Kaci Hickox Is A Hero–Now On Two Counts

Kaci Hickox is a hero. First for volunteering to help treat Ebola patients, as eradicating Ebola in West Africa is the only way to handle this disease. She became a hero again for standing up to unjust restrictions upon her civil liberties upon returning home and supporting the concept of making political decisions based upon science and reason as opposed to giving in to public hysteria.

It was Hickox’s protests which forced Governors Christie and Cuomo to back away from guidelines policies which were both unnecessary and counterproductive. Some state governments are still going beyond the extremely cautious CDC guidelines with policies such as home quarantine of individuals who show no sign of the disease for twenty-one days. We know that this is unnecessary based both upon our knowledge of how the Ebola virus is transmitted and based upon our experience to date.  Ebola is not contagious early in the disease and is not transmitted by casual contact. While highly contagious when people are having symptoms such as projectile vomiting and uncontrolled diarrhea, those who do not have symptoms are not contagious. People with Ebola do not yet pose a danger of spreading the disease when they initially reach the CDC’s threshold of a fever of 101.4 degrees, and they certainly are not contagious before reaching this point.

We have seen one patient in Texas be released in error by an Emergency Room and return to the community. We have seen a nurse later revealed to be infected with Ebola fly with a low grade fever. We have had a doctor traveling around a city as densely populated as New York City just prior to meeting criteria for isolation. Not a single person has contracted Ebola due to contact with these individuals. That is the nature of the disease.

Kaci Hickox, well aware of the science, has stated she plans to fight the involuntary home quarantine being imposed:

“I will go to court to attain my freedom,” Hickox told “Good Morning America” today via Skype from her hometown of Fort Kent, Maine. “I have been completely asymptomatic since I’ve been here. I feel absolutely great.”

One of her attorney’s explained her legal position:

New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.

“The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty,” he said.

Hickox will abide by daily monitoring, as recommended the by updated guidelines released Monday by the federal Centers for Disease Control and Prevention, Hyman said. She has been in regular contact with state health officials, Siegel said.

U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three African nations at the center of the epidemic — Sierra Leone, Liberia and Guinea — would require daily monitoring without isolation.

The new guidelines recommend considering isolation only for individuals exposed to Ebola who show symptoms. Those with no signs of illness should be monitored for 21 days after the last potential exposure, with symptom-free individuals at the highest risk subject to “restricted movement within the community” and no travel on public transportation, according to the guidelines…

“She understands the nature of the disease, she treated it,” Hyman said. “She understands the nature of the risk.”

The American Civil Liberties Union has posted an article on the over-reaction to Ebola coming from some politicians, in contrast to the more rational guidelines proposed by the Center for Disease Control and the Obama administration:

One over-reaction to the disease that has emerged is a proposal for a blanket travel ban from the affected countries in West Africa. Public health experts say that such bans are not necessary, would not be effective, and would be a poor use of resources. Worse still, experts say they would most likely make matters worse by further isolating the countries where the outbreak is taking place, worsening the situation in those countries and therefore the threat to the United States. Travel bans “hinder relief and response efforts risking further international spread,” as the World Health Organization warned. Experts say such bans would also inevitably drive travelers underground, making it difficult to retrace the path of a disease when a case does appear.

Proposals to close the border to all travelers from affected nations are not a scientifically and medically legitimate exercise of government power and therefore would be arbitrary and discriminatory whether applied to citizens or non-citizens.

Now, of course, we are also seeing the questionable use of quarantine powers in some states. Medical experts have opposed such steps given that Ebola is not transmissible until after a fever begins and is not a highly transmissible disease generally, and given that individuals have strong incentives to carefully monitor themselves. Doctors Without Borders, for example, has condemned these quarantines as a threat to its battle against the disease in Africa. It cites the effect the quarantines will have in deterring doctors and nurses from taking the already remarkably brave step of entering the fight against the disease—and in stigmatizing them when they do. In short such quarantines threaten to weaken the most effective weapon we have in stopping the disease at its source. (It’s also shameful to treat returning health care workers, who have put their own lives at risk to help others, as anything less than heroes.)

Where individuals cooperate with the authorities in allowing close monitoring of their health and other reasonable precautions, the imposition of quarantines on those without symptoms appears to be driven by politics rather than science, and therefore raises serious civil liberties concerns.

While some political leaders have acted out of fear, Obama Administration officials deserve praise for largely sticking to science and not caving in to some of the fear mongering that is swirling around them. The White House has prioritized medicine over politics. It has resisted calls for travel bans, tried to persuade the governors of New Jersey and New York to reconsider their quarantines, and has largely followed the advice of public health experts in the recommendations that they have made. The Administration has also taken helpful steps such as expediting emergency FDA authorization for the use of new machines for rapid detection of the Ebola virus—which could allow detection of the disease before symptoms appear.

In fact, the Obama Administration has a history of good policy on communicable diseases. As we described in a 2009 white paper on that year’s H1N1 flu scare, the Administration acted calmly and appropriately in response to that epidemic, and overall, President Obama has turned away from his predecessor’s military/law enforcement approach to fighting disease, which we criticized in detail in our 2008 report on pandemic preparedness.

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Arguing Against Counterproductive Hysteria Over Ebola

While the outbreak of Ebola began in West Africa about ten months ago, we have now had only nine patients with Ebola in this country. Most were brought in for treatment after contracting it elsewhere. One is currently undergoing treatment. One died. All the rest have recovered. There have been zero cases of transmission in the general population but two nurses have become infected while treating the patient who died.

There is a remarkable amount of hysteria in this country for a disease which has had so little actual impact. Some of this is natural fear, seeing how less developed nations have been affected, and some is due to hysteria being generated by Republican politicians for political gain. Unfortunately the proposals made by Republicans would be counterproductive, making it harder to treat Ebola at its source. Eliminating Ebola in West Africa is the only way to eliminate the problem and prevent further spread.

This is also turning out to be a learning experience, at least for those who respect science and are willing to consider the facts. In terms of treatment, hospitals around the country have learned from the mistakes made in Texas, and these are not likley to be repeated.

In terms of the political reaction, there are many sources which are trying to counter the over-reaction with reason. As we have seen on so many issues, some will pay attention to the facts, and others won’t.

The New England Journal of Medicine has released their editorial for next week’s issue, which includes a repetition of how Ebola is transmitted and the dangers of over-reaction:

The governors of a number of states, including New York and New Jersey, recently imposed 21-day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease. We understand their motivation for this policy — to protect the citizens of their states from contracting this often-fatal illness. This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal. The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.

Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan’s family members who were living in the same household for days as he was at the start of his illness did not become infected…

The American College of Physicians has made the same argument:

The American College of Physicians is strongly concerned about the approach being taken by some state health departments to impose strict, mandatory quarantines for all physicians, nurses, and other health professionals returning from West Africa, regardless of whether they are showing symptoms of Ebola virus infection. ACP agrees that physicians and other health professionals must take the necessary precautions to ensure the safety of others and prevent the spread of infection. However, the College maintains that mandatory quarantines for asymptomatic physicians, nurses and other clinicians, who have been involved in the treatment of Ebola patients, whether in the United States or abroad, are not supported by accepted evidence on the most effective means to control spread of this infectious disease. Instead, such mandatory quarantines may do more harm than good by creating additional barriers to effective treatment of patients with Ebola and impede global efforts to contain and ultimately prevent further spread of the disease…

Some newspapers, such as The New York Times, have repeated these arguments for a larger audience:

The Dangers of Quarantines

Ebola Policies Made in Panic Cause More Damage

… two ambitious governors — Chris Christie of New Jersey and Andrew Cuomo of New York — fed panic by imposing a new policy of mandatory quarantines for all health care workers returning from the Ebola-stricken countries of West Africa through John F. Kennedy and Newark Liberty international airports. There is absolutely no public health justification for mandatory quarantines…

Lost in this grandstanding was one essential point. The danger to the public in New York in the case of Dr. Craig Spencer, who had worked in Guinea for Doctors Without Borders, was close to nonexistent. Health experts are virtually unanimous in declaring that people infected with the virus do not become contagious until after they develop a fever or other symptoms, such as diarrhea, vomiting, or severe headaches, at which time they need to be hospitalized and taken out of circulation.

Health care workers like Dr. Spencer know that it is in their interest to ensure that — if symptoms do arise — they get care quickly to improve their chances of survival and to reduce the risk of infecting their friends and families. Dr. Spencer reported his temperature promptly when it was a low-grade fever of a 100.3 degrees and was rushed to Bellevue Hospital Center for isolation and treatment while his fiancée and two friends were put into voluntary isolation…

The problem with a mandatory quarantine, even if done at home, is that it can discourage heath care workers from volunteering to fight the virus at its source in West Africa. Doctors Without Borders, the nongovernmental organization that has led the battle there, typically sends its workers on arduous four- to six-week assignments. The risk of being quarantined for another 21 days upon return has already prompted some people to reduce their length of time in the field and may discourage others from volunteering in the first place…

Fortunately the response has been more rational at the federal than state level, including the statement from Barack Obama earlier today, pointing out that “If we don’t have robust international response in West Africa, then we are actually endangering ourselves here back home.”

President Obama pledged support for health care and aid workers in West Africa Tuesday, saying new rules for monitoring them for Ebola once they return to the United States would be “sensible and based on science.”

Obama gave brief remarks on the federal response to the disease after speaking with U.S. aid workers on the front lines of battling Ebola in West Africa.

“They’re doing God’s work over there, and they’re doing that to keep us safe, and I want to make sure that every policy we put in place is supportive of their efforts. Because if they are successful, then we’re not going to have to worry about Ebola here at home.”

Besides being counterproductive, there are civil liberties concerns when the government forcibly quarantines people who do not have the disease or who are not contagious.

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Juan Williams Debunks GOP Attempts To Blame Democrats For Lack Of A Surgeon General

While discussing the Republican hypocrisy in their response to an Ebola Czar earlier this month, I pointed out how the Republicans blocked  Barack Obama’s nominee for Surgeon General due to his concerns about gun violence, which kills far, far more people than Ebola in this country. Republicans who 1) are rarely willing to take responsibility for their action,  and 2) are fond of projecting their faults upon others, have been trying to shift the blame and falsely claim that the Democrats are responsible for blocking the nomination. Juan Williams of Fox News has called them out on this in a column at The Hill (also a Republican-leaning site even as not as overtly Republican as Fox). Williams also debunked the Republican claims that Harry Reid has not been fair due to not allowing them to add their “poison pill” amendments to bills, which would cause even greater gridlock. Williams wrote:

Republicans on the campaign trail tell voters that the Senate gets nothing done because Senate Majority Leader Harry Reid (D- Nev.) blocks votes on GOP legislation.

Away from the Halloween funhouse mirror, the reality is this: Reid is willing to hold votes — but not with an endless open amendment process that merely creates a stage for Republican political theater. “Poison pill” amendments on partial birth abortions and gay marriage would sprout everywhere.

The real problem is that Senate Republicans can’t agree on which amendments to attach to bills because of the Tea Party versus Establishment war raging among them.

Yet I’ve personally seen voters nodding in agreement at Senate debates and campaign events as Republicans put the fright-night mask on Reid as the evil ogre responsible for dysfunction in the Senate.

The GOP is having success by repeating this distorted version of political life on Capitol Hill. Their tactic on that score is consistent with an overall strategy that includes blocking President Obama’s nominees to courts, federal agencies and ambassadorial posts while condemning any mistakes made by the administration.

According to the Senate’s website, there are currently 156 nominations pending on the executive calendar.

With all of the fear-mongering by Republican candidates over the administration’s response to Ebola — part of a broader approach to scare voters by undermining faith in government, the president and all Democrats — there is one screaming nomination still pending that reveals the corruption of the GOP strategy.

The nation has not had a surgeon general since November 2013 because the GOP is blocking the president’s nominee, Dr. Vivek Murthy. At a time of medical emergency, what is the Republicans’ problem with Murthy?

In October 2012, the doctor tweeted: “Tired of politicians playing politics w/guns, putting lives at risk b/c they’re scared of the NRA. Guns are a health care issue.”

Dr. Murthy, a graduate of Harvard and the Yale School of Medicine, has impressive credentials for a 36-year-old. He created a breakthrough new company to lower the cost of drugs and bring new drugs to market more quickly.

But his big sin, for Senate Republicans, is that as a veteran of emergency rooms Dr. Murthy expressed his concern about the nation’s indisputable plague of gun violence.

When Dr. Murthy was nominated, the National Rife Association announced plans to “score” a vote on the doctor’s nomination, meaning any Republican or Democrat running in a conservative state who voted for Murthy would be punished in NRA literature and feel the pain in their fundraising come midterm election season.

When public anxiety over Ebola became a GOP talking point, 29 House Democrats wrote to Reid calling for the Senate to expose the Republicans for their deceitful strategy. They wanted, and still want, Senate Democrats to push for a vote on the surgeon general nominee and force the Republicans to explain their opposition. Their thinking is that swift action is needed to put a surgeon general in place and give the American people a trusted source of guidance on Ebola.

The Tea Party’s favorite senator, Republican Ted Cruz of Texas, last week agreed on the need for a surgeon general in a CNN interview. But in the funhouse mirror-style so loved by the Republican base, Cruz blamed Obama for the vacancy.

“Of course we should have a surgeon general in place,” Cruz told CNN’s Candy Crowley. “And we don’t have one because President Obama, instead of nominating a health professional, he nominated someone who is an anti-gun activist.”

Sen. Roy Blunt (R-Mo.) was also put on the spot recently over the GOP’s refusal to deal with the surgeon general vacancy.  As he railed against the president for perceived errors in handling the situation, NBC’s Chuck Todd interrupted to ask: “The NRA said they were going to score the vote and suddenly everybody froze him… Seems a little petty in hindsight, doesn’t it?”

“Well, the president really ought to nominate people that can be confirmed to these jobs, and frankly then we should confirm them, there’s no question about that,” said the senator, trying to find his footing as he backpedaled.

The fact remains that Senate Republicans, in lockstep with the NRA, have left a worthy nominee dangling while this vital post remains vacant.

This kind of game playing is what led Senate Democrats to consider using the so-called “nuclear option.” In its original form, it would have changed the Senate rules to require a simple majority for all confirmations, instead of the current 60-vote supermajority. But the Democrats decided to go with a more modest change that allowed a simple majority vote to confirm only federal judicial nominees, not presidential picks for the Supreme Court, the cabinet or the position of surgeon general.

Reid, speaking on the Senate floor this summer, said that despite the rules change “Republicans are still continuing to try and slow everything down…It is just that they want to do everything they can to slow down [Obama’s] administration, to make him look bad…even though they’re the cause of the obstruction… Everyone will look at us and say, Democrats control the Senate — why aren’t they doing more?”

As a matter of brazen politics, the Republican strategy of obstruction has worked.

What a shame.

I have seen contradictory interpretations regarding the filibuster rules as to whether the Surgeon General can be confirmed with 51 votes or if the post still requires a super-majority. It is academic in this case. Republican Senators have placed a hold on this nomination and if it goes to a vote are likely to vote unanimously against it. The NRA has indicated that they will include a vote on Murthy in their ratings, which makes it difficult for some Democratic Senators in red states who are up for reelection. Between these Democrats and the uniform Republican opposition there are probably not 51 votes for confirmation, although this could change after the election.

Despite the Republican actions to block the Surgeon General nomination, it is questionable as to how much of a difference it would have made. We don’t know how much Murthy would have said on the topic, and if he could have gotten a discussion of the science through, considering all the fear and misinformation being spread about Ebola by Republicans.

Despite all the panic, we have seen how small a threat Ebola actually is in a developed nation such as the United States. Ebola is a problem of developing nations which lack an adequate Public Health infrastructure. While the outbreak began in West Africa last December, we have had a tiny number of people who are infected enter this country, and the potential harm has been easily contained. Even in Texas, which does share some of the problems of a third world nation due to Republican rule, multiple mistakes were made with minimal harm. A patient was sent home despite meeting criteria for hospitalization, and yet he did not spread the infection to anyone else in the community. This is because Ebola is not contagious early in the disease before someone is symptomatic, and even then it does not spread by casual contact.

Maybe if there was a Surgeon General speaking about Ebola, the Emergency Room staff at Texas Presbyterian Hospital would have been better acquainted with the guidelines and hospitalized Thomas Duncan when he first presented. Maybe the hospital would have done a better job at following protocols to protect the staff. While possible, it is far from certain that having a Surgeon General would have made any difference.

Perhaps if there was a Surgeon General discussing the science there would have been less panic when Dr. Craig Spencer was found to have traveled on the subway and visit a bowling alley, where he did not spread Ebola. (Similarly the nurse from Texas Presbyterian who flew with a low grade fever has not spread the disease despite turning out to be infected). This might have prevented the poor, and unscientific decisions made by the governors in states such as New Jersey and New York. While I can see Chris Christie make such a mistake, I would  hope for better from Andrew Cuomo, even if he is faced with a Republican using fear tactics against him in his reelection campaign. This might have spared Kaci Hickox from being quarantined in an unheated tent in New Jersey despite showing no signs of being infected. Inhibiting health professionals from volunteering can only harm the cause of eradicating Ebola in West Africa–which is the only way of ending this matter.

It is impossible to know if a Surgeon General could have been effective in reducing the hysteria. Republicans are masters at spreading fear, and never have any qualms about ignoring science. It is very possible they could have still won out. We already have many Infectious Disease experts explaining the facts about Ebola, but that hasn’t been enough to maintain reason. While a Surgeon General might have had a little bigger soap box to speak from, I don’t know if that would have really mattered.

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Not Hearing Anything Lately From Republicans About Their Frivolous Suit Against Obama

Remember a few months ago when John Bohner was talking about filing a ridiculous law suit against Barack Obama? Politico points out that, despite the Republican hype, we haven’t heard anything about this suit recently:

House Speaker John Boehner came out swinging hard last June when he announced that his chamber would take President Barack Obama to court. The suit, charging that the president grossly exceeded his constitutional authority by failing to implement portions of the Obamacare law, was billed as an election-season rallying point for aggrieved Republicans. But days before the midterms the House’s legal guns seem to have fallen silent.

Lawyers close to the process said they originally expected the legal challenge to be filed in September but now they don’t expect any action before the elections.

Some attribute the delay to electoral politics — suggesting that Republicans were worried it could rile up the Democratic base — though the GOP is mum on why the suit has yet to be filed.

Whatever the reason, the delay means the core of the suit could effectively be moot before the Obama administration even has to respond to it in court. The case was expected to center on an employer mandate provision that Obama twice delayed but is now set to kick in for many employers on Jan. 1.

Bloomberg says the suit might be more trouble than it is worth for the Republicans:

Part of the problem may lie in the troubled history of the suit. In mid-September, the GOP’s law firm dropped the case over “political pressure,” according to a Republican aide speaking to Politico. That same week, the Seventh Circuit Court of Appeals tossed out a lawsuit similar to the House’s from the Association of American Physicians and Surgeons.

Politically, the lawsuit presents catch-22s for the GOP. First, the party has to choose between upsetting conservatives (some of whom support impeachment) by not suing the president or bewildering the rest of the country by suing the president.

A July CNN/ORC poll found that 65 percent of Americans don’t think the president should be impeached, 57 percent don’t support the lawsuit, and less than half of respondents thought Obama has gone too far with his executive orders. Fifty-six percent of conservatives were in favor of the impeachment, compared to 26 percent of moderates.

The lawsuit was a compromise, but appeasement didn’t really work. The pro-impeachment conservative wing of the party has been given voice by Sarah Palin, who told Breitbart News that “you don’t bring a lawsuit to a gunfight.”

Second, if Boehner had gone through with suing the president before the midterm elections, it might have help Democrats fundraise and motivate the liberal base even more than it already had. The Democratic Congressional Campaign Committee made $7.6 million in the month after the suit was announced, including $2.1 million in one weekend off emails warning of impeachment.

Plus Republicans might be embarrassed if small businessmen realize that the Republican Party is pursuing a lawsuit which seeks to punish Obama for trying to make conversion to the Affordable Care Act easier for small business, as many small business owners had requested. This hardly sounds like where the Republicans should draw the line in the sand against what they claim is tyranny from the Obama administration. Of course they had to settle for this suit as they couldn’t find anything of substance with which to pursue this absurd claim.

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Bruce Bartlett Argues That Obama Is A Republican

Obama is a Republican

There’s nothing really new here, but it will be interesting to see conservative response to Bruce Bartlett’s article in The American Conservative entitled, Obama Is A Republican. The article is a rehash of how Obama’s record is actually quite conservative, clashing with the conservative myth that he is a socialist. He started with mentioning other Republicans who supported Obama’s election, and next discussed foreign policy:

One of Obama’s first decisions after the election was to keep national-security policy essentially on automatic pilot from the Bush administration. He signaled this by announcing on November 25, 2008, that he planned to keep Robert M. Gates on as secretary of defense. Arguably, Gates had more to do with determining Republican policy on foreign and defense policy between the two Bush presidents than any other individual, serving successively as deputy national security adviser in the White House, director of Central Intelligence, and secretary of defense.

Another early indication of Obama’s hawkishness was naming his rival for the Democratic nomination, Sen. Hillary Clinton, as secretary of state. During the campaign, Clinton ran well to his right on foreign policy, so much so that she earned the grudging endorsement of prominent neoconservatives such as Bill Kristol and David Brooks.

After further discission of foreign policy, he went on to discuss economic policy and the deficit. The most important point is how the deficit has fallen under Obama and how fiscally conservative Obama has been:

With the economy collapsing, the first major issue confronting Obama in 2009 was some sort of economic stimulus. Christina Romer, chair of the Council of Economic Advisers, whose academic work at the University of California, Berkeley, frequently focused on the Great Depression, estimated that the stimulus needed to be in the range of $1.8 trillion, according to Noam Scheiber’s book The Escape Artists.

The American Recovery and Reinvestment Act was enacted in February 2009 with a gross cost of $816 billion. Although this legislation was passed without a single Republican vote, it is foolish to assume that the election of McCain would have resulted in savings of $816 billion. There is no doubt that he would have put forward a stimulus plan of roughly the same order of magnitude, but tilted more toward Republican priorities.

A Republican stimulus would undoubtedly have had more tax cuts and less spending, even though every serious study has shown that tax cuts are the least effective method of economic stimulus in a recession. Even so, tax cuts made up 35 percent of the budgetary cost of the stimulus bill—$291 billion—despite an estimate from Obama’s Council of Economic Advisers that tax cuts barely raised the gross domestic product $1 for every $1 of tax cut. By contrast, $1 of government purchases raised GDP $1.55 for every $1 spent. Obama also extended the Bush tax cuts for two years in 2010.

It’s worth remembering as well that Bush did not exactly bequeath Obama a good fiscal hand. Fiscal year 2009 began on October 1, 2008, and one third of it was baked in the cake the day Obama took the oath of office. On January 7, 2009, the Congressional Budget Office projected significant deficits without considering any Obama initiatives. It estimated a deficit of $1.186 trillion for 2009 with no change in policy. The Office of Management and Budget estimated in November of that year that Bush-era policies, such as Medicare Part D, were responsible for more than half of projected deficits over the next decade.

Republicans give no credit to Obama for the significant deficit reduction that has occurred on his watch—just as they ignore the fact that Bush inherited an projected budget surplus of $5.6 trillion over the following decade, which he turned into an actual deficit of $6.1 trillion, according to a CBO study—but the improvement is real.

Screenshot 2014-10-20 12.59.16

Republicans would have us believe that their tight-fisted approach to spending is what brought down the deficit. But in fact, Obama has been very conservative, fiscally, since day one, to the consternation of his own party. According to reporting by the Washington Post and New York Times, Obama actually endorsed much deeper cuts in spending and the deficit than did the Republicans during the 2011 budget negotiations, but Republicans walked away.

Obama’s economic conservatism extends to monetary policy as well. His Federal Reserve appointments have all been moderate to conservative, well within the economic mainstream. He even reappointed Republican Ben Bernanke as chairman in 2009. Many liberals have faulted Obama for not appointing board members willing to be more aggressive in using monetary policy to stimulate the economy and reduce unemployment.

Obama’s other economic appointments, such as Larry Summers at the National Economic Council and Tim Geithner at Treasury, were also moderate to conservative. Summers served on the Council of Economic Advisers staff in Reagan’s White House. Geithner joined the Treasury during the Reagan administration and served throughout the George H.W. Bush administration.

There is certainly nothing new. Forbes pointed out a couple of years ago how Obama has been the most fiscally conservative president since Eisenhower.It is worth repeating considering how many people have been fooled by the Republican line that Obama and other Democrats, as opposed to the Republicans, are responsible for the size of the deficit.

Bartlett next discussed how Obamacare is based upon old Republican policies proposed by the Heritage Foundation and later Mitt Romney. He discussed at length how the individual mandate was originally an idea which was strongly promoted by Republicans. While Bartlett concentrated on Romney, many other Republicans shared this view.

Bartlett then had briefer discussions of several other issues–drugs, national-security leaks, race, gay marriage, and corporate profits. His argument for Obama being a Republican is weaker on social issues. While Obama took “two long years to speak out on the subject and only after being pressured to do so,” there remains a big difference between Obama keeping quiet on the issue and Republicans who actively promoted bans on same-sex marriage and Obama.

Bartlett concluded with:

I think Cornell West nailed it when he recently charged that Obama has never been a real progressive in the first place. “He posed as a progressive and turned out to be counterfeit,” West said. “We ended up with a Wall Street presidency, a drone presidency, a national security presidency.”

I don’t expect any conservatives to recognize the truth of Obama’s fundamental conservatism for at least a couple of decades—perhaps only after a real progressive presidency. In any case, today they are too invested in painting him as the devil incarnate in order to frighten grassroots Republicans into voting to keep Obama from confiscating all their guns, throwing them into FEMA re-education camps, and other nonsense that is believed by many Republicans. But just as they eventually came to appreciate Bill Clinton’s core conservatism, Republicans will someday see that Obama was no less conservative.

There is considerable truth to what Bartlett wrote, especially if social issues are ignored. However to be less progressive than Cornell West desires is not sufficient to prove someone is a Republican. Anyone who saw Obama as a candidate of the far left, as opposed to being more centrist, just wasn’t paying attention to what he was saying. Of course there is room for disappointment in some of these areas from the left, especially on drug policy and aspects of his foreign policy.

If Obama is said to be governing like a Republican, the key point which would need to be stressed is he is governing as a moderate Republican from the past–something which no longer exists. Obama certainly would not fit in with the Republican Party of today, which has moved to the extreme right. Bartlett is viewing Republicans from the perspective of his days as an adviser to Ronald Reagan and George W. Bush. The reality is that today neither Reagan nor Bush would be sufficiently conservative to survive in the Republican Party. Therefore, while it is ludicrous to consider Obama to be a socialist, or even from the far left, those who share the extreme views of current Republicans are correct in not seeing Obama as one of their own.

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Republicans Attack Ebola Czar While Blocking Surgeon General Nomination

On the surface, Republicans have been all over the place regarding the idea of a government official to coordinate handling of Ebola. For example, there’s John McCain. Back in 2009 he attacked Obama over having too many czars:

Then McCain demanded an Ebola czar:

“From spending time here in Arizona, my constituents are not comforted,” Senator John McCain (R-AZ) told State of the Union host Candy Crowley Sunday morning. “There has to be more reassurance given to them. I would say that we don’t know exactly who’s in charge. There has to be some kind of czar.”

So Obama appointed an Ebola czar. Ezra Klein explained why Ron Klain is an excellent choice:

Today, the White House will announce that Klain is being named “Ebola czar.” It’s a good choice because it shows a healthy respect for how hard the bureaucratic job of coordinating the Ebola response really is.

The Ebola response involves various arms of the Department of Health and Human Services (particularly, though not solely, the Centers for Disease Control and Prevention), the Pentagon, the State Department, the National Security Council, the World Bank, the World Health Organization, President Obama’s office, private stakeholders, and many, many more.

The “czar” position requires someone who knows how these different agencies and institutions work, who’s got the stature to corral their efforts, who knows who to call when something unusual is needed, who can keep the policy straight…

Actual government experience is badly underrated in Washington. Politicians run for office promising that they know how to run businesses, not Senate offices. “Bureaucrat” is often lobbed as an insult. But in processes like this one, government experience really matters. Nominating Klain suggests the White House is thinking about this correctly: as an effort that requires the coordination of already ample resources, where the danger is that the federal government will be too slow in sharing information across agencies and getting the resources where they need to go.

John McCain’s reaction to the appointment of an Ebola czar was to again attack Obama for doing what he recommended:

“Frankly, I don’t think Mr. Klain fits the bill, as a partisan Democrat, certainly not in any effort to address this issue in a bipartisan fashion,” McCain said Friday evening on Fox News.

“He has no experience or knowledge or background in medicine,” he added.

McCain is hardly the only Republican with irrational attacks. For example, Steven Taylor has looked at even more irrational attacks from Mike Huckabee. The only common thread to Republican response appears to be a knee jerk opposition to whatever Obama does.

The duties of an Ebola czar are exactly the bureaucratic skills which Klain has, not being a medial expert. Of course there is a position in government which should have a background in medicine, and work closely with the Ebola czar. That would be the Surgeon General–a nomination which Republicans have blocked as Obama’s nominee has shown concern for gun violence.  Now Democrats are demanding that the Senate vote for approval of the Surgeon General nominee:

More than two dozen House Democrats are calling on the Senate to swiftly approve Vivek Murthy’s nomination to serve as surgeon general to help combat the spread of the deadly Ebola virus in the U.S.

Murthy’s nomination got sidelined after Republicans and vulnerable Senate Democrats voiced reservations about the Harvard Medical School physician’s outspoken views on gun violence and public health. But the House Democrats, in a letter set to be released next week, argue that the Obama administration needs a top official in place to help with the Ebola response.

“The American public would benefit from having a Surgeon General to disseminate information that is desperately needed,” the Democrats wrote. “The Surgeon General can also work to amplify the Center for Disease Control’s actions, reassure the American people, and combat misinformation here at home.”

We have around 30,000 deaths due to guns a year in this country, but Republicans would rather ignore this problem, while playing politics and creating hysteria with a disease which so far has resulted in exactly one death in this country.

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Is The Culture War Really Over?

Bill Scher has an article at Politico on How Republicans Lost The Culture War. While it might be premature to say they lost and the war is over, a subject I’ll get into later, he does have some good points as to what went wrong for the Republicans.

Scher makes three main points. First, Republicans stopped being savvy on abortion. Rather than taking the purist position which they actually favor, legislatively the Republicans had concentrated on more narrow victories. Although late term abortions are rare, they made a lot of noise about “partial-birth abortions.”

While Scher sees this as no longer being savvy, I think that the change in Republican tactics was inevitable. They were never satisfied with stopping the rare late term abortions and were bound to ultimately push for what they really want–a complete ban on abortions.

They might have been more open in pursuing this partially due to a misreading of the polls which show Americans to be more ambivalent on Row v. Wade. The problems is that many people in this country don’t really know what Roe v. Wade means, but that doesn’t stop them from saying yes or no to a pollster. However, when the real question is posed, Americans do not want to make abortion illegal, and a majority agrees that women should  have the right to first trimester abortions.  Americans do not want to ban abortions, and imprison either women or the doctors involved.

Misreading the polls might have been a problem for Republicans, and this was compounded by moderate Republicans being forced from the party. The far right wing ideologues who now dominate the GOP would push for their position regardless of how unpopular, just as they push for restrictions on birth control, the second item on Scher’s list–Republicans got weird about birth control. If Americans would not go for Republican opposition to legalized first trimester pregnancies, they certainly did not accept their opposition to forms of birth control which prevent implantation, along with wider attempts to reduce access to contraception.

Hysterical Republican cries of “baby killers” are even more absurd when applied to a fertilized egg which lacks a central nervous system and consciousness. The Republican position here makes no more sense scientifically than Republican attitudes which deny science regarding evolution and climate change.  This also helps debunk the false Republican frame of making the pertinent question be when life begins. Certainly a fertilized egg is alive, but it also is not deserving of rights which trump the rights of a woman to control her own body. The Republican attitude on contraception only acted to expose their fallacious views regarding abortion, not to mention destroy any false claims they might make for being the supporters of limited government and greater freedom. This seems especially absurd to thinking people as providing easier access to contraception is one obvious way to reduce the number of abortions.

His final point is that Republicans bet wrong on gay marriage. Attitudes in this country certainly have changed rapidly. As James Joyner put it, “As we’ve become more educated, appeal to tradition and cries of “We’ve always done it this way!” are simply less persuasive. Ultimately, the arguments for excluding people from marrying others of the same sex were revealed to be provincial at best and simple bigotry at worst.”

However, while liberal Democratic voters might have supported legalization of same-sex marriage, many Democratic leaders were also behind the country on this one. Still, it is Republicans who made a major issue of trying to again intervene in the private lives of individuals, while Democratic leaders were at least ready to get out of the way as the country changed. While Republican have lost on this issue, Democrats also lost the opportunity to win respect by clearly standing for liberal principles before becoming politically safe.

While the country has been becoming more liberal on social issues, and I see this as a gradual process, not a sudden victory, this does not necessarily mean the culture wars are over. This country still consists of those of us who live in the modern world, and a sizable number who continue to reject science and reason and follow conservative ideas.

Fortunately such ideas are diminishing as fewer young support such conservative attitudes, but they are not disappearing entirely. Young people are far more likely to be influenced by the fake news of Jon Stewart than the fake news coming from Fox. Republicans now will have a hard time winning a presidential election if they do not change their views, but with a two party system we cannot exclude the possibility of another conservative Republican president. Democrats have a significant edge in the electoral college, but not a lock.

The presidency is only one branch of government. The Republicans still have the Supreme Court, although they have decided it best to stay out of the marriage issue now that conservatives are clearly on the wrong side of history. Republicans will continue to have an influence in Congress due to structural issues which keep it from being a truly representative democratic institution. Republicans have a tremendous edge in the Senate as the small states receive the same two Senators as the much more populous blue states. The framers of the Constitution never envisioned such a vast difference in population between the large and small states.

Part of the Republican edge in the House comes from gerrymandering, but even without gerrymandering the Republicans benefit from the concentration of Democratic voters in cities, unless districts are made to account for this. Republicans also benefit from a higher turn out by their voters in midterm elections, and they attempt to increase this edge with laws directed towards making it more difficult for minorities and young college students to vote. The right to vote itself might be the next big division between the parties as Republicans continue to pursue voter suppression as a tactic.

Republicans also dominate in a significant portion of the country, primarily but not limited to the deep south. The culture war is bound to continue there, with Republican candidates also seeking to promote their views elsewhere. As Eleanor Clift wrote, the Republican War on Women continues, just more quietly. We might not be hearing comments such as Tod Akin on women’s bodies shutting down in case of legitimate rape, but  have heard plenty of other outrageous statements this year.  Republicans might be trying to be more quiet on social issues, but they are failing, and this certainly isn’t coinciding with a change in their views.  It is also hard to say that the culture war is entirely over when Republicans have been successful in multiple state legislatures to make abortion more difficult, even if the most draconian Republican proposals have failed.

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The Highly Successful Presidency Of Barack Obama

Paul Krugman has been defending Barack Obama much more recently, such as in a recent article in Rolling Stone and on ABC’s This Week. Krugman’s views on Obama have evolved over the years. I think that early on he was critical of Obama based upon disagreements on policy matters. Two things have altered how he discusses Obama. First there are all the off the wall attacks on Obama from both the right and many mainstream commentators. Secondly, he is doing a better job of separating differences of opinion with a more centrist president from outright condemnation where he disagrees. This includes both recognition of Obama’s actual accomplishments and realization that wherever he disagrees with Obama, the Republicans would be far, far worse.

In Rolling Stone, Krugman looked at the various types of attacks on Obama:

All Obama-bashing can be divided into three types. One, a constant of his time in office, is the onslaught from the right, which has never stopped portraying him as an Islamic atheist Marxist Kenyan. Nothing has changed on that front, and nothing will.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

Yes, Obama has a low approval rating compared with earlier presidents. But there are a number of reasons to believe that presidential approval doesn’t mean the same thing that it used to: There is much more party-sorting (in which Republicans never, ever have a good word for a Democratic president, and vice versa), the public is negative on politicians in general, and so on. Obviously the midterm election hasn’t happened yet, but in a year when Republicans have a huge structural advantage – Democrats are defending a disproportionate number of Senate seats in deep-red states – most analyses suggest that control of the Senate is in doubt, with Democrats doing considerably better than they were supposed to. This isn’t what you’d expect to see if a failing president were dragging his party down.

More important, however, polls – or even elections – are not the measure of a president. High office shouldn’t be about putting points on the electoral scoreboard, it should be about changing the country for the better. Has Obama done that? Do his achievements look likely to endure? The answer to both questions is yes.

From there, Krugman looked at Obama’s achievements on health care, financial reform, the economy, the environment, national security, and social change. As Obama has so many favorable accomplishments, I would suggest seeing the original article rather than trying to list them all here. He then concluded:

Am I damning with faint praise? Not at all. This is what a successful presidency looks like. No president gets to do everything his supporters expected him to. FDR left behind a reformed nation, but one in which the wealthy retained a lot of power and privilege. On the other side, for all his anti-government rhetoric, Reagan left the core institutions of the New Deal and the Great Society in place. I don’t care about the fact that Obama hasn’t lived up to the golden dreams of 2008, and I care even less about his approval rating. I do care that he has, when all is said and done, achieved a lot. That is, as Joe Biden didn’t quite say, a big deal.

Andrew Sullivan cited Krugman’s article and added:

Just a year ago, I had a conversation with a friend as the healthcare website was crashing. All that mattered, we agreed, was if, this time next year, the healthcare reform is working and the economy is doing better. Well, both those things have happened – Obamacare is actually a big success so far; the growth and unemployment rates are the envy of much of the Western world – and yet we are now told that he’s a failure. WTF? The architects of the Iraq War – like, yes, Clinton and McCain – somehow believe they have a better grasp of foreign affairs in the twenty-first century than he does. And the party that bankrupted this country in eight short years now has the gall to ignore the fastest reduction in the deficit ever, and a slow-down in healthcare costs that may well be the most important fiscal achievement of a generation.

Add to this two massive social shifts that Obama has coaxed, helped or gotten out the way: marriage equality and the legalization of cannabis. These are not minor cultural shifts. They are sane reforms, change we can absolutely believe in and have accomplished on his watch. Jihadist terrorism? It has murdered an infinitesimal number of Americans in the past six years, compared with almost any other threat. Yes, Americans are still capable of PTSD-driven panic and hysteria over it, and Obama has failed to counter that more aggressively, but to be where we are in 2014 is something few expected after 9/11.

The idea that he has “lost Iraq” is preposterous. We “lost” Iraq the minute we unseated the Sunnis, disbanded the Baathist army and unleashed the dogs of sectarian warfare.

The only sane response to continuing unrest there is to cut our losses, act as an off-shore balancing power, and protect ourselves. And one reason we have this capability is that Obama managed to pivot nimbly last fall to ensure the destruction of Assad’s WMDs. The Panettas and McCains and usual suspects still seem to believe that it would have been better to have bombed Assad, let him keep his WMDs, and … what exactly? Can you imagine ISIS with its hands on those weapons in a failed state with a deposed leader? Think Libya today with poison gas. Who prevented this? Obama. And he is still pilloried for it.

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Quote of the Day: Jimmy Fallon On The Clintons

“Congratulations to Chelsea Clinton, who gave birth to a baby girl named Charlotte on Friday. Or as Hillary described the baby, ‘Third in line to the throne.'” –Jimmy Fallon

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Control Of The Senate Too Close To Call–Several States Still Can Go Either Way

With under a month to go, the race for control of the Senate remains too close to call. The fundamentals support the Republicans and they maintain a slight edge based upon current polling, but there are so many close races that we cannot be certain what will happen, despite the pessimism of some Democrats. Some Republicans are starting to get worried.

Looking at Electoral-Vote.com, the latest polls do give the Republicans 51 seats. However look at how many races are extremely close. Polls this close could easily be off if the pollster is incorrect in their assumptions as to who will actually turn out to vote. In other words, Democrats could retain control of the Senate if their  turn out is better than in previous midterm elections. Only a slight increase could flip several of the states where Republicans are leading.

Some states might still change from basic changes in a campaign, such as Mary Landrieu replacing her campaign manager.

Unexpected events in other states could change things. We have already seen the situation in Kansas where an independent has a real chance of winning. Now South Dakota has unexpectedly turned into a three way race. Republican Mike Rounds has led Democrat Rick Weiland, but suddenly former senator Larry Pressler, running as an independent, has closed the gap. There is no run off in South Dakota making it possible that any of the three could win with less than forty percent of the vote. Pressler is a former Republican but has become disenchanted with the GOP. He endorsed Obama in the last two presidential elections and says that if elected he would be a friend of Obama in the Senate.

Another factor working against the Republicans is their problem of nominating candidates who are extremists, if not outright bat-shit crazy. Terry Lynn Lands disastrous campaign has turned Michigan into a safe seat for the Democrats to hold. Republican leads in Iowa and even Georgia are now in jeopardy. Michelle Nunn’s chances in Georgia are now much better after a 2005 deposition surfaced in which Republican David Perdue bragged about his record of outsourcing:

The controversy stems from a 2005 legal deposition focused on the money he made at Pillowtex, a North Carolina textile company that closed and laid off thousands shortly after he left as CEO in 2003.

“Yeah, I spent most of my career doing that,” he said when asked to describe his “experience with outsourcing.”

Perdue then walked attorneys through his career helping various countries increase production in Asia, and discussed his goal at Pillowtex of moving production overseas to try to save the company. That never occurred, as the company ended up collapsing before it could do so.

His initial response to the revelations didn’t help put out the fire.

“Defend it? I’m proud of it,” he said on Monday when asked by a local reporter about his “career on outsourcing.”

“This is a part of American business, part of any business. Outsourcing is the procurement of products and services to help your business run. People do that all day,” he continued before blaming bad government policies for killing American jobs.

With all these races which could still go either direction, I do not believe it is possible to determine before election day who will control the Senate. We very likely will not even know that Tuesday. With Alaska in play, we won’t have all the results until at least Wednesday. Complicating matters further, if the races in Georgia and Louisiana remain close we cold very easily have a situation in which neither candidate has a majority and we have to wait for a runoff election in December (Louisiana) and/or January (Georgia). Should Larry Pressler win in South Dakota and Greg Orman win in Kansas, the pair of independents would very likely be in a position to decide who controls the Senate and we might not know how that plays out until January.

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