“COVID-19 has forced doctors to postpone many types of surgeries, but some things can’t wait. Ophthalmologist Jay Singleton saw one man at risk of permanent blindness on a recent Friday evening in New Bern, North Carolina.
“He had a rare type of glaucoma caused by a large cataract, and the only thing to do was to remove it so the pressure would go down inside the eye,” Singleton says. “We knew it was a very real situation because he already had lost one of his eyes to the same thing.”
Singleton had all the skills and equipment necessary for the job at his state-of-the-art vision center. Unfortunately, the government won’t let him use his space for the vast majority of the surgeries he performs.
North Carolina and many other states impose a regulatory tool called a “certificate of need” (CON), which forces health care providers to prove an unmet need in the market before operating a facility, scaling up, or purchasing major medical equipment. In practice, CON laws block new competition, funneling traffic to big hospital systems—the last thing that should happen during a global pandemic.”
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“”You have to pick a side,” Singleton says. “If you treat it like a business, you must allow other people to enter the market and compete with you like every other business. If you treat it like a public partnership, then you can’t enrich yourself on the backs of Medicare patients. You can’t have it both ways.””
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“15 states—including California, Colorado, and most recently New Hampshire—have eliminated their CON programs.
None of these states has experienced any negative effects. Indeed, Matthew Mitchell, a researcher at George Mason University’s Mercatus Center, says states that got rid of their CON laws have more hospitals and surgery centers per capita, along with more hospital beds, dialysis clinics, and hospice care facilities.
“Forty years of peer-reviewed academic research suggests that CON laws have not only failed to achieve their goals but have in many cases led to the opposite of what those who enacted the laws intended,” he says.”
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“Many states, including Connecticut, Georgia, and South Carolina, suspended their CON laws after the pandemic came to America. Other states, such as Rhode Island, rolled back CON laws at hospitals and nursing facilities but not outpatient surgery centers or hospices.
Instead of just being a temporary reprieve, these emergency actions should be expanded and made permanent.”
“The controversy surrounding the PPP, which supports businesses with 500 employees or fewer, has a lot to do with a disconnect between the program’s design and how Americans think about business. The real goal of the PPP was to keep American workers on payroll, not to simply keep small businesses going. And so the majority of the money was disbursed to businesses with more employees, rather than to tiny ones with small staffs. That’s why a program widely perceived as being meant to boost the United States’ most vulnerable small businesses ended up prioritizing businesses that aren’t actually that small.”
“The Trump administration’s dismantling of independent federal watchdogs continued late last Friday, as Trump removed State Department Inspector General Steve Linick, who was reportedly conducting at least two misconduct probes into Secretary of State Mike Pompeo.
Politico also reported today that Linick had recently finished an investigation into a Pompeo aide and concluded she had likely failed to report allegations of workplace violence.
On Friday night Trump also replaced the acting inspector general at the Department of Transportation, who was investigating Transportation Secretary Elaine Chao—the wife of Majority Leader Sen. Mitch McConnell (R–Ky.)—for alleged favoritism in awarding contracts.
Friday’s moves follow a string of dismissals that congressional Democrats and government accountability groups say is a purge of the inspectors general system by the Trump administration. The president has then filled those watchdog positions with political allies.”
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“In April, Trump fired Michael Atkinson, the inspector general of the intelligence community. Atkinson’s referral of a whistleblower complaint to Congress launched the Ukraine investigation and eventual impeachment of Trump, and the firing was widely seen as retaliation.
Trump also replaced Pentagon Inspector General Glenn Fine, who was supposed to oversee the $2 trillion coronavirus aid package passed by Congress.
Inspectors general are independent offices that investigate waste, fraud, and abuse at federal agencies. They regularly audit agencies’ compliance with mundane rules and record-keeping, as well as investigate whistleblower complaints about misconduct.
Their investigative powers give them access to records and officials that the public and reporters don’t have, and as such, they fill an important role as watchdogs within the federal government.”
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“To do their job, inspectors general are supposed to be insulated from political pressure. They don’t report to agency heads, and although they’re appointed and can be fired by the president, the president must give Congress 30 days’ notice before any firing, along with reasons for the removal. (Trump subverted even this modest requirement in Atkinson’s case by placing him on immediate leave.)”
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“But the Trump administration, despite the president’s pledge to “drain the swamp,” is hostile to any oversight and has no use for inspectors general except as toadies and rubber stamps. Trump said he fired Linick at the request of Pompeo, but so far the administration has not given any detailed explanation, except that the president “lost confidence” in him.
And congressional Republicans, once champions of oversight and accountability during President Barack Obama’s administration, have become mute or blasé on the subject.”
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“If Congress wants to maintain any vestige of respectability—or even any indication that it’s still a functioning branch of government rather than the executive’s doormat—it needs to reassert its power to protect independent inspectors general, regardless of which political party holds the White House.”
“the novel coronavirus came, and President Trump did nothing for week after week, month after month. We sit, still, in the void where a plan should be, forced to choose between endless lockdown and reckless reopening because the federal government has not charted a middle path. Instead, we wake to presidential tweets demanding the “liberation” of states, and laugh to keep from crying when the most powerful man in the world suggests we study the injection of disinfectants. Trump has let disaster metastasize into calamity. The feared collision of global crisis and presidential recklessness has come, and it is not close to over.”
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“much of any presidency takes place in the murky realm of risk. Imagine that there are 10 horrible events that could befall the country in a president’s term, each with a 1 in 40 chance of happening. If a president acts in such a way that they all become much likelier — say, a 1 in 10 chance — he may never be blamed for it, because none of them may happen, or because the one that does falls during his successor’s term. But in taking calamity from reasonably unlikely to reasonably likely, he will have done the country terrible harm.
The logic works in reverse, too. A president who assiduously works to reduce risk may never be rewarded for their effort because the outcome will be a calamity that never occurred, a disaster we never felt. We punish only the most undeniable of failures and routinely miss the most profound successes.”
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“Of late, I’ve been thinking back to 2017, when Trump began a war of tweets with North Korea, the world’s most irrational nuclear regime. “Just heard Foreign Minister of North Korea speak at U.N.,” Trump wrote. “If he echoes thoughts of Little Rocket Man, they won’t be around much longer!”
Trump’s behavior stunned even Republican allies. Sen. Bob Corker (R-TN), then the chair of the Foreign Relations Committee, warned that the president was treating his office like “a reality show” and setting the country “on the path to World War III.”
But World War III didn’t happen. Trump and Kim Jong Un deescalated. They met in person and sent each other what Trump later called “beautiful letters.” The fears of the moment dissolved. Those who warned of catastrophe were dismissed as alarmist. But were we alarmist? Or did Trump take the possibility of nuclear war from, say, 1 in 100 to 1 in 50?
Moments like this dot Trump’s presidency. His withdrawal from the Iran nuclear deal dissolved the only structure holding Iran back from the pursuit of nuclear weapons. What’s followed has been not just a rise in tensions but a rise in bloodshed, culminating with Trump’s decision to do what both President George W. Bush and President Barack Obama chose not to do and assassinate Iranian military leader Qassem Soleimani. The end of that story is as yet unwritten, but possibilities range from Trump’s gamble paying off to Iran triggering a nuclear arms race — and perhaps eventually nuclear war — in the Middle East.
Trump’s withdrawal from the Paris climate accord, alongside his routine dismissals of the NATO alliance, similarly force us to imagine the future probabilistically. In both cases, Trump says he is simply being a tough negotiator, forcing the better deals America deserves. In both cases, unimaginable calamity may — or may not — result. The verdict will not come by Election Day. We will have to judge the risks Trump has shunted onto future generations.
Of the many risks that Trump amplified through lack of preparation, reckless policymaking, or simple inattention, a pandemic is the one that came due while he was still president. But it is not the only one lurking, nor is it somehow a charm against other disasters befalling us. Moreover, the coronavirus itself raises the risk of geopolitical crises, of financial crises, of disasters both expected and unexpected, manifesting.
Trump, in his daily rhetoric and erratic mismanagement, is placing big, dangerous bets, but he will not cover the losses if they go wrong: It’s America, and perhaps the world, that will pay, in both lives and money.”
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“Former New Jersey Gov. Chris Christie, who originally ran Trump’s transition team, relayed to Lewis a telling comment Trump made about the pre-administration planning, which he considered a waste of time. “Chris,” he said, “you and I are so smart that we can leave the victory party two hours early and do the transition ourselves.”
Each day, the president of the United States receives the President’s Daily Brief: a classified report prepared by US intelligence agencies warning of gathering threats around the globe. US intelligence agencies warned Trump of the dangers of the novel coronavirus in more than a dozen of these briefings in January and February. But Trump “routinely skips reading the PDB and has at times shown little patience for even the oral summary he takes two or three times per week,” reported the Post.
Two problems build amid this kind of executive impatience. First, the president is unaware of the nation’s constantly evolving risk structure. Second, the bureaucracy he, in theory, manages receives the constant message that the president doesn’t want to be bothered with bad news and does not value the parts of the government that produce it, nor the people who force him to face it.
It is, in fact, worse than that. “The way to keep your job is to out-loyal everyone else, which means you have to tolerate quackery,” Anthony Scaramucci, who served (very) briefly as White House head of communications, told the Financial Times. “You have to flatter him in public and flatter him in private. Above all, you must never make him feel ignorant.”
In March, speaking at the Centers for Disease Control and Prevention headquarters, Trump unintentionally revealed how much time his underlings spend praising him, and how fully he absorbs their compliments. “Every one of these doctors said, ‘How do you know so much about this?’” Trump boasted. “Maybe I have a natural ability. Maybe I should have done that instead of running for president.””
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” “When the president stands on top of a table and says, ‘This is super important, super urgent, everyone must do this,’ the government works moderately effectively,” Ron Klain, who managed the Obama administration’s Ebola response, told me. “That’s the best case. When the president is standing up and saying, ‘I don’t want to hear about it, I don’t want to know about it, this doesn’t really exist,’ well, then you’re definitely not going to get effective work from the government.””
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“we conflate the unlikely and the impossible. This pandemic, if nothing else, should shatter that conflation. It is hard to pretend the worst can’t happen when you haven’t been able to enter a store or see your parents for six weeks. And let’s be clear: coronavirus is not the worst that can happen. The H5N1 virus, for instance, has a mortality rate of 60 percent, and scientists have proven that it can mutate to become “as easily transmissible as the seasonal flu.”
Even scarier is the possibility of human-engineered pandemics. As bad as the coronavirus is, Bill Gates told me, “it’s not anywhere near bioterrorism — smallpox or another pathogen that was intentionally picked for a high fatality rate as well as delayed symptoms and a high infectious rate.”
We play for the highest of stakes. We must do what we can to improve our odds.”
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“No one bears a heavier burden in that respect than the US president. But Trump is reckless with his charge. That reflects, perhaps, his own life experience. He has taken tremendous risks, and if they have led him to the edge of ignominy and bankruptcy, they have also led him to the presidency.
But he has always played with other people’s money and other people’s lives. “The president was probably in a position to make riskier decisions in life because he was fabulously rich from birth,” says Murphy. “But it’s also true he has had a reputation for risk not backed up by reality. His name is on properties he doesn’t own. We think of him as taking risk in professional life, but a lot of what he does is lend his name to buildings with risks taken by others. He’s built an image as a risk taker, but it’s not clear how much risk he’s taken.”
In electing him president, however, we have taken a tremendous risk, and it isn’t paying off.”
“For years, states have been warned to stop making unrealistic promises about investment returns—a trick used to make shortfalls look smaller than they really are—and to fully fund their retirement systems instead of deferring payments to later years. Both strategies are widespread in state pension systems, and both have contributed to the mess that states now face. Policy makers have clung to the belief that reforms were unnecessary because future investment growth would close the funding gaps.
That idea should now be dispelled. Even a decade of growth wasn’t enough for many pensions to fully recover from the last recession—and that should have been a warning right there, if policy makers were paying attention.”