Later On

A blog written for those whose interests more or less match mine.

Archive for August 2017

Joe Scarborough: “Trump fatigue comes early”`

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Joe Scarborough writes in the Washington Post something I am sure is going to ignite a string of presidential tweets (meaning “done by the president,” NOT meaning “worthy of the office”):

Americans eventually tire of the presidents they elect. The political skills that fuel the rise of Roosevelts, Reagans and Obamas always seem to lose their allure over time as the promise of “Morning in America” and “Hope and Change” devolves into the cynicism of “Been There, Done That.”

Lyndon Johnson won in a landslide in 1964 but was pushed out of office four years later. Ronald Reagan breezed to reelection by winning 49 states in 1984, but two years later his power of persuasion was gone. In 1986, the Great Communicator couldn’t persuade voters living through the last days of the Cold War to support anti-communist allies in Central America. Even in the afterglow of Barack Obama’s 2012 reelection, the biggest political star in the world couldn’t pass gun reforms that 90 percent of Americans supported following the Sandy Hook massacre.

President Trump is, of course, the most radical example of this negative political phenomenon. Seven months into his maniacal presidency, Trump is driving his approval ratings to record lows and causing friends and foes alike to experience premature presidential fatigue.

Former allies on the editorial pages of the Wall Street Journal and Washington Examiner now criticize Trump for leadership failures and his abuse of power. Republicans on Capitol Hill more frequently call out the president’s aberrant behavior. Senate Majority Leader Mitch McConnell (R-Ky.) questions the president’s ability to survive. The chairman of the Senate Foreign Relations Committee questions Trump’s stability.

By now, the president’s low poll numbers rarely raise an eyebrow. Newspapers have repeated ad nauseam that Trump is saddled with the worst approval ratings in U.S. history at this stage of his presidency. But this week, those lame approval ratings collapsed to a new low of 34 percent. A Fox News poll released Wednesday found that nearly 6 in 10 Americans believe Trump’s presidency is “tearing America apart.” And only 20 percent of younger voters now support the 71-year-old former reality television star.

And even Trump’s famously forgiving base is growing tired of the commander in chief’s reckless routine. Trump supporters in a Pittsburgh focus group talked about how their patience with the petulant president was reaching an exhausting end. “Everybody knew he was a nut, but there comes a point in time where you need to become professional. He’s not even professional let alone presidential. Chill out, man,” was a woman’s advice. Another Trump supporter said that Trump’s manic need to dominate news cycles was driving him crazy. “He’s on the television all the time.” Another weary supporter said, “He’s such an incredibly flawed individual who has articulated many of the values that I hold dear and the messenger is overwhelming the message.”

That focus group sounded a lot like recent phone calls I had with friends in Pensacola and Birmingham who have been Trump supporters from the start. Not long ago,  . . .

Continue reading.

Written by LeisureGuy

31 August 2017 at 10:27 pm

Another Trump lie: Declaring a national emergency regarding opioid addiction.

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Nathaniel Weixel and Rachel Roubein report in The Hill:

 President Trump on Aug. 10 said the nation’s opioid epidemic was officially a national emergency.

More than three weeks later, Trump is dealing with a natural disaster.

Hurricane Harvey has displaced tens of thousands, leading Trump to declare federal emergencies in Texas and Louisiana. The decisions have freed up funding to help people who have lost their homes to rising waters.

In contrast, nothing has happened yet since Trump’s declaration on opioids. No paperwork has been issued formally declaring an emergency, and no new policies have been announced.

One reason is that there’s no established procedure for an emergency related to opioid abuse, which is new territory for the federal government.

The opioid epidemic is a chronic problem, and national emergencies are usually only intended to provide short-term relief.

Former agency officials and public health experts said it appears the administration was caught off guard by the president’s remarks announcing the emergency — which came during an appearance outside his Bedminster Golf Club in New Jersey while he was on a 17-day vacation, and after Health and Human Services Secretary Tom Price made a detailed argument about why declaring a national emergency isn’t necessary.

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency,” Trump said. “We’re going to draw it up, and we’re going to make it a national emergency.”

A White House spokesman told The Hill that Trump is considering all options available to him. . .

Written by LeisureGuy

31 August 2017 at 8:22 pm

Determined cat helps with making bed

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Just watch.

Written by LeisureGuy

31 August 2017 at 7:16 pm

Posted in Cats, Daily life, Video

General who oversaw Katrina relief rips federal response to Harvey

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John Bowden reports in The Hill:

The commanding officer who led the federal disaster relief response to Hurricane Katrina blasted current relief efforts in Louisiana and Texas following Hurricane Harvey, warning on Wednesday that officials were unprepared for the scope of the disaster.

“In Katrina, we had 40,000 National Guard [troops], 240 helicopters on the fourth day,” retired Lt. Gen. Russel Honoré told CNN. “They just got 100 helicopters in Texas. Something is significantly wrong in our command and control.”

“They need to stop patting each other on the back while these poor people are out here waiting to be rescued,” he added.

Honoré told CNN that the disaster caused by Harvey was “a lot bigger” than the devastation caused by Hurricane Katrina, which in 2005 left more than 1,200 dead and caused $108 billion in damage.

“This is a lot bigger. I went out on a boat this morning in this very same community right here. This is huge,” Honoré told CNN. “After Katrina, the air elements and air component of northern command created a significant grid system for search and rescue.”

“I don’t know where that is,” he said. “It didn’t look like anybody in Texas had ever read the plan.”

President Trump visited the hurricane relief efforts in Texas on Tuesday, where he told assembled officials, including Texas’s two senators, that he wanted his White House to be remembered for an effective response to the storm. . .

Continue reading.

Written by LeisureGuy

31 August 2017 at 7:08 pm

Stir-fried iceberg lettuce with shrimp

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We had this Mark Bittman recipe tonight, with these changes:

  1. Avocado oil for sautéing: very high smoke point, monounsaturated oil (like olive oil, another fruit oil).
  2. Double the garlic.
  3. Double the ginger.
  4. Use 1 lb of shrimp rather than 12 oz. Jumbo shrimp require fewer peels per pound. I cut shrimp in half cross-ways: easier to eat, feels like more shrimp.

Extremely tasty, fast, and easy. Do all prep before you heat the skillet/wok. (I’m a skillet guy: woks don’t work well on an electric range.) The stir-fried iceberg lettuce is excellent.

Written by LeisureGuy

31 August 2017 at 6:42 pm

Republicans Want to Sideline the Consumer Financial Protection Bureau. But It May Be Too Popular.

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Steve Eder, Jessica Silver-Greenberg, and Stacy Cowley report in the NY Times on how the Republicans, although strongly opposed to protecting consumers (while strongly supporting the protection of businesses), have not been able to shut down the CFPB:

With the election of President Trump, the nation’s consumer watchdog agency faced a quandary: how to shield the Obama-era institution from a Republican administration determined to loosen the federal government’s grip on business.

In the weeks after the election, Richard Cordray, the Democrat who leads the agency, the Consumer Financial Protection Bureau, directed his staff to compile stories from ordinary Americans thanking it for resolving complaints.

The anecdotes, which he solicited in an email to share with the Trump transition team, could provide a counterpoint to critics who had cast the agency as a regulatory scourge on the economy. And implicit in his request to employees was the belief that some accolades would come from parts of the country that helped elect Mr. Trump — evidence that the popularity of consumer safeguards transcends party divisions.

“There must be hundreds of such stories,” Mr. Cordray wrote in the email in November, which was obtained in a public records request. He added, “I can think of no better vindication” of the agency’s consumer relief efforts.

While many federal agencies have begun to loosen the reins on the companies they regulate, the Consumer Financial Protection Bureau, born out of the Dodd-Frank financial law in 2010, has taken the opposite course. Congress granted it unusually broad authority — and autonomy from the White House and Congress — to both enforce existing federal rules and write new ones, including issuing fines against financial companies.

Under Mr. Trump it has openly embraced its mission, cracking down on debt collectors, pushing out a major new financial rule on arbitration and pursuing a flurry of enforcement actions against payday lenders and others.

The approach, outlined in emails and other documents obtained through the public records request by The New York Times, comes as the Trump administration has taken an uncharacteristically low-key public stance toward the agency, a prominent blue holdout in a federal regulatory regime newly awash in red.

The White House’s restraint was based in part on a pragmatic assessment, according to people familiar with the strategy. At one point, contemplating a high-profile run on the agency, the White House examined polling data from political bellwether states, two people briefed on the matter said. The agency, they concluded, was too popular to pick a public fight with.

Republicans in Congress, who have vehemently opposed the agency since its creation, have also been unable to muster enough support to derail its work. Efforts to strike down a rule ordering new consumer protections on prepaid debit cards never made it to a vote in either the House or the Senate.

“The public does not share the G.O.P.’s ire toward the agency or its mission,” said Dean Clancy, a Tea Party activist who worked in the White House under President George W. Bush and is now a policy analyst who tracks actions of the consumer bureau. “It is an agency about protecting the little guy, and that is tough to oppose.”

The stories of gratitude rounded up by the agency’s staff for Mr. Cordray illustrated its appeal. Among them was a homeowner in Tennessee who got a disputed lien removed from a property, someone in Kentucky who got assistance warding off a debt collector pursuing a medical bill that had been paid, and a person in Pennsylvania who said the agency helped resolve a contested credit card debt.

That doesn’t mean the Trump administration and other opponents have given up on neutralizing the bureau’s work.

Administration officials have isolated the bureau from parts of the government that, under President Barack Obama, helped fulfill its mission. In public statements and documents, officials at the Justice Department, the Treasury Department and the Office of the Comptroller of the Currency have all turned a cold shoulder toward Mr. Cordray and his staff.

Lobbyists for the financial industry are working behind the scenes on efforts to dismantle some of the bureau’s signature initiatives, according to people directly involved in the plans. They include lawsuits to be filed in reliably conservative courts when new regulations are issued.

For now, though, it is mostly a waiting game. Mr. Cordray’s term as director expires next July, when he could be replaced with a sympathetic Trump appointee.  . .

Continue reading.

Does it strike you, as it does me, that the GOP really does not like most Americans?

Written by LeisureGuy

31 August 2017 at 5:37 pm

Why Giving Birth Is Safer in Britain Than in the U.S., which claims to have the best healthcare in the world

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Kate Womersley reports in ProPublica:

At 11:58 p.m. this past June 25, Helen Taylor gave birth to her first baby, a boy, at West Suffolk Hospital in the east of England. At 11:59 p.m., with 15 seconds to spare before midnight, his sister was born. The obstetrician and her team were pleased; the cesarean section was going smoothly, fulfilling Helen’s wish that her twins share a birthday.

But 40 minutes later, Helen had lost over a third of her blood.

Enraptured by new motherhood, she barely noticed when the obstetrician’s head appeared around the surgical drape. “We need to give you a drug to help stop the bleeding, is that OK?” Helen nodded. Ten minutes passed before the question came again. Then again. The fourth time, Helen realized something was seriously wrong.

During pregnancy, the uterine blood vessels that nourish the fetus are wide open. Once the baby is delivered and the placenta removed, these vessels should constrict and close. If they don’t, as with Helen, the mother can bleed profusely. She may reach a point where her body can no longer compensate for the blood loss. The extent of the flow can be unpredictable and sometimes catastrophic. The surgical team’s response must be meticulous. And fast.

Helen’s team — an experienced obstetrician with her resident in training, a pediatrician, an anesthesiologist with an assistant, two nurses (one scrubbed-in, one fetching equipment), and three midwives — responded to her developing hemorrhage with a routine ingrained from rehearsal and real life.

“We are like a Formula One race team at a pit stop,” the anesthesiologist had reassured Helen by way of introduction.

The key to this well-oiled machine is standardization. It used to be that every obstetrician in the U.K. had his or her own signature strategy to manage an emergency. In the U.S., that still sometimes happens. But these days, every British doctor, whether newly qualified or approaching retirement, is required to follow the same guidelines for many aspects of maternity care, including treatment of bleeding. Postpartum hemorrhage guidelines are regularly updated by the Royal College of Obstetricians and Gynecologists and The National Institute for Health and Care Excellence, and then written into local protocols for practice in every National Health Service hospital. You don’t need to be a doctor to read the guidelines: They are freely available online. Women can find out exactly what standard of care to expect.

Helen’s was the kind of deceptively complex case that shows why a consistent approach is desirable. Her hemorrhage flared from minor (over 500 millimeters) to major (over 1 liter) to massive (over 2 liters) in less than an hour. First, the team gave her IV fluids to help replace the lost volume. After checking for bits of retained placenta, the obstetrician massaged Helen’s uterus to encourage its natural ability to contract, but her bleeding continued. The anesthesiologist lifted the surgical drapes to inject Helen’s thigh with a drug containing syntocinon, which stimulates the uterine muscle to tighten the blood vessels. The same medication was then given by a drip.

But there’s a catch: Drugs that narrow arteries can increase blood pressure. During her third trimester, Helen had developed preeclampsia, a type of hypertension induced by pregnancy that can lead to seizures and strokes. Not only does preeclampsia complicate treatment for bleeding, it makes hemorrhage more likely in the first place.

The immediate danger of more blood loss outweighed the risk of raising the blood pressure. The anesthesiologist followed protocol and administered two more drugs to intensify uterine contraction, with several minutes of watching and waiting in between. Still the blood flowed. The final step would be a transfusion.

Then, just as the team was about to dial up units of O-negative from the blood bank, the obstetrician noticed that her absorbent surgical swabs were taking longer to soak through with red. The uterus felt firmer, more like a bicep than loose tissue. Helen’s bleeding was under control. Due to the guidelines, a more serious crisis was averted. A transfusion wouldn’t be needed after all.

As a medical student at the University of Cambridge in England, I got to know Helen on the ward. This account of her pregnancy, labor and medical emergency is based on my observations and interviews with Helen, her partner Marcus and caregivers at West Suffolk Hospital. The hospital approved my access to interview patients, and Helen gave full consent to share her experience. It’s a tale that highlights the profoundly different approaches in the U.K. and the U.S. to maternal care — and to saving mothers’ lives.

“Ultimately, it’s a story I didn’t think I’d get to tell,” Helen said.

For a pregnant woman in the 1950s, the two childbirth complications most likely to prove fatal were hemorrhage and preeclampsia. Whether American or British, one in every 1,000 expectant and new mothers died.

British health authorities recognized this number was unacceptably high, given that nearly half of the deaths were considered preventable. Starting in the late 1940s, a national commitment was made to standardize maternity care across the NHS, assess each maternal fatality, and learn how it might have been avoided.

That campaign has succeeded. Today, the average mother in the U.K. receives more comprehensive and consistent care, ranging from earlier prenatal appointments to closer monitoring after she gives birth, than does her American counterpart. And if a mother dies, the U.K. investigates and tries to learn from it. Medical authorities in the U.K. view maternal deaths as public health failures that underscore deficiencies in health care systems. In the U.S., maternal deaths are too often treated as disconnected, private tragedies. If they are scrutinized by hospitals or regulators at all, the findings typically prompt institutional rather than national reforms.

Underlying these contrasts is a different view of the medical responsibility to mother and child. In the U.S., laudable aspirations for infant safety have intensified focus on the fetus — more sonograms, continuous fetal heart monitoring and granting rights to the unborn. But these measures may at times distract attention from the mother’s health.

By contrast, British medical professionals are legally required to prioritize a mother’s wellbeing if both she and her baby are in danger. They’re trained to stabilize mom first, and then tend to baby. “That sense that the woman (while the fetus is in utero) is the agent in charge is in place. I think that’s the right way,” said Denis Walsh, a midwife and associate professor in midwifery at the University of Nottingham. “Otherwise you start undermining individual women’s autonomy and then you go down a slippery slope.”

The numbers reflect the difference in national priorities. Today in the U.K., 8.9 women for every 100,000 live births die from complications of pregnancy or childbirth, according to the Institute for Health Metrics and Evaluation. In the U.S., this figure declined in tandem with Britain’s until 1990. It then reversed course, rising to 25.1 women per 100,000 in 2015, almost three times higher than the U.K., and among the worst in the Western world.

These U.S. deaths are not spread equally. Women who are poor, African American or live in a rural area are more likely to die during and after pregnancy. . .

Continue reading. There’s a lot more. Later in the report:

. . . Ironically, the centerpiece of the U.K.’s strategy to reduce maternal mortality is an American import. In 1949, the British Congress on Obstetrics and Gynecology suggested adopting a new method for reviewing maternal deaths that was already practiced in some parts of the U.S. Fatalities in those regions were assessed by local committees of experts, who published reports in medical journals to educate the profession. The British minister of health agreed to try it. The result was the Report on Confidential Enquiries into Maternal Deaths in England and Wales, established in 1952.

The confidential inquiry has far outstripped its American forebears. Now run by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the United Kingdom), its report drives training, assessment and practice in British obstetrics — including the types of treatment protocols that saved Helen Taylor’s life. Crucially, hospitals can neither opt out of MBRRACE’s surveillance nor ignore its recommendations. . .

In the meantime, the GOP is working hard to makes sure that as many as Americans as possible don’t have healthcare insurance. See, for example, the NY Times report today, “Trump Administration Sharply Cuts Spending on Health Law Enrollment,” by Abby Goodnough and Robert Pear. It begins:

The Trump administration is slashing spending on advertising and promotion for enrollment under the Affordable Care Act, a move some critics charged was a blatant attempt to sabotage the law.

Officials with the Department of Health and Human Services, who insisted on not being identified during a conference call with reporters, said on Thursday that the advertising budget for the open enrollment period that starts in November would be cut to $10 million, compared with $100 million spent by the Obama administration last year, a drop of 90 percent. Additionally, grants to about 100 nonprofit groups, known as navigators, that help people enroll in health plans offered by the insurance marketplaces will be cut to a total of $36 million, from about $63 million. . .

Read the whole thing.

This step follows the failure of the GOP Senate to repeal the Affordable Care Act. The idea now is to sabotage the Affordable Care Act to ensure that it fails. Apparently making sure Americans have access to healthcare is undesirable to the GOP.

See also “Trump officials slash advertising, grants to help Americans get Affordable Care Act insurance,” by Amy Goldstein, in the Washington Post.

Written by LeisureGuy

31 August 2017 at 4:51 pm

Posted in Government, Healthcare

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