Don’t Look Behind The Curtain…

On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?

AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version will remain.

It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?

In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.

While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.

Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.

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How Many Justices Are On The Supreme Court? And Other Civic Literacy Questions…

One of the questions that routinely appears on surveys assessing what Americans know–or don’t–about their government is “how many justices serve on the Supreme Court?” It’s not as silly as “how many stripes are on the American flag?” but it’s close–neither question probes the respondent’s actual knowledge of the philosophy or structure of American government. They fall under the category of “government trivia.”

I’ve previously blogged about the difference between that sort of information and the nature of the non-trivial understandings that citizens ought to have, and I promise this isn’t one of those rants. (I know–you’re relieved.)

The answer to that question about the justices on the Supreme Court is nine. But there is no magic to that number.

It is not required by the Constitution. It hasn’t even always been nine. And as an article by a Rutgers law professor argues, it’s inadequate to the duties assigned to America’s top court. And his argument has nothing to do with suggestions that the Court be expanded if Kavanaugh is confirmed and Democrats subsequently take control of the Presidency.

The battle over court packing is being fought on the wrong terms. Americans of all political stripes should want to see the court expanded, but not to get judicial results more favorable to one party. Instead, we need a bigger court because the current institutional design is badly broken. The right approach isn’t a revival of FDR’s court packing plan, which would have increased the court to 15, or current plans, which call for 11. Instead, the right size is much, much bigger. Three times its current size, or 27, is a good place to start, but it’s quite possible the optimal size is even higher. This needn’t be done as a partisan gambit to stack more liberals on the court. Indeed, the only sensible way to make this change would be to have it phase in gradually, perhaps adding two justices every other year, to prevent any one president and Senate from gaining an unwarranted advantage.

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More Than Chutzpah

There are a number of translations of the yiddish term “chutzpah.” Among the best-known is some variation on the following: chutzpah describes the gall of a person who murders his mother and father and argues that he’s entitled to the mercy of the court because he’s an orphan.

The Trump administration may actually have gone that orphan one better.

After reluctantly beginning to comply with a court order requiring them to reunite families–to return the children to the parents from whom they had forcibly taken them at the border– the administration was going to charge the parents for the expenses incurred.

You want this kid back? It’ll cost you….

The judge was not amused.

A U.S. judge in California on Friday ordered President Donald Trump’s administration to pay the costs of reuniting immigrant parents with children separated from them by officials at the U.S.-Mexican border, rather than forcing the parents to pay…

“It doesn’t make any sense for any of the parents who have been separated to pay for anything,” U.S. District Judge Dana Sabraw, who last month ordered that the children be reunited with their parents by July 26, said at a hearing in San Diego…

A lawyer for the American Civil Liberties Union, which has sued the administration over the family separations, said at the hearing that immigrant parents had been told by immigration officials they had to pay for their travel. One parent was initially asked to pay $1,900 to be reunited with a child, according to ACLU court papers. Trump administration lawyer Sarah Fabian called the judge’s order on paying for the reunifications “a huge ask on HHS,” referring to the U.S. Department of Health and Human Services. Fabian said those decisions were handled at the field level, adding that HHS, which houses the detained children, had limited resources.

“The government will make it happen,” Sabraw responded.

So according to an administration lawyer, expecting the government to pay the costs of  cleaning up an inhumane mess of its own making is “a huge ask.” As Ed Brayton commented, first they kidnapped these children, and now they want to charge a ransom for them.

Words fail…..

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Just F**king Vote!

Some of you who have been regular readers of this blog know that one of my sons is a web developer.

Recognizing that turnout is far and away the most important aspect of the upcoming midterms–and believing, as his mother does, that these will be the most consequential American elections in a very long time–he and a couple of friends have developed a very simple, free application that allows people to check their registration status (and register if necessary), find their polling place, preview their ballots and more.

Here’s his description:

The Just Go Vote! app makes it easy to find all the information you need to be able to vote. You can check your registration and register, download a calendar of important election related dates, find your polling place, see your upcoming ballot choices and get an absentee ballot, and view a list of your representatives. To protect your privacy, there is no account sign up for this app. You enter info only to find what you need to vote, and it will be deleted if you delete the app.

Liz, Greg and I have worked really hard over the past few weeks to make this a reality. We agree that there is nothing more important at this moment than the mid-term elections, and to that end we wanted to make something that would help the millions of people who are eligible to vote, but who for whatever reason were unable to last time.

Please download the app, use it, and share it far and wide. Democracy does not work without participation. The Republican strategy of making it ever more difficult for people to exercise their right to vote has been working quite well for them. This app is our attempt to fight back and make it as easy as possible for people to participate in our democracy. If we move even a small percentage of voters who did not vote last time, we can easily take back our government and change our world for the better.

The app will shortly be available in the iOS App Store and in the Google Play Store, and it is already available as both a website and a PWA (progressive web app, just add it to your home screen) by simply visiting our site at https://justgovote.org

Thanks!!

I think the best thing about this app is how absolutely SIMPLE it is to use, even for non-techie, easily confused old folks (like his mother) who didn’t grow up in a digital world. Take a look–and spread the word far and wide.

If this simple tool helps to motivate even a few people per precinct who didn’t vote in 2016, it could make a huge difference.

Commenters to this blog have widely varied opinions about the economy, education, the reasons Trump won, what each of us should be doing about the country’s perilous situation, and much else–but I think everyone agrees on the importance of turning out the millions of eligible citizens who didn’t bother voting in November of 2016.

Here’s one thing we can all agree to do, and my kid has made it easy: DISTRIBUTE JUST GO VOTE!

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Another Reason To Reject Kavanaugh

Much, if not most of the opposition to Brett Kavanaugh, revolves around his obvious antagonism to Roe v. Wade. 

Most people’s arguments for and against Roe center on abortion. But that really isn’t what the ruling protects. The issue isn’t whether or not a woman should terminate a pregnancy–it is about who gets to make that decision. Judges who want to overrule Roe believe that government–not the pregnant woman– should have that authority, that the personal autonomy protected by the Bill of Rights can and should be limited when a majority of legislators see fit to substitute their judgment for that of the individual.

The implications of that position are what keep me up at night.

If you look carefully at the legal and philosophical arguments advanced by opponents of Roe (rather than the “pro-life” demonstrators who see it as simply a question of abortion, which they oppose) you will find a disquieting thread of authoritarianism. These are the judges and organizations who consistently favor the exercise of power–government over citizens, major corporations over consumers, the status quo over potential disruption.

That tendency to weigh in on the side of established authority is subject to one notable  caveat: authority is only right when it is “their guys” who are wielding authority. (They are like the Christian theocrats who are critical of the Taliban, not because individuals should have the right to form and hold their own beliefs, but because the Taliban is imposing the “wrong” beliefs.)

People who know him have remarked on Kavanaugh’s extreme partisanship. As his record has emerged, his strong bias for authority is becoming clearer.

(CNN)Judge Brett Kavanaugh two years ago expressed his desire to overturn a three-decade-old Supreme Court ruling upholding the constitutionality of an independent counsel, a comment bound to get renewed scrutiny in his confirmation proceedings to sit on the high court.

Speaking to a conservative group in 2016, Kavanaugh bluntly said he wanted to “put the final nail”in a 1988 Supreme Court ruling. That decision, known as Morrison v. Olson, upheld the constitutionality of provisions creating an independent counsel under the 1978 Ethics in Government Act — the same statute under which Ken Starr, for whom Kavanaugh worked, investigated President Bill Clinton. The law expired in 1999, when it was replaced by the more modest Justice Department regulation that governs special counsels like Robert Mueller.
Kavanaugh has often embraced the “unitary executive theory” beloved by Dick Cheney. An embrace of that theory by the Court would mean that an independent prosecutor–who is structurally part of the Executive Branch–would always serve only at the “pleasure of the President.”

U.S. Supreme Court nominee Brett Kavanaugh once questioned the correctness of the 1974 high court decision that forced then-President Richard Nixon to turn over secret White House tape recordings and led to his resignation…..The 1974 United States v. Nixon ruling unanimously rejected the president’s claim that executive privilege protected him from having to release the tapes to a special prosecutor…

Kavanaugh said the president, not the attorney general, is the country’s “chief law enforcement officer.”

These views didn’t prevent him from relatively enthusiastic participation as a lawyer working with Ken Starr during Starr’s investigation of President Clinton. But then, Clinton was a Democrat.

This preference for an expansive view of Presidential power ( when Republicans are exercising that power) raises some fairly serious concerns. If government has the authority to overrule intensely private decisions about procreation, and if the President’s authority over that government cannot be subjected to independent investigation, what other decisions is the President free to impose on the citizenry? What happens to other important checks and balances? The rule of law?

Yesterday, the New York Times editorial board highlighted several of Kavanaugh’s previous rulings in an editorial warning that his confirmation would hamper government’s ability to protect citizens against corporate overreach and would further expand the gap between rich and poor.

In 2012, Judge Kavanaugh wrote an appeals court opinion striking down an Environmental Protection Agency rule that required upwind states to reduce power plant emissions that cause smog and soot pollution in downwind states, a decision that was later struck down by a 6-to-2 majority of the Supreme Court. And in 2016, he wrote an opinion that said the leadership structure of the Consumer Financial Protection Bureau was unconstitutional because Congress decided that the president could only fire its director for cause. The full appeals court reversed that portion of his decision in January.

The editorial had much more–and the more we learn, the worse Kavanaugh looks.

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