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Was He Punished for Drug Pricing? Look again.

Dear Group,

Remember Martin Shrkeli, the nasty, un-repentent founder and chief executive of Turing Pharmaceuticals? He was briefly infamous for jacking up the price of a tablet of Daraprim (an old antibiotic) from $13.50 to $750.00 overnight in 2015. Do you remember a sense of satisfaction when he was sentenced to prison for seven years? Did you think, well, he got what was coming to him for such a heinous act? Think again. He may have gotten what was coming to him, but he wasn’t sent to prison for an immoral price hike that put people’s lives at risk. He was put in prison for defrauding the investor class.

Think about that. In 2015 Daraprim (pyrimethamine) had been around for sixty-two years. As an ophthalmologist, I used Daraprim to treat a vision-threatening infection by a parasite, Toxoplasma gondii. Later, its main use was for treatment of AIDS patients with a life-threatening systemic infection with the same pathogen. In 2015 when Shrkeli hiked the price of Daraprim, Turing was the only manufacturer. Cost to produce a tablet? In India at the time a dose of pyrimethamine could be purchased for as little as $0.10. The price hike left patients (and their doctors) scrambling to find funding for vision-saving or even life-saving treatment. The money from the inflated prices went to Shrkeli and Turing’s stockholders. Some patients no doubt had to forego treatment. These were folks too sick to navigate the complex web of pharmacy insurance or lacking the wherewithal to smuggle the drug into the country, Such people are in no condition to mount a political campaign. In our system they can be allowed to suffer. Their collective voice is too quiet for a free market Republican to hear. 

It is a grim irony that Shkreli went to prison not for a price hike that fell on the vulnerable, likely blinding some and hastening the death of others. No, he went to prison for “defrauding investors in two failed hedge funds.” Such is our system, such is the fealty the Republican/Libertarians pay to the “free market.” There were dramatic hearings in 2015 in the Republican majority House…and no action whatsoever. 

What does Daraprim cost today in the United States? $746.18 per tablet at Costco according to a quick online search. In Canada? $1.38 per tablet is the highest price I could find.

Outraged yet? It would take only a minute to come up with numerous other examples of immorally priced drugs, each affecting a relatively small group of patients, patients who spend time struggling with health insurance companies for coverage of inflated drug prices, patients who go without essential medicines or take half doses because they simply can’t afford the price, patients who pay ridiculous insurance premiums in part because of the unconscionable prices drug companies are allowed to charge.  

If you take this issue to McMorris Rodgers’ local office, perhaps her staff (funded by your tax dollars-Member’s Representational Allowance) will help you find some compassionate program to help you pay the bill…or perhaps you can appeal to Go-Fund-Me. What you will NOT get from McMorris Rodgers is any action to rein in the cost of pharmaceuticals. You will not get a bill to encourage reimportation from Canada. You will not get legislation to allow Medicare/Medicaid to volume bargain with the drug companies on price. Those straightforward ideas are contradictory to Republican/Libertarian “free market” ideology. Never mind health care and drugs are not part of a free market.

While McMorris Rodgers remains in office and in a Republican majority remains in Congress there will be no relief. Voting her out won’t fix this right away, but it is a necessary beginning. Lisa Brown understands health care economics and will work toward rational drug pricing. Here is your chance to elect a Representative to get things started.

Keep to the high ground,

Jerry

P.S. Please understand I am convinced of Cathy McMorris Rodgers’ fundamental desire to do good, but I fear she lacks the open mind, the education, and the mental bandwidth to deal with many issues. Her deep, unfounded faith the “free market” will solve all problems blinds her to circumstances where the market is not free. Drug prices and health care are cardinal examples.

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CMR and Kavanaugh

After I wrote this missive, Dr. Blasey Ford tentatively agreed to appear before the Senate Judiciary Committee this week. We would do well to remember the details of what Anita Hill was put through in 1991 as we listen to the grilling by men who, by their own words, have already made up their minds, who view this hearing as barely necessary window-dressing to approving the nominee. 

Dear Group,

Republican disappointment, even anger, at Dr. Christin Blasey Ford for coming forward now against the appointment of Brett Kavanaugh to the Supreme Court is understandable. Kavanaugh’s appointment would be the culmination of decades of ground work by corporate interests ignited, according to some, by reaction to Ralph Nader’s 1960s consumer advocacy. [See Powell Memorandum]  To have those decades of effort thwarted now, with victory in sight, must be frustrating, even more so since the problem arises from a woman. After all, Mitch McConnell and the Senate Republicans have cast aside both precedent and decency by stiff-arming Merrick Garland and then tossing out the traditional sixty vote majority requirement to confirm a Supreme Court nominee. Both were desperate acts, but they were just the prelude to the main goal: obtaining a Supreme Court majority that favors the oligarchy oner the individual.

Now they face a conundrum: Rush the nomination to the floor, vote, grab the goal…and reap a backlash against a Supreme Court majority deemed illegitimate or slow down the process perhaps for weeks to properly gather evidence and avoid a repeat of nasty male Senators attacking a female accuser, a woman up to now without the time, resources, and preparation the Republicans have amassed behind Kavanaugh? 

Then last Saturday morning the daughter of Ronald Reagan, Patti Davis, weighed in on the side of Dr. Ford and for deliberate process by recounting her rape by a prominent music executive. It came out in an article entitled “Why I don’t recall all the details of my sexual assault.” The article recounts the rape and her subsequent silence and confusion. Davis’ story was widely covered, including the New York Times and published in the Spokesman and the Washington Post, probably among others.

So where do Lisa Brown and McMorris Rodgers stand on all of this? We have some clues from last Wednesday’s debate:

Moderator: What should be the next steps on Capitol Hill in this [Kavanaugh’s] nomination process?

Dr. Brown: Well, certainly there needs to be a full investigation of the allegation. And the woman who has come forward needs, deserves to have an investigation done in an independent way and be heard. And the rush to judgement…confirm as quickly as possible…is not the right thing for a lifetime appointment and it runs over the rights of women just like what happened in 1991 when Anita Hill came forward with her allegations. That inspired a whole generation of women to run for office. I ran for office in 1992 and I predict that woman in the United States want this to be thoroughly investigated without a quick confirmation.

CMR: Well we’re working through the process. I think it’s important that we give every woman an opportunity to be heard. I think that that’s very important. In my understanding the Senate has scheduled a hearing for Monday where both Kavanaugh and the accuser will be in front of the Senate and given a chance to be heard and to answer questions and I just think we need to continue to allow this process to play out.

“In my understanding.” Could McMorris Rodgers be more disingenuous? She holds the fourth most powerful post in the Republican hierarchy. She knows exactly what the stakes are. She knows all the players and all the corporate donors. She has pushed for a Republican/Libertarian majority on the Supreme Court for years. Does she really imagine Dr. Ford could get a fair hearing today in front of a bunch of frustrated old white male Republican Senators bent on getting Kavanaugh seated?

The next day McMorris Rodgers’ “positive disruptor,” Mr. Trump, came out on Twitter:

I have no doubt that, if the attack on Dr. Ford was as bad as she says, charges would have been immediately filed with local Law Enforcement Authorities by either her or her loving parents,” the president tweeted.

How can McMorris Rodgers support a man capable of such a statement? Does she really not understand the gross unfairness of the process McConnell and Grassley are offering? Does she not remember the Anita Hill grilling? (Perhaps she missed it. She was fresh out of the Pensacola Christian College and working in the office of a staunch Republican state legislator at the time. Has McMorris Rodgers ever been exposed to the degrading details of those hearings?)

I copy below an article (with good links to the information quoted) that I found useful in putting this controversy in context. You can see it and a lot more at Popular Info written by Judd Legum. It provides a detailed comparison of the power dynamics in 1991 and the Republican efforts to use the same power against Dr. Ford. 

At the debate on Wednesday Lisa Brown got the right answer. McMorris Rodgers tried to distance herself from a process she supports and with which she is intimately involved. Don’t let her get away with it. There is no reason not to use more time to have a full and fair hearing. Demanding Dr. Ford’s appearance today (or anytime in the next couple weeks before a thorough investigation can be conducted) is a male Republican power play with the tacit approval of “our” Representative.

Keep to the high ground,

Jerry

 

The Anita Hill playbook

The Senate Judiciary Committee scheduled a hearing next Monday with Dr. Christine Ford, the woman who says that she was sexually assaulted by Brett Kavanaugh, and did before speaking with her. Ford, through a lawyer, responded that she wanted to cooperate with the committee but requested that the FBI conduct an investigation of her allegation first, which is the process the committee used for Anita Hill in 1991.

In a letter to Ford’s lawyer sent Wednesday afternoon, Grassley refused and said he planned on proceeding with the hearing on Monday. 

What’s the rush? First, Republicans are desperate to confirm Kavanaugh before the midterm election. To save time, they dispensed with the normal process for gathering records, which is run by the nonpartisan National Archives, and delegated the task to an old friend of Kavanaugh, Bill Burck. 

But there is another reason that Republicans are insisting Ford testify in just four days: They are seeking to maximize Kavanaugh’s advantage over Ford in a public hearing. 

Kavanaugh has the full resources of the White House, the Republican Party and a phalanx of outside groups to prepare him for the hearing and reinforce his message. The White House counsel, communications director, and press secretary have reportedly been grilling Kavanaugh for hours to prepare him.

White House officials engaged in a two-hour practice session, known as a murder board, in the Eisenhower Executive Office Building with Kavanaugh, where he answered questions on his past, his partying, his dating and the accuser’s account. Participants included McGahn, deputy chief of staff Bill Shine, press secretary Sarah Huckabee Sanders and Raj Shah, who is leading communications. 

Ford, up until a few days ago, was not a public figure. She has no entourage of political professionals to prepare her for a public cross-examination by 11 Republican men. In recent days, she has been subjected to death threats, forced out of her home and into hiding. 

Republicans want to pressure her to testify as soon as possible — before she can reasonably be expected to prepare and before more facts emerge that could bolster her account. 

They know this works because that’s exactly what they did with Anita Hill. And that’s not the only tactic Republicans are dusting off from 1991. 

The time pressure

In 1991, Republicans and Democrats agreed that hearings were necessary to consider Anita Hill’s allegations. Some Democrats advocated for a few weeks to investigate and prepare for the hearing. 

But the Republicans pushed for an immediate hearing — and their position prevailed. There was a break of just two days between the decision to hold a hearing and the hearing itself. Jane Mayer and Jill Abramson explain how it went down in their 1994 book, Strange Justice: The Selling of Clarence Thomas:

…Republicans wanted to get the new hearings over with immediately. “The idea,” [Republican Senator John] Danforth later conceded, “was to have them begin as quickly as possible and to last as briefly as possible.”

Appealing to [Democratic Senator Joe] Biden’s constant desire to seem evenhanded, Danforth and [Republican Senator Bob] Dole argued that fairness dictated speed. Biden initially wanted an interval of two weeks, but now he agreed to constraints that all but sealed Hill’s fate. The new hearings would begin that Friday, October 11…

There would thus be only two days to investigate Hill’s charge, find and interview other witnesses, and prepare for the new hearings, which would run through the weekend if necessary. If time ran out before important allegations were explored or witnesses heard, nothing could be done. “The schedule,” commented another Democratic senator, “was insanity.”

The decision, Mayer and Abramson write, sealed the power dynamics:

Three days before the hearings were to open, Thomas had the full weight of the White House and Senate Republicans behind him. But Hill was about to travel to Washington as an outsider with no connections, an ordinary citizen with strengths and weaknesses, pressured against her own instincts into challenging the most powerful institutions in American society largely by herself. 

Today, Republicans are seeking to put Ford in the same position. They demanded Ford commit to a hearing just two days after she first made her story public.

Unlike Ford, Anita Hill at least had the benefit of an FBI investigation into her allegations.

In his letter to Ford, Grassley not only rejected her call for a delay but moved the timeline up further. He said that, if Ford wished to appear, she would need to submit a prepared statement and biography by Friday at 10 AM.

The insane woman

Before the hearings began in 1991, allies of Thomas sought to portray Hill as mentally unstable. Mayer and Abramson tell the tale:

Armstrong Williams, an equally loyal member of Thomas’s circle, pitched in too, pronouncing Hill virtually mentally unstable with respect to Thomas. As he put it in an interview with the Wall Street Journal for a story that ran the day the hearings opened, “There is a thin line between her sanity and insanity.” Later, in another interview, he said, referring to Hill, “Sister has emotional problems.”

On Tuesday, Joe DiGenova, a lawyer with close ties to the White House who reguarly consults with the president, declared Ford a “loon.”

She really doesn’t want to testify. Because when she does, she’s going to look like the loon that she is. She may very well believe everything she’s saying, and that is one of the signs of lunacy, believing something that isn’t real.

Grassley offered a slightly toned down version of DiGenova’s attack, saying he didn’t “doubt that [Ford] believes what she says.” Left unsaid is that Grassley believes she might be delusional.

The polygraph

Grassley’s suggestion that Ford is imagining has another benefit: It explains how she passed a polygraph test. 

This was the same tack taken against Hill, who also passed a polygraph exam. 

Hill might not be a standard liar, as they had earlier implied, but, the Republicans now suggested in the open hearing room, she might be so delusional she believed her own lies. If so, she could pass a polygraph test and still be wrong about Thomas.

The political pawn

Republicans have sought to portray Ford as doing the political bidding of Democrats. Senator Lindsey Graham (R-SC), for example, claimed Ford was requesting an FBI investigation only to delay a vote on Kavanaugh until after the midterm elections.

 

Lindsey Graham@LindseyGrahamSC

Requiring an FBI investigation of a 36 year old allegation (without specific references to time or location) before Professor Ford will appear before the Judiciary Committee is not about finding the truth, but delaying the process till after the midterm elections.

September 19, 2018

A similar effort was made against Hill. During the hearing, Senator Hank Brown (R-CO), sought to portray Hill as a “radical, pro-choice feminist” who was attacking Thomas because “he was now in a position to threaten the Roeruling.”

 

The objective then, as it is now, is to establish a motive for the woman to lie.

What Anita Hill says now

In an interview on Wednesday evening with PBS Newshour, Hill urged that the hearing be delayed to make time for a professional investigation of Ford’s allegations.

When you get a professional involved, they will know the questions to ask, they will know the places to go, they will know the people to call on as witnesses to complete what is a thorough investigation.

So there — there’s a lot more than we can learn. I think, so often, we get — fall into this trap saying, oh, this is a he said/she said situation. And that rarely is the case. There is very often — and most often, I would say — ways that testimony can be corroborated, either through other individuals or other circumstances that are similar.

“[W]e have senators who are deciding about who is going to sit on the highest court, but they can’t really put partisanship aside long enough to put together a fair hearing to get to the truth about this situation,” Hill concluded. 

Maybe, 27 years later, it’s time to start listening to Anita Hill?

The latest from Ford

In a statement released Wednesday evening, Ford’s attorney, Lisa Banks, renewed her request for a delay and a full investigation but suggested that Ford might appear if all relevant witnesses were included: 

[T]he Committee’s stated plan to move forward with a hearing that has only two witnesses is not a fair or good faith investigation; there are multiple witnesses whose names have appeared publicly and should be included in any proceeding.

(For more on other potential witnesses see yesterday’s Popular Information.)

Thanks for reading! Please send your feedback and hate mail to judd@popular.info.

Popular Information comes out Monday through Thursday and will return on Monday, September 24.
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The Parallel Universe/No-Go

First, KHQ shows its colors. The first hour of Wednesday’s Lisa Brown v. McMorris Rodgers debate aired live on KHQ, Channel 6. Lisa Brown made the last statement, the debate closed with music, and as the music ended a particularly nasty and inaccurate McMorris Rodgers approved attack ad started up accusing Lisa Brown of being responsible for raising tuition at WSU by 80%. I was at the Bing, but I have listened to the audio. KHQ pretended to a non-partisan presentation. The ad placement, to say nothing of the ad’s content, makes a mockery of impartiality. I urge anyone who saw this attack ad placement to call KHQ to object and to submit a letter to the editor of the Spokesman.

Dear Group,

Last weekend I attended my high school reunion in Wisconsin. Several old friends whispered to me that we were in the most Republican county in the nation. Even so, it was not hard to find former classmates experiencing the same sense of dismay as I am feeling. So much for pervasive redness. 

All conversations were warm and cordial: kids, grandkids, retirement, what keeps one busy, the flood of fragmentary memories of place and people, the classmates who had died, the sense of mortality, of time moving on.

One classmate asked, “Are you still traveling a lot?” We talked a little of Europe and South America, and then he asked, “Isn’t it kind of scary, though, with those ‘no-go zones’?”

If you not have heard of no-go zones, take a moment and google the term. According to this image, there are pockets of population, usually inhabited by immigrants, often Muslims, into which the police have simply given up trying to maintain order. Such areas are often characterized as given over to sharia law. The overall painted image is one of a spreading cancer across the map of Europe (or Michigan or …), a cancer eating away at white christian society. It is an image cut of the same cloth as Trump’s memory of seeing Muslims celebrating on rooftops in New Jersey as they watched the twin towers collapse–a complete fiction. For the Fox news listener or frequent visitor to the right wing internet, “no-go zone” is a trigger term, easily conjuring a frightening image of any unfamiliar place. 

When I heard my classmate’s honest question I knew where I was about to tread. Anyone seriously asking such a question is not going to respond well to a direct challenge of his fact base. I spent a minute describing the ground I have covered in my travels, the foreign-ness of it.. I simply stated that in my experience no-go zones do not exist, that, in fact, I doubt their existence. I said I was suspicious that the concept of no-go zones was far overblown and may have been hatched for political ends. He seemed mildly surprised…and interested. 

The idea of scary “no-go zones” was injected into the public consciousness in the wake of the Charlie Hebdo shooting in Paris in January 2015. Fox News first talked up the term, which even CNN picked it up briefly. The mayor of Paris threatened to sue Fox News over their inaccurate portrayal. The threatened suit was a blip in the media, mostly unnoticed. Listeners to mainstream media have rarely heard the term “no-go zone” since the Hebdo shooting. Not so on the right. The opportunity to paint Europe as suffering a slow motion takeover by Muslim immigrants was just too useful to let die. Once introduced by Fox News, right wing commentators like Rush Limbaugh picked up the meme, nurtured it, circulated it. Taking advantage of most Americans limited foreign travel experience it was easy to play up the threat, magnify the fear of “the other.” 

Like “moving the embassy to Jerusalem,” the term “no-go zone” is now code for listeners in the parallel media ecosystem. “No go” is shorthand for “be frightened, be worried” about the other come to take over our country. We listeners to NPR would do well to pay attention to the words and the associated image.

The right wing propaganda machine was painstakingly grown but not quite mature when Trump was elected. Fox News (launched in 1996) is the first example that comes to mind, but Fox is now only a small part of a whole ecosystem that includes Breitbart, the Washington Examiner, The Daily Caller, The Washington Free Beacon, and a broad network of well funded conservative talk radio and many (nominally) “Christian” radio outlets. This media ecosystem provided the platform Trump used to become President. The media ecosystem may not have been fully ripe when Trump and Bannon commandeered it. Many of us were reading National Geographic, watching PBS, and reading the New York Times and the Wall Street Journal and almost willfully unaware of the growth of the right wing propaganda machine, vaguely hoping it contained only a few people on a lunatic fringe. Only when Trump threatened reporters, declared “fake news,” and welcomed sketchy media outlets to take part in White House press conferences did alarms began to ring. 

Now we find ourselves having conversations with former classmates who mention phrases like “moving the embassy to Jerusalem” and “no-go zones” that light up mental images for them, images of which we are mostly ignorant, not having been sufficiently primed. It behooves us to pay attention, to ask for definitions and expansions, and to declare it when our experience and values contradict the ideas presented…face-to-face, time and time again. We are losing our common language. We need to understand not just the words but the images that light up in the minds of the folks with whom we converse.

Knock on doors this weekend and have conversations. This November is our best chance to start on a path to understanding each other again.

Keep to the high ground,

Jerry

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The Debate. Were Minds Changed?

Dear Group,

Last evening the first of four scheduled debates was held. The first hour was broadcast live from the Bing theater on KHQ. For another half hour after the broadcast the candidates took questions from among those video recorded a little earlier. The theater was packed. I venture there were very few in attendance whose mind wasn’t already made up, and fewer still whose minds were changed. Some who watched on television were perhaps less partisan.

Both candidates acquitted themselves well with no memorable stumbles. 

This debate and the three that will follow are important, but do not make the mistake of thinking the applause heard tonight is indicative. This election will be won by convincing Democratic voters who don’t usually vote in the midterms to cast ballots this November. That will take knocking on doors and phone banking.

Come on out with Indivisible this Sunday or Monday (see details above) or connect with the canvassing links in the Calendar section below. There are door knocking events every day until November 6. Don’t wake up on the 7th wondering if you could have done more…

Keep to the high ground,

Jerry

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Health Care, Republican All-Purpose Talking Points

Dear Group,

Republican Leah Vukmir, a Wisconsin state senator, is challenging Tammy Baldwin (D-WI) for Baldwin’s seat in U.S. Senate. In 2009 Vukmir voted against a bill in the Wisconsin state house requiring insurance companies to cover hearing aids and cochlear implants for Wisconsin children. Vukmir was one of few who voted against the bill. Twice. The bill became law in spite of Vukmir. Recently, the mother of a child who received a cochlear implant using the coverage mandated by the law spoke out in an ad against Vukmir’s candidacy. The flap over the ad was covered on Wisconsin Public Radio. See if Vukmir’s defense sounds familiar:

Vukmir’s campaign manager, Jess Ward, pushed back on the criticism, saying Vukmir opposes, “government-run, one-size-fits-all healthcare.”

“As a nurse, Leah believes in providing patients with plans suited to their needs, and she opposes plans that increase costs for all patients, making health care less affordable,” Ward said.

She added Vukmir believes such changes also lead to fewer options and diminished health care quality for consumers.

Vukmir’s defense is familiar because it is Republican/Libertarian boilerplate (see the P.S. below). I have heard the same nonsensical talking points from every Republican who speaks on health care and health insurance, at both a state and federal level. Most certainly that includes McMorris Rodgers.

Republican’s always conflate health care and health insurance.Their fundamental objection is to any government regulation of business, specifically the business of health insurance. “Leah believes in providing patients with plans suited to their needs, and she opposes plans that increase costs for all patients, making health care less affordable,”  

Her statement should go this way: “Leah believes health insurance companies should be able to offer hard to comprehend, sub-standard insurance policies that do not protect the consumer from medical bankruptcy. Leah believes an inexpensive insurance premium for barebones coverage equals affordable health care.” That is nonsense.

Health insurance is merely a complicated vehicle, a middle man, a clearing house, for paying bills from a health care “system” that has not been a free market for more than half a century. Anyone who has ever looked at an Explanation of Benefits (EOB) knows the only thing regulating the charges posted by the health care system is public outrage, and in the case of drug prices even public outrage has limited utility. Health insurance companies actually blunt public outrage by serving as a buffer between health care charges and the patients they insure. (Note: Serving as a buffer, i.e. averaging cost over a subscriber population, is what insurance companies are expected to do.)

The only way in which health insurance companies regulate health care charges is through mostly opaque business deals concerning what insurance will cover at all, what it will “allow” (i.e. pay) for a given service, and whether the provider will accept the payment offered. What the patient can pay or is willing to pay for health care is not a significant factor. This arrangement has no guard rails. This system resulted in an aggregate average health care expenditure per person of over $10,000, more than twice that of many countries that provide better average care.

The spokesperson added: “…Vukmir believes such changes [changes like requiring insurance companies to provide coverage for hearing aids and cochlear implants] also lead to fewer options and diminished health care quality for consumers.”  If you are able to construct a rational train of thought leading to that conclusion you are doing better than I. 

The Republican/Libertarian party’s acolytes keep repeating the same words over and over,  They don’t stand up to inspection. 

Keep to the high ground,

Jerry

P.S. If you know Vukmir’s background it should come as no surprise she is spouting boilerplate Republican ideology. Vukmir served as the national chairwoman for the American Legislative Exchange Council (ALEC), a non-profit, 501(c)(3) “think tank” and clearing house. ALEC was set up to aid state legislators in sharing Republican legislative ideology. It provides boilerplate language for Republican bills at the state level. ALEC is heavily supported by the Koch brothers donor network as a way of dominating and homogenizing Republican ideology across the fifty states. If you are not already familiar with ALEC you should be. Read the wikipedia article for a start. 

Note the ALEC’s expropriation of “American,” It should be the “Republican” Legislative Exchange Council. ALEC was founded in the 1973 in response to the infamous Powell Memorandum.

P.P.S. At one time I thought Republicans who spouted this “healthcare” mantra were purposefully deceitful. No longer. I now believe most of them simply lack the bandwidth and education to understand economic reality.
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Nature Roars. Does CMR hear?

Dear Group,

I am taking this day off from writing. For those who may have missed this piece in the very successful New York Times published September 16th. Consider my copying it as an unsolicited advertisement for the NYTimes. I have subscribed to the online version since shortly after the Trump election. Here is the article:

Nature Roars. Washington Hears Nothing.

The elements offer a rebuke as President Trump rolls back policies designed to address global warming.

By The Editorial Board

As if this past summer of merciless heat waves, droughts and megafires were not warning enough, in the past several days the elements sounded another alarm about the state of a world made warmer by the burning of fossil fuels. It came in the form of a one-two punch of wind and rainfall from Hurricane Florence, which like Hurricane Harvey a year ago, has derived much of its wallop from unusually warm ocean waters and stalled weather systems linked to climate change. “Supercharged” is the word one prominent climate scientist, Michael Mann, used to describe Florence, echoing the findings of the federal Global Change report in 2014 that, along with a rise in other extreme weather events, “hurricane intensity and rainfall are projected to increase as the climate continues to warm.”

To no one’s surprise, this linkage went unacknowledged in President Trump’s Washington. Quite the contrary. On Tuesday, in a further retreat from President Barack Obama’s ambitious promises to reduce America’s emissions of the greenhouse gases deemed largely responsible for global warming, the Environmental Protection Agency proposed weakening rules aimed at reducing leaks of methane from oil and gas operations. Methane, a principal component of natural gas, is a short-lived but potent greenhouse gas that represents about 9 percent of this country’s total greenhouse gas emissions; one-third of it comes from oil and gas operations.

Though the changes seem small — reducing the frequency of inspections and fixes to wells and pipelines, for instance — they may well presage an administration decision to get out of the business of regulating methane altogether. (The Interior Department, in a companion move, is soon expected to release its own proposal to roll back Obama-era rules regulating the venting and flaring of methane from drilling operations on the millions of acres under its control.)

The change in the methane rule is just plain dumb. The savings to industry would be trivial, $75 million a year by the Environmental Protection Agency’s estimates, a rounding error for the powerful oil industry. The industry could in fact end up a loser, since captured methane can be sold at a profit. Moreover, leaking methane undercuts the industry’s claim that natural gas can be a bridge fuel to a cleaner energy future. Though the burning of natural gas emits only about half the carbon dioxide of coal, the leak rate — as high as 2.3 percent, according to studies organized by the Environmental Defense Fund — erodes much of that advantage.

Finally, and most sadly, the change pretty much completes the demolition job on Mr. Obama’s climate strategy: the rollback of automobile fuel efficiency standards announced in August; the planned repeal, also announced last month, of Mr. Obama’s Clean Power Plan aimed at reducing emissions from coal-fired power plants; and now the methane pullback. These three programs, plus an effort to regulate climate-forcing gases used in refrigerants, formed the basis for Mr. Obama’s pledge at the 2015 climate summit in Paris to reduce America’s greenhouse gas output by 26 to 28 percent from 2005 levels by 2025.

To redeem that pledge — and to reassure the other signatories of the Paris agreement that much of America still cares about climate change — was the purpose of the Global Climate Action Summit, an extraordinary gathering last week of 4,000 or so climate advocates, foreign dignitaries, investors and state and local officials. The meeting, co-hosted by Gov. Jerry Brown of California and Michael Bloomberg, the former New York mayor, was a bright spot in a week dominated by atmospheric fury in the Carolinas and political fecklessness in Washington.

Unlike the Paris summit, the meeting had no power to set goals or to legally commit anyone to do anything to reduce emissions. What it did have was messaging power. And the message was one of defiance as well as concern.

According to a report prepared for the conference, the states, cities and businesses that have joined the cause — what Mr. Brown and Mr. Bloomberg call the “coalition of the willing” — now represent over half the population of the United States, over half the American economy and more than a third of its nationwide greenhouse gas emissions. Thanks partly to their efforts (plus, of course, market forces, not least the declining cost of renewable energy sources and the switch in the power sector from coal generation to natural gas), the United States is almost halfway to meeting Mr. Obama’s Paris pledge. Simply honoring existing commitments and policies at the state and local level will get the country two-thirds of the way there.

The tough part is the rest of the journey, and to that end, the report offers strategies that it believes state and local governments can undertake without any help from Mr. Trump. Most are familiar: tougher ordinances to encourage more energy-efficient buildings, stronger state mandates for renewable energy sources like wind and solar power, more rapid deployment of electric vehicles (as California requires) and efforts to begin phasing out the super-polluting compounds used in commercial and residential cooling systems. And, as if in direct rebuke to Mr. Trump, the group called for new and tougher state and local regulations to stop methane leaks from oil and gas wells and municipal distribution systems.

Uniting these leaders is a belief that human ingenuity can lead us out of a predicament that humans have helped create and a faith in collective action that is almost impossible to find on the Potomac.

 

McMorris Rodgers carefully avoids saying in so many words that climate change is a hoax. Instead, whenever climate change/global warming is mentioned she quickly pivots to her defense of the Snake River damns and the renewable hydropower they provide. When confronted with a direct question as to her understanding of global warming she wanly notes the earth has been colder sometimes. Then last summer she and her Republican cronies in the House took time out from their busy schedule to declare in a resolution that a carbon tax would hurt the economy. 

McMorris Rodgers’ ideology prevents her from acknowledging the basic science of global warming. There is no amount of climate disruption sufficient to shake her conviction. It is time to vote her out.

Keep to the high ground,

Jerry
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Rural Hospitals, Mike Bell v. CMR’s non-analysis

Dear Group,

Mike Bell is the Democratic candidate for Washington State Representative (Position 2) against Joel Kretz in Legislative District 7, a huge rural district covering the northeast corner of Washington State and extending into the northern Spokane County.. Mike Bell is a retired Certified Public Accountant with a deep understanding of the finances of rural healthcare. He operated a CPA practice working with healthcare organizations for about 20 years with 20 employees in 14 states working “with about 100 hospitals, clinics, and nursing homes.”

I’ve heard him speak on the topic of rural hospitals twice in person. On July 20 he was interviewed by Doug Nadvornick on Spokane Public Radio. I’ve transcribed below the part of the interview in which Mike Bell speaks on the plight of rural hospitals. (You can listen to this very interesting interview here.) The closing of a rural hospital is often the beginning of a death spiral for a rural community. These hospitals are important linchpins. 

BELL: Let me just say that though the biggest concern I’ve got in healthcare right now is in rural areas (I’ve worked with every one of the hospitals and clinics in the 7th District.) I was up in Republic recently talking with them and they said the most important asset they had in their community was the hospital. I explained to them that seven years ago bad debts and charity care had just about killed off all the hospitals in rural America. They were growing to the tune of 25% a year. So a million dollars in bad debts and then several years later it’s $2 million and they were out of cash. Liabilities were high. They had already tapped the community for everything they could get and a lot of them were on the brink of going under.  Then all the sudden the bad debts declined. In the example, down from 2 million to 1 million and then declined again to 650,000 and suddenly they were back in the black. Their cash reserves were going back up and and that was what saved them. That was seven years ago.

NADVORNICK: Can I ask why did their debts declined so drastically?

BELL: Well, it was because of the Affordable Care Act. The Affordable Care Act required  people to get insurance and expanded Medicaid, so it reduces the uncompensated care, bad debts and charity care that were causing them such financial problems. So in my opinion it is this: that if you voted against the Affordable Care Act for those folks in Republic and Chewelah and in Newport you were voting against your local hospital because the Affordable Care Act was the one thing that saved them. There was one legislator that voted 50 times against the Affordable Care Act and that was Cathy McMorris-Rodgers. So she effectively voted 50 times to close the hospital that you consider the most important asset. That to me suggests that a lot of people are uninformed about the benefits of the Affordable Care Act. The concern I’ve got now is that of the bad debts are starting to creep up again because the current administration is undermining the Affordable Care Act. The Individual Mandate is not required. Insurance companies are not getting the subsidies that they require. Insurance rates are skyrocketing and it wouldn’t surprise me at this time next year if those bad debts are back up to where they were seven years ago and were then jeopardizing the rural hospital systems.

NADVORNICK: So let me go one step deeper. How did the Affordable Care Act help those hospitals reduce their debts?

BELL: Well, the Affordable Care Act…actually the bad debts and charity care were primarily caused by uninsured patients and of course the rural hospitals accept one and all regardless of ability to pay. The Affordable Care Act expanded Medicaid which covered, I think, 700,000 people here in Washington. It also required individuals to buy insurance, and some of them, many of them, were subsidized so they could afford it. It required employers to provide insurance so the uninsured rates declined significantly and of course the inverse of that is that bad debts and charity care also declined. But now we’re seeing that trend reverse, and it concerns me a lot. I worked very hard for 25 years to make sure those hospitals stayed open, and we didn’t lose any during my time, but I’m afraid that we’re on the verge of seeing a significant change in rural healthcare and that bothers me. It appears that a lot of people are voting against their own interest.

NADVORNICK: So as the state legislator what would you do in Olympia because you don’t have authority over the Affordable Care Act. The Affordable Care Act could be nullified, reversed by Congress. What do you do in Olympia to counteract that?

BELL: I think in Olympia what we have to do is is take a look at the rural hospital systems and if the federal government is not going to step in and make sure that they have the resources they need then I think the state needs to step in and take its place. So what I can do is make sure that people are aware of the danger. We don’t want to wait until after hospitals are closing because once they close they don’t open up again very easily. The professionals in the community move out. Frankly, if I have rural hospitals close that community probably will probably shrink dramatically. For every hospital job that’s lost there’s one or two or maybe even three jobs lost in the community because employers don’t want to move into a community that does not have a hospital. Retired people don’t want to live in a community without a hospital. It could be catastrophic for rural Washington and other rural places around the country. I can be the voice of those rural communities and make sure they get the attention they need.

I have no reason to doubt Mike Bell’s analysis of the situation with rural hospitals. I think sending such a man to Olympia to replace the incumbent is a great idea. (Along with Karen Hardy and Randy Michaelis the other two Democratic District 7 candidates.)

How does McMorris Rodgers assess the plight of rural hospitals? She tried to tackle the question in Green Bluff on May 29. I detailed and critiqued her answer in a post entitled CMR’s Non-Solution to the Health Care Dilemma, but I offer her words below to contrast with Mike Bell’s understanding. She does not grasp the economic difference between the cost to provide a medical service and the grossly distorted and inflated amount that is typically charged for the service in our bizarre health care system. Read and see if you agree:

One thing about Medicare and Medicaid. The government doesn’t pay the full cost of actually providing Medicare and Medicaid. So…ah…any provider, any doctor, any hospital, any physical therapist…anybody who takes Medicare or Medicaid will lose money every time someone comes in with their Medicare card or a Medicaid card. Medicaid is..I believe, 30, 35% of the actual cost and Medicare is 60, 70% of the actual cost…so the providers…how do the providers actually…how do the hospitals stay in business? How does a doctor stay in business? They’re making….so they charge the private health insurance higher so that they can keep their doors open. So…so that’s where we need to be honest about the actual cost…and I believe that the government needs…I have supported for our rural communities…so we’re losing our hospitals in rural areas right now because 70, 80% of their patients are on Medicare or Medicaid and they’re losing so much money every time somebody comes in with Medicare/Medicaid….They can’t keep their doors open!  So…. We’re not being honest about actual cost of, of a what the…way it currently works.. And that’s where I think Medicare is an important program and I, I believe we’ve got to make sure it is secure but it is on a path…right now it is not on a stable path and we’re signing up twenty thousand people a day.

Summary of CMR’s argument: Rural health care providers are in danger of going out of business because Medicare and Medicaid don’t pay enough. This is like the blind man examining an elephant. Holding firmly to the tip of the tail she declares her understanding of the essence of the elephant. Let’s elect a Representative with the bandwidth to perceive the whole animal. 

Keep to the high ground,

Jerry