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Public Health

yikes, neglected (what else is new :(

see adam conover, michael lewis

restore the commons

OMFG

an 11 25

When President Donald Trump posted a satirical music video on social media in early October depicting his budget director, Russell Vought, as the Grim Reaper lording over Democrats in Congress, public health workers recognized a kernel of truth.

Vought has exerted extraordinary control over government spending this year, usurping congressional decisions on how the nation’s money is used. His push for more layoffs during the government shutdown is only the latest blow, following months of firings, canceled grants, and withheld funds.

By cutting and freezing public health funds, in particular, the Trump administration has already begun to undercut efforts to provide medical care, outbreak response, housing assistance, and research across the U.S., according to health officials, nonprofit directors, and federal agency staffers interviewed by KFF Health News.

Since most federal funds for public health flow to states, Vought is rivaling the Department of Health and Human Services secretary, Robert F. Kennedy Jr., in his ability to upend government-led efforts to keep Americans healthy. In Texas, Centers for Disease Control and Prevention funds to stem a measles outbreak weren’t available until after the crisis had subsided and two children had died. A project to protect Alabamans from raw sewage and hookworm was abandoned. People with HIV have had to delay medical care as clinics scale back hours. Time-dependent surveys on HIV and maternal mortality were halted. Food banks have canceled events. Tobacco prevention programs lapsed. Initiatives to protect older adults at risk of falling have been harried.

No matter what budget Congress ultimately passes for next year, the Trump administration may continue to thwart financial support for such programs in ways that will harm people’s health. “The White House has shown that they are willing to unilaterally exert control over funding,” said Gillian Metzger, a constitutional law professor at Columbia University.

“This is a huge deal,” she added, “because the power of the purse is central to Congress’ ability to shape and direct policy.”

Before he was appointed to lead the White House’s Office of Management and Budget this year, Vought outlined budgetary strategies the executive branch could deploy to wrest power from Congress and federal agencies in Project 2025, the Heritage Foundation’s conservative blueprint.

Vought’s tactics unfolded this year, often below the radar. They include abrupt grant cancellations, extraordinary constraints on how funds can be spent, and excessive layers of review, agency officials say, at every step in the grantmaking process. Getting money out the door has been further complicated by layoffs that have gutted offices overseeing grants on chronic disease prevention, HIV, maternal mortality, and more.

Government employees have described these tactics to members of Congress, said Abigail Tighe, executive director of the National Public Health Coalition, a group that includes current and former staffers at the CDC and HHS. “We want Congress to act, because this is preventing states and communities from doing critical public health work to keep our country safe,” she said. “If they don’t have capacity, we all collectively suffer.”

Democrats on the House and Senate appropriations committees have pushed for transparency, but the extent to which money Congress appropriated for public health in 2024 and 2025 has gone unspent because of the administration’s disruptions is not yet known. “This is a sophisticated strategy to cause money to lapse and then say, ‘If they can’t spend it, they don’t need it,’” said Robert Gordon, a public policy specialist at Georgetown University and a former assistant finance secretary at HHS.

“No one thought this was possible or legal, but that is what’s happening,” he said.

Details on how the administration has subverted health spending have received little attention because many changes have been made quietly — and people who rely on federal funds fear retribution. The Trump administration has defunded and threatened federal offices that hold the government accountable and fired whistleblowers. It has abruptly revoked funds for local governments and organizations.

Vought and spokespeople at the White House and the OMB did not respond to queries from KFF Health News. However, Vought described his intentions in VID] a. He said that federal agencies and Congress had gained more power over spending since the 1970s and that their control became “woke and weaponized” under Presidents Barack Obama and Joe Biden.

“Thankfully, President Trump won,” he said. “And we have now been embarked on deconstructing this administrative state.”

Many Parts, Many Malfunctions

Like a car, the federal budget process has many components that can break down. Through the OMB and its partner, Trump’s Department of Government Efficiency, or DOGE, the administration has intervened at various junctures. “There are so many ways in which money is not operating in the way it is supposed to operate,” said Bobby Kogan, the senior director of federal budget policy at the Center for American Progress, a left-leaning think tank, and a former OMB adviser.

Typically, Congress passes a budget that appropriates money for the next fiscal year to federal agencies. For many public health programs, ranging from housing assistance to cancer screening, agencies then post open calls online for states, local governments, and organizations to apply for funding. Agency experts select winners and send notices of awards — or notices of ongoing funding to groups that previously won multiyear awards.

Next, the OMB, which administers the federal budget, activates money for agencies, like a bank activates a credit card, so that grantees can spend and get reimbursed rapidly. Auditors keep an eye on spending, but the government has in the past limited interruptions so that programs run smoothly.

Early on, the Trump administration canceled billions of dollars in awards granted in 2024 and early 2025 for research and global health. In March, it clawed back $11.4 billion in covid-era funds that Congress had earmarked for health departments that were using the money for disease surveillance, vaccinations, and more.

Although some funds have been restored because of lawsuits, the Supreme Court has allowed other cuts by the administration to stand while the cases move through the courts.

Beyond these “shotgun” cancellations, the administration has taken a quieter, “in-the-weeds, slowing, cutting, conditioning” approach that’s frozen funds for public health, said Matthew Lawrence, a law professor specializing in health policy at Emory University.

By August, the CDC’s center for HIV and tuberculosis prevention had doled out $167 million less than the historical average, according to an analysis by the Center on Budget and Policy Priorities, a think tank focused on reducing inequality. The CDC’s funding for chronic disease prevention lagged by $259 million, the Ryan White HIV/AIDS Program had underspent by $105 million, and funds for mental health at the Substance Abuse and Mental Health Services Administration were more than $860 million behind what was expected.

An unknown amount of Congress’ 2025 funding for research and public health has yet to be awarded and will probably lapse this year, said Joe Carlile, an author of the center’s analysis and an associate OMB director during the Biden administration. The obstructions appear to be concentrated in areas where the White House proposed cutting the federal budget next year. “The administration may be executing their 2026 budget request through administrative controls,” Carlile said.

“This is boring but crazy-high stakes,” he added. “A one-branch veto of spending neuters the power of the purse in the Constitution that Madison said was the fundamental check on the executive branch.”

Incremental Chaos

A key tactic Vought described in Project 2025 occurs when the OMB activates funds for agencies in installments, called apportionments. Vought wrote that “apportioned funding” could “ensure consistency with the President’s agenda.”

Under Vought, the OMB shrank the size of apportionments, HHS and CDC staffers said. It’s illegal for agencies to let grantees withdraw money before the total amount is in the metaphorical bank, so that delayed agencies’ ability to greenlight spending.

The OMB and DOGE also placed conditions on apportionments through memos, footnotes, and spoken directives telling agencies to ensure that spending “aligns with Administration priorities,” according to reports and HHS employees who said that notices of funding opportunities and awards required excessive layers of sign-off. The CDC and other agencies circulated lists of priorities that reflect White House stances, including those targeting diversity, equity, and inclusion efforts; immigration; and transgender rights. Public health efforts have been especially caught up in red tape, since many focus on populations bearing an unequal burden of death, disease, and injury.

Groups that rely on federal funds have largely been unaware of the reasons grants were held up, but they’ve fielded what they viewed as unsettling queries. For example, Kathy Garner, the head of a Mississippi nonprofit, said officials asked her to defend the exclusion of men from a program to shelter women who experienced domestic violence.

Delays were made worse by uncertainty. Grantees said they’ve been unable to reach program officers because tens of thousands of federal workers have been laid off. Agency officials said firings slow funding further.

“Everyone’s inbox is full of letters from grant recipients asking, ‘How do we proceed?’” one high-ranking CDC official told KFF Health News, which granted agency officials anonymity because of their fears of retaliation. “We just say, ‘Please wait.’”

Time was critical as a measles outbreak surged in West Texas early this year. The state asked for federal funding for the response in March, but it didn’t arrive until May, after the outbreak had largely faded in Texas, according to an investigation by KFF Health News. Apportionment control was a key reason, CDC staffers said.

In July, 81 HIV organizations sent a letter to Kennedy. “With every day of delayed FY2025 funding release, the delivery of essential HIV services is compromised,” said the letter, which was reviewed by KFF Health News. Because of delays and uncertainty, it said, HIV clinics had laid off case managers and reduced clinician hours, closed sites, and pared down hotlines that patients call with urgent questions. The funds arrived about a month later, but HIV providers remain shaken.

Lauren Richey, medical director at University Medical Center’s HIV clinic in New Orleans, backed out of hiring a sorely needed dentist she had recruited. “I was afraid to tell someone to move across the country for a job when I wasn’t sure if or when we’d get the funding for their salary,” she said. “The wait is now three to four months for dental services, when it was usually a couple of weeks at most.”

Tamachia Davenport, program director at the St. John AIDS outreach ministry in New Orleans, said that “a lot of us are having to rob Peter to pay Paul.”

When the group didn’t get CDC funds it expected this summer, Davenport had to decide between cutting staff or supplies. Concerned her top employees would take jobs elsewhere, she stopped buying the condoms they distribute throughout the city to prevent the spread of sexually transmitted infections.

Louisiana already has one of the highest rates of HIV, chlamydia, and gonorrhea in the country. Condoms cost far less than treating these diseases. For a person infected by HIV at age 35, such costs exceed $326,000.

Groups focused on cancer, diabetes, and heart disease also report lasting repercussions from delays, as well as ongoing fears that they will happen again. Louisiana State University’s Healthy Aging Research Center canceled some of its workshops to train health workers on caring for people with dementia. “There may be fewer people who have this very specific expertise next year in Louisiana and Mississippi,” said Scott Wilks, the director of the center. “That’s on top of the big shortage we have already.”

Nationwide surveys tallying maternal and infant mortality froze for about five months because of funding delays, causing an irrecoverable gap in data that had been collected continuously since 1987, CDC officials say.

“We are seeing the administration get their way with or without an approved budget,” one said. “It’s such a terrible shame to play with people’s health this way.”

DOGE also inserted itself into grant reimbursements this year, stalling the rapid turnaround that public health groups typically expect to cover salaries, rent, and other monthly costs outlined in budgets that have already been approved. In what’s now labeled Departmental Efficiency Review, itemized expenses must be regularly justified by multiple government officials, according to documents reviewed by KFF Health News.

DOGE posted on its website expense reports covering about a month’s span from April to May. Nearly 230 of the individual expenses filed to federal agencies during that period are for $1 or less. Other entries break down monthly salaries for individual employees and petty costs for postage or monthly subscriptions.

“Public funds deserve scrutiny, but this is different from audit practices I’ve been a part of,” Carlile said.

DOGE also stalled calls for applications for 2025 funding — and some calls never appeared as the fiscal year came to a close on Sept. 30. Among them are programs for groups that provide housing assistance. People will be evicted when these organizations run out of money left over from 2024, said Steve Berg, chief policy officer at the National Alliance to End Homelessness.

Other solicitations came out months behind schedule, leaving groups with a few weeks to put together complicated applications for multimillion-dollar awards, including for Alzheimer’s care, addiction recovery, senior support, and chronic disease management.

“They’ve set projects up to fail,” one HHS official said.

*KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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morano control BS?

Fox News is returning to its pro-COVID-19 stance by attacking Los Angeles, California, for considering an indoor mask mandate as infections in the county skyrocket. The right-wing propaganda channel, which has long spewed pandemic-related misinformation, is again lying about the efficacy of masks for slowing the spread of the disease.

The Los Angeles Times reported that LA County’s case rate “has been increasing since late October and is now triple what it was in the autumn low,” and is currently 188 weekly cases per 100,000 residents, with a case rate of 100 or more being considered high. The LA Times also reported that the county is suffering about 60 deaths from COVID-19 each week. According to City News Service, the county’s COVID-19 hospitalization rate already exceeds one of the two thresholds that County Public Health Director Barbara Ferrer said would trigger a universal indoor masking mandate.

Fox’s response to this news is to return to its history of killing its viewers by spreading medical misinformation that has contributed to the staggering national COVID-19 death toll exceeding 1 million people. In particular, Fox has spread lies about the usefulness of face masks in slowing the spread of COVID-19. Some Fox personalities have bizarrely claimed that wearing masks makes people crazy, while others simply told lies about their effectiveness. Fox as a whole worked very hard to incorporate masking into their deranged culture war, even though at least one Fox prime time host early in the pandemic repeatedly gushed about their potential in keeping people safe. (Fox also for a time required staffers to wear masks at the workplace.) Besides attacking face masks during a respiratory disease pandemic, Fox has also urged its viewers to distrust public health officials.

And with the possibility of a mask mandate coming back to LA, Fox personalities reacted with incredulity, pretending that masking is ineffective and attacking the county public health director as “power hungry.”

interesting to C&C ebola BO to trump fox covid fustercluck

https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/

State Public Health Departments Remain Chronically Underfunded

In 2003, a pivotal report by the Institute of Medicine (now the National Academy of Medicine) stated that “For governments to play their role within the public health system, policy makers must provide the political and financial support needed for strong and effective governmental public health agencies.”[[10]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn10)

However, after a wave of funding increases in the wake of the September 11th terrorist attacks, local public health departments subsequently experienced staffing cuts in excess of 50,000 staff positions nationally.[[11]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn11) This reflects both reduced spending in recent years by US states, but also a shift in where funds come from, with a much smaller proportion of public health spending now coming from the federal government (see...

Such public health funding discrepancies affect coordination and preparedness for dealing with countrywide health challenges. Beyond this, however, a failure to provide a sufficient minimum level of public health services can also lead to unnecessary increases in health care utilization, the cost of which greatly exceeds investment in prevention.[[9]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn9) For example, higher levels of investment in public health at the state level have been shown to reduce Medicare utilization,[[15]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn15) providing particular improvement in areas with higher poverty levels, perhaps reflecting the level of preventable harms responsive to public health initiatives.[[16]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn16)

Public Health Funding at the Federal Level Has Faced Cuts in Favor of Health Care Provision

More broadly, the United States has made long-term strategic commitments to ensure appropriate hospital infrastructure, as well as relatively stable levels of investment in biomedical research funding, to support future health care treatments and innovation. By contrast, public health structures in the United States have not been supported by consistent or predictable federal financial support.[[17]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn17)

Instead, public health funding has been cut to cover rising health care and other costs, despite constituting a small (around 2-3%) of total government health spending. While the Affordable Care Act included a renewed focus on prevention, with a planned $15 billion increase in public health funding under the Prevention and Public Health Fund, a 2012 law cut this funding by $6.25 billion, using the funds instead to forestall Medicare physician fee cuts.[[18]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn18) Sequestration, which cut federal spending across the board beginning in 2013, included a 5% cut to the overall CDC budget, a $160 million budget reduction for local, county, and state public health assistance, $25 million less for global infectious disease programs (including the Strategic National Stockpile), and $13 million less for emerging infectious diseases.[[19]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn19)Most recently, the Tax Cuts and Jobs Act (signed into law in December 2017) cut an additional $750 million from the Prevention and Public Health Fund, using it instead to cover the costs of the Children’s Health Insurance Program.[[20]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn20)

Public Health Funding Tends to be Reactionary

As with federal public health funding, there has been a downward trend for preparedness and disease surveillance in particular, with periodic injections of supplemental funds made for particular infectious diseases, but only after they emerged as serious threats to population health (see Figure 3),[[21]](https://www.milbank.org/quarterly/articles/covid-19-and-underinvestment-in-the-public-health-infrastructure-of-the-united-states/#_edn21) mirroring the response to the current coronavirus pandemic. It is self-evident that the unpredictable and reactionary nature of these funds does not allow for the stable building of a robust public health infrastructure or workforce that can engage in health protection and promotion in ways that reduce health care utilization and improve quality of life, while also being ready to respond to urgent demands, such as the current pandemic....

michael lewis 5th risk g word

https://www.statnews.com/2021/06/28/confronting-a-legacy-of-scarcity-a-plan-for-reinvesting-in-u-s-public-health/

https://www.alternet.org/**2022/05**/trump-administration-meat-industry-covid/

former President Donald Trump's administration colluded with top-level meatpacking industry executives to exploit the COVID-19 pandemic in order to drive up prices and downplay the severity of the emergency, according to an exhaustive investigation released on Thursday by the United States House Select Oversight Subcommittee on the Coronavirus Crisis.

Representative Jim Clyburn (D-South Carolina), the House Majority Whip and chairman of the Subcommittee, said in a statement that "the shameful conduct of corporate executives pursuing profit at any cost during a crisis and government officials eager to do their bidding regardless of resulting harm to the public must never be repeated."

The probe began last year and uncovered a spider web of corruption and flagrant disregard for human life involving American corporate titans and individuals in the highest ranks of the federal government.

Officials at the Department of Agriculture – including Secretary Sonny Purdue and Under Secretary for Food Safety Mindy Brashears – "collaborated" with corporate bigwigs to prioritize profits and production over the safety of employees and the public despite being fully aware of the hazards.

"Infections and deaths among workers for five of the largest meatpacking companies—Tyson Foods, Inc. (Tyson), JBS USA Holdings, Inc. (JBS), Smithfield Foods (Smithfield), Cargill, Inc. (Cargill), and National Beef Packing Company LLC (National Beef)—were significantly higher than previously estimated, with over 59,000 workers for these companies being infected with the coronavirus andat least 269 dying," the report states.

The powerful cadre also "engaged in a concerted effort with Trump Administration political officials to insulate themselves from coronavirus-related oversight," it explains.

In one instance, the chief executive officers of the conglomerates told Purdue on a phone call that their workers “should not be entitled to unemployment benefitsif they are otherwise able to work through the pandemic” and cautioned against “creat[ing] an incentive, much less a path, for food industry workers to choose unemployment overproducing food.”

In that same conversation, they "implicitly acknowledged how dangerous plants were, asking for liability protection against lawsuits if workers were infected on the job."

There was also an aggressive campaign to skirt "pesky" local, state, and federal regulations that would have kept workers and their products safe and healthy.

"Companies lobbied the White House to make clear that—despite concerns by state and local health departments—meatpacking companies should not have to address coronavirus risks if it would impact productivity," the investigation revealed.

Alarmingly, the CEOs managed to successfully lobby Trump to draft and sign an executive order in April of 2020 that"would insulate meatpacking companies from oversight by state and local health departmentsand provide legal protection against lawsuits for worker illnesses and deaths."

The edict led to Trump "invoking the Defense Production Act to ensure meatpacking plants 'continue operations.'"

Shortly thereafter, records handed over to the Subcommittee show that "meatpacking industry representatives and companies—Smithfield and Tyson in particular—engaged in constant communications with Trump appointees at USDA, the National Economic Council, and the White House, including calls between Smithfield CEO Ken Sullivan and White House Chief of Staff Mark Meadows; a joint call with Sullivan, Meadows, and Tyson CEO Noel White;a call between White and Vice President Pence’s Chief of Staff Marc Short; and a call from Meadows to White asking if White would be willing to meet with President Trump."

Trump subsequently "held a call with officers of the meatpacking companies who had lobbied for it on the morning the order was issued."

After Trump granted their wish, an effort was undertaken between the administration and the industry to "coordinate closely on messaging concerning the order and its effects, apparently hoping to generate positive press coverage" for the ex-commander in chief.

Worker fatalities, meanwhile, were swept under the rug.

In a particularly egregious example, an outbreak at Foster Farms in Livingston,California that infected "at least" 392 workers and killed eight in August of 2020 prompted the company to "intimidate" the Merced County Department of Public Health from shutting down the plant.

"Foster Farms attempts to obfuscate the death count by labeling fatalities as 'resolutions,'" investigators learned. "MCPH officials told the Select Subcommittee that an unidentified person on the call from either Foster Farms or USDA said these cases could be considered 'toe tag resolutions,' referring to the toe tag that is often put on a corpse at the morgue. MCPH said that Brashears asked this individual to 'stop' and said they would 'talk about this separately.'"

Operations at Foster Farms in Livingston were eventually temporarily suspended on August 31st.

Read the full report here.

aha: abortion turned xian anti-gubmint; in 80's RR televangelists had TV programs/stations; Rove courted (organized) for Bush 43; now drollinger cabinet and GOTV network (AI/digital tracking?); scary overlap with militias?! patriot prayer

https://www.alternet.org/2020/05/why-religious-freedom-stokes-coronavirus-protests-in-the-u-s/

Pamela E. Klassen, University of Toronto

Religiousfreedom,cherished as an American ideal, has been frequently invoked in the United States during protests against COVID-19 public health measures.

In Canada, forms of protests — including by churches — are more likely to focus on the systemic underfunding of long-term care and homeless shelters or the lack of sufficient medical and water infrastructure in Indigenous communities.

Why the difference?

Across the U.S., conservative Christians flouted state and municipal social distancing orders as late as March 31, sometimes by overtly breaking the law, claiming that God, not the state, will protect the people.

During the Christian Holy Week, evangelical and Pentecostal church leaders, often backed by Republican politicians, brought lawsuits against state and municipal governments, arguing that curtailing religious gatherings for the sake of limiting the spread of COVID-19 was a breach of religious freedom.

With lightning speed, federal and state lawyers weighed in on the balance between public health measures and religious liberty.

By contrast, the story in Canada is largely one of religious organizations of all varieties co-operating with public health measures. To date, there is no equivalent in Canada of these high-profile COVID-19 legal battles in which churches reject both public health directives and state legislation.

Suspicion of science, government

Religiously based suspicion of scientific and government authority is not unique to conservative Christians; Hasidic Jewish communities share these suspicions and constitute a significant number of those infected with COVID-19 in New York state.

Even in the case of Hasidic Jews, however, the border might make a difference: Hasidic communities in Québec have been praised for their diligence in adhering to social distancing, in contrast to those in New York, where some rabbis have mocked public health recommendations.

The contrasting responses to COVID-19 in Canada and the United States are rooted in very different national attitudes about individual and collective responsibility for public health.

In the United States, Democratic front-runner Joe Biden may come to embrace Bernie Sander’s plan for “Medicare for All,” but even the devastating reality of being the country hardest hit so far by COVID-19 has not seemed to turn the tide of public opinion on the need for universal medicare.

In Canada, by contrast, leaders across the political spectrum are throwing their support behind public health care, with even some conservative politicians calling for more funding, especially for long-term care. While Donald Trump tweeted a call to anti-public health protesters to “liberate” their states, in Ontario, Conservative Premier Doug Ford dismissed a scattering of such protesters in Toronto as selfish “yahoos.”

Invoking religious freedom in an attempt to opt out of health-care legislation is much more common in the U.S. than Canada. Both countries protect religious freedom, dating back to 1791 in the United States with the First Amendment of the constitution guaranteeing the “free exercise” of religion, while in Canada, the Canadian Charter of Rights and Freedoms has protected the “freedom of conscience and religion” since 1982.

Religious freedom as a rallying cry

These parallel guarantees, however, stem from very different histories of using religious freedom as a rallying cry, including to resist public health care. I’ve discussed this in my research, especially in relation to women’s reproductive health.

In the wake of former U.S. president Barack Obama’s Affordable Care Act, for example, Catholics and evangelical groups used a religious freedom argument to contest the new mandate that their health insurance plans provide access to contraception for women employees.

In Canada, the less frequent citing of religious freedom rights in the courts to curtail health-care access may be related to a wider acceptance of health care as a public good and a basic human right.

In both Canada and the U.S., the struggle for publicly funded health care in the mid-20th century depended on coalitions of politicians, medical professionals and religious leaders. In Canada, a Baptist minister-turned-politician, Tommy Douglas, galvanized the country with a vision that public health care for all was a human right and, for some, also a religious obligation.

Similarly, in the U.S., when Dr. Montague Cobb, leader of the National Medical Association, successfully argued for Medicare before Congress in 1965, he concluded his testimony with a Christian hymn.

The Canadian version of public health care, however, now serves a much wider range of the population than Medicare does in the U.S., and has become a cornerstone of Canada’s national identity, with minimal overt connections to religion.

But in the United States, public health care remains a source of profound national and religious division.The current Republican administration regularly uses religious freedom legislation, including conscientious objection rules for health-care providers, to chip away at Medicare, limiting access to health care for women, LGBTQ, poor and rural people.

A time of reckoning is coming when public health measures and public and private health-care delivery will be assessed for their effectiveness during the COVID-19 pandemic. The role of religious communities and the ideals of religious freedom in supporting or impeding public health must be included in this reckoning, especially in the United States.

Pamela E. Klassen, Professor of the Study of Religion, University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

8/26/21 up front kpfa big covid $ esp states that had defunded public health, not great results, we had to find work for them to do ~ Vt, colo, NM? wapo?

pol connections --> gigs

==

an 420

trump tries to blame his predecessors for his COVID-19 failures — but they actually understood the value of public health

Nancy LeTourneau / Washington Mont

TEA PARTY LEGACY CLIMATE ZOMBIES AND COVID PANDEMIC?

==

https://www.alternet.org/2020/04/how-tea-party-budget-battles-left-the-national-emergency-medical-stockpile-unprepared/

no lnx

How Tea Party budget battles left the National Emergency Medical Stockpile unprepared

Written by ProPublica April 4, 2020

Dire shortages of vital medical equipment in the Strategic National Stockpile that are now hampering the coronavirus response trace back to the budget wars of the Obama years, when congressional Republicans elected on the Tea Party wave forced the White House to accept sweeping cuts to federal spending.

Among the victims of those partisan fights was the effort to keep adequate supplies of masks, ventilators, pharmaceuticals and other medical equipment on hand to respond to a public health crisis. Lawmakers in both parties raised the specter of shortchanging future disaster response even as they voted to approve the cuts.

“There are always more needs for financial support from our hardworking taxpayers than we have the ability to pay,” said Denny Rehberg, a retired Republican congressman from Montana who chaired the appropriations subcommittee responsible for overseeing the stockpile in 2011. Rehberg said it would have been impossible to predict a public health crisis requiring a more robust stockpile, just as it would have been to predict the Sept. 11, 2001, terrorist attacks.

“It’s really easy to second-guess and suggest we didn’t do as much,” he said. “Why didn’t we have a protocol to protect the Twin Towers? Whoever thought that was going to happen? Whoever thought Hurricane Katrina was going to occur? You tell me what’s going to happen in 2030, and I will communicate that to congressmen and senators.”

There were, in fact, warnings at the time: [FOR ALL THE ABOVE ?!]  A 2010 Centers for Disease Control and Prevention-funded report by the Association of State and Territorial Health Officials urged the federal government to treat public health preparedness “on par with federal and state funding for other national security response capabilities,” and said that its store of N95 masks should be “replenished for future events.”

But efforts to bulk up the stockpile fell apart in tense standoffs between the Obama White House and congressional Republicans, according to administration and congressional officials involved in the negotiations. Had Congress kept funding at the 2010 level through the end of the Obama administration, the stockpile would have benefited from $321 million more than it ended up getting, according to budget documents reviewed by ProPublica. During the Trump administration, Congress started giving the stockpile more than the White House requested.

By late February, the stockpile held just 12 million N95 respirator masks, a small fraction of what government officials say is needed for a severe pandemic. Now the emergency stash is running out of critical supplies and governors are struggling to understand the unclear procedures for how the administration is distributing the equipment.

The stockpile received a $17 billion influx in the first and third coronavirus stimulus bills that Congress passed in March. But there had not been a big boost in stockpile funding since 2009, in response to the H1N1 pandemic, commonly called swine flu.

After using up the swine flu emergency funds, the Obama administration tried to replenish the stockpile in 2011 by asking Congress to provide $655 million, up from the previous year’s budget of less than $600 million. Responding to swine flu, which the CDC estimated killed more than 12,000 people in the United States over the course of a year, had required the largest deployment in the stockpile’s history, including nearly 20 million pieces of personal protective equipment and more than 85 million N95 masks, according to a 2016 report published by the National Academies of Sciences, Engineering and Medicine.

“We recognized the need for replenishment of the stockpile and budgeted about a 10% increase,” said Dr. Nicole Lurie, who served as the assistant secretary for preparedness and response at the Department of Health and Human Services during the Obama administration. “That was rejected by the Republican House.”

Republicans took over the House of Representatives in the 2010 midterms on theTea Party wave of opposition to the landmark 2010 health care reform law,the Affordable Care Act, also known as Obamacare.The new House majority was intent on curbing government spending, especially at HHS, which administered Obamacare.

Congressional Republicans, led by Mitch McConnell in the Senate and House Speaker John Boehner, leveraged the debt ceiling — a limit on the government’s borrowing ability that had to be raised — to insist that the Obama administration accept federal spending curbs. The compromise, codified in the 2011 Budget Control Act, required a bipartisan “super committee” to find additional ways to reduce the deficit, or else it would trigger automatic across-the-board cuts known as “sequestration.”

Even in the aftermath of the swine flu pandemic, the stockpile wasn’t a priority then. Without a full committee markup, Rehberg introduced a bill that provided $522.5 million to the stockpile, about 12% less than the previous year and $132 million less than the administration wanted. “Nobody got everything they wanted,” Rehberg said.

The Senate version of the funding bill offered $561 million for stockpile funding. Senators said they regretted the cuts even as they voted for the bill.

“In this bill we’re now getting into the bone marrow,” Tom Harkin, a Democrat from Iowa who then chaired the Senate appropriations committee, said at the markup. “Some of these cuts will be painful and unpopular.”

In the bill’s final version, Congress allocated a compromise $534 million for the 2012 fiscal year, a 10% budget cut from the prior year and $121 million less than the Obama administration had requested.

The next year, the “super committee” failed to secure additional savings demanded by the Budget Control Act, triggering the automatic, across-the-board cuts. This “sequestration” was an outcome that the leaders of both parties disliked — and blamed one another for.

“Did either party ever indicate sequestration was welcome, positive or desirable?” Dave Schnittger, Boehner’s deputy chief of staff at the time, told ProPublica. “Sequestration was conceived — not by Republicans, but by a Democratic White House — as a crude mechanism to compel the super committee to do its job. Republicans consistently advocated for reductions in mandatory spending programs that would have prevented sequestration from ever happening.” (Mandatory spending refers to entitlement programs such as Social Security and Medicare.)

McConnell’s office did not respond to requests for comment.

Katie Hill, a spokeswoman for Obama, pointed to numerous statements he made in 2013 urging Republicans to compromise, warning that the sequester would weaken economic recovery, military readiness and basic public services.

Gene Sperling, then a top Obama economic adviser, said Republicans focused attacks on the HHS budget, along with the Departments of Labor and Education, which are grouped under the same appropriations subcommittee.

“The Labor/HHS budget is where a significant number of progressive priorities are, from Head Start to (the National Institutes of Health) to the Education Department,” Sperling said. “There’s just so much in there, so it is often the hot spot for where conservative budget hawks who don’t believe in public investment go hardest.”

Under sequestration, the CDC, which managed the stockpile at the time, faced a 5% budget cut. In its 2013 budget submission, HHS decreased its stockpile funding request from the previous year, asking for $486 million, a cut of nearly $48 million. “The SNS is a key resource in maintaining public health preparedness and response,” the administration said. “However, the current fiscal climate necessitates scaling back.”

The decrease caught Rehberg’s attention at a budget hearing to review the request.

“Disaster preparedness is something that has been very important to me,” he said at the hearing. “I just would like to have you explain how such a large reduction can possibly not impact the national preparedness posture.”

Then-HHS Secretary Kathleen Sebeliusanswered that the CDC would prioritize replacing expiring drugs such as smallpox vaccines and anthrax treatments.

The next year, the administration again proposed cutting the stockpile’s funding from the 2012 funding level, but it warned that reduced funding could result in “fewer people receiving treatment during an influenza pandemic.”

Congress did grant extra funding in response to emergencies, but even then, the stockpile was a small-ticket item. In 2014, the Obama administration asked for and received billions of dollars to respond to the Ebola outbreak, but only $165 million went to the CDC’s public health emergency preparedness programs, including the stockpile. And in 2016, Congress granted emergency funding to respond to the Zika virus, but it gave the CDC less than half of what the Obama administration requested.

“It’s clear that the administration prioritized the SNS in this (Zika) request and in the Ebola supplemental,” said Ned Price, who was a spokesman for the National Security Council in the Obama White House. “In the case of Zika, congressional Republicans sat on the request for the better part of a year.”

The stockpile’s mission has steadily expanded as it confronts new public health emergencies. With limited resources, officials in charge of the stockpile tend to focus on buying lifesaving drugs from small biotechnology firms that would, in the absence of a government buyer, have no other market for their products, experts said. Masks and other protective equipment are in normal times widely available and thus may not have been prioritized for purchase, they said.

“It just was never funded at the level that was needed to purchase new products, to replace expiring products and to invest in what we now know are the really necessary ancillary products,” said Dara Lieberman, director of government relations at the Trust for America’s Health, a nonpartisan public health advocacy and research group.

The sequestration and strict budget caps ended with budget deals in 2018 and 2019 — a bipartisan rebuke to the earlier restraints. “It’s a burden off our shoulders,” Senate Appropriations Chairman Richard Shelby, R-Ala., told reporters at the time. “In a troubled world, I think that was the wrong message.”

Yet non-defense spending still hasn’t fully recovered.

“One of the things that happened to public health preparedness was just the result of the general budget stringency we had,” said David Reich, a consultant working on federal appropriations issues for the Center on Budget and Policy Priorities. “We’re still seeing the results of that.”

During the Trump administration, the White House has consistently proposed cutting the CDC and the HHS Office of the Assistant Secretary for Preparedness and Response, which took over stockpile management from the CDC. Congress approved more stockpile funding than Trump’s budget requested in every year of his administration, for a combined $1.93 billion instead of $1.77 billion, according to budget documents.

The White House budget request for 2021, delivered in February as officials were already warning about the dangerous new coronavirus, proposed holding the stockpile’s funding flat at $705 million and cutting resources for the office that oversees it.

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Former deputy national security adviser: Obama left a solid ‘global health infrastructure’ — and Trump shut it down

Alex Henderson

According to former Deputy National Security Adviser Ben Rhodes, the Obama Administration left Trump with a solid “global health infrastructure” when the former president left office in January 2017.