Reconciliation and Obamacare: what goes around comes around?

The New Neo Posted on by

I certainly hope we get to find out:

In a private meeting with Americans for Limited Government (ALG) staff, senior aides to Senate Minority Leader Mitch McConnell (R-Ky.) promised that should Republicans reclaim a majority in the Senate on Tuesday, they would use the budget reconciliation process to go after Obamacare.

It was unclear whether that meant full or partial repeal of the law under reconciliation, but according to ALG vice president of public policy Rick Manning who was at the meeting on October 29, “Aides acknowledged the only way to get any type of repeal or even major changes to the law would be reconciliation.”

The matter was further clarified in an October 30 statement by McConnell spokesman Brian McGuire: “if Republicans are fortunate enough to take back the majority we’ll owe it to the American people to try through votes on full repeal, the bill’s most onerous provisions, and reconciliation.”

The rest of the article is about the finer points of outright repeal vs. change through reconciliation, as well as the question of tax vs. penalty, the probability of an Obama veto, and tactics. But the strategy is to use the Senate majority to shake up Obamacare in a big way.

As I’ve said before: hope we get a chance to see.

Back when Obamacare was being passed, I wrote a ton of posts about the use of reconciliation as a process to drag that thing through. Without reconciliation—which, if I recall correctly, had never before been used to force a major and controversial piece of legislation—Obamacare would have remained in the dustbin of history. Reconciliation could be the first step towards putting it back there again, at least in its present form.

Obama would veto either repeal or a bill passed by reconciliation, of course, if the latter made anything other than tiny changes. But it would be quite the confrontation—and, as the article says, “would set up the 2016 presidential election as a clear referendum on whether or not to keep the law.” While Obama is president, there’s no way for Congress to actually get rid of Obamacare. Even mere defunding would be a disaster, because Obamacare has by now dismantled much of the system it replaced, and that system no longer exists. And even impeachment and conviction of Obama wouldn’t do it, because Biden would then become president, and he would probably veto a repeal or reconciliation bill as well.

But let’s say Republicans take the Senate in 2014. Let’s say they are determined to use reconciliation to change Obamacare into something better, which would at least challenge Obama and let the American people know what they’d do if they had the presidency and Congress in 2016. How much better would those changes be? Can they make it into something a conservative could be pleased with (inasmuch as conservatives can ever be pleased by a government program)? How market-based would it be, and how much of an entitlement program? How would it be funded? Would it reinstate or restrict choice, and how much?

This is all in the nature of counting unhatched chickens, of course. But let’s hope the reconciliation chicken begins coming home to roost.

More thoughts on this Tuesday’s election

The New Neo Posted on by

When I saw the title of this New Republic piece by Brian Beutler—“It Won’t Be Obama’s Fault When the Democrats Lose the Senate”—I practically snickered.

More sycophantic Obama apologia, I thought. But when I actually read it I changed my mind, because that’s not what the article is at all. Beutler rightly points out some trends in the 2014 election that I had noticed but not really thought about all that much before, trends that should disturb anyone on the right: the relatively poor performances and close races in many states where the Republican candidate ought to be running away with it.

A win is a win is a win, but some of these should be routs, and they’re almost certainly not going to be:

In 2012, Obama lost Alaska, Arkansas, Louisiana, and North Carolina by 13, 24, 17, and 3 points respectively. Right now in the states’ Senate races, also respectively, polling aggregators show Mark Begich trailing challenger Dan Sullivan by one to four points; Mark Pryor trailing challenger Tom Cotton by four to eight points; Mary Landrieu trailing Bill Cassidy by four to seven points; and Kay Hagan beating Thom Tillis by one to three points.

These Democrats are all outperforming Obama by significant margins, in states where Republicans have natural advantages, and in a year in which those advantages should magnify Democratic weaknesses.

The counterpoints to this observation can be found in Colorado, Iowa, and (to a lesser extent) New Hampshire. Obama won those states in 2012 by four, six, and six points respectively. Right now, also respectively, Mark Udall is trailing challenger Cory Gardner by about two points; Bruce Braley (running to replace retiring Tom Harkin) is trailing Joni Ernst by one to two points; and Jeanne Shaheen is leading Scott Brown by only one to two points.

The conservative narrative of a nationwide Republican wave is incubating in these states, where Democrats are underperforming Obama. It must therefore be true that allegiance to Obama is a decisive factor everywhere.

But that narrative cannot account for the GOP’s remarkable underperformance in Georgia, Kansas, and Kentucky. Mitt Romney won those states by eight points, 22 points, and 23 points respectively. Right now, also respectively, Republican David Perdue is leading Democrat Michelle Nunn by two to six points; GOP incumbent Pat Roberts is running behind Independent Greg Orman by about a point; and Senate Minority Leader Mitch McConnell is leading Democrat Alison Lundergan Grimes by three to five points. Grimes is outperforming McConnell’s 2008 challenger Bruce Lunsford, who lost by six points in a Democratic wave year. Kraushaar attributes this better-than-the-fundamentals resilience to “her attempts to appease both the party base and more-conservative voters in her state,” which have been “painfully awkward.”

If I had to, I’d put money on Democrats losing all three. But you have to be really invested in a certain conception of politics to explain races that close in states that red as evidence of a national anti-Obama wave. Or to attribute their losses to insufficient Obama bashing.

I think much of it comes down to candidates and their personal characteristics. For example, notice that in at least two of the states where the Republicans are outperforming what might be expected from their states’ 2012 vote (Colorado and Iowa), the Republican candidates are considerably more personable and magnetic than their opponents. That could also arguably be true in New Hampshire. Then there are people like Roberts in Kansas and McConnell in Kentucky, who are probably doing more poorly because they are less than compelling, and who have probably been coasting on their incumbencies in recent years.

I confess to not being keenly aware of the finer points of the dynamics in every one of the states with hotly-contested races, so I could easily be missing something. Some of you might say it boils down to “RINO bad, conservative good,” but that doesn’t explain some of the races I know best, where New England’s (formerly Massachusetts’, presently New Hampshire’s) very own supposedly RINO Scott Brown is doing better than expected against the widely-liked Jeanne Shaheen.

But I fear it’s more than the particular characteristics of these particular candidates that explains the phenomenon. I fear that what we are seeing is not some profound and thoughtful ideological shift in the electorate, but a free-floating disgust and impatience with the whole process that is both shallow and fickle, and can just as easily turn back the other way if things don’t go swimmingly well.

I leave you to duke it out about the reasons, but those are my guesses. But I’d like to see Republicans not only win on Tuesday, but win big. And then, of course, they have to perform.

Should be “interesting.”

The Times wonders whether Obama may replace some aides

The New Neo Posted on by

It has come to the Times’ august and rarefied attention that:

At a time when the Obama administration is lurching from crisis to crisis ”” a looming Cold War in Europe, a brutal Islamic caliphate in the Middle East and a deadly epidemic in West Africa ”” it is not surprising that long-term strategy would take a back seat. But it raises inevitable questions about the ability of the president and his hard-pressed national security team to manage and somehow get ahead of the daily onslaught of events.

Poor beleaguered folk, buffeted by all these crises that they had no part in bringing about.

And love that construction: “it raises inevitable questions.” Passive voice. Does the Times have any such questions, too?

The article’s headline is “Obama Could Replace Aides Bruised by a Cascade of Crises ” Note that word “could.” He could fly a kite on the White House lawn, too, but I doubt he will.

The Times may be trying to hint that he should (replace the aides, that is, not fly a kite). But the author doesn’t seem to think it will happen:

There is little evidence that the president plans a wholesale shake-up…Mr. Obama is also leaning more than ever on his small circle of White House aides, who forged their relationships with him during his 2008 campaign and loom even larger in an administration without weighty voices like those of Robert M. Gates, the former defense secretary, or Hillary Rodham Clinton, the former secretary of state.

When Hillary Clinton is your deeply-missed “weighty voice,” you’re in trouble. Of course, the Times is engaged here in burnishing her resume.

But I’m in agreement that Obama has no intention whatsoever of a shakeup. These are his trusted people, and they do his bidding.

Dr. Rick Sacra to Megyn Kelly: about those ebola patients without fevers

The New Neo Posted on by

[NOTE: I’d like to get the following information to Megyn Kelly, so she can do some further investigating on this point. Just emailing her seems futile, because it will get lost in the shuffle. Any ideas?]

Last night I watched Megyn Kelly’s interview with Dr. Rick Sacra, a Massachusetts doctor who contracted ebola in August while working in Liberia and who was flown to this country and recovered. His answers during this part of their exchange especially interested me:

DR. RICK SACRA, SURVIVED EBOLA: You know, [Kaci Hickox is] not ill. She’s not sick. She doesn’t have a fever. She doesn’t have other symptoms. And the science suggests that she’s really not a risk to anyone at this time. So in that sense, yes, I support her contention. She’s not a risk.

KELLY: OK.

SACRA: The reason you confine someone is because they’re a risk. She’s not a risk.

KELLY: Here’s why people are concerned about her and other workers, I think. Because, first of all in 13 percent of an Ebola cases, you have no fever. So not having a fever isn’t the end-all tell-all about whether you have Ebola, right?

SACRA: I think, you know, you can’t take a statistic like that in the absence of context. Sometimes people with Ebola at the end of their lives will no longer be able to mount a fever because they’re so weak. So when someone arrives at the tent for treatment in West Africa and they’re about to die, they may not be having a fever.

Generally, healthy people like Miss Hickox, when they develop Ebola, they will have a fever. I think they will look behind those kinds of statistics.

KELLY: OK. Understood.

That seemed plausible. However, Dr. Sacra didn’t cite from where he got his information. Perhaps there is a bona fide study that backs up what he’s saying, but I couldn’t find one (which of course doesn’t mean it doesn’t exist). What I did find was much more curious.

Before I go into that, let me say that for quite some time I’ve been doing online research about ebola itself, particularly transmission and early symptoms, as well as symptoms in general. I now have enough information to write about twenty posts, which means I despair of ever getting the information all out there, although I certainly plan to write a couple of lengthy ones.

But the summary version of what I’ve found is that the bulk of the information we have so far about ebola is based on data from past epidemics, plus animal research. The first source is hampered by the fact that this epidemic seems to be going differently and spreading further and faster, although what has caused that difference is as yet unclear . The second source is hampered by the usual caveat that a disease acts differently in different species, although some species (in the case of ebola, non-human primates) are more similar to humans in their responses than others.

There’s also a third problem with the data, which is that the the data from previous ebola outbreaks is sketchy, to say the least. That’s because record-keeping in medical facilities in those parts of Africa has been haphazard (plus some patients may not be coming in for care or even recognized as ebola patients):

Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.

But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system””originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May””and the results of that record-keeping appear in the New England Journal of Medicine.

The article goes on to discuss some of the findings, none of which seem to deal with the main subject matter of this post: fever’s reliability as a symptom of ebola.

Back to Kelly, Sacra, and fevers—here’s a discussion of the study Kelly is presumably referring to when she asks the question of Dr. Sacra—the research that suggested that around 13% of ebola patients don’t appear to exhibit fever. Note, when you read it, how “garbage in, garbage out” the data seems, due mostly to lack of resources in that part of the world. Note, also, that “fever” was defined at a suitably low level (100.4) rather than the higher 101.5 level previous protocols have laid out [emphasis mine]:

The official assumptions about the frequency of fever in Ebola patients have not been challenged publicly. But Dr. Paul D. Stolley, former chairman of the University of Maryland’s Department of Epidemiology and Preventive Medicine, said the matter “requires further investigation.”

Given the stakes, he said, the “absolute” assumption that Ebola can be spread only when an infected person displays fever should be reevaluated.

“It may be true,” said Stolley, a member of the Institute of Medicine, part of the National Academies. “It just doesn’t sound very plausible to me.”…

The authors of the recent World Health Organization study said they analyzed “a detailed subset of data” on confirmed and probable cases, including information from forms completed by doctors and other healthcare workers in the affected countries, indicating whether a patient had a fever and at what temperature and whether the reading was taken by armpit, by mouth or rectally.

The study defined fever as 38 degrees Celsius ”” 100.4 degrees Fahrenheit.

“To create the fullest possible picture of the unfolding epidemic,” the authors said, they collected additional information from “informal case reports” and other sources.

The researchers described imperfections in some of the data. In a footnote, they wrote that “in practice, healthcare workers at the district level often do not have a medical thermometer and simply ask whether the person’s body temperature is more elevated than usual.”

Yet the lead author, Dr. Christl Donnelly, a professor of statistical epidemiology at Imperial College London, stood by the findings on the prevalence of fever.

Asked by email whether the study found no fever in 12.9% of confirmed and probable cases, Donnelly replied: “Yes.”…

Three studies of previous outbreaks, cited in the same World Health Organization report, provide further grounds to question whether fever is a fail-safe signal.

Researchers studying an outbreak in Uganda in late 2000 and early 2001 reported that “the commonest symptom ”¦ was fever, which occurred in 85% of the cases.”

Another study of that outbreak, focusing on 24 confirmed cases of Ebola, found fever in 88%.

The third study, which examined a 1995 outbreak in the Democratic Republic of Congo, found fever in 93% of 84 people who died and in 18 of 19 individuals who survived.

Asked Friday how many people infected in the current outbreak should be expected to display fever, a CDC spokeswoman, Sharon Hoskins, said “the vast majority” would, but added that it was “impossible to give an exact percentage.”

For doctors and nurses fighting the epidemic in West Africa, the risk of encountering Ebola in the absence of fever is more than academic.

Dr. Nick Zwinkels, a Dutch physician, last month closed a hospital he had been running with a colleague in central Sierra Leone after five nursing aides contracted Ebola ”” possibly from unprotected contact with three patients who were not promptly diagnosed with the virus.

Four of the nursing aides died, as did all three of the patients belatedly found to have Ebola.

Interviewed by email, Zwinkels said that hospital staff members took the temperature of one of the doomed patients four times a day for three consecutive days, and the patient never showed a fever. The readings were taken by a digital thermometer placed in the armpit, he said.

Based on what his staff observed, Zwinkels wrote, “it seems that only measuring the temperature as a form of triage is insufficient.”

He added: “It seems that Ebola can present without fever especially in the first phase.”

Zwinkels said that without fever as a trustworthy marker, it is difficult for medical professionals to treat the many West Africans suffering from everyday maladies…

If Ebola cannot be readily identified, Zwinkels wrote, “Ebola patients will be admitted in the normal ward and possibly contaminating health staff and caretakers. This is why a lot of hospitals in West Africa are closed.

I wonder how Dr. Sacra would square those findings with his statements to Kelly about the absence of fever in ebola patients. I’ve seen no evidence that the absence of fever involves those in late stages only; on the contrary, experts in this article state that it tends more to involve the earlier stages (although there were also patients in late stages who lacked a fever, they seem to have never had a fever, which delayed their diagnoses, although after death they were finally documented as having had ebola). There is no discussion whatsoever of the sort of phenomenon Dr. Sacra describes.

Who is Dr. Sacra? According to this, he’s a family physician from Massachusetts. He doesn’t seem to be an ebola researcher or even an ebola expert, although I would imagine he certainly knows something about it, and not just from his personal experience of having suffered from the disease.

I had assumed that Sacra had gotten infected in Liberia treating ebola patients. But this was not the case:

Sacra, a family physician from Worcester, Massachusetts, wasn’t treating Ebola patients when he got infected. He was helping pregnant women. Like Writebol and Brantly before him, when a fever came on, he desperately hoped it was malaria and not Ebola.

I can only conclude that the most likely way Dr. Sacra contracted ebola was from treating a pregnant woman whose undiagnosed ebola was advanced enough to be contagious (diagnosis of ebola in pregnancy is easier to miss, by the way). Dr. Sacra’s story would appear to be evidence that ebola isn’t necessarily easy to diagnose or recognize even in contagious stages, and that symptoms do not always point so clearly to the disease, even when Western physicians are treating the patient in a hospital or clinic setting (much less when laypeople such as Thomas Eric Duncan are dealing with a similar patient presentation).

In terms of judgment, denial, and quarantines—it’s fascinating that Sacra, Brantly, and Writebol all thought and hoped they had malaria, a disease far more common in Africa, and certainly a possible diagnosis at the beginning. This shows that doctors and nurses are not always the best judges of what they have contracted. You know the old saying: a physician who treats himself has a fool for a patient.

[NOTE: As I said, I’ve got a lot more information on transmission and symptoms. Rather than deal with it all now, I’ll just offer a smattering.

This:

“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”

What’s more, we assume that diarrhea and vomiting are always present, but apparently they’re not:

Ebola virus RNA levels in the blood increase logarithmically during the acute phase of illness and significant numbers of EVD patients have vomiting (67.6%), diarrhea (65.6%) and unexplained bleeding (18% and generally late in the course of disease) presenting opportunities for EVD transmission.]

And speaking of candy corn…

The New Neo Posted on by

…which I was—this article, which chastises us for our Halloween indulgences, purports to give better candy alternatives to substitute for worse ones.

But why bother? I figure that, once you’re into Halloween candy, you may as well have the type you want, because you’re already sunk. However, I did notice that the authors helpfully offer candy corn as the better alternative compared to something that sounds pretty nasty to me, Reese’s Pumpkin thingees:

WORST SEASONALLY THEMED CANDY: Reese’s Pumpkin

170 calories, 10 g fat, 3 g saturated fat, 16 g sugar

MORE CALORIES AND SUGAR THAN FIVE NABISCO GINGER SNAPS!

This one should send your gimmick radar into the red zone. If it were flavored with pumpkin puree that would be one thing, but it’s not. It’s an oversized peanut butter cup shaped in a pumpkin-like mold. And what price do you pay for such fanciful novelty? Nearly two-thirds more calories than a regular Reese’s peanut butter cup. If you want to create a festive atmosphere, stick with Candy Corn and you’ll save yourself the calorie hangover.

Eat This Instead:

Brach’s Candy Corn (11)

81 calories, 0 g fat, 16 g sugar

Of course, the only people who eat only eleven pieces of candy corn are those who already hate it, although apparently their numbers are legion.

I can’t even eat Reese’s cups now, although I used to love them, because they contain peanuts and chocolate, the two main things that give me migraines. Double whammy. I had thought from the title of the pumpkin version that they had some actual pumpkin in them. But apparently not.

That’s okay. I’ve found that although pumpkins themselves are visually great, they leave a lot to be desired in the flavoring department. It’s not that the taste is so bad. It’s just that anything made with pumpkin tends to be better without the pumpkin.

Pumpkin makes you feel all warm and fuzzy and fall-like, but does it really enhance a single food? Muffins, doughnuts, candy, pie? Give me blueberry for the first, old-fashioned sour cream for the second, candy corn for the third, and almost any sort of pie but pumpkin for the fourth. Pumpkin pie is probably the only type of pie I don’t care for—I even like mince pie, so there.

Another seasonal thought: I wonder whether anyone is dressing up as Kaci Hickox for Halloween. That could be a way to scare a lot of people.

It’s that day again

The New Neo Posted on by

[NOTE: Yes folks, time passes swiftly and once again it is (blare of trumpets) National Candy Corn Day! Which means it’s time for a repeat of this post, originally published in 2008.]

No doubt all of my readers, being unusually well-informed people, were already aware that today is National Candy Corn Day.

But did you know it is estimated that in this country twenty million pounds of the classic treat (invented in the 1880s) are sold every year? I personally might be responsible for approximately a ton of that if I gave in to my worst impulses. However, I keep my addiction in tightly-controlled check.

It is part of my penance to confess here that I really like the dreadful stuff and always have. Once I even went to a Halloween party dressed as a piece of candy corn, and believe me I was already a grownup.

Apparently I am not the only adult who has dressed up as candy corn on Halloween. And no, I didn’t look like this—more’s the pity (although to be technical, isn’t she dressed as two pieces of candy corn, the body and the hat?):

candycorncostume.gif

I am not alone in my shameful liking for the tricolor tooth-destroyer. I heard on Fox News (can’t give a link here because I was unable to find the information online) that candy corn is the Halloween treat most often stolen by parents from their kids’ Halloween stash. I believe this to be undeniably true. It is a guilty, shameful secret for most, but I am glad this is finally seeing the light of day.

Even some fanatically health-consciously vegans seem to crave candy corn although alas, the treat is off-limits to them because of its animal-related ingredients. Animal ingredients? If you doubt my words, just take a look:

Sugar, Corn Syrup, Confectioner’s Glaze, Salt, Honey, Dextrose, Artificial Flavor, Gelatin, Titanium Dioxide Color, Yellow 6, Yellow 5, Red 3, Blue 1, Sesame Oil.

Gelatin and honey must be the big no-nos. But happily, a thoughtful vegan (are there any other kind?) mother has come to the rescue with a recipe for candy corn so complex and labor-intensive that it undoubtedly reflects a devotion to the stuff even more intense than mine. Try it if you dare—and if you are insane.

There are various gourmet variations on candy corn, and I’ve sampled quite a few in my day. To my mind they can’t compare to good old classic Brach’s. But after watching the following highly informative video, I may just try some Goelitz:

And here’s a burning question I was reminded of by the video: do you eat your candy corn in sections? And, if so, do you consider the top to be the yellow part or the white part? I’ve always seen the little white triangle as the “foot” of the candy corn, but I learned when I designed my costume years ago that most people see it the other way. For those who might be inclined to disagree with me, I offer the following exhibit from the realm of science:

corn-components.jpg

Lanny Davis, concern troll, looks ahead

The New Neo Posted on by

This piece by Lanny Davis purports to give helpful advice to Republicans just in case they win the Senate (he doesn’t think they will, by the way—but you know, just in case).

It’s manipulative and duplicitous, but unconsciously funny as well. It’s for the latter reason that I’m highlighting it. Davis has turned himself into a concern troll. But the funny part is that his trolling is so transparent, and basically involves telling Republicans not to do what Democrats do when they win.

Only of course he doesn’t put it in those terms.

A sample of what I mean:

First, [Republicans] could misinterpret their victory as a mandate to implement a hard-right agenda…

The second mistake could be that the Republicans who now control both houses of Congress will be unable to resist the Tea Party base to roll back Democratic programs on an entirely partisan basis. If they do so, they will be ignoring all the current polling data showing voters opposing such partisan power plays. And they will own the results.

Is that not an excellent description of what happened to Democrats—to a lesser extent in the 2010 midterms, and to a greater extent (we hope) now? Furthermore, aren’t mistakes number one and number two sort of the same thing, stated differently?

Come to think of it, so is Davis’ mistake number three:

Third, once the GOP is the majority party in both houses of Congress, Republicans will find it more difficult to suppress three powerful ideological groups within the party whose positions on key issues are way out of touch with most voters’, according to national polls.

Near the close of his missive, Davis comes up with this whopper:

But unlike Republicans, [Democrats] prefer candidates who can civilly debate fact-based solutions and can effectuate bipartisan compromises to break the gridlock in Washington.

Of course, Davis’ column isn’t really meant for Republicans. No Republican would listen to him (at least, I certainly hope not). It’s meant to rally the Democratic troops to vote next Tuesday rather than giving up, to look on the bright side after what may turn out to be a defeat, and to congratulate them for their wonderful civility and reality-based point of view.

Okay, so here’s my question

The New Neo Posted on by

Here’s an article about a study that says drinking more milk may be bad for you. It may not reduce the risk of bone fracture, and it may even increase the risk of death:

We indeed found higher oxidative stress and inflammation in women and men who consumed several glasses of milk per day compared with those who drank lower amounts,” lead author Karl Michaé«lsson told Yahoo Health. Michaé«lsson and his research team also found no reduction in fracture risk with higher milk consumption. Furthermore, women who drank more than three glasses of milk a day (average 680 ml) had a higher risk of death than women who drank less than one glass of milk a day (average 60 ml).

Regular readers of this blog may recall that I detest milk and always have. But I’ll go a step further and say that I don’t understand how anyone except young children can like it.

So, here’s my question: what adult willingly drinks more than three glasses of milk a day?

And might such people have a higher risk of death because they’re just plain crazy?

Kaci Hickox, America’s sweetheart

The New Neo Posted on by

New Jersey’s loss seems to be Maine’s gain:

Kaci Hickox, the nurse who was quarantined at a New Jersey hospital despite exhibiting no Ebola symptoms after arriving from West Africa, won’t follow the quarantine imposed by Maine officials, her attorney said tonight.

“Going forward she does not intend to abide by the quarantine imposed by Maine officials because she is not a risk to others,” her attorney Steven Hyman said. “She is asymptomatic and under all the protocols cannot be deemed a medical risk of being contagious to anyone.”

Hickox will abide by all the self-monitoring requirements of the Centers for Disease Control and Prevention and the state of Maine, Hyman said.

But I wonder how many people in Fort Kent, Maine are going to be eager to attend her “Welcome home, Kaci” party?

Now that Christie has washed his hands (metaphorically speaking) of Hickox—which is beginning to look more and more like a very savvy decision—what will LePage of Maine do? Treat her with kid gloves, apparently, although I wonder whether that will be enough for Ms. Hickox:

Maine requires that health care workers such as Hickox who return to the state from West Africa will remain under a 21-day home quarantine, with their condition actively monitored, Gov. Paul R. LePage said in a statement.

“We will help make sure the health care worker has everything to make this time as comfortable as possible,” he said.

The comments to the linked article are uniformly angry. Typical is this: “She makes it REALLY easy to hate her.” And that’s among the nicer ones.

From some of the statements in this article, however, it sounds like Maine may be ready for a legal battle with Hickox:

Early Tuesday evening, Maine Department of Health and Human Services Commissioner Mary Mayhew noted at a hastily called news conference that the state has the authority to seek a court order to compel quarantine for individuals deemed a public health risk.

Meanwhile, Connecticut has eight people already under forced quarantine, and we haven’t heard all that much about them:

Under guidelines issued by Connecticut Gov. Dannel Malloy, anyone returning to the state from Guinea, Liberia, or Sierra Leone is subject to mandatory health monitoring and may be placed under involuntary quarantine if the commissioner of the state’s health department determines they “have met the threshold for such action.”

One of them, however, is speaking up:

“I’m outraged and very upset about the impact that this policy and the subsequent policies in other states will have on the actual fight to contain Ebola in West Africa,” Boyko, a Ph.D candidate in the School of Public Health’s epidemiology of microbial diseases department, told the Hartford Courant.

We rubes just don’t understand everything there is to understand about ebola, unlike Boyko. He must know exactly how and when every single case of ebola in Africa was contracted, and that there is absolutely no chance whatsoever of someone catching it from someone in a relatively early stage of the disease, with mild symptoms and a fever. Note also his words “the actual fight to contain ebola in West Africa.” As opposed to what—the fake fight to contain it here, the one that states such as Connecticut are putting up? The one that restricts his freedom for three weeks? That one?

Boyko’s story is in some ways even more interesting than Hickox’s. When he was in Liberia he did not treat ebola patients (he’s neither an M.D. nor a nurse); he worked at a computer. But he had a meeting with Ashoka Mukpo, the NBC freelance cameraman who came down with the disease, the evening before Mukpo was diagnosed. After returning to the states he was not originally told to stay in quarantine [emphasis mine]:

Boyko said his plan was to lay low the first week back, not return to school, and rest. He didn’t do much ”” once he drove around in a car with his girlfriend to look at the foliage ”” but a few days later on Oct. 15 he developed a low fever and diarrhea.

He called doctors to tell them about his symptoms and said he wanted to wait until the next day before going into the hospital. He was convinced he couldn’t have Ebola. The disease is not transmitted through the air ”” it is only transmitted through bodily fluids ”” and it is only transmitted by people who are symptomatic. Boyko was certain his brief visit with Mukpo, who had no symptoms, could not have made him ill.

But the Yale doctors decided he should come in immediately. Boyko called his mother in St. Louis to tell her he was going to the hospital, but that he was sure he didn’t have Ebola.

That has turned out to almost certainly be correct. But what was all this initial certainty about, in the face of exposure to ebola, and symptoms? That was really playing with fire.

Hickox and Boyko are giving those who volunteer for ebola duty in Africa a bad name. I sincerely hope they are not typical of the genre. But the way they’re talking certainly doesn’t make me think these two could be trusted with a voluntary quarantine or even voluntary self-monitoring. Their arrogance, and their resentment of the very human desire to protect our communities from a scourge such as ebola, come through loud and clear.

[NOTE: It’s interesting that all this quarantine-of-health-workers business seems so far to be concentrated in the Northeast—New York and New Jersey (those make sense as places of entry), Connecticut and Maine.]

Netanyahu: chickenshit

The New Neo Posted on by

This administration has such class:

The other day I [journalist Jeffrey Goldberg] was talking to a senior Obama administration official about the foreign leader who seems to frustrate the White House and the State Department the most. “The thing about Bibi is, he’s a chickenshit,” this official said, referring to the Israeli prime minister, Benjamin Netanyahu, by his nickname…

“The good thing about Netanyahu is that he’s scared to launch wars,” the official said, expanding the definition of what a chickenshit Israeli prime minister looks like. “The bad thing about him is that he won’t do anything to reach an accommodation with the Palestinians or with the Sunni Arab states. The only thing he’s interested in is protecting himself from political defeat. He’s not [Yitzhak] Rabin, he’s not [Ariel] Sharon, he’s certainly no [Menachem] Begin. He’s got no guts.”

The article goes on to discuss the administration’s further criticism of Netanyahu in a way that can be summarized as: all he cares about is politics. What an extraordinary accusation for this group to make!

I am also in awe of their judgment and knowledge of history:

Netanyahu is the first Israeli prime minister born in Israel after the establishment of the state. Netanyahu joined the Israel Defense Forces during the Six-Day War in 1967, and became a team leader in the Sayeret Matkal special forces unit. He took part in many missions, including Operation Inferno (1968), Operation Gift (1968) and Operation Isotope (1972), during which he was shot in the shoulder. He fought on the front lines in the War of Attrition and the Yom Kippur War in 1973, taking part in special forces raids along the Suez Canal, and then leading a commando assault deep into Syrian territory. He achieved the rank of captain before being discharged.

If you’re not familiar with the Operation Isotope, it involved the rescue of the hijacked Sabena Flight 571:

Soon after the hijacking, the hijackers separated Jewish hostages from non-Jews and sent them to the back of the aircraft. The hijackers demanded the release of 315 convicted Palestinian terrorists who were imprisoned in Israel, and threatened to blow up the airplane with its passengers. Seeing the terrorists crying and hugging each other goodbye, Reginald Levy managed to send a message and ask for help to be delivered as soon as possible. The security minister Moshe Dayan conducted negotiations with the terrorists while also making preparations for a rescue operation, code-named “Operation Isotope.”

On 9 May 1972 at 4:00 p.m. the rescue operation began: a team of 16 Sayeret Matkal commandos, led by Ehud Barak and including Benjamin Netanyahu, both future Israeli Prime Ministers, approached the airplane. The commandos were disguised as airplane technicians in white overalls, and were able to convince the terrorists that the aircraft needed repair. The commandos stormed the aircraft and took control of the plane in ten minutes, killing both male hijackers and capturing the two women. All the passengers were rescued. Three of the passengers were wounded, one of whom eventually died from her wounds. Netanyahu was wounded during the rescue, presumably by friendly fire. The two female surviving terrorists were eventually sentenced to life imprisonment, but were freed as part of a prisoner exchange after the 1982 Lebanon War.

To paraphrase Winston Churchill: some chicken, some shit.

Oh, and by the way, extreme bravery (and airplane hostage rescue) runs in the Netanyahu family. His brother, Yonatan, was the only Israeli soldier killed in the famous Operation Entebbe:

Netanyahu joined the Israeli Defence Forces in 1964. He volunteered to serve in the Paratroopers Brigade, and excelled in the Officer Training Course. He was eventually given command of a paratroopers company. On June 5, 1967, during the Six Day War, his battalion fought the battle of Um Katef in Sinai, then reinforced the Golan Heights. During the battle, Yonatan received a wound to his elbow while helping rescue a fellow soldier who lay wounded deep behind enemy lines.

After the Six Day War, Netanyahu went to the United States to study at Harvard University, but returned a year later because of the War of Attrition. Instead, he studied at the Hebrew University of Jerusalem, returning to active military service after half a year.

In the early 1970s he joined Sayeret Matkal (Israeli special forces), and in the summer of 1972 was appointed as the unit’s deputy commander. During that year, he commanded a raid (Operation Crate 3) in which senior Syrian officers were captured and exchanged in return for captive Israeli pilots. The following year he participated in Operation Spring of Youth, in which the alleged terrorists and leadership of Black September were selectively killed by Sayeret Matkal, Shayetet-13 and the Mossad.

During the Yom Kippur War in October 1973, Netanyahu commanded a Sayeret Matkal force in the Golan Heights that killed more than 40 Syrian commandos in a battle which thwarted the Syrian commandos’ raid in the Golan’s heartland. During the same war, he also rescued Lieutenant Colonel Yossi Ben Hanan from Tel Shams, while Ben Hanan was lying wounded behind Syrian lines.

Following the war, Netanyahu was awarded Medal of Distinguished Service, Israel’s third highest military decoration, for his wartime conduct. Netanyahu then volunteered to serve as an armor commander, due to the heavy casualties inflicted on the Israeli Armored Corps during the war, with a disproportionate number of these in the officer ranks. Netanyahu excelled in Tank Officers course, and was given command of the Barak Armored Brigade, which had been shattered during the war. Netanyahu turned his brigade into the leading military unit in the Golan Heights.

In June 1975, Netanyahu left the Armored Corps and returned to Sayeret Matkal as unit commander. He was killed in action on July 4, 1976, while commanding an assault unit in Operation Entebbe, his first big operation since returning to the unit. Netanyahu was the only Israeli soldier killed during the raid (along with three hostages, all of the Popular Front for the Liberation of Palestine members, and dozens of Ugandan soldiers). Netanyahu was shot outside the building being stormed, and would soon die in the arms of Efraim Sneh, commander of the mission’s medical unit. The operation itself was considered a success by Israel, and is known as Mivtsa Yonatan (Operation Yonatan) in honor of Netanyahu.

Netanyahu was buried in Jerusalem’s Military Cemetery at Mount Herzl on July 6 following a military funeral attended by enormous crowds and top-ranking officials. Shimon Peres, then Defense Minister, said during the eulogy that “a bullet had torn the young heart of one of Israel’s finest sons, one of its most courageous warriors, one of its most promising commanders ”“ the magnificent Yonatan Netanyahu.”

Of course, that was back when the US had Israel’s back.

[NOTE: I speculate who the “senior official” might be. My leading guess is John Kerry.]

The great ebola policy divide

The New Neo Posted on by

It breaks down this way—

The Obama administration and liberals: don’t panic. Trust us, less is more. No travel restrictions, no forced quarantine, the CDC knows best. We are the educated scientists and smart people, you are the dummy hysterics are operating on emotion.

Republicans and the right: the CDC and government have shown themselves to be unworthy of trust, the science is unsettled on this. So why not err on the side of caution. We need to protect our country and our people.

The lines have been drawn, the talking points issued. But are the troops (that’s us, folks) falling into line?

Here’s an article on a recent CNN poll: “CNN poll: Americans confident in Ebola response.” And then below it is a graphic, shouting “More than 7 in 10 Americans say federal government can stop an ebola epidemic.”

Sounds pretty clear, doesn’t it? Americans must be happy with what the government is doing.

But that’s not actually what the poll indicates. It is question 36 that’s being referred to: “How confident are you that the federal government can prevent a nationwide epidemic of the ebola virus?” “Prevent” is not the same as “stop.” The latter assumes that an epidemic is already in the works and is halted in its tracks, which is harder to do than preventing one in the first place (“an ounce of prevention is worth…”). And there can be local spreads of the disease without a national epidemic occurring, of course, and the question specifically mentions a national epidemic.

In addition, it asks about “can stop” rather than “will stop.” There’s a difference between theoretical ability and actual execution. Last but not least, we have the usual form of such polls, where “very confident” (33%) and “somewhat confident” (38%) are lumped together as “confident.”

But there can be a very wide gulf between the two. For example, I might have answered “somewhat confident” to that question, because I certainly think it’s possible that a nationwide epidemic could be prevented (or perhaps avoided in the first place, although that question’s not an option). But I am strongly critical of the government and the CDC’s response.

If you read the entire poll you’ll see that a great many people consider ebola a big issue in the election, and many people think there should be more restrictive policies in place for the entry of nationals from the ebola countries as well as returning US citizens.

On a slightly different but related topic: the good news is that Amber Vinson has been released. I’m happy for her, her family, her friends, and her fiance. But I noticed in the comments section of the linked article that her swift recovery, and that of the other Americans who came down with the illness here, have fed a certain confidence among some people that this would be the norm here, and that the fear about the disease is overblown.

I plan to write at greater length on this topic in the future, because it’s both complex and important. But I’ll deal with it briefly now. There is growing evidence that early diagnosis and intervention can be extremely helpful. Each of the people who survived here got some sort of unusual medication and/or transfusion as well, and in reading the details of the recoveries of the ones who had started out sicker than Pham and Vinson in the first place, I was struck by the fact that they described those moments of receiving the medication or transfusion as a distinct turning point in their illness.

Plus, every single one of the survivors had known prior risk factors. They all had been taking care of ebola patients, and are health professionals. Therefore they knew enough to react at the very first symptoms. We can quibble about how early they reacted (how high the temperature was, for example). But they knew enough to suspect the disease at a very early stage and alert authorities, and they were hustled off to the best of care.

But if ebola were to make a leap into the general population (and there is most definitely a chance of that) and infect a person with no reason to suspect that he/she has been exposed to the disease, then all bets are off for early diagnosis.

To make the point more clear: Nina Pham and Amber Vinson got treatment when their fevers were about 100 degrees and they had no other symptoms. Unless everyone with a fever of 100 degrees starts coming into emergency rooms for an ebola test, the risk of the spread of ebola is significant. And of course, once it did spread into the general population and proliferated, the medical system would quickly become overwhelmed and the sort of treatment Pham and Vinson received would be impossible for most people. That’s what happened in Africa, and also what happened during the 1918-1919 flu epidemic.

I hope we’ll be able to avert these worst case scenarios, but they are very real. And it’s not the least bit hysterical to point them out. It’s realistic.

Election Day in one week

The New Neo Posted on by

Election Days make me nervous.

Back in the twentieth century (doesn’t that sound archaic?), that wasn’t the case. I always voted, and I always preferred one candidate to another, but it didn’t affect me very deeply. It seemed that even the candidate I didn’t like wasn’t going to do all that much damage. Despite their differences, everyone running seemed to have our interests at heart, and although they might disagree on how best to meet those interests, there were some basic assumptions on which we all agreed, including the need to protect this country and the free world.

I may or may not have been correct about this. But it was a strong perception, and I was hardly alone in it; it was the prevailing feeling.

No more.

Now I get much more agitated about elections. And that’s not because I idealize either side; I’ve got plenty of beefs with the Republican Party and particularly its leaders. But (as I’ve explained many times) they are so much better than the alternative that it seems important to give them a chance, or at least to throw somewhat of a monkey wrench into the left’s inexorable march to permanent control.

So, I get nervous—even in elections like this one, where it’s looking pretty good for Republicans. Will Scott Walker win? That seems important, particularly in terms of 2016 possibilities. What about the Georgia Senate race? Kansas? North Carolina? Those should all be gimmes, but they’re not.

Note that in some of them—North Carolina, for example—there is a Libertarian candidate who is acting as a possible spoiler (the candidate there draws as much as 7% of the voters in polls). Libertarians are of course free to run for office, and people are free to vote for them. To me it seems clear, though, that they tend to hurt the Republican candidates more than the Democrats, and are often responsible at least in part for the victory of the latter.

However, I’m extremely familiar with the arguments of libertarians who want to vote for their candidates even if it’s a losing cause this time, and even it helps the side they oppose more. I’m also familiar with arguments that say that Libertarians draw from each side equally; I just don’t find them convincing. But it’s probably true that many (not all) of the people on the right who vote for the “L” candidate would probably not vote at all if no one were running on the Libertarian ticket.

So, what happens if the Republicans do as well next week as I hope? Then they will need to show us it was worth voting for them. But we need to be realistic: with Obama as president, and lacking enough votes to override a veto, their hands are somewhat tied. They should pass a lot of bills to show what they would like to do, and challenge him to veto them. They should use the tools that Democrats handed them (no filibuster for judicial appointments) to tie up his judicial nominations. They need to hold Obama’s feet to the fire. And somehow (I don’t know how, if Obama chooses to do it through executive action, as has been threatened), they need to block amnesty, and strengthen the border.