity to demonstrate the fine art of political grandstanding. We were not disappointed. In fact, Senators Cruz, Hawley, Blackburn, Graham and Cotton exceeded our wildest expectations. The disrespect, utter poor taste, condescension, outright misogyny, and, let’s face it, naked racism on display by these five, while probably greeted with applause in their MAGA base, showed them for the woeful human beings they really are. That Judge Jackson took it all with grace and dignity, while responding cogently to their dog-whistle “questions” and sanctimonious, self-righteous speeches with exponentially more intelligence than they exhibited, was a credit to her beyond anything her cynical detractors could imagine.

But toward the end of the inquisition of the fifth female, and the first black female, ever nominated to the nation’s highest court, Senator Cory Booker’s turn came. He was fifth from the end of the ordeal. At that point, questions didn’t matter. Like an old time gospel preacher, he delivered a sermon on racial progress that reduced the hypocritical Torquemadas to burnt ash. Booker told Jackson:

“Your family and you speak to service, service, service. And I’m telling you right now, I’m not letting anybody in the Senate steal my joy. … I just look at you, and I start getting full of emotion.

“And you did not get there because of some left-wing agenda. You didn’t get here because of some ‘dark money’ groups. You got here how every Black woman in America who’s gotten anywhere has done. By being, like Ginger Rogers said, ‘I did everything Fred Astaire did, but backwards, in heels.’ And so I’m just sitting here saying nobody’s stealing my joy. Nobody is going to make me angry.”

I want to tell you, when I look at you, this is why I get emotional. I’m sorry, you’re a person that is so much more than your race and gender. You’re a Christian. You’re a mom. It’s hard for me not to look at you and not see my mom. I see my ancestors and yours. You faced insults here that were shocking to me. Nobody’s taking this away from me.  Republicans are gonna accuse you of this and that. But don’t worry, my sister. Don’t worry. God has got you. And how do I know that? Because you’re here, and I know what it’s taken for you to sit in that seat. You have earned this spot. You are worthy. You are a great American.

This was an emotional moment that broke through Judge Jackson’s week-long, iron-like wall of rectitude.

With the conservative bent of the current Supreme Court, it is a given that Judge Jackson’s presence won’t change much. But you never know. Over time, things can change.

The loss of Madeleine Albright

Speaking of formidable women, the nation has lost a great one.

As the first female U.S. Secretary of State and one of the few women in leadership on the global stage during the 1990s, Madeleine Albright — who died Wednesday at the age of 84 — stood firm against dictators and tyrants from the Balkans to Haiti to Rwanda.

Throughout her life, she demonstrated a steadfast belief that democracy would triumph over authoritarianism and that the United States had to lead for it to happen.

Born in Czechoslovakia just before World War II, she came to the United States at age 11 as a refugee from the Nazis and communism and graduated from Wellesley College in 1959. After her twins were born prematurely, she learned Russian staying in the hospital with them. She knew Russian would come in handy later in life. She earned a doctorate in government from Columbia University in 1976, and at the age of 39 reentered the workforce, having been shut out for many years prior due to the sin of being a woman. She always advised other working moms that “women have to work twice as hard.”

She joined the Clinton administration as U.S. ambassador to the United Nations in 1993, and in 1997 she became the first woman ever to be Secretary of State.

She was an ardent defender of democracy; her time in Czechoslovakia gave her a first hand look at what the other side was like, the other side that is now doing all in its power to eliminate an entire country of 44 million people. Her final Book Fascism: A Warning is exactly that, a warning we had best heed.

Madeleine Albright will be missed — Greatly.

 

Zelenskyy’s Heroism, Women’s Long March To Equality, And Then There’s Ron DeSantis

Tuesday, March 8th, 2022

“Be not afraid of greatness. Some are born great, some achieve greatness, and others have greatness thrust upon them.” — William Shakespeare, Twelfth Night

Ukraine update

Last night, Ukriane’s president, Volodymyr Zelenskyy, posted a nine-minute video from the Presidential Office Building on Bankova Street in central Kyiv.

Zelenskyy opened from a window looking out over Kyiv at night (a nice way to show everyone he was really there), and then selfied his way down corridors to his office where he sat at his desk to address the world, as well as the people of Ukraine. His fierce determination not only to defend Ukraine, but, more than that, prevail against a barbaric enemy was on full display. Speaking for all Ukrainians, he said, “I’m here, it’s mine, and I won’t give it away. My city, my community, my Ukraine.”

He closed his address by letting the nation know he had earlier in the day bestowed medals for bravery on 96 “heroes.” He then singled out five and described what they had done to earn the medals. Brilliant stuff.

Zelenskyy continues to unite his country and keep its spine stiff. His leadership, his rhetoric, his example are sharp enough to slice bread. He must be setting Putin’s hair on fire.

International Women’s Day

Today is International Women’s Day, and The Economst has released it’s annual glass-ceiling index, which measures the role and influence of women in the workforce across the countries of the Organization for Economic Cooperation and  Development (OECD).

According to The Economist:

A country’s performance on the index is measured along ten metrics, including the gender pay gap, parental leave, the cost of childcare, educational attainment and representation in senior management and political jobs.

We give more weight to the indicators which affect all women (such as labour-force participation) and less to those which affect only some (such as maternity pay). Paternity pay is also included. Studies show that where fathers take parental leave, mothers tend to return to the labour market (emphasis added), female employment is higher and the earnings gap between men and women is lower.

That “return to the labour market” point is important, given the tremendous difficulty American women are having right now in returning to the labor market due to the ridiculous cost of child care.

It is unfortunate that, in this year’s glass-ceiling index, the United States continues to rank lower in how it treats its women than the OECD average, 20th out of 29 countries.

You may notice the top four countries in the rankings, Sweden, Iceland, Finland and Norway, are Nordic countries so often ridiculed by conservatives as prime examples of “totalitarian socialism.” Actually, these countries have combined successful capitalism with, yes, welfare state benefits that allow their citizens to have a high standard of living, universal health care, and life expectancies higher than most other countries, certainly higher than the U.S.

But all is not Panglossian with the Nordic Model. These countries have large challenges, most notably what to do about an aging population and an influx of immigrants. Time will tell whether they’ll be able to marshal the political will to deal successfully with these significant headwinds.

That said, on International Women’s Day it seems fitting to suggest that, due to the collective culture the Nordics have fostered, their women are much better positioned for success than their peers in America. It pains me to write that.

DeSantis continues to be…well, DeSantis

Yesterday, at the conclusion of a 90-minute virtual video forum (make that show) in West Palm Beach, Florida’s Governor Ron DeSantis and his Surgeon General Joseph Ladapo announced a new state policy that will recommend against giving a coronavirus vaccine to healthy children, regardless of their age.

Sitting in front of what could have been mistaken for an IMAX screen where hundreds of forum participants were pictured, Ladapo enthusiastically proclaimed, “Florida is going to be the first state to officially recommend against the covid-19 vaccination for healthy children.”

Let’s hope it’s the last one, too. National data from the Centers for Disease Control and Prevention show more than 40 Florida children, from birth to age 17, have died from COVID-19. Nationally, the number is nearly1,600.

In an interview reported in today’s Washington Post, Peter Hotez, a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine and a leading expert on the virus, said, “To be at such distinct variance from the hundreds of physicians and scientists at the CDC and the FDA is reckless at best and dangerous at worst.”

Look, we get it that Governor DeSantis features himself as the next president of the United States and that he’ll say or do just about anything to get there. This is the man who just last week bullied a group of high school students for wearing masks at an event at the University of South Florida. “You do not have to wear those masks. I mean, please take them off. This is ridiculous,” he told the teens just before slamming his folder on a lectern.

These folks are playing with kids’ lives, all for their own opportunistic and hypocritical ends. I can only hope there’s a special place in hell reserved for such people.

I’ll leave you today with this question: How do you think DeSantis would do in Zelenskyy’s chair on Bankova Street? Or, would he have skedaddled to safety before the fun began?

Just a thought.

 

 

Stories I Was Planning To Address. They’ll Have To Wait.

Thursday, March 3rd, 2022

The life and death stories coming out of Ukraine, as its people continue to exhibit fierce and inspirational resistance to Vlad the Invader’s barbaric onslaught, tend to suck the air out of any room. Somehow, Joe Biden’s approval ratings, or America’s vitriolic partisan divide, or who will prevail in the midterms or the desperate state of our infrastructure, or the future of our newest Supreme Court nominee, while important at any other time, just cannot compete with Putin’s intentional and indiscriminate killing of anyone, man, woman, child, beloved pet, anyone in the way of his rapacious army. This is causing the most momentous change on the European continent and throughout the geopolitical world in nearly 80 years. And it’s taken only a week.

So, here are some quick takes of the things I would have written about, and maybe will in the future in more depth, were it not for the blackhole-like gravity of what’s happening in Ukraine.

Tuesday night’s State of the Union

Joe Biden’s speech to the Congress and the nation came in two chapters. Chapter One: Ukraine. Chapter Two: His domestic agenda.

Chapter One was riveting, and it appeared nearly everyone sitting on the floor and in the gallery of the House of Representatives was united in support of the West’s monumental pushback to  Vlad the Villain. I thought it ironic they were all sitting in a sacred building where, just 14 months ago fellow citizens tried to steal American democracy, and nearly did. Ironic, indeed, when one considers so many who were sitting on the R side of the aisle now want to look the other way and pretend it never happened.

Chapter Two was pretty much what you’d expect from any State of the Union speech — until the heckling. Representatives Lauren Boebert, R-Colo., and Marjorie Taylor Greene, R-Ga, put on a disgusting display of crass and boorish incivility. These two ladies have never demonstrated having had an original idea in their lives. Why should they? They’re both travelling on borrowed gas, and inferior gas, at that. Boebert, especially, raised poor taste to a new level when she screamed out accusing Biden of killing 13 soldiers during the evacuation of Afghanistan as he was describing the death of his beloved son, Beau, from cancer attributable to burn pits in wartime. These two, both of whom have about as much empathy as a New Jersey loan shark, would be rejected from Dante’s Inferno for giving the place a bad name. (Pity the poor fellow sitting between them  wishing he were anywhere else on earth — except maybe Ukraine)

Why can’t Medicare negotiate drug prices?

When you insure more than 61.2 million beneficiaries you’d think you’d have tremendous leverage to negotiate the lowest drug prices on earth. But that is not the case in the USA.

The Medicare Modernization Act (MMA) of 2003, the one that created the unfunded Part D drug program along with the infamous “doughnut hole,” specifically forbids Medicare from negotiating prices with drug companies, giving that responsibility, instead, to for-profit insurers and Pharmacy Benefit Managers. Health policy Guru John C. Goodman calls the MMA, “arguably the worst domestic policy decision in the history of the country.” At the time of enactment, the Social Security and Medicare Trustees estimated the long-term (75 years) unfunded liability of the MMA’s Part D program to be $17 trillion. The Trustees project that cost growth over the next 5 years will average 7.3 percent for Part D, significantly faster than the projected average annual GDP growth rate of 4.3 percent over the period.

And, still, Medicare cannot negotiate prices.  Result? High drug prices for Medicare and its beneficiaries.

By contrast, the VA is able to negotiate for its nine million veterans enrolled in its health care program, yours truly being one of them. Result? Low cost drugs.

Since passage of the MMA, there have been repeated attempts to introduce and pass legislation that would allow Medicare to bring the full weight of its considerable power to the price of pharmaceuticals. Two things have prevented any success in these endeavors. First, the bottomless well of pharmaceutical industry cash, and, second, members of congress who are the beneficiaries of that bottomless well of cash.

To quote that eminent American philosopher, Mark Twain, “We have the best government that money can buy.”

Federally Qualified Health Centers. Now there’s a well kept secret!

Federally Qualified Health Centers (FQHC) are community-based health care providers that receive funds from the Health Center Program of the Health Resources and Services Administration (HRSA) to provide primary care services in underserved areas. They must meet stringent requirements, including providing care on a sliding fee scale based on a patient’s ability to pay and operating under a governing board that includes patients. Specifically, at least 51% of their Boards must be patients.

By law, FQHCs must treat anyone, regardless of the ability to pay.

There are 1,368 FQHCs in the country. Most have a number of locations, called Service Sites, bringing the total health care locations to 14,200. They welcome people with insurance, but their main targets are poor people who could otherwise not afford health care.

In addition to FQHCs, the Health Center Program also funds Rural Health Centers (RHCs), whose mission is to increase access to primary care services for patients in rural communities.

FQHCs and RHCs are funded annually by congressional approval. Additionally, Section 330 of the Public Health Service Act provides grant awards to eligible health centers and outlines the requirements the centers must meet to be eligible .

Taken together, FQHCs and RHCs are Community Health Centers. They are ubiquitous throughout the country. For example, in my home state of Massachusetts, there are 52 community health center organizations providing high quality health care to some one million state residents through more than 300 sites statewide. For perspective, there are 351 cities and towns in Massachusetts.

Given the woeful state of our nation’s public health system, as was amply demonstrated by our response to COVID-19, it might not be a bad idea to consider the Community Health Center model as we attempt to re-engineer how we deliver health care to all of us.

Just a thought.

 

 

 

War And Death In Ukraine – And Sanctions

Thursday, February 24th, 2022

So, here we are.

Last night, moments after a threatening and vitriol-laden speech by Russian Federation President Vladimir Putin, the massive army he had assembled on the north, east and south of Ukraine’s sovereign borders began the full-out invasion all had been expecting. And innocent people began to die.

This afternoon, after conferring with the other 29 NATO countries, as well as the G-7, President Biden ordered profound economic sanctions intended to cripple the Russian economy. Today, even before the President announced those new sanctions, Russia’s stock market had dropped 45%. Will it matter?

For four years, Putin had a subservient partner in Donald Trump, but when Trump lost to Joe Biden Putin had to reevaluate his strategy. It appears 2021 was devoted to that reevaluation, and in 2022 he began revealing his true self.

On Monday of this week, the cover came off and the world got to see the real Vladimir Putin, the one former Secretary of Defense Bob Gates saw 16 years ago: “When I looked into his eyes I saw a stone cold killer.”

In a rambling, paranoid, seemingly-off-the-cuff, one-hour monologue filled with revisionist history, Putin laid out his case for the invasion of Ukraine. In the view of the Russian Federation President, Ukraine is part of Russia; always was, always will be, and wishing something else won’t make it so. He intends to return Ukraine to the bosom of Mother Russia, where it has always belonged. Same with the rest of the former Soviet Union. He blamed the unfortunate circumstance of Ukraine’s independence on mistakes made by Lenin following the 1917 revolution. He made it seem as if being part of Russia would be the best thing ever to happen to Ukraine. Of course, during his rant he conveniently forgot to mention anything about the millions of Ukrainians Stalin starved with cavalier cruelty during the famine of 1932-33. Thirteen percent of the population wiped out by another megalomaniac.

I know it’s asking a lot, but if you haven’t read his speech, you really should. It’s reminiscent of Hitler’s harangues prior to the annexation of the Sudetenland in 1938, which was the first step on the path to World War II. In a speech at the Sportpalast in Berlin prior to annexation, Hitler claimed that the Sudetenland was “the last territorial demand I have to make in Europe.” Sound familiar?

Putin has bent to his will the Russian Duma, the armed forces, Russia’s police, and what passes for a “news media.” However, the ultimate success of his invasion of Ukraine rests on his ability to continue to persuade the Russian people that Ukraine belongs to Russia and is vital for the country’s security.

It won’t be all smooth sledding for Mr. Putin. Last night, more than 1,000 anti-war protesters descended on Moscow’s Red Square demanding the troops leave Ukkraine. Russian police immediately began arresting them.  Mr. Putin will brook no protest. Which is one reason why Alexei Navalny is about to enjoy another 15 years of penal servitude. Putin failed to kill Navalny, so prison will have to do.

And what about those sanctions? Obviously, Putin has been planning this invasion for quite some time. As I’ve written before, he knows it would be foolish to move against a NATO country and risk the invocation of Article Five. But Ukraine is not a NATO country, so, in his mind, he can do pretty much what he wants. He doesn’t have to stand for any kind of legitimate re-election, so he can afford to play the long game. As Madeleine Albright wrote in a guest essay in this morning’s New York Times, “Mr. Putin is a planner.” She had first met him in early 2000, and was the first senior official in the Clinton administration to do so. Following that meeting she wrote in her notes, “Putin is embarrassed by what happened to his country and determined to restore its greatness.”

As a “planner” he must have taken full consideration of what the West can do to him economically. His apparent response? Sanctions? Shmanctions! They’re worth it for Ukraine, Europe’s second largest country (after Russia).

I am afraid this will not end well for anyone, least of all Russia. But Putin has gone all in. Given his history and his recent behavior, do you see him changing course anytime soon?

Neither do I.

News You Might Have Missed To End Your Week

Friday, February 4th, 2022

Interesting weather today, here in the heart of the Berkshire mountains. A little rain, a little sleet, a little freezing rain, a little snow and a lot of ice. The very definition of my newly coined word, quinaryfecta (I toyed with pentafecta).

Governor Baker has asked everyone to stay off the roads, so, here I sit putting together a few stories that might have slipped under your radar.

The cost of health care continues it ever-upward trajectory

In November, the Kaiser Family Foundation published the results of its annual Employer Health Benefits Survey, and 2021 continued what appears to be an unstoppable trend.

More than 155 million Americans get their health care from Employer Sponsored Insurance (ESI). That’s 55% of the working population. There are two facts about this year’s survey I would like to highlight:

First, the annual cost of health insurance for a family is rising faster than both wages and inflation.

To their credit, employers have been absorbing most of the rise in premium costs, but this prevents them from using those funds now going to health care insurance for other worthwhile endeavors, like growing their companies, enhancing their risk management programs, or raising wages.

Second, annual premium costs in 2021 rose 4% over 2020 to a record high $22,221. That’s $1,852 per month. Workers are paying an average of 28% of the cost, or about $500 per month. But that’s before a 2021 average deductible of $1,669, which is 92% higher than ten years ago. In 2021, 85% of workers in ESI plans were subject to a deductible.

As these costs continue their stratospheric rise it’s like employers and employees are side by side trying to outswim a Navy Destroyer ―  with every stroke they fall farther behind.

Speaking of upward trends, let’s consider traffic deaths in 2021

The Department of Transportation just released a statistical projection of traffic fatalities for the first 9 months of 2021 showing an estimated 31,720 people died in motor vehicle traffic crashes nationwide. This represents an increase of about 12% as compared to 28,325 fatalities that were projected in the first nine months of 2020. This is the highest percentage increase over a nine-month period since the Department began recording fatal crash data in 1975. The numbers in 2021 are 32.5% higher than they were a decade ago.

Something weird is happening on our roads. Over the last 45 years, traffic safety engineers and automakers have made remarkable progress in improving the safety of our roads and cars. But they haven’t been able to change the human element, about which we wrote a week ago.

Don’t go by raw numbers, however. The important statistic is the rate of traffic fatalities per million miles driven. From 2011 through 2019, the rate didn’t waffle much, going from 1.09 to 1.10, with a blip up to 1.17 in 2016.

All that changed in 2020, when the rate jumped to 1.35. In 2021, it inched up to 1.36 to prove 2020 wasn’t a momentary aberration.

Secretary of Transportation Pete Buttigieg announced the Department will dedicate significant resources to attack these daily tragedies. We will be paying close attention to this.

Another example of our fragmented health care

The Biden Administration has made it easier for people to get free at home rapid tests. Here at our home, we applied on Day One of the program, and four days later our tests arrived. And the Administration has distributed millions of tests to pharmacies and states. People can go to CVS or Walmart or any other participating entity, buy tests, and get reimbursed by their insurance company. That’s not how other countries are doing it, and they’ve been doing it longer. They’ve cut out the insurer middleman, and have just gone directly to their people with the tests. In the the UK, for example, testing has become a way of life.

The insurer reimbursement issue has become a Medicaid problem for the states. The rules of Medicaid do not allow for it, and, because each state administers the program in its own way, they’re all approaching the problem differently.

Some states have made it easier for the safety net program to reimburse pharmacies for providing the tests at no cost. Others are experiencing what CMS described in an 11 January call with the states as “operational considerations and challenges.” Here’s one such challenge: Some states require a prescription for Medicaid enrollees to get anything from a pharmacy. To deal with this, states are making what they are calling “standing orders” to allow enrollees to get free tests at pharmacies without a prescription.

Another challenge for the states: How to get tests to homebound enrollees. Some states are attacking this by setting up temporary mail order programs.

My point here is that each state has to create its own solution. That is counterproductive. All the states are facing the same COVID problems, but each is attacking those problems differently. Throughout, one thing has become clear to the various Medicaid State Directors: the more they communicate with each other, the better off they are.

It is becoming more and more evident that the absence of one cohesive system to guide everyone wastes time and money, and jeopardizes the health of Medicaid enrollees all over the nation.

Have a nice weekend.

 

Happy Christmas Eve Day

Friday, December 24th, 2021

“Twas the night before Christmas, when all through the house
Not a creature was stirring, not even a mouse.
The stockings were hung by the chimney with care,
In hopes that St. Nicholas soon would be there.”

For some, my beautiful spouse included, Christmas Eve Day is the best day of the year, even better than Thanksgiving, which is my favorite. Karen revels in the revels of getting everything ready, so the next day, the biggie, will be fantastic for all.

For many reasons we are living in perilous times, but I suggest there are many more of Karen’s ilk than the in-our-face whackadoodles, whose ambition in life seems to be to become famous by screaming the most outrageous and untruthful things possible. They shout louder, but they are a minority, and a poor one at that.

So, this little letter is a paean for the unsung heroes among us who constantly go out of their way to make life better for those around them. They offer an admirable, aspirational and humbling example for the rest of us.

 

 

As I Was Saying…

Monday, December 20th, 2021

Having taken a few days off―168 to be precise―your scribe has now returned to the writer’s desk to once more enter the fray.

No, I was not sidelined with a case of COVID. Nor did some momentous life experience throw a high hard one to the side of my head and put me on my backside. Family has been fine and health excellent (if you don’t count the shoulder that wants replacement after hitting about 950,000 overheads on the tennis court over the course of too many decades―simple arithmetic).

Being serious though, I’ve thought hard about why I fell victim to a 168-day writing famine, a real writer’s block, and I think it comes down to three things:

1. There is so much bloviation in the internet’s ether that one’s goal should be to subtract from it, rather than add to it. Technology now allows anyone and everyone to label themselves “expert” and throw their intergalactically significant thoughts up against the literary wall to see if any stick. Perhaps 5% are worthy of the effort, and that’s being generous. Ask yourselves how many pundit “opinions” land in your inbox every day. If you’re like me, it’s a lot. Separating the wheat from the chaff can be exhausting.

2. The “new normal” is not. It’s abnormal. For me, it’s like walking into an art museum and finding all the paintings just a little crooked. It’s woozy inducing. Like trying to plant cut flowers, to quote Daniel Boorstin, the late American historian and Librarian of Congress. And calling it the new “normal” is misleading, because “normal” suggests this is what life will be for all of us forever: The Norm. One hopes that, like every other plague in history, humanity will one day emerge into the bright sunshine of maskless and vaccinated good health, with COVID no longer the grim reaper. But that day is somewhere in the fog of the future.

3. The bitter, atavistic, and in many cases downright ignorant partisan wars erupting every day all over the media, social and otherwise, have changed the American landscape. They put in sharp relief the good and the bad of democracy’s fabric. The constant search for “gotcha” moments, the in-your-face bellicosity, the biblical attachment to lies regardless of truth no matter how well-proven, bring out the very worst in all too many people with cruelty as sharp as the edge of an ax. Vlad the Impaler could learn a thing or two from some of these folks who have all the intellectual honesty of a lap dance and whose minds are about as deep as a pool table’s side pocket.

For the last 168 days I’ve been the fly on the wall of the human condition. I’ve watched people as artificial and superficial as a casino lobby jockey for power and influence. While more than 800,000 Americans have died from COVID, self-interest has reigned and hobbled the best efforts of heroically dedicated people devoted to improving the lot of the rest of humanity, the rest of us. This has caused a kind of intellectual paralysis, like being thrown into a deep pit and finding it rough to climb out. Have you felt that way, too?

Three years ago this month. I told the story of how Frederick Banting’s team of himself, Charles Best and James Collip recovered and purified insulin from the fetal pancreases of cows and pigs in 1922, how they successfully tested it on humans, how Banting won the Nobel Prize the following year for his discovery, how the team sold the patent for the discovery to the University of Toronto for $3.00―a buck apiece―and how they and the University agreed to license the manufacturing rights to pharmaceutical companies royalty-free, because, in Banting’s words, “Insulin is my gift to mankind.” The team and the university wanted to incentivize drug companies to improve on the Banting team’s discovery, so the University and Banting agreed to allow the companies to improve Banting’s formulation if they could and patent any new discoveries that arose. Their hope was that drug companies would share their vision of making it possible for Type-1 Diabetics to live high-quality lives and to keep insulin prices low to help them do it.

That was 100 years ago. Today, the Build Back Better bill, the one West Virginia’s Senator Joe Manchin killed yesterday, would have, among other things, let Medicare negotiate prices with pharmaceutical companies for a very limited number of high-cost drugs and would have capped the monthly cost of insulin for many, but by no means all, diabetics at $35. That may still happen, but its odds of passing just went from perhaps to probably not. One wonders what Frederick Banting would think of all this.

At any rate, vacation’s over, and my tiny voice will do what it can to throw light into the dark that shrouds us all.

 

Thoughts Of The Day

Monday, January 18th, 2021

Was Azar intentionally lying, colossally incompetent, or both?

Given the last four years, I’m guessing Door Number 3.

Because both the Pfizer and Moderna vaccines require two shots, administered 21 and 28 days apart, respectively, Operation Warp Speed’s initial plan, announced in early December, was to hold back half the supply to make sure there was enough for the second shots. At the same time, the Trump Administration was saying it would vaccinate 20 million people by the end of the year.

On Tuesday, 12 January, as it became apparent the first doses of COVID-19 vaccinations were proceeding much slower than predicted (the 20 million prediction had turned into an 11.4 million reality), U.S. Secretary of Health and Human Services (HHS) Alex Azar announced the government was making all of the coronavirus reserve vaccine supply immediately available, urged states to provide shots to anyone 65 and older and warned governors that states with lagging inoculations could see their supply shifted to other places.

You could hear the collective country-wide sigh of relief. Help was on the way.

That is, until three days later when we learned the only place the “reserve supply” existed was in Alex Azar’s imagination, because the Administration admitted to state and federal officials it stopped stockpiling the second doses at the end of last year as it attempted to hit the 20 million goal. The reserve supply no longer existed. The states were left to scramble again, as they have throughout the pandemic. Remember the PPE fiasco? States were forced to compete against each other and the Feds to get any. Remember the Administration’s leadership about masking? Neither do I. I could go on.

This latest FUBAR catastrophe led President-Elect Joe Biden to tell the world the vaccine rollout was “a dismal failure.” Seems fairly accurate to me.

“Never ruin an apology with an excuse” – Benjamin Franklin

Here’s the way it worked. After the election, which he lost, Donald Trump spewed lie after lie about how he actually won “in a landslide.” And he convinced millions of people this was so. A new Quinnipiac poll reports 73% of Republicans believe there was “widespread fraud” in the election, which allowed Joe Biden to win. Trump’s two-month assault on truth led to the 6 January armed insurrection.

It is questionable whether he would have persuaded his millions of followers to believe the lies if he had not had profound assistance from Twitter, Facebook and conservative media. Case in point: the conservative outlet American Thinker which, with no investigation,  bought the Dominion Voting Machines stole-the-election line – again and again.

Yesterday, American Thinker “screwed its courage to the sticking post” and apologized. It was not one of those, “We did a bad thing, but we did it because…” things. No, this was an apology that would have made Ben proud. Here it is in full:

We don’t know what prompted American Thinker to so abjectly fall on its sword. I choose to think optimistically, believing journalistic ethics won the day. Regardless, this is how you do an apology.

Speaking of optimism

Why not end on a lighter note?

Back in pre-pandemic times (you remember those, don’t you?), when you wouldn’t think twice about sitting in a pub with friends discussing the metaphysics of Sartre, I once did just that with two friends, one a conservative republican with whom one could actually debate policy issues with smiles all around; the other, an MIT engineering professor.

We were talking about how people so often view the same thing in different ways, which led us to a discussion about optimism. That led to further discussion about the differences between people who were naturally optimistic and those who were naturally pessimistic.

One of us brought up the old glass half full or empty screed. I, the eternal optimist, said to me the glass was always half full. My conservative friend said he couldn’t help seeing it as half empty.

My friend from MIT said, “There’s too much glass.”

Stay safe – and, if you can, optimistic.