“At the end of 2019, Congress repealed three significant tax components of the Affordable Care Act, a.k.a. Obamacare. Each of them had been included in the initial legislation to raise the revenue required to pay for the new spending the law called for.”
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“What’s the problem with the repeal of a bunch of taxes no one ever really liked? That’s probably what the lawmakers who voted to end the taxes were thinking too. The main effect will be to increase the deficit by a little more than $373 billion over the next decade—and, in the process, to further weaken a central argument made by supporters of the legislation.
Obamacare was passed on a promise that it would be deficit-neutral or even reduce the deficit slightly. The Congressional Budget Office estimated that the law would reduce the deficit during its first decade, provided that all of its provisions were enacted as the statute called for. As The New York Times noted last summer, the Cadillac tax “was expected to be a key cost-containment provision in President Barack Obama’s signature health law and one of the main ways it was supposed to pay for itself.”
There are obvious lessons here about what we might expect from various plans to “pay for” Medicare for All now being touted by various Democratic presidential hopefuls. If nothing else, this episode is a reminder of how Washington works: First, Congress passes a law setting up an expensive new program along with (if we’re lucky) a system to pay for it. Years later, amid a bipartisan spending binge, those taxes are repealed while the rest of the program remains on the books. The public barely notices, and the lawmakers involved shrug and move on.”
“The Food and Drug Administration has a protocol called emergency use authorization, or EUA, through which it clears tests from labs around the country for use in an outbreak. Getting more of these tests up and running would greatly increase the capacity of doctors and public-health officials to screen patients for the coronavirus.
Former FDA officials I spoke with said that during past outbreaks, EUAs could be granted in just a couple of days. But this time, the requirements for getting an EUA were so complicated that it would have taken weeks to receive one..clinical labs were not allowed to begin testing at all before they had received the EUA, even if they had already internally made sure their tests worked. Though these regulations are in place to ensure that faulty lab tests don’t get used on patients, several microbiologists told me they felt the precautions were excessive for a fast-moving outbreak of this scale.”
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““Labs and companies need samples of the virus itself in order to make their tests, but delays in getting access to samples further slowed down the test-development process. The coronavirus originated in China, and as several microbiologists told me, the Chinese government does not allow specimens to be shipped outside its borders.”
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“Even when working with nonauthoritarian countries, a combination of government processes, researcher reticence, complex shipping regulations, and patient-privacy concerns makes getting samples difficult for diagnostic companies like his.”
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““Even though some hospitals actually have the new, functional CDC tests, the extraction machines and reagents that are used to perform them are in short supply.”
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“For months, President Trump has made light of the coronavirus, telling attendees at a Black History Month reception, for instance, that perhaps the virus could miraculously disappear. He claimed on Twitter that the U.S. has done a “great job” handling the outbreak. Such a cavalier attitude seems unlikely to have motivated health officials to take things seriously.”
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“Containing a new infectious disease requires a lot of close collaboration between the president, the CDC, the FDA, and other parts of the Department of Health and Human Services, several Obama-era health officials told me. “One reason we were able to move quickly [during the Ebola outbreak] was that there was a great deal of coordination and issue spotting and troubleshooting that went on,” Hamburg, the former FDA commissioner, told me.”
“For six weeks behind the scenes, and now increasingly in public, Trump has undermined his administration’s own efforts to fight the coronavirus outbreak — resisting attempts to plan for worst-case scenarios, overturning a public-health plan upon request from political allies and repeating only the warnings that he chose to hear. Members of Congress have grilled top officials like Health and Human Services Secretary Alex Azar and Centers for Disease Control Director Robert Redfield over the government’s biggest mistake: failing to secure enough testing to head off a coronavirus outbreak in the United States. But many current and former Trump administration officials say the true management failure was Trump’s.”
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““Interviews with 13 current and former officials, as well as individuals close to the White House, painted a picture of a president who rewards those underlings who tell him what he wants to hear while shunning those who deliver bad news.”
https://www.vox.com/2020/3/11/21166621/coronavirus-quarantines-legal-constitution-new-rochelle
https://www.vox.com/science-and-health/2020/3/11/21173187/coronavirus-covid-19-hand-washing-sanitizer-compared-soap-is-dope
“Accurate testing is critical to stopping an outbreak: When one person gets a confirmed diagnosis, they can be put in isolation where they won’t spread the disease further. Then their contacts can be identified and put into quarantine so they don’t spread the virus if they’ve become infected, too.”
https://www.vox.com/future-perfect/2020/3/12/21172040/coronavirus-covid-19-virus-charts
“the talking point the Trump administration is using to dispel concerns that Maguire’s dismissal was politically motivated doesn’t carry water.”
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“Maguire’s ouster may be part of Trump’s broader effort to get rid of government officials he perceives as being insufficiently loyal. On Sunday, Jonathan Swan reported for Axios that the Trump administration has “assembled detailed lists of disloyal government officials to oust — and trusted pro-Trump people to replace them.””
“the military’s own bases are very vulnerable to the effects of climate change because of rising seas and forest fires, storms, and floods.”
“Are quarantines a proportionate response to the threat that COVID-9 poses in the United States? “I don’t think that we have seen enough proof, in any cases, that quarantine is necessary for this particular virus,” bioethicist Kelly Hills told Business Insider last month. “It doesn’t meet what we would consider the minimum standards necessary for violating somebody’s civil rights.”
In a Journal of the American Association commentary published last month, bioethicists Lawrence Gostin and James Hodge argued that “quarantines of passengers arriving from mainland China appear excessive and are inconsistent with available epidemiologic data.” They noted that “thousands of US residents who have returned from China are already sheltering at home,” adding that “home quarantine orders are lawful, effective, and more respectful of individual rights to liberty and privacy than restrictive, off-site measures.”
The Cato Institute’s Alex Nowrasteh argues that “extreme options like travel and immigration bans” would be more expensive than can be justified based on what we currently know about COVID-9. “The cheapest and most effective way to combat the transmission of flu-type viruses is proper hand hygiene,” he notes, recommending increased use of hand sanitizers, especially at airports and nursing homes.
Nowaresteh also notes that mass quarantines can backfire. “It’s difficult to know who is sick and who is not, so quarantines end up locking many sick people in with many healthy people,” he writes. “Healthy people and those who think they are healthy understand accurately that they would reduce their chance of becoming ill if they emigrate. By doing that, some people transmit the disease. Under some scenarios, the stricter the quarantine, the more people invest in emigrating. Sometimes, this behavioral response results in wider transmission of the disease.”
In a society that values civil liberties, forcibly detaining people who may be carrying a disease that is readily transmissible but has a relatively low case fatality rate is not a step that should be taken lightly. And assuming it can be justified, the burdens it imposes should be mitigated as much as possible.”