COVID Update: Omicron Edition

Readers of this blog are most likely vaccinated to some extent against COVID-19 -- a big majority of Americans are. Of course, the level of vaccination varies greatly. The CDC says that about 78% of the US population has had one dose of vaccine and 67% has had the "complete initial protocol." Only about 38% of Americans have received the booster even though almost everyone 5 or older can get one dose. FYI: The CDC officially recommends that everyone eligible should get boosted. Below I reference some research suggesting the booster might save your life. 

A second booster shot (also recommended by the CDC for those eligible) is available for people aged 50 and above, plus the immunocompromised -- basically, the people facing the greatest risks during the pandemic.

Unfortunately, the virus keeps mutating and so neither the vaccines nor previous infection have been especially effective at preventing transmission of the latest version of the disease. They are doing a much better job at preventing hospitalization and death, as the rates for those outcomes have been lower in the US in 2022 than they were in 2020. 

The Washington Post reported in late April that the most recent variants have primarily been  killing peopled aged 75 and up: "nearly two-thirds of the people who died during the omicron surge were 75 and older." However, there are differences among the victims:

the bulk of vaccinated deaths are among people who did not get a booster shot, according to state data provided to The Post. In two of the states, California and Mississippi, three-quarters of the vaccinated senior citizens who died in January and February did not have booster doses.

A new study also finds that it is dangerous to become infected with the virus multiple times: 

The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.

This is likely already be baked into that data, but experts say about 1 to 5% of COVID patients develop what is commonly called "long COVID"

The percentage of people with severely debilitating symptoms is probably between 1 and 5 percent — amounting to millions of people in this country, according to Harlan Krumholz, a Yale University professor of medicine.

The April information referenced above is now a bit out of date as it is primarily discussing the Omicron variant that was then dominant -- version BA.2. The new BA.5 variant is seemingly much more contagious. Indeed, from Alpha to Delta and then through the several Omicron variants, virtually ever wave of the virus has been propelled by an ever more contagious version of the disease. 

There is some good news: While it was recently calculated and reported that the R-naught (or R0) of BA.5 is over 18, making it the most contagious viral infection known to man (worse than measles), that is apparently incorrect and fact-checkers have now corrected the reporting. It is, however, too soon to calculate the R0 precisely. By the time we can calculate it, the new BA.2.75 circulating in India might be dominant. 

The original reproductive rate of COVID was likely 2 to 3 with Delta probably around 5. The initial omicron variant number was apparently 8. 

Additionally, the current circulating versions of the disease remain deadlier than the seasonal flu -- at least for the unvaccinated. 

In all, the information fairly clearly reveals that the pandemic is not over -- no matter how many unhelpful strangers tell you that it is -- and people should continue to take precautions.

Get boosted. Wear an effective mask (N95 or KN95). Maybe even outdoors (in crowds). 

Practice social distancing. 

The government should be pushing harder to reinstate masks on planes and other forms of public transportation.  Indeed, because of standing room only crowds and poor ventilation, buses might be the most dangerous. 

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Fall Semester?

The President of my university issued a statement Sunday claiming that we are full steam ahead for fall 2020 semester live on campus:

President Bendapudi made the following announcements:

• The University of Louisville will have regular campus operations for the Fall semester.
• This entails students living on campus, learning on campus and online, and faculty and staff working together to advance our mission of teaching, and research, and service. 

Many faculty members have spent part of their day exchanging email and social media messages reflecting unhappiness with this decision. One issue is lack of consultation with faculty and staff. The decision undercut the work of committees that were supposed to meet this week to discuss this issue. The President acted without our input.

If the current situation with COVID-19 does not change, however, then the idea is completely unworkable. And that actually seems kinds of obvious to me. I suspect that University officials realize that public health uncertainty is going to reduce enrollments and tuition revenue, so they are saying something to seem positive and decisive. The latest message is basically PR, appealing to students and parents, as well as potentially gullible media who might report this uncritically. Administrators still have plenty of time to backtrack if the disease prevalence is significant and the case fatality rate (CFR) remains high.

If central administration does not realize this, then I am quite concerned. Universities are kind of like nursing homes, meatpacking plants, ships, and prisons (the 4 places that have suffered the worst outbreaks) in that people are in close proximity to one another for prolonged periods day after day. These are clearly incubators of the disease and some local facilities have suffered outbreaks of half to two-thirds of their populations. If half of the UofL community of 28,000 students and employees gets COVID-19 and the CFR is a fairly conservative 0.35%, then that’s 14,000 infections and nearly 500 fatalities. Even if it’s 0.01%, then that’s 140 deaths.**

No one will risk those lives, I would assume.

Before faculty and students can possibly return to crowded classrooms, the USA needs far more testing for the disease and antibodies, as well as extensive contact tracing --  unless there proves to be some kind of miraculous treatment for the disease in the next few months. The federal government has bungled its response, letting February pass without strong contact tracing and testing in isolated hotspots -- and the problems have only magnified in the subsequent months as testing continues to lag and contact tracing is nearly forgotten.

In short, I’m not optimistic that the situation is going to improve, so I’m not certain how we can possibly plan for anything other than online education.  Given that most faculty in A&S (by far the largest teaching unit) are not paid for work in June and July, any efforts to improve distance education needs to be happening NOW, in May. Exams are over and faculty cannot travel for personal or professional reasons, as many ordinarily would during May.

After performing well in March and April, UofL is botching its ongong COVID-19 response. .


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** Yes, I realize the case fatality rate is unknown, but see this post for an explanation of my use of 0.35.  I also realize that the population of a university community skews young and that's a population that has a lower mortality rate from the disease.  However, I'm also ignoring the probability that students will transmit the virus to family and community members in their jobs and homes. Louisville is a commuter school and most students work -- at least when the economy is functioning.


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Disease updates

A lot of news has been bouncing around my head. Let me start with the most recent information about Kentucky, then I'll say a few things about the US, and finally, compare America to the rest of the world.

Why Kentucky? Aside from the fact I live here, Kentucky has been held up as a bellweather state for its early, decisive, and consistent action to limit the spread of COVID-19 -- as contrasted to neighboring Tennessee, for example.

To begin, these are the latest COVID-19 figures for Kentucky, acording to Newsweek:

With the 273 additional confirmed infections, Kentucky now has 2,960 cases of the novel virus and 1,122 recoveries. [Governor] Beshear also announced four new deaths on Sunday, bringing the total number of fatalities across the state to 148.

If the disease kills 1% of those who have the virus, as has been frequently estimated, that would mean  there are about 15,000 current Kentucky infections. Likewise, if we assume that only the most serious cases are being tested, which still seems to be true, and that prior estimates are correct that about 20% of cases are very serious or critical, then there would be about 15,000 current Kentucky infections.

But 12,000 of those either had mild versions of the disease or are "silent carriers."

Some experts in the medical community estimate that the number of asymptomatic people is likely to be even higher than we think -- and that experience with prior pandemics reveals that case fatality rates (CFR) are almost always overstated in the early stages. Two different credible medical sources suggest the CFR might be closer to 0.35 or 0.37. That's good news, though still much worse than the flu or other illnesses.

If it's accurate, then the number of cases in Kentucky is closer to 50,000 and half probably don't know it at all.

Then again, there seems to be evidence that the COVID-19-related death rate is dramatically undercounted because lots of people are dying at home without ever entering the medical system. The uptick for people over age 65 is particularly dramatic compared to recent years. Some of those deaths are likely from other causes as people stay home despite evidence of heart attack or other illness that eventually proves fatal.

In any case, Kentucky has 4.468 million residents. If 15,000 people have had COVID-19, then that's 0.003% of the population. Obviously, slightly more than triple that (using a lower CFR) and the infection rate is higher -- 0.01%.

Basically, the lower estimate would mean a 15,000 person crowd at a rock concert or ballgame would likely include 45 infected people. With the higher rate, it would mean 150 infected people in that crowd. That assumes the infected are randomly distributed across the state and in attendance at this stadium.

For a 60,000 person football game, just multiple those numbers fourfold -- 180 infectious people in the crowd at the lower rate and 600 at the higher rate.

How long would it take for the virus to spread quickly to many new human hosts under those circumstances?

It's a major problem that up to 80% of those infected don't know it. Even if a substantial chunk of those individuals think they had the disease because of minor symptoms they experienced, half of the carriers are asymptomatic. Plus, some unknown percentage of people have had similar symptoms but did not actually have COVID-19 and are not immune. However, they might think they have had the sickness and erroneously believe they have developed lifesaving antibodies.

US and Comparative data.

The figures for the US as a whole are parallel. As that same Newsweek story providing Kentucky figures reported:

As of Sunday afternoon, more than 764,000 individuals had tested positive for COVID-19 in the U.S., with over 40,500 deaths caused by the new disease and 71,000 recoveries.

If 40,500 deaths reflect a 1% mortality rate, then 4.05 million Americans have been infected by the virus. If the 764K positive test results reflect primarily the worst 20% of cases, then 3.82 million people carry the virus. Both figures suggest about 4 million cases of infection across the country. In a nation of 328 million people, that's a 0.012 infection rate, nearly 4 times the Kentucky rate.

If the case mortality rate is actually at the lower ~0.35 figure mentioned above, then the US would have more like 12 million active cases, in a country of 328 million. That's a 0.037% infection rate, again more than 3 times Kentucky's rate using the same assumption about CFR.

Adjust the stadium figures accordingly. For the two different infection rates, figure 135 or 450 infected people in the smaller concert crowd, or 540 or 1800 in the larger football crowd.

What does this mean in a worldwide context?

Sadly, the US seems to be far behind the rest of the advanced industrial states based on the information available from the millions of tests that have now been conducted.

From month-to-month, March to April, the US positivity rate stayed flat. About 20% of those tested for the virus are positive -- and that many were also positive last month. That's not good compared to other countries and any nation nearing a decision to open its economy should have a much lower rate especially as the number of tests increases:

South Korea—which discovered its first coronavirus case on the same day as the U.S.—has tested more than half a million people, or about 1 percent of its population, and discovered about 10,500 cases. The U.S. has now tested 3.2 million people, which is also about 1 percent of its population, but it has found more than 630,000 cases. So while the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent—a full order of magnitude smaller. 

South Korea is not alone in bringing its positivity rate down: America’s figure dwarfs that of almost every other developed country. Canada, Germany and Denmark have positivity rates from 6 to 8 percent. Australia and New Zealand have 2 percent positivity rates. Even Italy—which faced one of the world’s most ravaging outbreaks—has a 15 percent rate. It has found nearly 160,000 cases and conducted more than a million tests. 

I think the only conclusion from all of this is that it is premature to be talking about opening the country on May 1. That link verifies that this understanding is Dr. Fauci's assessment. After about 2 weeks, it seems likely that the infection and death rate would begin to skyrocket again.

We need millions of tests, to find out the actual infection rate and identify the individuals who need to be quarantined and perhaps monitored for the good of public health.

At the same time, we need millions of antibody tests so we can figure out potential blood donors for use to aid the newly sick -- and so we can figure out who might be able to return to more active life sooner rather than later. We simply need much more information to act.

Moreover, "opening up" in its early stages, according to the experts, won't mean the old normal. Social distancing, masks, small crowd sizes, and other limitations would very much be needed. Regular poker games are going to be out for some time:

“What’s the downside to asking people to put on masks or wrap their faces with a shawl?” he [Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University] asked. “It may make some people think they’re bulletproof. Some bozo out there will say, ‘Let’s put on our bandannas and have a poker party tonight.’ 

“That’s what we call, in my family, ‘d-u-m dumb,’” he said.

And dangerous.

In fact, any premature return to the normal of February would apparently mean millions of new cases of the disease and tens of thousands of additional deaths. Hospitals would again face scarcities of PPE and risk collapse from overburden.

The infectiousness of this disease is part of the problem, but so is the prevalance in the USA. Either because the country's leadership reacted too slowly to the outbreak or because people have not been truly careful, the US is far behind other advanced nations.

The only real solution is to continue isolating for the foreseeable future. I know that's economically quite painful, but it's also true that other nations have used superior economic and social welfare policies to ease that pain as well. The US Congress and Trump administration can move on that issue with more political cooperation and leadership.

How about a rally to urge that?



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COVID 19 and ISA

Posted March 25: On March 8, I wrote the following note to a colleague who wondered why I was thinking about withdrawing from the ISA conference in Honolulu, scheduled for March 25-28. S/he was comparing the virus to the flu and noted Hawaii's lack of cases at the time. I have slighted edited it to fix typos, add links, and assure anonymity of individuals.
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I understand the flu risk argument and Hawaii’s lack of cases. However, the lack of cases is likely because of lack of testing. The US really dropped the ball on this with delays in preparation, a flawed first test, and an illogical containment strategy. Many experts are now saying containment obviously failed in many communities and it is time to consider mitigation of community spread.

The logic: The doubling rate for known cases outside China is every 4 days. Given the number of deaths in the US (20 now, I think), between 450 and 2000 people likely have the disease already. Nearly 500 have tested positive. The NYT reported yesterday that nearly 2800 New Yorkers are in self-quarantine. There are 76 in Hawaii. The Atlantic Monthly reports that fewer than 2000 people have been tested in the entire US – only 16 tested as of yesterday in Hawaii. If the true number of current cases is merely 500 people right now, we could still have 1 million US cases in 6 to 8 weeks time if the status quo prevails. There are serious concerns the virus could quickly outstrip the health system’s ability to function. This thread is from someone who used to work at CDC as an Epidemic Intelligence Service Officer: https://twitter.com/Farzad_MD/status/1236393626760032257
With testing just about to ramp up, many experts say the number of US cases is about to “explode” as the CDC guy wrote.

I actually have a personal story that illustrates the poor planning** in the US so far:  I had a colleague return from a research trip to Wuhan on December 14. We had beers together a week later at a popular local bar and socialized again together on New Year’s eve. By late January, however, the news coming from China was of such concern that the University required recent returnees from China to spend 14 days at home in quarantine. Of course, for people in my friend's social circle, the horse would have already been out of the barn if he was infected. 

Until this week, no one in Kentucky had been tested for the virus. They’ve tested 14 across the entire state and identified only 1 person with the virus. What scientists don’t really know with certainty is if asymptomatic people could be carrying and spreading the disease. 

That’s really the problem. Who knows?

And the risks are worrisome.

The evidence not only seems to suggest that that virus spreads much more quickly and readily than the flu (because of airborne droplets) – but that it is perhaps 20 times as lethal. I had the flu vaccine in the fall, but there is no vaccine against this virus. Even though the lethality is greater for the elderly, people in my age bracket are still dying at a 10-fold rate. With flu, about 1% of people end up in the hospital with a serious respiratory problem. With COVID 19 it is more like 15 to 20%. That’s largely why the health systems could be broken with a huge outbreak (to flu-like levels of cases).

Mitigation measures are going to become fairly draconian for the US:

Fauci of the National Institute of Allergy and Infectious Diseases said today on Meet the Press that “You don't want to go to a massive gathering, particularly if you're a vulnerable individual. If we continue to see the community spread go up I think you need to seriously look at anything that's a large gathering.”

Austin, Texas, canceled its annual South by Southwest event. Numerous universities are ending travel outside the CONUS. The Physics people canceled their large meeting in Denver. A friend who works in Department of Energy in DC told me that all work travel has been suspended. Someone tested positive who had just attended the CPAC (Conservative Political Action Committee) conference, where both Trump and Pence spoke.  

The Trump administration is still insisting that we are in containment mode, which means 14 day quarantines. Thus, if anyone at the ISA conference develops symptoms and tests positive, attendees could end up spending weeks in quarantine [Hawaii subsequently ordered all arrivals to the island to quarantine]. Even healthy people from the first cruise ship were quarantined for about a month (2 weeks offshore or in Japan and 2 weeks in the US).

I don’t think I’m especially alarmist.

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** "Poor planning" compared to Taiwan, for example, a democratic partner of the US, which learned about the disease in December and began its countermeasures at that time: "As early as the beginning of December, Taiwanese health officers started boarding flights arriving from Wuhan to check passengers for symptoms before they could leave the plane."

"Poor planning" also in that US public health officials could have immediately starting investigating recent arrivals from Wuhan, China, and finding out if those people, family members, or contacts in their social circle had unusual illnesses in December, January, or February. Top policymakers and members of Congress certainly received briefings about the dangers that early and some were worried: From Senator Richard Blumental (D-CT) after the January 24 briefing the Senate received: “We are far from having this potential epidemic under control. We should be worried and concerned about this potential epidemic as a nation” 

Sadly, it appears the negligence started at the top: "President Donald Trump ignored reports from US intelligence agencies starting in January that warned of the scale and intensity of the coronavirus outbreak in China, The Washington Post reported Friday."


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ISA 2020: Mulling withdrawal

March 25:

On February 28, I sent the following note to a colleague that I follow on twitter.
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Dear X:

I saw your coronavirus and ISA tweets. Are you attending? I'm supposed to stay 4 nights and give 2 papers but had delayed buying tickets even before the news about the 2 Japanese tourists. I saw that you referred to Hawaii as a vector and I think that’s true. Somewhere I read recently that Hawaii has about 800 flights per month to/from Asia.

News reports suggest Hawaii hasn't sent any samples from sick people to CDC for tests, so the Hotel/ISA statement about cases is somewhat misleading. Hawaii has quarantined dozens of people (56 as of last Friday). Doctors have apparently forwarded samples from some of those patients and requested CDC tests, but local authorities have said they don’t meet the criteria (because the people hadn’t traveled to Asia, basically). Because of tourism, Hawaii obviously has strong incentives to avoid an outbreak. Then again, they might have perverse incentives to slow-walk information that would imperil their economy. Trump is doing that with regards to the stock market. 

If this disease starts spreading from domestic cases (like the one in California), then Hawaii’s lack of testing makes no sense. Local authorities didn’t even know about the Japanese couple until they had returned home. The incubation period for the disease is estimated at 5 days, though they don’t really know.

Given that the contagion rate has been really high in some countries and the death rate is 2-3% (reportedly 20 times the rate for the flu), this is obviously a serious issue. The hospitalization death rate is around 15%, which would seem to indicate that as many as 20% of patients end up in the hospital. Even a prolonged hospital visit with a ventilator would be terrible.

I’m interested in your perspective as I mull pulling out of ISA.

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Staples and the 2012 Presidential Election

Mitt Romney claims that he is the superior choice for President because he has been a job creator thanks to his time in the private sector. Specifically, as the Wall Street Journal reported in July, Romney claims that he created "more than 100,000" jobs while running Bain Capital.

However, this figure seems to be overstated, as the WSJ noted:

Steven N. Kaplan, a finance professor at the University of Chicago who studies private equity, used another approach: counting 100% of the jobs gained and lost at Bain companies, but only until Mr. Romney left the firm in 1999. By that measure, Mr. Kaplan concluded that Mr. Romney had created "tens of thousands" of jobs....

"I don't think that an investor should get credit for the jobs created beyond the ones where an investor has a position in the company," said John M. Abowd, a labor economist at Cornell University who donated to the Obama 2012 campaign.

He suggests yet another way: Give Mr. Romney and Bain credit for a share of jobs created proportional to Bain's ownership stake in its investments at the time. Because Bain held minority stakes in all four firms, and sold out years ago, that method would produce a far lower total—less than 1,500.

By whatever counting method, it is clear that Staples figures prominently in Romney's jobs record. The Republican presidential candidate refers to Staples fairly frequently and the WSJ piece specifically evaluated Romney's contributions to the office supply company's success:

Mr. Romney includes in his tally the total Staples head count today, about 88,000 jobs. Securities filings show Bain owned 7.3% of the office-supply retailer when it went public in 1989 and had sold out by early 1992, when Staples had 5,300 employees.

Thomas Stemberg, Staples's founder and former CEO, said Mr. Romney's contribution to Staples came "from his personal advice, input and efforts, not his money." Mr. Stemberg, a major backer of the Romney campaign, said he would give Mr. Romney credit for 100% of Staples's 88,000 jobs.

By Mr. Kaplan's method, Mr. Romney should be credited with the 43,000 jobs Staples had when Mr. Romney left Bain in 1999. The weighted average count would be more like 250 jobs—a total Mr. Stemberg called "absurd."

Regarding Staples, the Journal does not address an issue that Mother Jones raised this past July:

Mitt Romney, who served on Staples' board of directors in addition to investing in the company when he was at Bain Capitol, likes to tout the chain as an example of private-sector success. But as the National Employment Law Project Action Fund points out in a new report, that success has not trickled down to employees.

The report lists Staples as one of the 50 largest low-wage employers in the US. The company has continued to turn high profits even in the recession, and its CEO made $8.8 million in 2011 (which was a 40 percent drop from what he made in 2010). And yet most of its nearly 33,000 employees make less than $10 per hour. 

The Mother Jones piece contrasts Staples to Costco, where employees earn $19 per hour, on average. Many (if not most) employees also receive health care benefits.

Readers might be interested to learn that the Costco CEO, Jim Sinegal, spoke at the Democratic National Convention:

“And that’s why I’m here, supporting President Obama, a president making an economy built to last,” Sinegal said in his prepared remarks. “See, in order for companies like Costco to invest, grow, hire and flourish, the conditions have to be right. That requires something from all of us.” And later: “here’s the thing about the Costco story: We did not build our company in a vacuum.”

The Washington Post story includes Sinegal's entire address, if you are interested. Incidentally, the Staples CEO, Stemberg, spoke at the RNC and often touts Romney in various media outlets.

I offer one note in closing for local readers: The cost-conscious University of Louisville Purchasing policy includes this opening paragraph in the section on office supplies:

"Office Supplies are to be purchased through the University's primary contractor, Staples Advantage. The cooperative effort between Staples and the Department of Purchasing continues to keep our University at the leading technological edge of procurement and together we are able to offer unprecedented discounts based on volume purchasing contracts. "

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ACA Today

The Supreme Court ruled 5-4 today that the Affordable Care Act is constitutional. Surprisingly, Chief Justice John Roberts voted in the majority and was thus the swing vote. Many court observers expected he would vote to uphold the act only if Justice Anthony Kennedy was the swing vote. But Kennedy dissented. Roberts got to assign himself the task of writing the majority opinion, but few expected this to occur in favor of ACA unless the vote was 6-3.

Did Roberts abandon his fellow conservatives altogether? No. Roberts, in fact, did not agree with the four more liberal justices that the ACA could be justified by the Commerce Clause of the constitution. Readers might recall the back-and-forth about whether consumers might be required to purchase a product like broccoli under the interpretation of the Commerce Clause offered by the President's lawyers in the courtroom. Incidentally, while Roberts may have been quite concerned about forced broccoli purchases, Justice Ruth Ginsberg destroyed that argument in her concurring opinion.

In any event, Justice Roberts ruled with the liberal justices that Congress had the authority to implement an individual mandate via its power (from Article I and in the Sixteenth Amendment) to tax individuals. After all, both the House and Senate versions of the ACA enforced the individual mandate using the Internal Revenue Service to impose a modest fine -- or tax: 

Since the ACA’s fine for failure to carry insurance is very low (and statutorily calibrated to the price of insurance so that no one will ever pay more for refusing insurance than for buying insurance), since the fine applies regardless of whether the individual knew she was uninsured, and since the fine is assessed and collected exclusively by the IRS, the Court held that it is a tax rather than a penalty under the long-standing constitutional test.

Many conservatives are hotly claiming that the mandate was NOT explicitly sold as tax policy. Some even point to this video of Barack Obama vehemently denying that ACA is a tax. However, if you watch the video, Obama denies that the law is a tax increase, he doesn't say it is not a tax. His argument is that people who don't pay for health insurance effectively force taxpayers to expend their resources when the uninsured seek medical care for emergency care that they cannot otherwise afford.

Certainly by mid-July 2010, as this New York Times story demonstrates, the Obama White House was arguing that the law was constitutional as a tax even in the face of Tea Party opposition to higher taxes and more spending. Incidentally, that Times story also claims that Obama argued ACA was not a tax, but it then quotes from the same ABC-TV interview where he says it is not a tax increase. The newspaper cut short an exchange and make it appears as if the President directly challenges the idea.

"ObamaCare" will likely become a major issue in the presidential election, though Democrats have some powerful arguments to counter the likely Republican attacks. After all, as Ezra Klein and others have demonstrated, the Obama health care law was grounded in ideas borrowed from Republican think tanks over the past two decades. In the Heritage Foundation Lectures, Dr. Stuart Butler argued in  1989 for the government to simply "Mandate all households to obtain adequate insurance." http://IBa BBack in 2010, left-leaning critics of ACA who favored the "public option" charged that this was a boondoggle for the private insurance companies as they would be getting millions of new customers thanks to this policy change.

In any case, conservative critics are also in trouble because Mitt Romney supported and helped pass a very similar bill in Massachusetts ("RomneyCare") during his tenure as governor. The Massachusetts individual mandate is enforced via the tax code. Thus, how can he, in particular, argue effectively against the ACA? I guess we will all find out in time.



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Arizona Assassination Attempt

Saturday, a young gunman shot and killed 6 people at a scheduled political appearance by a Democratic member of Congress. Representative Gabrielle Giffords was shot in the head, but is apparently expected to recover.

The local Sheriff of Pima County, Clarence Dupnik, took advantage of the national media audience to condemn the state of political discourse in his state -- though many of his arguments apply nationally as well. From CNN:

"We need to do some soul searching," Dupnik told reporters. "It's the vitriolic rhetoric that we hear day in and day out from people in the radio business and some people in the TV business.

"When you look at unbalanced people, how they respond to the vitriol that comes out of certain mouths about tearing down the government, the anger, the hatred, the bigotry that goes on in this county is getting to be outrageous. Unfortunately, Arizona, I think, has become sort of the capital," Dupnik continued.

"We have become the mecca for prejudice and bigotry," Dupnik said.

He continued:

"People who are unbalanced may be especially susceptible to vitriol," Dupnik said. "It's not unusual for all public officials to get threatened constantly, myself included. That's the sad thing that's going on in America. Pretty soon we're not going to be able to find reasonable people to subject themselves to serving the public."

Dupnik returned to the theme later in the press conference.

"People tend to pooh-pooh this business about the vitriol that inflames American public opinion by the people who make a living off of that. That may be free speech but it's not without consequences," Dupnik said.

Representative Giffords herself condemned the political discourse early last year when she pointed out the framing of Sarah Palin's rhetoric after the health care bill passed:

Last March, Giffords raised concerns about inflammatory rhetoric after her office was vandalized, and she cited how her name appeared on a website titled "take back the 20" as part of a list originally issued by Sarah Palin against vulnerable House Democrats.

A map on the site showed crosshairs over the contested Democratic districts.

Palin first posted the list in March 2010, naming 20 House members who voted for health care reform and represented districts that Republican Sen. John McCain of Arizona won in the 2008 presidential election.

"The thing is, the way that she has it depicted has the crosshairs of a gun sight over our district," Giffords said in March. "When people do that, they've got to realize there's consequences to that action."

Palin's map created a minor-firestorm at the time -- the women on "The View," for example, were very critical of Palin, including outspoken conservative Elisabeth Hasselbeck.

You can see the bullseye/gunsight map yourself on Palin's Facebook page -- or reproduced by others, in case Palin takes it down. On Twitter, Palin wrote,

"Commonsense Conservatives & lovers of America: "Don't Retreat, Instead - RELOAD!" Pls see my Facebook page.

As Firedoglake has already noted, Giffords's Republican (tea party) opponent Jesse Kelly (shown in "military garb holding his weapon") announced a June campaign event with this ad:

Get on Target for Victory in November Help remove Gabrielle Giffords from office Shoot a fully automatic M15 with Jesse Kelly.

Rachel Maddow has reposted a photo from the event, which showed participants aiming guns at human silhouettes.

Here's video from last March of Giffords raising her concerns about Palin's target map on MSNBC -- see especially the section beginning 2:10 into her interview:
The CNN piece includes a number of other quotes from political analysts and public officials criticizing the state of political discourse in this country -- and condemning the attacks. The latter point is bipartisan (who doesn't condemn the shootings?), while the concerns about the rhetoric are coming almost exclusively from Democrats.


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Journolist: Conservative hypocrisy

Conservatives have penned a number of outraged responses to the Journolist hullabaloo, but the most hypocritical response I've read so far was written by Fred Barnes:

Until JournoList came along, liberal journalists were rarely part of a team. Neither are conservative journalists today, so far as I know. If there's a team, no one has asked me to join. As a conservative, I normally write more favorably about Republicans than Democrats and I routinely treat conservative ideas as superior to liberal ones. But I've never been part of a discussion with conservative writers about how we could most help the Republican or the conservative team.

This appeared in the opinion pages of the Wall Street Journal.

Is Barnes unfamiliar with the so-called "vast right-wing conspiracy"? That phrase likely reflects a measure of hyperbole, but there's clearly intense overlap and message commonality among Republican party operatives and right-wing media outlets.

In fact, as noted at the end of his column, "Mr. Barnes is executive editor of the Weekly Standard and a commentator on Fox News Channel." The Journal is owned by Ruport Murdoch, who also owns Fox. Barnes went to work for Fox in 1996.

It's a media trifecta!

What about the links to Republican party politics?

The Weekly Standard is edited by William Kristol, who came to fame in part (aside from family connections), because of his work for Dan Quayle and more importantly, his leadership of the concerted effort to stop the Clintons' health care initiative.

The December 1993 memo, "Defeating President Clinton's Health Care Proposal" was penned under the auspices of the Project for the Republican Future. The memo was "his first of what would become legendary strategy memos circulated among Republican policymakers." Kristol published some parts of the memo in the Wall Street Journal in January 1994.

Brad DeLong helpfully posted the full memo in March 2009:

These four pages are an attempt to describe a common political strategy for Republicans in response to the Clinton health care plan.

The coordination was certainly effective. Media Matters, June 2009:

As Haynes Johnson and David S. Broder documented in The System (Little, Brown and Co., 1996), during the battle over President Clinton's reform plan, "a loose confederation of special-interest groups nationwide ... united for one purpose -- to kill what they termed derisively 'Clintoncare.'"

I've searched archives of The New Republic (Barnes employer) in 1993 and 1994 and he frequently cited Kristol's analysis on health care and other issues. On April 4, 1994, Barnes wrote, "Kristol makes a strong case, but few Republicans are willing to join him in attacking universal coverage."

Barnes seemed to be a team player even before he joined Fox in 1996.

After Clinton-care was defeated, "The Project [for the Republican Future] was disbanded and the staff incorporated into the operations of the magazine The Weekly Standard when it was begun by Rupert Murdoch and the News Corporation in 1995."

Barnes now seems to be fully committed to the Kristol-Murdoch-Republican cabal.


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Change?

With Scott Brown defeating Martha Coakley in Massachusetts, the Democratic Senate majority now stands at 59-41. In most legislative bodies, this election wouldn't matter at all since large majorities tend to get their way.

Republican exploitation of Senate rules, however, has made it virtually impossible to bring legislation to a vote because cloture requires 60 votes. Republicans won't agree to end debate to allow substantive votes.

At this point, I guess we'll find out if Barack Obama can deliver what he promised. Remember this?

We're up against decades of bitter partisanship that cause politicians to demonize their opponents instead of coming together to make college affordable or energy cleaner. It's the kind of partisanship where you're not even allowed to say that a Republican had an idea...

Of course, a lot of progressives would add that "It's the kind of partisanship where you're not even allowed to say that a Democrat had an idea..."

No President has all that much power in domestic politics -- aside from setting the agenda and employing the "bully pulpit." It seems apparent to me that Obama has to go on the offensive using one of his most effective weapons -- his own ability to frame issues in accordance with a populist understanding of preferences. In short, he should work to shape the agenda and pound the bully pulpit.

Many of the people telling pollsters they are opposed to the health care reform legislation are against it because they don't think it goes far enough (and it doesn't do enough for them). Obama has to convince a clear majority that it is a good idea. He has to fight for his ideas. Some key Democratic and Republican Senators have to feel that their own constituents want real change.

Most voters may have good health care coverage today, but millions are vulnerable in this economy. People understand that, at some level, but they need to know that the health care bill is for them -- not just the 30 or 40 million who are uninsured.

That aside, I suppose it's also possible that the House could just vote for the Senate health reform bill. Whatever the case, the country needs health care reform and then both branches of government should move on to topics that are clearly popular (and meaningful): limiting Wall Street's power, promoting jobs (perhaps via green energy, even if de-linked from the climate bill), etc.

A lot of people have been talking about deficit reduction, which most economists will report is a bad idea during a deep recession. Someone in authority needs to own that argument. Once the economy grows, tax revenues will increase and deficits will decline. Keynes 101.



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Health care debate

"If you spell something wrong, do you really deserve surgery?"

Protect Insurance Companies PSA from Will Ferrell

I'm no health insurance expert, but that line clarifies a lot.


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Global Health

Does foreign aid work? I've mentioned that question previously, but there's new disturbing data recently published in The Lancet, a prestigious medical journal. Here's the AP account of one recent study:

Trying to show health campaigns actually saved lives is "a very difficult scientific dilemma," said Tim Evans, a senior World Health Organization official who worked on one of the papers.

In one paper, WHO researchers examined the impact of various global health initiatives during the last 20 years.

They found some benefits, like increased diagnosis of tuberculosis cases and higher vaccination rates. But they also concluded some U.N. programs hurt health care in Africa by disrupting basic services and leading some countries to slash their health spending.

The other study discussed in the AP story about the journal articles notes that health aid dollars do not necessarily match need. It would appear as if many political factors influence aid decisions:

[University of Washington researcher Chris] Murray and colleagues also found AIDS gets at least 23 cents of every health dollar going to poor countries. Globally, AIDS causes fewer than 4 percent of deaths.

"Funds in global health tend to go to whichever lobby group shouts the loudest, with AIDS being a case in point," said Philip Stevens of International Policy Network, a London think tank.

Somewhat cynically, Philip Stevens of International Policy Network (a British think tank) points out the mixed motives of the aid community:

"The public health community has convinced the public the only way to improve poor health in developing countries is by throwing a ton of money at it," Stevens said. "It is perhaps not coincidental that thousands of highly paid jobs and careers are also dependent on it."

It's fairly disheartening.


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Ducking in

Today, at the Duck of Minerva group international relations blog, I posted "Ire of Newt." Former Speaker of the House Gingrich is calling for the head of successor Nancy Pelosi because of her accusing the CIA of lying about what they told her about waterboarding in 2002. I reveal the frequent occasions when Newt himself has called out the CIA and State Department during wartime.

Yesterday, I posted "KSM: NIMBY?" which is about the hullabaloo surrounding the closing of the prison at Guantanamo Bay. KSM is Khalid Sheikh Mohammed. NIMBY = "not in my backyard."

Wednesday, April 29, I posted "Neorealists as Critial Theorists: Film Edition." I examined the favorite IR films of Harvard academic (and blogger) Stephen Walt in light of my film class (and work on "comedy of global politics").

Tuesday, April 28, I posted "The flu: context," which discussed the broad human security implications of the flu in an ordinary year (without swine flu).


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Arts and leisure

Sunday, I saw Sicko, which is both entertaining and eye-opening. If you haven't been paying attention, or know the film only by the associated activism, then you might not realize that this latest Michael Moore movie is NOT about the 45 to 50 million Americans who lack health insurance.

Rather, it is about the quarter billion Americans who have health care -- and pay too much, receive too little, and are incredibly vulnerable to the whims of the marketplace.

Much of the film, in fact, is about the comparatively superior health insurance systems offered in Canada, the United Kingdom, France and Cuba (!).

I also watched the Venus DVD this week (thumbs up) and parts of the major league and AAA All-Star baseball games. I'm not a big fan of the All-star break, but the Ichiro inside-the-park homer was exciting and the 9th inning held my interest (despite all the walks).

Unfortunately, I missed the Futures game this year...it occurred while I was in the theater for Sicko.


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