Despite Solyndra, Energy Loan Program Now Making A Profit

Before Republicans became obsessed with Benghazi, and now putting far more significance on Jonathan Gruber’s comments on the Affordable Care Act than, as I explained earlier in the week,  there actually is, they loved to scream about Solyndra. Solyndra was granted loan guarantees under a program which was started under George Bush and expanded in Obama’s stimulus program. Never mind that the entire stimulus package was highly successful.  All they cared about was that Solyndra went under. The decision to invest in risky  energy companies which could advance clean energy in the United States is now paying off.  NPR’s Morning Edition reports that the energy loan program is now making a profit.

In 2011, solar panel company Solyndra defaulted on a $535 million loan guaranteed by the Department of Energy. The agency had a few other high-profile bankruptcies, too — electric car company Fisker and solar company Abound among them. But now that loan program has started turning a profit.

Overall, the agency has loaned $34.2 billion to a variety of businesses, under a program designed to speed up development of clean-energy technology. Companies have defaulted on $780 million of that — a loss rate of 2.28 percent. The agency also has collected $810 million in interest payments, putting the program $30 million in the black.

When Congress created the loan program under the Energy Policy Act of 2005, it was never designed to be a moneymaker. In fact, Congress imagined there would be losses and set aside $10 billion to cover them…

Conservatives who saw a scandal in the Solyndra loan guarantees appear not to understand how the economy works. Some companies are going to succeed and some are going to fail. The loan program did not stay away from risky investments, and this has sometimes paid off:

The Energy Department actively monitors all the companies in its portfolio for potential default risks, “and when there are warning flags, then the disbursements are suspended — possibly ended,” Moniz says.

But he says the Energy Department doesn’t want to go too far in the direction of only lending to safe investments. “We have to be careful that we don’t walk away from risk, because otherwise we’re not really going to advance the marketplace,” he says.

Moniz points to a small company called Beacon Power as an example. It got an Energy Department loan, went bankrupt and defaulted on about $14 million in debt. Today the company is back in business, providing a valuable service to electricity grids and repaying the rest of its loan.

The United States has now accepted new challenges in light of the major breakthrough on climate change reached this week with China:

The deal jointly announced in Beijing by President Obama and China’s president, Xi Jinping, to limit greenhouse gases well beyond their earlier pledges is both a major diplomatic breakthrough and — assuming both sides can carry out their promises — an enormously positive step in the uncertain battle against climate change.

It will be interesting to see if any of the companies which received loan guarantees through the Department of Energy are instrumental in enabling the United States to carry out these promises.

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Why The Republicans Won Despite Being Wrong On The Issues, Revisited

Paul Krugman discussed how the Republicans won in the midterm elections despite being wrong about pretty much everything. Kurt Eichenwald has more in Vanity Fair looking at many of the things conservatives were wrong about over  the past thirty years. Although the list is far from complete, I’d suggest checking out the full article for the specifics. Topics covered include:

  • Tax cuts pay for themselves
  • Deregulating the Thrift Industry Will Save It
  • Iraq I: The Tilt
  • Giving Iranian Moderates Weapons Will Help America
  • Raising Taxes Will Cause a Recession
  • Abolishing Some Bank Regulations Will Help the Economy
  • The U.S.–led Bombing of Yugoslavia Would Be a Disaster
  • Bin Laden Was a Front for Iraq
  • Iraq 2: W.M.D.s and a Short, Inexpensive War
  • Obamacare

Many people have given different ideas regarding the other part of the question as to how the Republicans won. Fivethirtyeight.com looked at one issue  from polling data in Iowa. They found that, “White voters in Iowa without a college degree have shifted away from the Democratic Party.”

Loss of white working class votes has been a problem for Democrats for several election cycles, and was most pronounced in the 2012 elections. It will be interesting to see if there is any reduction in this trend when Barack Obama is no longer on the ticket. This is certainly not exclusively an issue based upon a black president. The Republicans have depended upon the southern strategy since the 1960’s, using this in the south along with provoking racial fears to gain the votes of less educated white voters in the north.

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Conservatives Are Excited About Nothing In Statement About Obamacare

Once again we see that conservatives will quickly latch onto a headline which reinforces their biases, and then get so excited that they don’t bother to see if there is any substance. Some conservatives also seem to spend a lot of time looking for that big “gotcha” moment, again not caring whether it really means anything.

For the last couple of days multiple conservative blogs have been been excited about a video of Jonathan Gruber, an economics professor at MIT who was involved in the writing of both Mitt Romney’s health care plan and the Affordable Care Act. The key portion they quote from a panel held last year is:

“You can’t do it political, you just literally cannot do it. Transparent financing and also transparent spending. I mean, this bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes the bill dies. Okay? So it’s written to do that,” Gruber said. “In terms of risk rated subsidies, if you had a law which said that healthy people are going to pay in, you made explicit healthy people pay in and sick people get money, it would not have passed. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really really critical to get for the thing to pass. Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

Conservatives are excited by his words “lack of transparency” and “stupidity of the American voter”  but once you actually read his statement there isn’t anything there. Of course these words might sound totally different if we heard what was said before, but regardless this doesn’t mean what conservatives think it means.

First we see that the law was written to avoid calling the mandate a tax. No surprise considering the current political atmosphere where talking about taxes is toxic, even if for something beneficial. Politicians of both parties have gotten in the habit of finding ways to raise revenue without calling it a tax. Besides, the Supreme Court has already called this a tax, so if conservatives think they have something by finding evidence that this is secretly a tax, they are way behind. (Update: To be more precise, the Supreme Court did not call this a tax, but said that the penalties were constitutional because they were an exercise of Congress’s taxing authority.)

The other point in his statement  is that healthy people pay money in and sicker people benefit. That’s how insurance has always worked. This would be the case if there was no government involvement. A lot of people pay for insurance, not knowing if they will get sick in the future, and those who actually do get sick receive the benefits. The same is true for insurance against your house burning down. A lot of people whose house never burns down pay insurance, and a small number of people whose house actually burns down receive the benefits. Just like health insurance, it is a transfer from some people to other people.

Health insurance also would have worked this way under the health care plan proposed by the Heritage Foundation in the 1990’s in response to the Clinton plan. That plan had a lot in common with the Affordable Care Act, but conservatives didn’t object then. Health insurance worked this way before the Affordable Care Act–except then some people would pay in their premiums when healthy and get dumped from their insurance plan if they got sick and cost they cost the insurance company too much. That’s something far more serious to object to, and something fixed by the Affordable Care Act. It is a shame that conservatives are getting so excited about their objections to Obamacare and not about the real abuses which existed before this much needed reform.

Update:

The Hill reports that Gruber (who has a bad habit of calling the American people stupid) regrets his inappropriate choice of words:

“The comments in the video were made at an academic conference,” Gruber said on “Ronan Farrow Daily.” “I was speaking off the cuff. I basically spoke inappropriately. I regret having made those comments.”

The Hill also reports:

On Tuesday, Gruber said he only meant that much of ObamaCare’s financing was done through the tax code, calling that more “politically palatable” than other means.

“That was the only point I was making,” he said.

Gruber’s words would be far more meaningful if they came from Obama or someone high in his administration rather than from an academic consultant to both parties, or if he showed any actual deceit on the part of the Obama administration. Even if Gruber does think that Americans are too stupid to realize that a fine for not having insurance could be considered a tax, and that insurance is a transfer of money from some people to others, this has no bearing on the Obama administration and in no way diminishes the tremendous benefits we have received under the Affordable Care Act such as coverage at a lower cost for millions, including those who previously could not obtain coverage due to preexisting medical conditions or cost.

Besides, if you want to look at deceit, the real dishonesty came from Republicans who lied about death panels, the number of people obtaining coverage, the number not paying their premiums, the effects of the ACA on jobs and the economy, the cost of coverage, and falsely claimed that Obamacare is a government take over of health care.  Even when the lies are debunked, Republican politicians continue to repeat them. They are the ones who must think that Americans are stupid. When George Bush pushed through his Medicare drug plan, he not only lied about the cost, but threatened to fire the chief Medicare actuary if he testified before Congress about the true cost. Now that is lack of transparency.

Update II:

Talking  Points Memo relayed a response from a White House spokesperson (emphasis mine):

“Transparency is a key goal of the ACA: consumers now have more access to information about their health insurance than ever before,” White House spokesperson Jessica Santillo said in a statement to TPM. “The Affordable Care Act was publicly debated over the course of 14 months, with dozens of Congressional hearings, and countless town halls, speeches, and debates.

“The tax credits in the law that help millions of middle class Americans afford coverage were no secret, and in fact were central to the legislation,” she continued. “Not only do we disagree with those comments, they’re simply not true.”

An administration official also noted to TPM that — while Gruber is often described as an “architect” of Obamacare because he was a key consultant to the administration and was heavily involved in developing the Massachusetts health reform law that served as a starting point for the ACA — “he did not work in the White House or play the same role in developing the Affordable Care Act.”

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Why The Republicans Won Despite Being Wrong On All The Issues

Paul Krugman points out that the Republicans, despite winning the midterm elections on Tuesday, were wrong on everything:

First, there’s economic policy. According to conservative dogma, which denounces any regulation of the sacred pursuit of profit, the financial crisis of 2008 — brought on by runaway financial institutions — shouldn’t have been possible. But Republicans chose not to rethink their views even slightly. They invented an imaginary history in which the government was somehow responsible for the irresponsibility of private lenders, while fighting any and all policies that might limit the damage. In 2009, when an ailing economy desperately needed aid, John Boehner, soon to become the speaker of the House, declared: “It’s time for government to tighten their belts.”

So here we are, with years of experience to examine, and the lessons of that experience couldn’t be clearer. Predictions that deficit spending would lead to soaring interest rates, that easy money would lead to runaway inflation and debase the dollar, have been wrong again and again. Governments that did what Mr. Boehner urged, slashing spending in the face of depressed economies, have presided over Depression-level economic slumps. And the attempts of Republican governors to prove that cutting taxes on the wealthy is a magic growth elixir have failed with flying colors.

In short, the story of conservative economics these past six years and more has been one of intellectual debacle — made worse by the striking inability of many on the right to admit error under any circumstances.

Then there’s health reform, where Republicans were very clear about what was supposed to happen: minimal enrollments, more people losing insurance than gaining it, soaring costs. Reality, so far, has begged to differ, delivering above-predicted sign-ups, a sharp drop in the number of Americans without health insurance, premiums well below expectations, and a sharp slowdown in overall health spending.

And we shouldn’t forget the most important wrongness of all, on climate change. As late as 2008, some Republicans were willing to admit that the problem is real, and even advocate serious policies to limit emissions — Senator John McCain proposed a cap-and-trade system similar to Democratic proposals. But these days the party is dominated by climate denialists, and to some extent by conspiracy theorists who insist that the whole issue is a hoax concocted by a cabal of left-wing scientists. Now these people will be in a position to block action for years to come, quite possibly pushing us past the point of no return.

He then went on to look at why they won, expressing views similar to what I had written about the election earlier in the week:

Part of the answer is that leading Republicans managed to mask their true positions. Perhaps most notably, Senator Mitch McConnell, the incoming majority leader, managed to convey the completely false impression that Kentucky could retain its impressive gains in health coverage even if Obamacare were repealed.

But the biggest secret of the Republican triumph surely lies in the discovery that obstructionism bordering on sabotage is a winning political strategy. From Day 1 of the Obama administration, Mr. McConnell and his colleagues have done everything they could to undermine effective policy, in particular blocking every effort to do the obvious thing — boost infrastructure spending — in a time of low interest rates and high unemployment.

This was, it turned out, bad for America but good for Republicans. Most voters don’t know much about policy details, nor do they understand the legislative process. So all they saw was that the man in the White House wasn’t delivering prosperity — and they punished his party.

This was their strategy, literally beginning on Day 1, if not earlier. A Frontline documentary described what the Republicans planned:

On the night of Barack Obama’s inauguration, a group of top GOP luminaries quietly gathered in a Washington steakhouse to lick their wounds and ultimately create the outline of a plan for how to deal with the incoming administration.

“The room was filled. It was a who’s who of ranking members who had at one point been committee chairmen, or in the majority, who now wondered out loud whether they were in the permanent minority,” Frank Luntz, who organized the event, told FRONTLINE.

Among them were Senate power brokers Jim DeMint, Jon Kyl and Tom Coburn, and conservative congressmen Eric Cantor, Kevin McCarthy and Paul Ryan.

After three hours of strategizing, they decided they needed to fight Obama on everything. The new president had no idea what the Republicans were planning.

Of course we cannot just criticize the Republicans. The Democrats were at fault when six years later they still had no effective response to this Republican strategy, and were afraid to stand up for their accomplishments. Being right doesn’t do any good politically if they were afraid to explain this to the voters. Democratic candidates ran away from Obama and his policies and then were shocked when the Obama voters didn’t come out to vote for them. As Peter Beinhart wrote, the Democrats cannot keep playing not to lose:

This fall, Democrats ran like they were afraid of losing. Consider the issues that most Democrats think really matter: Climate change, which a United Nations report just warned will have “severe, pervasive and irreversible impacts” across the globe. The expansion of Medicaid, so millions of poor families have health coverage. Our immoral and incoherent immigration system. Our epidemic of gun violence, which produces a mini-Sandy Hook every few weeks. The rigging of America’s political and economic system by the 1 percent.

For the most part, Democratic candidates shied away from these issues because they were too controversial. Instead they stuck to topics that were safe, familiar, and broadly popular: the minimum wage, outsourcing, and the “war on women.” The result, for the most part, was homogenized, inauthentic, forgettable campaigns. Think about the Democrats who ran in contested seats Tuesday night: Grimes, Nunn, Hagan, Pryor, Hagan, Shaheen, Landrieu, Braley, Udall, Begich, Warner. During the entire campaign, did a single one of them have what Joe Klein once called a “Turnip Day moment”—a bold, spontaneous outbreak of genuine conviction? Did a single one unfetter himself or herself from the consultants and take a political risk to support something he or she passionately believed was right?

…We saw the consequences on Tuesday. According to exit polls, voters under 30 constituted only 13 percent of the electorate, down from 19 percent in 2012. In Florida, the Latino share of the electorate dropped from 17 to 13 percent. In North Carolina, the African-American share dropped from 23 to 21 percent.

By positioning himself as a moderate, he may have missed a chance to gin up more enthusiasm within the state’s expanding Democratic base, earning fewer votes in such deep-blue communities as Arlington County and Alexandria than left-of-Warner Gov. Terry McAuliffe (D) did a year ago.

All of it has left some to wonder whether Warner would have won bigger if he had eschewed the middle and embraced the left, and whether the winning path for moderates that Warner forged during his own bid for governor 13 years ago is becoming extinct.

“I think if you look at the returns around the country . . . it raises questions about just how successful the bipartisanship brand really is,” Rep. Gerald E. Connolly (D-Va.) said Tuesday after easily winning a fourth term in Northern Virginia’s 11th Congressional District by talking about women’s rights, immigration reform and climate change — and less about working with Republicans.

Here’s a similar take on what the Democrats did wrong: “They were so focused on independents that they forgot they had a base. They left their base behind. They became Republican-lite.”

That opinion came from Rob Collins, the executive director of the National Republican Senatorial Committee. He also said Democrats “sidelined their best messenger” by running away from Obama, and for not talking about the economy. Republicans might be wrong virtually all the time lately when it comes to governing, but quite often they are smarter than Democrats with regards to politics.

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Republicans Beat Something With Nothing Other Than Negativity And Fear

Ronald Reagan couldn’t save the Senate for the Republicans in his 6th year. While the closeness of the polls left hope until the end, realistically the Democrats were not in a situation to defy history. There were two tends which the Democrats could not overcome. When people are unhappy, they look at the president regardless of who is actually to blame. Running a campaign based upon negativity was a winning formula for Republicans. Democrats were further hampered by the older and whiter electorate in midterm elections as once again large portions of the Democratic base stayed home for a midterm.

Republicans won by avoiding discussion of what they would do in power, beating something (Obama) with nothing. Americans who vote for Republicans to retake control of the Senate out of concern about current problems are as delusional as Russians who want the return of Stalinsim. It makes no sense to trust the party which created the economic downturn with fixing it, and Americans certainly do not want the Republican social or militarist agenda. The party which opposes most government action (other than imposing the agenda of the religious right, foolish military action, or rigging the system to transfer wealth to the ultra-wealthy) is hardly likely to propose real solutions to problems.  Polling on issues generally shows a majority favoring Democratic views but that does not help in elections where Republicans concentrate on distorting the views of their opponents and  hiding their own views.

That said, I am disappointed (as usual) in the Democrats as a political party. Yes, all the fundamentals were against them. So they took the cowardly way out, running away from not only Obama but from principles. If they ran a campaign based upon their accomplishments and the problems with GOP principles they very well still might have lost in this atmosphere, but at least their campaign would have meant something. Plus, considering how close the polls were, just maybe they could have won some more seats.

Of course that isn’t something that can be done in the last few months of a campaign. It requires a change in attitude and behavior of the party every year, acting as if it was a perpetual battle of ideas–as Republicans do even though they run on bad ideas. When Democrats run from their own record and fail to speak out on the issues, they leave themselves wide open to being defined by their opponents.

The Republicans were successful in hiding their most extreme views. They did receive some help from a friendly media in this regard as many of the most extreme statements from Republicans such as  Joni Ernst received too little attention. When Mitch McConnell tried to make his desire to repeal Obamacare more popular by claiming the people of Kentucky would still have their popular exchange, the media concentrated far more on the less important refusal of Alison Lundergan Grimes to say whether she voted for Obama. When liberals spoke out on this, the media did begin to pay more attention to McConnell’s gaffe, showing there is benefit to serious discussion of the issues by liberals. If only Democratic candidates had the courage to do this too.

External events helped the Republicans. Widespread opposition to Congressional Republicans over the threat of a government shutdown of October 2013 was forgotten after the initial failed roll out of the exchanges, even if this was quickly fixed. Republicans gained further by promoting exaggerated fears of ISIS and Ebola.

The Republicans avoided saying what they would do while running, but now will be under closer scrutiny. Republicans decided upon a strategy of opposing everything Obama does, including if he promoted policies previously favored by Republicans, from before he took office. Now that they control Congress, this might no longer be their best strategy. Many Republicans will mistakenly see this election result as a mandate and try to move even further to the right. Some must be intelligent enough to realize that Republican victories with the midterm electorate will not translate into victories with the younger and minority voters who turn out in greater numbers for general elections. While it is hard to see the two parties work together on many of the big issues such as climate change, there might be some pragmatic legislation which both McConnell and Obama could agree on, considering Obama’s long-standing willingness to compromise with Republicans.

McConnell is attempting to portray a more moderate image, but even if this is his personal desire he still has to deal with the far right wing of his own party. He might even find that he cannot pass legislation without Democratic cross over support. It remains to be seen whether McConnell will pass legislation which doesn’t beg for a Democratic filibuster or presidential veto, especially if Tea Party Republicans push through amendments to legislation to attempt to repeal Obamacare or restrict access to contraception. The Tea Party wing is least likely to realize that this election does not signify agreement by American voters with their goals. An example of this was seen with the failure of Personhood measures even in red states. Republicans won midterm elections but their policies remain opposed by a majority of Americans.

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Court Rules Against Quarantine Of Hickox Representing A Victory For Science And Civil Liberties

A judge in Maine has ruled against the quarantine of Kaci Hickox which the governor of Maine has attempted to impose, agreeing with the medical evidence that Hickox “currently does not show symptoms of Ebola and is therefore not infectious.” This is a victory for Hickox personally, along with a victory for both science and civil liberties.

The politicization of Ebola has demonstrated the usual divisions between left and right in this country. As on so many other issues, the right wing has rejected scientific findings, distorted scientific information which conflicted with their political goals, and ignored the rights of the individual. This also provides another example of the emptiness of Republican claims of wanting to keep government out of health care decisions.

While the media has concentrated on a small number of people who have returned from West Africa, Médecins Sans Frontières (Doctors Without Borders) has had a staff of over 3300. Of these 3300 MSF staffers, only 23 have contracted Ebola. The staff includes over 700 who came to West Africa from other nations with only one developing symptoms of Ebola after he returned home.The one doctor who did return to New York subsequently followed protocols for continued monitoring and was hospitalized prior to spreading the infection to anyone else.

With these odds, there is no justification in assuming that Hickox, or any other medical worker, is infected with Ebola merely due to having worked in the affected nations. People who are infected have a very low viral load early and do not spread the disease until after they exhibit symptoms, which Hickox has not done. It is becoming increasingly unlikely that she will. While a twenty-one incubation period is commonly cited by the media, and should be used as a precaution, in reality the vast majority of patients exhibit symptoms in six to twelve days. Monitoring for twenty-one days provides an ample additional margin of safety to the public.

While some Republicans have played politics with the issue and, as happens far too often, some Democrats such as Andrew Cuomo initially acquiesced in fear, the guidelines from the CDC and precautions already in effect are sufficient to protect the public and, to err on the side of safety, call for greater restrictions than are necessary based upon the science. There is no need for politicians to go beyond these precautions and unjustly restrict the civil liberties of Americans. The monitoring protocols already in place from Doctors Without Borders can be seen here.

In response to the controversy engendered by those who have been ignoring the science, the American Nurses Association released this statement on October 29:

The American Nurses Association (ANA) opposes the mandatory quarantine of health care professionals who return to the United States from West African nations where Ebola is widespread. ANA supports registered nurse Kaci Hickox, who recently returned to the United States after treating Ebola patients in Sierra Leone, in her challenge of a 21-day quarantine imposed by state officials in Maine, her home state. Hickox arrived at Newark airport on Oct. 24 and was immediately quarantined in a hospital tent by New Jersey state officials, who eventually allowed her to travel to Maine via private transport on Oct. 27. After testing negative twice for Ebola, nurse Hickox, who continues to be symptom free, poses no public threat yet is restricted to her home.

ANA, along with the American Hospital Association and American Medical Association, supports the Centers for Disease Control and Prevention’s (CDC) guidance based on the best available scientific evidence. The CDC guidance would not require a mandatory 21-day quarantine of Hickox given risk levels outlined by the CDC in her particular case. ANA urges authorities to refrain from imposing more restrictive conditions than indicated in the CDC guidelines, which will only raise the level of fear and misinformation that currently exists.

ANA supports a policy of appropriate monitoring for health care workers who have cared for or been in contact with patients with Ebola. Those who are not exhibiting symptoms of illness consistent with Ebola do not require quarantine. Monitoring should follow recommendations outlined by the CDC based on risk levels and the presence or absence of symptoms, including regular monitoring of body temperature and oversight by a public health agency. If symptoms do occur, the appropriate next step is isolation and transport to a medical facility for further evaluation. ANA seeks to balance protection of public health and safety with individual liberties. Policies to protect the public from the transmission of Ebola must be based on evidence and science, not fear.

Mandatory quarantine for individuals who do not have symptoms or risk factors is not backed by science. Such actions undermine efforts to recruit sufficient numbers of volunteer nurses and other health care professionals, who are essential to help contain the spread of the disease in West Africa.

ANA’s position emphasizing evidence and science as the foundation for decision-making extends to proposals to ban travel to the United States from West African nations affected by the Ebola outbreak. There is no evidence to suggest that a travel ban would be effective; public health experts oppose it. In fact, a ban could be counterproductive, encouraging individuals to try to circumvent reporting and other systems. ANA supports the current requirement that those traveling to the U.S. from affected nations in West Africa, including health care professionals who have provided care to Ebola patients, once they have passed initial screening, engage in monitoring according to CDC guidelines and reporting to their respective public health agencies.”

Multiple other medical organizations have issued statements in opposition to imposing quarantines including the American Medical Association, the Infectious Diseases Society of America, and the Association for Professionals in Infection Control and Epidemiology.

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Ebola Hysteria Leads To Lousiana Interfering With Medical Conference

The hysteria continues regarding Ebola. We still don’t know how things will turn out with Kaci Hickox’s fight against the unconstitutional restrictions on her civil liberties when she returned from West Africa, and I’ve heard a doctor who is returning from West Africa also plans to resist the unscientific quarantine requirements.  We continue to face a variety of right wing conspiracy theories.

NPR reports on yet another counterproductive action arising from the current hysteria–preventing scientists from participating in a conference, which could interfere with the development of a disease or cure for Ebola:

Louisiana health officials say that anyone who’s been in an Ebola-affected country over the last three weeks will be quarantined in their hotel rooms.

The American Society of Tropical Medicine and Hygiene is telling researchers who’ve recently traveled to Ebola-affected parts of West Africa that they can’t come to the society’s annual meeting. That wasn’t the medical group’s idea.

The convention opens this weekend at the New Orleans Sheraton, but the specialists with the most current experience with Ebola in the field aren’t expected to be there.

The Louisiana Department of Health and Hospitals just ruled that anyone who’s been in Sierra Leone, Liberia or Guinea in the past three weeks “should NOT travel to New Orleans to attend the conference.” (That big “NOT” is in the original letter.)

“While the state of Louisiana’s policies are outside of the scientific understanding of Ebola transmission — and acknowledged by the state health officials’ own admission — we recognize that the state has determined its policy in this matter,” the society said in a statement. “ASTMH does not agree with the policy as outlined by the Louisiana DHH…

Dr. Piero Olliaro had big plans for the conference.

“This is the place to be,” says Olliaro, a researcher at Oxford University who specializes in setting up clinical trials to test drugs in the developing world. “It’s once a year. This is where you get to meet all the others.”

Olliaro was going to present several papers on his recent work involving treatments for malaria and river blindness. But two weeks ago he was in Guinea for the World Health Organization scouting a site to test an experimental Ebola medication.

Yesterday Olliaro got a letter from the Louisiana health department saying that anyone who’d been in Sierra Leone, Liberia or Guinea in the past 21 days would be quarantined…

Olliaro, who’s in England, says the decision is unfair, unwarranted and not based on medical science. But he’ll abide by it…

Olliaro says the problem is much larger than just this one convention. The world’s leading tropical disease researchers often fly back and forth from Africa to their labs in the United States.

The new patchwork of Ebola-related travel bans and quarantine policies, he says, make it unclear whether they’ll be able to continue to do that. And that could ultimately undermine research into a vaccine or cure for this terrifying viral disease.

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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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