The Widdershins

Posts Tagged ‘Health Care

 

Indeed, a bold move, let’s see if it pays off for them. So bold, the logic is nonexistent or exists in a parallel bizarro universe. Originally, I was going to post about a political science study, but it is too egg-headed and stuffy for a day like today.

Today we get to watch a bunch of Congressional one-eyed lemmings follow one another off the cliff because they’ve been told they can learn to fly on the way down.

 

These lemmings were tricked into trying to “midair Kitty Hawk” by King Don Dumb, the author of Schart of the Zeal.  That’s a book about living a goony-eyed life of believing your own sh!t so much you get all excited and poop yourself, but not before toot farting, thereby signaling your unbridled zeal.

Here’s the upside for King Don Dumb if it passes – 24 million lose their health insurance, premiums go up, deductibles go up, coverage goes down, but the really rich get millions in tax cuts.

Wreck-It-Ralph has let himself go…

Overnight, there was another ransom note from the freaky Freedom Caucus.  Not only does it cut essential benefits like maternity care, newborn care, pediatric care, mental health, drug treatment, rehabilitation, prescription drug coverage, preventative care, wellness care, chronic disease, laboratory services, hospitalization, and outpatient services, there’s more – even though that list looks like pretty much everything insurance is supposed to do.

To the things listed as essential services, add about eight other technical things that must have been written down during especially unctuous nocturnal emissions of insurance lobbyists.  They include eliminating the “single risk pool” allowing insurers to cull the cheap healthy from the expensive sick, reinstating lifetime and annual coverage limits, eliminating the requirement for no-cost preventative care like mammograms, and undoing the Medical Loss Ratio standards, which is a fancy term for forcing large insurers to pay out at least 85% of premiums on claims and rebating the rest.

And here’s what I can’t believe hasn’t been covered: This travesty – this atrocity increases the deficit. It’s only slightly cheaper than the ACA, but it still increases the deficit because of the tax cuts. These heartless, amoral, hell-bound morons are borrowing money to heap suffering on 24 million people. It’s like an arsonist taking a mortgage on a house before torching it.

For seven years we’ve heard that selling insurance across state lines is the magical elixir to reduce premiums. That tired story is just another hornless unicorn, but it is what “wonkinator” Paul Ryan has sworn will work. States already allow interstate insurance sales, but insurance companies don’t do it because it doesn’t make economic sense. As health care expert Austin Frakt, told the Los Angeles Times, “I never understood the appeal of this idea. It only makes sense if you don’t know what you’re talking about.”

Here in one chart is all you need to know. The chart depicts the percentage of income paid for premiums of a 60-year old making $20,000.00 a year. Under the ACA, she pays about 5% of her income no matter where she lives. Under this “Death Care” (© Fredster), in some parts of the country the same 60-year old pays 100% of her income for coverage. No one is going to do that. No one can do that.

 

The Council of Scary Lady Parts meets to cut mammograms, pregnancy, and pediatric care…

No idea how this will turn out in the morning, but I’m sure of these things: The legislative language is still being worked out, there is no CBO score so no one knows how much these changes will cost, and oh yeah, this Death Care is polling at 17%.

One other thing, even if it does pass, it is DOA in the Senate. King Don Dumb has tooted and schart his pants declaring, “Take it or leave it, I’m done with health care.” At about 11:00 p.m., he blamed the anime-eyed granny-starver for this fiasco. As if that is a surprise.

The bold strategy is whether or not they can hide the fact this “wealth care” is only about the rich and Republican swamp dwellers. Hell of a thing. If someone had only warned us.

The first procedural vote is scheduled for 8:00 a.m. EDT this morning.

What’s on your mind today?

 

 

When I’m cooking, I’ve learned if you have the luxury of time, low and slow is the way to go. Earlier in my scotch-addled life, my friends told me of limbo contests where I physically went low and slow. And speaking of my scotch-addled life, low and slow pretty much described my dating habits.

Low and slow is neither the way to run the government nor is it the way to run the economy. It is inconceivable to imagine a budget lower in basic human services than what we saw this week.

Yesterday in watching Dick Prick Mick Mulvaney, the dust ruffle of crazy town, claim that cutting Meals on Wheels is the compassionate thing to do, I’m pretty much convinced we can’t go much lower. As we say around here, we are “next to the belly of a snake in a wagon rut.”

Obviously, Dolt 45 is as dumb as a box of hair mated with some orange zest and Adderall. He could care less what these crazy ideologues do as long as he can continue belching his lies in front of half-empty venues.

So why should he care? He’s got Mulvaney and anime-eyed granny-starver Paul Ryan to shovel the steaming dump Jim DeMint and the Heritage Foundation just took on the country. This budget, which will never pass, is nothing but the greatest hits from 1980s Heritage Foundation. Not even Reagan dared going this low.

When someone has no shame, there just is no limit to the depths they will sink. Given this first fifty days, it won’t be long before we are plumbing the depths of the Mariana Trench.

When it comes to slow things, the economy is troubling. About a year ago, I started paying attention to certain economic indicators believing Hillary was about to inherit a lethargic economy. There are disturbing indicators.

Here is a truism:  Economic expansions never die from old age. The current expansion is seven and half-years old. That is long in the tooth.

Gallup surveys economic confidence and says it is at a historic high. The stock market is at a record high. The economy is still adding jobs. So why am I spending your time on the subject?

We are in a bubble. The confidence and stock market are anticipatory highs. It is not based in value. The highs are based upon a belief in massive Trumpanzee promised corporate tax cuts and the repatriation of $2.1 Trillion in offshore profits. Neither will be invested in expansion, but will be paid out in dividends or in stock buybacks. It will make the 1% even more one-percentier.

Unrelated to this economic giddiness, there are indicators screaming we are heading into another slowdown if not outright recession. Not to bore you, but just a few indicators:

  • Employers are cutting back hours. We are seeing the highest percentage in the decline of hours since the 2008 recession.
  • Tax receipts are down.
  • Retailers are missing their earnings projections.
  • Lending standards have tightened.
  • Job growth at the S&P companies has gone negative.

All of these are warning signs of a slowing economy or impending recession. Any external event could hasten an economic retreat. Perhaps even monkeying around with one-sixth of the economy with an ill-conceived health care plan or a federal budget that would decimate hundreds of thousands of employees could precipitate it. Who knows?

I do know this:  There are very few tricks left in the wheelhouse to combat recession. We will hear tax cuts from this bunch of Neanderthal MAGAbators, but as we have seen time and time again, sloganeering is not economic policy.

We are still paying for the last time we allowed this knuckle-dragging crowd to raid the Treasury with tax cuts, two wars, and unfunded benefit programs. Half of the national deficit is due to giving them the credit card and hoping for the best. Well, we know how that turned out.

Why do I think this is important enough to take your time this morning? From what I saw in the proposed budget, these people are unimaginative at best and stone-cold ignorant at worst. They are uncaring and vindictive. They are politically deaf. Power is a means to an end for them.

The choices represented in their budget were callous and heartless. If the worst happens, their response to an economic downturn will be likewise – callous, heartless, low, and slow. Human suffering will be but a minor inconvenience for a $2.1 Trillion payday. Daddy needs a new Gulfstream 650.

What’s on your mind today?

 

 

Noted scholar and transcendentalist Ralph Waldo Emerson said, “I hate quotations. Tell me what you know.” So to begin my self-allotted 800 words, what do I do? I quote a smart man explaining his utter disdain for quotes.

True story. I love quotes. Collect them I do. I’m always looking for smart words from those who have journeyed before. Their wisdom is manifest and unmistakable. I find comfort in that.

So this week while thinking about this post, I began looking for a quote about shame. There weren’t that many shame quotes and the few I found were all wrong. They talked about shame as a regulator of behavior – as something to be “ashamed of”. There weren’t any quotes about the lack of shame.

Given the lack of quotes about shamelessness, it might indicate we are regressing along the evolutionary continuum. I imagine shamelessness requires less higher reasoning and a greater reliance on the lower brain stem – which brings me to Supreme Commander Monkey Butt (hereinafter “His Redness” or sometimes “Dolt 45” or “His High Assholiness”).

When I’ve described Dolt 45’s personality traits, I’ve been quite reticent about his mental health. With a high degree of probability I can surmise his behavior patterns, but his mental condition I will leave to others.

This brings me to his shamelessness. The only shame he fears is being labeled a fraud which is his primary and paramount behavioral avoidance priority. For all other types of normal, human shame – he has none. The shame a normal human would suffer does not faze him.

Within the last forty-eight hours, he told Tea Party groups not to worry if the Trump/RyanCare plan failed because he would make sure the ACA failed so he could blame the Democrats. Or telling the same groups he was fine with accelerating the human suffering by speeding up the Medicaid cutbacks by two years if that’s what it takes to win. Sociopathic behavior for sure, but no evidence of shame.

My point is this: While His High Assholiness’ behavior is abhorrent, it is the new Republican Trumpism. He is near the perfect Republican or so says at least 89% of self-described Republicans. Again, my feeble mind is called to a quote from H.L. Mencken:

As democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart’s desire at last and the White House will be adorned by a downright moron.

The great and glorious day has arrived and the White House is now resplendently adorned by the consummate “downright moron” who happens to be unburdened by shame. He was the apple-eyed desire of the plain folks or at least 70,000 under-educated white men in three states. That desire still burns white-hot in nine out of ten Republican hearts.

The areas in green fare better under Trump/Ryan Care while the areas shaded in maroon fare better under the ACA.

These Trumpian sycophants know no shame. Just consider: Passing legislation affecting one-sixth of the economy without a hearing in the dead of night. Or ending life-sustaining medical care for maybe 15,000,000 people. Or ending opioid therapy or mental health treatment for millions. Or ending health clinics and outreach for the poorest and most under-served populations. Or doing all of this without an estimate of the costs.

All of this to give the wealthiest, most secure, and most powerful a massive tax cut. And on top of that giving insurance companies and medical device manufacturers a tax cut. And on top of that making sure the inadequate tax credits are as regressive as possible without regard to need or ability to pay. And on top of that, and this is where the shamelessness is extraordinary, financing the whole damn thing by draconian cuts to Medicaid – cuts to the poorest, weakest, and most vulnerable among us.

This bill isn’t a health care plan, it is a massive tax cut disguised as a political slogan to repeal the ACA. It is a WealthCare plan. It is a risible act of ignominy so outrageous it wouldn’t even make the SNL trashcan.

Not for a second do I believe this nasty pettiness wasn’t planned as a feature to make Grandpa Grumpy happy…

As discerning Widdershins, you are asking, “Why isn’t he mentioning the hypocrisy?” The answer is simple – without shame there is no hypocrisy. Talking to these people about hypocrisy is like talking to a cobra about venom or a skunk about stink. It is what makes them who they are.

The inimitable Mr. Emerson was a transcendentalist meaning he believed in the inherent goodness of individuals. I want to believe that too since there’s no shame in that – at least not yet.

I’m going to leave you with a musical interlude then I’ll list some links for interesting stories I couldn’t work into my self-indulgent rant/therapy. As always, take the safety off, comment at will, and thanks for listening.

 

Speaking of clowns, here’s one, and he’s a substitute for the Presidential Daily Briefing:

 

A wonderfully researched study of 1.25 million stories by the Columbia Journalism Review indicating Breitbart to be the right-wing media anchor hub of a distinct and insulated media system that appears to have set the agenda and overall tone for Hillary’s negative coverage.

An interactive demonstration that the “higher premium” lamentation by the shameless Republicans is, like so many things, made of whole cloth.

The lackadaisical use of military force is troubling and a bad omen of things to come. One week of bombing is equal to one year of missions under Obama.

Watch Paul Ryan’s Adam’s Apple when he’s asked about his “good, best friends” the rich.

One way the Trump Administration is a fine-tooled machine.

-Trump Chuckie

On March 4th, The Thing in the White House sent out a bunch of angry tweets blasting the previous President for wiretapping Isengard Trump Tower. “Terrible! Just found out that Obama had my “wires tapped” in Trump Tower just before the victory. Nothing found. This is McCarthyism!” Then 30 mins later: “How long has President Obama gone to tapp my phones during the very sacred election process? This is Nixon/Watergate. Bad (or sick) guy!” When asked to clarify this insanity, The Thing’s minions really could do nothing but heee and hawww. The Thing read it somewhere, they said. NY Times! Louise Mensch! BBC! Naturally once reporters dug deeper, they found that NO, none of those reports talked Trump Obamaabout wiretapping. Mensch broke the story on her right-wing blog HeatStreet on November 7th about the FISA warrant, but all she said was that a FISC court granted permission to “examine the activities of ‘U.S. persons’ in Donald Trump’s campaign with ties to Russia.” In question was a mysterious communication between two Russian banks and a server in Trump Tower. (David Corn of Mother Jones broke the story of the two banks and Trump Tower, but all media dismissed it as a bizarre conspiracy theory a couple of weeks earlier.) In the follow-up reports to Mensch’s story, BBC and the failing NY Times confirmed a FISA warrant, but nobody mentioned wiretaps… except Breitbart and then The Thing in its Tweets. Ahhhhh, the plot thickens. Where did Breitbart get the information about wiretaps at Trump Tower and did The Thing just leak top secret information in a series of Tweets? Sure seems that way. Will anybody hold him accountable? LOL.

There are fleeing moments when it feels like Lady Lindsey Graham and Hero John McCain might hold The Thing accountable for the numerous impeachable offenses it has committed. Earlier today Graham tweeted: “An attack on one political party should be considered an attack on all. We must push back on Russian election interference at home & abroad.” That sounds great! However it should also be noted that Graham had lunch with The Thing earlier in the day.

“Great lunch meeting with ‪@POTUS today. President Trump is strongly committed to rebuilding our military which is music to my ears. (1/3)

President Trump is in deal-making mode and I hope Congress is like-minded. (2/3)”

“How good was the meeting with ‪@POTUS?

I gave him my NEW cell phone number.”

Somebody responded: “1-800-DOOR-MAT?” And then “You, sir, are a profile in courage.”

And that, folks, is Lindsey Graham summarized in a handful of tweets. We have to get used to the notion that no, Graham and McCain won’t hold The Thing accountable for anything until they’ve gotten what they want from him: tax cuts for the rich, bigger military, gutting ACA, etc. etc. etc. Then maybe, possibly, once that’s all done, they’ll throw The Thing overboard.

Speaking of handing out cell numbers, can anybody afford a new cell phone after Republicans pass Trumpcare? Jason Chaffetz, the man who investigated Benghazi and Hillary Clinton’s e-mails to death, and who doesn’t think there is any reason to look into Trump’s connections to Russia, went on CNN to start selling Trumpcare to America.

Americans have choices. And they’ve got to make a choice. And so, maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on, maybe they should invest it in their own health care. They’ve got to make those decisions for themselves.

This is, of course, patently absurd. An iPhone unsubsidized by a phone company might cover one month’s premium for a single person. How many iPhones does Chaffetz think people buy? Of course, Chaffetz himself doesn’t have to buy his own phone. He gets one from work. His cell bill gets covered too. “How much does an iPhone cost” is the new “How much is a gallon of milk?” and Chaffetz doesn’t know  the cost of either.

Medicaire

Overall Trumpcare is going to gut poor people into oblivion. It gives tax breaks to the rich, provides insurance companies with tax deductions on CEO salaries, will raise costs of premium, reinstate caps, gut preexisting conditions. Millions of people will lose their insurance. Many of them were Trump voters. Sadly many of them were not. But they will suffer also.

Why do Republicans hate poor people? It’s a question that has been asked often and there are many answers. As it came up again in the current Trumpcare discussion, I was reminded of a scene in E.M. Forster’s great novel “Howards End.” In the 1910 novel ForsterForster explored 3 groups of people from 3 different classes: the extremely wealthy and conservative Wilcoxes, upper middle class but liberal Schlegels, and poor but aspiring for something bigger Basts. The Schlegel sisters, Margaret and Helen, try to help poor Leonard Bast, but their well-meaning interventions in his life, as well as not-well meaning interventions from the Wilcoxes, prove disastrous. He loses his job as a clerk in an insurance company after following bad advice from patriarch Henry Wilcox. When the impetuous Helen (played by Helena Bonham Carter in the magnificent film, with Emma Thompson as Margaret) tries to make her case for helping the poor to the condescending 1%-er Henry Wilcox (Anthony Hopkins in the film), the following exchange takes place. Written in 1910, “Howards End”is still relevant in 2017.

From Chapter 22

He [Henry Wilcox] raised his finger. “Now, a word of advice.”

“I require no more advice.” [said Helen]

“A word of advice. Don’t take up that sentimental attitude over the poor. See that she doesn’t, Margaret. The poor are poor, and one’s sorry for them, but there it is. As civilisation moves forward, the shoe is bound to pinch in places, and it’s absurd to pretend that any one is responsible personally. Neither you, nor I, nor my informant, nor the man who informed him, nor the directors of the Porphyrion, are to blame for this clerk’s loss of salary. It’s just the shoe pinching–no one can help it; and it might easily have been worse.”

Helen quivered with indignation.

“By all means subscribe to charities–subscribe to them largely– but don’t get carried away by absurd schemes of Social Reform. I see a good deal behind the scenes, and you can take it from me that there is no Social Question–except for a few journalists who try to get a living out of the phrase. There are just rich and poor, as there always have been and always will be. Point me out a time when men have been equal–”

“I didn’t say–”

“Point me out a time when desire for equality has made them happier. No, no. You can’t. There always have been rich and poor. I’m no fatalist. Heaven forbid! But our civilisation is moulded by great impersonal forces” (his voice grew complacent; it always did when he eliminated the personal), “and there always will be rich and poor. You can’t deny it” (and now it was a respectful voice)–“and you can’t deny that, in spite of all, the tendency of civilisation has on the whole been upward.”

“Owing to God, I suppose,” flashed Helen.

He stared at her.

“You grab the dollars. God does the rest.”

It was no good instructing the girl if she was going to talk about God in that neurotic modern way. Fraternal to the last, he left her for the quieter company of Mrs. Munt.

[…]

“Don’t ever discuss political economy with Henry,” advised her sister. “It’ll only end in a cry.”

“But he must be one of those men who have reconciled science with religion,” said Helen slowly. “I don’t like those men. They are scientific themselves, and talk of the survival of the fittest, and cut down the salaries of their clerks, and stunt the independence of all who may menace their comfort, but yet they believe that somehow good–it is always that sloppy ‘somehow’ will be the outcome, and that in some mystical way the Mr. Basts of the future will benefit because the Mr. Brits of today are in pain.”

Howards End

Also, in brief: Richard Steele, the British spy who wrote the infamous “pee pee” dossier, has resurfaced. While American Senators want to hear him testify about what he knows.

WikiLeaks is dumping top secret CIA documents.

And contrary to earlier denials that he’s never met the Russian Ambassador (a man nobody has ever met), a newly unearthed article in the Wall Street Journal from last April says that Trump met with the Russian Ambassador and greeted him warmly.

What’s on your mind Widdershins? This is an open thread.

Taxes

Russia Investigation

Country over Party

Six words, that’s it.  If we’re lucky, by 2018 we won’t even need a noun or a verb to finish the thoughts.

Come for the chaos, stay for conflagration.  This is the Dolt 45 fine-tuned machine.

Yesterday’s performance was a guided tour of Dolt 45’s brain. In 77 minutes, he demonstrated what I have so inadequately tried to explain.  He is the San Andreas of emotional fragility.  He’s not going to change.  You saw what stress does.  Behavior patterns become more pronounced.trump-presser

Dolt 45 is not crazy.  He’s a 70-year old man who has never worked an honest day’s work in his life who likes to watch television and tweet.  He believes he’s infallible because he doesn’t know what the word means.

Setting up warring factions in the White House ensures he is the eye in a hurricane of chaos.  It provides him the self-esteem he so desperately craves and the charade of power sustaining his veneer of legitimacy.

Let me try to explain.  Think about the best, mind-blowing, earth-moving sex you ever had.  That is what yesterday’s press conference was for the citrus pustule.  As he said, “I’m having a good time doing it.”

Here’s what I know from studying leadership.  Any organization centered on charismatic leadership (personality-centric) rests upon clay feet.  It is like the Platte River – a mile wide and three inches deep.  It evaporates in the least bit of heat.whats-wrong-with-trump

Crises are not planned via e-invites.  They are coming.  Whether it is a natural disaster, a Horizon oil spill, an incident in the Strait of Hormuz, or a terrorist attack, the time is ticking down.  It won’t just be a failure; it will be a Category 5, Frontline documentary fiasco.  Failure is simply the non-presence of success, but a fiasco is where anarchy apportions anguish and adversity.

This weekend troubles me.  It has been almost 84-years to the day since the Reichstag Fire.  It was a planned provocative act of arson to set emotions ablaze.  This weekend event in Florida has a certain suspicious air about it.  Nothing would change the media’s attention faster than paid insurrectionists rioting at an event where Dolt 45 is whisked away by Secret Service.  Just sayin’.gop-support-for-trump

Currently among Republicans, SCROTUS (So Called Ruler of the U.S.) is at a more robust approval rating than either Bush or Reagan was at a comparable time.  The symbiosis is complete.  Congratulations Dr. Frankenstein, it’s a boy.

And this brings me to the Country over Party part of TRICOP.  Never before has the reverse concept been so clear to me.  I’m guilty of mindlessly accusing Republicans of prostituting themselves as Party over Country and Power over Country, but when a future drapery salesman from South Carolina is your party’s lone moral compass, the GOP ain’t exactly writing new chapters for Profiles in Courage.

Here’s the takeaway:  The Republican Party will allow this orange stooge to do immeasurable harm to the country in order to eviscerate FDR’s New Deal and Johnson’s Great Society.

There is an ugly, angry, maniacal lust at work to deprive twenty million poor people of health insurance in order to allow the One-Percenters an obscene tax break.  I lack the intellectual capacity to understand that.  It isn’t just the repeal of the A.C.A.  It is also a rollback of Medicaid that happens to be the primary financing mechanism for the country’s nursing home/end of life care.

The gobsmacking piece of all of this:  To finance the lipstick for the piglet they are going to pass off as a “replacement,” they are proposing taxing some portion of employer furnished health insurance.

Here are a few highlights from the first 25 days:what-coal-mining-does-to-streams

The first Republican counteroffensive against the War on Coal was signed into law this past week.  Coal mines will now be free to pollute some 6,000 miles of once protected waterways in the country.

For those poor, over-regulated, underappreciated oil companies, they will no longer have to report their payments to foreign governments.  Anti-corruption is so déclassé.

If you are keeping score, this weekend we will be spending $1,240,000 a day to protect Trump Tower with no one home, another $3.0 Million for another Mar-a-Lago golf outing, and about $200,000 for Uday and Qusay Trump to open their Dubai golf course.

Finally, if you are a policy wonk like me, we can be alarmed that Dolt 45 swatted away 50-years of U.S. policy supporting a two-state Middle East solution as easily as he would a Citrus Whitefly.  And if you were worried about that pesky dust-up over a “One China” policy, it seems to have ironed itself out quite coincidentally with the granting of Chinese Trump trademarks.

For those 70,000 under-educated white guys in the upper Midwest:  Is America great enough yet?

What’s on your mind today?  Spasibo.  Never too early to learn some Russian.

a-trump-hat

 

Meerkat Tribe 2

This is a picture of the Republican Caucus shortly after Kevin McCarthy’s announcement he was bailing out on the House Speakership.  Attentive bewilderment seems to be the optimum description of the GOP these days.

It appears everyone and their dog is reaching out to Paul Ryan begging him to climb up on that Speaker’s cross and sacrifice himself.  He’s the same zombie-eyed, Granny-starver who has never worked a day in the private sector that is touted as the Republican expert on the private sector.

The fern is the one in the background...

The fern is the one in the background…

Ryan’s the guy who came under the spell of Ayn Rand courtesy of social security survivor benefits who now decries the immorality of the “urban culture” focusing on government entitlement programs.  And most importantly, he’s the guy who has infected proposed federal budgets with so many magical asterisks, the budgets resemble measles-ridden failures of Rubella vaccine trials.

Ryan is seen as the wonkiest of the wonkees – “Hey, Hey, we’re the wonkees and we got some monkeying to do!”  Ryan isn’t alone in the clay feet club.  There’s the youngest of the Mario Brothers – Marco Rubio – who has conjured a tax and budget plan of ponies and rainbows.  There’s Forrest Trump who has produced a tax plan creating a deficit of over $10 Trillion.  And we are still waiting, waiting since 2010, for the Republican Party to propose anything resembling a health care plan.

Paul RyanThe Republican Party has become an amalgamation of post-policy séances overseen by the likes of the Freedom Caucus.  We wrote about the infection called the Freedom Caucus a couple of weeks ago and rest assured, they haven’t gotten any better since then.  If there was enough chalk, the Freedom Caucus would be drawing an outline on the sidewalk for a CSI autopsy of the GOP.  The members of the Freedom Caucus exhibit self-aggrandizing narcissism only seen in mirror factories or bacchanal orgies.

This self-centeredness of the Freedom Caucus has resulted in the effective takeover of the House of Representatives, but it isn’t the only place where Republican open-mindedness has resulted in their unimpressive brains rolling out of the head.  Let’s look at the Presidential field.  The obvious candidate as the poster person for form over substance is either Forrest Trump or Carly Fiorina – both of whom are sensational self-promoters as long as reality is on holiday.

Never being one for the obvious, let’s take a look at someone who raised $20 million last quarter – none other than the squint-eyed neurosurgeon, Ben Carson.  While I’m sure Ben Carson is a good man who is inspirational to us all – he needs to have his head examined. Carson Cartoon

Remember, Carson’s number one qualification for notoriety is being the first person to ever politicize the National Prayer Breakfast by haranguing a President.  Because of that utter lack of decorum, he was immediately hired by Fox.  He was given a platform to comment and opine on any subject – be it foreign policy, the historical accuracy of the Flintstones, or his ideas around nuclear proliferation that are informed by the Book of Revelation according to the “end times.”

When it comes to politics, Carson is as crazy as an outhouse rat.  If his story about the Popeye’s restaurant is true, that of a vegetarian going to a chicken joint for fries, and telling a gunman to shoot the hourly employee behind the counter, I have a difficult time believing anyone in good conscience can say he never saw a bullet hole uglier than a gun safety law.

Carson has no idea what the Constitution says or what it means, he’s uninformed about Congress, has no idea about economics, believes in conspiracy theories then passes them along giving them validity, and is absolutely clueless without biblical analogies.  Yet, he is consistently second in national polling.

Meerkat Tribe 3The Republican Party has turned into the Frightwing of American politics.  Having been cowed to Limbaugh, O’Reilly, Hannity, and Levin, the only functional organization of the GOP are radio and television schedules.  The likes of Ben Carson are what you get as a result.  The Republican Party is a policy-free zone – it isn’t even a pesky afterthought.

All this shouldn’t come as a surprise.  I see the Republican Party suffering from Colony Collapse Disorder.  CCD is what kills otherwise thriving colonies of honeybees.  The central focus of the Republican Party has been a deep, all-consuming, hatred of Barack Obama.  It has been their reason for being for 7 years now – their sole organizational purpose.  Take that away and it is like the death of a queen for a beehive.  The drones and the workers have no direction, no reason for being, and they lose all focus.  That is what has happened to the Republican Party.Bee, we are taking you with us

When the only direction comes from fomenting anger by mean-spirited media imbeciles, it is a poisonous, caustic FlavorAid recipe not unlike that served in Jonestown.  The purest signs of this toxicity are Trump, Carson, and Fiorina.  The hatred they represent is just jealousy rolled up in a heaping dose of xenophobic ignorance.  Like CCD, there is no known cure – you just have to let it run its course.  I’m willing to do just that.

This is an open thread – enjoy your Wednesday, the day after the night before Hillary once again demonstrated her fierce superiority and overall awesomeness.

 

Good Thursday, Widdershins.  Welcome to the big, wide, wonderful world of Level 4 pathogens.

Ebola is not new – the first cases were described in 1976.  June of 1976 brought an epidemic in the Sudan;, then another erupted in August in Zaire, which is now known as the Democratic Republic of the Congo.  The Ebola virus is named according to various sites where the various epidemics began.  The Ebola River contributed the name of the virus, then Bundibugyo (BDBV), Tai Forest (TAVF), Sudan (SUDV), Reston (RESTV), and Zaire (EBOV) lent their name to the five known types.  All but the Reston can infect humans with varying degrees of severity. Ebola Zaire is the worst of them, and sadly is also the one currently running rampant in West Africa.

EBOV has the highest mortality rate, averaging 80-90% in previous epidemics.  Since many of these episodes occurred in less than desirable medical settings, I cannot help but believe that a more controlled environment would have better results.  Nigeria has eradicated the problem by using barrier nursing and proper burial techniques.

Please understand that EBOV is spread through contact with body fluids from an actively infected person.  Body fluids include urine, feces, blood, saliva, and stomach contents.  In an abundance of caution, many also include sweat and tears in this list.  Essentially, EBOV is spread the same way as AIDS and Hepatitis, but there is a much shorter period before the disease becomes apparent, and a much smaller window of opportunity for treatment.  You will not get Ebola because you sat next to someone whose cousin’s next-door neighbor’s best friend sat three rows behind a person who later developed Ebola,  (Don’t laugh.  I used to get calls at the hospital of a similar stripe whenever meningitis came to town.)

So here we find ourselves with the index case having already died, and a contact en route to the hospital with some early symptoms.  Clearly, the home team fumbled the kick off and need to regroup.  As a nurse who spent twenty or so years at triage, I am still shaking me head over the first ER visit, when Thomas Eric Duncan spoke to the triage nurse at Dallas Presbyterian.  The nurse apparently documented that he had a history of foreign travel, sent the chart and the patient back for treatment, and things went downhill thereafter.  Now, the earliest symptoms of EBOV are generic – fever, abdominal pain, general malaise – and could be a zillion other things, but Mr. Duncan’s point of departure was a really big red flag that somehow got missed.  Of course, the hospital initially blamed the nurse (it’s always either the bloody nurse or the will of God), then made the horrifying discovery that she had documented appropriately.  Then it was the fault of the EMR that the screen did not interface with the physician’s, then it was something else.  Of course, I have to ask myself why the nurse never followed up on this.  I can absolutely promise you that if I thought I had triaged an Ebola patient, I would have been on that phone asking questions at regular intervals.

It all goes downhill from there.  Mr. Duncan’s poor family needed intercession from CDC and PHD to get him re-admitted to the hospital, at which time they found themselves trapped in an apartment full of contaminated linens, towels, floors and the like without the supplies to clean it up.  Of course, that would presume that they had the knowledge base to knew how to do a terminal disinfection.  We don’t think that the virus lives all that long outside of a host, but it can’t be terribly pleasant.

Nursing staffs should know how to care for an Ebola patient, as they are taught from the time that they are students how to maintain Secretion Precautions.  We cover our hair, wear long disposable gowns with snug cuffs, double gloves and a mask.  In these cases, a mask with an eyeshield would be even better, as eye splashes are a nasty way to transmit pathogens.  What nurses are currently objecting to – and most strenuously – is that they see staff members at Emory as well as decontamination techs suited up like a casting call for Ghostbusters while someone hands them a paper gown and a box of gloves. I can’t blame them one bit.  Someone is going to have to pony up the funds for top quality gear, or we will have few nurses. There’s already a shortage, so if we make them sick/kill them off/scare them away, it will be really counterproductive.  A police sergeant who never touched anything while delivering an order of quarantine has developed some symptoms, so the old “abundance of caution” principle is now in high gear and he has been hospitalized.

We had a similar sideshow in Miami over the weekend.  A twelve year old who had arrived from Africa to go on a cruise developed flu-like symptoms and presented to a local hospital for treatment.  Said local hospital decided to rule out Ebola and transferred him to Jackson Hospital.  A number if my friends still work there, and told me that everyone got all suited up at 8 am, then waited.  And waited.  And waited.  Seems that the Mayor of Miami Beach and the Governor needed to make speeches prior to transfer, and Fire Rescue decided to line their unit with plastic.  Somewhere around 2 the patient arrived, just before the initial – and negative – blood test came in,  Chalk it up to a drill, folks.

Here’s the problem, as I see it.  Hospitals, health departments and CDC have all had funding slashed. All have fewer people working harder.   CDC is now worrying about seat belts and auto safety as well, rather than spending full time concerning themselves about controlling disease.  They virtually eradicated malaria, so we know  they can do it.  We have no Surgeon General because the Repubs are horrified that the nominee has the temerity to consider gun safety a health issue.  The whole thing looks ominously like the early days of AIDS when we missed the bus completely, only now we’re not even certain who’s driving.

There’s also the tiny problem of how to treat this.  There are few effective remedies, but some show promise.  The initial cases were treated with convalescent serum and an Ebola-specific antiviral.  They did well, but there apparently is no specific anti-viral left.  Convalescent serum is gleaned from the blood of someone who has made a recovery from Ebola, and I doubt that there is a current donor pool of any size. There is another drug which failed Mr. Duncan, but may have better results if used earlier in the course of the illness.   It’s a good opportunity to track the pharmacology, establish a treatment protocol, and strive to establish a good supply of whatever seems to work best. .  A vaccine would be even nicer, but a high level of cooperation between drug manufacturers and government will be needed, and recent history suggests that this may not go so well.  A nurse in Spain has died from EBOV, which demonstrates that the virus has found its way into Europe.  This will not make screening any easier. As of now, traveler’s from West Africa are screened and asked to see a doctor if they develop symptoms within 21 days. Adding travelers from Europe to the mix will blow those numbers through the roof.

For now, let’s just cross our fingers and hope that this brings out the best in mankind.

This is an open thread.


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