Archive for the ‘Research’ Category

Reflections On WCRI’s Recent Virtual Annual Conference: In A Word, It Was Excellent

Tuesday, March 30th, 2021

COVID-19 impact analysis

Last year, the Workers’ Compensation Research Institute held its Annual conference in Boston at the Westin Hotel on 5 and 6 March. The ballroom was full. COVID-19 was talked about in the conference and on the breaks, but it was too new to be on the Agenda. Everyone was doing elbow bumps instead of hand shaking. Four days after the conference wrapped, Governor Charley Baker declared a Massachusetts State of Emergency. The WCRI conference was likely the last one held in the City before everything shut down.

At that time, per the Johns Hopkins University COVID-19 Dashboard, the nation had seen ~139,000 cases and 2,425 deaths. In Massachusetts, where the conference was held, there had been 4,955 cases and 48 deaths.

The following month, the National Council on Compensation Insurance (NCCI) issued a Research Brief titled, COVID-19 and Workers’ Compensation: Modeling Potential Impacts. 

NCCI’s analysis projected a best case scenario, in which loss costs would increase $2 billion, and a worst case scenario, in which they would increase $81.5 billion, or 250% more than then current total loss costs. Willis Towers Watson also released a scenario-based analysis that suggested pretty much the same thing.

Also in April, the California Workers’ Compensation Insurance Rating Bureau (WCIRB) projected loss costs if conclusive (rebuttable) presumptions were provided to front line workers, something Governor Gavin Newsom actually did through Executive Order one month later, so the “if” became a “done.” The WCIRB report concluded costs would range “from $2.2 billion to $33.6 billion with an approximate mid-range estimate of $11.2 billion, or 61% of the annual estimated cost of the total workers’ compensation system prior to the impact of the pandemic.

A year later, at this week’s virtual annual conference, WCRI Economist Olesya Fomenko, Ph.D., reported results from her analysis of workers’ compensation claims in WCRI study states for Q1 and Q2, 2020. This period, ending 30 June, encompassed the pandemic’s first of what has been up to now three surges.*

Her data and presentation slides are preliminary, but more than likely will stand up to future scrutiny. Her findings confirmed what most students of COVID-19 were intuitively thinking. To wit, it does not appear that, at least through the study period of two quarters, COVID-19 would deal a death blow to the workers’ compensation industry. Claims in her analysis of 27 study states are plentiful, but relatively inexpensive. There is wide variation in the geographic distribution of claims, probably because COVID-19 surged at different times in different states. New York is not among the WCRI study states, but during the period of Fomenko’s analysis, it was the state with more COVID problems than any other. A lot more.

During the study period, Massachusetts, Connecticut and New Jersey had the most reported claims. Massachusetts claims were 42% of all reported claims in the study states and 59% of all lost time claims. Dr. Fomenko suggested that the presence of presumption laws, pay without prejudice (in the case of Massachusetts) and other compensability issues (in New Jersey) might is some way contribute to the high numbers in those states.

Looking at Massachusetts for a moment might be instructive.

At the top of this column we showed Massachusetts with relatively few cases as of early March, two-thirds of the way through Q1. Let’s look at Massachusetts now, at the end of Q1 a year later. The state has been hit hard, but has also rebounded. Here’s a look at the state by county:

As you can see, no county has had less than 3,000 infections, and three have had more than 10,000. But what came of those infections? How did the patients make out medically? Here is a look at cumulative cases from 9 March 2021 through yesterday, 29 March 2021.

There have been 17,130 total deaths since the beginning of the pandemic, but 97% of infected patients have recovered. Deaths are at 3%, which is less than the 5% predicted by the CDC one year ago. And this is the case for most of the country, and is one of the reasons Dr. Fomenko’s data shows claims to be relatively inexpensive.

NCCI Analysis

The WCRI studies define the concept of “early days.” So do those from the National Council on Compensation Insurance (NCCI). The point is, however, that analyses from both organizations appear to be congruent and complementary.

The lasting costs of COVID-19 to the workers’ compensation industry, aside from deaths, are going to come from permanent total and permanent partial disability awards. To that end, in October, 2020, NCCI published a Research Brief updating the Brief cited earlier in this column and titled, COVID-19 And Workers’ Compensation: Permanent Disability. These costs will be significant. NCCI’s analysis determined the average age of hospitalized COVID-19 patients at 49.5 years old. Average life expectancy allows for about 30 more years of benefits. The organization writes:

Given that severe cases are expected to have a higher likelihood of permanent disability, particularly PTD injuries, NCCI
assumed that all PTD claims would occur in this symptom grouping (infections and lung claims). Adjusting our PTD rate to between 0.0% and 1.5% to be applicable to only severe cases, we observe a PTD rate between 0% and 10% (= 1.5% / 15%) using the default Critical Care Rate from the NCCI Hypothetical Scenarios Tool.

Permanent Partial Disability cases are another matter. Here the frequency will be higher as well as the costs:

One interpretation of this assumption could be that moderate cases behave more like infection claims which tend to have a
near-zero PTD rate. If we compare the lung and infection PPD rates, we observe that lung claims have about twice the
likelihood of a PPD injury compared to infection claims. To the extent that moderate cases of COVID-19 behave like
infection claims and severe cases behave like lung claims, then a similar difference in the PPD rate may be expected. Under
this view, the Severe PPD rate would range between 40% and 50% with an implied Moderate PPD rate ranging between
20% and 25%.

With assumptions it clearly states contain wide variability, NCCI suggests the following COVI-19 benefits by injury type:

We’ll continue to follow the NCCI analyses as well as WCRI’s ongoing research.

Interview by John Ruser, PhD, with John Howard, MD, MPH, JD, LLM, MBA

John Howard is the longest serving Director of the National Institute for Occupational Safety and Health, three terms and counting. He is a legend in the field, and WCRI attendees got a good look at why during this wonderful interview by John Ruser. Howard, who has more letters after his name than there are years in elementary and high school combined, put on quite a show.

Some people are one inch wide and ten miles deep; others ten miles wide and one inch deep. Howard seems to know no inch or mile boundaries.  His subject was The Future of Work, and he made a number of highly interesting and prescient points, even going so far as to describe Aristotle’s concerns about automation in the ancient world of 350 BCE.

Asked about fears of jobs disappearing because of Artificial Intelligence and automation, Dr. Howard pointed to a study showing that in 2018 there were 60% more jobs than existed in 1940. Jobs have always gone away, but they’ve been replaced, and then some, by new jobs.

He’s concerned about a safety ergonomic vacuum employers are going to have to manage somehow. He believes employers are facing a “real challenge” adjusting to the new Work From Home paradigm.

My question is: How do employers deal with, let alone manage, workers’ compensation claims bound to occur while working in the home. You’re at your desk or dining room table working, get up for lunch, fall down the stairs and break an arm. Is that compensable? Is your employer going to make you prove it actually happened while you were actually working, and not just taking Junior out to the back forty for a little tag football?

And what responsibility does an employer have with respect to OSHA’s General Duty Clause, the one about providing a safe and healthful workplace?

If anyone can figure this stuff out, my money’s on John Howard.

Conclusion

Under trying circumstances, WCRI did an admirable job of hosting its 2021 Annual Conference. I’m told attendees gave it high marks, as well they should have. At the end of the second day, Dr. Ruser announced next year’s conference as being back in Boston’s Copley Westin Hotel on 15 and 16 March 2022. And I have a suggestion: After this ridiculously stressful year, it would be helpful and probably appreciated to devote a session to the impact of COVID-19 on employee mental health. A lot has happened in the last year to the field of Behavioral Health. It seems to have fitted in quite well to the new paradigm called Telehealth. It would be interesting to learn about that.

 

* Yesterday, CDC Director Dr. Rochelle Walensky said, “We do not have the luxury of inaction. For the health of our country, we must work together now to prevent a fourth surge. I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet.” Walensky said she is now feeling a sense of “impending doom.”

**The Future of Work: The Economist is presenting a discussion on 8 April, at 4 pm, EST. To reserve a place, go here.

The WCRI And Sidney Powell’s “No Reasonable Person” Nutty Defense

Tuesday, March 23rd, 2021

Interesting day today at the first 3-hour day of the Workers’ Compensation Research Institute’s virtual and strange two-day conference where all the presenters looked as if they’d really rather be in the Grand Ballroom of Boston’s Westin Hotel. I’ll have a wrap up of the two-day, six-hour conference after it ends tomorrow. But for today…

In early February, 2021, an Associated Press-NORC* poll found 65% of Republicans believed Joe Biden was not legitimately elected President of the united States. One week ago, a Monmouth University National Poll found exactly the same thing. Nothing had changed in a month and a half. Why do you suppose that is?

 

 

You don’t have to be Albert Einstein to know that since the election, in fact since well before it, authority figures in the Republican Party, including the President, insisted the only way Donald Trump could lose the election would be through massive fraud. One of the leaders of this disinformation campaign is the lady pictured here: Attorney Sidney Powell, Trump’s on-again off-again lawyer in his attempt to overturn the election result.

Powell manufactured far-fetched claim after monstrously far-fetched claim of election fraud beginning two days after the election. Powell and her team of conspiracy theorists filed more than 60 lawsuits around the country that all died in court. But that didn’t stop her and her sidekick Rudy Giuliani from sharing their bird-brained ideas from the stage of the Republican National Committee in a November press conference carried on C-Span. Neither did it stop them from doing the same dozens of times on Fox News and Fox Business, never challenged by anybody from the network.

When none of that worked, Powell went for the big time and won the Gold Medal for the craziest claim of 2021 (thus far). To wit, Smartmatic and Dominion Voting Systems conspired with Venezuela’s communist leadership, ditto with Cuba, and “likely” China to create software to fix the election for Joe Biden against Donald Trump. On 8 November on Fox Business she was interviewed by Maria Bartiromo and claimed Dominion created a secret “algorithm to calculate the votes they would need to flip. And they used the computers to flip those votes from Biden to—I mean, from Trump to Biden.”

In late January, after the Dominion Voting Systems leaders had heard this lie a few thousand times, they had enough and sued Powell, Giuliani and others for $1.3 billion for defamation. That’s billion.

Yesterday, Powell’s defense team responded to the lawsuit. It’s 90-page filing can be summarized in two words: Just kidding.

In legalese, what her lawyers said was, “no reasonable person would conclude that [Powell’s] statements were truly statements of fact.” Moreover, her high-priced defense team writes that Dominion itself “characterize(s) the statements at issue as ‘wild accusations’ and ‘outlandish claims,’” and that “Such characterization of the allegedly defamatory statements further support Defendants’ position that reasonable people would not accept such statements as fact…”

In otherwords, if the company she defamed considers the accusations off-the-chart lunacy, then nobody else could ever possibly believe them.

Finally, the Powell team claims she never knew her accusations were false. “In fact,” they write, “she believed the allegations then and she believes them now.” So, she’s not guilty; she’s just crazy.

This would all be riotously funny if it weren’t so deadly serious. Deadly, as in five people died and more than 140 were injured at the Insurrection of 6 January, a day, to quote Franklin Roosevelt, “that will live in infamy.”

But notwithstanding the Insurrection, could Sydney Powell’s defense team actually be right? Would no one believe her claims, as well as all the other ridiculous claims made by Trump apologists, because they are all so nutty? The early February AP-NORC and the mid-March Monmouth University polls, as well as the Insurrection itself, appear to give the lie to that defense. Sixty-five percent of Republicans still believe Biden cheated his way to the Oval Office. They’re getting that belief from somewhere. And unless we figure out how to disconnect this significant faction of the American public from the Big Lie, it will continue as a grotesque cancer on our society.

In the 1930s, Joseph Goebbels made famous the Big Lie.

“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”

We have seen this movie before. And it never ends well.
________________
* The National Opinion Research Center at the University of Chicago, founded in 1941 whose name is now officially NORC.

 

What Is The Real Reason Republicans Oppose The American Rescue Plan?

Friday, March 5th, 2021

At this moment, the Senate is debating the American Rescue Plan, the Biden administration’s $1.9 trillion stimulus proposal currently enjoying deep and wide bipartisan popularity across the country. Consequently, of course, not a single Republican senator will vote for it.

Why is this?

The Federal Reserve, not what you’d call a radically socialist organization, the Treasury Department, and nearly all reputable economists back the plan. A highly credible Morning Consult / Politico National Tracking Poll, with a 2% margin of error, conducted two weeks ago from 19 through 22 February, reported 66% of all registered voters considered stimulating the economy a “Top Priority,” and 76% of registered voters support the $1.9 trillion plan. And the icing on the cake — 60% of died-in-the-wool Republicans support it.*

Additionally, 63% of small business owners support the $1.9 trillion stimulus plan, according to the Q1 2021 CNBC|SurveyMonkey Small Business Survey, including 46% of Republican entrepreneurs.

With that kind of support, what possible reasons could congressional Republicans have for doing “everything we can to fight it,” as Mitch McConnell proclaimed this week?

There are a few reasons, and, is so often the case in political argument, most of them are nothing more than sound bites.

For example, Republicans claim the proposal is “replete” with giveaways having nothing to do with the pandemic. They object to the plan’s $350 billion aimed at helping cities and states, most notably the $10 billion (less than 1% of the entire plan) to shore up pension plans or lower future taxes.

Let’s look a little more closely at Republican opposition to city and state aid. No municipality — red or blue — has designed its fiscal affairs to withstand a simultaneous public-health crisis and economic lockdown. Unlike the federal government, states and cities cannot print or borrow money at near-zero interest rates. Most are constitutionally required to balance their budgets. When a pandemic annihilates their sales and income tax revenues — while dramatically increasing their Medicaid and health-care outlays — states have little choice but to lay off public-sector workers, cut social services, and/or raise taxes. All of those measures would make our current economic woes worse. There is no economic theory to support a stimulus strategy that combines massive stimulus at the federal level and simultaneous austerity at every lower level of government. If you believe that governments can improve economic welfare by filling in shortfalls in private incomes and consumer demand, then forcing state governments to reduce employment and spending is economically indefensible.

In the face of this, there is no coherent theoretical argument behind the GOP’s opposition to fiscal aid for states. But that hasn’t stopped it from trying. Unfortunately, every strata of our nation’s economy, from business, small and large, to the public sector’s 20.2 million federal , state, county and city employees, to nuclear families and single Moms, to you and me — all are in need.

On the other hand, I’d be interested in knowing just how much economic need our elected representatives and senators are experiencing at this moment. Would you?

*To be precise, this is the exact wording of the question in the Tracking Poll. It can be found on page 229 of the 368 page report: “Would you support or oppose a $1.9 trillion coronavirus relief package that provides up to $1,400 in direct payments to Americans making less than $75,000 a year, $350 billion in emergency funding for state and local governments, funding to support K-12 and higher education to re-open, and extends increased unemployment benefits until September 2021?”

Now What?

Tuesday, February 16th, 2021

The Trial of the Century —  So Far

During and after the second impeachment trial of Donald Trump, even Republicans admitted the House Managers had done a masterful job of presenting their case. Having voted the trial constitutional by a margin of 55 – 45, the Senate subsequently acquitted Trump with Republicans contending the trial was an unconstitutional abuse of power. And, as I have written earlier, that became the painted hook on the Senate wall upon which they hung their acquittal hats, all 43 of them.

The entire proceedings seemed scripted and predicable — that is, until Saturday morning, originally scheduled for closing arguments. That was when the leader of the House Managers, Representative Jamie Raskin, of Maryland’s 8th Congressional District, announced that overnight the Managers had learned of a phone conversation between House Minority Leader Keven McCarthy and President Trump at the height of the insurrection on the 6th. Representative Jaime Herrera-Beutler, Republican of Washington, had issued a statement saying McCarthy had described the conversation to her, a conversation in which McCarthy had begged Trump to forcefully call off the mob. Trump had dismissed the request cavalierly, saying, “Well, Kevin, I guess these people are more upset about the election than you are.”

Herrera-Beutler, one of the ten House Republicans who voted for impeachment, had said she was willing to testify under oath about the conversation with McCarthy, and that’s what Manager Raskin said was going to happen. Instead, Hellzapoppin happened.

Trump defense attorney Michael van der Veen, who is a personal injury lawyer, not a civil liberties lawyer, objected strenuously (to be kind about it; as I was watching I thought the Republicans were going to have to peel him off the Senate ceiling), saying if Herrera-Beutler were called to testify, he had at least a hundred witnesses he wanted to call, starting with Nancy Pelosi, and, by the way, he would depose all of them in his office in Philadelphia, because “that’s how these things are done.” At this point, the bell sounded and the fighters went to their separate corners to decide what to do next.

The House Managers, having made their point, and realizing that nothing short of something akin to the parting of the Red Sea, would persuade seventeen Republicans to vote to convict, and even that might not be enough, decided not to call Representative Herrera-Beutler as a witness. Instead, they and the defense team compromised by reading her statement into the record of the proceedings, thereby sparing us of more of Mr. van der Veen’s histrionics.

Shortly thereafter, Donald Trump was acquitted — again.

This was a show trial. With the conclusion foregone, the House Managers knew their real audience was the American public, not the 100 Senators in the chamber. It remains to be seen whether they won their case with the public. An Ipsos poll conducted Friday evening after the Defense had wrapped its case, if you could call it that, but before the Herrera-Beutler bombshell, revealed 55% of Americans believe Trump was “fully” or “largely” responsible for inciting the violence, but only 50% believe he should have been convicted. Strangely, 53% said he should be barred from holding public office again. The poll, which had a confidence level of 4%, shows in stark relief how deeply polarized this nation remains.

There will be more Trump litigation, a lot more. We may never see the end of it. Mitch McConnell, after voting to acquit, specifically mentioned this in a fiery speech (for him) putting Trump on notice that criminal and civil penalties are appropriate for what he did.

And today, it begins. This morning, Representative Bennie G. Thompson (D-Miss.), the chairman of the House Homeland Security Committee, filed a federal lawsuit accusing former president Donald Trump, attorney Rudolph W. Giuliani and two extremist groups whose members have been charged in the 6 January storming of the Capitol with illegally conspiring to intimidate and block Congress’s certification of the 2020 election. Citing an 1871, rarely used law aimed at the KKK, Thompson is suing in his personal capacity and is joined by the NAACP.

So many miles to go

With the conclusion of the world’s fastest impeachment trial, the Biden presidency can take center stage. Job #1: Defeat the pandemic and, in the words of someone who knew a thing or two about national division, “bind up the nation’s wounds.” However, right out of the gate we keep getting reminded just how delicate an undertaking that’s going to be.

Case in point: The scary growth of far right extremism in America and around the world got a boost from the Covid-19 pandemic.

Using historical data-sets from Germany, Kristian Brickle, of the Federal Reserve Bank of New York, concludes influenza mortality during the pandemic of 1918 – 1920 was directly correlated with both lower per-capita spending in the next decade, especially by the young, and the rise of extremist parties in 1932 and 1933, primarily the National Socialist Workers Party (the NAZI party). In her study, Pandemics Change Cities: Municipal Spending and Voter Extremism in Germany, 1918-1933, (May 2020, Revised June 2020), Brickle shows how Germany suffered high mortality in the pandemic, mortality that varied significantly across the country’s municipalities and regions. This variation represented tangible differences between cities and regions that reflected the beliefs and preferences of the inhabitants. In effect, the pandemic served as a means to exacerbate beliefs already held. One of these exacerbated beliefs was distrust for and hatred of minorities, predominantly Jews. Hence the significant increase of the deep-seated antisemitism of the late 1920s and 1930s.

Although Brickle’s work does not blaze a new trail — she builds on the work of many others — her research paints a clearer picture of what can be the unfortunate and unforeseen consequences of a pandemic. The United Nations and others have documented an “explosion” of antisemitism throughout the tenure of the Donald Trump presidency, but with a significant spike during 2020, the first year of the Covid-19 pandemic.

Joe Biden is going to need all the help he can find.

 

 

The Second Impeachment of Donald Trump Approaches

Wednesday, February 3rd, 2021

Next Tuesday, the 9th of February, the Senate will begin the second impeachment trial of Donald Trump. With ten Republican Representatives voting in the affirmative, the House impeached the former president for inciting insurrection on 6 January, an insurrection that has resulted in the deaths of five people.

Trump supporters in Congress and around the country have viciously attacked the ten House Republicans who voted for impeachment. Wyoming Representative Liz Cheney, the third most powerful Republican in the House, has come under particular fire. Die-hard Trump disciples have petitioned Minority Leader Kevin McCarthy to remove her from her leadership post. That group is reported to have more than 100 signatories to its petition. The entire caucus will meet about this later today. It could happen that when the dust settles tonight, Liz Cheney, who, with Leader McCarthy’s approval, gave voice to her conscience, could become the only person to this point punished for anything that happened on the 6th of January. I make this point to illustrate just how far the devolution of Congress has progressed.

On the Senate side of the building, Trump’s latest lot of lawyers yesterday filed a 15 page initial brief that bases their defense of the former president on two major points. First, Trump did nothing wrong either before or during his 6 January rally in DC; he was simply exercising his First Amendment rights. Second, they contend it is unconstitutional to impeach Trump, because he is no longer in office and therefore cannot be “removed,” a view that is shared by most Senate Republicans ( there is also a third defense position – the Bill of Attainder defense – that is altogether too wacky to go into).

With respect to the first defense, the question before the Senators is whether Trump’s oratory was advocacy or incitement. The U.S. Supreme Court explained in Brandenburg v. Ohio (1969) that “the constitutional guarantees of free speech and free press do not permit a State to forbid or proscribe advocacy of the use of force or of law violation except where such advocacy is directed to inciting or producing imminent lawless action and is likely to incite or produce such action.”  The Court’s ruling in Brandenburg meant that KKK leader Clarence Brandenburg’s statements such as “it’s possible that there might have to be some revengeance taken” did not amount to criminal syndicalism under Ohio law.

In addition to the “incitement to lawless action” charge, there is the “clear and present danger” test. In applying the clear and present danger test in Schenck v. United States (1919)Justice Oliver Wendell Holmes, Jr., observed: “The question in every case is whether the words used are used in such circumstances and are of such a nature as to create a clear and present danger that they will bring about the substantive evils that Congress has a right to prevent.” Holmes cited the example of a person who falsely shouts “Fire!” in a crowded theatre, causing a panic. The impeachment prosecutors will doubtless advocate that Trump really did, metaphorically, shout “fire” on 6 January, causing his followers to panic and storm the Capitol.

Regardless, the House Trial Managers are going to have great difficulty in convincing people who do not want to be convinced, in fact, refuse to be convinced, that Trump’s words at his rally on 6 January presented a clear and present danger to incitement to lawless action. This, despite the video and myriad recordings showing Trump egging on his followers to “fight” and “be strong,” because he “won in a landslide” and “the election was stolen” from him.

The Trump defense team’s second claim, that impeaching an out of office president is unconstitutional, will be equally difficult to counteract, even though the Congressional Research Service (the best research agency you’ve probably never heard of), at the request of House members, published a study on 15 January that showed clearly the precedence and constitutionality of such an action. The study, which is quite the civics history lesson, should be required reading for every high-school student.

In the study, Legislative Attorneys Jared P. Cole and Todd Garvey meticulously analyze this issue and write:

The Constitution does not directly address whether Congress may impeach and try a former President for actions taken while in office. Though the text is open to debate, it appears that most scholars who have closely examined the question have concluded that Congress has authority to extend the impeachment process to officials who are no longer in office. As an initial matter, a number of scholars have argued that the delegates at the Constitutional Convention appeared to accept that former officials may be impeached for conduct that occurred while in office. This understanding also tracks with certain state constitutions predating the Constitution, which allowed for impeachments of officials after they left office.

They also note:

Scholars have noted that if impeachment does not extend to officials who are no longer in office, then an important aspect of the impeachment punishment is lost. If impeachment does not apply to former officials, then Congress could never bar an official from holding office in the future as long as that individual resigns first. According to one scholar, it is “essential” for Congress to have authority to impeach and convict former officials in order to apply the punishment of disqualification; otherwise Congress’s jurisdiction would depend on the whims of the individual who engaged in misconduct. Another scholar notes that the grave nature of the disqualification punishment indicates that it should apply independently of the need for removal.

Some Trump defenders point to the Richard Nixon case. When Nixon resigned on 9 August 1974, the House of Representatives had already drawn up articles of impeachment. After his resignation, the House did not send the articles to the Senate for trial. Less than a month later, President Ford granted Nixon a full pardon, thereby ending the case. The Trump defenders claim not impeaching Nixon proves their case that a president cannot be impeached after leaving office. What they fail to mention is that Nixon had already served two terms as president and was barred from running again by the 22nd Amendment. The whole purpose of impeaching someone after leaving office is first, to set an example, and second, to disqualify them from future office. Donald Trump, if not impeached and convicted, is free to run again for President in 2024.

Let me end on a hypothetical question. Suppose a President commits an impeachable action on the 19th of January; say it is discovered a week later that he or she had been colluding with a foreign power for personal gain at the expense of our nation. If the action is committed while in office, but not discovered until after he or she flies off in Marine 1, what is to be done about it? It is almost sacred theology that a President cannot be criminally charged for actions committed while in office (See the Mueller Report). How else is the miscreant punished other than impeachment?

I have no illusions about the Senate convicting Donald Trump of “high crimes and misdemeanors,” although I think he is guilty as charged. Further, I think he is responsible more than anyone else for the deaths that happened during and after the storming of the Capitol.

It is dispiriting for me to have to conclude that, rather than suffering one day of punishment for any of it, he will just live in the lap of luxury for the rest of his horrid life, the same mass of stunted protoplasm he has always been.

 

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.

 

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.

COVID-19 Analysis from Jennifer Christian, M.D., M.P.H.

Monday, September 21st, 2020

I have written before of my great admiration for Dr. Jennifer Christian and for her Work Fitness and Disability Roundtable (WFDRoundtable@groups.io). The Roundtable is a mainstay for clinicians and other health care professionals.

I thought this morning’s Roundtable post by Jennifer to be particularly thoughtful and thought-provoking, so I asked her if she would allow us to republish the post in its entirety here at the Insider. She very kindly gave permission.

I think Jennifer is one of those brilliant three or four folks I’m lucky enough to know who think around corners. Her mind makes intuitive leaps where others (like mine) plod along.

Here is Jennifer’s post:

How many people have some pre-existing immunity to COVID-19

There is growing uncertainty about what this fall and winter is going to look like with regard to the COVID-19 pandemic.  Are we going to have a second, and possibly even bigger wave of worldwide infections — or is the biggest part of this pandemic over and done with once each geographic area has had its first wave?

A new review from the British Medical Journal says researchers may have been paying too much attention to antibodies and too little attention to a second part of the human immune system that protects against and reacts to infections:  T cells.   More on this in a moment…..

But first, a reminder.  We are in the middle of the first large-scale pandemic with a new and highly contagious respiratory pathogen since the field of immunology was born!   Immunology is still quite young compared to other specialty areas in biological science and medicine.  It was only in the mid-20th century that advances in cell biology started making it possible to study the detailed processes that make up the immune response in detail.  That has led to much deeper understanding of the mechanisms by which vaccines work, to the development of the first cancer chemotherapy agents that selectively killed rapidly-proliferating immune cells, and to the development of immune-modulating drugs, which enable the transplantation of organs by muting the body’s natural rejection of foreign tissues.

The appearance of HIV/AIDS in the 1980’s again precipitated huge leaps in funding for research to increase our understanding of the immune system, which in turn highlighted the function of T cells and other previously unrecognized aspects of it.   However, in comparison to other bodily systems and organs, our knowledge of the human immune system is still primitive — it’s obvious there is much left to learn — and some of what we don’t know may seem very basic!

If you’re an immunologist, virologist, epidemiologist — or a public health officer trying to figure out how to protect and guide your local population — this is the overwhelming challenge of a lifetime.  Personally, I hope that the media and the general public will remember that this pandemic has attacked our society at the very edge of what is known.  All of those professionals are working at a feverish pace to observe carefully, assemble enough data to be confident they have enough to detect a real pattern if it’s actually there, make sense of what they are seeing, and then figure out the implications for action.  Let’s agree to be forgiving of the fact that “the facts” have not all been revealed to us yet, and “the scientists” simply don’t yet know everything we wish they did.

Back to the T cell story.   Researchers have shown that people with the most severe cases of COVID-19 (the ones in ICU and who are most likely to die) often have low T cell levels.  But some other puzzling data has appeared. For example:

  • some countries — and especially some areas within those countries that had bad initial outbreaks — have not seen widespread new infections despite having relaxed protective restrictions; and,
  • blood tests in a noticeable fraction of people with no record of exposure to SARS-CoV-2 virus show some of the T cells reacting weakly to it anyway — indicating a potentially partial immune response.

This has led scientists to start wondering whether we really know enough about the human immune system’s ability to develop partial T cell “cross-reactivity” to families of closely-related viruses and whether that might predictably and reliably reduce the severity of illness or even reduce the likelihood of getting ill at all when a new-but-related virus appears.   And, that, of course, raises some possibilities that need to be investigated:

  1. Does cross-reactivity explain why some geographic areas that had first pandemic peaks are not seeing second ones — because the people who got sick had no immunity and were more susceptible, and most of the remaining ones have some limited immunity which is protecting them?
  2. Does cross-reactivity explain some of the disparity between people who get deathly sick from COVID-19 and people who are exposed to the virus but never get infected, or, if they do, remain asymptomatic or have only mild illness?  Note that there are two  possibilities:  Cross-reactivity could be making the illness worse or it might be making it less severe — we don’t know yet.
  3. How could cross-reactivity be protective if it develops after prior exposure to coronaviruses, because children are the least likely to get a severe case of the disease and adults are the most susceptible to severe COVID-19 illness and death?  (Children have not had a lifetime of colds, and thus less opportunity to be exposed to coronavirus and develop partial-immunity to SARS-CoV-2)

In short, my best advice as of 21 September 2020 is:

  1. Stay tuned for further developments in the factual realm – both changes in case counts and new research results;
  2. Hope for the best but prepare for the worst as autumn approaches and we all retreat indoors.

COVID-19 Update

Friday, September 18th, 2020

To close out your week we offer a few items that may have flown nap-of-the-earth under your radar.

The AstraZenica/Oxford vaccine bump in the road

On 8 September AstraZenica (AZ) halted its Phase 3 study, because one of its study participants came down with Transverse Myelitis, a neurological condition affecting the spine and caused by infection, immune system disorders or other disorders that can damage or destroy myelin, the fatty tissue that protects nerve cell fibers.

The UK has allowed AZ to restart its study there (AZ is a UK-based company), but as of this writing, the U.S. has not. In fact, in an interview with Kaiser Health News, the National Institute for Neurological Disorders and Stroke’s Avindra Nath said “the highest levels of NIH are very concerned.” According to Nath, the NIH has yet to access tissue or blood samples from the patient, who was part of the U.K. portion of AZ’s Phase 3 study. NIH believes AZ is being far too coy with its data. Nath called for the company “to be more forthcoming,” adding that “we would like to see how we can help, but the lack of information makes it difficult to do so.”

Given this halt in the U.S. study, it is not inconceivable that, if the AZ vaccine, known as AZD1222, proves efficacious and safe in the UK, regulators there could approve it for general use well before the U.S. does. This would not make our Commandeer in Chief happy.

The Mask versus Vaccine dust up

Speaking of the Commander in Chief, he recently took CDC Director Dr. Robert Redfield for a quick walk to the woodshed for suggesting during testimony to a Senate subcommittee, “Masks are more guaranteed to protect me against COVID-19 than a vaccine.”

President Trump, who is not a doctor, but repeatedly plays one on TV, took exception to this. He publicly chastised Redfield for his comments and said a vaccine could be available in weeks and go “immediately” to the general public. Diminishing the usefulness of masks, despite a wealth of scientific evidence to the contrary, he said his CDC chief was “confused.”

Well, no, he wasn’t. Redfield told subcommittee members that if everyone in the U.S. would wear masks in public the pandemic could be under control within 12 weeks. His issue with a vaccine lies in its degree of immunogenicity, which he suggested would be in the area of 70%, meaning if 100 vaccinated people are exposed to the virus, 30 of them will have insufficient protection to ward it off. Those 30 will probably be comprised of groups who are most susceptible to the vaccine now, like the elderly.

People, masks will be with us for a long time.

Health insurance losses

Before the pandemic, 49% of Americans got health insurance through employer sponsored insurance (ESI). COVID-19 has reduced that percentage, because 6.2 million of our neighbors have lost their jobs and, consequently, their health insurance. When you factor in spouses and children, the number of people who have been shoved out the door into the COVID cold becomes 12 million.

Researchers at the Economic Policy Institute (EPI) have recently documented the losses in a new study. Researchers Josh Bivens and Ben Zipperer write:

  • Extreme churn after February 2020 has led to very large losses in ESI coverage. In March and April, for example, new hiring led to 2.4 million workers gaining ESI coverage each month, but historically large layoffs led to 5.6 million workers losing coverage each month. This rate of lost coverage—over 3 million workers—dwarfs a similar calculation for the number of workers losing coverage each month during the biggest job-losing period of the Great Recession (September 2008–March 2009). Our analysis using the monthly, high-quality measure of the total number of jobs in the economy from the Current Employment Statistics (CES) program of the Bureau of Labor Statistics (BLS) is consistent with 9 million workers having lost access to ESI in March and April 2020 but 2.9 million workers having gained coverage between April and July 2020.

Bivens and Zipperer say about 85% of those who lost ESI coverage were able to gain at least some coverage either through a spouse’s plan, the Affordable Care Act or state Medicaid programs, but that still leaves about a million laid off workers and their familes with nothing. Bivens, Zipperer and others argue the job losses have only worsened the public health crisis created by COVID-19.

Of course, recognizing that millions of people losing employer sponsored health insurance is a public health crisis is not the same as fixing the system to prevent it from happening again. However, as I have written before, having exposed gross inadequacies in the nation’s health care system, COVID-19 also provides opportunities for improvement. What is needed now is the determined motivation and will to make that happen. That is a Herculean task about which I wish I were more optimistic.