Come for the politics, stay for the snark.

It’s the corruption, stupid.

Let’s bury these fuckers at the polls 2 years from now.

Putting aside our relentless self-interest because the moral imperative is crystal clear.

It is not hopeless, and we are not helpless.

Is it negotiation when the other party actually wants to shoot the hostage?

They traffic in fear. it is their only currency. if we are fearful, they are winning.

“In the future, this lab will be a museum. do not touch it.”

Pessimism assures that nothing of any importance will change.

Dear elected officials: Trump is temporary, dishonor is forever.

New McCarthy, same old McCarthyism.

The Giant Orange Man Baby is having a bad day.

The party of Reagan has become the party of Putin.

They want us to be overwhelmed and exhausted. Focus. Resist. Oppose.

With all due respect and assumptions of good faith, please fuck off into the sun.

The poor and middle-class pay taxes, the rich pay accountants, the wealthy pay politicians.

Nothing says ‘pro-life’ like letting children go hungry.

Republicans seem to think life begins at the candlelight dinner the night before.

The rest of the comments were smacking Boebert like she was a piñata.

Humiliatingly small and eclipsed by the derision of millions.

Human rights are not a matter of opinion!

Text STOP to opt out of updates on war plans.

“Alexa, change the president.”

Hey Washington Post, “Democracy Dies in Darkness” was supposed to be a warning, not a mission statement.

Reality always lies in wait for … Democrats.

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S/he’s Just an Asshole

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Unbelievably stupid:

The first Dallas health care worker with Ebola, Nina Pham, is in “improved condition today,” and the second Dallas health care worker with Ebola is “ill but clinically stable,” CDC Director Dr. Tom Frieden said Wednesday. Frieden said it’s still to be determined whether Pham will be transferred to another facility; Frieden earlier said the second patient will be transferred to Emory University Hospital.

Because she had helped care for Dallas Ebola patient Thomas Eric Duncan, this health care worker should not have traveled on a commercial airplane, CDC Director Tom Frieden said.

At that point, health care workers were undergoing self-monitoring. They were allowed to travel but not on a commercial plane with other people, he said.

Moving forward, the CDC will ensure that no one else in such a situation travels outside of a closed environment, he said.

If our health care professionals are this god damned stupid, there is no chance we are going to contain Ebola.

In a day and age where conscientious adults keep their kids home from school and people don’t go to work when they have a cold because they know better than to expose everyone at the school and workplace, this is just astonishing. Does this jackass really need to be told that after handling an Ebola patient, they shouldn’t be traveling on a public airline. In my mind, this nurse is just as guilty as someone who knows they have HIV running around having unprotected sex? This is a toxic cocktail of malicious ignorance, entitlement, and casual disregard for your fellow man. I don’t think we need to be restricting flights, but it should be common sense that people EXPOSED to Ebola should not be jaunting about in public.

I eagerly await the inevitable news that the person was traveling to and from a college reunion or a large family event or a football game, exposing untold thousands. Because you just KNOW they weren’t there for something important. And of course this asshole lives in Texas. Of course. FSM help us all if anyone in Florida gets Ebola, because then we are all surely screwed.

And I would wish this nurse well, but it doesn’t really matter. Should s/he recover, they will no doubt stick a fork in a socket or do something really stupid like mop naked.

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Wednesday Afternoon Open Thread

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I loved the book “Olive Kitteridge,” Elizabeth Strout’s novel that made a cantankerous math teacher the intersection point of a collection of stories about small town oddballs. So I’m delighted to hear Frances McDormand has taken on the title role in the upcoming HBO series.

fmcKITTREDGE

The New York Times has a piece on McDormand and the project here.

I think “Olive Kitteridge” was the last book my late mother read at my recommendation. She and I read a lot and often swapped recommendations, but our taste in books didn’t match all that well — she was more of a mystery fan than I and gravitated toward that genre.

Mom liked “Olive Kitteridge” the book but didn’t like Olive the character, which surprised me because they actually had a lot in common. Olive was ten times crankier than my mom, but neither put up with any bullshit.

Anyway, open thread.

[Photo credit: Alison Cohen Rosa for The New York Times]

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Pricing and formularies

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The Wall Street Journal has an interesting blog post on the pricing strategy for the next round of Hep-C drugs:

 

 Sanford Bernstein analyst Geoff Porges wrote that Gilead left AbbVie “less room to start a price war” than some may have expected. How so? Gilead priced the eight-week regimen at $63,000, which means average pricing for Harvoni would be about $80,000, assuming that as many as 45% of the patients with most common form of the virus use the drug for eight weeks.

This is actually less than what most insurers are now paying for Sovaldi, which costs $84,000 for a 12-week regimen, but must be taken with another drug. This pushes the cost to somewhere between $95,000 or so and $160,000…

As Longman sees it, AbbVie should contemplate a $76,000 price tag – or a 20% discount – for the simple reason that its own hepatitis C treatment, which is expected to win FDA approval shortly, is not as convenient….

Theoretically, the plan may not merely decide they prefer the AbbVie drug, but they mandate it, unless there’s some significant reason a patient can’t take it. If plans are willing to do this, the average cost [for hepatitis C treatment] may fall pretty significantly.” As a result, the cost per patient could fall to below $70,000, on average, …

The price per cure just fell again from $150,000 to $80,000, on average, with significantly less side effects.

Insurers and doctors have been “warehousing” non-critical Hep-C patients for the past couple of months as they knew another round of new drugs would soon be approved.  The FDA has approved a Gilead Solvaldi cocktail, and now it looks like another drug from AbbVie is getting ready to be approved.  There is an interesting discussion about the difference between cost per treatment which is still remarkably high and cost per cured patient which is falling dramatically.  We, as a society should be willing to pay a high cost of treatment if that treatment is very effective.  The new Hep-C drugs fall into that category while the older Hep-c regimes were much less expensive per patient but far less effective.

The number needed to treat for good outcomes have declined dramatically.  So from a social perspective, we’re probably better off at high cost per treatment than lower cost per far less effective treatment.

Now the interesting thing from the insurance company paper-pusher point of view is the formulary changes that a competitive drug to Sovaldi at a lower price point brings about.  We know that the marginal cost of production for a new Hep-C full treatment regime is in the low four digits.  Sovaldi had a limited monopoly with no near substitutes so they had free reign rein to name a price and get it.  Insurers countered by limiting payments by clinical indicators (severely compromised Hep-C patients without success on other treatments, abstaining from alcohol etc).  The existance of a near substitute means insurers can go a preferred pricing route where Drug 1 can have a better cost-share structure from the member point of view compared to Drug 2.  That would drive most providers to prescribe mostly Drug 1.  It is this ability to somewhat say no that will force pricing down.

The problems are two fold.  First, it is not accomodating to individuals whose clinical indicators suggest that Drug 2 is the better choice over the cheaper Drug 1.  Secondly, it will remove only a portion of the property rents currently being captured by Gilead, so it is an incomplete answer.  As more drugs of the same or better effectiveness and efficiency get approved, and the pool of near subsitutes increases, pricing will decrease a bit more.

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This Is a Job for Uncle Joe

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Further to the Ebola update thread below, it seems clear now that the World’s Best Healthcare SystemTM wasn’t prepared to safely treat patients after all, at least not in Texas. Valued commenter d58826 said the following:

It is with morbid ‘humor’ that I watch the events as they unfold in Texas. This is the heartland of profits before people. A state that prides itself on little regulation and what does exist is sold to the highest bidder for them to make a private profit. It is the poster child for cut government spending and every man for himself and the devil take the hindmost.

It represents the GOP plan to reduce government to the fit in a bath tub and then drown it. The agencies charged with confronting this type of outbreak have seen their budgets cut by 50% over the past decade. Almost 50k government public health workers have lost their jobs as a result of budget cuts. The GOP game plan in action.

The final ‘laugh’ comes from the GOP’s call for an Ebola czar to be named when they will not confirm Obama’s choice for Surgeon General.

d58826 goes on to note that the GOP will probably gain control of Congress despite the massive fuck-ups it authored, of which leaving health officials ill-equipped to deal with an Ebola outbreak is only the latest example. Is this because people are stupid, racist, tribal, etc.? Undoubtedly that’s part of it. But sheer ignorance is part of it as well, and this is a teachable moment.

Joe Biden would be the ideal teacher, in my opinion, and here’s the lesson plan: Go before every functioning TV camera and bring a chart illustrating CDC and public health department cuts. Talk about why regulations and public safety organizations are needed and how the GOP has undermined them in places like Texas.

Reference other incidents that illustrate what happens when industries go unregulated and regulatory and public safety organizations are underfunded, e.g., that plant that blew up a while back in Texas, the latest coal mine disasters and water contamination incidents. Point out the obvious, because it ain’t obvious to everyone.

This approach will not work on hardened partisans, obviously. Nothing will. But the fact is, elections turn on persuading unaffiliated voters, who seem to zigzag right and left in panicky fashion like a herd of antelope menaced by massive prides of lions on either side.

It’s not really about Ebola, which poses an infinitesimal risk to anyone who isn’t a healthcare worker treating an infected patient. It’s about not letting the Republicans once again get away with hamstringing government and then complaining that it’s useless. It’s about countering the Reagan era lie that the government is always the problem.

Back when he was running for president the first time, President Obama said he wanted to be a transformative president like Reagan. Some people (i.e., PUMAs) pounced on this as evidence that Obama was a closet wingnut, but a reading of the remarks in context revealed that what he meant was he wanted to change the perception of government in a similar way, and swing the pendulum back. Well, now’s your chance, sir. And in October no less.

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An Update on Ebola in America

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Good news, Nina Pham, the Dallas nurse who contracted Ebola caring for a fatally ill patient, is doing well so far (as is her little dog Bentley).

Here’s an NYTimes graphic explainer on “How hospital workers are supposed to treat Ebola safely,” demonstrating all the ways things might have gone wrong. And USAToday had a good story explaining why Ebola may pose a greater risk to ICU workers:

… Nurses and others caring for Ebola patients at the end of their lives are at high risk of infection, because the virus replicates wildly as the disease becomes more advanced, says Peter Hotez, dean of the National School of Tropical Medicine in Houston and a professor at the Baylor College of Medicine…

Unlike other dangerous viruses, such as SARS (Severe Acute Respiratory Syndrome), Ebola shuts down the body’s production of a virus-fighting substance called interferon, “the body’s first defense against viruses,” Hotez says. The substance jumps into action to fight viruses even before antibodies begin to shut them down.

Ebola begins to block interferon production within four to five days after infection. Without those chemical policemen to stop it, Ebola “has the ability to just replicate and replicate and replicate,” Hotez says. “So by the time you are in the end stages of your illness, your liver and your spleen and your kidneys are just teeming with billions of viral particles.”

Because the virus attacks the liver, it interferes with the liver’s ability to make clotting factors that help stop bleeding, Hotez sais. Patients infected with Ebola can bleed profusely, both internally and externally, and vomit blood.

So Ebola patients treated in intensive care units, such as Duncan, are far more infectious than those at earlier stages of illness. “When you are working with Ebola in an ICU, there can be no margin of error,” he says…

For that reason, Hotez says, it’s not yet possible for doctors to know how Pham was infected — whether she or a co-worker committed a “breach of protocol,” as the Centers for Disease Control and Prevention initially suggested — or whether something about the nature of providing intensive care allowed her to contract the virus…

***********
My home state had its first two serious “Ebola scares” over the holiday weekend, and handled them both with the native Masshole mixture of ‘efficient’ kludging and social suspicion, per the Boston Globe. First case, a guy who’d been to Liberia showed up at a walk-in clinic:

… The man, whom officials have not identified, was taken by ambulance to Beth Israel from Braintree’s Harvard Vanguard office, where his symptoms and travel history had prompted clinic staffers to muster a hazardous materials team, alarming patients as unofficial word of an Ebola case spread. People were prevented from entering and leaving the facility for several hours…

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And Now, I Complain

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Metrotwit, my twitter client of choice for my pc, has been discontinued. I hate change.

Although I should probably just stop tweeting, because two nights in a row I have thrown an f-bomb at the wrong people. I meant to target Jeff Greenfield the “newsman” and some poor software developer with the same name got a screen full of hate.

How is everyone else?

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Open Thread: The Unlovely McConnell

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Dave Weigel, at BloombergPolitics, on “the GOP’s Darth Vader“:

Last month, The New Republic’s Alec MacGillis published a meaty e-book biography of Kentucky Sen. Mitch McConnell, who’s on track to run the Senate after this November’s elections. Since then, McConnell’s bid for re-election has maintained a very small lead over Kentucky Secretary of State Alison Lundergan Grimes, but the press has looked for ways to find a pulse in the McConnell campaign and an open grave for the Democrats… Coverage of this race has often rewarded McConnell for his winningness and savvy, so I contacted MacGillis with a few questions about the politician and the portrait he declined to sit for.

DW: Right now, the political world is having a laugh over Alison Lundergan Grimes’s insistence on not admitting that she voted for Obama. I look at that and ask why she’s within spitting distance of McConnell when Obama lost the state by a bigger margin than Walter Mondale. McConnell always wins, but why does he always have a race?

AM: Exactly right. This shouldn’t be a race. Kentucky went for Mitt Romney by 23 points, all but one member of its congressional delegation is Republican, and McConnell’s sway as one of the most powerful people in Washington is still an asset even in the post-earmark era: for a state that’s used to being looked down on, it means something to have one of its own running the show. And he’s had 30 years to build a relationship with voters.

But that’s just it — he doesn’t have that relationship. He is so unnatural a politician that he hasn’t developed that reservoir of goodwill that a Robert Byrd had in West Virginia or Jack Warner had in Virginia. When McConnell was first elected to the Senate in 1984 (by a mere 5,000 votes in a year when Reagan won the state by nearly 300,000), Rep. Gene Snyder, a conservative who was McConnell’s first boss in Washington, was overheard remarking that Kentuckians had just elected to the Senate someone who had fewer friends in the state than “anybody elected to anything.” And that hasn’t really changed with time. Even in a state as Republican as Kentucky, familiarity has bred contempt more than affection. Kentuckians have watched from afar as McConnell climbed the ladder in Washington, and many of them, even ones who lean Republican, have been left with the sense that it’s all been about him, not them…

… It was indeed a revelation to me just how liberal McConnell had been in his early years… It’s hard to overstate how far he’s swung. This is someone who turned out for pro-civil rights rallies in college; who as a Senate staffer wrote the RNC with advice on how to go about “convincing Blacks and other minority groups in the country the Republican Party is a logical home”… who got the endorsement of the AFL-CIO in his first race, in 1977, by supporting collective bargaining for public employees; who repeatedly snuffed out anti-abortion legislation while he was county executive in Louisville; who opposed Reagan in both the ’76 and ’80 primaries.

Now, of course, he rails against unions, has twice voted against immigration reform (in 2007 and last year), appeared at CPAC last spring waving a rifle in the air; and a few months later declared to the National Right to Life Convention that “Kentucky is proudly pro-life.” It’s hard to find someone who more closely tracks the transformation of that party over the past three decades–which, for me, was part of the intellectual appeal of taking him on as a subject…

DW: On every page of the book or so there’s some McConnell acquaintance saying the guy had no friends. How did he end up taking over the GOP conference? Why, when it came down to it, was his only potential opponent Larry Craig?

AM: It’s like the sports cliche: he wanted it more than anyone else. He’s like Harry Reid in this regard: all he’s ever dreamed of is climbing in the Senate, unlike the other 98 senators who think they might someday become president. He actually failed in his first couple bids to move up the ladder, twice losing out to Phil Gramm to head the National Republican Senatorial Committee. But then he started gaming things out like Tracy Flick, sending Bob Bennett out as a wing-man months or even years before leadership elections to gauge support and bad-mouth possible rivals… It didn’t hurt that a lot of senators knew they owed McConnell for the dirty work he’d done in fighting campaign finance reform on their party’s behalf. He became the Darth Vader on that issue so that they could keep the money flowing, and earned their undying gratitude for that…

That’s the thing about turtles — they’re survivors. If you don’t mind breathing through your cloaca and urinating through your mouth, you too can survive a marginal environment for millenia…

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