Category: Health – Happiness

The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick

Vox

The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick

The revised Senate bill turns Obamacare into a high-risk pool.

by Ezra Klein       July 13, 2017

The revised Better Care Reconciliation Act was released today, and here’s the bottom line: It returns individual insurance markets to the bad old days when insurers competed on insuring the healthy and finding ways to avoid covering the sick.

There are a host of changes in the new BCRA, most of which leave the fundamental thrust of the legislation intact. But there’s one addition that genuinely changes everything.

Included in the new bill is a version of Ted Cruz’s amendment allowing insurers to offer plans that don’t comply with Obamacare’s insurance regulations so long as they also offer plans that do comply with Obamacare’s insurance regulations.

So imagine you’re an insurer. As long as you offer some Obamacare compliant plans, you can also offer plans that deny people coverage for preexisting conditions, that don’t cover mental health benefits or pregnancy.

What will happen here is clear: The plans that have to offer decent coverage to anyone who wants it, no matter their health care history, will become a magnet for the old and the sick or the soon-to-be-sick, as they can’t afford, or perhaps can’t even buy, the other plans. That will drive premiums in those plans up, pulling younger, healthier people into the non-compliant plans.

The Senate bill thinks it has a fix: a roughly $200 billion fund to offset the costs of sick enrollees. So, in short, what the GOP bill attempts to do is to rebrand high-risk pools as Obamacare plans and make them subsidized dumping grounds for the sick and the old, while everyone else buys insurance in a basically unregulated market.

This is a very bad idea for anyone who is sick, has been sick, or is likely to get sick. It attacks the core changes Obamacare made to build insurance markets that serve the sick, the well, and, crucially, everyone in between.

Prior to the Affordable Care Act, insurers in the individual market worked to sign up healthier people and avoid sicker people. They did this in ways that were crude, like simply refusing to insure people with preexisting conditions, and ways that were subtler, like designing plans that made sense for the healthy but didn’t cover key services needed by the sick.

The Affordable Care Act ended all that. It standardized the benefits insurers had to offer, so they couldn’t design plans that didn’t work for the sick, and barred them from turning the sick away, or charging them more.

The BCRA reverts individual health insurance markets to their pre-Obamacare days. Under this legislation, an insurer who had some Obamacare-compliant plans could also craft plans that were, say, great for 30-year-olds with a low risk of cardiovascular disease, but terrible for 53-year-olds with high blood pressure and cholesterol, or that simply denied coverage to anyone over age 60 with a history of health problems.

The GOP’s answer to this problem is to try to quarantine sicker people off to the side in subsidized plans. But sickness is not a binary state. Yes, the sickest people, the ones who need health insurance most, will do whatever is necessary to get insurance, and the high-risk plans might work for them. But what about young women who insurers consider demographically likely to be pregnant in a few years? They’re not sick enough to be willing to pay the exorbitant premiums of the high-risk plans, but they’re also going to be up-charged by insurers scared of their future costs.

Or how about the 42-year-olds who aren’t sick now, but had health scares in the past? To insurers, they might be basically uninsurable outside a high-risk pool. But to the healthy-feeling 42-year-old, the cost of the high-risk pool may be exorbitant. And so they go uninsured, and then disaster hits.

Nor is there any detail in the bill of how these high-risk pools will work. There are funds states can use to subsidize them, but will they use them? And how will they use them? And will the subsidies make the insurance worthwhile for people who are hard to insure but not yet truly ill?

And what kinds of insurance will actually be subsidized? Will people with serious illnesses and low enough incomes to qualify for Medicaid now be looking at plans with $5,000 deductibles?

Back in May, President Donald Trump said protections for “preexisting conditions are in the bill. And I mandate it. I said, ‘Has to be.’”

Well, now the protections for preexisting conditions are gone. The GOP vision is of health markets where the very sick can buy unaffordable Obamacare-compliant plans that are, maybe, made affordable by subsidies, but most people are back in an insurance market where past allergies or future pregnancy or a history of knee problems will leave you basically uninsurable.

The new Senate health care bill — and the return of preexisting conditions — explained

Vox

The new Senate health care bill — and the return of preexisting conditions — explained

by Sarah Kliff       July 13, 2017

Senate Republicans introduced a revised version of their bill to repeal and replace the Affordable Care Act on Thursday, one that would allow insurers to once again deny coverage based on preexisting conditions, and to charge higher rates to sick people.

The bill would keep most of the Affordable Care Act’s tax increases but repeal one aimed specifically at medical device manufacturers. It would deeply cut the Medicaid program, making few changes to the bill’s first draft.

Even with these new changes, the general structure of the bill stays the same from its original draft, which was itself largely similar to the bill that passed the House in the spring.

Healthier and higher-income Americans would benefit from the changes in the new Republican plan, while low-income and sick Americans would be disadvantaged. It would create a two-track system for health coverage on the individual market. One would offer cheaper, deregulated health plans, which healthy people would likely flock to. The other would include comprehensive plans governed by Obamacare’s regulations, which would cost more and mostly be used by less healthy people and those with preexisting conditions — a system experts expect would function like a poorly funded high-risk pool.

Deductibles would almost certainly rise under the Republican plan, as would overall costs for low- and middle-income Americans. Individual market participants would have more options to purchase catastrophic coverage, an option likely to appeal to those with few health care costs.

Experts expect the changes will do little to change the Congressional Budget Office’s estimates that 22 million Americans would lose coverage under the proposal.

You can see a full explainer on the Senate bill here, which will be updated shortly with the latest information. This post focuses on the changes made in the July 13 revision.

Health insurers could bring back preexisting conditions, offer skimpy health plans

Perhaps the biggest policy change in this revision is an amendment to allow health insurers to deny coverage based on preexisting conditions and cover few benefits, so long as they offer a comprehensive plan that covers the Affordable Care Act’s mandated benefits.

These deregulated health plans would be allowed to charge sick people higher premiums or simply deny them coverage. They would not have to pay by the rules of the preexisting condition ban that the Affordable Care Act sets up (Phil Klein at the Washington Examiner has a summary of the rules they’d be exempted from here). Instead, they would operate much like health plans in the pre-Affordable Care Act market, offering cheap rates to consumers they believe would have low medical bills.

Health policy experts know exactly how this would play out: Healthy people would pick the skimpier plan, while the comprehensive plan would essentially become a high-risk pool for sicker Americans.

Individual market enrollees would likely game the system too. A couple expecting a baby, for example, would be expected to upgrade to the plan that covers maternity care for one year before returning to the cheaper plan they had before.

“Someone with chronic illness, they’re going to end up wanting to buy the more comprehensive coverage,” says Joe Antos, a health policy expert with the conservative American Enterprise Institute. “This means that people with those kinds of illnesses will end up paying more. Even if they receive a federal subsidy, they will likely see higher cost sharing.”

As Antos notes, individuals who want to buy the comprehensive plan would receive federal tax credits to do so. They could not use the tax credits for the deregulated plans.

But even after that financial help, these people would still face significant out-of-pocket costs, including high deductibles and premiums. The Congressional Budget Office estimates, for example, that a 64-year-old individual earning $11,500 and receiving tax credits would still need to pay $4,800 to purchase that plan.

The updated Senate bill also allows individuals to use tax credits to purchase catastrophic coverage

There is a quieter way the Senate bill lets people buy skimpier plans: by using their tax credits to purchase catastrophic plans.

This is a practice the Affordable Care Act barred, as the law’s drafters wanted to encourage enrollment in more generous options. But the Senate bill would allow the tax credits to be used for these high-deductible plans. These plans would only include three primary care visits before individuals hit their deductibles and have to pay their medical bills out of pocket. The plans could cover a wide array of health benefits, including maternity and mental health, but, again, coverage would only kick in after paying a large deductible.

The updated bill would let individuals use pre-tax dollars to pay for their premiums

An estimated 29 percent of American workers are enrolled in tax-advantaged health savings accounts (HSA), that allow them to use pre-tax dollars to cover things like co-payments and coinsurance.

The Senate bill would allow HSA dollars to go toward premiums as well, meaning someone in the individual market could use pre-tax dollars to pay their monthly bill. This practice was not allowed under the Affordable Care Act.

Liberals have typically opposed this provision, which they argue would mainly benefit wealthy Americans who have the money to contribute to an HSA in the first place. This provision would have fewer benefits for low-income Americans, who rely on tax credits to finance the lion’s share of their premium.

The Senate bill gets rid of most Obamacare tax cuts — but keeps two on high earners in place

 

The Senate’s revised health care bill still includes an estimated $657 billion in tax cuts by eliminating the health law’s taxes on the medical industry and its individual mandate penalty for not carrying coverage, among other changes.

It does continue two taxes aimed at wealthy Americans: a 0.9 percent investment tax and a 3.8 percent Medicare payroll surtax. Keeping these two taxes in place would net the government an estimated $231 billion in revenue over the next decade, and eliminate some of the benefits high-income Americans would have received under the first draft.

These new taxes, however, do not seem to be fully spent on enhancing the law’s benefits. The new bill includes a $45 billion program to combat opioid abuse as well as $70 billion to offset the costs of expensive patients (this is in addition to the $112 billion already appropriated for that purpose in the first version of the bill). The inclusion of these taxes does not appear to lead to any additional funding of the Medicaid program or offset any of the cuts to the tax credits in the individual market.

The Senate bill still makes very deep cuts to Medicaid

The Senate bill is notable in what it doesn’t change: namely, significant cuts to the Medicaid program. While moderate senators have protested these cuts (particularly those who represent Medicaid expansion states), these provisions of the Senate bill remain largely intact.

One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Prior to the health law, the entitlement was restricted to specific groups of low-income Americans (pregnant women, for example, and the blind and disabled).

Obamacare opened up the program to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states (plus the District of Columbia) that opted to participate.

The Medicaid expansion gave states generous funding to cover this particular population. Typically, the federal government picks up about half the cost of the Medicaid program and states cover the rest.

For Medicaid expansion, however, the federal government currently pays 95 percent of the costs — an especially good deal for states meant to assuage their budget concerns during the original Obamacare debate.

The Senate bill would begin ratcheting down that Medicaid expansion funding in 2021. By 2024, states would get that same match rate they typically get to cover other populations. In 2021, for example, the match rate would fall to 90 percent, then decline in steps to 75 percent by 2023.

The Congressional Budget Office has projected in a separate analysis that this policy change would mean no additional states expand Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage.

“CBO anticipates some states that have already expanded their Medicaid programs would no longer offer that coverage,” the agency wrote in its analysis of the House bill, which makes a similar change.

The Senate bill would cut the rest of the Medicaid program too

There are significant changes to Medicaid in the Senate bill outside of the expansion too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.

This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.

The Senate bill would set different amounts for different groups of people. It envisions, for example, higher payments to cover Medicaid enrollees who are disabled (and tend to have higher costs) than for Medicaid enrollees who are kids (generally healthy with lower costs).

The rate at which these payments grow is also important. The Senate bill would have the funding growth tethered to the Medical Consumer Price Index plus 1 percentage point through 2025, and then switch to the urban Consumer Price Index. Analysis of this type of proposal suggests this change would amount to funding cuts for Medicaid, as the program’s spending typically goes up faster than these growth rates.

Home care workers have our lives in their hands. They’re paid only $10 an hour

the guardian

Inequality…Inequality and Opportunity in America

This series is supported by The Rockefeller Foundation

Home care workers have our lives in their hands. They’re paid only $10 an hour

Home care is expected to add more jobs than any other field in the coming years. Caregivers will look after us in old age – but do we care enough about them?

By Sarah Jaffe     July 13, 2017

June Barrett’s day as a home care worker starts at 5pm and lasts for 16 hours, overnight. All night long, she checks on her elderly clients, a married couple both in their 90s. They sleep in different parts of their Miami home, and much of Barrett’s job is spent trekking through the corridors, back and forth, to make sure husband nor wife has suddenly taken a turn for the worse. “I’m constantly on my feet,” she says.

Two million workers across the US do the kind of home care that Barrett does – the workforce has doubled in size over the past 10 years, and the Bureau of Labor Statistics predicts the field will add more jobs than any other occupation by 2024.

Barrett, a tall woman with short dark hair with a bright red streak and a Jamaican accent, started in the field in 2003, and has worked for her current clients for nearly four years. They require round-the-clock care and so she gets to her clients’ home when the day-shift carer is still there, ready for the handover. She then prepares dinner, helps them eat, and makes sure they get their medication. The wife, Barrett says, doesn’t like to take her pills, so this part of her day requires some finesse.

The husband is able to walk by himself, but the wife needs Barrett to bring her to the bathroom, to wash her and brush her teeth, and to bring her to bed. While her clients sleep, Barrett cleans the kitchen, prepares supplies for the next day, and checks to make sure they have everything they need.

When one of them is ill, the process gets more complicated. “When you do this work, you are responsible for people’s lives,” she says. “One mistake can cost your client his or her life.” Balancing two clients is challenging: when she has to help one bathe, she is worrying about the other’s safety. When things are difficult right now – the wife has slight dementia – she reminds herself that her client was a strong advocate for schools and students when she was younger. “I look at her, I see a warrior woman,” Barrett says.

All things considered, Barrett’s current situation is good. But in the past, she has worked with violent children, people in advanced stages of dementia, and clients who abused her verbally and sexually harassed her.

“Remember now, you and I, we are not sure what is going to happen to us when we become ill,” she says. “We don’t know. So with this work I do, I do it from a place of empathy and from a place of love. I am 53 now. I am giving that care the way that I, June Barrett, would like to get that care when I am old.”

Barrett first came to the US via New York in 2001 and then moved to Miami to join her sister, going straight to her first job interview from a 20-hour Greyhound bus ride. Stepping in to greet her new client, she was met with a racial slur. “I worked my magic and I ended up staying with her for about four months,” she says.

Shortly thereafter, she settled into a live-in job with another elderly couple. At first, she moved her things into the only spare bedroom in the house. But when her client asked where she was sleeping, and Barrett told her, “she said: ‘You must be out of your cotton-picking mind.’ That was the first time I was hearing those words, ‘cotton-picking’. She took everything out from that room. And for five and a half years, I spent those nights sleeping in the study – and I am a tall girl – on a sofa with my feet hanging over.”

She’s also faced sexual harassment on the job – one client demanded she come to bed, groped her and kissed her. “The humiliating part about it was that I wasn’t able to leave right away,” she says. She’d been out of work for a while, and could not afford to leave the job immediately.

Modern home care has its roots in the New Deal era as a way to give work to poor women, explains Eileen Boris, distinguished professor in the department of feminist studies at the University of California, Santa Barbara, and co-author of Caring for America: Home Health Workers in the Shadow of the Welfare State.

Home care exploded in the 1970s, she says, with the birth of the independent living movement among disability rights activists, combined with older people’s desire to avoid nursing homes, which were seen as underfunded warehouses.

“What had been a way to relieve the crisis of public hospitals and to give employment to poor women on public assistance became an integral part of the limited healthcare rights that Americans developed with the Great Society,” Boris says.

The Obama administration was a high point for the rights of home care workers, many of whom were still locked out of basic labor protections. In 2013, the labor department extended federal minimum wage and overtime protections to them. Elly Kugler, who leads federal policy work at the National Domestic Workers Alliance, says it was meaningful because it recognized them as workers, and afforded them additional pay. Wages for home care have been largely stagnant, hovering just above $10 an hour on average.

Low wages had often driven people out of the field who otherwise found the work meaningful, Kugler notes. “Though many of our members care deeply for the work they do … they had to go and work in other kinds of jobs. Meaning fast food, other sectors, making a little bit more money.”

I am giving that care the way that I, June Barrett, would like to get that care when I am old

“I think one of the interesting things about home care is that it forces all these different worlds to connect,” Kugler adds. “The world of state funded home care and and healthcare and also worker rights and disability rights and senior rights and racial justice – all these different worlds are connected in home care.”

Nowhere is that more clear than in the Affordable Care Act (ACA), also known as Obamacare, now under fire from the Trump administration and a Republican Congress.

The expansion of Medicaid, which took effect in 2014, meant more funding for home care and more jobs for care workers. The bill also expanded healthcare for the workers themselves – Barrett had never had chicken pox as a child, and when she contracted it as an adult from a client with shingles, it aggravated her asthma.

The Inequality Project: the Guardian’s in-depth look at our unequal world

“Before the Affordable Care Act passed, one in three home care workers was uninsured,” says Josephine Kalipeni, director of policy and partnerships at Caring Across Generations. After its passage, that rate dropped by 26%.

Because of the general forward trajectory, Kugler says, the Obama years had meant that the movement for care workers had gained more public traction with bigger issues, such as immigrants’ rights (many home care workers are immigrants like Barrett), racial justice, and the value of women’s work. Home care workers had joined the Fight for $15, initiated in part by the Service Employees International Union, which represents tens of thousands of home care workers around the country.

Workers who liked their care jobs, like Barrett, could begin to think about their work as a career.

And then came Trump.

“When I think about how work is being talked about right now and by Trump [when he was] on the campaign trail, it is almost like he colors some jobs pink and some jobs blue, even though there are women in the manufacturing sector and men in the care sector,” Kugler says.

Despite the fact that home health care is one of the fastest-growing jobs in the country, “it has colored the tenor of the debate ever since. We still have this very pink and blue tenor to the debate and only the blue ‘boy’ jobs are really getting talked about.”

It would be bad enough if the Trump administration was merely ignoring the efforts of Barrett and others like her. But the administration’s policies seem designed, Kalipeni says, to uphold a “myth around creating jobs” that returns to the values that created entrenched inequality between rich and poor, black and white, men and women.

Discussions about infrastructure tend to focus on bridges and roads – which are important, certainly, but ignore the equally necessary infrastructure of care that allows a workforce to exist in the first place.

Those priorities are clearly demonstrated in the Republican plan to “repeal and replace” the ACA, currently moving through the Senate. Estimates compiled by the National Domestic Workers Alliance range from 1.8 to 3 million jobs lost in just a few years if “Trumpcare” passes; between 305,000 and 713,000 of those will be home care workers.

The latest version of the bill to be scored by the Congressional Budget Office predicts that 22 million people would lose their health insurance by 2026 if the bill were passed as is. Premiums would spike for elderly people like Barrett’s clients, as Medicaid spending would be slashed by $772 billion over 10 years. Changes to Medicaid could include a “per capita cap,” or a limit to how much the federal government pays states per enrollee in the program.

“It is basically saying, ‘Your state can only get so sick. You can only have so much of a disability and then you are just going to have to pay,’” Kugler says. These cuts, Kalipeni notes, will fall squarely on the shoulders of women – the women of color and immigrant women who do the paid home care work, the women who still do most of the unpaid care work that will pick up the slack when the budgets for paid care are cut.

Until such cuts directly affect people’s lives, she says, people often don’t realize the importance of these systems – and by then it is frequently too late.

When Ana Ramirez came to the US from the Dominican Republic, she got a job at the airport, but the work was grueling and the schedule made it difficult for her to take care of her child. She decided to go through training to become a home care worker.

That was 10 years ago. “I am very good at taking care of people,” she says through a translator. “You get very close to them. When I go and take care of people, they want me to come back. There are people who don’t have a family, and the home care attendant becomes their family.”

Ramirez – a warm, motherly woman with reddish-black hair in a ponytail, who greets me with a hug and a kiss on the cheek – works through an agency in Queens that sends her to different clients. She works 10-hour shifts four days a week, but there have been plenty of times when her hours run beyond that.

Sometimes, her clients’ family members demand things that are not in her job description. “There are people whose family believes that the home attendant is their own domestic worker,” she says.

Some of her clients are bedridden, meaning she must bathe and change them, as well as bring food and water. But she says that the thing that many of them value the most is when she sits with them and listens to them talk about their lives. For Ramirez, it is meaningful work.

Still, the low wages (she is paid $11 an hour) and the sometimes harsh conditions led her to the National Domestic Workers Alliance. Her listening skills from years of care work have made her a natural organizer, a role in which she listens to the complaints of other home care workers and brings them into the organization.

One of those complaints in New York, she says, is that many home care workers moved into the field from other low-wage service work, hoping that it would be an improvement. But then Andrew Cuomo, the state governor, increased the minimum wage specifically for fast-food workers, pushing some care workers to consider returning to fast food.

Barrett first heard about domestic worker organizing when the New York Domestic Workers Bill of Rights passed, in 2010. Then, a year ago, she got a phone call from the Miami Workers Center, and they told her that they were organizing workers like her. When she went to the first assembly, she saw women wearing T-shirts that read “National Domestic Workers Alliance”.

“I can’t explain to you the joy that came to me,” she says of that first meeting. “I’ve always been involved with activism, but I didn’t want it to get involved with work, so I’ve kept my politics, including my queerness, quiet.”

But after the assembly, she says, “I was on fire”. She called her current clients’ daughter, technically her boss, and asked to meet her and her father. In that meeting, she says, she told them that she was going to be a part of the domestic workers’ movement. “I said, ‘I’m sorry, but if this movement needs me then I’m going to be there. If you want, you can fire me, but please give me two weeks’ notice so I can get another job.”

To her surprise, they not only did not fire her, but they gave her a check to donate to the National Domestic Workers Alliance. They have supported her membership in the organization, and have even given her paid time off to travel to speak – she has just returned from a trip to Nicaragua. They said they didn’t want Barrett to fight the fight without taking part themselves. They’ve also given her and the other care workers in the household paid sick days and paid vacation time.

Other clients weren’t so supportive. “They didn’t see me as a human being,” Barrett says. Organizing, she says, is the way to change those conditions. “My self-esteem was stripped from me, horrible stuff was said to me,” she says. “Some women just do [home care] because there’s a check at the end of the month. But if they can regain their own self-worth, their own dignity, they can do this work with pride.”

Three weeks ago, Barrett was one of the speakers at a press conference at Senator Marco Rubio’s office, testifying to the positive changes the Affordable Care Act brought to her life. She is angry, as many of her colleagues are, that once again she has to fight for her work to be seen, to be recognized, for her efforts to be counted as real work and not just a budget line to be slashed.

“People look down on you when you do this work,” she says. “They have to remember that they too are going to get old and this work will continue until the end of the world. There is always going to be somebody needing care.”

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This is no ‘rookie mistake.’ The Trump team shouldn’t even be on the field.

Washington Post Opinions

This is no ‘rookie mistake.’ The Trump team shouldn’t even be on the field.


Donald Trump Jr. gives a thumbs up. (Mike Segar/Reuters)

By Dana Milbank, Opinion writer        July 11, 2017

“I love it.”

That’s how Donald Trump Jr. responded, we now know, to an email last year offering dirt on Hillary Clinton from the Russian government.

What I love is the defense of this attempt by senior Trump campaign officials to receive Russian help in the election. As my colleagues John Wagner and Rosalind Helderman report, presidential advisers are explaining away the meeting with the Russian lawyer as a “rookie mistake” by an “unsophisticated” campaign.

“Rookie mistake”: the all-purpose defense of the Trump White House.

When President Trump failed to support NATO’s collective-defense promise, Senate Majority Leader Mitch McConnell (R-Ky.) called it “a rookie mistake.” After revelations of Trump’s meddling in the FBI’s Russia probe, House Speaker Paul D. Ryan (R-Wis.) explained that Trump is “new at this.” The rookie-error explanation has been employed to describe Trump’s firing of FBI Director James B. Comey, his handling of health care and his legislative approach.

There have been enough rookie errors to send this whole team back to Double-A ball. The longer this goes on — we’re now six months into Trump’s term — the less it looks like growing pains than incompetence and mismanagement aggravated by nepotism and dishonesty.

Returning from three weeks abroad, I’ve been catching up on developments at home. These weeks, though highly abnormal by usual standards, were fairly typical of the Trump presidency. Mistakes and outrages are so common that we become numb to them. But stack three weeks of the embarrassments together and the cumulative effect makes it plain that this is amateur hour for the greatest nation on Earth:

The president, representing the United States at the Group of 20 summit in Germany, tweets that “everyone” at the world conference is talking about why Clinton campaign chairman John Podesta wouldn’t give DNC servers to law enforcement. Trump erroneously claims the CIA sought the server. Podesta, who had no authority over the DNC, urges “our whack job” president to “get a grip.”

Trump gives a speech in Warsaw contradicting an earlier speech he gave in Riyadh, Saudi Arabia. While in Poland, he publicly disparages U.S. intelligence agencies.

The president meets with Chinese President Xi Jinping and the White House press release identifies his country as “the Republic of China” — that is, China’s foe Taiwan.

Trump meets with Vladimir Putin and tweets that he “discussed forming an impenetrable Cyber Security unit” with Putin. Twelve hours later, Trump tweets that such a “Cyber Security unit” can’t happen.

Secretary of State Rex Tillerson tells reporters that Trump discussed sanctions with Putin. Trump tweets the next day: “Sanctions were not discussed.” (The previous month, Tillerson called for the end to a blockade of Qatar; hours later, Trump touted the Qatar blockade.)

Trump’s voter-fraud commission requests voter files and is roundly rejected by Democratic and Republican state officials alike; the Mississippi secretary of state, a Republican, tells the commission to “go jump in the Gulf of Mexico.”

In spite of Trump’s vow that a North Korean missile capable of reaching the United States “won’t happen,” North Korea tests an ICBM. Trump calls this “very, very bad behavior.” After the missile test, Trump’s U.N. ambassador, Nikki Haley, complains on Twitter on Independence Day: “Spending my 4th in meetings all day. #ThanksNorthKorea.”

Trump gives a speech at the Kennedy Center, in July, vowing, “We’re going to start saying ‘Merry Christmas’ again.”

The president tweets that a cable-news host, Mika Brzezinski, was “bleeding badly from a face-lift” when he met her. Sen. Ben Sasse (R-Neb.) responds: “Please just stop.”

Trump follows this by tweeting a mock professional wrestling video of him pummeling “Fraud News CNN.”

The Post’s David Fahrenthold reports that fake Time magazine covers featuring Trump were on display in at least five of Trump’s clubs.

The president, who had implied he had tapes of his talks with Comey, tweets that there are no such tapes. Lawmakers, calling the president’s word insufficient, threaten to subpoena the tapes.

Former CIA director David Petraeus, asked in a panel discussion whether Trump is fit to serve, replies: “It’s immaterial.”

Trump claims the Senate health-care bill “is working along very well.” Republican leaders soon abandon plans to have a vote on the bill.

The White House issues a statement threatening to bomb the Syrian regime. Both the intelligence community and the Pentagon appear to be caught off guard.

Eight months after the election, Trump tweets: “Hillary Clinton colluded with the Democratic Party in order to beat Crazy Bernie Sanders.”

Now, after months of Trump denials of Russia contacts, comes proof of a Russia meeting with Donald Jr., Jared Kushner and then-campaign chairman Paul J. Manafort during the campaign. Among Junior’s conflicting explanations: It was okay because the Russian didn’t produce good dirt on Clinton.

And these are just some of the misfires.

They aren’t rookie mistakes. This is a team that never should have taken the field.

Twitter: @Milbank

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New Technology Creates Highly Efficient New Type of Solar Cell

Newswise    Doe Science news source

The DOE Science News Source is a Newswise initiative to promote research news from the Office of Science of the DOE to the public and news media.   Article ID: 677700

Scientists Design Solar Cell That Captures Nearly All Energy of Solar Spectrum

New Technology Creates Highly Efficient New Type of Solar Cell

Credit: Matthew Lumb

Stacked solar cell

WASHINGTON (July 11, 2017)—Scientists have designed and constructed a prototype for a new solar cell that integrates multiple cells stacked into a single device capable of capturing nearly all of the energy in the solar spectrum. The new design converts direct sunlight to electricity with 44.5 percent efficiency, giving it the potential to become the most efficient solar cell in the world.

The approach is different from the solar panels one might commonly see on rooftops or in fields. The new device uses concentrator photovoltaic (CPV) panels that employ lenses to concentrate sunlight onto tiny, micro-scale solar cells. Because of their small size—less than one millimeter square—solar cells utilizing more sophisticated materials can be developed cost effectively.

The stacked cell acts almost like a sieve for sunlight, with the specialized materials in each layer absorbing the energy of a specific set of wavelengths. By the time the light is funneled through the stack, just under half of the available energy has been converted into electricity. By comparison, the most common solar cell today converts only a quarter of the available energy into electricity.

“Around 99 percent of the power contained in direct sunlight reaching the surface of Earth falls between wavelengths of 250 nm and 2500 nm, but conventional materials for high-efficiency multi-junction solar cells cannot capture this entire spectral range,” said Matthew Lumb, lead author of the study and a research scientist at the GW School of Engineering and Applied Science. “Our new device is able to unlock the energy stored in the long-wavelength photons, which are lost in conventional solar cells, and therefore provides a pathway to realizing the ultimate multi-junction solar cell.”

While scientists have worked towards more efficient solar cells for years, this approach has two novel aspects. First, it uses a family of materials based on gallium antimonide (GaSb) substrates, which are usually found in applications for infra-red lasers and photodetectors. The novel GaSb-based solar cells are assembled into a stacked structure along with high efficiency solar cells grown on conventional substrates that capture shorter wavelength solar photons. In addition, the stacking procedure uses a technique known as transfer-printing, which enables three dimensional assembly of these tiny devices with a high degree of precision.

This particular solar cell is very expensive, however researchers believe it was important to show the upper limit of what is possible in terms of efficiency. Despite the current costs of the materials involved, the technique used to create the cells shows much promise. Eventually a similar product may be brought to market, enabled by cost reductions from very high solar concentration levels and technology to recycle the expensive growth substrates.

The research builds off of the advancements made by the MOSAIC Program, a $24 million research project funded by the Advanced Research Projects Agency-Energy (ARPA-E) that funds 11 separate teams across the U.S., each seeking to develop technologies and concepts to revolutionize photovoltaic performance and reduce costs. The researchers note that funding for this type of research is essential for developing viable commercial technology in the future.

The study, “GaSb-based Solar Cells for Full Solar Spectrum Energy Harvesting,” was published in Advanced Energy Materials on Monday.

-GW-

Koch Brothers Launch Attack to Kill Electric Cars

EcoWatch   DeSmogBlog

Koch Brothers Launch Attack to Kill Electric Cars

By Ben Jervey   July 11, 2017

Fueling U.S. Forward, the Koch-funded campaign to “rebrand” fossil fuels as “positive” and “sustainable,” has released a new video attacking the Dirty Secrets of Electric Cars, signaling a possible strategic pivot from straightforward fossil fuel cheerleading to electric vehicle (EV) and clean energy bashing.

The video and accompanying Dirty Secrets of Electric Cars web page feature blatant factual errors, misleading statements and glaring omissions (all of which will be debunked thoroughly below), while essentially attacking electric cars for using the same materials needed to manufacture cell phones, laptops, defense equipment and gas-powered cars, and which are even a critical component of the very oil refining processes that form the foundation of the Koch fortunes.

When Fueling U.S. Forward launched last August, the organization’s president Charles Drevna described the campaign as an effort to rebrand fossil fuels by focusing on the “positive” aspects of coal, oil and gas. This newly released video seems to further confirm investigative journalist Peter Stone’s reporting from last spring that the Kochs were “plotting a multimillion dollar assault on electric vehicles.”

How do we know that Fueling U.S. Forward is this Koch-funded campaign? First, Charles Drevna, who is leading the effort, developed the concept while serving as a distinguished senior fellow at the Institute for Energy Research, a pro-fossil fuel think tank that was partially founded by Charles Koch and that is run by a longtime lobbyist for Koch Industries. Second, and more concretely, Drevna told DeSmog’s Sharon Kelley that he was working with Koch Industries’ board member (and longtime Koch brothers’ confidant) James Mahoney on the campaign and that it was funded by “one of the brothers.”

Echoes of America Rising Squared

Fueling U.S. Forward and America Rising Squared (or AR2) have no public affiliation. Yet within a few weeks in June, both groups launched attacks on electric vehicles using the same misleading arguments and nearly identical language. While the former group is a known Koch-funded campaign to promote fossil fuels, the latter has close ties to the GOP establishment, and has invested heavily in promoting alleged hypocrisy among climate action advocates, even paying “trackers” to follow around the likes of Tom Steyer and Bill McKibben.

In June, as DeSmog reported, AR2 published a white paper that purports to reveal the “human and environmental costs of ‘clean energy,'” taking electric vehicles and solar panels to task for their reliance on rare Earth metals. As we wrote at the time:

Here’s what the white paper doesn’t mention: many of the very same rare Earth minerals that the AR2 report bashes are critical components of cell phones, computers, cameras, military and defense equipment, and even traditional gas-powered vehicles. What’s more, the petroleum refining process is critically dependent on some of the same rare Earths that AR2 lambasts in this white paper.

The new video from Fueling U.S. Forward echoes the AR2 talking points, almost to the word. (For a closer analysis of the AR2 report, see the original DeSmog article).

Debunking the New Fueling U.S. Forward Electric Car Attack Video

The Fueling U.S. Forward video (which is still unlisted on Youtube, but available to be shared and viewed by anyone with the link) is short enough that we can walk through it line by line.

“This is an electric car/ Car companies say it’s a clean alternative/ But electric cars are more toxic to humans than average cars.”

This depends on an exceedingly narrow definition of “toxic.” If you only consider the materials that go into the batteries of electric cars versus the batteries of “average” cars, then this is maybe defensible. But if you consider the materials that go into the entire vehicle, as well as the fuel used to power the vehicle, than EVs are far cleaner and less toxic.

First, there’s the fact that gas-powered vehicles require some of the same “toxic” rare Earth metals that the video criticizes. (More on that below). Then there’s the even bigger issue that tailpipe emissions—including ozone, particulate matter and other smog-forming chemicals—are the dominant source of ground level air pollution, and nearly one half of all Americans live in areas that don’t meet federal minimum air quality standards. In fact, emissions from road transportation cause roughly 53,000 premature deaths every year in the U.S., according to MIT researchers.

“Their batteries are made of rare Earth metals/ Like cobalt, lithium…”

First, a fact check: cobalt and lithium aren’t rare Earth metals. This isn’t to say they aren’t problematic—cobalt mining in particular is plagued by some very serious environmental and labor problems, as documented in in-depth reports by Amnesty International and the Washington Post. But these problems are economy-wide. Cobalt is used widely in the lithium-ion batteries that power most cell phones and laptops. (See the subheadline of the very Washington Post article that the FUSF video cites: Tracing the path from deadly hand-dug mines in Congo to consumers’ phones and laptops). There’s no question that lithium-ion battery manufacturers have to clean up their supply chains, but that’s something that Apple and Panasonic and Samsung are as responsible for as Tesla and Ford and General Motors.

“…and cerium”

True, cerium is used in the batteries of electric vehicles. It is also found on every catalytic converter fitted into an internal combustion vehicle. That’s right—every gas-powered car relies on this rare Earth metal that Fueling U.S. Forward criticizes.

“That are extracted mostly overseas/ From countries like China/ And Congo/ Where pollution is rampant/ And children are forced into oppressive labor.”

Again, electric vehicle manufacturers must do their part to clean up the mining of these metals. But so do the cell phone and laptop makers, companies that supply communications and combat equipment to the Department of Defense, satellite communications system operators, medical device manufacturers, and so on.

“These metals are scarce/ Their extraction is dangerous/ And many of the batteries end up in landfills”

This last point is simply untrue. First of all, very few electric vehicle batteries have even run through their usable lives. Once they do, companies are already lining up to start recycling them, either for use on the electric grid or to be disassembled and the materials reused.

“This makes electric cars toxic/ For both people and the planet.”

Some of the components of electric car batteries have localized health and environmental impacts. But compared to the alternative—internal combustion vehicles spewing carbon and other air pollution—electric cars truly are much cleaner from cradle to grave.

Reposted with permission from our media associate DeSmogBlog.

American farmers are facing a political paradox because of Republicans’ hard line on immigration

Business Insider

American farmers are facing a political paradox because of Republicans’ hard line on immigration

Dana Varinsky        July 8, 2017

  • US dairy farmers tend to be conservatives, but many depend on immigrant workers to keep their operations running.
  • Republicans’ tough stance on immigration has created a political rift between some farmers and their representatives.
  • This disconnect highlights the complicated place farmers hold in American politics.

MAURICE, Iowa — The congressman who has represented northwest Iowa for 15 years once suggested that Mexican immigrants had “calves the size of cantaloupes” from smuggling drugs across the border. He has been seen with a Confederate flag on his desk (though Iowa supported the Union Army), and he tweeted in March that the US “can’t restore our civilization with somebody else’s babies.”

He even built a model of a border wall on the floor of Congress in 2006 — nearly a decade before Donald Trump adopted the cause.

But on the farms that fill Steve King’s district, his constituents have more nuanced, complicated politics than the Republican congressman’s rhetoric might suggest.

Thousands of immigrants have moved to northwest Iowa in recent decades, attracted by farms and meat producers in need of workers willing to raise pigs, milk cows, or butcher animals. Between 2000 and 2015, the Latino population in Sioux Center, one of the larger cities in the district, more than tripled. According to the census, King’s district is now home to nearly 50,000 people who consider themselves Hispanic or Latino — about 6% of the area’s population.

That means that even some of King’s supporters — he took 61% of the vote in November — are being forced to reconcile their conservative politics with a business reality that has taken on a moral weight. They rely on immigrants, and some will go to extraordinary lengths to support them.

‘They’ve done everything as a citizen should’

Maassen Dairy sits on a rural, unpaved road in Maurice, Iowa, less than half an hour from the South Dakota border. The Maassen family started producing milk on the land with about 15 cows during the 1920s. Five generations later, that number has grown to more than 1,300, and the animals spend their days in a covered, open-air barn, a pile of food easily reachable through a metal gate.

Lee Maassen grew up on the farm and started working there full-time soon after he got married at age 20. He now runs the operation with his sons.

On nearly every issue, Maassen is a reliably conservative voter. He supported King and Trump in the latest election. He agrees with King’s positions on limiting environmental regulation, he said, and on what Maassen refers to as “morality issues” like abortion.

But on immigration, they diverge. For the past 30 years, the Maassen family has been hiring more and more immigrant workers — of the 26 employees currently at Maassen Dairy, 16 are immigrants, mostly from Mexico. The family has even sponsored many to apply for citizenship. Often, that involved accompanying the workers on the more than two-hour drive to the Mexican consulate in Omaha, Nebraska, since there isn’t one in Iowa.

Maassen estimates his family has successfully helped half a dozen immigrant workers become citizens since they hired their first Mexican employee in 1985.

“All of our workers, they’ve paid their full amount of federal income tax, full amount of state tax. They’ve done everything as a citizen should,” he told Business Insider. “So why shouldn’t they be granted that? That’s why we need some reform.”

Maassen knows, however, that his idea of reform doesn’t align with the one espoused by King and other Republican politicians — especially since Trump’s election.

“The stance is sometimes really negative: Anybody that’s not classified, an immigrant, we’re going to send them all back, we’re going to close down the border, whatever,” he said of those with hardline stances on immigration. “But I’m thinking, do you really understand what the full impact of that would be?”

Immigrants or robots

Farmers are fairly accustomed to occupying a unique, complicated place in American politics.

They make up less than 2% of the US population, but their work has a dramatically disproportionate effect on the country’s economy. Environmental regulations affect them heavily, yet a changing climate can threaten their livelihoods. They generally vote Republican, but plenty of crop farmers utilize government insurance subsidies, and many in the industry are wary of big business and increasing consolidation.

Plus, free trade has proved a boon for agriculture — the value of US dairy-product exports more than quadrupled from 2004 to 2014, and pork exports have increased nearly eleven-fold since 2000 — but farmers were left in a lurch after both Democrats and Republicans came out against the Trans-Pacific Partnership in the 2016 election.

However, nowhere is farmers’ complex political position clearer than on immigration.

The Department of Agriculture estimated that only about 22% of the country’s crop farm workers in 2013 and 2014 were born in the US. Immigrants also permeate many other agricultural sectors that get less attention. Dairy workers aren’t employed seasonally. They don’t toil in fields picking delicate fruit like grapes or strawberries. And many don’t work anywhere near the Mexico-US border.

No nationally gathered statistics are available about laborers in livestock industries. But in a report put together for the National Milk Producers Federation in 2015 based on a survey of 1,000 dairy farms around the country, responses indicated that immigrants accounted for 51% of all dairy labor in the US, and that dairies employing immigrants produced 79% of the country’s total milk supply.

It’s the physical nature of dairy farming, Maassen said, that has made it almost impossible to fill positions with Iowa natives.

“We can’t find enough employees to fulfill the job role,” he said. “We need immigrant labor in order to do that.”

A crackdown on immigration would dramatically affect Maassen’s business — and the dairy industry overall. The NMPF report estimated that eliminating immigrant labor would cause the total number of dairy farms in the US to drop by over 7,000 and retail milk prices to increase by 90%.

“We’ve thought about that and considered what’s our disaster program if that would happen,” Maassen said of that worst-case scenario. “It would affect us greatly. We’d have to make some adjustments to how we’d hire the labor in order to do it. We’d have to switch over to all robots.”

Some dairy farms around the US have installed robotic milking machines to eliminate the problems that come from labor shortages and employee management. But for now, Maassen is sticking with his workers.

‘What more could one want, right?’

The cows at Maassen Dairy get milked three times a day, seven days a week. There are shifts around the clock.

Pilar Garrido spends her eight-hour shift in the farm’s milking parlor with two other employees, Mexican radio playing as groups of well-trained cows file onto elevated platforms. Garrido and her colleagues walk by each cow and coat her udders with a disinfecting cleaner, which stimulates the cow to let her milk down, the same way a nuzzling calf might.

After the cows have been cleaned and wiped, the workers attach milking tubes to each teat. The tubes pop off when the supply of milk is exhausted, and then the workers clean the udders once more before the cows leave and a new group is herded in.

“It’s hard because you’re working the whole eight hours, moving your feet, arms, the whole body,” Garrido, who emigrated to the US from Pachuca, Mexico, 15 years ago, told Business Insider in Spanish while the cows were being milked. “You arrive [home] wanting to bathe and go to sleep and not think about anything.”

Garrido and the others who do this work must power-wash the parlor several times per day. Other workers must also replenish the cows’ food and push it back into accessible piles. A few are in charge of herding the groups into the milking parlor. And then there are the cows ready for artificial insemination, since dairy cows are kept in a nearly permanent postpartum state. And there are the inevitable calves that need tending to.

Garrido said she grew up in a humble, country family and enjoys being with animals. But the work was all new to Mirza Salazar, who shares a shift with Garrido.

“I had an office career,” Salazar said in Spanish as Garrido tended to the cows behind her. She moved from Mexico City to Iowa in 2005, she said, because she had family in the area.

“Here, I learned to milk, about the outdoors, about maternity, I learned all of this,” Salazar said. “It’s very different. It’s tough. It’s simple, but it’s also humble, and it’s a job.”

Salazar and Garrido both fled abusive husbands — Salazar left hers in Mexico, and Garrido separated from hers in Chicago. Each is now raising kids solo. Garrido earns $11.25 an hour and manages to send money back to her parents in Mexico every month or two on top of providing for her kids.

“What more could one want, right? To improve and continue moving forward,” she said. “This is a lovely job, very honorable, and I like it.”

Fear, dialogue, and compromise

Step off Maassen’s farm, and there’s more fear. Garrido said she respected Trump and his decisions but had heard of many in the immigrant community losing hope.

“It causes a lot of remorse to go out into the street, and you don’t know if you’re going to return,” she said. “It’s almost as if you’re like, ‘Oh God, help me to get to work, and God help me to return home.'”

Maassen knows his employees have a heightened awareness of immigration politics since the presidential election. He, too, worries about Trump’s and King’s positions on the issue.

“I had some fear,” he said of King’s anti-immigrant rhetoric. “That’s why we met with Steve King a number of times, just to say, ‘Do you realize?'”

Maassen Dairy is part of an industry group called the Western Iowa Dairy Alliance, which has organized discussions between the state’s dairy farmers and their political representatives. Through those efforts, Maassen attempted to explain his situation to King a couple of years ago. He has also met with Republican Sen. Charles Grassley.

King did not return Business Insider’s request for comment on those meetings, and WIDA representatives said they didn’t believe the conversations led to any noticeable changes in King’s position. But Maassen believes the group did have some success in conveying to King what the consequences of an immigration crackdown would be for his voters. He thinks Trump, too, has been tempered since the campaign.

“Even from a conservative approach, there’s compromise being done already on that as we’re working through it, working for an alternative,” Maassen said.

He might be right — Trump told farmers at a roundtable in May that he would make sure his tough immigration-enforcement policies wouldn’t harm the agriculture industry. And despite King’s years of inflammatory comments, the congressman hasn’t succeeded in enacting many laws that have changed how Maassen goes about his business or his hiring.

That leaves Maassen free to base his vote on the other issues that matter to him — abortion, regulation, taxes. And it leaves King free to keep stepping into the bright spotlight of controversy, all the while hanging onto a decade-old model of a wall that’s unlikely to be built.

SEE ALSO: These robots are milking cows without any humans involved

NOW WATCH: Why organic milk lasts longer than regular milk

More: Dairy Agriculture BI Innovation Iowa

The President’s IKEA Cabinet Is Falling Apart Right on Schedule

Esquire

The President’s IKEA Cabinet Is Falling Apart Right on Schedule

You get what you pay for.

Charles P. Pierce     July 6, 2017  

While the president* is overseas checking in with the home office, the ill-suited elves of his spectacularly unqualified cabinet are very busy at the job of dismantling their jobs, which is their only apparent function in this administration. Energy Secretary Rick Perry, for example, dropped by to visit some coal miners and laid a little ee-co-nomix on them.

There are not many people in this world who don’t understand the concept of a “glut,” but Perry apparently is one of them. Hell, with that kind of thinking, I’m surprised Perry isn’t the Treasury Secretary.

Meanwhile, Secretary of Education Betsy DeVos is busy getting sued by 19 state attorneys general because she’s delaying a rule enacted by the previous administration that made it easier for students to get their loans forgiven if their colleges were found to have been fraudulent. DeVos is dragging her feet here because she sees education as a profit center, and because phony for-profit educational “reform” is the only reason anyone ever heard of her. From NPR:

The filing by 18 states and Washington, D.C., asks a U.S. District Court to declare the Education Department’s delay of the rule unlawful and to order the agency to implement it. The states say they have pursued “numerous costly and time-intensive investigations and enforcement actions against proprietary and for-profit schools” that violated consumer protection laws.

(Point of Personal Privilege: once again, Maura Healey, the attorney general of the Commonwealth—God save it!—is out front on this issue. Her statement reads, in part, “Since day one, Secretary DeVos has sided with for-profit school executives against students and families drowning in unaffordable student loans.” And fighting off grizzly attacks, one assumes.)

But, as you might’ve guessed, the real lasting damage is being done by Attorney General Jefferson Beauregard Sessions III. His Department of Justice has decided that Texas is doing just fine at this whole voter suppressi…er…voter ID thing, as The Texas Tribune notes:

“Texas’s voter ID law both guarantees to Texas voters the opportunity to cast an in-person ballot and protects the integrity of Texas’s elections,” the filing stated. Federal lawyers were referring to Senate Bill 5, which Texas Gov. Greg Abbott signed into law last month. It would soften a 2011 voter ID law — known as the nation’s most stringent — that courts have ruled purposefully burdened Latino and black voters. If allowed to take effect, the law would allow people without photo ID to vote if they present alternate forms of ID and sign affidavits swearing a “reasonable impediment” kept them from obtaining what was otherwise required. “S.B. 5 addresses the impact that the Court found in [the previous law] by dramatically reducing the number of voters who lack acceptable photographic identification,” the Justice Department argued, adding that U.S. District Judge Nelva Gonzales Ramos should “decline any further remedies.”

Of course, this is a complete reversal of the Obama DOJ’s efforts at curtailing the voter-suppression that was the true purpose not only of the original law, but of the inadequate fig-leaf of the state’s proposed changes. The Department of Justice is now on the other side and, somewhere in Jeff Sessions’ deepest heart, he knows what this is all about.

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Protesters opposing GOP health care bill descend upon lawmakers, some arrested

ABC Good Morning America

Protesters opposing GOP health care bill descend upon lawmakers, some arrested

Ali Rogin and David Caplan,  Good Morning America    July 7, 2017

https://www.yahoo.com/gma/protesters-opposing-gop-health-care-bill-descend-upon-051305078–abc-news-topstories.html

Protesters around the country on Thursday responded to lawmakers who declined to hold town halls by bringing their complaints straight to the doors of their elected officials’ offices.

From Arkansas to Arizona, supporters of Obamacare chanted, sang songs and in some cases, got arrested as they made their case against the Senate Republican health care bill.

ARIZONA

The Arizona chapter of the Progressive Democrats of America, a grassroots PAC operating inside the Democratic Party, said five of its members were arrested at a gathering outside the Phoenix office of Sen. Jeff Flake after a building manager called the police, claiming they were standing on private property. ABC affiliate KGUN reported that the four women and one man were taken into custody for trespassing after they repeatedly refused to leave the private property.

Protesters chanted “Where is Jeff Flake!” and “Now’s the time to stand and fight! Health care is a human right!”

In Tucson, Pima County Sheriff’s deputies arrested two men at a health care-related protest at Sen. Jeff Flake’s office Thursday morning, according to KGUN. Deputies say the men were arrested just before 9 a.m. for reported threats. One of the protesters allegedly referenced the shooting of U.S. Rep. Steve Scalise, according to KGUN.

ARKANSAS

In Arkansas, protesters waited in Sen. Tom Boozman’s Little Rock office, but were told by a staffer to limit themselves to ten people inside the small waiting room.

“Let’s please be respectful of each other,” the staffer told the group.

“Well, we would like for our senator to be respectful,” a protester responded. “If you’re going to have constituents, and if he’s going to be the U.S. Senator, he should have an office where constituents can come sit and speak their minds!”

At Sen. Tom Cotton’s office, in the same building as Boozman’s office, other protesters sang pro-Medicaid songs, to the tune of “Glory, Glory Hallelujah.”

And another protester told a Cotton staffer, “The legislation is supposed to make cuts to VA services … as a veteran Sen. Cotton should have other veterans in mind.” The staffer responded, “We appreciate your service. Thank you.”

TEXAS

Sen. Cruz was one of the few Senate Republicans to hold a town hall. Most of the questions at the event in Austin were on veterans’ health care, but he did have a few spirited exchanges with supporters of the ACA.

“I’m happy to have a conversation, but if we’re just yelling back and forth at each other, we can’t have that,” he told one heckler.

At the end of the event he thanked the largely friendly audience for a “respectful and spirited debate,” adding, “we may not have convinced each other but that’s part of the democratic process.”

Protesters, who chanted songs, also rallied outside of Sen. John Cornyn’s office in Austin.

Police were spotted escorting protesters away, and one of the officers was spotted frisking a male protester.

COLORADO

Obamacare supporters held a “Save Medicaid Rally” in Denver, where several hundred people showed up.

One female protester urged rally-goers to call Sen. Corey Gardner. “Call him at least once a day and tell him to vote no and to commit to us, before he leaves Colorado, to vote no on this ridiculous tax cut for the wealthy!” she said.

Activists at Sen. Corey Gardner’s Denver office didn’t get a face-to-face meeting, but they did get a 15-minute phone chat with their senator, who was not in the Denver area.

They told him they “demanded” that he vote “no” on the Senate bill — but Gardner said he couldn’t say how he would vote because the bill as presented is just a “discussion draft,” not the final version.

“I can’t commit yes or no,” he told the activists, from the Denver chapter of Democratic Socialists of America.

KENTUCKY

A few dozen protesters chanted and held signs outside Sen. Mitch McConnell’s office in Lexington.

“Don’t get sick! Please die quick!” chanted protesters, mocking the GOP’s healthcare plan.

KANSAS

Sen. Jerry Moran was treated warmly by a crowd at a town hall in Palco that seemed largely supportive of Obamacare, because he opposes the current Senate GOP bill.

He had a few exchanges with the liberal members of the audience, but all of them were respectful. This was a crowd that clearly appreciated being among the few that actually had an opportunity to talk to their senator over this recess.

“If public hearings are not held in the Senate on the next Senate bill, will you withhold your vote?” one attendee asked Moran of the health care bill.

“I will not necessarily. That’s not the criteria. I know that’s not the answer you were looking for,” Moran responded.

“No!” she said back, though she listened attentively as he explained why that wasn’t the case.

Moran touched on the scarcity of Republican town halls.

“I’ve been told that it’s silly to hold town hall meetings,” he said. “You may not be my voters, but you are my constituents. And you deserve to have a conversation with me,” he added, to applause.

TwinCities Pioneer Press

Health care bill would have devastating effects on Minnesotans, Dayton says

S.M. Chavey, Pioneer Press         July 5, 2017

At a Minneapolis news conference Wednesday, Gov. Mark Dayton and U.S. Rep. Keith Ellison, both Democrats, railed against the proposed health care bill in the U.S. Senate.

The Republican-written health care measure would unwind parts of the 2010 Affordable Care Act, known as Obamacare, and replace them with a less generous and, to backers, a less onerous health insurance program.

The bill threatens health insurance for an estimated 22 million Americans, according to the Congressional Budget Office. The CBO, a nonpartisan office, said the planned Senate health care measure would deliver a 35 percent spending cut to Medicaid, a program for people with low incomes, by 2036.

About 1 million Minnesotans are on Medicaid, with a further 100,000 on the state-run MinnesotaCare. That’s about 20 percent of the state’s population, Dayton said. The national health care bill under consideration would cost Minnesota $2.8 billion a year by 2026 and a total of $31 billion by 2030 — and that’s too big of a cut for the state to back fill, the governor said.

He and Ellison, who represents Minneapolis, urged Minnesotans to speak out against the bill.

“Quality health care is a right, and it should be treated as such,” Dayton said.

The U.S. House replacement for the federal Affordable Care Act passed by just two votes in May. The three Republican House members from Minnesota voted in favor of the measure. The five Democrats voted against it.

Republican U.S. Rep. Jason Lewis said the measures being debated in Congress would create a more robust, affordable and nimble health insurance market.

“We undo the price controls, we undo the mandates, so young and healthy people can get back in the insurance pool with lower premiums,” said Lewis, in his first term representing Minnesota’s south-suburban 2nd District.

Lewis defended slowing the growth of Medicaid, saying that the able-bodied poor adults it expanded to cover under the Affordable Care Act shouldn’t be the program’s focus.

In the face of opposition from Senate Republicans, the Senate delayed a vote, originally planned for the end of June, on its replacement until after the July 4 recess.

“It’s not too late to raise your voice to stop this terrible Senate bill,” Ellison said Wednesday. “If we want to preserve ACA and even extend it and make it better, it’s time to raise your voice and to understand that we are right.”

Minnesota Department of Human Services Commissioner Emily Piper said the bill would affect Minnesotans in particular by removing federal funding from MinnesotaCare and by not giving Minnesota credit for the reforms it has made to Medicaid.

“If Congress and the president are serious about reducing health care costs, they should really look to states like Minnesota that have innovated and reformed the way we deliver health care for the people of Minnesota, and not punish us for the reforms,” Piper said.

Piper said Medicaid pays for almost half of substance-abuse treatment in Minnesota. Medicaid enrollee James Robinson, of Minneapolis, said Medicaid helped him work through his addictions.

“If it weren’t for the funding of some of these programs … there would have been no support system that saw the good in me and said, ‘You deserve to live,’ ” Robinson said at the news conference.

David Montgomery contributed to this report.

Is Trump mentally fit to be president? Let’s consult the U.S. Army’s field manual on leadership

LA Times  Op-ed

Is Trump mentally fit to be president? Let’s consult the U.S. Army’s field manual on leadership

By Prudence L. Gourguechon   June 16, 2017

Since President Trump’s inauguration, an unusual amount of attention has been paid to the 25th Amendment to the Constitution. That’s the measure, ratified in 1967, that allows for removal of the president in the event that he is “unable to discharge the powers and duties” of the office. What does that mean, exactly? Lawyers surely have some ideas. But as a psychiatrist, I believe we need a rational, thorough and coherent definition of the mental capacities required to carry out “the powers and duties” of the presidency.

Although there are volumes devoted to outlining criteria for psychiatric disorders, there is surprisingly little psychiatric literature defining mental capacity, even less on the particular abilities required for serving in positions of great responsibility. Despite the thousands of articles and books written on leadership, primarily in the business arena, I have found only one source where the capacities necessary for strategic leadership are clearly and comprehensively laid out: the U.S. Army’s “Field Manual 6-22 Leader Development.”

The New York Times published a letter signed by 35 psychiatrists, psychologists and social workers. The letter suggests Trump’s “grave emotional instability… makes him incapable of serving safely as president.” (Feb. 21, 2017)

The Army’s field manual on leadership is an extraordinarily sophisticated document, founded in sound psychological research and psychiatric theory, as well as military practice. It articulates the core faculties that officers, including commanders, need in order to fulfill their jobs. From the manual’s 135 dense pages, I have distilled five crucial qualities:

Trust

According to the Army, trust is fundamental to the functioning of a team or alliance in any setting: “Leaders shape the ethical climate of their organization while developing the trust and relationships that enable proper leadership.” A leader who is deficient in the capacity for trust makes little effort to support others, may be isolated and aloof, may be apathetic about discrimination, allows distrustful behaviors to persist among team members, makes unrealistic promises and focuses on self-promotion.

A good leader ‘demonstrates an understanding of another person’s point of view’ and ‘identifies with others’ feelings and emotions.’

Discipline and self-control

The manual requires that a leader demonstrate control over his behavior and align his behavior with core Army values: “Loyalty, duty, respect, selfless service, honor, integrity, and personal courage.” The disciplined leader does not have emotional outbursts or act impulsively, and he maintains composure in stressful or adverse situations. Without discipline and self-control, a leader may not be able to resist temptation, to stay focused despite distractions, to avoid impulsive action or to think before jumping to a conclusion. The leader who fails to demonstrate discipline reacts “viscerally or angrily when receiving bad news or conflicting information,” and he “allows personal emotions to drive decisions or guide responses to emotionally charged situations.”

In psychiatry, we talk about “filters” — neurologic braking systems that enable us to appropriately inhibit our speech and actions even when disturbing thoughts or powerful emotions are present. Discipline and self-control require that an individual has a robust working filter, so that he doesn’t say or do everything that comes to mind.

Judgment and critical thinking

These are complex, high-level mental functions that include the abilities to discriminate, assess, plan, decide, anticipate, prioritize and compare. A leader with the capacity for critical thinking “seeks to obtain the most thorough and accurate understanding possible,” the manual says, and he anticipates “first, second and third consequences of multiple courses of action.” A leader deficient in judgment and strategic thinking demonstrates rigid and inflexible thinking.

Self-awareness

Self-awareness requires the capacity to reflect and an interest in doing so. “Self-aware leaders know themselves, including their traits, feelings, and behaviors,” the manual says. “They employ self-understanding and recognize their effect on others.” When a leader lacks self-awareness, the manual notes, he “unfairly blames subordinates when failures are experienced” and “rejects or lacks interest in feedback.”

Empathy

Perhaps surprisingly, the field manual repeatedly stresses the importance of empathy as an essential attribute for Army leadership. A good leader “demonstrates an understanding of another person’s point of view” and “identifies with others’ feelings and emotions.” The manual’s description of inadequacy in this area: “Shows a lack of concern for others’ emotional distress” and “displays an inability to take another’s perspective.”

The Army field manual amounts to a guide for the 25th Amendment. Whether a president’s Cabinet would ever actually invoke that amendment is another matter. There is, however, at least one historical precedent. The journalists Jane Mayer and Doyle McManus tell the dramatic story in their 1988 book, “Landslide: The Unmaking of the President 1984-1988.”

Before he started his job as President Reagan’s third chief of staff, in early 1987, Howard Baker asked an aide, James Cannon, to put together a report on the state of the White House. Cannon then interviewed White House staff, including top aides working for the outgoing chief of staff, Donald Regan. On March 1, the day before Baker took over, Cannon presented him with a memo expressing grave concern that Reagan might not be sufficiently competent to perform his duties. Reagan was inattentive and disinterested, the outgoing staff had said, staying home to watch movies and television instead of going to work. “Consider the possibility that section four of the 25th Amendment might be applied,” Cannon wrote.

After reading the memo, Baker arranged a group observation of Reagan for the following day. On March 2, Baker, Cannon and two others — Reagan’s chief counsel, Arthur B. Culvahouse Jr., and his communications director, Tom Griscom — scrutinized the president, first at a Cabinet meeting, then at a luncheon. They found nothing amiss. The president seemed to be his usual genial, engaged self. Baker decided, presumably with relief, that Reagan was not incapacitated or disabled and they could all go on with their business.

Much has changed since the Reagan era, of course. Because of Trump’s Twitter habits and other features of the contemporary media landscape, far more data about his behavior are available to everyone — to citizens, journalists and members of Congress. And we are all free to compare that observable behavior to the list of traits deemed critical for leadership by the U.S. Army.

Prudence L. Gourguechon, M.D., is a psychiatrist and psychoanalyst in Chicago.