In February of this year, a new organization was formed to combat the anti-intellectual, anti-knowledge MAGA administration: Stand Up for Science.
The organization has three policy goals, the most important of which (in my view) is the first: ending censorship and political interference in the conduct of science. As the website reminds readers, science can only thrive when there is open inquiry and evidence-based decision-making. Stand Up for Science therefore demands an end to government censorship, including restrictions on the topics of scientific research that are eligible for federal funding, the restoration of public access to the scientific information that has been scrubbed from federal websites, and full public access to primary scientific sources.
In addition, Stand Up wants legal safeguards against political interference to preserve the integrity of federal research and communication and a commitment to freedom of scientific expression– protection of scientists’ rights to communicate their findings freely, without fear of retaliation or suppression.
The organization also wants to protect government funding for scientific research, and wants the government to continue prior efforts to ensure that citizens of all backgrounds have an equal opportunity to become scientists.
The site describes several activities that citizens can take to display support for unbiased, rigorous scientific research. Most do not require a science background–just a belief in the importance of intellectual honesty. But perhaps the most significant effort currently being launched is Stand Up’s demand that Congress impeach and remove RFK, Jr. for lying to Congress under oath and for failing to uphold the mission of the department under his charge.
You can read the organization’s entire letter to Congress on its website. A couple of paragraphs will convey the tenor:
Since being sworn in as HHS Secretary, Kennedy has falsely claimed that the Measles Mumps and Rubella (MMR) vaccine causes death, terminated $500 million in mRNA research contracts, canceled studies in vaccine hesitancy, dismissed all members of the Advisory Committee on Immunization Practices and dictated changes to vaccine recommendations and timelines without scientific evidence. The list below—which we update daily—outlines key evidence supporting our charges.
During his brief tenure, Kennedy has continued a years long disinformation campaign promoting pseudo-science that has resulted in preventable deaths, the disruption of the world’s preeminent biomedical research ecosystem, violation of medical data privacy statutes and regulations, billions of dollars in economic losses, removal of public data, ethical and research misconduct in the production of government reports, the adoption of public health policies and guidelines that are in direct opposition of scientific evidence, and the unlawful termination of thousands of dedicated public servants.
I spend a lot of time on this platform advocating resistance. I realize that it isn’t always easy to find opportunities to participate in that resistance, but supporting groups like Stand Up for Science by adding one’s name to their declaration is clearly one such opportunity.
It’s probably too much to hope that the invertebrate Republicans currently dominating Congress will actually act in the people’s interest and rid our government of this massively unfit and dangerous conspiracy theorist, but the louder the calls for his removal and the wider the promulgation of information about why he poses such a threat to the well-being of all Americans can only help Democrats dislodge those poor excuses for legislators during the midterm elections.
Every day, in every conceivable way, the Trump administration is waging war against equality–rooting out that hated effort to replace tribalism with acceptance of diversity and difference. Media outlets report on “DEI” assaults daily; the mediocre (and worse) White males of the administration are busy scrubbing government websites of evidence of the accomplishments of women, gay people and non-Whites and issuing discriminatory edicts. It is impossible for any fair-minded observer to miss the ferocity of their White “Christian” Nationalist effort to roll back any movement toward civic equality.
MAGA’s hatred of “others” recently manifested itself in an executive order barring transgender people from the military. As a soldier who is a self-described Evangelical described that order in an op-ed for the New York Times,“The order may be legally sound, but it is neither moral nor ethical. I believe that it is my duty as an officer to dissent when faced with such an order.”
I may not be the sort of person you would expect to oppose a ban on transgender troops. I am a conservative evangelical Christian and a Republican. Though I have deep compassion for people who feel they are in the wrong body, I do not think that transitioning — as opposed to learning to love and accept the body God gave you — is the right thing to do in that predicament. But my views are irrelevant to the issue of transgender troops.
This soldier understands–as so many do not–a foundational principle of American democratic governance: individuals have the liberty to believe as we choose, but no right to imposethose beliefs on our fellow citizens.
The executive order barring transgender troops is a legal command that provides cover for bigotry. It delivers hate in the guise of a national security issue, dressed up in medicalized language.
The meek compliance of military leadership with the ban sends a chilling message to all service members — namely, that our ranks are open only to those who fit a specific ideological mold, regardless of their ability to serve. Equally concerning is the message that military compliance sends to policymakers. If officers accept this kind of unethical order, where does it end? I fear that the White House will ask members of the military to perform increasingly loathsome tasks.
And indeed, since publication of this op-ed, the military has been asked to perform other loathsome tasks–and it has obeyed, as citizens of LA and Washington, DC, can attest. This soldier resigned rather than allow his continued participation to serve as implied concurrence with a policy he found morally reprehensible. As he concluded:
I am just one officer in a large military organization. I do not expect my resignation to persuade the president or the secretary of defense to reconsider the policy. I do hope, however, that my actions will prompt some reflection among military leaders about what it would take for them to disobey a lawful but unethical order. Most important, when my children grow up and look back at this moment in history, I want them to see an example of someone who chose the harder right over the easier wrong.
And there we have it. That–in a nutshell–is what each of us must decide, and sooner rather than later: where we draw the line between resistance and accommodation. Between the American Idea and “blood and soil” fascism.
It’s depressing to see how many people are willing to “go along to get along.” History will not be kind to them.
It gets harder and harder to read (or listen to) the news. Every day, there’s a new outrage–a new front in Trump’s war on reality, a new offense to the Constitution and the rule of law. When federal troops are, in essence, being sent to invade cities with Black mayors, when museums and cultural centers are being stripped of historical facts offensive to the Mad King, when a once-storied and proudly independent Justice Department has been turned into the personal tool of a would-be dictator, when the National Institutes of Health reject sound science in favor of voodoo medicine, when the Presidency has become a mechanism for corruption and graft…When everywhere you turn, something horrific is happening, it begins to seem as if we are all living in a dystopian nightmare.
Given the “firehose” nature of the information we waken to daily, it’s easy to lose sight of some of the most important losses we are suffering, or the thread that connects the assaults. When you stand back, when you try to assess the overall motivation of this retrograde MAGA movement, you do see a pattern. There is, of course, the deep-seated racism that forms the basis of Trump’s appeal and that prompts the administration’s daily efforts to erase information about the contributions and tribulations of women, gay people and Blacks. But MAGA’s animus against social progress is even more deep-seated.
MAGA is an all-out assault on knowledge. “Owning the libs” is shorthand for “we’ll get rid of those smarty-pants elitists who think they’re superior because they know stuff.”
That deep-seated resentment against scholarship and knowledge–against things like evidence and fact and the scientific method–is what has motivated the war on America’s universities. And if that war is successful, America’s decline will be inexorable.
I was returning from Marseille, France after participating in a workshop in March that I co-organized at the Iméra research institute on climate change and religious conflict during the Little Ice Age. The topic is now effectively banned from federal funding after the Trump Administration stripped support for scientific research that mentions the word “climate,” amid a broader purge of “woke” keywords in the federal government….
For months, I have watched coordinated attacks on the National Endowment for the Humanities, Smithsonian Institution, Institute for Museum and Library Services, Fulbright Program, Woodrow Wilson Institute, U.S. Institute of Peace, Kennedy Center, USAID, Department of Education, National Science Foundation, National Institutes of Health, and other federal agencies that support academic research and education.
As the author notes, when politicians—rather than professionals— select the research to be funded, the entire pursuit of knowledge is corrupted.
So when Aix-Marseille Université (amU) decided to launch a “Safe Place for Science” program, I became one of the 298 researchers who applied. After all, I was already due to spend one year there as a visiting professor, and the initiative promises three years of research funding. The university has invested €15 million for the program and is lobbying the French government to match that amount, so it can double its planned hires to 39 people.
Europe has seen an opening and is taking advantage of it. The European Commission recently unveiled a €500 million program to make the continent a “safe haven” for researchers. France has committed another €100 million. And American scholars–including many of our very best– are applying in large numbers. As the author writes,
Packing up and relocating to France, or any other country, will be an adjustment. But it is clear that an era of U.S. brain drain is beginning, as researchers and scientists seek opportunities in places where academic freedom and research are still valued.
If MAGA’s war on knowledge continues–if it succeeds in ridding this country of those detested “elitists”– America’s decline will be irreversible.
In the wake of the last report from the Bureau of Labor Statistics–a report reflecting the effect of Trump’s insane approach to economic matters–the Mad King responded by firing the chief labor statistician, Erika McEntarfer, a highly respected expert.
Trump has now nominated one EJ Antoni to be the chief labor statistician for the Bureau of Labor Statistics.
Robert Hubbell reports that Antoni would be leaving his job at the arch-conservative Heritage Foundation, “where he specialized in generating economic propaganda that had only a passing acquaintance with economic reality. In other words, he is a perfect candidate to create fake reports about the imaginary performance of the US economy.” As Hubbell notes, although it’s rare for members of a profession to criticize one another publicly, Antoni has been an exception; he’s drawn withering criticism from numerous respected members of the economic community.
Should average Americans care who heads up the Bureau of Labor Statistics? Or for that matter, which government pooh-ba is put in charge of determining whether government should fund development of a vaccine against, say, bird flu? How much are our everyday lives affected by obscure government agencies that are charged with determining the outlines of our shared reality?
That seemed like a good question to ask Chatgpt, so I did. The AI pinpointed a number of consequences, including misguided monetary policy, with the Fed raising or lowering interest rates inappropriately, risking recession or runaway inflation. Also, in normal times, Congress and the White House rely on BLS data to design stimulus programs, tax changes or spending cuts. (These, of course, are not normal times. Bad numbers lead to bad decisions, and we can expect some terrifyingly bad decisions as a result of this latest attack on facts and real-world evidence.)
The AI also noted that it isn’t just government that relies on the data generated; private companies use BLS data to forecast demand for their products, to set wages and to make hiring and location decisions.
There was a lot more, but the bottom line was that “inaccurate BLS data can ripple from policy boardrooms to factory floors, from Wall Street to Main Street, and from short-term market moves to long-term structural harm. Even though BLS regularly revises its data to correct errors, the damage from bad initial reports—especially in fast-moving markets or politics—can’t always be undone.” In other words, even good-faith efforts by competent analysts will sometimes generate inaccurate results, and those errors can damage the economy. How much more damage can fanciful numbers manufactured for political reasons do? (Don’t look now, but we’re about to find out…)
Trump’s assault on the Bureau of Labor Statistics is consistent with MAGA’s other frantic efforts to ignore and reject much of contemporary reality. Unfortunately for these angry, unhappy people, replacing accurate economic data with propaganda will not magically usher in a more robust economy, just as jettisoning sound science will not make Americans healthier, and rewriting American history will not return White “Christian” men to social dominance.
It will simply destroy the American experiment.
If I decide that gravity is just a “theory” and jump off a tall building, my rejection of that “theory” won’t save me. Fudging the numbers at the Bureau of Labor Statistics won’t help Americans find jobs or afford groceries. No matter how desperately MAGA folks want to bend reality to their will, it just doesn’t work that way.
It’s easy to lapse into despair at the daily destruction of the America we once inhabited. There’s no use whitewashing the fact that an anti-science “health” administration threatens the lives of thousands of people unnecessarily, that insane trade “policies” will inflict enormous damage on the economy, and that– thanks to the Mad King– our global stature may never recover.
Those things and many others even worse are all true. But it’s also true that our government was far from perfect, and that the wholesale destructruction we are experiencing will–when the fever breaks–leave us with a task that is arduous, but that also will represent an opportunity to–in Biden’s phrase–build back better.
I have occasionally quoted my cousin, an eminent cardiologist, for insights into America’s fragmented healthcare system. Today, I’m sharing an op-ed he recently published with a co-author whose expertise is financial. They are looking beyond the devastation, and explaining how we might eventually build a better health system.
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HOW THE DEMISE OF MEDICAID MAY BENEFIT US ALL
By Morton Tavel, MD, and Paul Nolan, CPA
The recently passed “Big Beautiful Bill,’’ among its many deficiencies, contains changes that will negatively impact the already suboptimal nationwide Medicaid programs. Among these changes is a reduction of the federal funding for these various state programs, which, according to estimates of the Congressional Budget Office (CBO), these provisions could result in 11.8 million fewer people enrolled in Medicaid over the next decade, meaning a loss of all financial support of healthcare for many of our neediest citizens. But, as is suggested by this title, how could such an apparently egregious act pave the way for better national healthcare? Let us now delve into the obvious answer:
PRESENT HEALTHCARE IN THE UNITED STATES
Currently, national healthcare is provided through a fragmented healthcare system, with private health insurance companies competing with each other and the government. Private insurers offer health insurance primarily through employers. The government also supports healthcare coverage through programs such as the Affordable Care Act (ACA), Federal Employees Health Benefit Plans, and Veterans Benefits, Medicare, and Medicaid. In many plans, premiums are collected through payroll taxes and general tax revenue, often leaving significant out-of-pocket costs (copays, deductibles, and coinsurance), at an unsustainable cost. The overall healthcare cost in the United States is approximately 18 percent of Gross Domestic Product (GDP), the highest in the world. This compares with costs in other western nations that generally range from 10-12% or lower, yielding national health and mortality rates equal or better than those of the U.S.
WHY ARE HEALTHCARE PRICES SO HIGH IN THE U.S.?
Although comparison shopping makes sense when we buy consumer goods, such normal market forces do not apply to healthcare. Negotiation of prices of various treatments is seldom available, and as costs of tests and treatments constantly rise, the multiple private insurance plans provide no effective means to control prices, simply passing on the expenses to consumers. Although the Affordable Care Act (ACA) has introduced insurance reforms that reduce the average costs to individuals, this nation’s presently excessive overall price tag continues to rise, and given our current healthcare structure, there is no evidence that these costs can be controlled. Thus, more measures are needed to solve this problem.
Insurance companies, in addition to their inability to limit prices, have balked at ACA’s requirement to spend at least 80-85 percent of their revenue on health care. By contrast, more than 98 percent of Medicare’s expenditures are devoted to this end. Estimates vary, but one-quarter to one-third of our current healthcare costs are driven by insurance companies’ profits together with their administrative costs. Thus, roughly half of these costs could be recovered under a single-payor system.
MEDICAID
Medicaid began in the 1960s, as was Medicare; however, Medicaid was not created as medical insurance but rather as a broad public welfare program to provide states with the opportunity to receive federal funding for services given to eligible, needy people, providing many important supportive, non-medical, functions. By contrast, Medicare was formed to provide broad healthcare insurance coverage for all citizens, but it has been limited to the elderly, for reasons explained below. As a result, Medicaid functions by default as a broad welfare safety net for more than 70 million impoverished Americans with spending of over $860 billion in combined state and federal funds. On average, the federal government covers about 70 percent of the program’s costs. In addition to hospital care, Medicaid recipients are covered with a broad range of custodial services that include helping those with chronic illnesses, disabilities, or age-related self-care limitations with activities of daily living that include eating, bathing, dressing, toileting, walking, and continence, etc. Although Medicaid is a joint federal and state program, each state has the flexibility to administer the program differently within broad federal guidelines. Therefore, eligibility criteria for Medicaid inclusion varies unevenly from state to state, relating to factors such as personal income, assets, dependents, disability status, and age. Although all states are required by federal law to provide Medicaid’s mandatory healthcare benefits, each state decides its own criteria for covering many specific medical procedures and payments. The average yearly national Medicaid expenditures for all needy individuals are placed at approximately $8,800. But these amounts vary widely from state to state, ranging from $10,000-$13,000 in most New England and middle west, south central, and mountain states. This is contrasted with approximately $4,000-$6000 in east, south central, west south central, and mountain states. Florida falls in this latter, lowest spending group, at approximately $5,500.
Thus, Medicaid is an inherently inequitable low-level healthcare system. In addition to relegating a substantial number of people into an inferior status, it also compensates physicians less, and in comparison to Medicare, Medicaid caregivers receive an average two-thirds of these fee amounts, often barely sufficient to support office expenses. This leads to substandard care and frustration for the caregivers. This factor alone causes many physicians to limit or refuse care for such recipients. By contrast, Medicare’s Physician Fee Schedule pays more fairly and consistently across the nation.
Although Medicare is a primary payor of hospital charges, one vital role played by Medicaid is in the support of long-term care in the U.S., covering a major portion of spending on nursing home services. In 2022, Medicaid spent approximately $154.4 billion on these long-term care services, paying for nursing home care for periods that meet the program’s eligibility limits that vary by state. Abetted by support of patients’ hospital charges, Medicaid also acts as a financial lifeline to rural hospitals, which is a major factor contributing to their viability.
COULD A SINGLE PAYOR (MEDICARE-STYLE) PROGRAM PROVIDE A SOLUTION?
At its inception in 1965, the architects of Medicare believed that establishing a successful program for the elderly would serve as a steppingstone toward future general coverage. To gain support, their approach was to introduce a program that could be incrementally expanded later, rather than presenting a universal health insurance plan upfront. However, the political landscape during the cold war era was marked by much anti-communist sentiment, and the idea of universal healthcare was derided as “socialized medicine;” however, because of Medicare’s current wide public acceptance and satisfaction, this label is no longer applicable. Nevertheless, political fears of excessive costs have limited the idea of Medicare expansion. Contrary to popular belief, this method, as we explain, could be far more economical than our current system. Moreover, if we wish to adhere to our egalitarian principles, i.e., basic healthcare available to all, an effective remedy is to replace the entire system with a single payor entity, resembling “Medicare for all.”
Ideally, Medicare and Medicaid would be best combined into a single administratively efficient financing system. Eliminating Medicaid’s role in healthcare is justified because, as noted, such a low-level system provides substandard, poorly compensated medical care. Billing under a single entity would save medical care providers vast amounts of overhead, while also reducing the headaches that trigger much provider burnout that is increasingly being recognized. If properly structured, this consolidation would allow Medicare to assume support for all hospital expenses, both rural and metropolitan, thus providing for evenly distributed, cost efficient, and national support of long-term care.
CONTROL OF DRUG PRICES
The cost of prescription drugs varies widely among health plans from state to state. In efforts to decrease drug prices, pharmacy benefit managers (PBMs) work as middlemen between drug manufacturers, insurance companies and pharmacies, leveraging their large buying power to negotiate lower drug prices to benefit users such as Medicare Part D plans. PMBs, through negotiation, do obtain price concessions and rebates from drug companies, retaining a portion and remitting the rebate balance to insurance companies which in turn are expected to reduce prescription costs for consumers. However, depending upon the portion of the rebates retained by the PBMs, this can even drive up the price of available drugs. Since the Inflation Reduction Act was enacted, Medicare now negotiates directly with drug companies, which could, if expanded, eliminate the PBMs and provide a means for a single payor to control the entire pricing structure. The U.S. Department of Veterans Affairs provides a model for this process by direct negotiation of drug prices, resulting in payments of roughly half the retail price of drugs.
COMPENSATION OF CAREGIVERS AND HOSPITALS
Medicare has a detailed method of setting compensation for both physician and hospital services, all of which are lower than those of private insurers. According to the findings of 19 recent studies comparing Medicare and private health insurance payment rates for all services, private insurers paid nearly double Medicare rates for all hospital services, ranging from 141% to 259% of Medicare rates. For physician services, private insurance paid an average of 143%, ranging from 118% to 179% of Medicare rates. As noted, a single payor would eliminate Medicaid’s meager present caregiver’s compensations.
VARIED COVERAGE PLANS
Instead of adopting a strict single-payor system, the U.S. may need additional tiers of care as provided presently by private insurers. These strata could offer extra services beyond basic care, such as private room options, shorter waiting times for non-urgent issues, elimination of co-pays, long-term care, and dental care. Such extras could be provided for patients who are willing and able to pay them in addition to a basic single-payor system. Such a structure would also allow the privately run insurance companies to continue involvement, much as they are presently providing in the form of Medicare “supplement” or “gap” plans.
OTHER ADVANTAGES OF UNIVERSAL COVERAGE
Since the entire population would ultimately participate in a basic single payor system, automatic coverage would be provided for everyone, including those with pre-existing conditions, another stumbling block eliminated! This would also eliminate the controversial need for an individual mandate.
Although employer-financed coverage could simultaneously be continued, individuals so covered could opt out at any time to enter a single-payor governmental sponsored system. This choice would provide a means for employers to reduce their financial burdens, while allowing patients the flexibility to move freely within a national system without losing coverage.
WHY HEALTHCARE MORE COST-EFFICIENT IN OTHER ADVANCED COUNTRIES AND COULD PROVIDE A MODEL FOR US.
Advanced western nations have adopted universal healthcare as a basic right that is mandatory for all citizens. In all systems, (Canada and Germany are two examples) the government acts as a central authority that supervises universal fee schedules, either by direct mandates or through other means such as by negotiation among a combination of insurance providers, public funds, and caregivers. This usually results in lower, fixed costs for all services.
In this nation, the federal government, specifically through the Centers for Medicare & Medicaid Services (CMS), sets the prices for hospital and physician services. These prices are not negotiated like in the commercial insurance sector. CMS uses different payment systems for various types of services, such as inpatient and outpatient prospective payment systems for hospitals and for the fee schedule for physicians. CMS updates the payment rates for both hospital and physician services annually, incorporating changes in costs and other relevant factors. If the U.S. were to establish a uniform overall pricing structure in a single payer system, this would closely parallel those of the other advanced nations noted above and result in reduced healthcare costs for the entire nation.
CONCLUSION
Although no system is perfect, the federal Medicare system works reasonably well; by contrast, the federal-state Medicaid system doesn’t. Folding Medicaid into Medicare-for-all would adopt the long-delayed visionary 1965 universal healthcare plan. We are now presented with a timely opportunity to make important corrections, permitting the replacement of Medicaid in its present form, while at the same time, embarking on a truly effective healthcare system for all that has been long overdue.
