Thumbs Down on Healthcare?

Most will remember the words of the song – “This Land is Your Land” by Woody Guthrie. Guthrie saw the plight of the farmers in the dust bowl and working men in the depression and wanted a narrative that spoke to them when he wrote this song in 1940. When the President was in Tulsa recently, he might have missed the mural on the side of the Guthrie Museum in Tulsa – where his guitar proclaims: “This machine kills fascists”. It was his way of saying that folk singers speak truth to power.  Petula Dvorak wrote recently in the Washington Post that among Guthries’ archives was found a tune he composed in the 1950’s about the color line drawn by the Presidents’ father in his housing project for veteran’s post World War II; that project was later investigated for profiteering and racial discrimination issues. As a veteran, Guthrie had lived in that project and spoke out against the discrimination.

Today, with more than 40 million workers on the unemployment lines, the worker is again threatened with being tossed by the wayside. True, some unemployment checks have been beefed up and some stimulus checks have helped for a few months, but this is all going away in a few weeks, even while some states have still not gotten their employment offices up to speed. Although utility companies were not supposed to suspend services and landlords were not supposed to evict tenants during this crisis, these protections will end soon without employment returning in many cases; it is possible that many will find themselves homeless.

The pandemic coronovirus was supposed to be over by now according to pronouncements from VP Pence and first son-in-law Jared. But, somehow, the virus is not listening and states that had opened up public places too early are trying to close them back up in response to rapidly rising case load counts. New cases across the country have exceeded 40,000 each of the last few days. Texas, Florida, Arizona and California are among the hardest hit areas.

So, in the midst of huge unemployment, and a rising incidence of virus cases – what does the administration decide to do – why have the Department of Justice (DOJ) sign on to support the case before the Supreme Court brought by Republican State Attorneys to rule the Affordable Care Act (ACA, aka Obamacare) unconstitutional, of course.  As a country, we have not yet tallied the enormous costs of the pandemic ICU and ventilator use, not to mention the costs to families, emotionally and financially of this wide spread illness.  According to the National Law Journal, more than 29 million people would lose health care coverage if this law were to be overturned and it would double the number of Americans who are uninsured. The brief filed by the DOJ did not mention the pandemic, nor did it discuss the young adults who might be unemployed or gig workers who could still be covered by their parent’s insurance if they were under 26 years old. It did not mention the approximately 40 million Americans who are self employed or who have pre-existing conditions and were able to buy insurance for themselves and their families on the Market Places (albeit at inflated prices). 

The expanded Medicaid attached to the ACA has allowed 75 million people to be covered (10 million disabled individuals and 9.6 million children under CHIP [in 2018]) especially in the mostly blue states which signed on to the expanded coverages.  Medicaid is funded partly by the states and partly with Federal matching funds.  Some states have very strict allowances for benefits, including work options or job training programs.  But when such programs are mandated and do not adequately consider health conditions or child care needs, they are less than effective. Who can forget the days of insurance denials for pre-existing conditions? Or the bankruptcies suffered by families who faced large medical bills without insurance coverage? They could all come roaring back if the ACA is deemed unconstitutional.

Do you remember that early morning Senate session where the ACA was on the chopping block and Senator John McCain, already diagnosed with the brain tumor which would kill him, strode to the floor of the Senate and said thumbs down on the repeal effort and cast the deciding vote to keep it?  He was not happy with the attempt at railroading through of this legislation without proper process and “regular order”.

According to Vox he stated: “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation’s governors, and produce a bill that finally delivers affordable health care for the American people,” he also said. “We must do the hard work our citizens expect of us and deserve.” (John McCain 7/27/17) Three years later, that has not happened as there are no Republicans of courage apparently to follow his stand of honor and disagree with the President.

We can only hope that the Supreme Court will oppose the efforts of the DOJ and others and put an end to these needless lawsuits. Then the nation can get about the business of fixing the ACA, which was never expanded the way Obama wanted, due to concessions made to get something passed.  There was always the intent to go back and modify the original bill.  Maybe now this can happen.

COVID-19 Stats for today from the CDC:

Total US cases: 2,504,175 (44,703 new since yesterday) Total Deaths: 125,484

Total Maryland cases: 66,777 Total deaths: 3,163.  Maryland is still partly in phase two of re-opening.

Timely Tidbits for today:

• Message to Americans – Stay Home: The European Union is considering banning Americans from traveling to member countries because the danger of pandemic transmission is considered to be so high from US travelers.  Chinese travelers will be allowed in, but Russian and Brazilians are also on the no-fly list.

• The President is doubling down on his racially divisive messages mentioning“Kung flu, hombres, thugs and the honorable heritage of beautiful confederate statues”; today he retweeted, then deleted messages about white power.  It seems that he really does want to divide, instead of unite, this country.

• The House voted last week to make Washington DC the 51^st state.  Senator Tom Cotton, who is getting ever weirder in his remarks, stated that DC has no industry and should not be a state - (he discounted lobbying – where does he get his contributions?), not like a real state such as Alaska where they have fishing or Wyoming where there is both logging and fishing (my paraphrase)! Note to the Senator: annual median income in Wyoming is $61, 584, in DC it is $104,000.  Just sayin’, facts count.

Well, I guess that is about all for today.  Please let me know of topics you would like to see covered.  Do you have a choice for Candidate Joe Biden to choose as his VP – let me know – and tell me what issues factored in your choice.

What do you think of statues being toppled?  George Washington and Thomas Jefferson were slave owners – but they helped form our country and set in place the freedoms we applaud today.  Where does one draw the line – is there a line to be drawn?  Tell me your thoughts.

‘Til next week - stay safe – peace.

Rule of Law?

America is a country where the principles in governing are maintained by following what is known as the Rule of Law.  According to US Courts – “Rule of law” is a principle under which all persons, institutions, and entities are accountable to laws that are:

·         Publicly promulgated

·         Equally enforced

·         Independently adjudicated

·         And consistent with international human rights principles.

We have been subjected to a government over the last three years which has disregarded established laws, tried to circumvent the Federal Courts processes, favored certain groups over others, ignored validly issued subpoenas, and demanded that civil servants serve the President rather than the people. These actions have been supported by Senate Majority Leader Mitch McConnell, Republican Senators and their party; their actions in the impeachment hearings were inexcusable. So, it might well be time to question whether we are actually a nation under the Rule of Law. Our country was set up with three equal areas of governance: Legislative, Judicial and Executive, but this President speaks about ‘his’ military and ‘his’ judges and ‘his’ party as if no others have a say. He obviously does not believe in these three divisions of power.

Chief Justice of the Supreme Court Earl Warren during the 1950’s brought the Court to a unanimous decision in Brown vs. the Board of Education of Topeka which ruled that segregated education was always unconstitutional because it was inherently unequal. A subsequent ruling indicated that integration must proceed with all deliberate speed.  Senator Harry Byrd of Virginia responded with an attempt to organize massive resistance across the South to this change which was deemed to demand an “unnatural mixing of the races”. Many states closed their public schools or decreased funding for education, so that black students had only inadequate education, while white students went to hastily established private segregated academies. President Eisenhower sent Federal troops into Little Rock, Arkansas to integrate schools there in 1957 as courts had ruled that integration must proceed. Massive state resistance continued into the next decade. Signs were erected throughout the South to “Impeach Earl Warren” as the justice was blamed for his leadership on this matter of integration. So, the turmoil based at the court today and the prayers for the health of Justice Ginsberg are not unique to our time.

The President has had the chance to appoint two new justices to the Court during his term, due to the unethical and probably illegal moves by Mitch McConnell who denied President Barack Obama his valid chance to appoint another justice.  McConnell has also seen as his major function appointing judges to lower courts; appointments which he refused to process under President Obama. Both of the new appointees, Neil Gorsuch and Brett Kavanaugh have been deemed sufficiently conservative and strict constitutionalists to appease the far right and religious conservatives whose only concern appears to be that of abortion restriction. The President has bragged about wanting to appoint even more Justices as decisions this week ran contrary to his concerns.

What were those decisions: The first – Bostock vs. Clayton County Georgia was written by Justice Gorsuch and indicated that the Civil Rights Law of 1964 under Title VII, did not permit employers to discriminate on the basis of sex, which includes sexual orientation, gender identity and transgender status, thus providing a victory for the LBGTQ community and a defeat for the President who has been actively prohibiting transgender rights under the ACA and in the military. Sadly, however, the travel through the courts system took so long that two of the three original petitioners died before this verdict was rendered. According to census information – 5.1% of women and 3.9% of men in the US identify as gay which is approximately 15 million people.  About 1.6 million Americans identify as transgender.

The second decision, written by the Chief Justice, (John Roberts) ruled against the Presidents’ overturning of the Deferred Action for Children Act (DACA).  The Administration wanted to leap- frog the usual judicial processes of stepping up through the courts and eventually reaching the Supreme Court if accepted as an issue. This decision ruled on procedural matters which dealt with adequate notice to the parties and other niceties of the law which were bypassed in this instance, in fact this action was deemed arbitrary and capricious by Justice Roberts. Basically, if I understand this correctly, the administration changed its argument between presentations at different courts thus negating its own case. If arguments differ then one is compelled to start anew.  As Linda Greenhouse wrote in this New York Times article:

"Given the decisions due in the next few weeks on abortion, religion, the president’s tax returns and the Electoral College, among other cases, it’s too soon to place a label on this pandemic-disrupted Supreme Court term. The justices will issue decisions that will infuriate, reassure, surprise and even break hearts…"

DACA primarily affects young people who came to the United States with their parents who were undocumented and have spent most of their lives in this country – many now known as dreamers – who through no fault of their own could not become citizens.  President Obama tried to provide a path for them, provided they attended school, kept out of trouble, joined the military or served their communities - to eventually apply for citizenship and – in the meantime – be able to work legally when they came of age.  Approximately 650,00 young people are in the program now.  Homeland Security has not allowed any new applicants, but has allowed renewals so far in this program.

I tend to agree with her – maybe they are giving the President a few raps on the wrist before they deliver the meatier decisions mentioned above. I think they might go along with the religious rights schools tax issue, punt back to precedent from the court on the abortion issue (and basically rule against Louisiana on the requirement for providers of abortions to hold local hospital privileges) and rule against the President on the tax returns along the lines of the Nixon tapes/papers decisions – I hope. But I am not a lawyer, just a concerned citizen here who worries that the court is losing its nonpartisan mantle. But I am trying to make an educated guess, rather than just go out on a limb, not quite the lottery, it seems.

But what should I think, especially after the 2010 Citizens United decision which allowed corporate speech and unlimited hidden financial contributions to political campaigns and The Shelby decision of 2013 written by the Chief Justice. This took away the protections for elections which were under the Voting Rights Act but which had to be renewed periodically. This, today, has allowed the states of Georgia, Texas, Florida and Alabama, among others, in recent years to further restrict access to voting, purge voting lists, require id’s, which - if the law had been upheld - would still have been under the jurisdiction of Justice Department review, due to past inequities. He concluded that enough time had passed, states had adhered (because, argued Justice Ginsberg in dissent, they knew that they were subject to review by pre-clearance before they changed requirements) and racial disparities had improved so that these protections were no longer needed unless Congress so decided.  Perhaps he needs to look outside his windows these days, racial inequities are still very much with us.

Timely Tidbits       

•  Attorney General Barr fires the US Attorney for the Southern District of New York – and lies about the process – perhaps the investigations were getting too close to his boss – or should I say co-conspirator?·       
• The President holds a rally and people stay away - due to COVID-19 worries, protesters, the media, lack of enthusiasm, young activists pranking? Maybe all of these?
• The Bolton Book passes Court review – sorta – would his testimony have made a difference in the Impeachment hearings?  Are you going to read his book?
• Finally, the President admits he slow walked Corona virus testing, because the numbers did not look good, then said he was joking.  Well, he was right about one thing, the numbers do not look good!

COVID-19 Weekly update:  Not really showing much of a slowdown.

Total Cases in the United States - 2,248,049  

Totals Deaths in the US – 119,615

Total cases in Maryland –    64,606                         

Total MD Deaths –                   3,056

So, how to sum up this week – tumultuous, much as the previous few months have been. Some states are opening up, then closing back as virus numbers increase.  People are talking about the experiences of dining out in the Age of The Virus. Businesses are opening their doors gingerly as the economy stutters with 40 plus million on the unemployment rolls and unemployment remittances are not keeping up.

So, maybe as the President accepts no responsibility for anything, blames Obama and the leftists for his troubles and bemoans his fate as underappreciated, perhaps I will send out a few lines from Shakespeare as fitting to him for my close tonight:

When in disgrace with fortune and men's eyes
I all alone beweep my outcast state,
And trouble deaf heaven with my bootless cries,
And look upon myself, and curse my fate, [abridged] Sonnet 29

‘Til next week – peace.

Symbols and Heritage

Today is Flag Day, so I think that the flag as a symbol and symbols in general are subjects to consider. 

There has been a lot of chatter recently about symbols and heritage, so I thought now might be a good time to take a minute to see what those words mean. Obviously, people can have their own interpretations of these words, so I thought I would share an example from my own background. I grew up in New England in a suburb of Boston which was first settled in the 1630’s. One example of heritage would be the history of that area and a symbol of that might be historic buildings in the town. Another might be events which happened near by such as the Salem Witch Trials or Paul Revere’s Ride which we learned about from history books. Another could be the fact that I have ancestors who settled in the “colonies” before the Revolution. 

But, what do we do if heritage and symbols from one group cause pain for another group? There are those who consider the Confederate soldiers as heroes fighting for a noble cause, while others see them as traitors fighting to perpetuate slavery of black people. But today, many see examples of clinging to this failed heritage as a continuation of the racism that some thought the Union fought to stop. It wasn’t until 2018 that textbooks in Texas were changed to say that the war was not fought for states’ rights but rather to end slavery. And it was not until the hate crime of the slaying of nine black parishioners at the Mother Emmanuel AME Church in Charleston South Carolina that the Stars and Bars of the confederate flag were removed from the State Capitol. This was 155 years after the end of the Civil War. 

Throughout the South communities have argued about the removal of symbols of the Civil War, whether they be statues or commemorative plaques, names of stadiums, schools or parks festooned by confederate flags. Some claim that heritage should not be denied and to do so is an attempt to rewrite history; others find such reminders as an excuse to continue vestiges of Jim Crow, separate but unequal practices and the denial of voting rights. Others have considered these symbols to have been used for intimidation and to create an atmosphere of fear in the African American populace. Recently the President has emphatically stated that he will not rename Southern military bases which were named for Civil War officers. There are currently 10 such bases, only one – named for General Robert E. Lee – was active during the Civil War. Fort Bragg in North Carolina is a major training base and is considered the largest military base in the world. Many of our current military forces continue to be trained on that large base. Four bases were created for troops in the time of World War I; the other five were not created until World War II (WWII) – over 70 years after the Civil War. The decades between the wars above was also a time when many of these statues were placed and activities of the Klan and lynching were widespread. 

The American military was segregated until desegregated by President Truman in 1948. Many returning troops from the battles of WWII were finding issues with coming home to the same segregated practices they had seen before the war. 1.2 million African Americans served in the military in WWII. Every minority group in the United States claims a proud heritage of service in that war, even though often in units separated mostly from the majority battalions of white troops. The famed Tuskegee Airmen were pilots in an all-black unit which flew more than 15,000 combat missions during the war for the Army Air Force. 44,000 Native Americans – almost ten percent of the entire native population served. Some were with a special unit created of Marines and others, such as the Navajo translators who were called the Code Talkers and used their language to circumvent the German military spies. Hispanic soldiers claimed between 400-500,000 veterans who fought proudly in that war; Puerto Ricans were used at times in the Philippines due to their Spanish speaking skills. Even Japanese Americans, though in small numbers, since many were in internment camps, numbered over 30,000 enlistees; many who fought in the European theater, while others were used as translators. America, as can be seen with these numbers, has been defended by armed forces of all races. Yet, it seems to me, that some must wonder how their blood is good enough to be spilled on foreign soil, but their skin color is suspect back at home. 

Today the military is still largely a white majority group of volunteers, since there is no longer a draft as was seen for previous wars. According to Statista white men and women comprise over 60% of the active duty armed forces (all services), African American men and women about 25% and Hispanic and other races make up the rest (numbers averaged and rounded for a rough estimate here). Additional numbers from State National Guard units may skew these totals a bit. The recent controversy about using US military forces against the American people needs to be considered in light of this multiracial cohort. One can see why Senator Tom Cotton (R-AR) was so wrong in using statements such as give no ground to terrorists - his term for the protesters – as was the Defense Secretary Mark Esper who talked about cities as "battlespace". Battles such as this could easily set brother against brother, sister against sister. The current military leaders have taken much criticism from former leaders and retired generals for allowing the politicization of the military in the demonstrations in DC and elsewhere. This has further diminished our standing abroad and anywhere we promoted America as a land of free expression. The President frequently refers to troops as his military when the oath they swear is to uphold the Constitution of the United States. 

Timely Tidbits from here and there: 

• Although most colleges and universities have managed to have virtual online graduation ceremonies, the President insisted that his planned address before West Point cadets be held in person at the military school. This made the Academy have to bring all graduates back two weeks early for quarantine and then seat them six feet apart on the parade grounds so that the President could have his show. 

• Former Homeland Security Secretary Jeh Johnson spoke of heritage recently and said – to me, continuation of Southern heritage means that my African American Great-great grandmother who was freed by the Civil War – would never have become free. (paraphrase -but something to think about.) 

• The President planned his first campaign rally in this COVID-19 era, to take place in Tulsa, Oklahoma on Juneteeth – or Freedom Day - the anniversary of when Emancipation was first announced to the population in Texas. It has long been celebrated by African Americans and many would like to see it become a national holiday. Tulsa is the site in 1921, where a white mob massacred hundreds of black Americans in a riot that destroyed a middle-class black community. After significant push back, the date was moved to the next day - a rare retreat for him. 

COVID-19 updates: This week saw several states which had opened up or reduced restrictions note increases in cases of the virus. Some have paused the moves to open. Numbers below from the CDC website. 

Total US cases 6/14/20 – 2,063,812 Total numbers of deaths – 115,271 

Total Maryland cases - 61,701 Total numbers of deaths – 2,939

 So, generally the totals seem to be slowly going down as numbers per day, although they are still increasing nationally with about 147,575 new cases and 5,230 new deaths; Maryland shows 4931 new cases with an increase of 237 new deaths. This is down from a previous daily average of 1000 new cases per day. 

So how to conclude this discussion about symbols and heritage – what does heritage mean to you? 

What does the symbol of a statue, a military uniform, a flag mean to you? 

All three of my brothers served in the military – what about your family? 

What does the symbol of a person in uniform or a veteran mean to you? 

 Should this service be politicized? 

As I write, residents of Atlanta are protesting the shooting death of another black man by police in a situation that it appears could easily have been de-escalated, instead of ending in gunfire. 

It brought to mind the words of a black poet from the days of the Harlem Renaissance in the early twentieth Century, Contee Cullen, who ended his poem “Yet do I Marvel” with these words: 

“Do I marvel at this curious thing - to make a man black and bid him sing?” 

Let’s try to make this a world where we all can sing. 

‘Til next week – Peace.

Best and Worst of Times

Charles Dickens wrote in the opening of his powerful novel A Tale of Two Cities:  (modified)
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, ….. it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair…”

America is at a crossroads and it is up to us to decide if we are in the Spring of hope or in the Winter of despair. We can continue the way things have always been and allow mistreatment of minorities to continue or we can listen to the voices of the thousands in the streets and head into a springtime of hope. Black Lives Do Matter and they should not be subjected to different treatment by law enforcement, the justice system, educators or employers. Income inequality does exist. Police brutality does exist; George Floyd was murdered.

The middle class is slowly eroding due to many factors. Some of those factors are a result of the lack of unions to look out for workers rights and benefits; as a result of strong anti-union laws, fewer workers have pensions, work guarantees and health care benefits. Lack of manufacturing jobs have also eroded the middle class taking away the entry level jobs which created a strong domestic manufacturing class into which many African Americans and immigrants found their first steps toward the American dream.  For some the American Dream has become a nightmare. No surprise that they are in the streets.

According to the Brookings Institution:  …“the top one percent alone holds more wealth than the [entire] middle class. They owned 29 percent—or over $25 trillion—of household wealth in 2016, while the middle class owned just $18 trillion.” Additionally, it is pointed out, only the top 20% have recovered from the great recession of 2008, for the rest, growth has been flat or regressed due to losses in jobs, lack of increases in incomes, decreased home values and the decline of the ability to save or invest.

Black and Hispanic unemployment figures have always been higher than that for the white population, even in times of high employment. Last hired, first fired is not a truism. It was true in the days of the Great Depression in the 1930’s and has continued to be true to this day.  The fact that many jobs are structured by seniority also affects the more recently hired.  Covid-19 has created a massive loss of jobs across many income levels. Over the last year, the average hourly wage was $11.73, while the Federal minimum hourly rate remained at $7.25/hour. The average salary, excluding benefits or housing in the US in 2019, was $69,181.  The average annual income for the top 1% is 1.3 million dollars.  One of the main drivers for the French Revolution (which is a part of the plot in the Dickens book noted above) were the extreme disparities in classes in that society.  The aristocracy was amazingly extravagant, throwing lavish galas, while the lower classes could be thrown into debtors’ prison for petty amounts or into the Bastille for minor offenses and lose any possessions they had.

So, we have income inequality, lack of equal access to jobs, adequate housing and education and lack of civil rights in many instances. Each of these concerns needs to be addressed so that our democracy can prosper and fulfill its promise. As I have pointed out in previous posts, access to adequate healthcare is also a significant struggle in our society.

According to the Sentencing Project, an African American male born in 2001 has a 1 in 3 chance of being jailed in his lifetime, while a Latino male has a 1 in 6 chance and a white male has a 1 in 17 chance.  Much of this discrepancy is due to poor legal representation, plea bargaining, mandatory minimum sentencing, over policing for drug crimes and inequities in the judicial system. Some reforms introduced over the last few years have begun to impact some of these numbers and many imprisoned for non-violent offenses or minor drug crimes are being released.  Hopefully this will be a start.

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Timely tidbits from here and there:

• Many Americans are wondering about the use of force by some paramilitary forces - without insignia - against protesters in the streets of the Nations’ Capitol – who is their commander or to whom do they report?
• Germanys’ Angela Merkel has declined to join the planned June meeting of the Group of Seven national leaders at Camp David, stating she fears the level of COVID-19 in the US. The meeting has now temporarily been postponed until the fall. 
• President Trump is still lobbying for President Vladimir Putin of Russia to be included in the G7; Putin is currently excluded due to international sanctions for his bad behavior regarding assignations on foreign soil and incursions into Ukraine, among other things.

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Total COVID-19 Statistics to date:

United States – Total number of cases: 1,916.237            

                           Total number of deaths:  110,041, about 6,341 more than last week

Maryland        -  Total number of cases:      56,770           

                           Total number of deaths:      2,702, about 200 more than last week.

In summary, the numbers nationally are increasing at a slightly lower rate both in deaths and incidence (about 154,000 new cases), while those in MD have decreased in total new deaths, but noted the numbers of cases increase (about 4,000 more)at a slower rate than last time or more than 500 daily.  Wear those masks, and social distance, everyone!

Some concluding thoughts:

This has been a tumultuous week, but I think some lasting good has come from it.  The youth, who have become used to mobilizing ever since Parkland, have turned out in force in streets across the country in cities and towns large and small.  We saw large, diverse crowds (in age, race, and ethnicity) marching with a single purpose.  If those marchers can become voters and activists, they can question some of the reasoning and racism of the older generations and, hopefully, change the world.

Many have also started to question the use of our military by the President.  Numerous military leaders, active and retired, have indicated that these actions (armed troops and armored vehicles stationed in the Nations’ Capitol and actively engaging the marchers – some with gas and pepper spray) have been implemented contrary to our Constitution.  There is no tradition of using American troops against Americans.

Recently, my grandson and I were looking at tombstones in an old churchyard, when we found the grave of a soldier from the Revolutionary War.  If you had asked that soldier why he fought, I would guess that one of his answers might be that he was fighting against tyranny.  Jefferson is quoted as saying: When governments fear the people, there is liberty. When the people fear the government, there is tyranny. Here is another crossroad, which way will our country decide to turn – toward liberty or tyranny?

Until next week – Peace.

Deaths from COVID -19 Continue to Rise

Today the New York Time has an extraordinary front page, there were no photos, no articles of interest, no headlines.  There are just names – 1000 names, to be precise – about one percent of the total deaths from COVID-19 seen so far this year. These names cover the front page and tumble inside for a few more pages. This is an effort to show that these deaths are not numbers or statistics alone, they represent lifetimes lived sometimes courageously, sometime outrageously, but lived each in its own unique way.  Americans are proud of their individualism and it shows in these descriptions which were culled from obituary pages in papers across the nation and briefly noted here: last names omitted by me: “(Susan, 74 – Palm Beach Florida – loyal and generous friend to many; Morris, 90 – Northbrook Illinois – Endlessly curious, never really finished; April, 33 – Baton Rouge, Louisiana, advocate for disability rights; Cornelius, 84, -  Bellevue Washington, sharecroppers son)”. These are strangers, friends or neighbors, people just around the corner, perhaps, others whom we never knew but who helped make our country what it is today.

Tidbits from here and there:

This weekend The White House noted both Memorial Day and the COVID-19 deaths approaching the 100,000-total mark by flying flags at half staff and ordering that this be done nationwide.  It seems a bit of a tardy response, but hey, better than nothing, as they say. But by Tuesday it will be back to opening up for business everywhere.  The odd declaration by the President that all states must open churches, synagogues and mosques this weekend seemed more political than politic, as religious gatherings at close quarters have presented some of the most often noted sources of infections.  Of course, as was swiftly noted by many commentators, he does not have that right, constitutionally, anyway!

Beaches were crowded along the East Coast as formerly locked down sunseekers headed for the surf and sand nearby.  There were reports of crowds, few masks or social distancing in many places.  This is far too early to break free; it seems to me.

Doctors Without Borders have arrived in the southwest to assist in the virus outbreak in the Navajo Nation and other tribal areas. They are usually known for arriving in third world hot spots with famine and disease outbreaks.  What does this say about American healthcare?

GO Fund Me efforts by these Native Americans have been aided by an outpouring of donations from the country of Ireland which was giving payback for the aid these tribes sent to Ireland during the 1840’s potato famine. So far, the Irish have donated more than $600,00 to support the struggling nations.

COVID-19 Totals from the Centers for Disease Control: 5-24-20 

Total number of cases – US = 1.622,114.   Total number of Deaths = 97,049 about 7,000 more than last week.

Total number of cases in MD = 46,313.      Total number of Deaths = 2,162 approximately 700 more than a week ago.

Return to a problem:

Last week I mentioned that approximately 30% of the deaths in the United States came from patients in nursing homes. That means 30,000 people who could have been protected from infections with a better care system! The first major US COVID-19 outbreak happened in a nursing home in the State of Washington and eventually accounted for 37 deaths in that facility.  Later tests revealed that there were multiple deficiencies in this center, which is part of a nationwide chain of nursing homes.  This home has been fined for inadequately providing for its residents.  Senator Ron Wyden (D-WA) asked the General Accounting Office (GAO) to do a study of incidence of infections in the homes and how Medicare was monitoring this care.  The findings will be summarized below.  

But Senator Wyden was critical of the way HHS is monitoring this care: “This new report shows that warning signs were ignored and nursing homes were unprepared to face a pandemic,” Wyden said. “For years nursing home surveys pointed out areas where federal standards for nursing home safety and enforcement efforts should be improved, but the Trump administration chose not to correct them. Too many seniors and their families have suffered as a result of this pandemic, and there need to be big changes in the way nursing homes care for seniors.”

The report included a pie chart noting that 18% of the homes were not cited for infection control problems.  However, 82% were noted for having infection control prevention deficiencies in one or more years.

The report goes on to note that improper techniques for infection control such as lacking masks and personal protective equipment, while important, were not cited as important an offense as was the inability to isolate a patient with Methicillin Resistant Staph Aureus (MRSA), which is contagious.  It did note that a home was cited in New York State for failure to contain an outbreak of respiratory illness in a previous year which sickened 38 residents. That report went on to say that homes need to isolate persons who are sick with symptoms away from other residents and keep the staff who care for them away from communal areas such as dining rooms.  These are not new concepts, but with lax enforcement and trivial penalties, when cited, many homes do not make the efforts necessary to comply.  For a home of the average size – which is only 108 beds, it may not be easy to set up a separate wing for sick patients as they operate usually at about 80% capacity. Unlike acute care facilities which have gone over to single occupancy rooms, many nursing homes still have rooms which have 2 to 4 occupants. This increases the ease of infection spread and makes it more difficult to relocate patients. Staff turnover is high as the wages are low and new staff is not always well educated on infection control processes.  Medicare (CMS) sets standards and states are required to enforce them; however, homes are usually visited only once a year unless deficiencies are found, which need corrections right away. GAO plans to review these CMS standards more deeply in a future report.

Many do not realize that Medicare only covers and pays for nursing home care in limited circumstances, such as rehabilitation after a hip replacement, for example.  Medicaid, which is jointly funded by the Federal government matching funds with each state individually, accounts as the payer for 62% of nursing home costs; 69% of the nursing homes are for profit businesses.

According to the Kaiser Family Foundation, there were approximately 1.6 million people in nursing home care in the US recently living in some 16,000 facilities. Annual costs without extras – and everything is an extra – averages about $80,000; far beyond the ability of most seniors or their families to afford. Many of the patients in long term care facilities need personal care as 60% have issues with mobility, meaning that they need help getting up and around and may need help using the bathroom, with bathing and getting in a wheelchair or using a walker. This population needs to be protected from falling, as they are often on many medications and have balance and visual perception deficits. These matters require hands on care.  Those who have issues with dementia, or need Alzheimer’s care, have cognition problems and may not comprehend what they need to do or even where they are, which makes their care more difficult.  There are many other concerns such as incontinence, bedsores, over medication and fragility which factor into the need for knowledgeable caring personnel to be able to meet the needs of these often helpless, elderly and keep them safe.  

I do not have a solution for these issues. It seems that there must be a way to take care of these senior citizens who need such direct care and often cannot look after themselves. The physical demands of caring for such ill or debilitated patients is often beyond the capacity of many families, which creates the need. As a society, we have made many medical advances as some people are indeed living to extreme ages; medicine has not, however, helped us learn how to protect these patients and meet their needs in a manner which respects their dignity and treats them as fellow humans.

Until next week, the news keeps driving the agenda.  Who do you think VP Biden should choose as a running mate? Let me hear from you!  Do you have a solution for long term care? What is your opinion on opening up vs. staying home?  What do you think about AG Barr?

Stay safe!

The Faces of COVID-19

Carl Sandburg famously wrote that “fog comes in on little cat feet”, it is silently, suddenly around us. A virus is much like fog; it gives no warning, does not signal its arrival nor does it indicate when it is gone. In New York City its’ presence was noted by the silencing of a busy metropolis, broken only by the omnipresent wail of ambulance sirens and the beeping of the machines keeping patients alive in ICUs and Emergency Departments. It was also known by the faces of those whose lives it took away from our families, nursing homes, neighborhoods, country lanes and city streets. Those faces are old, their heads are gray, they may occasionally be immigrants or young, but most often they are people of color. The statistics are startling.

Another study with partial data indicates Black Americans are approximately 13% of the total population, but are accounting for 27% of the deaths. American Public Media (APM) also reports: “White Americans are dying at elevated rates in eight states (Oklahoma, Rhode Island, Connecticut, Idaho, Texas, Washington, Minnesota and Delaware); Asians in Alaska alone; and Latinos in New York, Missouri and New Hampshire.” A third of all deaths are from people who resided in nursing homes or assisted living facilities. The United States currently has about 1.5 million people living in nursing homes. The variability of care in these homes is a topic for another time.

Research by APM research documents deaths per 100,000 population by the following percentages: (note – not all states are reporting cases with a breakdown by race; Native American deaths will be noted below.)

Asian - 18.4%

Black - 42.8%

Latino - 19.1%

White – 16.6 %

Currently COVID-19 deaths in the United States are right around 90,000 as of this weekend; the number of confirmed cases here is about 1.52 million, making the US total about one-third of all cases in the world.

Last week Maryland (where I live) noted 29,374 cases with 1401 deaths; this week the totals are still rising with the latest reports noting 37,968 total cases with 1957 deaths.

Other studies have looked at Native American deaths in the southwest, primarily in Arizona, Utah and New Mexico and found that social cautions such as hand washing and social distancing do not work well on reservations where fresh water or hand sanitizer is not readily available and social distancing is very difficult in a small dwelling or trailer. Currently the Navajo nation is reporting deaths of 30 per 100,000 in those areas. New Mexico has noted that of the 23 tribal nations in the state, (which comprise 11% of the population), Native Americans account for 42% of the infections in that area.

Immigrants who come to America often take jobs that are less desired by local citizens. That is why meat packing and processing plants are often staffed by new arrivals, some of whom have no work permits. The lack of access to health care, which is often denied to those who do not have documents and passports, means that when they get sick they do not go to the hospital, because they cannot afford it; they stay at home until it is often too late to benefit from care. The clusters of cases around these plants was made worse when the President deemed them essential and decreed that, even in the face of mass outbreaks, these plants must stay open. The inability to understand healthcare warnings for communities with poor English is also another concern seen in these immigrant populations.

Many African Americans, Latinos and Native Americans have high rates of diabetes, obesity and hypertension which leads to other complications when trying to fight a respiratory or systemic disease.  One common factor in the treatment of disease in minority communities is the lack of adequate health care, whether it is on a reservation, an inner-city Hispanic neighborhood or a poor Black community in Mississippi; access to affordable services, follow-up care and medication is often lacking. Several of the states that did not expand Medicaid or placed restrictions on qualifications for its’ services are now seeing disproportionate illness in these communities across many healthcare fronts. Generally, most Americans are unaware that immigrants, or those without documentation, are denied legal access to Federal or State services, except in emergencies.

Black communities, especially, are seeing incidence of COVID-19 both in rural and urban centers, far greater than the proportion of their presence in these counties. The Commonwealth Fund noted that in the higher incidence counties mentioned above that Blacks accounted for one-third of the population, but 53% of the cases and 63% of the deaths. The authors of the study conclude that the United States needs to mandate collection of information about the race of the patients with COVID-19 and then determine how to adequately allocate resources to those affected communities.

Of course, much of this goes back to the absolute mismanagement of this health care pandemic crisis. The President noted we are testing too much as he realized that higher case numbers and continued closed businesses reflected badly on his happy talk agenda. He took none of the blame for his continued fight against the Affordable Care Act (ACA, also known as Obamacare) which has knocked many off the enrollment lists, either from closed clinics, reduced services and lack of access or increased costs, so lack of affordability. The Kaiser Family Foundation noted that the U.S. has now tested 10.7 million people, (not counting the daily tests for those in the White House, of course). We still have to go a long way to meet necessary international standards and do contact tracing and follow-up.

I have been lucky enough, through this crisis, to work from home. I do not have to work in food service, janitorial services or in a nursing home, where I must be exposed to a hostile environment, possibly without adequate protective gear. I do not have to leave my home and take public transportation to arrive at my city job. So, my exposure to COVID-19 is limited, while those mentioned above might have maximum exposures. Is it any wonder then, that one might fall ill?

My state has only opened some areas, my county is not among them, so I am not concerned about crowds of people suddenly streaming by my home or nearby parks and recreations centers, not to mention bars and restaurants. However, I remain concerned about those states that have opened up everything, where people are not wearing masks and some are putting the lure of the dollar for a few, over the health and safety for many.

Well, time to say good evening for now – so many topics I did not get a chance to cover tonight, but there is always next week.  Hope to see you back here and hope to hear from you.  Loved President Obama's remarks on Saturday, so much more to day; stay tuned as they say.

It is All in the Numbers (2)

Back in the Vietnam war era a draft lottery was instituted due to the unpopularity of that war and the reality that the draft was unfairly targeting the less fortunate, those who could not afford to go to college and get deferred, those who could not move to Canada or afford to get a doctors note for some type of injury or disability. So, those who did not serve - such as for heel spurs - perhaps, were spared eventually getting drafted and perhaps going to the war in southeast Asia. Consequently, to try for fairness, random numbers were assigned to birthdays arbitrarily drawn and given a ranking.  The first day drawn that year was number 258 which matched September 14^th and that became number 1.

A certain number of draftees were to be selected, based on projected troop needs and numbers of selectees and that year the numbers stopped at 195 so it was considered important for young men to know their “number” or briefly, their chance at being drafted and they could make some plans as a result. If the number was higher than 195, they essentially had a pass. (These changes to the draft were a first step towards what eventually became what we now know as an all-volunteer military.)

So, once again knowing your numbers has become an important issue for Americans. How is your state fairing against the Covid-19 viral pandemic?  Do you have high infection rates or low ones?  Are you living in an urban area with modest numbers or in a more rural area with high numbers due to meat packing plants, prisons or nursing homes?

Here are some important numbers for today.  

US Population 328.2 million - MD - 6.3 million

Total Covid-19 cases in the US: 1.36 million -  Maryland (where I live) - totals -29,374

Total recovered patients: 208,000                      Maryland - recovered - 2,029

Total Deaths: 80,562                                            Maryland – Deaths - 1401

In the United States statistically, based on previous years data, about eight thousand people a day die from all causes.  In the last flu season approximately 161 people died from influenza each day.  As of May 6, 2020 - 2528 deaths were attributed on that day alone to the Covid-19 virus, just in the US. According to studies done by the New York Times there were three times as many deaths in early April this year in New York, when compared to previous years.

So, one might ask, what is the point here – we know people are dying from this virus.  Well, what is important to know is that the US is having many more deaths proportionately than other countries because our response to this pandemic has been haphazard at best. We did not control the spread and we have not tested enough or tracked for contacts. Currently the Centers for Disease Control (CDC) indicates that only eight million tests have been reported to date. The Presidents touts a number indicating that we have done more testing than any other country, but when compared to our total population, that number is tiny. 

Now, the virus is even reaching the White House where they are rapid testing each day, yet members of the Secret Service and White House staffers have tested positive.  Yet the word from there is to say, we need to open up for the economy, so we’ll probably lose a few more patients that way, but that is the cost of doing business, the country is suffering.  Actually, what is suffering is the President’s re-election bid and he will do everything in his power to get re-elected.  The New York Times today indicated that senior citizens, who are disproportionately afflicted by this virus, are not looking favorably on this president and his lack of candor on the subject.

But never fear – the reason I suggested that you pay attention to these numbers and those in your area is this – there is now a concerted effort by many of those in the right wing media and members of the blogging world to accuse governors, mayors and scientists of overstating the numbers of sick and dying patients just to undermine the President. (Personally, I do not understand just which part of refrigerated trucks full of bodies and burials in mass graves, that they do not understand about an overwhelmed system.) There is a reason behind the “open it up movements” protests, and that is to make it seem that this is much ado about nothing and only scare tactics of the left, but the same people who tried to undermine the ACA, deny climate change and who supported the Tea Party are back again – and probably with Putin’s blessing.  Facebook and Twitter both report removing hundreds of fake accounts touting conspiracy theories on these topics.

The CDC website currently has statistics, which I suggest you keep an eye on, at least as long as the website is not censored.  Apparently the 15-page Guideline it recently sent out for states to use as they reduced restrictions is being held up from wide spread distribution by the Task Force which wishes to tweak it a bit. I wonder about the document that will result. In my opinion we will not, as Jared Kushner recently stated “be rocking as we head into July”. Is your state opening up; do you think it should? Personally, as much as I would love to eat out at a nice restaurant, as long as my state numbers continue to increase, I shall dine at home. There is indeed, much to be afraid of these days, so do stay informed.

So, what else have I not mentioned – there is just so much happening now – AG Barr going around the Rule of Law and attempting to free General Flynn who has pled guilty to a felony – what part of that is untrue?

A young African American jogger is gunned down in Georgia with an attempted cover up as a ‘legal citizen’s arrest’ – is this a Trayvon Martin incident all over again?

Voting by mail – just what tactics will be used to dilute this widespread effort; how will gerrymandering be used to undermine the votes of minorities?

How will we, as a country, deal with the 33 million workers who have filed for unemployment?  How will we feed these huge numbers of needy people?

Do let me know your thoughts.  If you like what I have to say please share this site with your friends.