Can RFK Jr. Fix Our Dysfunctional Public Health Agencies?

“The NIH is the world’s largest public funder of biomedical and public health research, with a budget of $47 billion, most of which is used to support research at universities and academic medical centers. The agency has long been criticized for being way too risk-averse when it comes to choosing which research projects to fund.”

“Being informed by the best information is certainly the right goal. But RFK Jr.’s long history of anti-vaccination agitation suggests he is not a source of the best information for the safety and efficacy of modern vaccines. This includes false assertions that vaccines cause autism; that they are not tested using placebo-controlled trials; and, contradicting the previous claim, that COVID-19 vaccines killed more people than did a placebo.
Again, the CDC needs fixing, but RFK Jr.’s skepticism about the safety and efficacy of modern vaccines would further undermine what should be the CDC’s main focus: the prevention of the spread of dangerous infectious diseases.”

“Four years into the post-COVID era, most research has found that ivermectin and hydroxychloroquine provide no treatment benefit for the infected. In April, the Journal of Infection published a report about a randomized controlled trial that concluded, “Ivermectin for COVID-19 is unlikely to provide clinically meaningful improvement in recovery, hospital admissions, or longer-term outcomes.””

“Giving drug development and infectious disease an eight-year break seems inadvisable. After all, the death rate for cancer has continued to drop from 2016 to today, partially as a result of lower incidence stemming from lifestyle changes, but also because of better and more widely available pharmaceutical treatments. Recent calculations show the value of medicines to patients far outweigh the profits the drug companies rake in. And, as ever, infectious diseases lurk in the background waiting for us to lower our guards or seeking just the right mutation to enable them to jump into the human population.”

“RFK Jr.’s solution to stemming the tide of chronic illnesses is better diets and physical fitness. History suggests government interventions will have little effect on either. After all, the federal government has been periodically issuing dietary guidelines since 1979 and promoting physical fitness since 1956. The Lancet authors agree with RFK Jr.’s aspirations but suggest in the meantime that “regulations need to be put in place to eliminate barriers to accessing new-generation obesity clinical treatments, ensuring the availability and affordability of these options to the broader population.””

“The FDA needs streamlining to speed biomedical innovation, the NIH needs greater risk-taking in research, and the CDC needs to be laser-focused on preventing infectious diseases. None of these appear to be high on the agenda of possible incoming secretary of health and human services.”

https://reason.com/2024/11/15/can-rfk-jr-fix-our-dysfunctional-public-health-agencies/

Noah Smith is too down on nuclear energy

“Noah acknowledges, in passing, one particular provision of the existing nuclear regulatory framework on the United States that’s very important: radiation is held to the As Low As Reasonably Achievable (ALARA) standard, which makes it essentially impossible for nuclear to be cost-competitive.
Suppose I had a design for a cost-effective nuclear reactor, and I said I should be allowed to build it, because electricity is good and air pollution is bad. The regulator is going to look at it and say, “Well, that reactor seems awfully cheap to build, why not add a bunch more features to make the radiation levels even lower?” And then I will say, “That would be hideously expensive in a way that is net bad for public health, because it leads to more burning of fossil fuels and worse air pollution.” But the regulator comes back and says, “We’re not using a cost-benefit framework, we’re using ALARA.” And I say, “That doesn’t make sense, coal ash is radioactive — you are creating more radiation by raising my costs.” And the regulator says, “I don’t regulate coal plants, I regulate you — ALARA!”

As Jason Crawford writes, “any technology, any operational improvement, anything that reduces costs, simply gives the regulator more room and more excuse to push for more stringent safety requirements, until the cost once again rises to make nuclear just a bit more expensive than everything else. Actually, it‘s worse than that: it essentially says that if nuclear becomes cheap, then the regulators have not done their job.”

This is a deeply dysfunctional regulatory paradigm, and it reflects the Nuclear Regulatory Commission’s origins in 1974 legislation that was explicitly motivated by a belief that the old Atomic Energy Commission was too friendly to the industry.

In 2019, Congress passed the Nuclear Energy Innovation and Modernization Act, which, among other things, “requires the NRC to develop new processes for licensing nuclear reactors, including staged licensing of advanced nuclear reactors.” The hope of NEIMA’s proponents was to change 45 years of the NRC fundamentally being an agency that says “no” to stuff and make them into an agency that would create a regulatory pathway under which new kinds of nuclear reactors could be licensed and built. And after several years, the NRC did get around to writing the new rules for SMRs, but they came up with an even longer and more cumbersome regulatory process.

Earlier this summer, the ADVANCE Act reiterated Congress’s determination for the NRC to change.

But the NRC staff, to the best of my knowledge, fundamentally does not believe that America’s elected officials genuinely want them to make it faster and cheaper to build nuclear reactors. And one reason they don’t believe it is that even though the Biden administration says lots of pro-nuclear stuff, has plenty of pro-nuclear appointees, signed the ADVANCE Act, and has done a lot to help with SMRs in terms of financing, they still coughed-up an NRC nominee who basically supports the status quo. You need a team of political appointees at the agency who are willing to both drive change and also personally take the heat when change makes people mad. You can’t “just use nuclear, bro.” You need to put people in place to actually drive specific policy change in a way that will let the industry grow and work.

And of course, even if you did that, it might not work.”

https://www.slowboring.com/p/noah-smith-is-too-down-on-nuclear

Idaho Child Care Program Faces $16 Million Deficit as Bureaucrats Overextend Benefits

“The driver of the ICCP’s $16 million budget deficit wasn’t just the rising cost of child care, but also the agency’s overpromising of generous welfare benefits at the expense of taxpayers.”

https://reason.com/2024/08/28/idaho-child-care-program-faces-16-million-deficit-as-bureaucrats-overextend-benefits/

J.D. Vance has made it impossible for Trump to run away from Project 2025

“Former President Donald Trump has lately been trying to distance himself from Project 2025, claiming it was cooked up by the “severe right” and that he doesn’t know anything about it.
But it turns out the severe right is coming from inside the house.

Kevin Roberts, the self-proclaimed “head” of Project 2025, has a book coming out in September — and the book’s foreword is written by Trump’s vice presidential candidate, J.D. Vance, who lavishly praises its ideas.

“Never before has a figure with Roberts’s depth and stature within the American Right tried to articulate a genuinely new future for conservatism,” Vance writes, according to the book’s Amazon page. “We are now all realizing that it’s time to circle the wagons and load the muskets. In the fights that lay ahead, these ideas are an essential weapon.”

What ideas? Like Vance, Roberts is obsessed with the idea that the left controls major American institutions — he lists Ivy League colleges, the FBI, the New York Times, the National Institute of Allergy and Infectious Diseases, the Department of Education and even the Boy Scouts of America. The book argues that “conservatives need to burn down” these institutions if “we’re to preserve the American way of life.” (Vox has requested a copy of the book, but has not yet received one at the time of this writing.)

Obviously, this poses a problem for Trump’s attempts to distance himself from the virally unpopular Project 2025 and its lengthy agenda for what he should do if he wins, which includes proposals to restrict abortion access and centralize executive power in the presidency.

And it’s one more indication that Trump’s pick of Vance might be politically problematic for him. Vance has a fascination with provocative and extreme far-right thinkers, and a history of praising their ideas. He is not a running mate tailored to win over swing voters who are concerned Trump might be too extreme — quite the opposite.

The book was written and announced before Vance was chosen as Trump’s running mate. But there’s some indication that people involved had some late second thoughts about it. It was originally announced as “Dawn’s Early Light: Burning Down Washington to Save America,” with a cover image showing a match over the word “Washington.”

More recently, though, the subtitle has been changed to “Taking Back Washington to Save America,” and the match has vanished from the cover.”

“Project 2025 contains a multitude of proposals in its 922-page plan, not all of which J.D. Vance necessarily supports.

But he’s on record backing ideas similar to those put forth in two of Project 2025’s most controversial issue areas.

The first is abortion. Project 2025 lays out a sweeping agenda by which the next president could use federal power to prevent abortions, including using an old law called the Comstock Act to prosecute people who mail abortion pills, and working to prevent women from abortion-banning states from traveling out of state to get abortions.

Vance is on record supporting these ideas. Last year, he signed a letter demanding that the Justice Department prosecute physicians and pharmacists “who break the Federal mail-order abortion laws.” In 2022, he said he was “sympathetic” to the idea that the federal government should stop efforts to help women traveling out of their states to get abortions. That year, he also said: “I certainly would like abortion to be illegal nationally.”

At other points, Vance has struck a different tone. ““We have to accept that people do not want blanket abortion bans,” he said last December. And this month he said he supported a Supreme Court decision that allowed the abortion bill mifepristone to remain available. Here, Vance is trying to align with Trump, who — fearing political blowback — argues he merely wants abortion to be a state issue, despite his long alliance with the religious right. But Vance’s record implies his true agenda might be otherwise.

The second controversial area where Vance is sympatico with Project 2025 is centralizing presidential power over the executive branch. The project lays out various proposals to rein in what conservatives view as an out-of-control “deep state” bureaucracy — mainly, by firing far more career civil servants and installing far more political appointees throughout the government.

Vance, as I wrote last week, has backed a maximalist version of this agenda. In 2021, Vance said that in Trump’s second term, Trump should “fire every single midlevel bureaucrat, every civil servant in the administrative state, replace them with our people.” The courts would try to stop this, Vance continued, and Trump should then “stand before the country like Andrew Jackson did, and say, ‘The chief justice has made his ruling. Now let him enforce it.’”

So it’s no big surprise that Vance would write the foreword for a book by Project 2025’s architect. They fundamentally agree on how they see the world, and in much of what they want out of politics: a battle against the left for control of institutions, and expanded government power to stop abortions.”

https://www.vox.com/politics/362917/jd-vance-project-2025-book-kevin-roberts-trump

J.D. Vance’s radical plan to build a government of Trump loyalists

“Donald Trump’s allies have laid out sweeping plans to reshape the executive branch of the federal government if he is returned to power, plans that involve firing perhaps tens of thousands of career civil servants and replacing them with handpicked MAGA allies.
But how far, exactly, would Trump go in trying to tear down what he calls the “deep state?” The answer hasn’t been clear.

In picking J.D. Vance as his vice president, he’s picked someone who will egg him on to go very far indeed.

“If I was giving him one piece of advice” for a second term, Vance said on a 2021 podcast:

“Fire every single midlevel bureaucrat, every civil servant in the administrative state, replace them with our people.”

That was no idle talk. To an extent unusual for a politician — and perhaps because he hasn’t been in politics very long — Vance is interested in big ideas. He’s been deeply influenced by thinkers on the movement known as the New Right, who want to seize and transform societal institutions they believe are dominated by the left.

A big part of that would involve a restored President Trump purging any resistance to him, or checks on his power, from the executive branch.”

“As Trump was about to leave office in 2020, he finally got around to trying to do something about the supposed “deep state”: He issued an executive order known as Schedule F.

This order laid the groundwork for reclassifying as many as 50,000 career civil servant jobs as political appointees who could then be fired and replaced by Trump. He was out of office before it could be implemented, however, and Biden quickly revoked it.

There’s been much fear about Trump restoring this policy in his second term, replacing a great many nonpartisan career experts with political hacks or ideologues willing to go along with his extreme or corrupt plans.

Such a move could be implemented in any number of ways, from the more limited and less disruptive to more sweeping and very disruptive. Considering Trump has only intermittent interest in the details of policy and implementation, I’ve thought that how this plays out would depend on who staffs his administration, since he could be pulled in various directions. Advisers worried about chaos and political blowback could counsel restraint.

Vance would not do that. He would be a key voice in Trump’s administration urging him to go very big indeed.

Elsewhere in the podcast, Vance said that the courts would inevitably “stop” Trump from trying to fire so many employees. When they do, Vance went on, Trump should “stand before the country like Andrew Jackson did, and say, ‘The chief justice has made his ruling. Now let him enforce it.’”

That is: Vance urged that Trump radically remake the executive branch even if the Supreme Court said doing so was illegal.”

https://www.vox.com/politics/361455/jd-vance-trump-vice-president-rnc-speech

SCOTUS Repudiates Doctrine That Gave Agencies a License To Invent Their Own Authority

SCOTUS Repudiates Doctrine That Gave Agencies a License To Invent Their Own Authority

https://reason.com/2024/06/28/scotus-repudiates-doctrine-that-gave-agencies-a-license-to-invent-their-own-authority/

The Supreme Court decides not to trigger a second Great Depression

“The Supreme Court delivered a firm and unambiguous rebuke to some of America’s most reckless judges on Thursday, ruling those judges were wrong to declare an entire federal agency unconstitutional in a decision that threatened to trigger a second Great Depression.
In a sensible world, no judge would have taken the plaintiffs arguments in CFPB v. Community Financial Services Association seriously. Briefly, they claimed that the Constitution limits Congress’s ability to enact “perpetual funding,” meaning that the legislation funding a particular federal program does not sunset after a certain period of time.

The implications of this entirely made-up theory of the Constitution are breathtaking. As Justice Elena Kagan points out in a concurring opinion in the CFPB case, “spending that does not require periodic appropriations (whether annual or longer) accounted for nearly two-thirds of the federal budget” — and that includes popular programs like Social Security, Medicare, and Medicaid.

Nevertheless, a panel of three Trump judges on the United States Court of Appeals for the Fifth Circuit — a court dominated by reactionaries who often hand down decisions that offend even the current, very conservative Supreme Court — bought the CFPB plaintiffs’ novel theory and used it to declare the entire Consumer Financial Protection Bureau unconstitutional.

In fairness, the Fifth Circuit’s decision would not have invalidated Social Security or Medicare, but that’s because the Fifth Circuit made up some novel limits to contain its unprecedented interpretation of the Constitution. And the Fifth Circuit’s attack on the CFPB still would have had catastrophic consequences for the global economy had it actually been affirmed by the justices.

That’s because the CFPB doesn’t just regulate the banking industry. It also instructs banks on how they can comply with federal lending laws without risking legal sanction — establishing “safe harbor” practices that allow banks to avoid liability so long as they comply with them.

As a brief filed by the banking industry explains, without these safe harbors, the industry would not know how to lawfully issue loans — and if banks don’t know how to issue loans, the mortgage market could dry up overnight. Moreover, because home building, home sales, and other industries that depend on the mortgage market make up about 17 percent of the US economy, a decision invalidating the CFPB could trigger economic devastation unheard of since the Great Depression.

Thankfully, that won’t happen. Seven justices joined a majority opinion in CFPB which rejects the Fifth Circuit’s attack on the United States economy, and restates the longstanding rule governing congressional appropriations. Congress may enact any law funding a federal institution or program, so long as that law “authorizes expenditures from a specified source of public money for designated purposes.””

https://www.vox.com/scotus/24158216/supreme-court-cfpb-clarence-thomas-community-financial

Congress takes aim at nation’s nuclear regulator

“Lawmakers who support a new generation of advanced nuclear power are setting their sights on what they see as the technology’s top obstacle: the Nuclear Regulatory Commission.
The Biden administration has touted small, factory-built reactors as a possible lifeline for an aging nuclear industry and a crucial step toward cutting the nation’s planet-warming emissions. But only one reactor design has gotten the greenlight from the NRC, and administration-backed advanced nuclear energy projects are struggling to get off the ground.

Key leaders in the House and Senate are now considering fundamental changes to the NRC, an independent federal agency tasked with protecting public safety and health.

The House Energy and Commerce and Senate Environment and Public Works committees are negotiating a compromise legislative package that would streamline regulations at the NRC and potentially adjust the agency’s mission statement, as I write today.

The talks come after four Senate Democrats recently kneecapped a renomination bid for one of the NRC’s longtime regulators, Jeff Baran, who was first appointed by former President Barack Obama.

Sen. Joe Manchin (D-W.Va.) was among the Democrats who called Baran an overzealous regulator overtly hostile to nuclear energy. Today, Manchin said he won’t support any nominee who’s too focused on safety.

“We’re just looking for people who understand that we have to have nuclear energy in the mix,” Manchin said.

Lawmakers believe fundamentally changing the NRC, in leadership and policy, will give so-called small modular reactors a fighting chance to succeed.”

https://www.politico.com/newsletters/power-switch/2024/01/24/congress-takes-aim-at-nations-nuclear-regulator-00137531

‘Something Was Badly Wrong’: When Washington Realized Russia Was Actually Invading Ukraine

“Daleep Singh, deputy national security adviser for international economics, National Security Council, White House: We thought we had quelled his appetite for territory by meeting him in Geneva and trying to address some of the strategic concerns he’d been raising, but then here we were again, with an even larger force.”

“Gen. Mark Milley: It’s 30 days after the exit from Afghanistan. Some people said that the invasion of Ukraine was a result of the withdrawal. I don’t agree. It’s obvious the invasion was planned before the fall of Afghanistan.”

“Bill Burns: [While I was in Moscow,] I was talking to [Putin] on a secure phone. It was a strange conversation. He was in Sochi — this was the height of yet another wave of Covid, Moscow itself was under a curfew — so he was isolating himself. The conversation was pretty straightforward. I laid out what the president had asked me to lay out to him. His response was a lot of what I had heard before from him about his convictions about Ukraine, and in many ways, his cockiness about Russia’s ability to enforce its will on Ukraine. His senior advisers were pretty consistent as well. Not all of them were intimately familiar with his own decision-making, so at least one or two of them were a little bit surprised with what I laid out to them because the circle of advisers had gotten so small.”

“Bill Burns: My own impression, based on interactions with him over the years, was a lot of this had to do with his own fixation on controlling Ukraine. He was convincing himself that strategically the window was closing on his opportunity to control Ukraine.”

“Bill Burns: His conviction was that without controlling Ukraine and its choices, it’s not possible for Russia to be a great power and have this sphere of influence that he believes is essential. And it’s not possible for him to be a great Russian leader without accomplishing that.”

“Wally Adeyemo: The diplomacy between the president and the secretary getting people aligned on sanctions before Russia invaded was probably the biggest difference between this time and Crimea in terms of our ability to act quickly and effectively — things that we were unable to do back then.”

“Gen. Paul Nakasone: We sent a [U.S. Cyber Command] team forward, and they land in Kyiv on the fourth of December. Within a day or two, the leader calls back, and she tells my Cyber National Mission Force commander, her boss, “We’re not coming home for a while. In fact, send more people.” We sent our largest “hunt forward” package into Kyiv. That stays there for a little over 70 days. What is a “hunt forward” operation? A hunt forward operation is focused at the partner’s request to look at a series of networks — we identify malware, tradecraft and anomalous behavior in those networks that point us to adversaries and allow the partner — in this case, Ukraine — to strengthen those networks.
The interesting thing that she — the team leader — said: “They’re really serious about this.” This is the third time that we had been back in Ukraine, and there was just a different feeling in terms of how Ukraine was approaching it. When we provided information, they were moving on it, correcting the vulnerability, and looking for more.”

“Amb. Michael Carpenter: We thought, “OK, if there’s a crisis of European security, then let’s talk about it. Let’s identify the Russian concerns and see if there’s a way that we can address them through diplomacy.” Poland assumed the chairperson-ship of the OSCE on January 1, 2022, and so I immediately went to go visit with the Polish Foreign Minister to talk about the diplomatic angle. He was very receptive, and subsequently launched a process called the renewed European Security Dialogue. Russia basically refused to engage, and that’s when it became increasingly clear the Kremlin really had no interest in diplomacy all along. It was bent on war.

All of its alleged concerns — everything that it was putting out there in the public domain — was really a smokescreen. They turned their backs completely on the diplomacy that we were proposing at the OSCE, the diplomacy that was being proposed on behalf of NATO and then also bilaterally what we were discussing with the Russians. There was nothing to offer them, because they didn’t even want to talk.”

“Bill Burns: I saw Zelenskyy in the middle of January to lay out the most recent intelligence we had about Russian planning for the invasion, which by that point had sharpened its focus to come straight across the Belarus frontier — just a relatively short drive from Kyiv — to take Kyiv, decapitate the regime and establish a pro-Russian government there. With some fair amount of detail, including, for example, the Russian intent to seize an airport northwest of Kyiv called Hostomel, and use that as a platform to bring in airborne forces as well to accelerate the seizure of Kyiv.”

“Antony Blinken: I saw Foreign Minister Lavrov in Geneva in late January, the 21st, because we were determined to exhaust every diplomatic avenue. It was incredibly blustery in Geneva — I’ve never seen Lake Geneva more agitated in my life, like an ocean with a major storm setting in. I alluded to that and said, “You know, we have a responsibility to see if we can calm the seas — calm the lake.” Lavrov was uncharacteristically focused on his talking points, and there wasn’t much extemporaneous give and take, which is not usually the case with him.

I wanted to see if there was some final way of breaking through and suggested we spend some time alone after the meeting with our teams. We sat in chairs about a foot from each other. I asked him, “Tell me, what are you trying to do? What is actually going on here? Is this really about your purported security concerns? Or is this about something theological, which is Putin’s conviction that Ukraine is not an independent state and has to be subsumed into Russia? If it’s the former, if this is genuinely from your perspective about security concerns that Russia has, well we owe it to try to talk about those and our own profound security concerns about what Russia is doing, because we need to avert a war. But if it’s about the latter, if this is about this profoundly misplaced view that Ukraine is not its own country, and you’re determined to subsume it into Russia, well, there’s nothing to talk about.” He couldn’t or wouldn’t give me a straight answer.”

“Emily Horne: We decided Jake was going to go out to the podium with [White House spokesperson] Jen [Psaki] the next day and do a couple of things: One, was going to make very, very clear that any American or dual nationals in Ukraine needed to get out immediately and that the calvary would not come to rescue Americans after an invasion has begun. That was certainly a lesson learned from Afghanistan: You can’t over-message that, and you have to be extremely clear, even at the risk of causing a little bit of panic. The Ukrainians were not terribly happy about that message, but we absolutely did not have a choice, given what we were seeing. The new phrase that Jake deployed on that February 11 press conference was “We are in a window where an invasion could begin at any time.””

“Gen. Mark Milley: I know that was a huge lot of diplomacy. There’s a lot of effort being done by Secretary Austin, Secretary Blinken, Jake Sullivan, myself, the president himself, to try to dissuade Russia from doing this and to warn them if they did it these will be likely consequences.

Derek Chollet: There have been multiple attempts — not just by us. There were other countries, the French, the Germans, others were engaging Putin. No one was getting anywhere.”

“Antony Blinken: The invasion didn’t take place for another week, precisely because we were able to call Putin out publicly. The fact that we were able to continue to declassify information, call him out at the Security Council, have the president use the ultimate bully pulpit to call him out — that put them a little bit off the timeline that we had seen.”

“Jake Sullivan: This was uncharted territory — the idea that there would be a major land war in Europe, with all of the ripple effects that that could cause, that felt like an enormous weight on me, on the whole team, most especially on the president. It was extremely hard to sleep.”

“Gen. Mark Milley: The Ukrainians, at the very end — probably about two weeks prior — really begin to mobilize their country into a nation at arms. They really got into full swing, where you started seeing all the men — and a lot of the women — learning how to use weapons, mines, hand grenades, explosives and all that stuff. Then you also saw a significant mobilization of Ukrainian people into the army — reservists — and you saw the disposition of the Ukrainian forces to begin to change into their wartime locations.

There was a large evacuation of civilians out of what was expected to be the frontline areas, a real flurry of diplomatic activity, and then also decisions made by the international community — most countries pulled out their embassies out of Kyiv. That’s a big, big decision. When you start seeing stuff like that happening, you start realizing that war is getting close.”

“Matthew Miller: There is sometimes this unrealistic sense that America can wave a magic wand and control the world. That’s just not true. We don’t have magic wands.”

“Colin Kahl: Sometimes people say, “Well, if you were going to give them this stuff, why didn’t you give them all at the beginning?” And the reality is, as a matter of dollars and logistics, we couldn’t. We’ve given $27 billion of security assistance. We didn’t have $27 billion at the beginning of the war. As a matter of actual and bureaucratic physics, you have to prioritize. What the secretary has been ruthless about is, “What does Ukraine need right now for the fight?” In the initial phases of the conflict, that was anti-armor, man-portable and short-range air defense systems, and artillery and ammunition for their Soviet legacy systems, and more Soviet legacy air defense systems. We poured in the Javelins and the Stingers and scoured our own stocks from the Cold War for Soviet era ammunition and stuff we swept up around the globe.”

“Gen. Mark Milley: People don’t think about war — even today. When I say to people, “There have been 35,000 or 40,000 innocent Ukrainians killed in this war, a third of their economy has been destroyed, an estimated 7 million internally-displaced persons, and another 7 million refugees out of a pre-war population of 45 million — you’re looking at 30 to 40 percent of that country displaced out of houses.” People sit there and go: “Oh?””