CRITICAL CARE - America vs the World

NOTE:  U.S. healthcare costs are considerably higher than other countries as a share of GDP, among other measures.  According to the OECD, U.S. healthcare costs in 2015 were 16.9% GDP, over 5% GDP higher than the next most expensive OECD country.  A gap of 5% GDP represents $1 trillion, about $3,000 per person or one-third higher relative to the next most expensive country.

The high cost of health care in the United States is attributed variously to technological advance, administration costs, drug pricing, suppliers charging more for medical equipment, the receiving of more medical care than people in other countries, the high wages of doctors, government regulations, the impact of lawsuits, and third party payment systems insulating consumers from the full cost of treatments.  The lowest prices for pharmaceuticals, medical devices, and payments to physicians are in government plans.  Americans tend to receive more medical care than people do in other countries, which is a notable contributor to higher costs.  In the United States, a person is more likely to receive open heart surgery after a heart attack than in other countries.  Medicaid pays less than Medicare for many prescription drugs due to the fact Medicaid discounts are set by law, whereas Medicare prices are negotiated by private insurers and drug companies.  Government plans often pay less than overhead, resulting in healthcare providers shifting the cost to the privately insured through higher prices.  - Wikipedia

"The U.S. spends nearly $4 trillion on health care, but inequities still exist.  Here’s why." PBS NewsHour 4/21/2021

Excerpt

SUMMARY:  The U.S. spends nearly $4 trillion on health care, yet inequities in care continue to persist.  With 30 million Americans uninsured during the pandemic, is universal health care the answer?  William Brangham explores the matter in our new documentary, "Critical Care: America vs. The World."  He joins Judy Woodruff to preview and discuss the special.

HEALTH CARE - Drowning in Debt

"Should the federal government be able to negotiate the prices of prescription drugs?" PBS NewsHour 12/12/2019

Is this even a real question?  Of course we should, that is one reason we pay more for medical drugs than many other nations.  And of course Republicans receive very big 'donations' for Big Pharma.

Excerpt

SUMMARY:  Americans spend more on prescription drugs than any other country in the world: about $1,200 per person every year.  One in four say the cost is problematic, and some say they haven’t taken their medicine as directed as a result.  In Congress, both parties are looking to address the problem -- but with different approaches.  William Brangham talks to Emmarie Huetteman of Kaiser Health News.

"Americans are drowning in medical debt, so this nonprofit is buying — and forgiving — it" PBS NewsHour 12/12/2019

Excerpt

SUMMARY:  Collectively, Americans owe nearly a trillion dollars of medical debt, and Congress is trying to figure out a policy response.  But in the meantime, economics correspondent Paul Solman reports on an unusual non-profit’s effort to relieve the burden of medical debt for those in need.

Here's another thought:

1. Our present health care system = [you] -> [middle man, fee & profit driven health insurers] -> [health care provider, doctors, hospitals, pharmacy]
2. Better way = [you] -> [Medicare, fix fee not-for-profit] -> [health care provider, doctors, hospitals, pharmacy]

TRUMP ADMINISTRATION - Are Health Insurance Giants Running Medicaid?

"Are Trump’s Top Medicaid Regulators Ignoring Major Problems?  Insurance Giant’s Tense Meeting With a Senator Adds to Growing Concern." by J.  David McSwane (ProPublica) and Tom Benning (The Dallas Morning News), ProPublica 8/6/2019

The CEO of Centene, a company now entangled in a broader federal inquiry, met with Sen. Bob Casey to allay concerns that patients are being neglected.

This story was co-published with The Dallas Morning News.

The ranking member of the Senate health committee has complained for months about the Trump administration’s failure to look into Medicaid contractors that have reaped big profits while sometimes failing to provide crucial patient services.

So last week, Sen. Bob Casey (D-Pa) called in the top boss of Centene, the nation’s largest Medicaid managed care company.  He wanted to question the company about reports that its Texas subsidiary denied life-sustaining care to sick and disabled children — in one case, leaving a baby in foster care to suffer a catastrophic brain injury.

The meeting with longtime Centene CEO Michael Neidorff did not go well, according to Casey.

“I thought they would try to persuade me that they were going to do better, but they didn’t seem interested in that at all,” Casey told ProPublica and The Dallas Morning News in an interview.  “I just couldn’t believe it.”

Casey said the Centene official denied providing inadequate care and cast blame for failures on foster parents and nurses.

Centene declined to make Neidorff available for an interview and emailed a brief statement in response to questions about the meeting with Casey.

“Centene and its subsidiaries care deeply about each and every member we serve,” the email read.  “We work tirelessly to ensure we provide the appropriate level of care for our members.”

Under Neidorff, Centene has grown from a tiny health network in the Midwest into a $60-billion-a-year health care empire, backed almost entirely with taxpayer money.  The company cares for more than 8.5 million Medicaid patients.

The company came under criticism last year after an eight-part investigation published in The Morning News examined whether Centene and other Medicaid managed care companies were skimping on care to bolster profits.  The series raised questions about Centene’s Texas subsidiary, Superior HealthPlan, and its handling of the case of D’ashon Morris, a Texas toddler who was born with severe defects and was living in a foster home.

The series, titled “Pain & Profit,” reported that D’ashon was denied 24/7 nursing care and suffered brain damage after a medical incident that occurred while he did not have his nurse around.  (Read the full story here)

The Morning News reported that state health officials had found the Centene subsidiary in violation of state and federal Medicaid rules and recommended the company face steep fines for what happened to the child.  But top Texas health officials never assessed those fines, The Morning News reported.

D’ashon’s adoptive mother sued the Centene subsidiary in Texas state court.  That case is tied up in the Texas appeals court, where the Centene subsidiary has argued that the lawsuit should be dismissed because D’ashon and his mother are stifling the company’s right to free speech.

During hearings in the state Capitol, Superior representatives denied that the company’s refusal to provide 24/7 nursing was improper.

After his meeting with the Centene official, Casey sent a strongly worded letter to Seema Verma, a former health consultant appointed by President Donald Trump to run the Centers for Medicare and Medicaid Services.

In the letter, Casey called Centene’s response to questions about D’ashon’s case “callous.”

He also asked Medicaid officials to dig further into Centene’s business practices and to provide documentation on any response to The Morning News investigation.

“It’s another indication that the regulatory approach here by the administration is, at best, suspect,” Casey said.

A CMS spokesman said that Texas officials have shared with the agency an “action plan they intended to take to address the concerns raised,” adding that CMS is in regular communication to ensure the state improves.

“CMS has received Sen. Casey’s letter and will respond to his office directly,” spokesman Brian Leshak said in an email.

Casey’s position as the top Democrat on two Senate panels overseeing federal health programs gives him the standing to raise questions about the Medicaid managed care system.

It’s not unusual for company officials facing a federal audit or investigation to meet with members of Congress to address concerns, but it is unusual for such meetings to spill into public view.

Casey said he sent the letter to CMS because of what he called Centene’s “cold and clinical” defense of what happened in D’ashon’s case.  He said it gave him concern about how the company cares for other patients — and what, if anything, regulators are doing when things go wrong.

Last month, more than a year after The Morning News story was published, Centene officials provided Casey’s office with a one-page rebuttal titled: “The Dallas Morning News got it wrong.”

The company’s explanations include that D’ashon’s foster mother was a trained nurse.  But, as The Morning News reported, she was on an approved vacation at the time of D’ashon’s injury, and he had been placed in a different foster home.

The company also said D’ashon’s foster mother should have restrained the baby, but The Morning News previously reported that Texas foster care officials confirmed restraints would have required a doctor’s order, which she did not have.

“It was all blame shifting and pointing to other factors,” Casey said of Centene’s letter.

Casey said the meeting left him wondering why federal regulators weren’t doing more.

“It might even be worse than asleep at the wheel,” he said of CMS under Verma’s watch.

“They may be awake at the wheel but choosing consciously to say, ‘We’re going the other direction.’”

Without commenting on specific cases, the CMS spokesman said the agency routinely monitors states and intervenes when necessary.

Problems with this privatized Medicaid model have grabbed headlines in other states, too.  And advocates in those states said they haven’t heard much from CMS, which they say is a shift from the Obama administration.

In Iowa, for instance, The Des Moines Register reported failures to provide care and chronicled patients who had been caught in that state’s broken medical appeals system.

Rob Sand, Iowa’s state auditor, wrote to state officials in June that two large managed care companies had “significantly harmed” two paraplegic patients by refusing to provide services they needed.

Mary Nelle Trefz, of Iowa’s Child and Family Policy Center, said she’s been shocked to hear nothing about that from CMS.

“I don’t feel, or can’t observe, or point to anything, where CMS has stepped in to provide that oversight and accountability,” she said.

In March, California’s state auditor found that millions of children in that state’s privatized Medicaid system weren’t being provided services that taxpayers had paid for.  Auditor Elaine Howle blamed California health officials’ “deficient oversight of the managed care plans.”

Andy Schneider, a researcher at Georgetown’s Center for Children and Families, and a former top adviser to CMS under the Obama administration, said these episodes come at an inconvenient time for the Trump administration, which is focused on reducing regulation and creating additional eligibility hurdles like work requirements.

CMS has taken a hands-off approach compared with the previous administration, he said.

“These are reports coming from reputable media sources,” he said.  “They’re very concerning, they have to do with the operation of the program, they suggest that something is wrong.”

OPINION - Shields and Brooks 7/19/2019

"Shields and Brooks on Trump’s attacks, Biden vs Sanders on health care" PBS NewsHour 7/19/2019

Excerpt

SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week’s political news, including President Trump’s attack on four congresswomen of color, the Republican response to Trump’s controversial rhetoric, whether race politics is smart election strategy and the battle over health care policy among 2020 Democrats.

Judy Woodruff (NewsHour):  And that brings us to the analysis of Shields and Brooks.  That's syndicated columnist Mark Shields and New York Times columnist David Brooks.

Hello to both of you.

Mark Shields, syndicated columnist:  Thank you, Judy.

Judy Woodruff:  So let's go back to these attacks by the President.  They have now lasted a full week on these Democratic congresswomen, all of them, congresswomen, all members — all women of color.

He has called them a variety of names and he's told them, David, to go back to their countries, their home countries.  Of course, they're all U.S. citizens.  Three of them were born in the United States.

What does all this tell us about President Trump, about these women member of Congress, about our country?  And what does it say about racism?

David Brooks, New York Times:  Well, it's racist.  Let's get that off the top.  It's a pretty clear example of it.

To me, it shows that what Trump wants to do is make this election about what America is.  And he has a certain vision of what America is.

And his vision, America is xenophobic.  The good people of the heartland are being threatened by outsiders and by Muslims and by people who don't look like them.  It's a vision that is nostalgic, looking backward to the past.  And it's a vision of a white America, that white Protestants created this country, and the rest of us are here by their sufferance.

And this is the national story he wants to tell.  And I think it's up to the rest of us to tell a better story about America, that we're a universalistic country, we're a country defined by our future, what we're building, and not by our past, and that we're a country that's traditionally had a mission to cross frontiers.

And one of the missions we have right now is to create a mass multicultural democracy, where people of all races can be united in one democratic process.  And that is a hard thing to do.

But Donald Trump is pointing us in the exact opposite direction.

Judy Woodruff:  How do you see all this?

Mark Shields:  I see it probably less cosmically than David…… although I agree totally with his historical and philosophical perspective.  I don't think Donald Trump has a vision.

I think he has a vision of the campaign.  What Donald Trump wants to do — Richard Nixon, who, along with Franklin Roosevelt, only two Americans ever to run five times for national office, and win four times, said of vice Presidents, when you pick a vice Presidential running mate, it never helps you, it always hurt you, because you're either explaining or defending or apologizing for what that vice Presidential nominee said that morning in Portland or Peoria.

Case for the prosecution, Sarah Palin and John McCain.  And what Donald Trump is trying to do, in a very cynical and callous fashion — and David's absolutely right about the racist implications of it — is to marry these four freshman members, to make them the running mate, whoever the Democratic nominee is.

And the Democratic nominee then would have to — these — the four of them — let's be very blunt about it — like Donald Trump, are heliotropic plants.  Heliotropic plants, sunflowers, seek the sun.  They turn to get the sun's rays.

These four women have shown a remarkable facility and gift for seeking cameras and seeking microphones, and winning that attention, just as Donald Trump did.

And so that's what he wants to do.  They have said — got there by saying terribly controversial things, by criticizing their own party leadership.  And that's what Donald Trump wants to do to whoever the Democratic nominee is.

He knows, if the election of 2020 is a referendum on who he is and his failings, Americans do not like him.  They do not trust them.  They do not respect him.  They do not think that he is an object of inspiration in any way to them or their children.  Then he loses.  But he has to make it about something other than himself.

Judy Woodruff:  But — so, David, does this help the President?  I'm asking in part because we watched the cross-section of Republican reaction.  Some Republicans were critical.

A few, a number of them embraced him, but a lot of them were quiet.

David Brooks:  Yes, there are two theories of how Trump could win this election.

One is — and they're both based on, I, Donald Trump, have to win over people who don't like me, because the majority doesn't like Donald Trump.

[1] The one theory is, he drives the Democratic Party so far left that people think they have no choice but to vote for Donald Trump.

Mark Shields:  The '72.

David Brooks:  Right.

And by embracing the Squad — and by attacking the Squad, he forces the entire Democratic Party to embrace the Squad, and the Squad becomes the voice of the Democratic Party, at least for a week.

And that's one theory.

[2] The second theory is, I don't like Donald Trump, but I like this economy.  And that theory is, you lay low and just let the economy do your speaking for you.

Laying low is not really Donald Trump's style.  So he's going with this.

Do I think it will end up working?  No, because, fundamentally, the vast majority of America like living in a diverse country.  The vast majority of America abhor racism.  And so it may work with a small base, but I think, on balance, the evidence is very clear the vast majority of the country finds it repellent.

Judy Woodruff:  Well, we had a crowd behind him this week in North Carolina, Mark.

Mark Shields:  He did.  They were — he was with the crowd, and then he was against the crowd.  Now he's back with the crowd, we have learned most recently.

Judy, the vote for President is the most personal vote that any of us Americans cast.  We're far more apt to cast a vote based on issues, whether it's the economy, or immigration, or the environment, for the United States senator for Congress.

But in a Presidential race, we have an information overload.  We have a feel for who these people are as individuals and whether we would like them, whether we trust them.

Donald Trump is presiding over the greatest economy, in employment terms, in the history of any American under the age of 68.  You could say, 50 years ago, it was, you know, almost as good.  We were at war then.  This is a peacetime economy.  It's a remarkable thing.

And yet, Judy, we sit here tonight, and 13 percent of Americans say they're often inspired by what he says.  And half of Americans say they're never inspired.  Americans do not trust him.  I mean, one-third think he's honest and trustworthy.

So, Donald Trump has to make this election not about him.  If it's about him, if it's a referendum on him and his qualities, because Americans have already decided.  They don't.  He's never been a single day of his presidency had a majority of Americans say they approve of him, with this greatest economy ever.

So, I mean, he wants to make it — he doesn't want to make it about him.  He was smart, he would just withdraw and go to ground zero and say, look at the economy.  I have done it.  I'm working on it.  That's all I'm doing, and keep — he can't.  He cannot.

David Brooks:  Yes.

It's worth pointing out that my newspaper had an analysis today by heliotropic on how the Electoral College could differ from the actual popular vote.  And the analysis was, Trump could lose the popular vote by 5 percentage points, which is way more than I think the 2.8 he lost last time…

Mark Shields:  Ya.  Ya.

Judy Woodruff:  Ya.

David Brooks:  … and still carry the Electoral College.

So this really is about Wisconsin, Michigan, Pennsylvania, and Ohio.

OPINION - Shields and Brooks 6/28/2019

"Shields and Brooks on Democratic debates, Supreme Court rulings" PBS NewsHour 6/28/2019

Excerpt

SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week’s political news, including the first debates for 2020 Democratic candidates, whether that party has shifted too far to the left to be viable and Supreme Court decisions on partisan gerrymandering and including a citizenship question on the 2020 census.

Judy Woodruff (NewsHour):  It's been a big week for news.

Twenty Democrats took the stage for the first time, and nine Supreme Court justices finished their term, with two key cases that could reshape how our democracy functions.

Here to reflect on it all are Shields and Brooks.  That is syndicated columnist Mark Shields and New York Times columnist David Brooks, who joins us from Aspen, Colorado.

Hello to both of you.

David, I'm going to start with you.

You are — you are in Aspen, but I gather you did watch those debates over the last two nights.  Let's start by talking about the main takeaways.

David Brooks, New York Times:  Yes, I'm getting in touch with the real America out here.

You know, I think my main takeaway is how far the Democratic Party has gone to the left and how little the moderates in the debates have any interest in fighting it.

Two candidates, Warren and Sanders, said they wanted to get rid of all private health plans, employer-based health plans.  Only 13 percent of Americans agree with that.

All of the candidates of all stripes seem to think they can't get anybody to their left on immigration policy, and they're wondering very close to sort of an open borders-type approach.  And this would be, I think, devastating in the fall.

This country has 35 percent of the people who call themselves conservative, 35 percent who call themselves moderates, and 26 percent who call themselves liberals.  You can't win with 26 percent.

But this debate was entirely within that — that little parenthesis.

Judy Woodruff:  Is that what you're seeing, Mark, in this first debate?

Mark Shields, syndicated columnist:  Well, I don't see things exactly the way you do from Aspen.

But, no, I would say this, Judy.

For those Democrats for whom the highest mortal objective politically in 2020 is the retirement of Donald Trump, it's not been a good week.  The — if you think about it, the great unfinished business of Franklin Roosevelt's New Deal and Lyndon Johnson's Great Society and Harry Truman's Fair Deal and Jack Kennedy was national health insurance.

And at great political cost, the Democrats, without any help from the Republicans, with total objection and resistance, passed it in 2010, under a Democratic President, Barack Obama.  And ever since then, five consecutive elections, Republicans have run on, we're going to repeal it, going to repeal it.

As a consequence, Democrats — public by 2-1 thinks the Democrats are better on health care.  So what do the Democrats suggest?  We're going to get rid of it.  We're going to get rid of it, going to get rid of — you like private health insurance that you have and guaranteed for preexisting conditions covered under the Affordable Care Act, we're going to get rid of private insurance.

I mean, and this is a party, let's be honest, in a polarized Washington [DC], couldn't pass an adjournment motion, but they're going to pass this national health.

So I would say — I would say it was impractical, unhelpful, and flirted with open borders on immigration.  And I just — I just think the whole image coming out of that was not of a party that was responding to voters, but responding to its own interests and its own constituencies.

Judy Woodruff:  But, David, when you stack all the Democrats up, isn't it the case that most of them are saying they're not ready to throw out private insurance yet?

David Brooks:  Right.  That is true.

And I think one thing that it's worth reminding ourselves about is that most voters are new to these people.  And the instant polls after the debates are not quite what we read on Twitter.

A lot of people — and I mean a lot of the candidates saw their approval rating go up significantly, because, for Cory Booker, it's the first look for a lot of people.  And they sort of liked what they saw.

For Biden, the conventional wisdom he did so poorly, but not so much the instant polls.  He did suffer little with that Harris interchange on busing.  But people still like Joe Biden, and so he hasn't sunk himself.

I do think he [Biden] has to prove next time that he's able to go toe to toe with Donald Trump.  And if he couldn't go toe to toe with Kamala Harris on an attack that was pretty — he should have anticipated, it'll be harder to go toe to toe with Trump.

So, in some sense, his debate performance next time becomes much more crucial.

Judy Woodruff:  How did you read how Joe Biden handled last night.

Mark Shields:  Badly.  Badly.

I mean, he was unprepared.  He had to know the charge was coming, having had so much coverage for his mentioned sort of and reminiscence about Jim Eastland of Mississippi and Herman Talmadge of Georgia, his colleagues for whom he had gotten along with, and who were arch segregationists, both, and that he was unprepared for it, almost like he recoiled and it was personal.

I thought that Joe Biden stood in bad contrast, quite frankly, to Pete Buttigieg, the mayor of South Bend, who accepted responsibility.  He [Buttigieg] owned the fact that the South Bend Police Department had not — had failed to recruit African-Americans, and took that responsibility and said, it's on me.

And Biden just somehow couldn't do that.  And it was a tortured argument he made for the difference between his position in Wilmington and Kamala Harris'.

I mean, let's be very frank.  Civil rights has been a national issue in this country.  States' rights has been the resistance mantra.  And I just — I just thought Joe Biden did not — did not handle it well.

When he was asked what his principal objective would be on first day in office, he said, defeat Donald Trump.  Well, if you're going to have a first day in office, that's sort of a given.  You have defeated Donald Trump.

Judy Woodruff:  So, David, whether it was Kamala Harris or Pete Buttigieg or we — lest we forget the first night, when we had Elizabeth Warren up there with the others.

Were there candidates who significantly help themselves in these debates?

David Brooks:  Yes, I would say Warren and Harris would be the two.

What's interesting is, right now, the key fight is, who's going to be the progressive rival?  Who's going to be the progressive — the face for the progressive side of the party?  And Warren and Sanders and Harris are all vying for it.

I think Warren and Harris did particularly well.  I have always thought Harris was going to be the most formidable progressive, just because her whole life going back to when she was a prosecutor, she's just a forceful arguer.

She says, I have been an eye for an enemy, and I know how to go after them.  And that strikes me as right for the mood of a lot of progressive and a lot of Democrats.  So I think they helped themselves.

What's interesting to me is, will there be a moderate reprisal?  Amy Klobuchar from Minnesota should have come up and say, no, I don't think that our party should go there.

She should have pulled that punch.  Michael Bennet from Colorado tried to do that.  And then the final piece is Buttigieg, who seems to hover between the two camps.

And so I would say his path to the nomination, the way it looks today, is that the two camps get tired of fighting each other, and they need some sort of unity candidate, and Buttigieg could potentially be that kind of person.

Judy Woodruff:  How do you see the — whether anybody, anybody in this group helped themselves?

Mark Shields:  Judy, I would take us back to December 9, 2003, six weeks before the Iowa caucuses.

Al Gore, former vice President, who had won the popular vote against George Bush in 2000, just three years earlier, broke the political world wide open.  He endorsed Howard Dean, the Democratic chairman, former chairman, and made his nomination inevitable.  Five weeks later, it was over, was the Dean campaign.

I mean, so, this is the opening day of the season is what we're seeing.  I would say this.  I would say, collectively, for the Democrats, it was not good.

Just think of the 80 yards of the field that Republicans have surrendered to them on the abortion issue.  Republicans have been running away from what Republicans did in Alabama and Georgia and in Missouri, in Ohio.  And the President has been distancing himself even.

And what do Democrats do?  I mean, they basically just endorse abortion and throw in — well, how about trans people, covering abortion?

I just — I mean, to me, they just — wasn't thinking in terms strategically.  I mean, they owned the majority position in the country, safe, legal, rare.  And so, to me, I just don't understand the strategy.

David Brooks:  Yes.

I would say, across all issues, there's an insularity problem.  They sometimes talk as if they're campaigning for Brooklyn.  And so on a lot of issues, whether it's the economy, whether it's abortion, whether it's immigration, I don't think they're quite perceiving how a lot of people, even in Democratic House districts, are perceiving them and seeing them as something quite strange.

Judy Woodruff:  I want to ask you both about the big Supreme Court decisions that came down yesterday.

David, I'm going to come back to you on this.  You saw a divided court, two big decisions, the first one on what's called partisan gerrymandering.  It's when states draw lines based on — for partisan reasons, to hurt the other political party.  The court basically said, that's OK, that can continue.

David Brooks:  Yes, I think we're all disgusted by gerrymandering.  It's a complete manipulation of the electorate.

The question is, how do we fix it?  And I sort of think that the best way to do it is through independent commissions.  Voters in eight states so far, five in 2018, voted to create an independent commission, and to have them draw the lines.

And I, frankly, think that's a better option than letting legislators do it, who are inherently compromised, because it's political, or letting the courts do it, who have no accountability.  So I'm sort of glad that the courts decided this is not going to be a court issue.  We're not going to impose this on the country, because I think it would politicize the courts.

But it does mean everybody has to work a lot harder to try to get independent commissions in their own state.

Mark Shields:  The court found out that segregated schools were separate, but unequal, but we're not going to go near that, because it's going to be too difficult.

That's basically what the decision was yesterday.  We found out that this is unjust, it's undemocratic, it's corrupting to have this system, but we're not going to get — we're not going to dirty our own hands with it.

I agree with David in the best of all possible worlds.  It's an Iowa, Arizona approach, where you have a commission and it's fair and fairly done, and not done like it's been done in Ohio, or Maryland, or North Carolina.

But it's got to be remedied.  I mean, we're talking about a democracy that's under siege in this country and from Russia, as we have learned again.

So, to me, I just think it's — Justice Kagan was absolutely right.  It's a duty and a responsibility to act.

Judy Woodruff:  Both of these decisions very much affecting the functioning of our democracy.

Just quickly, David, less than two minutes.  Of course, the other decision had to do with the Trump administration's attempt to insert a citizenship question in the 2020 census.  The court in this case said that the Trump argument had just not — had not been one that they could buy.  So — and they sent it back and said, for now, we're going to let this go forward.

What does this say to you?

David Brooks:  Yes, the word I think the justices used was contrived.

It was a contrived argument.  They were trying to think of some way to deter immigration or not provide benefits for communities that had a lot of immigrants or maybe undocumented immigrants.  So I think there's no reason to ask this.  There's no reason to try to use the census to push people into the shadows, which is really what this is an attempt to do.

So I'm — I wish there had been a more clear ruling, but at least they did utter the elemental truth that this was a contrived reasoning, which was really an attempt to deter immigration from coming out into the open.

Judy Woodruff:  And this was a case, Mark, just quickly, where the chief justice joined with the four more liberal justices.

Mark Shields:  He did.  He did.

And it was based on a lie, I mean, Commerce saying the Justice Department wanted this to enforce the Voting Rights Act, which was a total fabrication.  It came from the Department of Commerce.  It came from the political arm of the Trump organization.

Wilbur Ross, the Secretary of Commerce, it did not originate with him intellectually, but it did politically.  So it was — it was obviously just an attempt to rob people of what is deserved, I mean, not simply representation in numbers, but so many programs, the formula is based upon need.

And if we don't even know these people, as David said, if they're in the shadows, if they don't exist, they're going to be deprived of what they are owed.

Judy Woodruff:  Both of these decisions very much worth — worth reading over the weekend, if people haven't had a chance to so far.

Mark Shields:  I agree.

Judy Woodruff:  Thank you both, Mark Shields, David Brooks.

Mark Shields:  Thank you.

U.S. HEALTH CARE - Hidden Costs

"Trump pushes for new transparency with health care prices — but will it lower them?" PBS NewsHour 6/24/2019

Again, the U.S. lags behind the other nations that have universal health care, that the citizens like (worth every penny).  And these nations have smaller GNP than the U.S. and still afford it.

NOTE:  Trump's solution only applies to ELECTIVE heath care.  So what about when you have a heart attack and are taken to a out-of-network ER?  You can guess, you're out of luck (unless you're rich).

Excerpt

SUMMARY:  Uncertainty around the costs of prescription drugs and health care in general is worrying Americans.  A recent study found that one in six were surprised by a medical bill from a hospital treatment in 2017.  On Monday, President Trump issued executive orders requiring greater transparency around medical costs.  But will they help?  Nick Schifrin talks to Elisabeth Rosenthal of Kaiser Health News.

OPINION - Shields and Brooks 3/29/2019

"Shields and Brooks on Mueller report, Trump’s health care move" PBS NewsHour 3/29/2019

Excerpt

SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to analyze the week's news, including Attorney General William Barr’s handling of the Mueller report, President Trump’s “bewildering” announcement on the Affordable Care Act, and how Democrats should approach health care policy.

Judy Woodruff (NewsHour):  From the Attorney General's handling of the Mueller report to the renewed battle on health care, it's been a busy week in Washington [DC].

Here to help us understand it all, syndicated columnist Mark Shields and New York Times columnist David Brooks.

Hello to both of you.

So, we now just in the last few hours have heard from the Attorney General that we are going to see this almost 400-page report, but with — David, with redactions, that all he's saying he's sent so — he's said so far is, he shared some principal conclusions.

But, based on that, what do we make of it?

David Brooks, New York Times:  I think Barr's doing a good job.  He got the — basically, the headlines out of the way right away, which is all he could do.

And now he's gone through a nearly 400-page report.  He can't release everything because there are still ongoing investigations that he doesn't want to compromise.  And there are sources and methods.  So, he had to comb through it and had to take some time.  But he's made it very clear that it's going to be released.  He's made it very clear he is not going to give the White House an early shot that will allow them to claim executive privilege.

And he's made it clear it's going to be out within a couple weeks.  So, overall, I think he's acting like a professional.

Judy Woodruff:  Like a professional, Mark?

Mark Shields, syndicated columnist:  Very much.

I mean, Bill Barr had a reputation, earned reputation, in Washington of being a square shooter, a fair guy.  And he's living up to that.  I mean, there were questions about surrounding his taking of the job, because it looked like he had a job application when he sent this extended memo to the White House on doubting the authority and purview of the special counsel and the particular investigation.

But I just think it's what the Democrats have been asking for.  It's what the public's been asking for and it's what the press has been asking for.

Judy Woodruff:  But you said, David, you're confident he's going to release most of it.  But he did say redactions for security reasons, for legal reasons and also personal reputation.

We are — there was a poll that was done in the last few days that we did in conjunction with NPR and Marist.  People were asked, should the whole, should the full report be seen?  Seventy-five percent said yes.  And more than half of Republicans said, we should see the full report.

David Brooks:  That's sort of the good news.

I was more struck by 40 percent of Republicans don't want to see the report.  Like, who are the "we don't want any information" party?

Mark Shields:  Yes.

David Brooks:  That seemed kind of surprising to me.

But I do think it was inevitable — I think we talked about this a couple weeks ago — that it was going to come out.  When a prosecutor indicts are not indicts a normal human being, they should not release their information if there's no indictment.

But this is not strictly a criminal case.  This is a case about the behavior of the administration, the behavior of the nation's highest elected officials.  And voters certainly have a right to know, beyond legal or illegal, the nature of the administration.

Let's face it.  Mueller has had an eye into this administration that no other — no reporter has had, nobody has had.  And so he will have — he will tell us interesting things, which voters can make their mind up about in a couple years.

Judy Woodruff:  But, Mark, it seems to me the Attorney General is signaling today with this letter to Congress that he is going to leave some things out that are part of grand jury business.

Mark Shields:  Well, grand jury, Judy, of course, that's the rule that's been cited, 6(e), the rules of civil procedure, criminal procedure, that you have to — you have to keep that secret, testimony before a grand jury.

And let's be very blunt.  I mean, this is going to get out.  The whole thing is going to get out.  And so if he holds back substantial, significant, relevant information, then he's putting his own reputation on the line.

I question whether he's going to do it.  The fact that was mentioned at the outset that he's got a question of whether in fact executive privilege, the White House doesn't, I mean, that's a pretty big weapon he has.

Judy Woodruff:  And I noticed that he said, although the President would have the right to assert privilege, he has stated publicly he intends to defer to me.

Mark Shields:  Yes.

Judy Woodruff:  And, accordingly, he says there are no plans to submit the report to the White House.

(CROSSTALK)

David Brooks:  And it should be said over all this that, just as a country, whatever you think of Donald Trump or not Donald Trump, we have averted a lot of disasters.

I mean, it would be, frankly, a disaster to learn the President of the United States was colluding with a foreign enemy.  It would also be a disaster to get involved in a Presidential claim of executive privilege, as happened in Watergate, and we get mired in to months or years-long legal fights.

And so, so far, we're avoiding what could be the worst of all this situation.

Judy Woodruff:  But you already have the President saying, I have been exonerated, I'm cleared by this, and the people who criticize me are all wrong.

Mark Shields:  Yes.  That surprised the dickens out of me, that, Judy.

(LAUGHTER)

To be very blunt about it, what Donald Trump has done is, in the words of Daniel Patrick Moynihan, is, he has defined deviancy down.

I mean, this is a man who exalted, who took a victory lap, who did chest-pounding, spiked the football on the news that his campaign chairman is a convicted felon, his principal adviser on national security is a convicted felon, his deputy campaign chairman, his personal lawyers are all convicted felons.

I mean, this hasn't happened in any administration in the history of the country, including Richard Nixon's.  And he goes before the Republican Senate luncheon last Tuesday, and they give him a standing ovation, a standing ovation.

I mean, that is defining deviancy down.  But, I mean, the fact is, Bob Mueller, a week ago or 10 days ago on this broadcast, David, I think, were in total agreement, is a patriotic, able, committed, honest, and exceptionally professional prosecutor and lawyer.

And he is today, even after the decision.  I mean, and I think we have to acknowledge that.

Judy Woodruff:  But he did clear — and he did clear the President, at least according to these conclusions by the Attorney General, of any — of conspiracy.  He said there was no conspiracy, no evidence of that, or he didn't use the word collusion, but coordination with the Russians.

And then he went on to say, no evidence of any obstruction of justice.  So the President can say…

(CROSSTALK)

David Brooks:  He can say that.

And a lot of people got out ahead of the evidence and claimed there was collusion and claimed there was — he was an agent, that he had betrayed the country.  And they did their cause great harm, because they allowed Donald Trump to say, see, they're wrong.  And they were wrong.

For Donald Trump to claim that he's therefore exonerated is the exact opposite of the truth, for reasons Mark enumerated.

I was struck by the reaction of two different Democratic Presidential candidates.  Saturday after the — we learned there was going to be a report of no collusion, Beto O'Rourke still went out and said he had colluded and still went out and inaccurately described what Donald Trump had done with the Russians.

Pete Buttigieg, the Democratic mayor of South Bend, who is also running, said, why don't we talk about the issues that voters care about?  Why don't we talk about why people felt they had to vote for Donald Trump?

And so one candidate was really focusing on the scandal.  And one candidate was focusing on, what are the issues that people are going to decide?  And that is sort of a decision the Democrats and, frankly, we in the media have to make.  What issues do we pay attention to or what do we give what weight to?

And I would say the latter are more valuable in informing.

Mark Shields:  I agree with David.  I would just say this.  There isn't evidence of collusion.  That's what they came to — or the conclusive evidence of collusion.

But, I mean, let's be very blunt about…

Judy Woodruff:  But I should say, the President also didn't submit to an interview with…

Mark Shields:  He did not submit on that.

But this is also a President and his campaign that actively sought the interference of a foreign government and welcomed it and saw nothing wrong with it, in corroding and eroding America's trust in our system and attacking a Democrat — a Democratic Presidential nominee.

I mean, the fact that he saw nothing wrong with it, it's not — I'm not talking about criminal, but it is of interest and of importance.  And it does signify something about the character of the individuals.

David Brooks:  Yes, Mike Gerson, who sometimes sits in this chair, said the report seems to show that Trump is a stooge of a foreign power, but not an agent of a foreign power.

Mark Shields:  Yes.

David Brooks:  So, if that's your victory, that's your victory.

Judy Woodruff:  Well, you mentioned, David, the Democrats, some of the Democrats anyway, talking about issues, and some of them saying voters are not bringing up to me the Mueller report when I'm out on the trail.

The President turned to health care after this in an interesting way, said — his administration is trying to completely repeal the Affordable Care Act, Obamacare.  But he also said the Republicans are going to be the party of health care.

David Brooks:  After he's the President of humility and modesty.

(CROSSTALK)

(LAUGHTER)

Yes, I thought it was bewildering.  And a lot of other Republicans felt it was bewildering too.  McCarthy in the House advised the President not to do this.  It's not an issue on which he [Trump] has any credibility.

It's not an issue, frankly, the party has led in any glorious way.  It's not anything he has run on before.  It seems, to me, wandering into a mine field.  Mitch McConnell's already made it quite clear that he's not going to help write a Republican piece of legislation.

And so they could come up with a plan, which would be a good thing to do.  But why Donald Trump thinks this is the right move for him or for his party is something of a mystery.  And it's always an error, I think, with the President to try to divine his motives and his strategy, because there's usually no — nothing back there.  It's just things coming out.

And so, — it's a weird chapter in his [Trump] Presidency.