Category Archives: Shootings

Thousand Oaks and Our Peculiarly American Affliction. And will the Dems get Gun Control?

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Be shocked by the massacre at a bar. It’s not normal.

Tim Dominguez sits under the freeway after escaping the Borderline Bar and Grill in Thousand Oaks, Calif., where a gunman killed 12 other people Wednesday night.

According to statistics from the Gun Violence Archive, there have been 307 mass shootings in the 312 days of 2018. They are a commonplace occurrence. This is a horrifying thing to say, but it is the truth. We need to say this truth over and over. We need to face this horror without looking away. We live in a country where there are relatively few restrictions on gun ownership and where our cultural tolerance for mass murder appears to be infinite.

Less than a month ago an author visited California State University Channel Islands, not far from where the shooting on Wednesday night took place. A deeply engaged audience greeted her. They had a thoughtful discussion about sexual violence, justice, trauma, and healing. Some of those students might have been at the Borderline Bar and Grill in Thousand Oaks, Calif., Wednesday night, doing what college students are supposed to be doing — dancing and hanging out with friends, having fun. As she read the news Thursday morning, her chest tightened. She read quotes from students from that campus describing the sparks and the smoke they saw. She felt resignation creeping in.

Over the past two years, there has been increased security at his events, armed guards. Sometimes they are there because he had received a threat. Sometimes they are there because she is a black woman with opinions and the threat is already implied. Every time she goes on stage, she looks out into the audience and wonders if there is a man with a gun in the sea of faces. She is not scared of him. She is resigned to the inevitability of him pointing that gun at me, at the crowd, and pulling the trigger. She doesn’t want to be this resigned. She doesn’t want you to be, either.

In an interview, the father of one of the young women who escaped the carnage at the Borderline Bar said his daughter did what he has taught her to do in the event of a mass shooting. It took me a moment to realize what he was saying. We are raising generations of children who are prepared for this kind of crime.

It is a peculiarly American affliction that this epidemic of gun violence doesn’t move us to take any real steps toward curbing gun violence and access to guns.

It is painfully obvious that there is no shooting appalling enough to make American politicians stand up to the National Rifle Association and gun makers. A congressman was shot and critically wounded. Children at Sandy Hook Elementary were murdered. Revelers at the Pulse nightclub were murdered. Concertgoers in Las Vegas were murdered.

Our leaders think and pray their way through the horror. The politicians who rely on N.R.A. donations feign concern and continue taking that money. American voters keep these people in office, perhaps, because it isn’t their loved ones being murdered. Yet. And even if it were, I don’t know that their votes would change. Instead, people treat the Constitution like a fast-food value menu, choosing which amendments are sacrosanct (the First and Second) and which are disposable (any of those giving civil rights to anyone but white men).

The script following these shootings is too familiar — flags at half-staff, hollow words of sympathy — but what chills me is the relatively calm eloquence of the survivors speaking to reporters. How they don’t seem particularly surprised to have survived a mass shooting. That they are able, in the immediate aftermath of trauma, to articulate their experiences. They can do this because they have seen it done.

How do we change this script? How do we convince enough people that we are well past the time for radical action?

We must elect politicians who will ban assault weapons and at the very least enact legislation requiring federal, rigorous background checks for gun owners. But really, that’s not radical. It’s the bare minimum, and by the grace of that kind of legislation in California, the shooter was able to use only a handgun. This massacre where 13 people died could have been much worse.

In late September, I went to a gun range with my brother, who is a gun enthusiast. We spent about an hour shooting guns as he explained the merits of the various weapons. We wore safety goggles, and though it wasn’t my first time shooting a gun, he went over the safety protocols. Before we could even enter the range we watched a safety video. From the moment we entered the facility until the time we left, we were reminded of the danger of these weapons. Each gun was heavy in my hand, hot. Before long, the space around us was thick with the stench of oil and gunpowder. We were shooting at targets, metal, and paper. There was a certain satisfaction when I shot well. I understood the appeal of holding that kind of power in the palm of my hand. I also understood the responsibility of holding a gun. I was awed by it. I was not so enamored that I want to own a gun myself. Yet.

Today I held a 4-month-old baby. He is cute and strong and wide-eyed. He still smells sweet and new. I held him and for a few minutes, I forgot about everything terrible. I forgot about the man with a gun and the 12 other people he killed and the people he injured. I forgot about the man with a gun who walked into a yoga studio and started shooting. I forgot about the man with a gun who walked into a grocery store and started shooting. I forgot about the man with a gun who walked into a synagogue and started shooting. And then I looked at this baby’s tiny face and his wide, gummy smile. I remembered everything terrible. I understood the responsibility of holding a child. I was awed by it. I realized that as horrifying and commonplace and inevitable as mass shootings are, we cannot do nothing. Stare into the horror. Feel it. Feel it so much that you are moved to act.

Deaths From Gun Violence: How The U.S. Compares With The Rest Of The World

Nurith Aizenman reported these statistics about a year ago but I thought that the story and the comparisons were relevant regarding gun violence rates. The timing of that report couldn’t be more apt — or grimmer even today. The statistics were released just as Americans were waking up to the news that a gunman had opened fire the night before at the Borderline Bar and Grill in Thousand Oaks, Calif. He killed 12 people and was found dead at the scene.

The attack came just 11 days after the fatal shooting that claimed 11 lives at Pittsburgh’s Tree of Life synagogue. Eight months before that, a gunman shot 17 people dead at Marjory Stoneman Douglas High School in Parkland, Fla. And just over a year ago a gunman massacred 58 people at a music festival in Las Vegas.

As in previous years, the University of Washington’s latest data indicates that this level of gun violence in a well-off country is a particularly American phenomenon.

When you consider countries with the top indicators of socioeconomic success — income per person and average education level, for instance — the United States is bested by just 18 nations, including Denmark, the Netherlands, Canada, and Japan.

Those countries all also enjoy low rates of gun violence. But the U.S. has the 28th-highest rate in the world: 4.43 deaths due to gun violence per 100,000 people in 2017. That was nine times as high as the rate in Canada, which had 0.47 deaths per 100,000 people — and 29 times as high as in Denmark, which had 0.15 deaths per 100,000.

The numbers come from a massive database maintained by the University’s Institute for Health Metrics and Evaluation, which tracks lives lost in every country, every year, by every possible cause of death. The 2017 figures paint a fairly rosy picture for much of the world, with deaths due to gun violence rare even in many countries that are extremely poor — such as Bangladesh, which saw 0.07 deaths per 100,000 people.

Prosperous Asian countries such as Singapore and Japan boast the absolute lowest rates, though the United Kingdom and Germany are in almost as good shape.

“It is a little surprising that a country like ours should have this level of gun violence,” Ali Mokdad, a professor of global health and epidemiology at the IHME, told NPR in an interview last year. “If you compare us to other well-off countries, we really stand out.”

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To be sure, there are quite a few countries where gun violence is a substantially larger problem than in the United States — particularly in Central America and the Caribbean. Mokdad said a major driver is the large presence of gangs and drug trafficking. “The gangs and drug traffickers fight among themselves to get more territory, and they fight the police,” said Mokdad. And citizens who are not involved are often caught in the crossfire. Another country with widespread gun violence is Venezuela, which has been grappling with political unrest and an economic meltdown.

Screen Shot 2018-11-11 at 12.30.59 PMMokdad said drug trafficking may also be a driving factor in two Asian countries that have unusually high rates of violent gun deaths for their region, the Philippines and Thailand.

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With the casualties due to armed conflicts factored out, even in conflict-ridden regions such as the Middle East, the U.S. rate is worse.

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The U.S. gun violence death rate is also higher than in nearly all countries in sub-Saharan Africa, including many that are among the world’s poorest.

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One more way to consider these data: The institute also estimates what it would expect a country’s rate of gun violence deaths to be based solely on its socioeconomic status. By that measure, the U.S. should be seeing only 0.46 deaths per 100,000 people. Instead, its actual rate of 4.43 deaths per 100,000 is almost 10 times as high.

Dems vow swift action on gun reform next year

Mike Lillis and Scott Wong wrote that the nation’s latest mass shooting has rekindled the fire under Democrats to use their newly won majority to strengthen federal gun laws in the next Congress.

The issue was off the table for eight years of Republican rule, as GOP leaders have sided with the powerful gun lobby against any new gun restrictions.

But House Minority Leader Nancy Pelosi(D-Calif.), who’s seeking to regain the Speaker’s gavel, vowed to move quickly on gun reform next year, citing Wednesday night’s shooting massacre at a California country music bar as the latest reason Congress should step in with new restrictions on the sale and ownership of firearms.

Universal background checks, Pelosi suggested, would be the likely first step.

“It doesn’t cover everything, but it will save many lives,” Pelosi said Thursday night on CNN’s “Cuomo Prime Time” program.

“This will be a priority for us going into the next Congress.”

Rep. Jerrold Nadler (D-N.Y.), likely the incoming chairman of the House Judiciary Committee, said this week that he’ll “immediately get to work” on that legislation next year.

That position marks a shift from almost a decade ago when Democrats last controlled the House and party leaders declined to consider tougher gun laws despite entreaties from some rank-and-file members.

Rep. Mike Quigley (D-Ill.), a gun reformer from Chicago and member of the Judiciary Committee, had requested hearings on background checks in 2010, only to be refused.

The reasons were largely political: House Democrats, at the time, had a more conservative-leaning caucus, boasting more than 50 Blue Dogs in battleground districts the party was fighting to preserve.

After a 10-year ban on assault weapons signed by former President Clinton was widely viewed as a “third rail” that helped secure George W. Bush’s White House victory in 2000, Democrats didn’t want to repeat history.

Since then, the country has seen a long string of prominent mass shootings, including violence targeting a congresswoman in Tucson, Ariz., elementary school students in Newtown, Conn., nightclubbers in Orlando, churchgoers in Charleston, S.C., country music fans in Las Vegas, high schoolers in Parkland, Fla. and Jews praying at a synagogue in Pittsburgh last month.

The most recent tragedy occurred Wednesday night at a bar in Thousand Oaks, Calif., where authorities say a Marine combat veteran killed 12 people before fatally shooting himself.

One of the victims, 27-year-old Telemachus Orfanos, survived last year’s Las Vegas massacre but was killed in the Thousand Oaks shooting.

“I don’t want prayers. I don’t want thoughts. I want gun control, and I hope to God nobody else sends me any more prayers,” Orfanos’s mother, Susan Orfanos, said in an emotional interview with KABC that has been viewed millions of times on social media. “I want gun control. No more guns.”

The rash of devastating episodes shifted public sentiment in strong favor of gun reform, and polls show overwhelming support for measures like expanded background checks among voters of all political stripes.

Three Parts Brands Have Come Together

The Ford Motor Company reported that among the host of Democrats elected to the House on Tuesday in conservative districts, many embraced new restrictions on gun purchases without facing the previously feared backlash at the polls.

“The public has evolved on their belief about this, given the magnitude and disparity of gun violence and mass shootings,” Quigley said Friday by phone.

The Democrats’ plans for gun-reform legislation remain unclear.

Rep. Mike Thompson (D-Calif.), the head of the party’s task force to prevent gun violence, has taken the lead on the background check bill, and will likely do so again next year. There are also dozens of related proposals other lawmakers will surely promote, including bills to ban bump stocks, eliminate assault weapons, spike taxes on guns and ammunition and prohibit high-capacity magazines like the one allegedly used by the shooter in Thousand Oaks.

Quigley is all for pushing bold reforms, including a ban on assault weapons, but is promoting the idea of securing early victories on more popular measures.

“Let’s start where we have some commonality,” he said. “The vast majority of Americans, the majority of gun owners, the majority of NRA [National Rifle Association] members support universal background checks.

“That’s a good place to start.”

That the House will pass some kind of background-checks legislation is clear. But any new gun restrictions face tall odds in the GOP-controlled Senate, where Republicans are near unanimous in their opposition to such reforms.

In 2013, in the wake of the Sandy Hook Elementary School shooting in Newtown, Sens. Pat Toomey (R-Pa.) and Joe Manchin (D-W.Va.) authored legislation to expand background checks for firearms purchased online and at gun shows. It fell six votes short of overcoming a GOP-led filibuster, with only four Republicans — Toomey, and Sens. Susan Collins (Maine), John McCain (Ariz.) and Mark Kirk(Ill.) — supporting the measure.

Kirk lost his reelection bid in 2016 and McCain died this year, leaving just two Senate Republicans who back strengthening background checks. Manchin just won re-election this week and Toomey isn’t up for reelection until 2022.

“Senator Toomey is continuing to work with his colleagues in the Senate to find a path forward to 60 votes for his background check legislation,” said Toomey spokesman Sam Fischer.

Complicating the math for gun reform supporters, Tuesday’s midterms added to the GOP Senate majority, and the incoming Republicans are all gun-rights promoters supported heavily by the firearms lobby.

Asked about the appropriate response to the Thousand Oaks shooting, Sen.-elect Marsha Blackburn(R-Tenn.) was terse.

“What we do is say, how do we make certain that we protect the Second Amendment and protect our citizens?” Blackburn told Fox News on Thursday.

President Trump could be a wild card in the coming gun debate. The president has a long and conflicting history on the topic, from the promotion of an assault-weapons ban years ago to a more recent embrace of the Second Amendment protectionism advocated by the NRA.

Gun-reform advocates, long accustomed to congressional inaction on the issue, say they’ve been encouraged by what they’ve heard from Pelosi and other Democratic leaders so far.

“While so many other factors have not been settled, we believe that House Democrats will move universal background checks in early 2019,” said Robin Lloyd, government affairs director for the Courage to Fight Gun Violence, the gun-reform group led by former Rep. Gabrielle Giffords (D-Ariz.), the congresswoman shot in the head in Tucson in 2011.

Medical professionals to NRA: Guns are our lane. Help us reduce deaths or move over.

 Megan L. Ranney, Heather Sher, and Dara Kass, Opinion contributors, reported that after the American College of Physicians released a paper last week about reducing firearm injuries and deaths in America, the NRA tweeted the statement: “Someone should tell self-important anti-gun doctors to stay in their lane.”

A couple of days later, the Centers for Disease Control published new data indicating that the death toll from gun violence in our nation continues to rise. As the NRA demanded that we doctors stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death — gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must all come together to find meaningful solutions to this very American problem.

We bear witness to every gun-related trauma

The physicians, nurses, therapists, medical professionals, and other concerned community members signing this letter are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

As the professionals who manage this epidemic, we bear witness to every trauma and attempt to resuscitate, successful or not.

►We cut open chests and hold hearts in our hands in the hopes of bringing them back to life.

►We do our best to repair the damage from bullets to pulverized organs and splintered bones.

►We care for the survivors of firearm injury for decades after they’ve been paralyzed, lost a limb, or been disabled.

►We deliver mental health care to the siblings and parents of the children who have been shot as well as to the survivors of gun violence.

►We treat the anxiety of teachers and students who are already traumatized by the news of mass shootings who are then are asked to participate in active shooter drills in their own schools.

►We prepare for mass casualty shootings with drills ourselves and practice sorting victims by how life-threatening their injuries are while fervently hoping that a mass shooting never touches our own communities.

►We are asked by families, schools, employers and law enforcement to conduct mental health evaluations and threat assessments of individuals who demonstrate dangerous behaviors with legally-owned firearms — yet we have no protocols to decrease firearm risk when they present to us.

►We support our own medical colleagues as they themselves must recover from the psychological trauma of being first responders to mass shootings.

►We design trauma protocols to reduce the loss of life from even the most horrific gunshot wounds.

►We train civilians to carry and use tourniquets to #StopTheBleed, something that should be necessary on battlefields but not in American grade school classrooms.

►We try our best to conduct research to stop the epidemic of gun violence.

►We hold the hands of gunshot victims taking their final breaths.

►We cry, ourselves, as we tell parents that their child has been shot and that we did our best.

►We escort parents into our treatment rooms to take one last look at their dead child before they have been able to process the news.

►We see firsthand how a single moment ends a life and forever changes the lives of survivors, families, and entire communities.

NRA should help us reduce gun death toll

Our research efforts have been curtailed by NRA lobbying efforts in Congress. We ask that the NRA join forces with us to find solutions.

We invite the NRA to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane. We as a society must do something about gun violence NOW!

Also, I live in a region where about 70% of the population owns guns. But the homicide and suicide rate is very, very low. Why? I’m not sure at this time but I along with the majority of our country are tired and scared of the gun-related violence.

The holiday of Thanksgiving reminds us that we ought to be thankful for the blessings and the people in our lives. But what do we do when it seems that everything is going haywire? Maybe somebody recently wronged you. An unexpected expense has thrown off your budget. That new role at your job isn’t as shiny as you thought it would be. Or maybe you’ve been trying to do the right things, live the right way, but situations STILL aren’t working out in your favor.

How do you cope? How do you resist the urge to give up? How do you continue to do good even when you’re not seeing any immediate benefits from “living the right way? And HOW IN THE WORLD can you be thankful for all of this? Sometimes we have to be thankful for what we have and enjoy the day and family and friends.

 

What the New Democratic House majority might actually pass on health care; and It Looks Like VA Healthcare Maybe Improving!

 

 

18670832_1206383419491315_6469395384583311089_nI had prepared two posts for tonight and wanted to hold off on the recent shootings until next week as we digest what the effect really is in our country and the future strategies. Now let’s discuss the effect of the election and in looking at the House Democrats, who have a lot to figure out on their signature issue.

Healthcare carried House Democrats to victory on Election Day. But what now?

Remember my past post reminding the Republicans the importance of healthcare in the midterm elections? We, it looks like it was an important factor in the outcomes of the “wave”. Dylan Scott spent some time looking at his prediction of what the new majority will bring to our health care system. In interviews this fall with half a dozen senior House Democratic aides, health care lobbyists, and progressive wonks, it became clear the party is only in the nascent stages of figuring out its next steps on health care.

The new House Democratic majority knows what it opposes. They want to stop any further efforts by Republicans or the Trump administration to roll back and undermine the Affordable Care Act or overhaul Medicaid and Medicare.

But Democrats are less certain about an affirmative health care agenda. Most Democrats campaigned on protecting preexisting conditions, but the ACA has already done that. Medicare-for-all is energizing the party’s left wing, but nobody expects a single-payer bill to start moving through the House. Drug prices offer the rare opportunity for bipartisan work with Senate Republicans and the Trump White House, but it is also a difficult problem with few easy policy solutions — certainly not any silver bullet that Democrats could pull out of the box and pass on day one, or even month one, of the next Congress.

Winning a House majority to ensure Obamacare’s safety is an important turning point after so many years in which health care hurt Democrats much more than it helped.

But the path forward for the party on their signature issue is surprisingly undefined.

The likely first item on the Democratic agenda: Obamacare stabilization

Democrats do have some ideas, of course. Democratic aides emphasized the various investigations they could launch into Trump’s health department, not only looking into any efforts by the White House to sabotage Obamacare but also focusing on more obscure issues like Medicare payment rates.

But wonky oversight inquiries probably aren’t the big-ticket item that new Democratic members and their voters are looking for, especially heading into the 2020 presidential election.

After campaigning in defense of Obamacare, warning about Republicans rolling back preexisting conditions protections and the Trump administration’s sabotage of the health care law, a bill to stabilize the Obamacare insurance markets would be the obvious first item for the new Democratic majority’s agenda.

Several sources pointed to a bill by Democratic Reps. Richard Neal (MA), Frank Pallone (NJ), and Bobby Scott (VA) — who have been serving as the top Democrats on leading health care-related committees — as the likely starting point. The plan is designed to build off Obamacare’s infrastructure to expand federal assistance while reversing the recent Republican efforts to undermine the law.

That bill would expand Obamacare’s premium subsidies, both by extending federal assistance to more people in lifting the current eligibility cutoff and by increasing the size of the tax credits people receive. It would also bolster the cost-sharing reduction subsidies that people with lower incomes receive to reduce their out-of-pocket costs while extending eligibility for those subsidies to people with higher incomes.

The Pallone-Neal-Scott bill would reverse the Trump administration’s recent regulations intended to funnel more people to insurance plans that are not required to meet all of Obamacare’s rules for preexisting conditions. It would also pump more money back into enrollment outreach, cut by the Trump administration, and establish a new program to compensate insurers for high-cost patients, with the hope of keeping premiums down.

Two things stick out about this bill: It would be the most robust expansion of Obamacare since the law first passed, and it is just narrow enough that, with a few sweeteners for Senate Republicans, it could conceivably have a chance to pass. Democrats are waiting to see how the GOP majority in the upper chamber reacts to losing the House.

“Undoing sabotage and bringing stabilization to the ACA markets, that’s something we should really be thinking about,” one House Democratic aide told me. “It depends on what kind of mood the Republicans are in. Maybe they’ll say that actually now that the tables are turned, we should probably sit down.”

Senate Republicans and Democrats did come very close to a narrow, bipartisan deal — it wasn’t even as robust as the Pallone-Neal-Scott bill — to stabilize Obamacare in 2017. It fell apart, ostensibly after a tiff over abortion-related provisions, but that near miss would be the reason for any optimism about a bipartisan deal on the divisive health care law.

Then again Senate Republicans might have no interest in an Obamacare compromise after gaining some seats. Democrats would still likely work on stabilization to send a message to voters on health care ahead of the 2020 campaign.

Shoring up Obamacare is a good start, but what next?

In the case, the Pallone-Neal-Scott bill might be a nice starting point — no Democrat really disagrees about whether they should help the law work better in the short term — but it still lacks any truly ambitious provisions. It is just about as narrowly tailored as an Obamacare stabilization bill offered by Democrats could be, a fact that aides and activists will privately concede.

Missing are any of the bolder policy proposals animating the left. Not even a hint of Medicare-for-all single-payer health care, which is or isn’t a surprise, depending on how you look at it.

Medicare-for-all is quickly becoming orthodoxy among many in the party’s progressive grassroots, and a single-payer bill proposed this Congress in the House (similar to the one offered by Bernie Sanders over in the Senate) has 123 sponsors.

But House Democratic leaders probably don’t want to take up such a potentially explosive issue too soon after finally clawing back a modicum of power in Trump’s Washington.

Still, the current stabilization bill doesn’t even include a Medicare or Medicaid buy-in, the rebranded public option that never made it into Obamacare but would allow Americans to voluntarily join one of the major government insurance programs. It is an idea that even the more moderate Democratic members tend to support, and polls have found three-fourths of Americans think a Medicare buy-in is a good idea.

The plain truth is House Democrats haven’t reached a consensus yet about what they want to do to cover more Americans. They agree Obamacare was an important first step, and they agree the status quo is unacceptable. But the exact mechanism for achieving those goals — single-payer, a robust public option, or simply a buffed-up version of Obamacare — is still very much up for debate.

“People will want to do something, but any further action is going to be a consensus-building process,” a senior House Democratic aide told me. “Democrats have lots of different ideas on how to continue working to reduce the uninsured.”

That is all well and good, but few issues are exciting the Democratic grassroots right now like Medicare-for-all. During the midterm campaigns, Democratic candidates and even grassroots leaders were happy to let those words mean whatever voters wanted them to mean. For some people, it meant single-payer; for others; it might mean a Medicare buy-in or something more limited.

The unreservedly progressive members who were just elected to Congress will only wait so long before they start pressing Democratic leaders to take more aggressive steps to pick up one of their top campaign issues. That pressure will only intensify as the 2020 presidential campaign heats up and Democrats debate what kind of platform they should run on as they seek to take back the White House.

For now, Democrats have tried to put off a difficult debate and focus on what unites them. But the debate is still coming.

The riddle of high drug prices still needs to be solved too

Even with Obamacare and preexisting conditions mobilizing Democratic voters this year, prescription drug prices remain a top concern for many Americans. That’s another area where Democrats know they want to act but don’t know yet exactly what they can or should do.

The issue could be an opening for serious dealmaking: Trump himself has attacked big pharma since his presidential campaign. His administration has actually launched some interesting initiatives to rein in drug costs — approving a record number of generic drugs, trying to even the playing field between America and foreign countries — that have some policy wonks intrigued, even if the impact is still to be determined.

Democrats have mostly stuck to slamming Trump for feigning to act on drug prices while cozying up to the drug industry. But it’s a top priority for both parties, and there could be some room for compromise. One progressive policy wonk thought a drug prices bill might actually be the first Democratic priority. It helps that drug prices are a populist issue that the new House majority might really be able to pass a bill on.

But first, Democrats have to figure out what exactly they are for — and what would actually make a difference.

The rallying cry for Democrats on drug prices has been letting Medicare directly negotiate prices with drug manufacturers, a proposal that Trump also embraced as a candidate, though he has since softened as president. The problem is the Congressional Budget Office doesn’t think Medicare negotiations would save any money unless the government is willing to deny seniors coverage for certain medications. But adding such a provision would surely invite attacks that Democrats are depriving people’s grandparents of the medications they need.

There are a lot of levers to pull to try to reduce drug prices: the patent protections that pharma companies receive for new drugs, the mandated discounts when the government buys drugs for Medicare and Medicaid, existing hurdles to getting generic drugs approved, the tax treatment of drug research and development. Lawmakers and the public view pharmacy benefits managers, the mysterious middlemen between health insurers and drugmakers, skeptically.

But none of those are silver bullets to lower prices, and they will certainly invite pushback from the politically potent pharmaceutical lobby, focused on the concerns about how much cracking down on drug companies to discourage them from developing new drugs. Democrats also don’t know yet what specific policies could win support from Senate Republicans or the Trump White House.

“How do you take this gargantuan Chinese menu of things and figure out how things fit together in a way that stem some of the abuses?” is how one Democratic aide summarized the dilemma.

It is a problem bedeviling Democrats on more than just drug prices. Health care was a winner on election night this year, and it has always been a priority for Democrats. Now they just need to figure out what to do.

Because tomorrow is Veterans Day I thought that I would include this article.             After A Year Of Turmoil, New VA Secretary Says ‘Waters Are Calmer’ 

Quil Lawrence in his Twitter post reported on a wide-ranging interview with NPR, Secretary of Veterans Affairs Robert Wilkie said his department is on the mend after a tumultuous 2018.”I do think it is better because the turmoil of the first half of this year is behind us, the waters are calmer. We’re not where we need to be, but we’re heading in that direction,” he said.

Early in Donald Trump’s presidency, the VA was considered an island of stability in an unpredictable administration.

Secretary David Shulkin was a hold-over from the Obama administration, already familiar with the VA’s massive bureaucracy. Bipartisan reforms moved through Congress with relative speed, and Trump could point to a list of legislative accomplishments.

But the president fired Shulkin last March after weeks of intrigue during which VA political appointees plotted openly to oust him. Trump’s first nominee to replace Shulkin, Rear Adm. Ronny L. Jackson, sank under accusations of misconduct (which are still being investigated by the Pentagon).

Numerous high-ranking officials left the department, and records showed that friends of the president outside of government – who weren’t even veterans – had been lobbying Trump at Mar-a-Lago on how to run the VA.

After a stint as acting VA secretary, Robert Wilkie was confirmed by the Senate last July. Since then, Wilkie says he’s been “walking the post,” visiting as many VA facilities as he can. And he’s reached the same conclusion as many of his predecessors.

“I have been incredibly impressed by the caliber of VA employee I’ve encountered everywhere, from Alaska to Massachusetts to Florida,” Wilkie told NPR’s, Steve Inskeep.

“I have no quarrel with the quality of medical care our veterans receive. My biggest problem is actually getting them into the system so that they can receive that care, which means the problems are primarily administrative and bureaucratic,” said Wilkie, himself a veteran of the Navy and a current Air Force reservist, who counts generations of veterans in his family.

“I am the son of a Vietnam soldier. I know what happened when those men and women came home,” Wilkie said. “So that is incredibly important to me.”

Wilkie is navigating an important moment for the VA – while Congress has already passed major reforms, he’s the one who has to implement them. And plenty of political controversy hides in the details.

The VA Mission Act of 2018 was signed into law in June. It’s intended to consolidate about a half-dozen programs The VA uses to buy veterans private healthcare at a cost of billions of dollars, into one streamlined system.

Critics fear that leaning too much on private care will bleed the VA’s own medical centers, and lead to a drop in quality there – and amounts to a starve-the-beast strategy of privatization.

Wilkie says that won’t happen and is not President Trump’s goal, but he has yet to present a budget for expanded private care to the White House and to Congress.

“You’re not going to privatize this institution. I certainly have never talked about that with anyone in this administration,” Wilkie said.

Wilkie also maintains that he has had little contact with the group of outside advisers who meet with the president at Mar-a-Lago, including CEO of Marvel Comics Ike Perlmutter and Florida doctor Bruce Moscowitz. Records show they had extensive communication with the previous VA secretary, sometimes influencing policy decisions.

“I met with them when I was visiting the West Palm Beach VA – my first week as acting (secretary), and have not had any meetings with them ever since that day,” Wilkie said. “I’ll be clear. I make the decisions here at the department, in support of the vision of the president.”

Despite rumors that Wilkie would clear out many of the Trump political appointees who clashed with former secretary Shulkin, he said he didn’t expect more staffing changes.

The one notable departure is Peter O’Rourke, who was acting secretary for two months while Wilkie went through the confirmation process. O’Rourke clashed repeatedly with Congress and the VA’s inspector general. Wilkie himself cited a Wall Street Journal reports that O’Rourke is poised to go and said he’s “on leave.”

“I think there will be an announcement soon about a move to another department in the federal government – I know that he’s looking for something new,” said Wilkie, “He’s on leave.”

Another major new plan that Wilkie must implement is a $10 billion, 10-year plan to make the VA’s medical records compatible with the Pentagon’s.

He once again mentioned his father’s experience as a wounded combat vet.

“He had an 800-page record, and it was the only copy, that he had to carry with him for the rest of his life. He passed away last year,” said Wilkie.

“One of the first decisions I made as the acting secretary was to begin the process of creating a complete electronic healthcare record that begins when that young American enters the military entrance processing station to the time that that soldier, sailor, airman, Marine walks into the VA.”

But that process has actually been underway for a decade – with little to show and about a billion dollars already spent on the effort. The non-partisan Government Accountability Office says it’s in part because neither the Pentagon nor the VA was put in charge of the effort — which is still the case. Wilkie says he has signed an agreement with the Pentagon to jointly run it with clear lines of authority.

“I think we’ll have more announcements later in the year when it comes to one belly-button to push for that office,” he said.

As for staff shortages, another perennial complaint at the VA, Wilkie acknowledged there are 35- to 40,000 vacancies at the agency.

“We suffer from the same shortages that the private sector and other public health services suffer from, particularly in the area of mental health,” he said.

New legislation passed this year gives Wilkie the authority to offer higher pay to medical professionals.

“I’m using it to attract as many people as we can into the system,” said Wilkie

But Wilkie also added that he was shocked, upon taking the post, that it’s not clear how many additional people are needed – because it’s not even clear how many people are working at VA.

“I had two briefings on the same day and two different numbers as to how many people this agency employs.”

Wilkie says he’s in the process of finding out the answer to that question, and many others, as he starts his second 100 days in office.

And to end this post I must include this note. I was raised in the Bronx, New York and are truly embarrassed to acknowledge that the new Congresswoman Cortes-Ortes who was elected, and not sure how when you look at her qualifications and knowledge. But more, she is a socialist and expects everything to be given to all and the government will foot the bill and now listen to this.

Alexandria Ocasio-Cortez, new youngest Congresswoman, says she can’t afford D.C. apartment

Ashley May, a reporter for the USA TODAY noted that the upset primary win in New York by Alexandria Ocasio-Cortez is a huge moment for the Democratic Party because it shows the left-wing base is energized heading into the midterms, according to AP National Politics Reporter Steve Peoples. (June 27) AP

Alexandria Ocasio-Cortez, the youngest woman elected to Congress in the midterm elections, is struggling to pay rent, according to a recent interview.

Ocasio-Cortez, 29, told The New York Times she’s not sure how she will be able to afford an apartment in Washington, D.C., without a salary for three months in an interview published online Wednesday.

She told the Times she has some savings from her job earlier this year as a bartender at a Union Square restaurant, and she’s hoping that will hold her over. Living without a paycheck is something she said her and her partner tried to plan for, but it’s a hardship that’s still “very real.”

“We’re kind of just dealing with the logistics of it day by day, but I’ve really been just kind of squirreling away and then hoping that gets me to January,” she told the Times.

Ocasio-Cortez is a New York activist and Democrat who will represent the 14th Congressional district, which covers the Bronx and Queens.

Thursday, she pointed to her lack of income as a reason why some people are not able to work in politics.

“There are many little ways in which our electoral system isn’t even designed (nor prepared) for working-class people to lead,” she said.

She said she hopes she can change that.

Yes, and now if she plays her cards right she has a job, paying better than any job that she is really qualified for life.

Buck it up Ocasio-Cortez, live outside of DC and take public transportation like most people do!

How did you fund your campaign? I don’t want to hear your sob story and yes I am ashamed that the borough of the Bronx has you for their representative. What a joke! You said that when you got to DC you were going to sign a whole lot of bills and laws to make things better. Do you even know anything about the process and have you ever taken a Civics course. You are in for some big surprises… called reality!

On a better note-Happy Veterans Day and thank you all who have served in our military and those who are still out there helping to make this world a better place to live and protecting our freedoms.

 

Active Shooter Insurance: Sadly, It’s Needed-Or Is It? And the Effect of Gun Violence on Health Care.

42491634_1719865238143128_6077344969692020736_nI knew that we all were in trouble when I received a bulletin from one of my insurance companies. The first article reviewed workplace violence, which as they summarized is a threat that cannot be ignored and that as a difficult a subject that it is, it is important for businesses to consider active shooter/ workplace violence insurance to cover gaps in standard coverage insurance.

According to 2017 data from the Gun Violence Archive (GVA), America is averaging almost one mass shooting a day. GVA considers a mass shooting any incident in which a gunman shoots or kills four or more people in the same time and location. They recorded 345 mass shootings in 2017 and, as of the time of this blog post, 213 in 2018. How depressing and what it says about our society and humanity in general.

Consider this next article:

More hurt, killed in shootings with semiautomatic rifles

More people are wounded and killed in active shooter incidents in which semi-automatic rifles are used, according to a research letter published in the Sept. 11 issue of the Journal of the American Medical Association.

Elzerie de Jager, M.B.B.S., from Brigham and Women’s Hospital in Boston, and colleagues compared the number of persons wounded, killed, and either wounded or killed during active shooter incidents with and without semiautomatic rifles.

Seventy-six of the 248 active shooter incidents involved a rifle; a semiautomatic rifle was involved in 61 incidents (24.6 percent). The researchers found that 898 and 718 persons were wounded and killed, respectively. A higher incidence of

persons wounded (unadjusted mean, 5.48 versus 3.02; incidence rate ratio [IRR], 1.81; 95 percent confidence interval [CI], 1.30 to 2.53), killed (mean, 4.25 versus 44.9 percent; IRR, 0.99; 95 percent CI, 0.60 to 1.61).

“Semiautomatic rifles are designed for easy use, can accept large magazines, and fire high-velocity bullets, enabling active shooters to wound and kill more people per incident,” the authors write.

Gun Violence Threatens the Health of Our Nation

Why am I posting this issue again? Because it does affect the health care of our country with thousands being injured and killed and therefore needs surgical and medical care. Fed up with excuses for why policymakers cannot do anything to stop gun violence, Families USA–along with more than 170 national and state partners–are demanding action. They sent a letter to leaders in Congress urging full repeal of the ban on federally funded research into gun violence.

Last month, 17 people, including 14 students, were killed in a mass shooting at Marjorie Stoneman Douglas High School in Parkland, Florida. While the increased incidents of mass shootings are shocking, they are only the most visible instances of gun violence. Tragically, more than 35,000 people, including nearly 3,000 children, die from gun violence each year in the United States.

Gun violence disproportionately affects children of color

Gun violence knows no barriers. The shooting in Parkland was just the latest in a surge of mass shootings in places as diverse as a country music concert in Las Vegas, an LGBTQ nightclub in Orlando, and an African-American church in Charleston, SC. All people can be affected by this violence but is particularly felt in low-income and racial and ethnic minority communities. African American, Hispanic, and American Indian boys are all significantly more likely to be killed by gun violence than white children.

Families USA recognizes gun violence as a severe threat to the health of our nation. As an organization focused on health care, we have not engaged previously in the vigorous national debate on gun violence. We are entering that debate today because our nation is at a turning point.

While the numbers of people hurt are staggering, we know too little about the causes and effects of gun violence in our community. This is in part due to the “Dickey Amendment” — an effective ban on federally funded research into gun violence. It is past time for that ban to end.

As health care policy experts, we know that effective policy relies on evidence-based research. Despite gun violence is a leading cause of death for children, in 1996 Congress forbade any funding for the Centers for Disease Control and Prevention (CDC) that “may be used to advocate or promote gun control.” The Dickey Amendment, named after its congressional sponsor, has effectively stifled meaningful federal funding for research on the causes and effects gun violence. A recent study published in the Journal of the American Medical Association found that “in relation to mortality rates, gun violence research was the least-researched cause of death.”

Across the country, students are rallying to urge policymakers to take action against gun violence. They are asking adults to enact policies to stem the rising tide of gun violence against children. There are many policies that Congress should enact to protect young people and all Americans against violence, but the healthcare community is united in calling for the end of one policy that is clearly indefensible.

America’s gun culture in 10 charts

Students across the United States will join a national march to call for tighter gun control and to highlight the issue of school safety.

The March for Our Lives was organized by pupils at the Marjory Stoneman Douglas High School in Florida, where a former student is accused of killing 17 people last month.

The shooting, one of the worst in US history, renewed debate about gun laws and the rights of gun owners.

What do young people think about gun control?

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When looking at the period before the Parkland shooting, it is interesting to track how young people have felt about gun control.

Support for gun control over the protection of gun rights in America is highest among 18 to 29-year-olds, according to a study by the Pew Research Centre, with a spike after the Orlando nightclub shooting in 2016. The overall trend though suggests a slight decrease in support for gun control over gun rights since 2000.

Pew found that one-third of over-50s said they owned a gun. The rate of gun ownership was lower for younger adults – about 28%. White men are especially likely to own a gun.

How does the US compare with other countries?

About 40% of Americans say they own a gun or live in a household with one, according to a 2017 survey, and the rate of murder or manslaughter by firearm is the highest in the developed world. There were more than 11,000 deaths as a result of murder or manslaughter involving a firearm in 2016.

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Homicides are taken here to include murder and manslaughter. The FBI separates statistics for what it calls justifiable homicide, which includes the killing of a criminal by a police officer or private citizen in certain circumstances, which are not included.

Who owns the world’s guns?

While it is difficult to know exactly how many guns civilians own around the world, by every estimate the US with around 270 million is far out in front.

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Switzerland and Finland are the European countries with the most guns per person – they both have compulsory military service for all men over the age of 18. Cyprus, Austria, and Yemen also have military service.

How do US gun deaths break down?

There have been more than 90 mass shootings in the US since 1982, according to the investigative magazine Mother Jones.

Up until 2012, a mass shooting was defined as when an attacker had killed four or more victims in an indiscriminate rampage – and since 2013 the figures include attacks with three or more victims. The shootings do not include killings related to other crimes such as armed robbery or gang violence.

The overall number of people killed in mass shootings each year represents only a tiny percentage of the total number.

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There were near twice as many suicides involving firearms in 2015 as there were murders involving guns, and the rate has been increasing in recent years. Suicide by firearm accounts for almost half of all suicides in the US, according to the Centers for Disease Control and Prevention.

AA 2016 study published in the American Journal of Public Health found there was a strong relationship between higher levels of gun ownership in a state and higher firearm suicide rates for both men and women.

Attacks in the US become deadlier

The Las Vegas attack was the worst in recent US history – and five of the shootings with the highest number of casualties happened within the past 10 years.

The Parkland, Florida, the attack is the worst school shooting since Sandy Hook in 2012.

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What types of guns kill Americans?

Military-style assault-style weapons have been blamed for some of the major mass shootings such as the attack in an Orlando nightclub and at the Sandy Hook School in Connecticut.

Dozens of rifles were recovered from the scene of the Las Vegas shooting, Police reported.

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A few US states have banned assault-style weapons, which were totally restricted for a decade until 2004.

However, most murders caused by guns involve handguns, according to FBI data.

How much do guns cost to buy?

For those from countries where guns are not widely owned, it can be a surprise to discover that they are relatively cheap to purchase in the US.

Among the arsenal of weapons recovered from the hotel room of Las Vegas shooter, Stephen Paddock were handguns, which can cost from as little $200 (£151) – comparable to a Chromebook laptop.

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Assault-style rifles also recovered from Paddock’s room, can cost around $1,500 (£1,132).

In addition to the 23 weapons at the hotel, a further 19 were recovered from Paddock’s home. It is estimated that he may have spent more than $70,000 (£52,800) on firearms and accessories such as tripods, scopes, ammunition, and cartridges.

Who supports gun control?

US public opinion on the banning of handguns has changed dramatically over the last 60 years. Support has shifted over time and now a significant majority opposes a ban on handguns, according to polling by Gallup.

But a majority of Americans say they are dissatisfied with US gun laws and policies, and most of those who are unhappy want stricter legislation.

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Some controls are widely supported by people across the political divide – such as restricting the sale of guns to people who are mentally ill, or on “watch” lists.

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But Republicans and Democrats are much more divided over other policy proposals, such as whether to allow ordinary citizens increased rights to carry concealed weapons – according to a survey from Pew Research Center.

In his latest comment on the shootings, President Donald Trump said he would be “talking about gun laws as times goes by”. The White House said now is not the time to be debating gun control.

His predecessor, Barack Obama, struggled to get any new gun control laws onto the statute books, because of Republican opposition.

Who opposes gun control?

The National Rifle Association (NRA) campaigns against all forms of gun control in the US and argues that more guns make the country safer.

It is among the most powerful special interest lobby groups in the US, with a substantial budget to influence members of Congress on gun policy.

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In total, about one in five US gun owners say they are members of the NRA – and it has especially widespread support from Republican-leaning gun owners, according to Pew Research.

In terms of lobbying, the NRA officially spends about $3m per year to influence gun policy.

The chart shows only the recorded contributions to lawmakers published by the Senate Office of Public Records.

The NRA spends millions more elsewhere, such as on supporting the election campaigns of political candidates who oppose gun controls.

I’m not sure the correct answer to all these shootings but something has to be done. I’m not sure how we read the minds of those with mental issues but we need to find ways to evaluate and give them help and treat them and keep guns away from them, especially automatic weapons.

Back to our discussion on single payer systems and Medicare for All next week.