Donald Trump Continues To Threaten To Run As Third Party Candidate

DONALD-TRUMP

Last week I pointed out that Donald Trump was refusing to rule out running as a third party candidate. Several days later The Hill  received the same response in another interview:

Donald Trump says the chances that he will launch a third-party White House run will “absolutely” increase if the Republican National Committee is unfair to him during the 2016 primary season.

“The RNC has not been supportive. They were always supportive when I was a contributor. I was their fair-haired boy,” the business mogul told The Hill in a 40-minute interview from his Manhattan office at Trump Tower on Wednesday. “The RNC has been, I think, very foolish.”

Pressed on whether he would run as a third-party candidate if he fails to clinch the GOP nomination, Trump said that “so many people want me to, if I don’t win.”

“I’ll have to see how I’m being treated by the Republicans,” Trump said. “Absolutely, if they’re not fair, that would be a factor.”

Typically primary candidates remain in the race until they drop out of money. Donald Trump differs as he will not run out of money, not being dependent upon contributions from others. He has the ability to remain in the race as long as he desires–including after the conventions are over if he should feel that the RNC has been unfair to him.

While polls continue to show Trump with a lead (which might not last much longer after his comments on John McCain) for the Republican nomination, he is also among the weakest Republican candidates in head to head match ups against Hillary Clinton. A Washington Post/ABC News poll gives a clue as to what it would mean if Trump were to run as a third party candidate:

The survey shows that in a hypothetical three-way race, Clinton is at 46 percent, Bush is at 30 percent and Trump is at 20 percent among registered voters.

Trump takes more support away from Bush than Clinton in such a contest. In a head-to-head matchup, Clinton tops Bush by 50 percent to 44 percent among registered voters.

The current polls suggest that the Republicans will lose if they nominate Trump, or if someone else wins and Trump decides to run as a third party candidate. These numbers can change quite a bit by next November, but in this poll the vast majority of the votes taken by Trump come at the expense of the Republican candidate, and I would expect that pattern to continue. Possibly the magnitude of Trump’s vote will decrease by then, but this suggests there is an excellent chance that he could take at least five to ten points from the GOP candidate, which would probably tip the balance towards the Democrats should the race become closer (as other polls suggest it might be).

The same pattern is likely to also hold should Sanders or someone else manage to beat Clinton for the Democratic nomination, or someone other than Bush be the Republican candidate. It is certainly premature to assume Bush will be the Republican nominee. If he is, the Democratic candidate might not need any help from Trump in winning if Bush keeps taking about phasing out Medicare.

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Factcheck.org Debunks Conservative Smear Campaign Against Planned Parenthood

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The conservative attack on Planned Parenthood follows the pattern we have seen so many times in the past. Groups such as Breitbart put out edited tapes or videos to attack organizations which they disagree with based upon false claims. Now that fact checkers have had time to evaluate the recent attacks on Planned Parenthood, it is becoming clear that this is just one more example, and hardly comes as a surprise considering that most of the conservative reports on the issue which I’ve read quickly degenerate into a tirade against reproductive rights and legitimate scientific research.

Factcheck.org has evaluated the claims, and points out that, “it remains legal to donate tissue from a legally aborted fetus, and for that tissue to be used for research purposes.” They point ethical guidelines on the issue from the American Medical Association: “Fetal tissue is not provided in exchange for financial remuneration above that which is necessary to cover reasonable expenses.”

Reviewing the tapes, Factcheck.org found numerous examples which demonstrate that Planned Parenthood was operating within the law and established ethical guidelines:

Nucatola’s comment, though, isn’t evidence that Planned Parenthood or its affiliates are selling “body parts” or fetal tissue for profit. The full video shows that after Nucatola mentions the $30 to $100, she describes how those amounts would be reimbursement for expenses related to handling and transportation of the tissues. Nucatola talks about “space issues” and whether shipping would be involved…

Nucatola does make one statement in the unedited video that suggests to critics that some clinics would be comfortable with a payment that was slightly more than their expenses for providing the tissue. “I think for affiliates, at the end of the day, they’re a nonprofit, they just don’t want to — they want to break even. And if they can do a little better than break even, and do so in a way that seems reasonable, they’re happy to do that,” Nucatola says.

But immediately after this statement, Nucatola goes on to say: “Really their bottom line is, they want to break even. Every penny they save is just pennies they give to another patient. To provide a service the patient wouldn’t get.” Planned Parenthood told us that she may have been referring to more general operations of the clinics.

Nucatola repeatedly talks about affiliates only wanting to provide a service to their patients, who elect to donate the tissue for medical research, and not having that service impact their bottom lines. She says that it’s “not a new revenue stream the affiliates are looking at” and that “nobody should be ‘selling’ tissue. That’s just not the goal here.” She says some affiliates might donate the tissue for free.

Nucatola also discusses Planned Parenthood clinics’ interactions with a tissue procurement company called StemExpress. The company’s website says that partnering with StemExpress can be “financially profitable” for a clinic — a point that some conservativewebsites have singled out. But this also does not constitute evidence that Planned Parenthood is profiting in such a way…

Richards, the Planned Parenthood president, said in a video response to the controversy: “The allegation that Planned Parenthood profits in any way from tissue donation is not true.”

On July 21, the Center for Medical Progress released a second, similar video, again featuring a discussion with a Planned Parenthood official in a restaurant. The numbers mentioned in the edited video are similar to what Nucatola said. The official, Mary Gatter, quotes a rate of $75 per specimen, and says she was thinking of saying $50. The discussion only reaches $100 because the “buyers” in the video mention higher prices. At one point, Gatter says that “we’re not in this for the money,” and later she reiterates that “money is not the important thing.”

Though few studies of costs associated with fetal tissue acquisition are available, existing evidence does suggest the prices named in the video are in line with general practices. The National Institutes of Health conducts research with fetal tissue, and in the late 1990s, the Government Accountability Office (then known as the General Accounting Office) looked into the acquisition of such tissue, finding that the direct cost to researchers was “low.” GAO said payments primarily went to “central tissue suppliers,” as opposed to health clinics. In most cases, GAO found that clinics did not charge researchers, but when they did, the cost ranged from $2 to $75. The report did not address how much clinics might have received from central tissue suppliers, which is more analogous to the situation presented in the video.

PoltiFact has also reviewed the topic.

The New York Times has run an editorial on the subject. After summarizing the issue, the editorial concludes:

Anti-abortion groups have long pushed to defund Planned Parenthood, even though no federal money is used to provide abortions. But that hasn’t stopped their efforts to shut down the clinics, which provide services like contraception, cancer screening and other tests.

The Center for Medical Progress — which managed to get tax-exempt status in 2013 as a biomedicine charity, according to a report by The Huffington Post — appears to have done little beyond producing the undercover video. According to its registration form with the California attorney general, it has three officers: Mr. Daleiden; Albin Rhomberg, who has participated in anti-abortion protests; and Troy Newman, the president of the anti-abortion group Operation Rescue.

In a statement last week, Cecile Richards, the president of the Planned Parenthood Federation of America, said that “our donation programs — like any other high-quality health care providers — follow all laws and ethical guidelines” and that “Planned Parenthood stands behind our work to help women and families donate tissue for medical research when they wish to.”

Researchers use fetal tissue to study and develop treatments for diseases and conditions like H.I.V., hepatitis, congenital heart defects, retinal degeneration and Parkinson’s. Last year, the National Institutes of Health gave $76 million in grants for fetal tissue research. Planned Parenthood is certainly not the only collector of fetal tissue — clinics associated with universities also supply tissue for research.

The Center for Medical Progress video campaign is a dishonest attempt to make legal, voluntary and potentially lifesaving tissue donations appear nefarious and illegal. Lawmakers responding by promoting their own anti-choice agenda are rewarding deception and putting women’s health and their constitutionally protected rights at risk.

Considering the potential health benefits, research on fetal tissue is the true “pro-life” position.

Update: The Department of Justice plans to investigate this matter.

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Single Payer Coming?

It looks like we might be heading in the direction of a single payer health care system, but note in the way we wanted. Aetna is seeking to buy Humana. While this would not actually be single payer, it would further decrease competition in the insurance industry. There is also speculation that UnitedHealth is interested in purchasing Cigna and Aetna. Instead of a single=payer system modeled on Medicare, we could wind up with a more monopolistic system, which should please Republicans. These purchases would be subject to anti-trust review.

Aetna purchasing Humana would also give Aetna a much larger share in the Medicare Advantage market. So much for George Bush’s plan to supposedly increase competition and choice for Medicare patients. The plan has was more designed as a reward to the insurance industry for all the contributions they have made to the Republicans.

In related news, The New York Times repeated misleading information on health care rates which I previously discussed. Only plans desiring rates over ten percent are required to submit their requests. Insurance companies have multiple plans, and are only seeking increases on some plans, leaving less expensive choices for those who take advantage of the exchange to compare plans. Plus the requests for larger rate increases will not necessarily be granted.

However, should private insurance rates still be too high, single payer remains the most cost-effective means of providing health care coverage. This could turn into a major issue in Bernie Sanders’ favor.

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What Bernie Sanders Believes

Bernie Sanders

Bernie Sanders has become the first to officially announce his plans to run against Hillary Clinton for the Democratic nomination. The conventional wisdom is that he has no chance to win (a type of prediction which I fear the media helps become true) but will move the conversation to the left. Unlike most politicians, Sanders’ views have remained quite consistent, making it a good bet that looking at his past statements will give a good idea of what he will be talking about while campaigning.

Common Dreams has a lengthy article on Sanders. This includes, “In December of last year, Sanders put forth what he called an Economic Agenda for America, a 12-point plan”

  1. Invest in our crumbling infrastructure with a major program to create jobs by rebuilding roads, bridges, water systems, waste water plants, airports, railroads and schools.
  2. Transform energy systems away from fossil fuels to create jobs while beginning to reverse global warming and make the planet habitable for future generations.
  3. Develop new economic models to support workers in the United States instead of giving tax breaks to corporations which ship jobs to low-wage countries overseas.
  4. Make it easier for workers to join unions and bargain for higher wages and benefits.
  5. Raise the federal minimum wage from $7.25 an hour so no one who works 40 hours a week will live in poverty.
  6. Provide equal pay for women workers who now make 78 percent of what male counterparts make.
  7. Reform trade policies that have shuttered more than 60,000 factories and cost more than 4.9 million decent-paying manufacturing jobs.
  8. Make college affordable and provide affordable child care to restore America’s competitive edge compared to other nations.
  9. Break up big banks. The six largest banks now have assets equivalent to 61 percent of our gross domestic product, over $9.8 trillion. They underwrite more than half the mortgages in the country and issue more than two-thirds of all credit cards.
  10. Join the rest of the industrialized world with a Medicare-for-all health care system that provides better care at less cost.
  11. Expand Social Security, Medicare, Medicaid and nutrition programs.
  12. Reform the tax code based on wage earners’ ability to pay and eliminate loopholes that let profitable corporations stash profits overseas and pay no U.S. federal income taxes.

PBS Newshour has this information on his views, including additional links:

Campaign finance: Limit corporate and interest-group spending in campaigns.

Sanders proposes a Constitutional amendment that would effectively reverse the Supreme Court’s Citizen United ruling and ban corporations and nonprofits from unlimited campaign expenditures. The independent senator would also require disclosure of any organizations spending $10,000 or more on an election-related campaign.

Climate change: Charge companies for carbon emissions

Considered to be a “climate change hawk” and use some of the money raised to boost renewable energy technology.

Education: Two years free tuition at state colleges. Reform student loans.

Sanders would provide $18 billion to state governments to allow them to cut tuition at state colleges by 55 percent. And he would allow anyone paying off a student loan currently to refinance at a lower rate.

Federal Reserve and banks: Break up big banks. Open up the Fed.

Sanders would divide large banks into smaller entities and charge a new fee for high-risk investment practices, including credit default swaps. In addition, he believes the Federal Reserve is an opaque organization which gives too much support to large corporations. His pushed for a 2011 audit of the Fed and he would use the Fed to force banks into loaning more money to small businesses. Finally, he would ban financial industry executives from serving on the 12 regional boards of directors.

Guns: A mixed approach. No federal handgun waiting period. Some protection for gun manufacturers. Ban assault weapons.

In the House of Representatives, Sanders voted against the pro-gun-control Brady Bill, writing that he believes states, not the federal government, can handle waiting periods for handguns. Soon after, he voted yes for the 1994 Violent Crime Control and Law Enforcement Act that included an assault weapons ban. He has voted to ban some lawsuits against gun manufacturers and for the Manchin-Toomey legislation expanding federal background checks.

Health care: Change to single-payer government-provided health care

Sanders voted for the Affordable Care Act, but believes that the new health care law did not go far enough. Instead, he espouses a single-payer system in which the federal and state governments would provide health care to all Americans. Participating states would be required to set up their own single-payer system and a national oversight board would establish an overall budget.

Immigration: Offer path to citizenship. Waive some deportations now.

Sanders generally agrees with President Obama that most of the undocumented immigrants in the country now should be given a path to citizenship. He voted for the senate immigration bill in 2013, which would have increased border security and issued a provisional immigrant status to millions of undocumented residents once some significant security metrics had been met. In addition, Sanders has supported President Obama’s use of executive orders to waive deportation for some groups of immigrants, including those who were brought to the United States as children.

Taxes: Raise some taxes on the wealthy. Cut taxes for middle class.

The current ranking minority member on the Senate Budget Committee, Sanders would nearly double taxes on capital gains and dividends for the wealthiest two percent of Americans. In addition, this year Sanders asked President Obama to use executive action to close six tax deductions benefitting corporations and hedge funds. The Vermont senator would use some of the revenue gained from higher taxes on the rich to lower taxes for middle and lower class Americans.

Iraq, Islamic State and Afghanistan: Opposed the Iraq war. Calls for troop withdrawal as soon as possible.

A longtime anti-war activist, Sanders voted against the Iraq war resolution in 2002. He has regularly called for the U.S. to withdraw troops from Afghanistan and Iraq as soon as possible. Regarding the Islamic State, Sanders has said the U.S. should not lead the fight. In general, he believes the U.S. should focus less on international conflict and more on the domestic needs of the middle class.

Iran and Israel: Supports current talks with Iran. Critical of Israeli Prime Minister Benjamin Netanyahu.

In an interview with ABC News Sanders called the Clinton Foundation money, along with money from conservative sources, a very serious problem:

Sen. Bernie Sanders, I-Vermont, said he is concerned by the millions of dollars flowing into the Clinton Foundation at a time when he thinks money plays too strong a role in politics.

“It tells me what is a very serious problem,” Sanders said in an interview with ABC News’ Chief White House Correspondent Jonathan Karl. “It’s not just about Hillary Clinton or Bill Clinton. It is about a political system today that is dominated by big money. It’s about the Koch brothers being prepared to spend $900 million dollars in the coming election.

“So do I have concerns about the Clinton Foundation and that money? I do,” he added. “But I am concerned about Sheldon Adelson and his billions. I’m concerned about the Koch Brothers and their billions. We’re looking at a system where our democracy is being owned by a handful of billionaires.”

The issues in the above lists are primarily, but not exclusively, based on economic views. Sanders, as opposed to Clinton, also has a strong record of support for liberal positions on foreign policy and social issues. While it is inevitable that economic issues will dominate the campaign this year, I hope that during the course of the campaign more is said about both Clinton’s hawkish foreign policy views, along with her conservative cultural views.

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Marijuana, Needle Exchange Programs, And Clinton’s Cultural Conservatism

Clinton Marijuana

Following recent posts about Lincoln Chafee talking about running for the Democratic nomination I began looking to see if there are any other issues where the two have major differences besides Clinton’s support for the Iraq war, which he has been attacking Hillary Clinton on. which he has been attacking Hillary Clinton on. I was pleased to see that back in 2011 Chaffee called for a reclassification of medical marijuana from a Schedule I controlled substances, which puts states which have legalized medical marijuana at odds with federal laws.

Three years later, Martin O’Malley took this a step even further, signing a bill decriminalizing marijuana, while opposing outright legalization. Hillary Clinton, as would be expected from her overall cultural conservatism, has lagged behind the country, and the Democratic Party, on both legalization of marijuana and medical marijuana.

On a related issue, Clinton’s opposition to needle exchange programs, while certainly not a major issue, was also an early issue in the 2008 nomination battle which differentiated the political philosophies of Clinton from the more liberal Barack Obama. Martin O’Malley, who is also moving well to the left on economic issues, signed a bill allowing needle exchange in Maryland. Clinton and Obama also differed in 2008 on reforming sentencing for violation of drug laws. While Obama’s record on the drug war has certainly been mixed, I would hate to see a move further to the right under Clinton.

Clinton’s cultural conservatism and promotion of conservative causes has often been traced to her membership in The Fellowship while in the Senate. From Mother Jones in 2007:

Through all of her years in Washington, Clinton has been an active participant in conservative Bible study and prayer circles that are part of a secretive Capitol Hill group known as the Fellowship. Her collaborations with right-wingers such as Senator Sam Brownback (R-Kan.) and former Senator Rick Santorum (R-Pa.) grow in part from that connection…

That’s how it works: The Fellowship isn’t out to turn liberals into conservatives; rather, it convinces politicians they can transcend left and right with an ecumenical faith that rises above politics. Only the faith is always evangelical, and the politics always move rightward…These days, Clinton has graduated from the political wives’ group into what may be Coe’s most elite cell, the weekly Senate Prayer Breakfast. Though weighted Republican, the breakfast—regularly attended by about 40 members—is a bipartisan opportunity for politicians to burnish their reputations, giving Clinton the chance to profess her faith with men such as Brownback as well as the twin terrors of Oklahoma, James Inhofe and Tom Coburn, and, until recently, former Senator George Allen (R-Va.). Democrats in the group include Arkansas Senator Mark Pryor, who told us that the separation of church and state has gone too far; Joe Lieberman (I-Conn.) is also a regular.

Unlikely partnerships have become a Clinton trademark. Some are symbolic, such as her support for a ban on flag burning with Senator Bob Bennett (R-Utah) and funding for research on the dangers of video games with Brownback and Santorum. But Clinton has also joined the gop on legislation that redefines social justice issues in terms of conservative morality, such as an anti-human-trafficking law that withheld funding from groups working on the sex trade if they didn’t condemn prostitution in the proper terms. With Santorum, Clinton co-sponsored the Workplace Religious Freedom Act; she didn’t back off even after Republican senators such as Pennsylvania’s Arlen Specter pulled their names from the bill citing concerns that the measure would protect those refusing to perform key aspects of their jobs—say, pharmacists who won’t fill birth control prescriptions, or police officers who won’t guard abortion clinics.

Clinton has championed federal funding of faith-based social services, which she embraced years before George W. Bush did; Marci Hamilton, author of God vs. the Gavel, says that the Clintons’ approach to faith-based initiatives “set the stage for Bush.” Clinton has also long supported the Defense of Marriage Act, a measure that has become a purity test for any candidate wishing to avoid war with the Christian right…

The libertarian Cato Institute recently observed that Clinton is “adding the paternalistic agenda of the religious right to her old-fashioned liberal paternalism.” Clinton suggests as much herself in her 1996 book, It Takes a Village, where she writes approvingly of religious groups’ access to schools, lessons in Scripture, and “virtue” making a return to the classroom.

As noted in the above excerpt, Clinton’s affiliation with the religious right was seen in her support for the Workplace Religious Freedom Act, a bill introduced by Rick Santorum and opposed by the American Civil Liberties Union for promoting discrimination and reducing access to health care, along with her promotion of restrictions on video games and her introduction of a bill making flag burning a felony. Her social conservatism is also seen in her weak record on abortion rights, such as supporting parental notification laws and stigmatizing women who have abortions with the manner in which she calls for abortion to be “safe, legal and rare.”

(Links to additional material added on April 19)

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John Oliver Exposes Pharmaceutical Marketing

John Oliver and Last Week Tonight returned on HBO last weekend with a biting expose of the pharmaceutical industry (video above). Like Jon Stewart, Oliver’s comedy version of the news is far more revealing than what is seen on most actual news reports. Last Week Tonight also has the advantage of spending more time on a single story than either Jon Stewart or actual news shows.

Oliver pointed how how Americans are addicted to prescription drugs, spending almost $330 billion on them. He suggested that Walter White of Breaking Bad could have made a lot more money cooking up drugs for rheumatoid arthritis instead of meth. He lampooned the efforts of pharmaceutical companies to influence the prescribing habits of physicians, describing their ethics with this comparison:  “Drug companies are a bit like high school boyfriends; they are much more concerned with getting inside you than being effective once they are in there.”

Oliver concluded with a warning about doctors who take large amounts of money from the pharmaceutical industry with a mock public service commercial, Ask Your Doctor:

Here’s how it works. Money combines with the cash receptors in your doctor’s wallet to create fast-acting financial relief, so your doctor can rest easy and enjoy life.

Common side effects of doctors taking money may include chronic overprescription, unusually heavy cash flow, dependency on free samples, inflammation of confidence, affluenza and an increased tendency to suggest off-label prescriptions, which in turn can cause heart attack, stroke, loss of feeling in arms and legs, seizures, blurred vision, grinding of the teeth, temporary deafness, total blindness, numbness, sudden bursts of rage, angry erections lasting over 17 hours, and death.

Ask your doctor today if he’s taking pharmaceutical company money. Then ask your doctor what the money is for. Ask your doctor if he’s taken any money from the companies that make the drugs he’s just prescribed for you. Then ask yourself if you’re satisfied with that answer.

The story was quite accurate. If this was a documentary as opposed to a comedy show my only complaint is that it concentrates on one side of the story in portraying doctors who take money and are susceptible to pharmaceutical sales pitches. Many doctors actually are quite aware of the problem and many do not take any meaningful amount of money from pharmaceutical companies.

For example, Oliver quoted a drug rep as being disturbed when a doctor asked her for advice on treating a patient as she is just a poli-sci major. I often feel the opposite, when pharmaceutical reps act as if they are qualified to give me advice (invariably involving greater use of their drug), knowing how little pharmaceutical or medical background most of them have. While I do accept samples in order to help out patients, which requires me to have some contact with drug reps, I am certainly not going to consider anything they say to be anything other than advertising. One time I even had a drug rep run out of my office crying when I didn’t play long with her sales pitch. We also have not been too welcoming to the rare drug rep who attempts to get back into our sample room in order to put his drugs in front and hide the samples form the competition.

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Rand Paul’s Past May Catch Up With Him

Rand Paul

Paul Waldman reminds us of some of the nutty things Rand Paul has said in the past, such as his belief in the NAFTA Superhighway conspiracy theory and past statements on the Civil Rights Act. He got in trouble again this week, along with some other Republicans, when discussing measles vaccination. It is not surprising that Paul, as is the case with the many in the Tea Party faction of the Republican Party (along with some mainstream Republicans) has a history of association with anti-vaccine groups. Paul has gone further than most other Republicans in the past in both questioning the science of vaccines and questioning the right of the state to mandate vaccinations.

Waldman has a good suggestion as to why Paul has made it to the Senate despite a history of holding views which would have prevented others from winning such a position:

But that’s not the path Rand Paul followed. Whatever his talents, he’s a United States senator because he’s Ron Paul’s son. Over his time in Congress, Ron Paul developed a small but fervent national constituency, made up of some ordinary libertarians and a whole lot of outright wackos. That constituency was greatly expanded by his 2008 presidential campaign. Despite the fact that Paul had plenty of interesting and reasonable things to say, it’s also the case that if you were building a bunker to prepare for the coming world financial crash and ensuring societal breakdown (and possible zombie apocalypse), there was only one presidential candidate for you. When Rand Paul decided to run for Senate in 2010, having never run for anything before, the Ron Paul Army mobilized for him, showering him with money and volunteers. He also had the good fortune to be running in a year when Republicans everywhere were looking for outsider, tea party candidates, so he easily beat the choice of the Kentucky GOP establishment in the primary.

You may remember that early on, and unseasoned Rand Paul got in trouble for his ideas about things like the Civil Rights Act. But he quickly discerned what was acceptable and what wasn’t, and he set about moderating his views, sanding down the rough edges of libertarianism to find something that would fit more neatly within the Republican Party while also finding issues where he could say something distinctive. It’s been very effective, but you can’t erase the past.

And I’m guessing there’s more in Paul’s past that will be of interest now that we’re getting into the 2016 campaign. I don’t mean scandalous behavior, I mean scandalous notions. I wouldn’t be at all surprised if there are a dozen more videos like this one out there, in which the now-respectable senator says some alarming things to groups of people who revere his father in all the elder Paul’s eccentric glory. I could be wrong, of course—the NAFTA superhighway and vaccines causing autism may be the only conspiracy theories Rand Paul has ever entertained. But we’re going to find out.

Rand Paul is not Ron Paul and we cannot attribute all of Ron Paul’s nuttier views and actions to Rand without evidence. I do bet that plenty more will come out if he has to face the scrutiny of a presidential campaign, and his Republican opponents for the nomination won’t hesitate to begin the opposition research.

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A Bigger Computer Fiasco For The Obama Administration Than Healthcare.gov

The fiasco with the initial opening of the exchanges at healthcare.gov has become a well-known IT glitch from the Obama administration, but that might not turn out to be their biggest mistake regarding computers and health care. As it primarily involves physicians and hospitals, as opposed to the general public, far fewer people are aware with the ongoing problems regarding implementation of Meaningful Use Stage 2 requirements for electronic medical records.

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.

Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.

It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

The biggest obstacle is that the rules require communication between systems which do not exist in the present software. Before making such requirements, the government should have set up a secure system for communication between computer systems rather than hoping that each individual vendor would offer a solution. Another problem is that the requirements include factors which are outside of a medical office’s control. For example, a medical office could set up a patient portal as required in order for patients to assess medical information. However, there are requirements not only to establish this, but for five percent of patients to utilize it. Many physicians, such as those with primarily elderly patients are especially concerned that not enough will even be interested in using such computerized tools. Fortunately this requirement was at least reduced from ten percent in the original regulations to five percent.

Compliance with the rules is further complicated by it being all or nothing. A medical office might follow 90 percent of the rules but will get zero incentive money and pay the full penalties for non-compliance. There are some exclusions and some flexibility in some areas, but this still creates far too great a burden on physician practices.

When the government first changed the rules last fall delaying the requirements for Stage 2 until January, some members of Congress did realize that this was not long enough to have any impact. There was a bipartisan bill introduced to reduce the requirements for a 90 day period in 2015, essentially giving physicians until October instead of January. This was not introduced until shortly before Congress went on recess prior to the election, and died before the end of the last session. Earlier this month Renee Ellmers (R-N.C.) and Ron Kind (D- Wis.) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2015 to restore the 90 day requirement. The bill also has the support of organizations including the American Academy of Family Physicians, American Hospital Association, American Medical Association, College of Healthcare Information Management Executives and Medical Group Management Association.

Even this only postpones the problem and we don’t know if the technology will be any better this fall than it is now. A recent survey of physicians found that 55 percent do not plan to attest to Stage 2, despite the financial penalties.

This failure in the implementation of computerized medical records could be a far worse fiasco than the initial roll out of the exchanges under the Affordable Care Act. The manner in which the Obama administration quickly fixed that problem turned out to be a tremendous success, and this problem is also fixable. A real fix will take more than just postponing requirements.

The government must rethink the logic behind the requirements. Most industries have computerized on their own without being forced to by the government. Some government assistance in conversion to electronic medical records would be helpful, such as establishing standards for communication between systems. Physicians must also be given flexibility to determine for ourselves which aspects of computerization are really of value for caring for our patients and which are not, rather than being forced to follow a long set of rules and only receive credit for 100 percent compliance, or being dependent on factors beyond our control.

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PolitiFact Lie of The Year: Exaggerations about Ebola

Conservatives used Ebola as one means of spreading fear, helping them in the 2014 midterm elections. PoltiFact has now made exaggerations about Ebola their 2014 Lie of the Year. This includes both conservative hysteria which greatly exaggerated the threat faced in a developed nation such as the United States and many of the right wing conspiracy theories. I have already discussed many of these false claims, often in the context of debunking right wing attempts to restrict civil liberties while ignoring the science. From PoltiFact:

Thomas Eric Duncan left Monrovia, Liberia, on Sept. 19, for Dallas. Eleven days later, doctors diagnosed Duncan with Ebola.

Eight days after that, he was dead.

Duncan’s case is just one of two Ebola-related fatalities in the United States, and since Duncan traveled to Dallas, more Americans — at least nine, and likely many more — have died from the flu.

Yet fear of the disease stretched to every corner of America this fall, stoked by exaggerated claims from politicians and pundits. They said Ebola was easy to catch, that illegal immigrants may be carrying the virus across the southern border, that it was all part of a government or corporate conspiracy.

The claims — all wrong — distorted the debate about a serious public health issue. Together, they earn our Lie of the Year for 2014…

Fox News analyst George Will claimed Ebola could be spread into the general population through a sneeze or a cough, saying the conventional wisdom that Ebola spreads only through direct contact with bodily fluids was wrong.

“The problem is the original assumption, said with great certitude if not certainty, was that you need to have direct contact, meaning with bodily fluids from someone, because it’s not airborne,” Will said. “There are doctors who are saying that in a sneeze or some cough, some of the airborne particles can be infectious.” False.

U.S. Sen. Rand Paul, R-Ky., described Ebola as “incredibly contagious,” “very transmissible” and “easy to catch.” Mostly False.

Internet conspirators claimed President Obama intended to detain people who had signs of illness. Pants on Fire. Bloggers also said the outbreak was started in a bioweapons lab funded by George Soros and Bill Gates. Pants on Fire.

A Georgia congressman claimed there were reports of people carrying diseases including Ebola across the southern border. Pants on Fire. Sen. John McCain, R-Ariz., said Americans were told the country would be Ebola-free. False.

When combined, the claims edged the nation toward panic. Governors fought Washington over the federal response. The Centers for Disease Control and Prevention stumbled to explain details about transmission of the virus and its own prevention measures. American universities turned away people from Africa, whether they were near the outbreak or not.

The post went on to discuss the actual medical facts.

Not surprisingly the misinformation came from many of the usual subjects such as Fox and Republicans such as John McCain and Rand Paul. Their conspiracies theories also involved the usual subjects of right wing attacks like Barack Obama and George Soros.

At least one good thing did come about from the Ebola hysteria. Republicans, with the help of the NRA, had blocked the appointment of Vivek Murthy for Surgeon General for months. The Ebola outbreak placed increased attention on this vacancy and he was finally confirmed by the Senate today.

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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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