Friday Rant: Idiots and Morons

A long time ago I had a boss my family referred to as “Bad Eric”. (I later had a boss named “Good Eric”). Anyway, Bad Eric thought he was a really smart guy. I’m not talking about any of those esoteric views of intelligence, he thought his actual, tested, IQ was higher than anyone else’s in the company, especially mine. This was a big deal to him. He liked to say hello to me in the following way “Good Morning, you dumb b***h”, although in fairness, he sometimes used the “c” word in lieu of the “b” word.

Working for Bad Eric was no picnic, but I did end up learning the difference between “idiot” and “moron”. It turns out that “moron” used to have a technical meaning in DSM classifications of someone with an IQ of 80 or below. (100 is average on a Bell Curve.) And so, when I talk about the stupid things that voters do, I no longer refer to them as morons, I use the strictly pejorative term “idiot”. And today, I’m going to rant about idiots. Feel free to skip to the end to find out what happened when Bad Eric and I went head to head in the quest for who was smarter.

In the past few days, a number of media outlets have gone out and interviewed Trumpkin voters who will now be affected by changes to the ACA. Their overall response is that while they do understand that they will no longer be able to afford insurance, and thus cancer treatments, insulin and other necessary medical care, they believe that  #TheAngryPumpkin will actually save them because he’ll negotiate with Paul Ryan and let them keep, basically, the ACA as it is. I kid you not. Idiots.

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Notes from your Doctor: Protecting Yourself

One of the microbiology journals recently reported on the transference of MRSA and C.diff in hospitals. Why do you care? Because you, or someone you love, is going to end up in the hospital and this may save a life. A group of researchers were puzzled about how secondary infections often showed up in patients who were in rooms where the patient a week earlier had had the infection. Over that week, the room was cleaned top to bottom, and possibly had an uninfected patient in said room. What they found was that MRSA and C.diff were washed down the sink, where the bacteria colonized and grew in the S-curve of the drain pipe and then worked its way up the drain, and ended up splashing out when someone washed his/her hands. How long did that process take? Yup, a week.

They’re still experimenting to see how to best take care of this issue. My guess is that they’ll need a viscous bleach that clings like drain cleaner to make sure all the bacteria is killed. But while they’re still working on it, what can you do? Personally, I’ll be pouring a cup of bleach down the sink in any hospital rooms I visit.

Next: The Muslim Ban may affect your health. Any idea how many doctors are from foreign countries? Tens of thousands. Of note, 8,400 are from Syria and Iran. And we need them, we have a huge doctor shortage because we don’t produce enough doctors to meet demand. (More on that further down.) The effects are in two general areas: newly minted doctors for hospital residency programs, and practitioners in Appalachia and the Rust Belt. If you think people won’t die because of the ban, you’re wrong. (Source 1, Source 2.)

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Random Thoughts for 7 March 2017

Years before Facebook, there was blogging. And as blogging was making a crescendo to its brief heyday, I used to send out an email every day about what was going on in the world. It took a while for the readership to hit 1,000 recipients, and then gmail decided I was a spammer, and luckily Matt and Tom let me join them here at DCW.

Almost a decade later, the world has changed, and attention spans have greatly decreased. But here is the list of what I’m thinking about today…see how far you can get.

The New House ACA Repeal Bill: Have you read it? If not, you can do so here.  (You’ll need to use the PDF download link as the front page is just lies.)  As I always tell you READ IT. Otherwise you’re just going with someone’s interpretation and it’s hard to quote your favourite insanity verbatim. It’s short, 123 pages. Nothing like the original 3,000+ ACA bill. And that matters, because the new bill lacks CBO scoring, and answers to the kind of important questions that make #NotMyCheeto complain that healthcare is difficult. Of course it’s difficult you moron, human lives are involved.

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The Never-ending Battle — Redistricting 2011

One of Charles Dickens’s lesser known novels is “Bleak House,” dealing with a legal case over an estate that lasted so long and was so expensive that the expenses of the case exceeded the value of the estate.  The same is unfortunately true of disputes over the redistricting process.   We are now almost six years into the current ten-year cycle of district lines.  The run-up to the next cycle begins with elections in several states this year and next that will pick some of the governors and legislators that will be in office in 2021 when the redistricting process begins again.  You would think that, by this point of the cycle with three congressional elections and two or three state legislative elections (depending on the state) under the new lines, all court cases about those lines would be over.  Unfortunately, we are not at that point yet.

This week, the Supreme Court decided the most recent redistricting case (and it has another one under submission).  This week’s decision involved the Virginia House and whether the  drawing of its lines represented a “racial gerrymander” that violates the Equal Protection Clause of the Fourteenth Amendment.  The key issues in a racial gerrymander case is whether race is the predominate reason for the drawing of the lines of a particular district and (if race is the predominate reason) whether there is a sufficiently compelling reason for the reliance on race.  Such a challenge focuses on particular district lines.

In this case, the challenges concerned twelve districts.  The original three judge panel found that race was only the predominate reason for one of the twelve districts.  In part, this decision relied on the fact that the other eleven districts did not have unusual shapes and the lines could be justified by “traditional” redistrict considerations.  While the panel found that race was the predominate explanation for the twelfth district, the panel found that the need to bump up minority votes in that district to survive pre-clearance (as the Virginia lines were drawn before the Supreme Court abolished the pre-clearance requirement of the Voting Rights Act) was a sufficiently compelling reason.

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Deciphering the Federal Budget

Tonight 45 will speak about the budget plan his folks leaked out yesterday.  He’ll likely speak about other things, also, but that budget is all over the news and he’ll capitalize on that.  However, it’s rare that Congress actually passes a budget (the last time was in 2015, and that was the first time in six years) and rarer still that the presidential framework made it through the process.

So, let’s take a look at what was proposed, where it falls apart, and then what the process actually involves. Go get a cup of coffee, you’re going to need it.

First, the good news. Appropriations come from Congress, not from the Executive branch.  Per the Origination clause in the Constitution, all appropriations bills must start in the House, although the Senate may concur and/or offer amendments. In real life, normally this leads to negotiations between the Chambers prior to anything being enacted. Thus, nothing is happening quickly. That means there is time to lobby your reps for things that matter to you.

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Hate in America

Last night, we in Philly heard that hundreds of headstones were turned over Saturday night at a Jewish cemetery, a week after similar vandalism in St. Louis. Many people are saddened, appalled and surprised. They should be sad and appalled, but not surprised. This is Trump’s America.

I have been working with Indivisible locally, and I am heartened by the number of people completely new to politics who are suddenly aware, and ready to take action to both resist the Trump agenda, and help elect people who will serve America, and not what is actually the Bannon administration.

I keep hearing two themes through my work with Indivisible. First, people are concerned about what they can do to stop hate. And by “hate” I mean not just the vandalism, but the verbal abuse people see foisted upon innocent people, just for the colour of their skin,  The ICE roundups are another form of hate: people question what they can do to help those who will be caught up in the dragnets. Hate also in the form of the administration’s moves against sick people (“repeal Obamacare” and dismantle Medicaid), Hate in the form of transgender bathroom rights. I’m a doctor, and I’m telling you, the only thing that matters is that you wash your hands. (If you’re a long-term reader, you remember back to SARS and fingers, nails, fingers, fingers, fingers.) And let’s not forget the hate of literacy in terms of claiming the media is the “enemy of the people”.  The hate is creeping down from the Cheeto Team, and up from the GOP state legislatures.

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And so it’s Tom Perez

The vote on the second ballot was 235-200 indicating that the rift between the old guard and the new left continues. So what does this mean for our party?

First, Tom Perez is a good guy. He’s smart, he’s well educated, he has held political positions (both elected and appointed) of increasing responsibility, most recently as Secretary of Labour.  While his tenure at Labour was not a rousing success, he is in favour of the Fight for $15.

However, he was in favour of TPP. In addition, he feels that the Democratic Party does not answer enough to rural Americans, and that the DNC did nothing to help Hillary Clinton directly. And therein lies the problem with his election.

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Transgender Rights and the Supreme Court (UPDATED — 3/6/17)

At the end of March, the United States Supreme Court is currently scheduled to hear arguments in a case involving Title IX and bathrooms for transgender students.  After this week, it seems likely that the case will be removed from the docket and sent back to the Fourth Circuit for reconsideration.   (Updated 3/6/17 — This morning, the Supreme Court sent the case back to the Fourth Circuit for reconsideration.)

As noted in earlier posts, after the adoption of Title IX (barring discrimination on the basis of gender by schools and colleges that receive federal funding which is effectively all public schools and most colleges), the federal government adopted a regulation permitting schools to have separate bathrooms for males and females.  The student filed a case seeking to have the court rule that the student’s gender for the purposes of those regulations was the student’s desired gender not the student’s birth gender.  At an early stage of this case, the Department of Education took the position that it would be interpreting those regulations as requiring schools to allow transgender students to use the bathroom consistent with the desired gender of those students rather than their birth gender.  When it decided the case, the Fourth Circuit deferred to the Department’s interpretation of the regulation and did not independently find what the regulation required.  When the school board appealed to the U.S. Supreme Court, two of the three issues raised involved whether the Fourth Circuit should have deferred to the Department’s interpretation of its own regulation.  In taking the case, the U.S.  Supreme Court only accepted one of the two questions about deference (whether deference was appropriate under the circumstances) and also took the question about the proper interpretation of the relevant regulation.

Because the Fourth Circuit decision relied on a judicial doctrine (Auer deference) that dictates that courts should defer to an agency’s interpretation of its own regulation, it was dependent on the agency not changing that interpretation.  When the Supreme Court took the case in October, the Department still interpreted the regulation consistent with the student’s position in this case.  After Trump won the election, it was unclear whether the new administration would change its interpretation of the regulation.

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Judge Gorsuch and Same Sex Bathrooms

While, for the most part, Judge Gorsuch reflects the views of the current conservative legal establishment (which is substantially more conservative today than it was thirty years ago), one of the areas in which he stands out is his view on the scope of regulatory authority.  Current case law is mostly bounded in the reality of current politics.  Some conservatives want courts to disrupt the way things currently operate.

Currently, Congress tends to write broad statutes establishing programs or general rules for some type of activity.  Congress then delegates responsibility for filling in the details to some department or agency.  To use health care as an example, such an approach keeps legislation relatively simple and prevents it from being bogged down in the tiny details (should there be a copay for vaccines, do policies have to cover erectile disfunction or contraceptives).  Additionally, leaving the details for the regulatory agency makes it easier to adjust to changes — as new drugs are discovered, the agency can adjust the list of covered drugs to reflect those new drugs.   The best example of this process of adjustment is in the case of pollution where the Clean Air Act and Clean Water Act both allow the EPA to regulate new pollutants upon determining that the evidence demonstrates that a previously unregulated substance is a pollutant.

Current case law supports the ability to operate in this way through three doctrines.  First is the current limited version of the non-delegation doctrine.  Back before the New Deal, the courts regularly struck down regulations on the theory that Congress had improperly delegated legislative authority to the executive branch.  Current law permits such delegation as long as the statute gives sufficient guidance to the administrative agency.  While sufficient is somewhat in the eye of the beholder, most courts only require very broad guidance.

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Judge Gorsuch — What should we do?

On Tuesday, the maniac-in-chief nominated Judge Neil Gorsuch to fill the vacancy left by the death of Antonin Scalia.  This nomination creates a significant question for Senate Democrats on how to proceed.

On the merits, at least based on current public knowledge which may change, Judge Gorsuch is a typical member of the Republican conservative establishment:  The son of Reagan’s EPA chief, educated at top schools, a mix of government and private practice before being appointed to the bench by George W.   While it is tough to tell for sure by a decisions on a lower court — where judge’s are bound by Supreme Court precedent and are trying to read between the lines to avoid reversal — Judge Gorsuch seems very similar to Justice Scalia.  It is not really possible to tell if he is on the Alito (more conservative) or Roberts (more moderate) side of Scalia.  In any case, with the exception of some criminal cases, Justice Scalia was rarely the fifth vote in a progressive decision.  As such, barring someone on the loony side, it is unlikely that any Trump nominee is going to substantially alter the balance on the Supreme Court from what it was before Trump died.  (Of course, it would have been preferable to have a Democratic president replacing Justice Scalia, but that is not now a possibility.)  And Trump is likely to nominate a candidate in his/her upper 40s or lower 50s like Judge Gorsuch, so the next opportunity for Democrats to replace any of the four conservative judges will be at least a decade or more in the future barring any unexpected deaths.  Given this reality, the question is how hard to fight this nomination.

The battle over judicial nominations — like everything else — has become more a matter of political trench warfare with each cycle.  In the 1960s, the nomination of Thurgood Marshall was contentious, but — at that time — the ideological lines between the two parties were blurrier and the opposition was regional (Southern senators of both parties) rather than partisan.  However, with the exception of the nomination of Abe Fortas in 1968, all nominees received a vote on the merits (except for those who withdrew before any floor vote) until 2016.   At the time of his retirement in 1991, Justice Marshall was one of two members of the court who received double digit “no” votes on confirmation (with 11 no votes).  However, the last four nominees all received more than twenty “no” votes and only Chief Justice Roberts received less than thirty “no” votes.

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