Recovery Rate, Survival Rate, Mortality Rate — What Words Mean

Welcome to another edition of What Words Mean! Today we’re going to look at some medical terms. Full disclosure, I am not a physician. The most medical training I have was to get a first aid Girl Scout merit badge, ca. 1965. But I’m good at looking stuff up.

Yesterday I ran into somebody claiming that covid-19 has a 99 percent survival rate. This set off an alarm. I learned a long time ago, in arguments about U.S. health care, that “survival rate” doesn’t mean what we might think it means. We might assume that the survival rate of a disease measures the percentage of patients who get the disease, are cured, and go on their merry way, happy and healthy, but that’s not so.

“Survival rate” in medicine is a measure of the percentage of people who survive a disease for a particular period of time after diagnosis, or after the onset of the disease. Cancer survival rates, for example, are usually given in five-year increments. It’s the percentage of patients who are still alive five years after diagnosis. It doesn’t mean they are cancer free, just that they are still alive. If the same people all die of cancer after five years and one month, that doesn’t count in the five-year survival rate.

You might read that cancer patients in the United States have x percent higher survival rate than cancer patients in some other country, like France. And that might sound impressive. But if you dig deeper, you might find this means the American patients are living just five months longer than the French patients, not that they are cured.

There is also what’s called a relative survival rate

A way of comparing the survival of people who have a specific disease with those who don’t, over a certain period of time. This is usually five years from the date of diagnosis or the start of treatment for those with the disease. It is calculated by dividing the percentage of patients with the disease who are still alive at the end of the period of time by the percentage of people in the general population of the same sex and age who are alive at the end of the same time period. The relative survival rate shows whether the disease shortens life.

Without knowing exactly what is being measured, saying that covid-19 has a 99 percent survival rate is meaningless. Are we talking survival after two weeks? A month? What? It’s too soon to calculate a five-year survival rate, obviously.

And then there’s “recovery rate.” I’ve seen a lot of claims that covid-19 has a 99 percent recovery rate. “Recovery rate” doesn’t appear to be a medical term. I found recovery period, which refers to how long it takes most patients to recover from a particular disease. Example: The recovery period of measles ranges from two to four weeks, or something. But medically, to say that any disease has a “recovery rate” that is figured as a percentage is nonsensical.

“Mortality rate,” very broadly, refers to the number of deaths in a population over a period of time, given as some kind of scale — for example, the number of deaths per 100,000 people. The morality rate of a disease is calculated by the number of deaths by that disease divided by the total population. It’s not the percentage of people who get the disease who die, which I think is what a lot of us assume. Here’s a discussion of mortality rate at the Center for Disease Control. Mortality rates in epidemiology are very difficult to calculate, I understand.

What most of us want to know is, how many people who get this disease will die? And, if I get the disease, what are my chances of not dying? And we need to look at other measures for that.

Here’s a World Health Organization page called Estimating mortality from COVID-19.

There are two measures used to assess the proportion of infected individuals with fatal outcomes. The first is infection fatality ratio (IFR), which estimates this proportion of deaths among all infected individuals. The second is case fatality ratio (CFR), which estimates this proportion of deaths among identified confirmed cases.

Now we’re talking.

To measure IFR accurately, a complete picture of the number of infections of, and deaths caused by, the disease must be known. Consequently, at this early stage of the pandemic, most estimates of fatality ratios have been based on cases detected through surveillance and calculated using crude methods, giving rise to widely variable estimates of CFR by country – from less than 0.1% to over 25%.

In other words, we don’t really know, and it appears to vary a lot. For those of you who understand mathematics, the calculation looks like this:

My impression is that it will be a while before the epidemiologists have an IFR number they feel confident about.

Case fatality ratio is “the proportion of individuals diagnosed with a disease who die from that disease and is therefore a measure of severity among detected cases.” That calculation looks like this:

The WHO people say we won’t have a reliable CFR for some time. While an epidemic is ongoing, they’re making a lot of assumptions that could turn out to be wrong. “In the COVID-19 pandemic, we have seen broad variations in naïve estimations of CFR that may be misleading,” WHO says. Again, it sounds like they don’t really know yet.

This page from Johns Hopkins looks at the CFR they have calculated for several countries. It varies from over 15 percent in the UK to 1.1 percent in Kazakhstan. The CFR for the United States is 3.3 percent. The page was updated today, it says.

(Update: I wanted to say something about the continuing claims that covid-19 is no worse than the flu. Just the raw numbers ought to have laughed that claim off the planet, but they haven’t. According to this publication, the CFR for seasonal flu is 0.1 percent. The CFR for the 1918 flu was 2.5 percent.)

In doing any of these calculations, we’re obviously at the mercy of a lot of inaccuracy. Nobody’s numbers are perfect. Any number anybody throws around, high or low, needs to be understood as a provisional thing subject to change. Nobody really knows how deadly covid-19 is. It kills a bunch of people, obviously. But to know what any one person’s chances of getting the disease and then completely recovering isn’t something anyone knows yet.

But I think we can safely say that it’s kind of stupid to keep yapping that covid-19 has a “99 percent” recovery or survival rate. That means nothing.

It’s also the case that we don’t yet know how many people will suffer some kind of long-term damage as a result of this disease. A lot of people who have been discharged from hospitals and are considered out of danger are still not recovered.

Athena Akrami’s neuroscience lab reopened last month without her. Life for the 38-year-old is a pale shadow of what it was before 17 March, the day she first experienced symptoms of the novel coronavirus. At University College London (UCL), Akrami’s students probe how the brain organizes memories to support learning, but at home, she struggles to think clearly and battles joint and muscle pain. “I used to go to the gym three times a week,” Akrami says. Now, “My physical activity is bed to couch, maybe couch to kitchen.”

Her early symptoms were textbook for COVID-19: a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For weeks, she struggled to heal at home. But rather than ebb with time, Akrami’s symptoms waxed and waned without ever going away. She’s had just 3 weeks since March when her body temperature was normal.

“Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU,” says Akrami, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner.

The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain.

The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic disease.

You probably know that people who have had chicken pox might develop shingles decades later. We don’t know what’s going to happen with covid-19 patients, including the ones who remain asymptomatic. It might be years before we know.

Just be careful and don’t catch it. Please.

Missouri and Medicaid

There are a lot of headlines today about how a Black Lives Matter activist won a primary over a ten-term congressman yesterday. The ten-term congressman is also Black and not a bad guy, but now Cori Bush will be the first Black woman elected to Congress from Missouri. She will represent the 1st congressional district, which takes in all of the city of St. Louis and a portion of northern St. Louis County, including Ferguson. This is considered a safe seat for Democrats.

Circuit Attorney Kimberly M. Gardner, the chief prosecutor for the city of St. Louis, easily won her primary to keep her position yesterday — 60.8% to 39.2% — and no doubt will win her general election as well. Until recently she was expected to lose the primary. But then came the McCloskeys and the badmouthing of Gardner by Trump and by Missouri governor Parsons. And a landslide was born.

The third happy result in the Missouri election yesterday was the passage of a constitutional amendment referendum to expand Medicaid under the Affordable Care Act. This was proposed as a constitutional amendment so that the looney tune wingnut legislature couldn’t block it with legislation.

This doesn’t surprise me

Support for expansion came largely from voters in and around the urban centers of Kansas City, Saint Louis, Springfield and Columbia. Voters in Kansas City, Mo., for example, approved the measure by 87.6%.

Amendment 2 was rejected overwhelmingly by conservative voters in the mostly rural parts of the state that have the highest uninsured and poverty rates.

Voters in McDonald, Morgan and Scotland counties, which have the three highest uninsured rates in the state, rejected the measure by margins of nearly 2 to 1 or greater.

The key to Democrats winning anything in this state is to whip up a big turnout in the cities. I think Claire McCaskill lost in 2018 because she played it too safe, campaigning on being a pragmatic centrist, and the city voters were uninspired. I haven’t seen numbers, but I get the impression that turnout for yesterday’s primary was unusually high. This is encouraging.

And Gov. Parsons has got to be worried about his general election chances. It could be close. It was Parson’s bright idea to put the Medicaid referendum on the primary ballot, thinking that the lower voter turnout would cause it to fail.

Getting back to the mostly rural parts of the state, where people tend to be poor and uninsured — this is democracy’s great weakness, isn’t it? These people will benefit enormously from expanded Medicaid, yet they voted against it.

People of the rural areas in this state tend to be poor, uneducated, and bigoted. For example, next door Washington County, 95 percent white, has a per capita income of $18,915, it says here. 21.7% of county residents are officially in poverty. Instead of formal education, they get their heads filled with Fox News, Rush Limbaugh, and holy roller preachers. Washington County voters said no to Medicaid, 63.53% to 36.47 percent.  But they’ll get it, anyway. A whole lot of them really need it.

But they are just way too susceptible to manipulation because of their ignorance. I’ve seen the mailers they got to get them to vote against Medicaid expansion. Taxes will go up! Illegal immigrants will get the benefits! Government-run health care! blah blah blah.

I blame both parties for this. The Democrats abandoned the rural poor decades ago. The Repubicans do them no good, but they are able to flood rural areas with right-wing propaganda to keep them voting for Republicans. I’ve been complaining about this for years. And Washington County folks will march to the polls and vote for Trump in November.

But yesterday, at least, the Medicaid initiative passed. And maybe eventually the ones who get on Medicaid will realize it’s okay.

Historic building in Washington County, Missouri. French settlers moved into the area in the late 18th and early 19th centuries. A dialect of French was spoken there until well into the 20th century. The French settlers built “vertical log” cabins that tended to rot after a few years, but this one seems to have survived.

The Jonathan Swan Interview

If you want to watch the Jonathan Swan interview of Trump, here it is.

I tried to find a free transcript, but failed. But a lot of it has been posted in news stories. In short, it is appalling.

Aaron Rupar at Vox:

Asked how he can say the pandemic is under control when roughly 1,000 Americans are dying from Covid-19 each day, Trump said, remarkably, that “it is what it is.”

“They are dying. That’s true. It is what it is. … It’s under control as much as you can control it.”

On the topic of America’s struggles with coronavirus testing, including long wait times for test results that render testing almost worthless, Trump resorted to making stuff up.

“There are those that say you can test too much. You know that?” Trump said at one point.

“Who says that?” Swan responded.

“Read the manuals. Read the books,” answered Trump.

“What books?” Swan challenged, but no answer was forthcoming. Instead, Trump said that “when I took over we didn’t even have a test” — as if the Obama administration was supposed to develop a test for a virus that didn’t exist until nearly three years after Trump’s inauguration.

A few minutes later, just as he did on Wallace’s show, Trump waved around pieces of paper with charts and graphs in an unconvincing effort to make it seem as though the US coronavirus death toll of more than 150,000 isn’t as bad as it seems.

“Right here, the United States is lowest in … numerous categories … ah, we’re lower than the world,” Trump stammered, which prompted Swan to respond, incredulously, “lower than the world? In what?”

“Oh, you’re doing death as a proportion of cases,” Swan continued. “I’m talking about death as a proportion of population. That’s where the US is really bad. Much worse than South Korea, Germany, etc. … Look at South Korea: 50 million population, 300 deaths.”

Trump responded by suggesting South Korea is faking its numbers. But when Swan challenged him on that point, Trump quickly changed the topic back to his pieces of paper.

“Here’s one right here. You take the number of cases. No, look. We’re last. Meaning we’re first,” Trump said.

“I mean, 1,000 Americans die a day,” Swan responded. “If hospital rates were going down and deaths were going down, I’d say terrific, you deserve to be praised for testing. But they’re all going up!

There was a long exchange between Swan and Trump in which Trump kept insisting deaths were going down, and then Trump would say well, they’re going down in Arizona. (True, but the numbers tend to spike up and down, which may be irregular reporting.) The latest data I could find are in these tweets:

Again, the top chart does not represent number of cases, but the rate of positive results of tests. The bottom charts represent the rate of cases and deaths per million people. This ain’t good, folks.

Philip Bump at WaPo writes that Trump doesn’t appear to understand how bad the pandemic really is.

President Trump came prepared, or so it seemed.

When he sat down for an interview with Axios’s Jonathan Swan last week, Trump held a number of loose sheets of paper, each with a graph that, he clearly believed, showed how well the United States has done in combating the coronavirus pandemic. He had a graph showing the number of tests completed in the United States, for example, a soaring line rising above other countries tallying the tens of millions that have been conducted over time. Another had a simple bar chart, four colored rectangles demonstrating his administration’s success.

These were the emperor’s clothes, and he was proud of them. But Swan, given one of the few opportunities for a non-sycophant to interview the president, revealed them for what they were. Trump was left fumbling, unable to rationalize his repeated claims that all was well. Because, of course, it isn’t.

“Right now, I think it’s under control,” Trump said at one point. “I’ll tell you what—”

“How? A thousand Americans are dying a day,” Swan interjected.

“They are dying, that’s true. And you ha— It is what it is,” Trump replied. “But that doesn’t mean we aren’t doing everything we can. It’s under control as much as you can control it. This is a horrible plague that beset us.”

“You really think this is as much as we can control it? A thousand deaths a day?” Swan said.

“I’ll tell you, I’d like to know if somebody—” Trump began, then switched directions. “First of all, we have done a great job.”

He then went into his standard patter about ventilators and protective equipment. This has emerged as a standard defense mechanism for the president: What he’s done is the best that could have been done, and nothing he hasn’t done would have been useful to do until such time as he does it. The number of tests completed is an unalloyed success, although the slow ramp-up in testing allowed the virus to spread without detection for weeks this spring, spurring massive numbers of deaths. To Swan, Trump blamed this on his having taken office without there being a test for the virus — a virus that emerged in humans more than two years after Trump became president.

Seriously, in the interview he blamed Obama for there not being a test, and he gave himself massive credit for having eventually come up with a test, even though the U.S. was way behind the rest of the world in coming up with a test.

Even within the confines of Trump’s bounded successes, though, it quickly became apparent that he didn’t have a grasp on what was happening with the pandemic. He was holding numbers in his hands, but didn’t understand what they showed and, importantly, what they didn’t.

I think it’s entirely possible his staff is feeding him carefully, um, prepared versions of what’s happening so that he doesn’t have a meltdown.

“Right here,” he said at one point, showing Swan a chart, “the United States is lowest in— numerous categories, we’re lower than the world.”

“Lower than the world?” Swan asked. “What does that mean?”

“We’re lower than Europe,” Trump continued. “Take a look. Take a look. Right here.”

He handed Swan the sheet of paper, allowing the reporter, at least, to actually understand what Trump was claiming.

“Oh, you’re doing death as a proportion of cases,” Swan said. “I’m talking about death as a proportion of population. That’s where the U.S. is really bad. Much worse than South Korea, Germany, etcetera.”

“You can’t do that,” Trump replied.

“Why can’t I do that?” Swan asked.

“You have go by—” Trump continued, fumbling with his papers. “You have to go by where— Look, here is the United States— You have to go by the cases of death.”

Whatever “cases of death” means. Swan threw some real data at him for South Korea — Fifty-one million population, 300 deaths — and Trump just dismissed it as misreported statistics.

Bump goes on to explain that Trump is focused on the ratio of deaths to cases because, a few weeks ago, that ratio was looking pretty good for the U.S. The number of cases was going up, but the number of deaths was lagging behind. “Lagging” is the operative word here; time has passed, and the rate of deaths is going up now, too. Sort of the way winter follows fall and night follows evening. More cases will eventually lead to more deaths, although not right away.

“There’s never been anything like this,” Trump said. “And by the way, if you watch the fake news on television, they don’t even talk about it. But, you know, there are 188 other countries right now that are suffering— some proportionately far greater than we are.”

The example he used was Spain, which he said was “having a big spike.” Spain has been averaging 2,600 new cases a day over the past seven days and five deaths, according to data from Johns Hopkins. The United States has seen nearly 60,000 new cases per day and a bit over 1,000 deaths. Looking at those number as a function of population — which Trump endorses here — we see that Spain is seeing 56 new cases per million residents each day and 0.1 deaths, compared to 184 cases and three deaths in the United States.

Again, my suspicions are that he doesn’t grasp any of this and is just using data his dutiful staff prepare for him to keep him from taking off their heads.

On Tuesday morning, Politico published an article looking closely at how the White House operates under its new chief of staff, former North Carolina congressman Mark Meadows. One White House staffer who spoke with Politico’s reporters said that Meadows and his team were protecting Trump from bad political news.

“I don’t know if they’re giving him the whole picture,” the official said, calling the group “Kool-Aid drinkers.”

Not that it would matter if they did tell him the truth. He still wouldn’t do anything about it.

Here’s more analysis from Aaron Ruper:

But perhaps Trump’s most tone-deaf remarks were reserved for the end when Swan asked him a string of questions about racial inequalities and his reaction to the death of John Lewis.

Presented with a statistic that succinctly illustrates systemic racism in the country — “Why do you think Black men are two and half times more likely to be killed by police than white men?” Swan asked — Trump dodged with an equivalency.

“I do know this: that police have killed many white people also,” he said.

After Trump claimed he’s done “more for the Black community than anybody with the possible exception of Abraham Lincoln, whether you like it or not,” Swan asked him: “You believe you did more than Lyndon Johnson, who passed the Civil Rights Act?”

“How has it worked out?” Trump responded. “If you take a look at what Lyndon Johnson did. How has it worked out?”

Here Swan asked, “You think the Civil Rights Act was a mistake?” Trump changed the subject.

The interview closed with what should’ve been a softball — “How do you think history will remember John Lewis?” Swan asked. But instead of paying lip service to Lewis’s record as a Civil Rights icon, Trump denigrated him for the pettiest of reasons.

“I really don’t know. I don’t know. I don’t know John Lewis. He chose not to come to my inauguration,” Trump said.

“Taking your relationship with him out of it, do you find his story impressive, what he’s done for this country?” Swan followed up.

“He was a person that devoted a lot of energy and a lot of heart to civil rights. But there were many others also,” Trump demurred.

Small and petty to the end. There’s more, but you get the picture.

Trump: Old Dog With Old Tricks

There is much breaking news today that the Manhattan district attorney is investigating the Trump organization for bank and insurance fraud, not just for payments to porn stars. Yesterday we learned that Deutsche Bank opened an internal investigation into the personal banker of Donald Trump and Jared Kushner. Given the past history of these two, I’d say the odds they are guilty of something are pretty high.

Speaking of history: Trump is reacting to the coronavirus just like he reacted to the lawsuits against Trump University.

Trump University, which shut down in 2011 after multiple investigations and student complaints, was treated as a joke by many of Trump’s political opponents — much as they treated Trump Steaks or Trump Vodka. But to those who knew the school well, it wasn’t a joke.

It was a premonition.

The saga of Trump University showed how far Trump would go to deny, rather than fix, a problem, they said — a tactic they have now seen him reuse as president many times, including now, in the face of a worsening pandemic. For months, President Trump promised something wonderful but extremely unlikely — that the virus would soon disappear.

Even through courts shut down the fake school and ruled that Trump owed $25 million in damages, Trump does not admit fault. If there’s a problem, he simply denies it (or blames somebody else) rather than fix it. And the way he handled criticism of his fake school is just like the way he’s handling criticism of his administration.

The judge was out to get him, he said. So was that prosecutor in New York, whom he called a dopey loser on a witch hunt. So were his critics, who he said were all liars. Even some of his own underlings had failed him — bad people, it turned out. He said he didn’t know them.

Sound familiar? At WaPo, Paul Waldman describes how the wheels are coming off Trump’s spin machine.

Campaigns and White Houses always seek “message discipline,” the state of having everyone repeat the same carefully chosen phrases and arguments over and over in an endlessly numbing drone in order to pound their ideas through the skulls of the electorate. It’s something the Trump campaign and the Trump administration have never achieved, for a few reasons.

First, as a group, the people who work for President Trump are not particularly smart or skilled at politics. Second, because they work for Trump, they are often called upon to defend the indefensible, whether it’s disastrous negligence, shocking corruption or farcical lies. And third, Trump is so erratic and self-contradictory that it can be almost impossible for them to keep track of which brand of lickspittlery they’re supposed to perform at any given moment.

So watching the Trump spin machine whining, clunking and throwing off sparks isn’t a bad way to ascertain just how deeply this president is failing, in both practical and political terms.

The article goes on to describe how some of Trump’s minions are better at defending the indefensible than others. Dr. Deborah Birx is now on Trump’s shit list for admitting “What we are seeing today is different from March and April. It is extraordinarily widespread. It’s into the rural as equal urban areas.” Which is a plain fact. But Trump complained in a tweet that Birx “hit us.” But others — Steve Mnuchin, Mark Meadows, Jason Miller — are steadfastly repeating the lie that everything is fine and just open the schools, already.

In other words, what we’re seeing now is a kind of concentrated version of what has characterized the Trump administration all along: a chaotic stew of fantasy and lies in which brief eruptions of candor from administration officials are quickly punished, but not before they highlight how ludicrous the prevailing line of spin is. And behind the spin is a reality of horror.

Because he doesn’t actually understand pandemics or science or much of anything else, he fakes and blusters and spins. And he also grasps at straws; quick fixes that might make the problem go away.

And this takes us to vaccines. Scientists are throwing up warning flags that the administration is pushing for a vaccination to be ready by October. As in two months from now. This is to save Trump’s ass in the November election, obviously.

“There are a lot of people on the inside of this process who are very nervous about whether the administration is going to reach their hand into the Warp Speed bucket, pull out one or two or three vaccines, and say, ‘We’ve tested it on a few thousand people, it looks safe, and now we are going to roll it out,’” said Dr. Paul A. Offit of the University of Pennsylvania, who is a member of the Food and Drug Administration’s vaccine advisory committee.

“They are really worried about that,” he added. “And they should be.”

Of course, even if a vaccine is months away from being available, expect the Trump enablers to lie about one being just around the corner.

The happy talk doesn’t seem to be working on most voters.

Americans take an increasingly negative view of how their country’s handling of the coronavirus pandemic compares with the rest of the world, a new HuffPost/YouGov survey finds.

A 46% plurality of the public now says the U.S. is handling the outbreak worse than other countries, with 24% saying it’s handling the outbreak as well as other countries and just 19% saying it’s doing better than most.

The results reflect a continuing decline in confidence over the course of this year. A March poll found that just 28% of Americans thought the U.S. was handling the outbreak worse than other countries, while a May survey put that figure at 36%.

These results split along partisan lines.

A 71% majority of Democrats say the U.S. is doing especially poorly in its fight against the pandemic, up from 49% who said the same in March. Among Republicans, 19% share that judgment, up from just 2% in March.

Some 38% of Republicans and just 8% of Democrats currently think the U.S. is faring better than most other countries. In March, 12% of Democrats and 62% of Republicans thought the U.S. stood out positively.

The overall results suggests that independents are agreeing with the Democrats.

If you read nothing else today, please see How the Pandemic Defeated America by Ed Yong at The Atlantic. It’s not behind a firewall. It’s the best analysis of the pandemic response failures I’ve seen yet. See also Trump campaign nears point of no return and Trump gets an education in the art of reversal.

 

Trump Is the Dreamer Now

This is just weird:

It was a bold claim when President Trump said that he was about to produce an overhaul of the nation’s health-care system, at last doing away with the Affordable Care Act, which he has long promised to abolish.

“We’re signing a health-care plan within two weeks, a full and complete health-care plan,” Trump pledged in a July 19 interview with “Fox News Sunday” anchor Chris Wallace.

Now, with the two weeks expiring Sunday, there is no evidence that the administration has designed a replacement for the 2010 health-care law. Instead, there is a sense of familiarity.

Trump promised great health care policy in 2016. The Republicans have been promising something on and off since the Clinton health care proposal crashed and burned in 1993. What their best minds put together turned into the blueprint for the Affordable Care Act, but since a Democratic president took ownership of that idea, the GOP disowned it. Since then Republican legislators have occasionally hauled stacks of paper in front of cameras that they claimed was their new health care policy proposal, but it never goes anywhere. See, for example, old posts from 2009 and 2014. The 2014 post asks whether such a beast as a Republican health care plan can exist, since there is no way to address our health care issues without the kind of tax-supported “big government” programs that are the root of all evil, they think.

This is from a 2013 Jonathan Chait article that’s worth reviewing.

Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly. It’s not so much an issue of “hypocrisy,” as Klein frames it, as a deeper metaphysical question of whether conservative health-care policies actually exist.

The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the “Heritage Uncertainty Principle.”

When pressed, Republicans trot out the same old tweaks to the system — high-risk pools, “tort reform,” allowing insurers to price gouge older and sicker folks — that no one who knows anything about how health care works thinks wouldn’t just make things worse.

It’s safe to say that there is no Trump health care plan and there cannot be a Trump health care plan. No one in Congress is working on a Trump health care plan. It’s possible Trump has Mr. Ivanka working on a health care plan, which means that one of these days we may be treated to the sight of another stack of paper filled with nonsense that won’t address the problems and will never be enacted.

Instead, it appears Trump has his staff — including Mr. Ivanka — working on a whiz bang executive order he can sign so he can pretend he’s done something.

Sen. Lindsey O. Graham (R-S.C.), who regularly meets and golfs with the president, said the health-care plan that Trump has referred to would come in the form of an executive order that Graham called “fairly comprehensive.” However broad, an executive order would fall short of a full legislative overhaul.

Graham said what Trump has in mind now would ensure that consumers do not risk losing their health plans if they get sick, but he did not give details.

“He’s pretty excited about it,” Graham said of the president. The ACA’s consumer protections for people with preexisting medical conditions is one its most popular facets with the public, and it is the one part of the law Trump consistently says he would preserve if he could get rid of the rest. How he could do that while containing costs after he and congressional Republicans remove the law’s requirement that everyone has to purchase health insurance remains the question.

The insurance companies aren’t going to agree to insure the preexisting condition folks unless they get something substantial in return. The mandate was the deal Obama offered. Short of substantial tax subsidies to underwrite the policies, which is way not Republican, I don’t see a deal getting made. More likely, Trump will demand that insurers offer policies to everybody, but at premiums nobody can afford.

Trump’s latest promise comes amid the outbreak of the novel coronavirus, which has infected millions, caused more than 150,000 deaths and cost Americans their work and the health benefits that often come with jobs. His vow comes three months before the presidential election and at a time when Trump’s Republican allies in Congress may least want to revisit an issue that was a political loser for the party in the 2018 midterm elections.

Yet Trump has returned to the theme in recent days.

“We’re going to be doing a health-care plan. We’re going to be doing a very inclusive health-care plan. I’ll be signing it sometime very soon,” Trump said during an exchange with reporters at an event in Belleair, Fla., on Friday. When a reporter noted that he told Fox’s Wallace that he would sign it in two weeks, Trump added: “Might be Sunday. But it’s going to be very soon.”

Steve Benen provides another detail:

Two weeks ago today, Donald Trump sat down with Fox News’ Chris Wallace in the White House Rose Garden, and the host asked about the president’s ongoing efforts to destroy the Affordable Care Act, which would strip benefits from tens of millions of families. The president replied that he still intends to “replace” the ACA.

The host reminded Trump, “But you’ve been in office three and a half years, you don’t have a plan.” It was at this point that the president responded with an unexpected vow:

“Well, we haven’t had. Excuse me. You heard me yesterday. We’re signing a health care plan within two weeks, a full and complete health care plan that the Supreme Court decision on DACA gave me the right to do…. [T]he decision by the Supreme Court on DACA allows me to do things on immigration, on health care, on other things that we’ve never done before. And you’re going to find it to be a very exciting two weeks.”

The Supreme Court decision on DACA? I missed that one. Apparently Trump believes this decision gives him the right to step in and enact policy by executive order if Congress hasn’t done it. Remember John Yoo? Trump has been listening to John Yoo.

Trump signed a bunch of executive orders on prescription drugs a few days ago that, among other things, called for price controls.

Commenting on how he had the authority to control those prices unilaterally, without Congress passing a law or an agency completing a formal rulemaking process, Trump said, “I was given that right because of the DACA decision. The DACA decision allowed me to do things that some people thought the president didn’t have the right to do. I was given that right. Drug prices will be coming down very, very substantially. No other president has been allowed to do that. No other president has been able to do that.”

Yeah, no. Trump has tried to snatch victory out of the jaws of the court’s DACA ruling, but he’s dreaming. Granted, it’s a dream shared by some influential conservative thinkers, but there’s no basis for it in the ruling.

The court found that DACA was more than just an administrative decision not to enforce immigration law against a group of people brought into this country as children by their parents. It also offered these “Dreamers” benefits, such as the ability to obtain work permits. Ending DACA, therefore, required reversing a substantive policy that had been in place and relied upon by hundreds of thousands of Americans for years. That sort of policy change is governed by the Administrative Procedures Act, which bars actions that are arbitrary, capricious and procedurally deficient. Because the Trump administration did not follow the APA in rescinding DACA, as in so many of its actions, its decision was invalid.

Trump turns the court’s reasoning on its head. Because the court focused on the legality of Trump’s reversal of DACA instead of President Obama’s adoption of the program, he seems to believe he can issue whatever orders he wants, and any future president attempting to undo what he’s done will have to jump through months or years of procedural hoops under the APA.

That’s hogwash. As Harry Litman ably explained in The Times, executive orders that launch substantive new programs have to comply with the APA, and anyone damaged by a Trump order can sue to stop it under that law.

Like I said, this is just weird. But price controls are something like original sin to the free market people. That we haven’t heard screaming from here to eternity tells us something. I’m not sure what.

The Trump Amateur Hour

In the New York Times, Jim Tankersley asks, Does Trump Want to Save His Economy?

The United States just suffered its worst economic quarter in nearly 75 years. Its recovery from the depths of a pandemic-induced recession has stalled, as coronavirus deaths rise again across the country. President Trump has what appears to be one final chance to cut a deal with Congress to ensure hard-hit workers and businesses do not collapse before the November election.

He has shown little interest in taking it.

Rather than push for a comprehensive plan that could win support from both Democrats and Republicans, Mr. Trump has instead embraced big-ticket items that Senate Republicans did not want and that would do little to help millions of struggling workers and businesses.

That included a payroll tax cut and an expanded tax break for business lunches, along with $1.75 billion to rebuild the F.B.I.’s headquarters in Washington. He has derided efforts to find middle ground with Democratic leaders on a broad economic rescue package, declaring on Wednesday that “we really don’t care” about several possible parts of it.

And so on. To answer the question, I suspect Trump wants passionately to fix “his” economy. But it was never “his” economy; he has just been coasting on Barack Obama’s economy. Nothing Trump has done, including the massive tax cuts, have been particularly advantageous to the economy or changed any trajectories for the better. And now that the pandemic has tanked the economy, Trump has no idea what to do to fix the economy. He really doesn’t. He has no idea how any of this stuff works. It’s pointless to pretend otherwise.

Nothing will “work” as long as the pandemic is out of control. There’s a fascinating piece at Vanity Fair that I recommend. It’s not behind a firewall. In How Jared Kushner’s Secret Testing Plan “Went Poof Into Thin Air,” Katherine Eban writes that Kushner and some of his privileged trust fund buddies spent March and April putting together a national testing strategy.

Inside the White House, over much of March and early April, Kushner’s handpicked group of young business associates, which included a former college roommate, teamed up with several top experts from the diagnostic-testing industry. Together, they hammered out the outline of a national testing strategy. The group—working night and day, using the encrypted platform WhatsApp—emerged with a detailed plan obtained by Vanity Fair.

Rather than have states fight each other for scarce diagnostic tests and limited lab capacity, the plan would have set up a system of national oversight and coordination to surge supplies, allocate test kits, lift regulatory and contractual roadblocks, and establish a widespread virus surveillance system by the fall, to help pinpoint subsequent outbreaks.

This was all being done without coordination with the government officials tasked with taking care of testing, and it’s likely Kushner’s merry band of entrepreneurs got in the way more than they helped. Even so, they did come up with a plan. But the plan was never announced. In the words of one participant, it went “poof into thin air.”

By early April, some who worked on the plan were given the strong impression that it would soon be shared with President Trump and announced by the White House. The plan, though imperfect, was a starting point. Simply working together as a nation on it “would have put us in a fundamentally different place,” said the participant.

But the effort ran headlong into shifting sentiment at the White House. Trusting his vaunted political instincts, President Trump had been downplaying concerns about the virus and spreading misinformation about it—efforts that were soon amplified by Republican elected officials and right-wing media figures. Worried about the stock market and his reelection prospects, Trump also feared that more testing would only lead to higher case counts and more bad publicity. Meanwhile, Dr. Deborah Birx, the White House’s coronavirus response coordinator, was reportedly sharing models with senior staff that optimistically—and erroneously, it would turn out—predicted the virus would soon fade away.

Against that background, the prospect of launching a large-scale national plan was losing favor, said one public health expert in frequent contact with the White House’s official coronavirus task force.

Most troubling of all, perhaps, was a sentiment the expert said a member of Kushner’s team expressed: that because the virus had hit blue states hardest, a national plan was unnecessary and would not make sense politically. “The political folks believed that because it was going to be relegated to Democratic states, that they could blame those governors, and that would be an effective political strategy,” said the expert. [emphasis added]

So, instead, Trump dumped the responsibility for testing onto the states. You know the rest of the story.  Seriously, none of these geniuses apparently grasped that viruses spread. Dr. Anthony Fauci testified to Congress this morning:

The Trump administration’s decision to leave coronavirus shutdown decisions to the states created a patchwork of policies that effectively only imposed restrictions on about half of the country, NIH infectious diseases expert Anthony Fauci told a House hearing on Friday.

There’s also a long bit in the Vanity Fair article about a March requisition from the White House for 3.5 million tests from the United Arab Emirates, which was invoiced at $52 million. The order didn’t go through the usual government purchasing channels, so the invoice cannot be paid. Plus the tests were all contaminated, possibly because they were shipped without being refrigerated. Amateur hour all around.

We don’t know that Jared Kushner had anything to do with ordering the tests from the UAE, but this kind of cowboy “the hell with procedure” stuff is his standard modus operandi. I do wonder if these were the “millions of tests” that Mike Pence kept promising last March that never arrived anywhere.

Yesterday the White House announced a new initiative to address the pandemic. It’s called the “embers strategy.” Axios:

The Trump administration is sending increased personal protective equipment, coronavirus test kits and top health officials like Drs. Anthony Fauci and Deborah Birx to coronavirus hotspots across the U.S. as part of a campaign called the “Embers Strategy,” White House officials tell Axios. …

… Public health surrogates will appear on local and regional television and radio to educate the public on mitigation tactics, including wearing masks, practicing social distancing, frequent hand washing and staying home when ill.

*They will focus on areas reporting positive rates between 5% and 10% to prevent them from slipping into a “hot zone” category of above 10% positive rates.

*The Trump administration is expecting to land around 200 media segments over the next two weeks, as Axios reported on Sunday.

Seriously? That’s the plan? This is supposed to reassure people that Trump is “refocused” on the pandemic, the article says. Seriously?

Going back to the Vanity Fair article, although the U.S. is testing more that it was, that’s still not enough, especially when results take too long.

Though President Trump likes to trumpet America’s sheer number of tests, that metric does not account for the speed of results or the response to them, said Dr. June-Ho Kim, a public health researcher at Ariadne Labs, a collaboration between Harvard’s T.H. Chan School of Public Health and Brigham and Women’s Hospital, who leads a team studying outlier countries with successful COVID-19 responses. “If you’re pedaling really hard and not going anywhere, it’s all for naught.”

At WaPo, Greg Sargent discusses the “embers” analogy.

The imagery of embers may seem unthreatening and even comforting. Indeed, that’s almost certainly the point — to create the impression that what remains of the coronavirus is a gentle glow here and there that you associate with your childhood camping trips.

Indeed, it would be surprising if this language hadn’t been poll-tested up the wazoo. The White House has tentatively been experimenting with this embers language for some time: Trump tweeted in June that our economy was vaulting back, and that any coronavirus “embers” would be “put out as necessary.”

And even earlier than that, Vice President Pence approvingly told governors that Trump has been describing what remained of the virus as “embers,” which was supposed to be persuasive and reassuring to them.

Since then, of course, the coronavirus has once again surged in many states across the country, especially in places such as Arizona, Florida and North Carolina, which will be crucial to Trump’s reelection hopes. At the same time, Trump continues to urge a rapid reopening.

In other words, the analogy is more about reassuring people that the pandemic is being taken care of rather than providing an accurate picture of the mess we’re in, or coming up with a plan for how to get out of it. Because they don’t know how to get out of it.

And while Trump wants to delay the election because of the pandemic, sending the kids back to school will work out just fine, they tell us. We are so screwed.

Going back to the economy — the economy is screwed for reasons that are bigger than Trump, of course. A big chunk of the Republican Party in Congress won’t do anything to save the economy because all of the fixes go against their beloved ideology.

Paul Krugman:

Trump, his officials and their allies in the Senate have been totally committed to the idea that the U.S. economy will experience a stunningly rapid recovery despite the wave of new infections and deaths. They bought into that view so completely that they seem incapable of taking on board the overwhelming evidence that it isn’t happening.

Just a few days ago Larry Kudlow, Trump’s top economist, insisted that a so-called V-shaped recovery was still on track and that “unemployment claims and continuing claims are falling rapidly.” In fact, both are rising.

But because the Trump team insisted that a roaring recovery was coming, and refused to notice that it wasn’t happening, we’ve now stumbled into a completely gratuitous economic crisis.

Kudlow, Trump’s chief economic advisor, is an amateur. He somehow became known as an economist even though he has no graduate degree in economics and is always wrong. “He’s a die-hard supply-sider for whom corporate tax cuts are the highest goal,” it says here.  See also “A Used-Car Salesman, Both in Demeanor and Honesty”: Wall Street Isn’t Sold on Larry Kudlow’s Economic Delusions by William Cohan.

See also the New York Times editorial board, Mitch McConnell Could Rescue Millions. What Is He Waiting For? Bascially, they’re waiting for reality to reflect their ideology. As long as it doesn’t, they cannot act. They don’t know what to do.

Today, A Moment in Time

I’ve been watching John Lewis’s memorial service. It was very moving. There were also many calls to not let up the struggle. President Obama spoke of “those in power” who are trying to undermine voting rights. And he called for ending the filibuster, which will pretty much ensure that will happen if Dems retake the Senate.

The New York Times published an op ed by John Lewis that he had given them before he died, asking that it be published on the day of his funeral. Among other things, he said,

Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble. Voting and participating in the democratic process are key. The vote is the most powerful nonviolent change agent you have in a democratic society. You must use it because it is not guaranteed. You can lose it.

You must also study and learn the lessons of history because humanity has been involved in this soul-wrenching, existential struggle for a very long time. People on every continent have stood in your shoes, though decades and centuries before you. The truth does not change, and that is why the answers worked out long ago can help you find solutions to the challenges of our time. Continue to build union between movements stretching across the globe because we must put away our willingness to profit from the exploitation of others.

Though I may not be here with you, I urge you to answer the highest calling of your heart and stand up for what you truly believe. In my life I have done all I can to demonstrate that the way of peace, the way of love and nonviolence is the more excellent way. Now it is your turn to let freedom ring.

When historians pick up their pens to write the story of the 21st century, let them say that it was your generation who laid down the heavy burdens of hate at last and that peace finally triumphed over violence, aggression and war. So I say to you, walk with the wind, brothers and sisters, and let the spirit of peace and the power of everlasting love be your guide.

Three presidents were at the service, plus a statement from Jimmy Carter was read. The other living POTUS was neither there nor welcome. The absence was a huge subtext of the day. Trump is so far outside American norms and tradition that he would not be there, could not be there, would have been utterly out of place there.

Meanwhile, the Great Orange Pestilence must be terrifed by his internal polls.

This nation has never delayed a presidential election. Note that we didn’t delay the presidential election during the bleeping Civil War. On election day 1864, General Sherman’s troops were occupying Atlanta, and Sherman was considering marching to Savannah. General Grant was headquartered at City Point, Virginia, while his troops beseiged Petersburg and hacked away at Lee’s supply lines. There were other generals and other troops deployed in several hot spots in several states. Lincoln sincerely believed he could lose, because people were exhausted with the war. But there was no talk of delaying the election.

I understand that, so far, no Republican has seconded the suggestion. Of course Trump does not have the power to delay the election. Congress might, but I don’t see that happening.

And Hermain Cain, who attended Trump’s June 19 Tulsa rally without a mask, is dead of covid-19.

Oh, and the economy suffered its biggest one-quarter drop in 70 years and possibly ever.

The U.S. economy shrank 9.5 percent from April through June, the largest quarterly decline since the government began publishing data 70 years ago, and the latest, sobering reflection of the pandemic’s economic devastation.

The second quarter report on gross domestic product covers some of the economy’s worst weeks in living memory, when commercial activity ground to a halt, millions of Americans lost their jobs and the nation went into lockdown. Yet economists say the data should also serve as a cautionary tale for what is at stake if the recovery slips away, especially as rising coronavirus cases in some states have forced businesses to close once again.

And the Senate can’t get its act together on a relief package.

I keep thinking of the old abolitionist hymn, “Once to Every Man and Nation.” I do feel that we’re poised between a great darkness and a great light right now.

Once to every man and nation,
comes the moment to decide,
in the strife of truth with falsehood,
for the good or evil side;
some great cause, some great decision,
offering each the bloom or blight,
and the choice goes by forever,
‘twixt that darkness and that light.

(The fifth line is usually read as “Some great cause, God’s new messiah,” but some people don’t like that line. The lyrics are taken from a much longer poem by James Russell Lowell called “The Present Crisis.” It’s sung to a Welsh tune, of course.)

 

What Fresh Excrement Is This?

The Creature tweeted today:

AFFH is the 2015 Affirmatively Further Fair Housing rule, which President Obama implemented to fight housing discrimination.

The rule required local governments receiving federal housing funds to create plans that would combat housing discrimination, which advocates said helped strengthen the 1968 Fair Housing Act, it says here.  The rule “required local governments to prove that federal subsidies for housing projects would not go to developments with zoning laws or other regulations that are effectively discriminatory to minorities, particularly Black and Hispanic Americans,” it says here.

So AFFH not really about building low-income housing in suburbs, but whatever. The Creature probably thinks this will help him win back the suburban vote he has seriously been losing. Keep the lily whiteness in those lily white suburbs! And it would have worked for him in the 1970s. Whether it will move any needles now seems farfetched to me.

Trump is replacng AFFH with what he calls “opportunity zones,” which provides discounts on capital gains taxes for investors sending money into one of over 8,000 designated areas, it says here.

According to the New York Times, Trump’s opportunity zones were enacted as part of his signature tax cuts in 2017. The Times reported in November 2019 that while some money went to more depressed areas in Pennsylvania and Alabama, the lion’s share has appeared in rapidly-gentrifying cities like Atlanta, Houston and Miami.

And let us not forget …

In 1973, the Justice Department filed a civil rights case against Trump’s company, accusing him of violating the Fair Housing Act by not renting to Black tenants. The case was settled in 1975, with Trump signing an agreement that his company would not discriminate against future tenants or homebuyers, as well as place ads informing minorities of their rights to obtain housing at his properties. At the time, Trump said the settlement did not mean he admitted to any wrongdoing, while the DOJ celebrated it as “one of the most far-reaching” agreements it had negotiated.

Big Daddy Fred Trump made most of his fortune by building shoddy housing with federal subsidies and cheating on his taxes.

Anyway, it appears that a program intended primarily to discourage housing discrimination has been gutted and replaced with one that funnels money to places that don’t need it. Grand.

Here’s another outrage — A small federal agency focused on preventing industrial disasters is on life support. Trump wants it gone. The Chemical Safety and Hazard Investigation Board is without enough voting members, and its investigations are stuck in limbo.

That agency, the Chemical Safety and Hazard Investigation Board, investigates accidents and makes recommendations — but it doesn’t regulate the industry. Since 1998, it has looked into some of the nation’s biggest industrial disasters, including the 2010 Deepwater Horizon blowout, which killed 11 workers and dumped an estimated 4 million barrels of oil into the Gulf of Mexico; and the 2005 explosion at the BP refinery in Texas City, Texas, that killed 15 workers and injured 180. The board’s work has led to changes in industry practices from Texas to Kansas and laws in states from Mississippi to Connecticut.

It’s likely, however, that when the investigation into the AB Specialty Silicones explosion wraps up, the board will not be able to meet the quorum needed to vet and approve investigators’ findings and recommendations. Since May 2, it has been operating with only one voting member out of a possible five — one vote short of a quorum. It’s been effectively disabled.

The White House hasn’t announced plans to fill the board’s four vacant seats. In fact, President Donald Trump has been trying to do the opposite, pushing to eliminate the board in each of his annual budget proposals — though he hasn’t persuaded Congress to defund it.

Trump has been rolling back workplace safety rules for the past three years. As the daughter and granddaughter of mine workers, this is chilling to me. I’m sure he’s got it in his head that killing regulations is good for business, but in the long run it really isn’t. And he’s getting people killed. See Workplace Fatalities Rising Under Trump OSHA as Enforcement Declines.

Trump hates regulations so much that he’s been cutting regulations that industries don’t want cut. This is from a year ago:

In the latest instance, the Environmental Protection Agency unveiled a proposal Thursday to eliminate mandates paring methane leaks from oil wells — despite major oil companies insisting they don’t want the relief.

Similarly, automakers and the nation’s top business lobbying group are begging the White House to alter course in its plans to weaken fuel efficiency standards and pick a fight with California. And power-plant operators say an administration effort to undermine requirements for mercury pollution controls may keep them from recouping the cost of that equipment.

The willingness to defy traditional business interests extends beyond environmental regulation. Most notably, Trump has escalated a trade conflict with China, even as manufacturers and retailers complain it will increase costs and retard growth in the U.S. And some of Trump’s efforts to change immigration policy have been condemned by chief executives from Apple Inc., AT&T Inc., Coca-Cola Co., and dozens of other businesses who say they could disrupt their operations.

Trump’s zeal to deregulate — even when the regulated industries advise against it — runs counter to the pro-business ethos of previous Republican presidents, whose policies may have been more aligned with commercial priorities. Yet the approach underscores Trump’s populist streak and is another reminder this “is not a typical Republican administration,” said GOP energy strategist Mike McKenna.

“What many fail to grasp — and what may be the most important characteristic of this administration — is that it is largely indifferent to arguments driven solely by commercial interests,” McKenna said. “They believe that consumers, workers, citizens are the most important reference points in decisions.”

None of this is helping consumers and workers, either.

Also, too: Trump’s crackdown sputters as ‘phased withdrawal’ from Portland begins.

Bill Barr versus the Constitution

One of Bill Barr’s biggest critics is Donald Ayer, who was U.S. Deputy Attorney General under George H. W. Bush. In June 2019, Ayer published an article in The Atlantic that explained how Barr sees his role as attorney general and his relationship with Donald Trump. Here is the meat of it:

For many decades, Barr has had a vision of the president as possessing nearly unchecked powers. That vision is reflected in many OLC opinions, and in arguments advanced and positions taken since the 1970s. But the most compelling source for present purposes is Barr’s memorandum submitted just a year ago. Notable near its beginning is his statement that he was “in the dark about many facts,” followed immediately and repeatedly by vehement assertions that “Mueller’s obstruction theory is fatally misconceived,” and if accepted “would have grave consequences far beyond the immediate confines of this case and … do lasting damage to the Presidency.”

As this introduction suggested, Barr’s memo rested not on facts, but on a much more sweeping claim that as a matter of law, the obstruction-of-justice statute, 18 U.S.C. Section 1512, cannot possibly apply to any conduct by the president that is arguably at issue. In a five-page section, Barr’s memo advanced arguments based on interpreting the words of the statute. Then in a much longer second section, he got to the meat of the matter. He claimed that, regardless of whether the statute is correctly understood to have been intended to apply to actions by the president to interfere with an investigation of himself—as the Mueller report concluded it was—it would be an unconstitutional infringement on the president’s Article II powers to apply that law to the president.

The vehemence of Barr’s memo is breathtaking and the italics are all his: “Constitutionally, it is wrong to conceive of the President as simply the highest officer within the Executive branch hierarchy. He alone is the Executive branch. As such he is the sole repository of all Executive powers conferred by the Constitution.”

Thus, “the Constitution vests all Federal law enforcement power, and hence prosecutorial discretion, in the President.” That authority is “necessarily all-encompassing,” and there can be “no limit on the President’s authority to act [even] on matters which concern him or his own conduct.” Because it would infringe upon the total and utterly unchecked discretion that Barr believes Article II confers on the president, “Congress could not make it a crime for the President to exercise supervisory authority over cases in which his own conduct might be at issue.” Indeed, according to Barr, “because the President alone constitutes the Executive branch, the President cannot ‘recuse’ himself.” Thus, in Barr’s view, the only check on gross misconduct by the president is impeachment, and the very idea of an independent or special counsel investigating the president is a constitutional anathema.

What’s fascinating is that Barr has been, in effect, conducting a master class on why this view is absolutely wrong and dangerous to our nation. And he’s too lost in his own head, in his own ideology, to see that. If applied to a president with intelligence and integrity, maybe it would have worked to the nation’s benefit. But Donald Trump? Seriously?

As I keyboard, Barr is testifying to the House Judiciary Committee. I take it it’s not going all that well for Barr; you can read live updates here and here. However, one of my Facebook friends watching it says the Dems on the committee are doing way too much grandstanding and not letting Barr answer questions, which is self-defeating.

And Donald Ayer has another article at The Atlantic. Here is the first paragraph:

Throughout his first year in office, Bill Barr worked overtime to advance the personal and political interests of President Donald Trump, and to alter the structure of American government to confer virtually autocratic powers on the president, in accordance with views that Barr has held for several decades. Now, less than 100 days before the election, the attorney general’s focus has narrowed and his methods have become more transparently outrageous: Facing gross mismanagement of the coronavirus pandemic, a diminished economy, and sinking presidential poll numbers, Barr is using the most intrusive and offensive tools he can command simply to extend his and the president’s tenure in office into a second term.

Indeed, there are those who think that Barr is the real power behind the throne.

Nichols, part of the Lincoln Project, said in another tweet that Barr is now the de facto head of the Executive Branch.

Today, Greg Sargent writes that William Barr’s new defense of Trump actually unmasks his corruption. You need to read the whole thing to get the argument. See also Heather Cox Richardson, from last night:

Tonight, [Barr] released a combative opening statement which begins by slamming “the grave abuses involved in the bogus ‘Russiagate’ scandal,” despite the fact that, in December 2019, the Justice Department’s own inspector general, Michael Horowitz, found that the investigation had been initiated properly and without political bias. The Republican-led Senate Intelligence Committee has also unanimously supported the conclusion of the Intelligence Community that Russia attacked the 2016 election to benefit candidate Trump. …

…There was, in Barr’s opening statement, a line that jumped out. He wrote that what is happening in Portland, Oregon, where protesters have vandalized a federal courthouse, “is, by any objective measure, an assault on the Government of the United States.”

No, it is not.

The interference of a foreign country in our elections is an assault on the government of the United States. Undermining the rule of law is an assault on the government of the United States. Vandalizing a courthouse does not threaten our nation. It is vandalism that should result in arrests by local police officers, as it has.

That the Attorney General is characterizing local vandalism as an assault on our national government is worrisome. It suggests that, less than four months before an election, he intends to keep sending into Democratic cities federal officers who are loyal to him and his president.

And if it happens, that will be an assault on the government of the United States, for sure.

Barr has a lot to answer for, and he can’t be removed from his position as long as Republicans dominate the Senate. But there’s always next year. Barr has to be held accountable for what he’s done.

Stuff to Read

Michelle Goldberg, Twilight of the Liberal Right

Liberal democracy per se was never the animating passion of the trans-Atlantic right — anti-Communism was. When the threat of Communist expansion disappeared, so did most of the right’s commitment to a set of values that, it’s now evident, were purely instrumental.

Paul Krugman, The Cult of Selfishness Is Killing America

You see, the modern U.S. right is committed to the proposition that greed is good, that we’re all better off when individuals engage in the untrammeled pursuit of self-interest. In their vision, unrestricted profit maximization by businesses and unregulated consumer choice is the recipe for a good society.

Support for this proposition is, if anything, more emotional than intellectual. I’ve long been struck by the intensity of right-wing anger against relatively trivial regulations, like bans on phosphates in detergent and efficiency standards for light bulbs. It’s the principle of the thing: Many on the right are enraged at any suggestion that their actions should take other people’s welfare into account.

This rage is sometimes portrayed as love of freedom. But people who insist on the right to pollute are notably unbothered by, say, federal agents tear-gassing peaceful protesters. What they call “freedom” is actually absence of responsibility.

Rational policy in a pandemic, however, is all about taking responsibility. The main reason you shouldn’t go to a bar and should wear a mask isn’t self-protection, although that’s part of it; the point is that congregating in noisy, crowded spaces or exhaling droplets into shared air puts others at risk. And that’s the kind of thing America’s right just hates, hates to hear.

Jordaon Weissmann, The Republicans Have Written a Pro-Virus Bill

Update: Here’s a bit of the testimony today.

I must add that Rep. Jayapal is talking about state government. Barr’s justification for sending goons to Portland is that they were to protect federal buildings, although by all accounts that hasn’t stopped them from detaining people not on federal property.