“Only a tiny portion of the spending in the bill goes toward vaccinations and other priories directly related to the pandemic.
Much of the rest of the spending is not well-suited, or even designed, to respond to current economic conditions, which are increasingly favorable.”
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“Take public education, where Democratic-allied teacher unions dominate. It’s not clear why any additional spending is necessary, given that tens of billions of education funding from prior Covid relief bills are still unspent, even as many districts have already begun to reopen for in-person instruction.
Nonetheless, the bill spends roughly another $130 billion on K-12 education. According to a CBO estimate, by the time most of the money is spent we will have long exited the pandemic that supposedly justifies it.”
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” The $350 billion in aid to states and localities comes despite state and local tax revenue being down only a tick through much of 2020 compared with the year before. According to widely cited Moody’s economist Mark Zandi, the state and local funding gap will be roughly $60 billion through fiscal 2022. Still, states and localities will be showered with money, after more than $500 billion in aid to states and localities last year.”
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“The bill spends $86 billion bailing out union-negotiated multi-employer pension plans.
Transportation gets tens of billions of new spending, which by its nature doesn’t happen quickly, and more than $30 billion goes to expanding Obamacare, a long-term Democratic policy goal.”
“Although less than half of 1 percent of the U.S. population resides in nursing homes, they account for nearly 40 percent of all Covid deaths. Nursing homes are supposed to help residents remain safe and healthy, but the opposite turned out to be the case: When it came to the coronavirus, residents in nursing homes were more vulnerable, not less.”
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“rebuilding nursing home facilities is an expensive and long-term solution to an immediate crisis. I’ve been studying long-term care settings for many years, and I think there’s a quicker and possibly even more effective approach we can take in the short term to ensure better care for our seniors in the post-Covid era: improve staffing.
It’s no secret that nursing home staff are paid relatively poorly for incredibly demanding work. Certified nurse aides who provide over 90 percent of direct resident care are often paid at or near minimum wage — the same wages as entry-level workers in retail establishments or fast-food chains. Nursing staff are also underpaid; registered nurses and licensed practical nurses who work in nursing homes are often paid below their counterparts who work in hospitals and other health care settings.
What’s more, nursing home staff often lack essential benefits, like health insurance and paid sick leave. That means nursing home workers are incentivized to come to work even when sick — how does that make sense when they are caring for medically vulnerable residents during a pandemic?
Nursing homes are also very hierarchical workplaces with lower-level staff having little autonomy and control in their jobs. Not surprisingly, being undervalued and unempowered makes it hard to recruit and retain individuals to work in nursing homes.
The result is that many facilities around the country often have dangerously low levels of staffing. Additionally, the average U.S. nursing home was recently found to have an annual staff turnover rate of 128 percent. This suggests an average facility’s staff completely changes over the course of a year, and many nursing homes have even higher turnover rates — as much as 300 percent — suggesting the staff changes every four months. If some part of good nursing home quality depends on the relationship between staff and residents, it’s hard to see how those relationships can develop when staff keep changing.”
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“There are a number of things we can do to improve this situation. Here are a few ideas”
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“One solution would be to increase the number of direct care workers by raising the federal minimum staffing standards in nursing homes. The federal standards are relatively low and have not been updated in over 30 years. Many states set staffing levels above the federal standards and these state policies have generally been found to increase staff.”
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“Another idea is to raise minimum wages to increase nursing home staff pay. Many certified nurse aides would see their hourly wages increase under the $15 minimum wage proposed by the Biden administration. In the absence of a broader minimum wage hike, policymakers could also increase wages specifically for nursing home and other long-term care workers.”
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“The elephant in the room is what additional Medicaid or other public funding would be necessary to pay for greater staffing and higher wages. The nursing home industry will inevitably push back against any “unfunded mandates.” The Medicare Payment Advisory Commission has found overall nursing home operating margins are currently thin based on the Medicare cost reports. However, there is quite a bit of variability in profitability across facilities. It is also unclear whether some facilities are accurately reporting their costs. Resident advocates have questioned whether a sufficient amount of existing public nursing home funds are spent on staffing. Thus, higher Medicaid funding will be necessary to improve staffing levels and wages, but it needs to be paired with the next suggestion.”
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“We currently lack transparency in how nursing homes spend public dollars on staffing and other areas. Nursing homes are required to submit Medicare cost reports each year to detail their revenues and spending, but these data are known to be incomplete, especially in the context of increasingly complicated corporate ownership arrangements. A series of financial reporting and oversight steps need to be taken to tighten the requirements for facilities. The bottom line is that regulators need to be able to follow the public’s money and ensure it is being spent on staffing as policymakers intended.”
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“Beyond putting more money into wages, policymakers might also consider ways in which they could provide financial support to allow additional education and training to certified nursing assistants and licensed practical nurses seeking upward mobility within a facility. For example, some nursing homes currently have ladder programs that provide nursing assistants with financial support in seeking nursing degrees. These programs could be expanded through direct reimbursement via Medicare and Medicaid.”
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“Improving wages and benefits is a necessary but insufficient step towards valuing nursing home caregivers; we also need to begin to value the work these individuals do and the individuals that do it. If you can believe it, this might be harder than increasing staffing standards and wages. Finding additional money is one thing — changing the culture around nursing home staffing is another.”
“The US did succeed at flattening the curve — at least at first. Businesses closed and most states issued stay-at-home orders; later research concluded those lockdown measures helped prevent tens of millions of Covid-19 cases.
But America failed to take advantage of that window to ramp up its virus testing and tracing capabilities, and states quickly faced intense pressure to relax their policies to alleviate the economic costs of the shutdowns. Reopening began earlier than public health experts believed it should. The political will to impose new lockdowns had evaporated by the time cases spiked again.
At the end of 2020, with more than 20 million Covid-19 cases and nearly 350,000 deaths in the US, it is evident that trying to flatten the curve was not sufficient to end the pandemic. That doesn’t mean it failed entirely. Slowing the spread of Covid-19 was meant to buy time to figure out what came next. But the US never did.”
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“Multiple studies have found that mitigation measures suppressed the virus’s spread and likely prevented millions of cases — and with them many deaths. A study published in Health Affairs in May found that social distancing policies, particularly stay-at-home orders and closing bars and restaurants, had staved off as many as 35 million cases in the US by the end of April. More recent research published in Science concluded that closing schools and businesses, as well as limiting the size of private gatherings, reduced spread considerably.
“NYC flattened the curve. Other places delayed it,” William Hanage, an epidemiologist at Harvard University, told me. “But that ought to provide an opportunity to ramp up testing and health care and prepare people for the long haul. You know that did not happen.”
Experts came up with roadmaps for how to proceed once the initial curve was flattened. A proposal from the American Enterprise Institute set specific thresholds for case numbers, hospital capacity, and testing that were designed to allow states to safely begin relaxing their lockdown measures once the virus had been sufficiently suppressed and the health system’s capacity had been expanded.
But the Trump administration never embraced those plans. Instead, the president often said that the cure (lockdowns) could not be worse than the disease (Covid-19). The White House eventually settled on a message that the US would need to learn to live with the virus.”
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“many US states that had avoided the worst of Covid-19 in the spring saw the lack of an outbreak as a sign that they could push ahead with reopening. Once the curve was flat, the political will to keep it that way began to crumble.
America wasn’t the only place to struggle with figuring out how to move forward from its spring lockdown; many European countries saw their own second waves over the summer. But the missed opportunity still set the course for the rest of the pandemic.”
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“In some ways, flattening the curve did work as intended.
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“Hospitals have not — yet — been overwhelmed, as they were in the dire situation in Lombardo, Italy, in the spring. But today, with cases and hospitalizations still rising, US hospitals warn they are again nearing a breaking point.
Slowing the spread of the disease in the spring also gave scientists a chance to learn more and more about the virus.
Among other things, they learned that people were the most infectious before they showed symptoms. They figured out the virus primarily spread through respiratory droplets, not through touch or surfaces. The elevated fatality risk to the elderly became more apparent. Researchers quickly began to figure out which treatments worked (putting patients in a prone position, administering remdesivir and dexamethasone) and which ones didn’t (the Trump-favored hydroxychloroquine).
With this information, the US could have used the time it bought by flattening the curve to figure out whether more targeted interventions would work better than lockdowns, as the Science study suggested, and whether individual cities or counties could best manage their own outbreaks.”
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“in other ways, flattening the curve still failed to accomplish its goal of preserving health care access. While hospitals have not yet been completely overwhelmed, some people aren’t getting the care they need. ProPublica reported that over the summer in Houston, medical examiners saw a spike in the number of people found dead in their homes. Some of those deaths were from Covid-19; some were from heart attacks, strokes, and other conditions. Either way, the news of the virus’s rapid spread in the area may have kept people from seeking medical assistance, with deadly consequences.”
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“330 million Americans were left to make their own risk assessments — or not.
Given the research that shows a small percentage of infected people account for a very large share of the transmission, that was a recipe for disaster. And rather than take proactive measures as infection rates first ticked up, which public health experts say are most important given the pre-symptomatic spread of Covid-19 and its slow gestation, governors seemed to be paralyzed and waited to act until the crisis was already upon them.
“Every American’s personal definition of Covid-caution is completely unique, with some holed up at home for weeks at a time and others traveling the country to visit friends,” Kumi Smith, an epidemiologist at the University of Minnesota, told me over email. “While the institutional level measures may seem extreme, if they had been more uniformly implemented around the country for longer, we might have been able to achieve low enough community transmission to the point that a careful reopening coupled with other measures like contact tracing and widespread testing and isolation would have been possible.””
“At least $63 billion—an amount larger than the current annual budgets of 42 states—of the boosted unemployment payments distributed as part of the federal government’s pandemic response has been distributed improperly, according to an estimate from the Department of Labor Office of the Inspector General. The office attributes a “significant portion” of those improper payments to fraud, and preliminary audits indicate that the actual amount of improper payments may be higher.”
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“The inspector general reports “a forty-fold increase” in the number of fraud-related matters, which have “exploded” since the CARES Act passed.”
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“payments to people who can’t work because of the pandemic (or due to the government’s response to it) is a defensible proposal. But even defensible proposals have costs to consider. Extending the federally boosted unemployment payments through August will cost taxpayers an estimated $246 billion—and that likely means that another $24 billion, or more, will be lost to fraud.”
“What the 95 percent figure really means here is that vaccinated people in the clinical trials had a 95 percent lower risk of getting COVID-19 compared with the unvaccinated control group participants. That means that vaccinated people were 20 times less likely than the control group to get COVID-19.”
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” There is even more good news about COVID-19 vaccine efficacy. As LiveScience reports, the Pfizer/BioNTech, Moderna, and Johnson & Johnson clinical trials all found that their vaccines were essentially 100 percent effective in preventing severe disease six to seven weeks after trial participants had received a first/single dose. As biotech journalist Anna Nowogrodzki notes, “Zero vaccinated people in any of the trials were hospitalized or died of COVID-19 after the vaccines had fully taken effect.” Now that’s the kind of vaccine efficacy that we can all cheer.”
“Vaccine supply chains are extremely specialized and sensitive, relying on expensive machinery, highly trained staff and finicky ingredients. Manufacturers have run into intermittent shortages of key materials, according to the U.S. Government Accountability Office; the combination of surging demand and workforce disruptions from the pandemic has caused delays of four to 12 weeks for items that used to ship within a week, much like what happened when consumers were sent scrambling for household staples like flour, chicken wings and toilet paper.
People often question why the administration can’t use the mighty Defense Production Act — which empowers the government to demand critical supplies before anyone else — to turbocharge production. But that law has its limits. Each time a manufacturer adds new equipment or a new raw materials supplier, they are required to run extensive tests to ensure the hardware or ingredients consistently work as intended, then submit data to the Food and Drug Administration. Adding capacity “doesn’t happen in a blink of an eye,” said Jennifer Pancorbo, director of industry programs and research at North Carolina State University’s Biomanufacturing Training and Education Center. “It takes a good chunk of weeks.”
And adding supplies at any one point only helps if production can be expanded up and down the entire chain. “Thousands of components may be needed,” said Gerald W. Parker, director of the Pandemic and Biosecurity Policy Program at Texas A&M University’s Scowcroft Institute for International Affairs and a former senior official in the Department of Health and Human Services office for preparedness and response. “You can’t just turn on the Defense Production Act and make it happen.”
The U.S. doesn’t have spare facilities waiting around to manufacture vaccines, or other kinds of factories that could be converted the way General Motors began producing ventilators last year. The GAO said the Army Corps of Engineers is helping to expand existing vaccine facilities, but it can’t be done overnight.
Building new capacity would take two to three months, at which point the new production lines would still face weeks of testing to ensure they were able to make the vaccine doses correctly before the companies could start delivering more shots.”
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“The Trump administration deployed the Defense Production Act last year to give vaccine manufacturers priority in accessing crucial production supplies before anyone else could buy them. And the Biden administration used it to help Pfizer obtain specialized needles that can squeeze a sixth dose from the company’s vials, as well as for two critical manufacturing components: filling pumps and tangential flow filtration units.”