Curmudgeon Junction: Short Term Thinking Long Term Losses

Halloween Pumpkin Want something to be afraid of this Halloween week?  No, it’s not Ebola, nor is it ISIS, nor is it that some undocumented person will cast an “impersonation ballot” at some polling station… it’s Short Term Thinking.  Today’s rant from Curmudgeon Junction is a general grouse about the lack of foresight intrinsic in our economic and political institutions. 

The Economics of Myopia

The whole artificial edifice of Shareholder Value would collapse in a heap if the Management Interests would take a longer view of their corporate health.  When one’s interests are aligned with quarterly earnings reports, and the effect on stock market prices, then what we will get are executives who place cost cutting measures above the long term interests of the corporation.  It will be necessarily more important to lay off expensive workers than to promote long term corporate loyalty.  It will be necessarily more important to engage in stock buy backs than to allocate resources to research and development.  It will be necessarily more important to invent ever more exotic tax treatments and financial products than to invest in corporate expansion.  It will be necessarily more important to conflate the interests of trade with the interests of financial markets.  It will necessarily be more important to accumulate a profitable financial product revenue stream than to invest in modern plants and equipment.  And, this is a recipe for a witch’s brew for short term “results” and long term losses.

What U.S. steel industry?  Yes, U.S. Steel is still in business, but it’s no longer producing 67% of this country’s steel. [USX] Did anyone notice when U.S. Steel was removed from the Standard and Poor 500 Index? [NYT] Yes, the company has diversified, but it also moved in and out of some very risky propositions in the process, and simply surviving isn’t a particularly impressive item in comparison to actually thriving. 

VWonder Bread is back on the shelves, but why did the process have to be such a mess?  Let’s start with what financial writers are pleased to call a “highly leveraged capital structure with little room for error.” [Forbes]  And, we can add in an obsolete line of products – where was the investment in product research and development? And,  we can add in relatively high labor costs – which were cut in return for a promise (unkept) that the management would allocate resources into more efficient plants and equipment… So, the Twinkies got the axe, (rather later than perhaps that product line should have in the face of changing consumer trends), and the whole jerry-built private equity backed operation couldn’t take the strain of having to turn a mismanaged company around in the face of immediate capital needs.

Chevron made much of its prowess in developing alternative energy, it even created a renewable power group (CVX) and then shut the lights down.

“In January, employees of Chevron’s (CVX) renewable power group, whose mission was to launch large, profitable clean-energy projects, dined at San Francisco’s trendy Sens restaurant as managers applauded them for nearly doubling their projected profit in 2013, the group’s first full year of operations. But the mood quickly turned somber. Despite the financial results and the team’s role in helping launch more than a half-dozen solar and geothermal projects capable of powering at least 65,000 homes, managers told the group that funding for the effort would dry up and encouraged staffers to find jobs elsewhere, say four people who attended the dinner.” [Bloomberg]

The renewable power group created a net profit of $27 million in 2013, well above the $15 million target, so why did Chevron pull the plug? 

“When you have a very successful and profitable core oil and gas business, it can be quite difficult to justify investing in renewables,” says Robert Redlinger, who ran a previous effort at Chevron to develop large renewable-energy projects before he left in 2010. “It requires significant commitment at the most senior levels of management. I didn’t perceive that kind of commitment from Chevron during my time with the firm.” [Bloomberg]

Translation: OK, the renewables were making money just not enough money to get the attention of top management.  More translation: the Renewables group wasn’t making enough money in the short term to get management support in the long run.

How many investments banks are there in the United States? If you guessed Zero you got it right.  None, zilch, zip. We now have Bank Holding Companies, as the former high flyers on Wall Street sought the protection of the Federal Reserve to avoid financial oblivion in September 2008. [MotleyFool]  After running, ever so willingly, into the arms of the government in their debacle of 1002-2008, the bankers now want to revert to playing by their own rules – Repeal Dodd Frank – and re-engage in the same short term behaviors which brought on the collapse of the financial sector in 2007 and 2008.

The Politics of Myopia

There’s never been a shortage of self-serving myopia in politics. Ever.  Nor has there been a surfeit of times in which there was less costuming going on in political campaigns than there were little goblins out seeking confectionary items to put in their pillow cases.  However, turning the politics of fear into an art form, is to emphasize the fear and trivialize the long term prospects of hope.

So, we have politicians ginning up fear of a virus – of which we now have ONE case in the entire country  of 330 million people – to secure short term votes based on “Did the administration do enough?” Has the administration been strong enough?”  Probably – given that we have ONE case in a population of 330 million.   Notice, we’re not talking about (1) What should U.S. funding priorities be for the research and development of vaccines for relatively rare viral diseases which occur primarily in third world nations? or, (2) What should be the U.S. contribution to world wide efforts to eradicate viral infections?  Those would be long term questions – and we seem to have the attention span of fruit flies when it comes to politics.

The Media and Myopia

While we’re on the topic of viral diseases – has it occurred to anyone in the management end of public media that Wolf! is not to be carried to extremes, or have we missed that point from the kindergarten reading list?  How many times have we been told that Swine Flu!  Avian Flu! West Nile Virus! MERS! SARS! was going to be the End of Humanity! Or, close to it.   Now, it’s Ebola – and the media circus begins once more.  Has it not taken hold in the imaginations of media management that there may come a time when something like the Spanish Flu – a real pandemic – may creep up on us and because the “Wolf!” cry has been offered up so often and in such a dramatic way, that health care professionals will have trouble convincing the public that “This time it’s REAL?”  Are the monthly, or weekly, ratings really so important in the short run that we’d take this risk in the long run?

How many editors across the nation are assigning people to cover stories for which the reporter is simply unqualified?  That’s not ‘on’ the reporter.  If a reporter turns in a story about race relations in a mid-western city based on impressions made during a few nights of protest, with little or no background knowledge of the historic context, do we blame the superficiality of the reporting on the writer – or on the management which decided to cut back on the number of writers in order to “increase shareholder value?”  How many media outlets retain the services of several persons with a background in economics or finance to craft articles about our economy?  How many media outlets hire individuals with a background in history/sociology to write about race and ethnic relations?   How many can afford to?

It’s one thing to blast the banality of much political reporting – and another to remember that national pundits aren’t reporters.  The pundits are time fillers.  It’s expensive to send reporters to New Hampshire, Colorado, or Nevada. It’s more expensive to send them to Ukraine,  Burkina Faso, and China.  It’s cheaper to keep a pool of reporters in central locations and send “teams” out to cover events – whether or not the team members have any expertise in the regions to which they are sent.

In return for short term economies we get a long term prospect of sensationalized reporting on the dramatic and very little contextual information about subjects of greater long term impact ( such as, the efforts of Middle Eastern nations to come to terms with the historic impact of post World War I boundaries).  Are we hearing about what mega-studies of student learning models tell us about how children actually learn, or are we getting packaged news about how children in one city measure up against children in another on a high stakes standardized test?

Are we hearing about how most bridges in the United States are designed to last 50 years, and the average age of bridges in this country is 43?  Do we know that in just ten years one out of every four bridges in this country will be over 65 years of age, that would be some 170,000 of them. [BridgeReport pdf] Or, do we wait until another one collapses and more lives are lost? 

And so it goes. We’ll shove more and more eye-catching events with less and less context into the great maw of 24 hour news cycles until the information is granulized into particles about which the Time Fillers will offer interminable speculation because that’s what they’re paid to do – speculate. In the short term it’s entertaining – in the long run it isn’t conducive to a well informed electorate.

Worse still, we’ll probably keep doing this until the old song lyrics are true: “I get all the news I need from the weather report.”

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Corporate Interests, Consumer Safety?

banker 2 Columnist Steve Sebelius has an article posted which is high on DB’s Must Read List: “Heck opposes ‘junk lawsuits’ ? Since When?”  It’s hoped that after reading this you’ll come back for more information on the Republican assault on your rights in the Courthouse.  Medical malpractice litigation is only one of several categories in which the Republican Party is ready and ever-so-willing to restrict the rights of ordinary citizens to have their day in court.  Failing that, there’s always the option to force litigation on those least able to afford it.

Your Body vs. Health Insurance Corporations

It’s time to remember that one of the very few specific proposals incorporated into the GOP version of health care insurance reform was “litigation reform.”  One of the more recent comes from a Louisiana Congressman:

“Representative Steve Scalise, Republican of Louisiana, is one of several Republicans pushing for the proposed legislation, which would repeal the Affordable Care Act, place new restrictions on medical malpractice suits and provide more access to health savings accounts.”  [LFC]

The standard line from Republicans is that malpractice litigation creates “runaway health care spending increases” because medical professionals order unnecessary tests, and if damages are limited fewer people will have any incentive to file law suits.  However, we’ve known since 2009 that some physicians have ordered extra testing merely to increase their billings, [TNY] and after Texas legislature capped damages costs still hadn’t dropped in the area highlighted as the poster child for escalating health care costs (McAllen, TX). [Wire]  A Florida law restricting medical malpractice suits was declared unconstitutional – after the Florida Supreme Court found that only the health insurance corporations benefited from the restraints. [Wire] And what was achieved by restraining the ability of ordinary citizens damaged by medical malpractice?

Not much:

“Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.” [HA.org, National Cancer Inst] (emphasis added)

May be overstated?” They are being overstated. And, they are being overstated in the pursuit of policies which are blatantly aligned with the interests of the health insurance corporations.   Might any Nevadan oppose litigation seeking to hold accountable those responsible for the Hepatitis C outbreak from the Shadow Lane Clinic? [LVRJ/Sebelius]  Would Floridians oppose the efforts of the family of Michelle McCall to hold a medical facility accountable for her death – the result of a case of preeclampsia being handled about as poorly as might be imagined in a nightmare. [FSC 2014 pdf]

Who in Missouri would castigate the efforts of the Schneider family in the wake of a stroke suffered by Jeffrey Schneider, an IT specialists with the Federal Reserve, which caused damage to his speech, the right side of his body, and loss of short term memory – and which was preventable had the physician paid attention to his own notes going back to 1996. [STLpd] Also left un-noted in the hyperbole about Runaway Costs from Irresponsible Juries – the fact that medical malpractice suits are extremely difficult to win.

The physicians and medical facilities usually win in most cases. In one study of 10,000 malpractice cases between 2002 and 2005, just a bit over half (55%) ended up in an actual lawsuit. Of that 55% more than half were dismissed by the court. When all the winnowing was final, less than 5% of the cases ended up being decided by a trial verdict – and 80% of the verdicts were in favor of the physicians. [reuters]  For this, we are being asked by Representatives Heck, Scalise, and others, to voluntarily abrogate our rights as citizens to have our day in court.

Your Body vs. Gun Manufacturers and the NRA

On October 20, 2005 Congress passed a law protecting gun manufacturers and dealers from any liability.  The NRA was positively elated. [NYT]  The vote on S. 397 was 283-144 [roll call 534] The law is a gun manufacturer’s delight, it:

Prohibits a qualified civil liability action from being brought in any state or federal court against a manufacturer or seller of a firearm, ammunition, or a component of a firearm that has been shipped or transported in interstate or foreign commerce, or against a trade association of such manufacturers or sellers, for damages, punitive damages, injunctive or declaratory relief, abatement, restitution, fines, penalties, or other relief resulting from the criminal or unlawful misuse of a firearm. Requires pending actions to be dismissed. [Thomas]

Did we notice the damage might have resulted from “the criminal or unlawful misuse of a firearm?”  P.L.109-92 protects gun manufacturers and dealers like no other sector of our economy.  Did the safety fail? You have no case. Did the gun malfunction because of a preventable engineering flaw causing an injury or loss of life? You have no case. Did the Saturday Night Special shatter when fired? You have no case.  If your complaint is with a firearms manufacturing corporation – you will not have your day in court.

There are also moves afoot to make being a consumer in this consumer economy a matter of a perverted form of survival of the fittest – or the wealthiest at least.  In this regard the advocates of corporate interests want to remove the very agencies which provide administrative options to litigation.  Instead of eliminating your day in court, the massive corporations would like very much to make you challenge them in court – if you dare.

Your Wallet vs. The Financial Institutions and Big Banks

Nothing so alarmed the bankers and other participants in the Great Mortgage Disaster of 2007-2008 as the creation of the Consumer Financial Protection Bureau.  In fact, a small community bank in (where else?) Texas along with two conservative groups,  were moved in 2012 to file a lawsuit saying the appointment of CFPB director Richard Cordray was unconstitutional and the agency was without “checks and balances.” The bankers also didn’t like the Financial Stability Oversight Council – the one that studies risk in the financial sector. [Reuters]  In September 2012 some Republican state attorneys general were planning “non-cooperation” with the CFPB, following along the talking points made in the litigation. [Bloomberg]  Nothing would please these folks more than the repeal of the Dodd-Frank Act, so that the wheels of the Wall Street Casino could be free to spin again.

And what subjects does the Consumer Financial Protection Bureau review? Student Loans, Manufactured Home financing,  Bank Overdraft and other fees… As of June 2014 the CFPB reviewed (pdf) complaints in a variety of financial transaction categories – 34% concerned mortgages, 20% concerned debt collection activities, 14% were about credit cards, 12% about banking accounts and services, 3% were about consumer loans, 3% about student loans, and payday loans 1%.  In other words, disputes about loans and other services common, ordinary, everyday, citizens of the U.S. might be involved in.  

The legal system usually demands that all administrative options be finished before litigation is initiated.  If there is no CFPB then there is one less way for disputes to be resolved at the administrative level – and the individual citizen (the one in the mobile home, in the student apartment, in the apartment house complex…) is left with no option except the expense of litigation.  If the big banks had their way – you’d get your day in court – at your expense, and there would be no agency tasked with protecting you before you faced the battalion of legal forces arrayed against you.

Your Life vs. Manufacturing Interests

Calls for the abolition of the Consumer Product Safety Commission are nothing new, they’ve been around since at least 1980. [Sanders]  The Libertarian Party is pleased to offer the following vision:

We oppose all so-called “consumer protection” legislation which infringes upon voluntary trade, and call for the abolition of the Consumer Product Safety Commission. We advocate the repeal of all laws banning or restricting the advertising of prices, products, or services. We specifically oppose laws requiring an individual to buy or use so-called “self-protection” equipment such as safety belts, air bags, or crash helmets.

Does someone “voluntarily” purchase a crib for an infant which has features potentially lethal for a baby?  Who “voluntarily” buys a four wheeler where the components of the front gear case can fail causing a loss of control and crash hazard?  Or a lawn mower in which the welding on the drive axle can fail, again causing a loss of control and crash hazard?  Would you “voluntarily” purchase a bicycle helmet which fails in cold temperatures?  Would you “voluntarily” buy a scarf which doesn’t meet federal flammability standards? Or a infant’s “hoodie” the drawstring of which creates a strangulation hazard? Or a riding lawn mower wherein the ignition fails to ground and tends to overheat and melt? [CPSC]

What is the response when the four-wheeler’s front gear case fails, the vehicle goes out of control, and the resulting crash causes injury or death? You should have had a degree in Mechanical Engineering before you purchased the rig?  Or, is it if enough people are injured or die in crashes consumers won’t purchase the vehicle? How many have to die?

Again, without the Consumer Products Safety Commission not only is the likelihood of death or injury made more commonplace, but there is no administrative remedy intermediate to litigation.  Worse still, the “pro-business” Republicans don’t even want the public to know which products have been the subjects of complaints.   When the CPSC allowed the publication of its consumer database, the Republicans went off the deep end.

They said: “…that the database “wastes taxpayer money, confuses and misleads consumers, raises prices, kills jobs, and damages the reputations of safe and responsible manufacturers.” Testifying last month before the House Subcommittee on Commerce, Manufacturing, and Trade, Wayne Morris, a vice president for the Association of Home Appliance Manufacturers, complained, “It is wrong for the federal government to allow companies and their brands to be unfairly characterized, even slandered.” The National Association of Manufacturers said the database’s “credibility” and “usefulness to consumers” is “severely damaged.” In response to such criticism (and possibly also in response to Koch Industries, which showered an improbable $79,500 on his campaign), Rep. Mike Pompeo, R-Kansas, a Tea Party freshman, sponsored an amendment zeroing out funding for the database that cleared the House, 234-187. The CPSC database, Pompeo said, “will drive jobs overseas.” [Slate]

There’s “voluntarism” for us – not only should manufacturers be able to slap together unsafe products and sell them to American consumers, but those potential consumers should be prevented from finding out that other consumers have had problems with the products.  We should remember that then Representative Dean Heller (R-NV) was one of the 234 House Republicans who voted in favor of Pompeo’s amendment cutting the funding for the CPSC database. [roll call 137]

The Ties That Bind

There is a common thread to all of this.  In the instances of medical malpractice and gun manufacturing and sales, it is assumed by the Republicans that the consumer – the average American – must be prevented from challenging the major corporations who provide the goods and services; or at least their dismal chances of successful litigation must be further curtailed.

In the examples of the Consumer Financial Protection Bureau and the Consumer Product Safety Commission the notion that some administrative option prior to expensive litigation must be removed for the sake of the manufacturers and dealers. Only those with the financial wherewithal to take on interminable legal battles should be able to challenge the desire of manufacturers to cut corners (“increase shareholder value”) and thereby produce and distribute potentially lethal products.

Nowhere in any portion of these Republican challenges to consumer safety and security will we find any true concern for the average American consumer, patient, or victim. Unfortunately, for the GOP it’s  all about the corporate Benjamins.

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A Tale of Two Epidemics

AIDS Ebola

Wake me up when there are more actual cases of Ebola infections in the United States than there are chattering heads on television screens launching uninformed speculative comments.  All this palaver might serve a purpose (other than generating ratings) if it weren’t composed of, and targeted toward, the intellectually disenfranchised.

We’ve seen all this before – Swine Flu, Bird Flu, MERS, SARS – each one a Threat to Humanity! Like never before. Like nothing we’ve ever seen. Except we have. It was AIDS.

By the end of 1981 there were 159 cases of AIDS recorded in the United States, it wasn’t until 1982 with 771 cases reported and 618 deaths that the CDC labeled the disease AIDS and associated it with male homosexuality, intravenous drug use, Haitian origin, and hemophilia A.  The CDC didn’t add women as being a group at risk until 1983, and cautioned blood banks that there might be a problem.  By then 2807 cases had been reported, and 2118 deaths were associated with the disease.

No one was screeching about the need for an AIDS Czar in 1984, and no one was calling for the government to “move faster.” But 7,239 cases were recorded, there were 5,596 deaths, and one Congressional hearing.

In 1985 we were introduced to the tragic story of Ryan White, who was barred from attending school in his Indiana home town. The Department of Defense announced it would screen recruits for AIDS, and actor Elizabeth Tayler, Dr. Michael Gottlieb, and Dr. Mathilde Brim announced the creation of the American Foundation for AID Research in September. There were 15,527 cases reported, and 12,529 deaths.

It wasn’t until 1986 that the U.S. Surgeon General called for a comprehensive program of sex and AIDS education, and more information on condom use. 1986 was also the year in which the National Institutes of Health planned the formation of the AIDS Clinical Trials Group.  Dr. Krim and Elizabeth Taylor testified before Congress about the need for clinical research, accelerated research, and more timely access to experimental HIV/AIDS medication.  In 1986 there were 28,712 cases reported, and 24,559 deaths.

“And the Band Played On” was published in 1987 while the FDA finally allowed condom manufacturers to advertise that the use of their product would reduce the possibility of contracting HIV/AIDS.  50,378 cases were reported, and 40,849 deaths.  In 1988 the federal government finally responded with legislation – the HOPE Act, during that year there were 82,362 cases and 61,816 deaths.  At the end of 1989 there were 117,508 cases of AIDS, and 89,343 deaths.  The numbers were worse in 1990, 160,969 reported cases, and 120,453 deaths.  1991, 206,563 cases, with 156,143 deaths.  Fast forward to another bad year, 1995 with 513,486 cases reported and 319,849 deaths, however the research funded earlier is beginning to pay off in terms of therapeutic drugs and better prevention education.  As of 2011 there were approximately 1.1 million people in the United States living with HIV/AIDs and more than 33 million living with the disease in other parts of the world. [AmFar]

There’s been enough hyper-partisanship about the way the Reagan Administration handled the AID epidemic. However, the President was not one to discuss it publicly – not until a September 17, 1985 press conference. There are conflicting stories about whether Reagan moved Koop to speak out, or if it were the other way round.  Democrats in Congress did manage to move the money, from $8 million in research funding in 1982 to $26.5 million in 1983 bumped up to $44 million, and more during the remainder of the decade.  [RCP]   What can be said with some certainty is that the Reagan Administration was painfully slow in addressing the calamity that was HIV/AIDS, and did not adopt a leadership role until late in 1985, some four years after the disease was first noted (1981).

The national media and D.C. press corps weren’t helpful either – Chris Geidner notes 13 instances researched by Jon Cohen during which the press corps erupted in laughter at insensitive comments made from the podium by White House Spokesperson Larry Speakes beginning in  October 15, 1982.

Myth Making

It doesn’t take too many little gray cells to figure out why conservatives are so adamant about “blaming the Ebola crisis” on the current President.  To discuss the executive branch reactions to a public health problem invites comparison to the Reagan years, and the comparison doesn’t polish the lustrous image of the the conservative President.

The Congress passed a budget in January 2014 which severely constrained the budgets for the CDC and the National Institutes of Health, calling for across the board cuts in spending – including research on the Ebola virus. [CNNOn March 23, 2014 Officials in Guinea confirmed 49 cases of Ebola infection, and by March 31 Ebola infections were at an epidemic level. As of May 2014 cases are reported in Liberia, and by the end of the month cases are confirmed in Sierra Leone. [NHReg]

On August 8, 2014 the World Health Organization issued a full-on warning about the spread of the Ebola virus in west Africa, saying, among other warnings, that the infections constituted an “extraordinary event,” and a public health risk to other countries.

The Obama Administration’s response in this instance is to be measured in days, not years. On August 5, 2014 the CDC issued a Level 2 travel alert for travelers to Nigeria, and a Level 3 travel alert notice remained in effect for Guinea, Liberia, and Sierra Leone. [CDC]  The agency had also deployed health professionals to the affected area as of August 4th – 6 to Guinea, 12 to Liberia, 4 to Nigeria, and 9 to Sierra Leone.  The CDC also initiated the use of the Epi-Info software tool to determine “contact tracing” to break the chain of transmission. [CDC]  By September 17th the President announced that 3,000 troops would be sent to Liberia to establish a command center to oversee the construction of 17 health care facilities of 100 beds each to isolate and treat victims. The U.S. mission would also be tasked with training 500 health care workers per week. [VOA]

By October 22nd the Administration had launched the deployment of 170 medical professionals from multiple agencies and departments, some of whom were part of the USAID’s Disaster Assistance Response Team to the core of the epidemic area in west Africa; had scaled up the deployment of DoD teams including members from the U.S. Naval Medical Research Center to operate three mobile laboratories providing 24 hour turnaround results on samples.  The Administration had obligated $300 million for fighting the outbreak in west Africa, including funds for the construction of one hospital completed and staffed by U.S. Public Health Service officers.  The efforts also included initiating 65 “safe burial teams” to help Liberians facing the epidemic.  [WH]

The conservative response to these measures was quick and predictable.  One opinion given much air time was that the mission to Liberia wasn’t a legitimate military operation in the commonly held sense of the term, and therefore beyond the scope of “fighting and winning wars.” Another complaint was that the Commander in Chief was sending soldiers, “valuable highly trained war-fighters” just to support health care workers. And, then there was the “why are we sending troops over there when we should be doing something here,” complaint – missing the point that this was precisely the argument for sending more troops to the Middle East in 2003. [MMA]

Meanwhile on the Home Front

Speaking of the domestic front – In March 2014, the Republicans in the U.S. Senate balked at the nomination of Dr. Vivek H. Murthy to be the Surgeon General because the doctor had run afoul of Chris Cox, the head lobbyist for the National Rifle Association.  Dr. Murthy’s experience in hospital emergency rooms caused him to believe that assault weapons do serious damage to human bodies, and that limiting ammunition sales might reduce the number of such fatalities and serious injuries. [NYT]  Right wing pundits called for the “immediate withdrawal of the nomination” in October 2014, so an “experienced professional” could be considered. [PJM]  The ever-media-seeking Senator Ted Cruz (R-TX) dismissed Murthy’s nomination saying, “And we don’t have one because President Obama, instead of nominating a health professional, he nominated someone who is an anti-gun activist,” which got an immediate smack down from Politifact.

While the obstructionists in the Senate blocked the nomination, the CDC was adjusting its guideline and issued revised, or “interim,” guidance for hospitals dealing with Ebola infections on August 8, 2014.  The August interim guidance sounds predictive in the case of the Texas hospital which later experienced infections:

“It emphasized that anyone collecting or handling such specimens are to follow standards compliant with the Occupational Safety and Health Administration bloodborne pathogens standards, including wearing appropriate personal protective equipment (PPE) and implementing other safeguards.

For specimen collection and laboratory testing, PPE recommendations include full face shield or goggles, masks to cover all of the nose and mouth, gloves and fluid-resistant or impermeable gowns. For laboratory testing, the recommendations also include use of a certified class II biosafety cabinet or plexiglass splash guard.”

Politics and Protocols

The CDC tightened the guidelines further, issuing revised guidance to health care workers and hospitals on October 20, 2014.  It also provided more stringent guidance for travel and airline operations, and prospective patient monitoring.

Back in the Senate, Arizona Senator John McCain issued a call for an “Ebola Czar” to coordinate the response to the cases on U.S. soil on October 12-13th. [Hill]  This would be the self-same Senator who decried the Administration’s appointment of “more czars than the Romanoffs.” [HuffPo]  The nomination of Surgeon General Murthy was still the subject of a Republican filibuster.  No sooner than President Obama had appointed an experienced administrator, Ron Klain, an individual with a solid reputation for dealing with complex bureaucratic issues, [CNN] than the GOP lambasted the appointment as “tone deaf and insensitive,” whatever that might mean; and, Senator Cruz criticized the appointment of anyone. [CNN]  The nomination of the Surgeon General nominee remains in Senate limbo.

All this partisan bickering was highlighted by the October 23rd performance of Rep. Jason Chaffetz (R-UT) who announced that the Surgeon General needs to be in charge of the efforts to prevent the spread of the Ebola virus, evidently unaware that his GOP colleagues in the Senate were filibustering the nomination of Dr. Murthy. [HuffPo]

While the Republicans squabbled over who should be appointed to what if anyone should be appointed to anything – the Administration continued to ramp up the coordination of public health efforts.

In addition to increasing the stringency of screening measures and travel restrictions,  activating post arrival monitoring, tightening CDC health care protocols, the Administration approved the creation of a Dedicated Response Team to be assigned to any hospital that receives a confirmed case of Ebola, a “Lessons Learned” training and outreach program based on what occurred in Texas, a Northern Command 30 person short notice assistance team to provide service to civilian medical professionals, and the offering of FEMA coordination for federal assistance to meet “needs on the ground.” [WHFS]

Now, imagine what might have been different if the Reagan Administration had adopted the same robust response to those first 159 cases of AIDS in 1981? Little wonder the conservatives are cranky.

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Thank You For Your Service, Maybe?

PTSD There’s a difference between Militarism and Supporting Our Military.  There is also a difference between being militaristic and being supportive of our nation’s service members and veterans.  A militarist tends to regard military efficiency as the best ideal of the state, and to subordinate all other interests to those of the military services. [DictRef]  Now that the terms are defined, why do conservatives have such a difficult time comprehending the problems created when they call for a “strong” Department of Defense, and a “strong” nation, or a “strong” foreign policy, and almost simultaneously disparage the members of the military and veterans when those people express their needs?

The latest manifestation of this issue comes from radio talker Michael Savage, who offered his opinion on Armed Forces members and veterans who are suffering with PTSD:

“If the whole nation is told, ‘boo-hoo-hoo, come and get a medication, come and get treatment, talk about mental illness,’ you know what you wind up with? You wind up with Obama in the White House and lawyers in every phase of the government, that’s what you wind up with. It’s a weak, sick nation. A weak, sick, broken nation.” [...] “You need men like me to save the country,” he said. “You need men to stand up and say stop crying like a baby over everything.” He continued that “men are so weak and so narcissistic” that it is “no wonder ISIS can defeat our military.” [Savage/RRW]

It Helps To Know What You’re Talking About

Mr. Savage must know what he’s doing; he must know that there’s an audience for this kind of nonsense.   First, it is obvious Mr. Savage has absolutely no personal military experience.  Had he any experience he’d know the truth of the old adage: A war leaves no one unwounded.  He was about 26 at the height of the war in Vietnam, but didn’t serve.  Nonetheless, he’s certain the nation needs “men like me to save the country.”

Shut Up and Shoot Yourself?

Secondly, the fossilized notions about mental illness embedded in Savage’s rant are appalling.  If a person seeks treatment for mental health issues, then he is “weak, sick, and broken?”  Savage/Weiner couldn’t have crafted a more blatant recipe for further weakening injured individuals.  Again, even a cursory familiarity with the U.S. military would demonstrate the Department of Defense takes PTSD very seriously, in fact there’s been the establishment of the Defense Centers of Excellence – for Psychological Health and Traumatic Brain Injury.  

In August 2013, the DoD, the Veterans Administration, and other agencies created a joint research program to study PTSD and Traumatic Brain Injuries. [Defense.Gov]  One element of the study will be a collaboration to study the factors influencing the chronic effects of mild TBI in order to improve diagnostic and treatment options, keying on a better understanding of the relationship between TBI and neurodegenerative disease.   No “boo hoo hoo” here, simply a directive from the Department of Defense and the White House that we take a serious scientific look at nature and treatment which ought to be available to any of the 2.5 million U.S. service members who have been deployed to Iraq and Afghanistan since September 2001 and need mental health treatment.

The conception that “real men (and women) don’t cry” or that “real men (and women) don’t want to be stigmatized as having a mental health issue is dangerous in and of itself.  During a presentation for the American Psychiatric Association in 2012 it was noted that fewer than half the soldiers who reported combat related PTSD received the necessary care, and of those who participate in a treatment program between 20% and 50% will stop before the treatment is complete.  When 93% of Army infantrymen have come under fire from rockets, artillery, or mortars, and when 91% report having been ambushed or attacked, and 87% report they know someone who has been seriously injured or killed, then it’s obvious some form of scientifically based treatment programs will need to be in place to assist those who develop PTSD. [Stripes]

There’s no “boo-hoo-hoo” factor when a mental health issue, such as PTSD,  produces intrusive memories, flashbacks, nightmares, avoidance symptoms, negative feelings about self and others, inability to experience positive emotions, feeling of emotional numbness, feelings of hopelessness, memory problems, difficulty in maintaining close relationships, anger and irritability, overwhelming guilt or shame, self destructive behaviors, problems with concentration, problems with insomnia, difficulties created by being easily startled or frightened.  [MayoClinic]

This is serious stuff.  While the rates for civilian suicides remained steady at 19:100,ooo over the period of a recent study for the National Institute of Mental Health, the Army suicide rate – historically lower than the civilian rate – surpassed it in 2008 and kept climbing, until it finally dropped a bit in 2012-13.  [USAT]  What is Savage/Weiner advocating? Is his message so divorced from reality that it’s little more than “Just Shut Up and Shoot Yourself?”

An Alternative Universe of Memory

Mr. Savage/Weiner evidently defines ‘manhood’ in antediluvian terms.  Men back in the good old days were Real Men, and women knew how to act like ladies?  This TV scripted perspective never existed in any real form. Mr. Savage/Weiner seems stuck in a wonderland of Leave it to Beaver, and Ozzie and Harriet.  His definition of masculinity sounds more like an interpretation of a John Wayne movie script.  It certainly isn’t Bogart sending Bergman off in Casablanca, or Sidney Poitier in Raisin in the Sun. It most certainly isn’t ultimate slacker Hoffman in The Graduate. [NPR]  Nor is it to be found in Gregory Peck’s performance in To Kill a Mockingbird.  And, merciful heavens, it must not be anywhere near the comedic rendition from Tony Curtis and Jack Lemmon in Some Like It Hot.  The hard sad truth is that Mr. Savage/Weiner’s interpretation never even existed in Hollywood outside the genre of stock war movies and derivative westerns.

If Mr. Savage/Weiner is reaching about 3 million Americans with his entertainments,  about 1% of the population, then why waste pixels and print?  Because, his views energize some of the least attractive and least socially useful elements in our national repertoire of ideas.  Surely, nothing is less useful than militaristically bantering about the glories and barbarities of war, while disparaging those who come home from it  to the nightmare of PTSD.

Talk Without Money

Perhaps this isn’t such a far fetched perspective when placed in proximity to the Republican budget proposals of the recent past.  Flags, color guards, pomp and circumstance are all part of the 4th of July atmosphere attached to political performances.  However, when it comes down to the money, the appropriations for Veterans’ services life gets stickier. 

The lack of specificity in budgets crafted by Representative Paul Ryan make it very difficult to predict what the impact of his budget slashing might be, especially in the short term.  Rep. Ryan once referred to budget cuts in cost of living formulas for retired service-members as a “modest adjustment to a particularly generous program.” [WaPo]  Other modest adjustments were considered:

“The House Budget Committee, chaired by Rep. Paul Ryan (R-Wis.), has told a veterans’ group it is studying a plan to save $6 billion annually in VA health care costs by cancelling enrollment of any veteran who doesn’t have a service-related medical condition and is not poor.

Committee Republicans, searching for ways to curb federal deficits and rein in galloping VA costs, are targeting 1.3 million veterans who claim priority group 7 or 8 status and have access to VA care.” [vmusa]

In other words, “No matter what we told you about taking care of you if you volunteered to take care of our country, if we can cut back on government spending at your expense we’ll do it.”  A veteran with a priority group 7 or 8 status is on his or her own – no matter how many paeans were offered and “thank you’s for your service” rendered.

Since when did we decide, as a nation, that a veteran is not really a veteran if he or she is in the “wrong category” and is thereby less worthy of a nation’s gratitude?

How much difference is there between the hate-radio talker who disparages the mental illnesses exacerbated or triggered by combat experience and the impact of that experience on a returning veteran, and the casual elimination of veterans’ benefits from selected categories merely to satisfy the “drown the government in a bathtub” crowd?

There is a point at which it must be acknowledged that militarism creates veterans, and promises to those veterans should be kept.

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Filed under Afghanistan, conservatism, Defense Department, Foreign Policy, Health Care, Iraq

Here Comes The Dark Money

Dark Money Here comes the money – into the Nevada District 4 Congressional race:

“Crossroads GPS, a conservative group, said Tuesday it has bought $820,000 worth of TV time for ads to start airing today and run through Election Day on Nov. 4. A source familiar with the ad buy said it is aimed at Horsford, who represents the 4th Congressional District.

Paul Lindsay, communications director for Crossroads GPS, confirmed the group’s eleventh-hour spending plans for the campaign, which could be a game-changer, but offered no details.

“We have placed a buy in the Las Vegas media market and have an important message to communicate,” Lindsay said.” [LVRJ]

And what might the “important message” be? It’s that Representative Horsford is in the same political party as the President of the United States.  Horsford, the ads explain, supports the Affordable Care Act.  Yes, that’s the law which restrains some of the more egregious practices of health insurance corporations, requires that comprehensive insurance cover flu vaccinations, and autism screening, and makes shopping for private health care plans more convenient.   Then there’s the almost an outright lie.

The Affordable Care Act cut Medicare.” This prevarication has been one of the pillars of Republican opposition to the Affordable Care Act.  Those “cuts” actually: (1) Close the do-nut hole in Medicare Part D prescription coverage until the ‘hole’ is eliminated in 2020; (2) Expands existing coverage for senior citizens; (3) Supports initiatives to support care coordination; (4) Does not reduce benefits from Medicare Advantage (the private option to Medicare); (5) Reduces payments to Medicare Advantage rewarding those providers who improve the quality of their coverage, bringing payouts in line with other areas of Medicare; (6) Helps protect the Medicare trust fund.  [OFacts]

The “cuts” were made to over-payments to Medicare Advantage providers which were higher than payments made to Medicare providers – in essence supplying the private Medicare option with a public corporate subsidy. “Your” Medicare (Advantage) benefits weren’t cut!  What was cut were unjustifiable taxpayer subsidies to private health insurance corporations.   And, maybe we should be reminded that those same “cuts” about which Rove’s Dark Money ads are caterwauling, are the same “cuts” which appear in  Representative Paul Ryan’s budget plans?

Someone doesn’t like “cuts” made to the public funds available to private health care insurance corporations.  Who might that be? We’ll not know because Crossroads is a Dark Money 501 (c) 4 which doesn’t have to reveal the names of its donors. [IBT]  There’s nothing grass-roots about Rove’s organization which takes advantage of the decision in Citizens United to cover the tracks of mega-donors.

“The large donations may renew questions from Sunlight and others about whether Crossroads GPS should be able to file as a nonprofit “social welfare” group under the tax code, allowing it to avoid disclosing donor names. According to IRS regulations, the group’s “primary purpose” cannot be influencing elections, but the group can spend up to half of its money on political campaigning.” [WaPo] (emphasis added)

This goes toward explaining why the GOP was so anxious to attack the IRS for “politicizing” 501 (c) organization decisions?  There are legitimate questions about the “social welfare” activities of organizations like Crossroads GPS, and someone didn’t want those questions answered.

Republicans may see an opening in Nevada District 4 and are willing to unleash the Dark Side Money into the breach. We can hope that the constituent services, and the person campaign style of incumbent Representative Stephen Horsford can overcome the money accreting to the Tea Party Radical campaign of challenger Cresent “Segregation” Hardy.  [NVProg]

Early voting has started, and the GOP base is out in force – as usual – Every. Vote. Counts. GOTV.

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Filed under Nevada politics, Rove

Fear mongering is hazardous to our health

Halloween Mask Finally, a headline making some sense: “Washoe health official: Worry about the flu not Ebola.”

“(Washoe County Health Officer) Dick said the “media barrage and sensationalism has frightened people,” emphasizing that medical responders are the ones who need to be trained and prepared.

“We are straining resources across my agency and the hospitals are ramping up and getting prepared for the training and drilling,” Dick said. “The community can help by getting a flu shot and not showing up at the emergency rooms with flu-like symptoms.”

That’s right – FLU – good old fashioned influenza.  And, no, we don’t have exact figures on the numbers of people in the United States who succumb to influenza each year because (1) the states aren’t required to report such cases in individuals over the age of 18; (2) the disease isn’t noted on death certificates very often; and (3) death may result from associated illnesses such as bacterial pneumonia well after the flu infection. [CDC] The CDC can offer some context, and report from 2012 studies that there are about 1,532 deaths from influenza a year, and that about 45.2% of youngsters 6 months to 17 years old have gotten a flu shot, while only about 26.3% of adults 18-49 have done so.  Adults 50-64 have a better rate, at 42.7%, and those over 65 have a 66.5% vaccination rate.  [CDC]

If these figures say anything, it’s that we’re less likely to get flu from those little Germ Bags who crawl on carpeting or share the contents of soda pop cans with alarming alacrity than we are from the “adults” in the room – except for Granny, who’s on Medicare and gets her flu shot without a hassle.

And here’s the part where the Affordable Care Act comes into play.

If a family enrolled in a new health care insurance plan on or after September 23, 2010 the plan will be required to cover recommended vaccinations without charging a deductible, copayment, or coinsurance.  This means FLU shots.  [HHS]

The CDC provides a schedule of vaccinations adults should receive, which is available in almost any format from PDF to an app for your Smartphone.  Because of the Affordable Care Act, influenza, tetanus, etc. vaccinations must be covered in comprehensive health insurance plans. Now, does anyone want to discuss “repealing the Affordable Care Act?”

And here’s the part wherein pure stupidity comes into play.

There were school closings and/or panics in Texas, Ohio, and Maine… because “Ebola.” [NYT] [Denver]  It seems a teacher from beautiful downtown Strong, Maine (Google that one) went to a conference in Dallas, Texas and has been asked to take a 21 day paid leave of absence. Let’s review. The immediate family of the man who died from the disease in Dallas has been cleared, having passed the time limit without infection – so a teacher who attended a conference across town is on leave?

There are continuous calls for a travel ban with west Africa. Which goes nowhere toward explaining why a musical group from Kenya (EAST Africa!) had a U.S. performance cancelled. Actually, the travel ban blather says more about the intrinsic American problem locating anything or anyone on a map than about a sentient reaction to a world health problem.

We’re going to stop flights from Freetown, Sierra Leone? What flights from Freetown?  The flights go through Casablanca (Morocco) and Brussels (Belgium) [VSL.org] Or, stop flights to and from Monrovia, Liberia?  Flights from Monrovia, Liberia to New York make stops in Casablanca, Montreal, Paris, and  Madrid [TripAdv]  A “flight ban” makes absolutely no sense – unless it’s being advocated that we stop flights from Brussels, Casablanca, Montreal, Paris, and Madrid.

What we could do instead of getting all panicky?

#1. Provide funding for the CDC and the National Institutes of Health to conduct research into the Ebola disease (and others) and increase funding for programs which improve local and state emergency preparedness, for both natural and man-made disasters.

#2. Stop worrying about who the “czar” is …and start worrying about when the Senate of the U.S. might confirm the next Surgeon General. 

#3. Provide funding for medical relief activities in countries such as Liberia, Guinea, and Sierra Leone, which will help curb the disease in place.

#4. Get a flu shot and don’t run to the ER with the sniffles.

#5. Vote for candidates who promise to do numbers 1-3.

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Filed under Health Care, health insurance