Drug prices

Dear Donald – 

Prescription drugs are expensive, for a number of reasons. First off, it costs drug companies a lot of money to bring a drug to market. It may take them years to bring a single drug from research through to development and marketing. That being said, drug companies are rewarded by receiving patents for those drugs that allow them to exclusively produce those drugs for a number of years. 

Drug companies typically exploit these patents by charging exorbitant prices to consumers. Unfortunately, no one actually buys enough prescription drugs individually to actually exert sufficient pressure on drug companies to keep the prices reasonable. No one, that is, except for the Federal government through Medicare. Only 3 weeks ago, you even recognized that fact, saying that you would use the bargaining power of Medicare to keep down prices. In fact, you made the patently ridiculous claim that leveraging that power would save the government $300 billion. 

You see, demand for prescription drugs is what we call “inelastic,” meaning that it’s not particularly sensitive to price. Whether that heart medication costs $50, $100, or $500, if I need it to survive, my demand for the drug won’t go down. This gives sellers incredible pricing power, particularly when they have a monopoly on the drug. It’s why Martin Shkreli bought the rights to an HIV/AIDS drug and sent the price through the roof – he knew customers needed the product and couldn’t go elsewhere, regardless of the price. The way to reduce this market power is to either remove the monopoly, meaning to undercut patents, by, for example, cutting down on their length, or to increase the power of buyers to negotiate by having a single buyer or group of buyers with a large enough market share to meaningfully do so (e.g., Medicare). 

Today, after meeting with pharmaceutical representatives, you walked back your intention to bargain with companies, saying that you didn’t want to do anything to make it harder for companies to bring drugs to market, including reduce the prices they can command. Truly a cowardly backtrack. 

People across this country struggle every day to cover the cost of their medications. Why wouldn’t you seek to reduce their burden, unless the focus was on corporate profits and not working folks?  (And don’t worry, I’m looking at Cory and his vote on Canadian drug imports,too)

Medicine should be accessible to those who need it, and corporate profit margins are not a good enough reason to fleece the American people. 

The Martyrdom of Sally Yates


Dear Donald –

In May 1972, Attorney General Elliott Richardson appointed Archibald Cox as a special prosecutor to investigate the Watergate break-in. In October, Cox subpoenaed President Richard Nixon, seeking access to taped conversations Nixon had in the Oval Office. Nixon refused but offered to let a notoriously hard-of-hearing Senator listen to the tapes and summarize them. Cox, understandably, declined the “compromise.” The next day, Saturday, October  20, Nixon ordered the AG to fire Cox. He refused and resigned in protest. Nixon then ordered the Deputy AG to fire Cox. He also refused and resigned. Nixon finally found Robert Bork willing to fire Cox. Shortly thereafter, calls for Nixon’s impeachment reached a crescendo. 


I don’t mean to indicate that what you did last night to Sally was commensurate with the Saturday Night Massacre, but the parallels are hard to ignore, as is that  framed letter from Nixon in your office saying what a great leader you’d be. 

Let’s be clear, the order is, at best, borderline legal but completely contrary to the spirit of the law and the Constitution. The Immigration and Nationality Act holds, in part, that:

…no person shall receive any preference or priority or be discriminated against in the issuance of an immigrant visa because of the person’s race, sex, nationality, place of birth, or place of residence  

The language of the statute seems to clearly bar actions like your most recent executive order.  You can’t refuse to issue a visa just because someone lives in a particular country just as you can’t refuse to issue a visa because they’re black. 

Now, I’ve seen several folks make the argument that a different provision of the law gives you the discretion you need. That section says that 

Whenever the President finds that the entry of any aliens or class of aliens into the United States would be detrimental to the interests of the United States, he may by proclamation…suspend the entry of all aliens or any class of aliens as immigrants or no immigrants, or impose on the on the entry of aliens any restrictions he may seem to be appropriate. 

That seems to give you pretty broad authority, but there’s one problem – the non discrimination clause says that there are only three places in the law that it doesn’t apply, and this “detrimental” clause isn’t one of them. 

Maybe it’s in the weeds, but it’s at least an issue that, on the face of it, can be decided by the Courts.  They could easily rule that the broad discretion of 8 U.S.C. 1182(f) supersedes the nondiscrimination clause, but it would clearly be outside the bounds of typical statutory construction. Specific provisions of the law are exempted from the non discrimination clause, but this isn’t one of them. As such, the presumption should be that, if Congress wanted the President to be able to discriminate on the basis of race or national origin, it would have drafted helaw that  way. It didn’t write it that way, so it’s presumed that’s not what they wanted. 

I go into this detail mainly to demonstrate that, outside of any other arguments related to religious discrimination, your order is on shaky legal ground. As for religious discrimination, there are usually two basic tests – does there appear to be discriminatory intent and was there a disparate impact. Your prior statements advocating for a Muslim ban are a prima facie case for discriminatory intent, particularly when paired with your recent interview with CBN in which you said there would be a preference for Christians seeking entry. On those bases alone, you’d find it hard to prevail in Court, without even getting to the question of impact. 

You are clearly within your rights to dismiss a political appointee who doesn’t align with your policy preferences. The underlying concern for me, though, is the lack of apparent concern for the rule of law. If you were concerned about legality, you could have asked Sally for a clear statement outlining why she believes the order is, on its face, clearly illegal. After all, the clear historical standard for whether DOJ defends an action in court is clear illegality, not a failure to be convinced of legality, which is what Sally used.   You could have then directed her that, short of meeting that standard, the DOJ should defend the order in Court. If she didn’t want to order the attorneys under her to do so, she would be free to resign, but at least you would have provided her the opportunity to make a case as to why the order was indefensible. Now, your firing of her seems geared more towards steamrolling dissent, regardless of legal concerns. That’s a bad place to be in. 

To be clear, I think all public servants have a duty to stand up and speak out about those things that contradict our values as a nation, not just when orders are illegal (though they have a duty to do that as well). Dissent is part of democracy, and the bureaucracy is meant to protect democracy, and never the politician in charge. When you punish well-intentioned and reasoned dissent, you have a chilling effect on the proper functioning of our government. 

What happens when the next official refuses to accede to your whims because they believe it is contrary to the law? Is there a back bench of Robert Borks ready to step in at every agency to do your bidding, legality be damned?  What is the standard? Is it total fealty or bust? Sean’s statement about State Department employees definitely seems to imply as much. 

It’s a horrible precedent, and I’m afraid it foreshadows much more dangerous times ahead. 

The votes that counted


Dear Donald –

I’d like to tell you a story. I know a German citizen who lives in Florida. Back in November, he was in line to vote for President when he was told he couldn’t vote. He was obviously upset, and even more so when he saw several people in front of and behind him in line who didn’t look like they should be voting. My guess is they were probably from somewhere inSouth America, and we’re clearly voting for Hillary. 

Sounds a little weird and racist, right?  Turns out it’s the story you told Congressional Republicans about how you “found out” about the supposed voter fraud during the election.  It’s a truly bizarre and problematic story, and to think that you’ve actually told it, in public, multiple times, to justify your own insecurities about the legitimacy of your election. 

The worst part for democracy is that you’ve sonfully convinced yourself of this foolishness that you’re calling for a commission to look into your accusations. Of course, no self-respecting expert in the field will come within 10 miles of your commission, meaning you’ll stock it with cronies who only have allegiance to you. As such, they’ll probably conclude, with no evidence, that there was rampant voter fraud and then it’ll be used as the basis for purging voter rolls nationwide. 

Let’s be clear, there was no fraud. But the persistent belief that it existed will lead to actions that undermine the voting rights of real citizens. When dealing with voting rights, the presumption should always be to expand, not contract, the franchise, and your petty insecurities and inability to grasp reality may endanger the rights of countless millions nationwide. 

Regulatory burden


Dear Donald –

I have to give you credit. You’re moving ahead with all of your campaign promises, no matter how inane or disconnected from reality they may be. You gave people plenty of warning as to what was coming, so no one can claim to be surprised. But your most recent executive order just shows a complete lack of understanding about how government works on a fundamental level and ultimately hamstrings you more than anyone else. Let’s take a look. 

Your most recent order tells all agencies that for every new regulation enacted, two should be deleted. Supposedly this is meant to reduce burden on businesses and thereby end the American carnage, make America great again, Anerica first, and all that. It’s a plan your great aunt Mildred or drunk uncle Jeff would come up with, not anyone who he any clue about how this works. 

First off, there’s absolutely zero clarity about what constitutes a “regulation.” The Code of Federal Regulations has 50 titles, each one concerning a particular policy area – agriculture, highways, immigration, employee benefits, the judiciary, and on and on. Each title is made up of a different number of parts, each of which is made up of sections. Which one constitutes a regulation? Is it one of these, or does it refer to the documents when one of these sections are rewritten? 

Think of Federal regulations like a big book that keeps getting edited. You’ve basically just said that for every section that gets changed, two have to go. Well, how much has to go? What constitutes a section? If I add a comma or change a single word, do I have to delete two whole chapters?

Also, not very piece of the regulations is created equal. Some create very large burdens, while others do little at all. An agency could easily comply with this order by passing a regulation that creates $100 million of burden while just deleting the section describing what its seal looks like. Does that reduce regulatory burden? 

An order that would actually be effective could, for example:

  • Direct all agencies to submit a formal plan within 120 days for reducing regulatory burden, with an emphasis on regulations that disproportionately impact small entities
  • Lower the threshold for “significant regulatory action” to ensure that more regulations are subject to increased oversight
  • Require all new regulations not required by new or revised statutory authorities to demonstrate a net negative burden (by including cost savings related to repealed regulations)
  • Direct OMB to revise its procedures for reviewing new regulatory proposals with a view to minimize burden on small entities 

As we’ve seen this far, you don’t seem particularly concerned with effective management, but you should probably get concerned with it, and fast. 

National Security Council

Dear Donald –

Arthur Vandenberg was a U.S. Senator from Michigan from 1928 until his death in 1951. In 1948, Vandenberg was the Republican  Chairman of the Senate Foreign Relations Committee while Democratic  President Harry Truman was considering a security treaty with North Atlantic allies. Vandenberg famously said that “politics stops at the water’s edge” in defending his support of Truman’s efforts leading to the creation of NATO. The national security of our country is not an issue of Democratic or Republican politics or what provides the electoral advantage at home. It’s about what makes us safer and our citizenry more secure.

That’s why your reorganization of the National Security Council is so disturbing. The Director of National Intellligence and Chairman of the Joint Chiefs of Staff are out and your chief political strategist is in. When asked yesterday about what Steve brings to the table that qualifies him to be a member, Sean Pointed to his career as a naval officer. Steve was in the Navy from 1976 until 1983 rising to the rank oflieutenant (the third lowest rank). General John Dunford, current Chairman of the Joint Chiefs of Staff, joined the Marines in 1977 and is currently a four-star General (the highest rank). Who are we supposed to believe has greater military insights?

Sean also insinuated that the NSC is often tasked with taking in and assessing raw intelligence data and therefore needs to be more streamlined. First off, no one at that level is looking at raw intelligence data. They’re looking at summaries and assessments. But let’s assume that’s not the case. Who is more qualified to analyze and provide context for those data – Steve or the Director of Narional Intelligence?

Having a political advisor take precedence over the intelligence and military communities is dangerous. Back in 2003, the decision was made to invade Iraq and the White House went on a fishing expedition to find facts to support that decision, contexts be damned. Nada Bakos, one of the CIA’s top analysts at the time, could do a point by point rebuttal in real time of Colin’s presentation to the U.N. Security Council with all the facts, while technically true, pulled wildly out of context. Letting politics drive decision-making leads to a “ready, fire, aim” approach to international relations, and we can’t afford to do that.

Lives are on the line. This is not a game. We need to act internationally with restraint and respect for both the context and the commitment we’re making. We should be taking into account the views of military leaders and intelligence officers, not a political strategist who’s demonstrated himself to be racist, misogynistic, and islamophobic. That’s a recipe for disaster. 

Campaigner in chief

Dear Donald –

I saw that you’ve already filed for reelection with the FEC. Maybe this is just to get the paperwork out of the way, but it could have a chilling effect on nonprofits and federal employees. 

If you’re already a candidate, then any speech or statement about you could be spun as political action. For 501(c)(3) non-profits, any public statements criticizing you or your policies could be used by a vindictive man in charge of the tax apparatus of the federal government against them. How much of a stretch is it to imagine your ordering the head of the IRS to revoke the non-profit status of Planned Parenthood if it steps out of line?

What about government employees? Any statement critical of you could be used as grounds to claim a Hatch Act violation. If an employee questions too forcefully or prevents you or your agents from acting improperly or whistleblows, it’s easy to imagine your conjuring a claim that they engaged in improper political speech in the workplace as cover to fire them. 

If anything, the FEC should clarify your status immediately to avoid these issues. 

Refugees


Dear Donald –

I’ve been struggling for the last few days to figure out how to express my feelings about your order banning travel from seven majority-Muslim nations for 90 days, stopping the refugee program for 120 days, and indefinitely suspending Syrian refugees entering this country. 

Do I take the tack of pointing out that none of the countries you’ve singled out has been responsible for an act of domestic terror in the U.S. since 9/11? Do I point out that none of the countries from which the 9/11 hijackers originated is in the list? What about the fact that none of the countries that would pose an economic problem for your properties or investments made it in the list? Maybe it’s the fact that it was so poorly implemented that DHS agents were literally making up the rules as they went along because they had been provided no guidance? Or I could just make a point about American values, quoting Emma Lazarus as I go?

I just don’t know what to do with this, so I’ll speak briefly. Now that you’re in charge, the details are important. This is not someone putting your name on a golf course or a condo building. There, whether the pool goes on the 17th or 18th floor doesn’t matter. Now, your decisions impact lives around the world. Refugees get left behind and are killed. Brilliant Muslims don’t come here to study or work because they don’t know what the future holds for them in this country. Your decisions need to be carefully considered and thought through. The implications are gravely important. You can’t have government officials making up the rules as they go along. It’s already clear that your order has nothing to do with national security. It’s pure Islamophobia, with a touch of personal greed: 


Our country is one that welcomes immigrants and is a shelter to those in need. It is supposed to be a shining light on a hill for all to see, to be the beacon of what is good and right in this world. We are inclusive and we don’t discriminate on the basis of religion. We aren’t this.  

I keep thinking about the family in Syria who has seen their country torn apart, friends die, everything they know destroyed. The ones who sat in a filthy refugee camp for years while they were screened and vetted. The family who were finally told they had gotten their chance and that there was a home waiting for them in a safe country that accepted all people. That family days away from finally escaping their nightmare, only to be told “no.” 

We are not this. We are better. 

#resist

A pro-life agenda


Dear Donald –

Another week, and another march. The annual March for Life came to D.C. today, as it has every year since 1974. Today’s march, though, was radically different than Saturday’s Women’s March on Washington. Unlike last week, today’s protesters were marching to restrict rights, not maintain or expand them. They were marching to enshrine their religious beliefs in the law, not separate the two. They said they were marching for life, but their agenda seems woefully inadequate to promote life – a good, quality life for all children – in our country. According to the organizers, they have four main priorities:

  1. Have you appoint an antiabortion judge to the Supreme Court
  2. Make the Hyde Anendment permanent law
  3. Make all abortions after 20 weeks illegal under Federal law
  4. Defund Planned parenthood 

On the first issue, let’s be clear that an antiabortion justice is an anti-Constitution justice. A woman’s right to choose a safe, elective medical procedure in consultation with her physician has been constitutionally protected for 43 years, which is why I was baffled when you said that you thought Obergefell was settled law, but Roe v Wade was not. Keep in mind that constitutional rights are not whisked away simply because a vocal minority doesn’t want them to be rights anymore. The only thing that should be unsettled about Roe is that it is a right still denied to too many women. A Supreme Court justice should never be chosen on the basis of his intent to deny rights and protections to people. 

As for the Hyde Amendemnt, banning the use of Federal funds for abortions, it’s been passed every year since 1976. You’d be hard pressed to find any provision of law with that many up votes in its favor. It’s clearly not going anywhere anytime soon. It’s basically permanent law already. 

Even at the State level, 20 week bans are wildly misguided and impractical. At the Federal level, it’s ridiculous, and you’d burn trough a ton of political capital for something that would go nowhere. 57% of the American people believe that abortions should be legal in all or most cases. You’d likely lose the fight in Congress, or you’d relegate your party to the trash heap for years to come. Just say it’s not a Federal issue and move on. 

And defunding Planned Parenthood is truly a bad idea. If nothing else, the organization helps women reduce the likelihood of unplanned pregnancies, actually dropping the number of abortions nationwide. Defunding it would likely increase the number of unplanned pregnancies and abortions, as well as increasing the number of deaths from various cancers. It is a truly bad and ideologically driven agenda item that has no basis in the reality of the work that Planned Parenthood does every day.

With all that being said, what would a real pro-life agenda look like? Maybe something like this:

  • Free healthcare for expectant mothers 
  • A stipend for low-income expectant mothers or those who plan to put their children up for adoption to help offset costs
  • Bolstering the foster care system to ensure quality homes for as many children as possible 
  • Removing adoption restrictions (e.g., gay bans) for otherwise qualified families
  • Increase the availability of affordable child care options
  • Universal healthcare
  • Ensuring that the minimum wage is a living wage
  • Expanding food assistance programs to ensure that no child (or adult) goes hungry
  • Ensuring high quality schools in low income communities
  • Increase the value of Pell Grants to cover the cost of tuition at 4 year colleges
  • Promoting competitive integrated employment for individuals with disabilities
  • Criminal justice reform 
  • Increasing the number of SROs and transitional housing programs to reduce homelessness
  • Reducing the availability of guns
  • Increasing the availability and reducing the cost of drug treatment programs
  • Reducing prescription drug costs for seniors (and all people)
  • Ensuring that no senior receiving Social Security lives in poverty
  • Promoting and protecting death with dignity laws

To me, that’s much more of a pro-life agenda than anyone was talking about today. 

A Holocaust without Jews

Dear Donald –

Happened to notice your statement on Holocaust Remembrance Day. The Holocaust remains one of the darkest periods in human history, and it’s important that we remember what can happen when a nationalist populist leader who scapegoats minorities wields the power of the State. Just one small thing. Did we forget about the Jews?

Maybe it’s just me, but it seems odd not to mention six million people dying for their religious beliefs on the day meant to remember that very fact. 

Chicago


Dear Donald – 

I’ve seen reports that your aides are having trouble getting you to stop watching TV and to actually do work. I guess it’s not surprising then that your most recent tweet about Chicago came just about an hour after Bill O’Reilly did a segment on the violence in the city and posted this graphic:


Just after that segment and after an interview in which Rahm wasn’t particularly deferential to you, you tweeted this:


All of this doesn’t seem unrelated, and gets back to a core problem – you’re way too reactionary for your own good. You lash out with poorly constituted facts and no follow-through and you end up looking silly. With all that being said, I’m sure Chicago would love you to “send in the Feds.”  

Im going to just sidestep all of the Jade Helm type conspiracy stuff here. I’m assuming your aides have already explained to you that you can’t send in federal troops to serve a law enforcement function. Back in 1878, Congress passed the Posse Comitatus Act to prevent federal troops from enforcing civil rights in the South. Even today, it limits what you can do. You can’t institute martial law. But here’s a few things you can do to “send in the Feds” and really help out in Chicago:

  • Provide federal funding to hire more police officers. More cops on the beat with better training in community policing can help bring down the crime rate. 
  • Embed FBI agents in the Chicago PD. Barack did this with a number of police departments needing assistance and the agents provided both staff and expertise to help out on the ground. 
  • Order the ATF to help crack down on guns flowing in from other states. 60% of guns recovered in Chicago from 2010 to 2013 were purchased out of state. 19% came from Indiana. Maybe Mike knows where they came from. 
  • Have DOJ prosecute individuals on Federal gun trafficking and racketeering charges. Increasing prosecutions may help relieve local prosecutors while also removing he worst offenders from neighborhoods
  • Have the Departments of Edication and Labor direct resources to the city. Increasing educational opportunity and job training can help provide a way out of the cycle of poverty for thousands of kids. Someone who is gainfully employed doesn’t have a need for gangs or drugs. 
  • Direct HUD to improve its after school, child care, and community programs in public housing. 
  • Increase the availability of Small Business Administration loans to minority owned businesses in the city and prioritize those that agree to hire individuals under 35 and on some form of public assistance. 
  • Designate more areas on the south side and West side of Chicago as Empowerment Zones, making them eligible for more federal aid. 
  • Direct HHS to fund more Head Start and Early Head Start programs (and other child care and support programs) in the city. 

In short, send in the Feds. Send in all the Feds. I’m sure Rahm would be happy to have them.