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Rant 575: Focusing Our Minds on Healthcare Reform

3/27/2020

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COVID-19 exposes the glaring vulnerabilities of our under-siege healthcare system, forcing us to consider what we need to do to overhaul it once the current crisis has passed.
 
We can quickly identify at least four major reforms that need to be implemented:
 
1. Every American must have access to affordable healthcare at all times. No exceptions. As Bernie Sanders says (and I am no Bernie supporter): “Healthcare is a human right.” This means, at a minimum, that we need to provide an affordable public option to supplement the private insurance model that has served employed people and their families reasonably well for years. It is unconscionable that, during this health crisis, the Trump administration continues to pursue its court case seeking to terminate the Affordable Care Act (Obamacare) and take away health coverage for 48 million Americans, removing their protection from pre-existing condition coverage denials and throwing their children off their insurance coverage long before the current age 26 mandate. The next Congress needs to enact “Medicare for all who want it” immediately upon convening.
 
2. The connection between employment and health insurance must be severed. The Health Insurance Portability and Accountability act of 1996 was supposed to accomplish this, but did not. Neither did Obamacare. The 158 million Americans who get their health coverage through their employer must be permitted to take their health coverage with them if they lose their jobs. They, and people who are not working, must be automatically enrolled in a public option plan while unemployed. No one should ever be without health coverage.
 
3. The Strategic National Stockpile (SNS) must always be fully funded and fully stocked. The Stockpile is the public health emergency equivalent of the National Defense Stockpile. Its purpose is simple and straightforward: rapid deployment (within 12 hours) to resupply overwhelmed local medical supplies during any public health threat. It has failed to achieve this, falling woefully short in the current pandemic. In 2009, the H1N1 influenza pandemic triggered the largest deployment in SNS history when 12.5 million antiviral regimens were deployed across the country as well as 19.6 million pieces of personal protective equipment (PPE) and 85.1 million N95 respirators. Since 2017, the Trump administration allowed the number of ventilators to plummet to only 16,600 (or 2½ per U.S. hospital)! The SNS must be stocked with more than enough PPE—masks, ventilators, scrubs, gloves, etc.—so that we are never caught short again when a pandemic strikes. And it is a certainty that, in an increasingly complex and intertwined world, there will be more pandemics.
 
Since assuming office, the Trump administration has undermined the SNS by: (1) moving responsibility for it—and what should be included in it—from the non-political Centers for Disease Control and Prevention (CDC) to a political appointee in the Department of Health & Human Services. This was a license to politicize what products the government purchases for the SNS. Pharmaceutical firms began to lobby heavily for their products in lieu of the prior approach where only CDC medical experts made purchasing decisions; and (2) attempting, year-after-year, to slash the SNS budget despite its already being underfunded. So far, Congress has managed to stave off these cuts, but at the cost of being unable to increase funding for SNS supplies deemed essential to combatting a pandemic.
 
4. International cooperation to combat public health emergencies is a must. “America First” in this context means “America Worst.” The U.S. should take the lead in crafting an international treaty committing the nations of the world to work together to plan ahead, to combat future pandemics and to coordinate supply chains of essential materials so that they can be produced and shipped wherever needed. In the absence of such an agreement today, a German startup is currently trying to coordinate the production of PPE around the world by 3-D printing firms that have volunteered to aid in the battle against COVID-19. Viruses do not give a damn about borders. Neither should politicians.
 
Dick Hermann
March 27, 2020

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Rant 574: Life in a Time of Minnows

3/20/2020

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America and the world are faced with the gravest crisis since World War II, but there is a dearth of national leaders essential to cope with it. The contrast of our present principals with Winston Churchill and Charles De Gaulle in May 1940, Franklin D. Roosevelt in December 1941 and Dwight D. Eisenhower in June 1944 could not be more striking. Instead of colossi like Churchill and Roosevelt at opposite sides of the pond, we are encumbered by clowns.
 
The giants who strode the planet back then and literally saved civilization are nowhere to be found today. Rather, we are saddled with minnows and plankton, calling into question whether we can emerge from this pandemic without enormous lasting damage to our health and economic welfare. At the moment, the jury is out. Thank God that, at least at the state level, there are some responsible governors (e.g., Inslee, Cuomo, DeWine, Hogan, Beshear) whose limited powers are being wisely exercised in the absence of federal competence. Regrettably, that is not the case with all states. Florida’s Ron DeSantis, who proudly labels himself a “mini-Trump,” is doing more to spread COVID-19 infections than anyone other than Trump and his bumbling crew by permitting thousands of spring breakers to congregate on the beaches. Kevin Stitt, Oklahoma’s sorry excuse for a governor and the Devin Nunes of the gubernatorial set, texts images of himself and his family going out to eat.
 
This is not exclusively an American problem. While Donald Trump frittered away two full months before taking the Coronavirus threat seriously, he is hardly the only national leader to fall down on the job of leading and managing. China’s Xi Jinping did something similar when the first cases of COVID-19 popped up, suppressing information and denying any trouble for several months while locking up healthcare professionals who tried to warn the public. The UK’s Boris Johnson has put his country in deep trouble by not even going as far as his trans-Atlantic counterpart, advocating “herd immunity,” the opposite of social distancing. Germany’s Angela Merkel disappeared from public view for weeks at the very time her country needed to hear from her daily about how to proceed and survive this plague. And then there’s Italy, with a history of dysfunctional government going back at least 75 years, and now suffering the consequences of its inability to get its governing act together.
 
What all of these so-called leaders have accomplished by their inattention to the crisis or disdain for facts is recklessly upping both the infection and death rates while putting millions of their countrymen at needless risk, tragic outcomes that could and should have been avoided had even a modicum of competency been present.
 
Meanwhile, in stark contrast to the U.S., UK and Germany, nations like Singapore, South Korea and Taiwan knew immediately what had to be done and did it. Strikingly, both the United States and South Korea recognized their first COVID-19 infections on the same day. Since then, South Korea has tested hundreds of thousands of its citizens and, based on the results, was able to identify victims and hot spots and institute treatment and quarantining in order to successfully protect the rest of the population. Lives were saved. The United States took a different approach led by a President who downplayed the danger, denied that there was a looming crisis, spouted foolish bromides, resorted to his customary lies and hyperbole, and failed completely to step up to the plate and tackle the problem before it escalated out of control. When it comes time to tote up accountability, we should remember that people died because of this criminal negligence. People like Trump, Johnson and sadly, the heretofore highly capable Merkel, must never be allowed to assume positions of power again.
 
Even if we can no longer expect giants to rise to the occasion when their nations call, we have a right to expect minimal capability from those who aspire to lead us. We are not getting that. The bar is low and getting lower and it is now unclear if we will be able to crawl out from the morass in which these minnows have buried us.
 
Dick Hermann
March 20, 2020

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Rant 573: How Can We Continue to Tolerate This?

3/13/2020

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We can’t. There is a possible way to end this Trump travesty sooner than November. More on that at the end of this piece.
 
My local hospital, one of the largest healthcare institutions in the Washington, DC metropolitan area (400 beds), told me on March 11 that they do not have any Coronavirus test kits despite desperate pleas for them to the U.S. government. Nearby Johns Hopkins Medical Center, one of the world’s premier hospitals, also could not get any test kits, so it went ahead and developed its own alternative kits.
 
This Federal ineptitude is unacceptable. Especially because, had the Trump administration had its act together months ago when it was apparent a pandemic might be looming, we would be in a much better position now to manage this scourge. Led by Donald Trump, it was asleep at the switch. His gutting of the offices put in place by his predecessors for precisely this purpose—to protect us from pandemics—along with his delusional denial that there was even a problem—“We only have 15 cases and soon we will have zero”—make this debacle worse than the Hurricane Katrina response times a factor of ten.
 
Had the government operated competently like it did when SARS, MERS, H1N1 and Ebola threatened and been prepared to test widely before the horse left the barn, we would have been able to identify and isolate individuals who tested positive for Coronavirus, thus offering a high degree of protection to everyone else. That’s what Americans have a right to expect. And what presidents have a Constitutional duty to provide.
 
Instead, our President visited the Centers of Disease Control (CDC) and likened his “perfect” response to his “perfect” phone call where he shook down the President of Ukraine in an attempt to dig up dirt on a political opponent. Moreover, he passed himself off as a medical expert (sure!) and he came to CDC crudely sporting one of his campaign hats (probably not a Hatch Act violation, but appalling just the same).
 
He wastes his time finger-pointing at Democrats, China, Europe and anyone not named Donald Trump instead of manning up and accepting blame for his monumental screw-ups. And the capstone? His March 11 Oval Office speech replete with his customary lies, exaggerations and shocking omissions that also tanked the stock market and made Americans nervous:
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  • He blamed the crisis on a “foreign virus.” Who knew viruses had a nationality?
  • He announced a Europe travel ban that might have been effective two months ago, but no longer. The virus is here and skyrocketing. Interestingly, Great Britain and Ireland, home of Trump’s golf courses, are exempt from the ban. Hmm.
  • He said no trade or cargo would be allowed in from Europe for 30 days, a stunning bit of misinformation walked back by the Tweeter-in-Chief himself minutes after the speech.
  • He said insurance companies agreed to no co-pays for Coronavirus treatments—also walked back by the White House.
  • He claimed that testing was widely available, a blatant lie he continues to spout. He doesn’t want testing because it will drive the infection numbers way up and his poll numbers way down.
 
This was bar none the worst Oval Office speech to the nation in our history. That’s what we can expect from the worst president who has no idea what to do.
 
Trump’s lies and pie-in-the-sky flim-flammery will do nothing to (1) slow down the spread of the virus, (2) keep victims alive, (3) put a viable vaccine in place quickly, or (4) turn around an economy in free-fall. This is intolerable.
 
While governors and mayors are stepping into the Trump void and doing what they can in their jurisdictions to compensate for his abject failure and inability to respond rationally to this crisis, their powers are limited. Kudos to Governors Jay Inslee of Washington State, Andrew Cuomo of New York and Andy Beshear of Kentucky for stepping up to the plate and taking intelligent, aggressive action while Trump golfs and tweets out Nero-fiddling memes (thus unwittingly but accurately depicting his callousness). The governors show the importance of having adults in the room.
 
To paraphrase Samuel F.B. Morse’s first-ever telegraph communication: ”What hath God [and the Trump base] wrought?”
 
There is something we can do other than wait more than ten months to put someone in office who knows how to manage and lead. That’s much too long a time to have to put up with someone whose every utterance and act puts us more in harm’s way.
 
The Constitution mandates an election every four years. But the timing of the election is a matter of statute law. Congress posited a November election because it allowed time to get through the harvest. That is no longer an issue. I urge Congress to move up the election so that we can get this fiasco behind us before the Trump Apocalypse does even more damage.
 
If and when Trump’s base finally realizes how badly he is hurting them, even congressional Republicans might abandon him and finally act in the national interest.
 
Dick Hermann
March 13, 2020

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Rant 572: The Trump Infection Goes Viral

3/6/2020

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The Trump administration’s botch of its first crisis not of Trump’s own making is both predictable, appalling and terrifying. And it has been three years in the making. Ever since Trump came to office, he has been determined to eviscerate the very agencies and programs that are in place to protect us from potentially deadly scourges like the Coronavirus (COVID-19). Each Trump budget has called for draconian cuts in these programs and now, Americans are suffering the consequences of this short-sighted policy.
 
Specifically, Trump has slashed the relevant government agencies tasked with protecting us against pandemics:

  • He eliminated the National Security Council’s Global Health unit, which coordinated U.S. responses to pandemics.
  • He decimated the U.S. Agency for International Development’s Emerging Threats Division.
  • He defunded 80 percent of the Centers for Disease Control and Prevention’s (CDC) efforts to prevent global disease outbreaks. Now, instead of working in 49 countries, it only has enough money to monitor 10.
  • His budget proposal for the next fiscal year calls for another 16 percent cut in CDC’s budget and a 10 percent cut in the budget of the Department of Health and Human Services (HHS). The CDC’s Public Health Preparedness and Response Program, responsible for the agency’s laboratories and public health surveillance and epidemiology would be cut by $25 million, and HHS’s Hospital Preparedness Program is in line for an $18 million cut.
  • Trump is also proposing a $3 billion cut to global health programs, including a 53 percent cut to the World Health Organization and a 75 percent cut to the Pan American Health Organization.
 
Couple Trump’s blowing up of these first-line pandemic defenses with his “management” of the coronavirus crisis and it is not a pretty picture. He--
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  • tells Americans to go to work even if they’re sick (Sean Hannity Interview, March 4, 2020);
  • fails to assure enough test kits despite knowing two months ago they would be needed;
  • calls coronavirus a Democratic hoax;
  • puts Mike Pence, the ex-governor who (1) took a meat axe to his state’s public health programs, (2) said “smoking doesn’t kill,” and (3) failed miserably in dealing with an HIV outbreak, in charge of managing the federal response;
  • tries to muzzle the scientists who are the sources of all accurate information about the virus and how to protect against it;
  • lies about when a vaccine might be developed;
  • claims the coronavirus death rate is much lower than the 3.4 percent World Health Organization figure (34 times higher than the death rate from flu);
  • believes that the flu vaccine can be used to combat coronavirus;
  • goes to court to destroy Obamacare, which would increase the coronavirus danger many times because people without health insurance don’t see doctors; and
  • flails around with no clue as to how to manage or how to lead.
 
What a mess.
 
Despite ample warning that the disease was inevitably going to affect the United States, Trump ignored the experts and, as always, went with his ever-expanding “gut,” which he has often claimed provides him far better advice than any of the professionals whose expertise he disparages. His gut told him we didn’t need to test Americans for coronavirus and isolate those who had contracted the disease. Until recently, only 500 Americans had been tested compared to millions of Chinese and tens of thousands of Brits, Italians and South Koreans.
 
The Trump Administration’s unpreparedness has also prompted it to steal $139 million from programs that help the poor to apply to fighting the virus:

  • $37 million from the Low Income Home Energy Assistance Program that pays for heating and cooling assistance for the poor;
  • $4.9 million from Substance Abuse and Mental Health Services;
  • $4.2 million from Aging & Disability Services; and
  • zero from his bonehead border wall.
 
So the poor—the most vulnerable to disease—are being hung out to deal with a threat to their lives with no resources to fight back.
 
Meanwhile, Pence had to be pressured into adding the Surgeon General and the Food and Drug Administrator to his coronavirus task force, two positions key to combatting a pandemic.
 
We are in a very bad fix thanks to Trump’s perverted view of government, his obsession with the non-existent deep state and his pathological concern only for himself. The virus is spreading rapidly at the worst possible time—while the government is directed by a bungling incompetent and malicious paranoid who is in denial after dismantling the very institutions established to keep us safe. His daily chaos, confusion and resort to lies, crazy claims and insults will only exacerbate the crisis and cause needless suffering.
 
Bottom line: We should listen carefully to what our health experts tell us and ignore what our political leaders say about the coronavirus.
 
Dick Hermann
March 6, 2020

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    Author

    Richard Hermann is the author of thirteen books, including Encounters: Ten Appointments with History and, most recently, Mother's Century: A Survivor, Her People and Her Times. Soon to be released is his upcoming Close Encounters with the Cold War, a personal reflection on growing up in the nuclear age. He is a former law professor and entrepreneur, and the founder and president of Federal Reports, Inc., a legal information and consulting firm that was sold in 2007. He has degrees from Yale University, the New School University, Cornell Law School and the U.S. Army Judge Advocate General’s School. He lives with his wife, Anne, and extraordinary dog, Barkley, in Arlington, Virginia and Canandaigua, New York.

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