Spring Sale: Get 1 Year, Save 58%

Exclusive: Dan Crenshaw hit with ethics complaint following report he worked to smear fellow vet

A government accountability watchdog group filed a complaint with the House Ethics Committee on Tuesday, demanding Rep. Dan Crenshaw, R-Tx., be expelled from Congress for his alleged role in what a federal investigator described as a concerted effort on the part of top Veterans Affairs officials to smear a sexual assault victim.

The complaint, filed by the Campaign for Accountability (CfA), draws on a recent report from the VA Office of Inspector General (OIG) describing efforts at the highest levels of the agency to undermine the department’s probe into a woman’s allegation that a contractor had assaulted her in a VA hospital. The report outlines a number of “troubling” issues, including allegations that VA Secretary Robert Wilkie disparaged the woman after personally looking into her background.

According to the report, Crenshaw told Wilkie that Andrea Goldstein, a former Democratic congressional staffer and Navy veteran who served in Crenshaw’s unit, frequently made frivolous complaints. Goldstein and her legal counsel rejected that claim in testimony to the OIG, while Crenshaw’s office refused to cooperate with investigators.

“It is shocking that Representative Crenshaw would defame a fellow Navy veteran and employee of one of his colleagues in an attempt to interfere in a sexual assault investigation,” CfA Executive Director Michelle Kuppersmith told Salon in a statement. “His conduct and his colleague’s lack of reaction are a black mark on the important work done in recent years by activists, Congress, the military, and the Department of Veterans Affairs to combat sexual assault in the military. Representative Crenshaw’s actions described by Inspector General report appear so egregious that the House ethics committee should recommend his expulsion from Congress.”

House rules require the chamber to deal with members who commit “flagrant” ethical violations that reflect poorly on “Congress as a whole.” The CfA’s complaint points out that the Ethics Committee has enforced this a number of times, including with failures to report campaign contributions, accepting gifts in exchange for legislative favors and making false statements. In a 2017 memo, the committee emphasized that the House should apply the rule in cases of sexual harassment and discrimination against congressional staff.

On Monday, Rep. Jackie Speier, D-Calif., also called on her colleagues to investigate.

“Rep. Crenshaw’s alleged involvement is abhorrent. If true, Rep. Crenshaw fed false information to Sec. Wilkie in order to help vilify a victim & impugn her character,” Speier wrote on Twitter. “The Ethics Committee must launch an investigation into these claims.”

Goldstein, who once worked for House Veterans Affairs Committee chair Mike Takano, D-Calif., claimed in 2019 that while she waited in a VA hospital, a department contractor “bumped his entire body against mine and told me I looked like I needed a smile and a good time.”

Takano called for a department investigation, however, the report describes that senior VA officials showed an “unusual level of engagement” for a criminal investigation. Testimony from current and former VA officials indicated that Wilkie had looked into Goldstein himself almost immediately after she filed her complaint, and personally disparaged her several times to top staff.

One former VA official testified that Wilkie had claimed Goldstein filed “at least six EEO-type complaints” while on active duty in the Navy, information that the former official believed had come from the Secretary’s contacts at the Pentagon. Another witness said that a senior VA official once remarked that Wilkie had already obtained information about Goldstein.

Wilkie and Crenshaw had spoken about Goldstein at a fundraiser. The OIG cites an email Wilkie sent to two top aides immediately after the event, saying, “Ask me in the morning what Congressman Crenshaw said about the Takano staffer whose glamor (sic) shot was in the New York Times.”

The secretary later acknowledged the conversation to investigators but claimed that the Texas Republican merely said that he had served with Goldstein. Asked why that benign observation prompted the email, Wilkie simply replied: “Well, I don’t remember. I have no idea.”

One VA official testified that Crenshaw “might have said something to the fact that [Goldstein] made allegations in the military,” and another claimed that Wilkie had said Crenshaw told him about the alleged past complaints.

Goldstein, who told the OIG that Crenshaw’s claim was false, said that she had filed one harassment claim when she served, which an investigation substantiated and later led to disciplinary action against the perpetrator. Although Crenshaw did not cooperate with the OIG, in an earlier interview with ProPublica he did deny that he and Wilkie ever even discussed Goldstein — directly contradicting the Secretary’s testimony.

The secretary also speculated in an email that Takano requested the investigation because the HVAC chair was “laying the grounds for a spectacle,” according to the IG’s report, and VA department staff expressed suspicion of Goldstein’s claim due to her specific work regarding sexual assault issues for Takano’s office. After the investigation, Wilkie sent Takano a letter falsely claiming that the investigation into Goldstein found her claims were “unsubstantiated.”

This violated the OIG’s explicit directions to VA staff not to comment on the merits of the accusation. The OIG also reminded Wilkie that his investigation had not reached that conclusion: “Neither I nor my staff told you or anyone else at the Department that the allegations were unsubstantiated.”

The secretary denied all accusations against him, but despite the fact that the OIG found his testimony “incomplete or incorrect,” investigators could not clear up the contradictions because Wilkie declined a follow-up interview, and others — including Crenshaw — would not cooperate. While the OIG could not prove wrongdoing, the report concluded that the Secretary and senior officials showed “a lack of genuine commitment” that jeopardized a “safe and welcoming environment” for victims of sexual assault.

“The tone set by Secretary Wilkie was at minimum unprofessional and at worst provided the basis for senior officials to put out information to national reporters to question the credibility and background of the veteran who filed the sexual assault complaint,” the OIG wrote, adding that the conduct would “appear to undermine VA’s stated goals of providing a safe and welcoming environment for all veterans and to treat complainants of sexual assault with respect.”

A House Ethics Committee spokesperson declined to comment. Crenshaw did not respond when asked for comment.

ESPN’s “30 for 30” challenges the fetishization and appropriation of the barefoot ultramarathon

In 2013, Vibram — the company that manufactures the FiveFingers “barefoot shoes” — settled a class action suit led by consumers who alleged that the company “deceived customers by advertising that the footwear could reduce foot injuries and strengthen foot muscles, without basing those assertions on any scientific merit.” 

This was following the heyday of the “barefoot running” trend. You may remember it: Some runners eschewed modern footwear to run in minimalist shoes or completely barefoot because they perceived it as being more in line with the way our bodies were naturally meant to move. It was a small, but significant, fringe group within the sport and it caught a lot of media attention. 

Publications ran profiles on athletes like Rick Roeber, who had run more than 50 marathons barefoot. In 2009, the Barefoot Runners Society was founded as a national club and its membership doubled within a year to nearly 1,500 members; that year the New York City Marathon reported an uptick in barefoot participants. 

Some analysts connected the trend to a cultural movement towards minimalism following the recession, as well as shifts in spending patterns (the current average list price of a pair of running shoes is around $121, so why not ditch that cost entirely?). But what really catapulted the movement into the mainstream was the release of Christopher McDougall’s 2009 book, “Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen.” 

McDougall’s best-selling book explored the lives of the Tarahumaras, an Indigenous community who live in Chihuahua, Mexico and are known for what some have described as a superhuman ability to run distances of over 100 miles regularly, often while barefoot or in flimsy sandals. Alongside his ethnological research of the Tarahumaras, McDougall asserted that modern cushioned running shoes were a major cause of running injury. 

Thus began a multi-year romanticization of the Tarahumaras, who also call themselves the Rarámuri, within the running community. People ditched their running shoes. Articles with headlines like “4 Secrets of the Tarahumara That Will Improve Your Running” and “How to Run WIth Perfect Form Like the Tarahumara Tribe – Posture, Breathing and Footstrike Explained” began popping up. International athletes flocked to Mexico to run alongside the Rarámuri in the annual Ultra Maraton Caballo Blanco—named after American ultrarunner Micah True, who was a central figure in McDougall’s book. 

But for many people, the fascination with the Rarámuri was just a trend, much like the popularity of Vibram’s FiveFingers, especially once drug cartel violence infiltrated their community. This is where director Bernardo Ruiz’s ESPN 30 for 30 documentary, “The Infinite Race,” picks up, delving into the sometimes murky lines that emerge between championing a community and the superficial fetishization of ancient, indigenous practices. 

“The Infinite Race” begins, fittingly, during a run. Here, viewers are introduced to Silvino Cubesare, who says, “When I was young, I had many dreams. I always wanted to be a runner. We Tarahumara are born with a gift.”

But, as Ruiz establishes over the next hour, it’s not a one-dimensional gift that should be reduced to training programs and fad workouts. The Rarámuri have lived a purposely isolated life since they first literally ran into the mountains to escape Spanish conquistador rule. They lived separate from modern Mexican society and, until recently, tourist visitors. 

Rarámuri communities were separated by miles of challenging terrain. Running was both a necessity for connection, and a deep part of their heritage. Irma Chávez, a Tarahumara activist, explains that the Rarámuri had traditional games; the men’s version, called rarajipari, involves repeatedly kicking and chasing a wooden ball over long distances, while the women’s equivalent, ariweta, involves running with a stick and a hoop. Both games traditionally lasted for days and many miles. 

Both Chávez and Cubesare are skeptical of why a runner who could actually afford shoes would run without. “I don’t know what they’re thinking,” Cubesare says. “Why do they want to run barefoot? I think they are crazy.”

Chávez, in particular, views the barefoot running trend as a clear example of corporations profiting off misconceptions about the Tarahumara. They don’t run barefoot for performance enhancement, she says, but because most Rarámuri communities are deeply impoverished due to drought, famine and cartel violence. 

The top prize for the Ultra Maraton Caballo Blanco? Sure, there’s money, but there are also vouchers for corn. Many Rarámuri, like Chávez, don’t view ultramarathon competitions as part of their heritage, but they participate because they are desperately in need. 

Through Ruiz’s lens, we see that these are the hard truths that often get overshadowed when Indigenous communities are painted by outsiders as romanticized ideals instead of real, modern people. This was a point that indigenous writer Kelly Anderson made in her “Spring’s least-wanted fashion trend: The co-opting of Aboriginal dress.” 

She pointed to the litany of instances of Native imagery being presented without context. In 2012, No Doubt released their “Looking Hot” video — and subsequently pulled it after fans objected to Gwen Stefani writing around in a provocative buckskin outfit and headdress. Several weeks later, Victoria’s Secret model Karlie Kloss walked down the runway in a  bikini and full headdress — even though the headdress is revered and intended for respected leaders, not for use as a fashion accessory.

And while last year many musical festivals across the country finally banned attendees from wearing Native American-style headdress, “Sexy Indian” outfits, with names like “PocaHottie,” still appear on costume shop shelves. It’s like, Anderson said, Indigenous populations are like a fairy tale to some people, and are presented as such in mainstream markets. 

“When society only sees us as the images you presented, it means that our modern issues of poverty don’t exist; nor do our modern efforts like schooling and economic development through sovereignty and nation building,” explained Keene. “We have sophisticated tribal governments and communities, but how will we be able to be seen as modern, successful people if we are continually represented through plastic tomahawks and feathers?”

This misguided fetishization takes place in more subtle ways, too, like through the appropriation of Native rituals as New Age self-help or wellness trends or, in the case of the Rarámuri, the unthinking influx of tourism for their annual race without actually supporting the community.

In 2015, the organizers of the Caballo Blanco ultramarathon were forced to cancel the event the night before it was to be held after multiple incidents broke out during the lead-up to the race. This was a decision made unilaterally by non-local organizers, and foreign runners evacuated as quickly as possible, though a substitute race was held in the municipality of Urique. 

“I didn’t see the face of a single foreign runner,” Cecilia Villalobos, Urique’s former director of tourism, told Ruiz. “And I thought, how ironic. Where are all those folks who support the Tarahumaras?” 

This decision also called into question whether the promised food vouchers would be available for the winners of the abbreviated race. While the tourists could simply leave the race behind, some of the Rarámuri were counting on it for survival. 

This is the story that “The Infinite Race” lays bare. It strips away the decades-long myth of the Tarahumaras being almost superhuman and gives them the opportunity to finally tell their own story without glossing over the historic trials they have and continue to face. For them, running isn’t about the competition or reaching peak performance capacity. It’s a way of life, a tradition and a key to survival. 

Chávez sums it up like this: “Running is our resistance to imposition.” 

“The Infinite Race” is available to watch on ESPN online with a valid cable subscription starting Dec. 16.

Here are 6 great film performances you missed in 2020 – and how to watch them

Given the universal shift to home viewing during the pandemic this year, there were almost too many films to see via all of the digital platforms and streaming options. Many of the best films were lower profile and featured performances that largely flew under the radar. Here are six great performances from 2020 that deserve a look.

Rob Morgan in “Bull” (Available on DVD and VOD)

As Abe Turner, a bull rider in the sunset of his career, Rob Morgan gives arguably the year’s most soulful performance. Abe is a man who is physically and mentally broken, and Morgan makes you feel all his pain — especially when he hits bottom, being demoted to working as second fiddle to a rodeo clown. “I ain’t no clown,” he insists, trying to keep a shred of dignity. But as he sneaks sips of whiskey — in addition to the painkillers he takes to numb himself — Abe’s suffering is palpable. Late in the film, he stares down a (possibly imaginary) bull. His power and his weariness in this moment speak volumes about Abe’s life, and Morgan is at his most downtrodden and most heartbreaking. 

Carrie Coon in “The Nest” (Available on VOD)

Sean Durkin’s suffocating drama, “The Nest,” is a magnificent showcase for Carrie Coon’s (“The Leftovers,” “Fargo”) unflinching performance as Allison O’Hara, the long-suffering American wife of supercilious British businessman Rory (Jude Law). Coon is coolly resigned as she endures moving to England with a man she soon does not love or trust. Putting on a brave face and quietly seething for most of the film, Allison occasionally takes control, such as at a dinner with her husband where she orders an expensive meal and embarrasses him — especially when she samples the wine by drinking right from the bottle. Such impulsive moments are why Coon’s portrayal is so delicious. But it is when she finally punctures things at an important business dinner that Allison shows her mettle. No longer stifled, she gives the coat check girl her fur, walks off and finds a bar where she drinks and dances, finally liberated. It may be her first taste of freedom in the entire film, and Coon makes viewers feel its rush, even as she sinks further into despair. 

Orion Lee in “First Cow” (Available on Blu-Ray and VOD)

Kelly Reichardt’s unhurried gem about male friendship in the 1800s benefits from Orion Lee’s finely calibrated turn as King Lu, a man who is first seen naked and hiding in the woods by Cookie (John Magaro). King Lu is vulnerable here, but Lee projects such confidence as he explains that he is Chinese, not Indian, and on the run from Russians, that he secures Cookie’s trust. He becomes more ingratiating after the men reunite a while later, and King Lu dreams about the value of beaver oil, wanting a farm to grow nuts, and needing capital to start a business. Stating how he “believes different things in different places,” King Lu reveals himself as a seductive shapeshifter who adapts to his environment but is always aware of which way the wind blows. Lee’s internal performance — watch him as he sizes up the various fools he encounters — is as irresistible as the oily cakes Cooke and King Lu sell in their community using milk they steal from a landowner’s cow.  

Sierra McCormick in “The Vast of Night” (Amazon Prime Video)

This sleeper sci-fi mystery features a fantastic performance by Sierra McCormick as Faye, a teenage telephone operator who is friendly with Everett (Jake Horowitz), a local DJ in Cayuga, New Mexico, circa 1950. As they walk to their jobs one night (a fabulous tracking shot), the loquacious Faye recounts popular magazine articles about radio-controlled cars, vacuum tube transportation, and cell phones in an effort to “razz Everett’s berries.” Her enthusiasm is infectious. This leads into her key scene, a 10-minutes switchboard sequence where she speaks far less. As a strange sound comes in over the telephone line and radio, Faye expresses her concern with a furrowed brow and quizzical looks behind her cat’s eye glasses. It is in this dazzling set piece that, McCormick, reminiscent of a young Sissy Spacek, is as awe-inspiring as Faye is awestruck. 

Luca Marinelli in “Martin Eden” (Available on VOD, virtual cinemas & Blu-Ray)

More folks saw Luca Marinelli as half of a gay couple in Netflix’s sci-fi action flick “The Old Guard” this year, but the attractive Italian actor also gave one of the year’s best performances in “Martin Eden,” a sumptuous adaptation of the Jack London novel. As the title character, a poor, uneducated laborer who falls in love for the wealthy Elena (Jessica Cressy), Marinelli is absolutely magnetic. In a scene where he confesses his dream to become a writer to her, his anxiety and excitement are palpable. His eyes search Elena’s for approval, which is not entirely forthcoming. Martin, however, is as realistic as he is determined, and applies to get educated only to be told that he is lacking in basic knowledge. He is, of course, dejected, but as he grapples with being denied an opportunity, he becomes more resolute. Marinelli communicates Martin’s fortitude with grace as he resiliently bootstraps to achieve his dream. It is impossible not to root for him to succeed. 

Lovie Simone in “Selah and the Spades” (Amazon Prime Video)

Lovie Simone is exceptional as the calculated, controlling Selah, leader of the underground faction, the Spades, in this juicy tale of backbiting teenagers at an exclusive private school. However, she has one weakness: her formidable mother Maybelle (Gina Torres). Selah’s mom is a woman who instills the kind of fear in her that Selah instills in her classmates. When Selah returns home one day, the camera deliberately does not show her face. As she enters the house s-l-o-w-l-y, running her hand along a hall table, this is a teenager about to be rebuked. When Maybelle casts a withering look at her disappointing daughter, Selah bows her head, shamefully. Simone has very few lines in this pivotal scene; it is all her silently reacting to her mother telling her that Selah needs to be “put in her place” and “saved from herself.” Selah may act contrite, but this lecture disputedly empowers her, and Simone’s hypnotic performance shows how Selah both embraces — and cracks — under the pressure she internalizes. Simone’s performance, however, is flawless.

Pompeo goes into quarantine after hosting State Department holiday party in the middle of a pandemic

Secretary of State Mike Pompeo is in quarantine after he was exposed to someone who tested positive for the coronavirus, the State Department confirmed on Wednesday. The nation’s top diplomat abruptly canceled a pair of holiday parties for diplomats where Pompeo was scheduled to speak the night before, CNN reported.

“Secretary Pompeo has been identified as having come into contact with someone who tested positive for COVID,” a representative from the State Department said in a statement to CNN. “For reasons of privacy we can’t identify that individual.”

The spokesperson added that Pompeo tested negative for the coronavirus but will be in quarantine and is “being closely monitored” by the department’s medical team in accordance with guidelines from the Centers for Disease Control and Prevention.

It is unclear when or where Pompeo was exposed but the news comes as the State Department and Trump White House have held numerous in-person holiday parties amid the coronavirus pandemic. Public health officials have warned against holding large indoor gatherings as infections in Washington DC and across the country continue to spike.

Pompeo, whose name was atop the invitations, was scheduled to speak at a Tuesday event but canceled and sent deputy Stephen Biegun instead after just 70 of the 900 invitees RSVP’d for the event, The Washington Post reported. Only “a couple dozen guests” actually showed up, according to ABC News, even though past gatherings have typically drawn crowds of 200 to 300 people.

The event featured “drinks, boxed meals and a masked Santa who walked around from table to table to chitchat with adults and children,” according to the Post. Though the State Department vowed to enforce mask requirements and social distancing guidelines, many attendees removed their masks to eat and drink.

“It was a completely irresponsible party to throw,” the spouse of a diplomat who declined the invitation over concerns about her children told the Post.

Lawmakers also criticized the event and urged Pompeo to cancel the gathering.

“I am concerned that these parties pose a significant health risk, not only to attendees, but to the employees and workers who must staff these events, as well as to State Department employees who may feel pressured to attend,” Sen. Bob Menendez, D-N.J., said in a letter to Pompeo earlier this month.

Following the announcement of his planned quarantine, Pompeo canceled his scheduled appearance at President Donald Trump’s Cabinet meeting on Wednesday and his in-person Thursday meeting with Antony Blinken,  picked by President-elect Joe Biden to succeed Pompeo at State.

The American Foreign Service Association, a nonpartisan union that represents the department’s diplomats, issued a statement calling on the department to “reverse course and model responsible behavior in accordance with its own guidelines.”

“The Department’s leadership has urged embassies and consulates around the world to host only virtual holiday gatherings this year. It is therefore disconcerting to hear of these plans, which not only go against the Department’s own guidelines but also health regulations in Washington, D.C. and the recommendations of the Centers for Disease Control and Prevention,” the statement said.

The union said that although the parties are not mandatory for invitees, “the same is not true for State Department employees and contract catering workers.”

“The catering workers often do not receive health insurance from their employers and must staff these events in order to keep their jobs,” the statement said.

The State Department is expected to receive its first coronavirus vaccines this week, according to an internal email obtained by ABC News. A “very limited number” of vaccines will be given to a small group of critical or at-risk employees, including front-line personnel serving in Afghanistan, Iraq, and Somalia.

It’s unclear whether Pompeo would get a vaccine but the outlet reported that Pompeo and his staff likely fall into one of the “critical” categories listed by the department. Acting Defense Secretary Chris Miller became the first known Cabinet secretary to receive a vaccine on Monday.

The vaccines will “allow the Department to advance U.S. national security interests and ensure America’s essential diplomacy continues unimpeded,” a State Department spokesperson told ABC News.

Pompeo has frequently hosted lavish parties organized in part by his wife Susan, who also frequently traveled with her husband on official business trips.

Documents obtained by the government watchdog Citizens for Responsibility and Ethics in Washington showed that Pompeo spent more than $40,000 in taxpayer dollars on the so-called “Madison Dinners” that were attended by major donors and Republican Party figures with no clear ties to the State Department or foreign affairs. Pompeo was rumored as a potential candidate for a Senate seat in Kansas at the time. Pompeo scrapped some of the dinners early in the pandemic but restarted them in the fall, according to Politico.

“Dozens of department employees who support these dinners, from security officers to catering staff who prepare the food, facilities management and protocol staff,” a State Department official told the outlet, “do not have the option to work these events remotely or turn down an assignment.”

Giada De Laurentiis’ easy one-pot pasta is our new favorite weeknight recipe

If there’s one thing we hate about cooking, it’s the clean-up. Finding a yummy recipe, getting the ingredients together, tasting as we go . . . we’re into all that. But after a long day of work and parenting, and then, you know, actually cooking, facing a pile of dirty dishes in the sink is no fun. Thankfully, Giada De Laurentiis knows our pain. De Laurentiis constantly gets us through the week with her easy to follow recipes. And folks, she’s done it again! You’ll only need one pan to prepare her Calabrian Chili Pasta. Hello, easy clean-up time!

“This easy one-pot pasta is loaded with big flavor from piquillo peppers, Calabrian chili, lemon, chives and Pecorino. Easy weeknight dinner, check!” she captioned the post, shared on her Giadzy Instagram account.

Simple, delicious and only requires one pot? The queen of pasta may have unlocked the holy trifecta with this one. And somehow, it gets even better: The prep time is just five minutes, which is basically the time it takes to listen to one good Adele song. Then the cooking time is a lovely 15 minutes. So yep, we’re talking dinner on the table in 20 minutes, which is . . . amazing.

You’ll begin by boiling water in your high-sided skillet (we recommend this chef-favorite Lodge skillet). Once it’s boiled, add in your penne and salt.

Once cooked, there should be a little water left in the pan. You’ll want to sprinkle pecorino cheese on top of the pasta (add as much or as little cheese as you’d like).

Finally, you’ll add and mix in the mere handful of ingredients this easy recipe calls for. And now, dinner is served.

Get the full recipe for De Laurentiis’ Calabrian Chili Pasta. And if you’re craving more pasta (who wouldn’t be) check out our favorite pasta recipes from Giada!

Read more SheKnows:

  1. The Best Ina Garten-Approved Kitchen Gifts for Foodies
  2. 17 Holiday Main Courses You Can Make Right in Your Slow Cooker
  3. Don’t Miss These Incredible Ina Garten Holiday Recipes & Gift Ideas

What vaccine distribution planners can learn from Amazon and Walmart

The initial rollout of Pfizer’s COVID-19 vaccine has begun, and vaccines are shipping across the U.S. Demand for COVID-19 vaccines will outpace supply for the foreseeable future. Yet experts have warned that a substantial proportion of these highly perishable vaccines could go to waste if they are not being used before they expire.

With such short supplies and high demand, worrying about waste may sound paradoxical, but is actually a predictable result of two well-known medical distribution challenges: complicated storage requirements and variability in demand.

We are two supply-chain experts who have studied vaccine purchasing and distribution. Drawing from our decadeslong research into supply-chain management and health care operations, we believe two supply-chain ideas practiced by Amazon and Walmart can help reduce waste and minimize shortages of COVID-19 vaccines.

Fulfillment centers solve demand variability

For a given county, it is reasonable to expect demand for COVID-19 vaccines to be relatively stable. But forecasting demand at individual vaccination sites within a county on a weekly or daily basis is going to be challenging. People might miss or skip appointments for a variety of reasons, and few hospitals have the ability to share real-time usage and inventory information with public health authorities. Any time there is a mismatch between supply and demand, there is waste: Doses could spoil if they were already defrosted, or be sitting unused in freezers at one hospital while another hospital nearby is running short.

Fast fulfillment of uncertain demand is not unique to vaccine distribution. Amazon faces highly volatile demand for millions of products and yet is able to offer same-day and one-day delivery to 72% of the U.S. population. Its secret lies in regional fulfillment centers that pool inventory to meet demand across large regions.

Instead of shipping vaccines directly to hospitals and pharmacies, states could set up regional “fulfillment centers” in different counties with pooled inventory — much like Amazon’s. These fulfillment centers can restock vaccination sites on demand on a daily or weekly basis as needed. By using this just-in-time distribution strategy, supply could better match demand at specific sites and reduce potential waste of vaccines.

Getting vaccines to where they are needed

Regional fulfillment centers can help alleviate waste from fluctuating demand at different local sites, but you still need to be able to get vaccines to fulfillment centers. The faster this happens – and the less storage needed along the way – the less possibility for wasting vaccines.

Pfizer’s vaccine has to be kept at minus 70 degrees Celsius (minus 94 degrees Fahrenheit) for long-term storage. This requires expensive, ultralow-temperature freezers that have quickly become scarce as countries and states race to build their vaccine logistics infrastructure. Moderna’s vaccine requires only regular freezers, but some rural areas in the U.S. and many developing countries lack cold-chain infrastructure.

One way to minimize storage needs is to use an approach called cross-docking. Walmart, sometimes called “the king of cross-docking,” popularized this idea that all but does away with excess storage requirements.

Instead of taking deliveries from incoming trucks to intermediate national or state-level warehouses, and then from warehouses to outgoing trucks, cross-docking skips the storage step. You can simply move goods across a loading dock directly from the trucks that came from airports or vaccine manufacturers straight to the outgoing trucks that are headed to various regional fulfillment centers.

Applying the cross-docking idea to vaccine distribution would greatly reduce the need for cold storage by getting rid of the need for freezers at intermediate warehouses. This would be especially beneficial to rural areas and developing countries.

To be certain, cross-docking requires meticulous planning and coordination from vaccine manufacturers, distributors, health departments, ground transportation companies, health care providers and patients, but it is doable. Walmart has built one of the most efficient supply chains on earth using this very idea.

A smooth chain from manufacturer to hospital

U.S. health authorities could set up a system that uses cross-docking and freezer trucks to first deliver the vaccines from airports or manufacturers to multiple regional fulfillment centers while minimizing the need for intermediary storage. Pfizer’s vaccine is shipped in packages containing a minimum of 975 doses. Once taken out of the the freezer and put in a refrigerator, each vaccine can last no more than five days. But not every vaccination site, especially in rural areas, can give 975 doses within five days. At the fulfillment centers, the vaccines would be split up into smaller packages and moved into vehicles that distribute these defrosted doses in small batches to local vaccination sites for just-in-time immediate use.

Large retailers like Amazon and Walmart have developed time-tested supply-chain tools that public health authorities could learn from. Designing effective COVID-19 vaccine supply chains could help vaccinate the population efficiently and smoothly with less waste.

Tinglong Dai, Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of Nursing and Christopher S. Tang, Distinguished Professor and Edward W. Carter Chair in Business Administration., University of California, Los Angeles

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

Palm Beach residents are trying to bar Trump from returning to Mar-a-Lago

Donald Trump’s post-presidency plans could be upended by local officials in Florida, where he intends to live after leaving the White House.

Palm Beach residents sent a demand letter to local officials and the U.S. Secret Service arguing that Trump had given up his right to live at Mar-A-Lago when he agreed to turn his private residence into a private club, and the town code enforcement board could prohibit him from living there.

“Well, he may not imagine it, but there are quite a few neighbors who are up in arms about the fact that he’s returning, and not just because of his politics,” Washington Post reporter Carol Leonnig told MSNBC’s “Morning Joe.” “He’s had a long history of ticking off his neighbors.”

Trump has tried to violate that 1993 agreement before by trying to erect an enormous flagpole, planning to subdivide his lots and seeking permission to build a dock, she said.

“There’s a lot of distrust in this community about Donald Trump, because he has sued the town of Palm Beach when it tried to block him from dividing this property to residences,” Leonnig said. “I’d say it’s also important that Donald Trump’s organization and the club have not so far consistently complied with the agreement that we’re talking about. For every single year Donald Trump is supposed to report how he’s complying with that non-residency requirement, by explaining where members live, explaining that they haven’t stayed longer than seven days consecutively. For four of the 20 years he hasn’t reported it.”

“Another important thing [is] he has stayed at that club and visited it 30 times during his presidency, so he’s already flouted that law pretty clearly, and there are a lot of neighbor there’s who say just on its face, they can’t trust Donald Trump to comply, and they want the town of Palm Beach to force the president to do that,” Leonnig added.

Peppermint bark is the perfect holiday gift that you can make right at home

Gifts don’t need to be expensive or luxurious to be meaningful. Sometimes the best gifts are made at home and during the holidays, candy is one of the easiest and most delicious homemade gifts you can make. There are countless holiday candy recipes out there but my personal favorite is peppermint bark. Peppermint is the quintessential holiday flavor and this recipe is not only easy, but fun to make your own by adding a variety of toppings. For this recipe, I chose to make peppermint bark with three different toppings in addition to the peppermint candy: crushed Oreos, candy holly leaves and gold sprinkles. But feel free to experiment with whichever toppings you have available or keep it traditional and stick to the crushed peppermint candy. Either way, it’s sure to be a meaningful gift that any friend or family member will be thrilled to receive.

***

Recipe: Peppermint Bark

Ingredients:

  • Semi-sweet chocolate, chopped
  • White chocolate, chopped
  • Peppermint extract
  • Crushed peppermint candy

Instructions:

  1. Line a 9×13 dish with parchment paper.  Set aside.
  2. Add water to saucepan until saucepan is about 1/3 full. Place heatproof bowl on top to create a double boiler and turn on the heat to medium.
  3. Put the semisweet chocolate in a heatproof bowl and stir until one-third of the chocolate is melted.
  4. Stir 3/4 teaspoon peppermint extract into the chocolate.
  5. Turn off the heat and continue stirring until all of the chocolate is melted.
  6. Pour into the prepared baking dish and spread in an even layer.
  7. Set aside at room temperature and allow to set for about 30 minutes.
  8. Repeat the melting process with the white chocolate.
  9. Stir in 3/4 teaspoon peppermint extract; pour over the semisweet chocolate and spread in an even layer.
  10. Sprinkle immediately with the crushed candy, gently pressing it into the white chocolate.
  11. Set aside at room temperature until firm.
  12. Lift the bark out of the pan using the parchment paper and break or cut it into pieces.

Read more SheKnows:

  1. The Best Ina Garten-Approved Kitchen Gifts for Foodies
  2. 17 Holiday Main Courses You Can Make Right in Your Slow Cooker
  3. Don’t Miss These Incredible Ina Garten Holiday Recipes & Gift Ideas

Republican megadonor hired former Houston police captain accused of assault in “voter fraud” probe

A former Houston police captain who was arrested on Tuesday after prosecutors said he assaulted an innocent man with a gun in search of nonexistent fake ballots after being hired by a prominent Republican megadonor to investigate false ballot fraud allegations.

Mark Aguirre, who reported unfounded voter fraud allegations to officials before the November election, was charged this week with aggravated assault with a deadly weapon for “running a man off the road and pointing a gun at his head” in an attempt to prove his false claims, the Harris County District Attorney’s Office said in a news release.

Aguirre, 63, faces up to 20 years in prison after prosecutors said he rammed his SUV into the back of an air conditioner repairman’s truck in October and then “pointed a handgun at the technician, forced him to the ground and put his knee on the man’s back,” an incident that prosecutors say was captured by a police officer’s body camera. Aguirre then directed police to a nearby parking lot where an unidentified accomplice had taken the stolen SUV in search of fraudulent ballots.

Aguirre told police that he and other unidentified suspects set up a “command post” at a Marriott Hotel to spy on the air conditioner repairman’s mobile home because he believed the man was “using Hispanic children to sign the ballots because the children’s fingerprints would not appear in any databases.” He suggested the scheme was funded by Facebook founder Mark Zuckerberg, according to police.

Aguirre called the Texas attorney general’s office, which later led a failed legal effort to block states won by President-elect Joe Biden from casting their electoral votes, days before the incident to request help with his “investigation,” according to a police affidavit obtained by KTRK. The office reported the call and another subsequent call on which Aguirre expressed that he was disappointed police would not intervene based on his baseless accusations.

Aguirre told police that he was part of a group of private citizens called “Liberty Center” who were investigating an alleged ballot fraud scheme, according to the release. He told officers he had surveilled the victim for four days because he believed he was “the mastermind of a giant fraud” and had 750,000 fraudulent ballots in his truck. Police found no ballots in the truck and arrested Aguirre.

“Aguirre’s claims of election fraud were found to be baseless after thorough investigation,” the DA’s office said. “He crossed the line from dirty politics to commission of a violent crime and we are lucky no one was killed,” Harris County District Attorney Kim Ogg said in a statement. “His alleged investigation was backward from the start – first alleging a crime had occurred and then trying to prove it happened.”

Aguirre told police that he was paid $266,400 by the Liberty Center for God and County, about $211,000 of which was deposited into his bank account the day after the incident.

The Liberty Center is run by prominent Republican megadonor and activist Steven Hotze, The Texas Tribune reported. Hotze was part of a Republican group that unsuccessfully sued to have 127,000 ballots which were cast at drive-through voting locations in Harris County thrown out in what county officials described as an “un-American attempt to disenfranchise voters.” A judge ultimately rejected their lawsuit but the effort successfully derailed the county’s plans to have multiple drive-through voting locations on Election Day.

Hotze was also part of a Republican group that unsuccessfully sued to block Gov. Greg Abbott, a fellow Republican, from extending early voting amid the coronavirus pandemic. Aguirre said in an affidavit filed in the suit that he was part of an investigation into a “wide-ranging and fraudulent ballot harvesting scheme.”

Jared Woodfill, an attorney and spokesman for Hotze, confirmed that Hotze’s group hired Aguirre and about 20 private investigators to investigate fraud in the state.

“[Hotze] did not direct or lead any of the investigations,” Woodfill told the Tribune, adding that Hotze instead sent tips to the investigators. “The [Liberty Center] employed the investigation team that looked into the allegations,” Woodfill said.

Hotze launched a GoFundMe page to raise money for his “investigation” and claimed on Facebook that he had raised over $600,000 to “expose” the so-called scheme. The GoFundMe page showed that he had raised nearly $70,000 before the page was removed this week after questions from Business Insider. The company said the fundraiser violated its terms of service.

Hotze is a major Republican donor who contributes to candidates around the country. The Tribune described him as “one of the most prolific culture warriors on the right” who unsuccessfully pushed a 2017 anti-trans “bathroom bill” in Texas and left a voicemail earlier this year urging Abbott’s office to shoot and kill protesters demonstrating after the death of George Floyd. Hotze also runs an anti-LGBT group called the Conservative Republicans of Texas, which was labeled a hate group by the Southern Poverty Law Center.

Aguirre worked for the Houston Police Department until he was fired in 2003 after he led a controversial botched raid that prompted the largest internal affairs investigation in the department’s history.

“I think it’s a political prosecution. I really do,” Terry Yates, Aguirre’s attorney, told KTRK. “He was working and investigating voter fraud, and there was an accident. A member of the car got out and rushed at him and that’s where the confrontation took place. It’s very different from what you’re citing in the affidavit.”

Hotze, meanwhile, touted his effort as a success.

The right-wing Republican megadonor claimed after the election that his fundraising “prevented the Democrats from carrying out their massive election fraud scheme in Harris County, and prevented them from carrying Texas for Biden. Our efforts saved Texas.”

The Houston incident is the latest alleged violent incident linked to false voter fraud claims pushed by President Donald Trump and fellow Republicans despite being unable to show any evidence of fraud in court. At least four people were stabbed, numerous police officers and others were assaulted, and multiple Black churches were attacked after a Washington DC Proud Boys protest backing Trump’s fictitious claims over the weekend.

Many lawmakers, including Republicans, have also faced death threats. The Michigan state legislature was shuttered this week due to “credible” threats of violence. Georgia election officials pleaded for Trump to speak out after they received a deluge of death threats but he ramped up his attacks instead.

“Mr. President, you have not condemned these actions or this language. Senators, you have not condemned these actions or this language,” Gabriel Sterling, Georgia’s Republican voting system manager, said at a news conference earlier this month. “Someone’s going to get hurt, someone’s going to get shot, someone’s going to get killed, and it’s not right. Be the bigger man here, and stop, step in, tell your supporters, don’t be violent, don’t intimidate. All that’s wrong, it’s un-American.”

Trump plan may set clock ticking on many health rules — setting off alarms

The Trump administration wants to require the Department of Health and Human Services to review most of its regulations by 2023 — and automatically void those not assessed in time.

A proposed rule would require HHS to analyze within 24 months about 2,400 regulations — rules that affect tens of millions of Americans on everything from Medicare benefits to prescription drug approvals.

The move has met a fierce backlash from health providers and consumer advocates who fear it would hamstring federal health officials while they seek to control the COVID-19 pandemic, which has killed more than 250,000 Americans.

The HHS proposal appears designed to tie up the incoming Biden administration, say critics. They note the timing of the proposal, which was issued Nov. 4 — the day after Election Day, when it appeared President Donald Trump would likely lose his bid for a second term.

“The cynical part of me thinks this is a perfectly designed way to bring the department to a standstill in the next administration,” said Mary Nelle Trefz, health policy associate at Common Good Iowa, a consumer advocacy group.

She said HHS does not have the bandwidth to review all these regulations during the next two years while running its many programs, including Medicaid and Medicare.

If the proposal is finalized before Jan. 20, it is likely to be undone by the incoming Biden administration. But the chore would add to duties of HHS officials trying to attack the pandemic, she said.

HHS officials deny their proposal was aimed at the Biden administration. Brian Harrison, chief of staff at the department, said he first sought legal review of the proposal in April. “Our lawyers moved as fast as they could,” he said, and the rule was written with the expectation it would be implemented during Trump’s second term.

“The outcome of the election had nothing to do with it,” he said.

Democrats and Republicans for the past 40 years have failed to review existing regulations, leaving unnecessary and irrelevant rules on the books, Harrison said.

But Andy Schneider, a research professor at the Center for Children and Families at Georgetown University who has written about the proposal, said he fears the sunset provision will be one of many actions the Trump team will take to distract the incoming administration.

“It speaks volumes that they waited until the end of the fourth year of the administration to decide that the regulatory process needs to be improved,” he said.

Incoming administrations have typically frozen new rules that were pending but have not taken effect before Inauguration Day. That gives new administrations time to unwind them.

Efforts to enact reviews of funding bills and other legislation, known as sunset clauses, have been popular among conservatives for years. The federal government has occasionally used sunset provisions in legislation, such as the tax cuts enacted during the George W. Bush administration, but it is rare to make department regulations subject to these types of mandatory deadlines.

The option is more popular among states, which have adopted varying procedures for measures passed by the legislatures or regulatory boards. Those efforts run the gamut from requiring most initiatives to be reviewed to identifying specific agencies or legislation that must be reconsidered on a regular timetable.

HHS accepted public comments on the proposal though Dec. 4, except on part of the rule affecting Medicare regulations, which has a Jan. 4 deadline. A final rule is expected before Biden becomes president on Jan. 20.

HHS officials don’t point to any specific regulations they say are outdated. However, in their supporting material for the proposal, they note in part:

“An artificial-intelligence-driven data analysis of HHS regulations found that 85 percent of department regulations created before 1990 have not been edited; the Department has nearly 300 broken citation references in the Code of Federal Regulations, meaning CFR sections that reference other CFR sections that no longer exist.”

Harrison said the scarcity of reviews is due to “inertia” and “lack of an incentive mechanism.”

“Many presidents have formally ordered their agencies to review existing regulations, and it has been existing law for 40 years, so simply asking the divisions to review these regulations has been tried for decades and proven to be ineffective,” Harrison said.

“We need to incentivize their behaviors,” he said.

With more than 80,000 employees, the department should be able to complete the review of 2,400 rules in 24 months, he added.

Harrison said the proposal is authorized by a law signed by President Jimmy Carter in the late 1970s requiring federal agencies to review existing rules. But that law has no provision that calls for cutting regulations that are not reviewed within a certain time frame, Schneider said.

The proposal says the HHS secretary would have flexibility to stop some regulations from being eliminated “on a case by case basis.”

HHS estimates the reviews would cost up to $19 million over two years. Regulations would have to be reviewed every 10 years under the proposal.

When he took office in 2017, Trump vowed that for every regulation his administration issued, it would remove two. In July, he said his administration had more than exceeded that goal.

“For every one new regulation added, nearly eight federal regulations have been terminated,” he said in a Rose Garden speech. The Washington Post Fact Checker said that claim was based on “dubious math and values each regulation as having equal weight.”

One of the few groups to endorse the HHS proposal is the National Federation of Independent Business. The group said the proposal would alleviate regulatory burdens on small businesses.

But other groups, such as the American Academy of Neurology, suggest the proposed rule would limit input from interest groups on changes to existing regulations, because it would not follow the usual process of seeking public comments when altering rules. “The AAN is highly supportive of the current process to modify and rescind regulations through the notice and comment period, as it affords stakeholders the necessary opportunity to provide feedback on proposed regulations prior to changes being implemented,” the group told HHS.

The Medicaid and CHIP Payment and Access Commission, which advises Congress, opposes the proposal. “MACPAC questions the need for a proposed rule that creates a duplicative and administratively burdensome new process that is likely to create confusion for beneficiaries, states, providers, and managed care plans,” the group said in a letter to HHS. “The new requirements will create additional unnecessary work that will distract the department and CMS from the critical roles they play in our health care system, Medicaid and CHIP amid the pandemic and its resulting economic challenges.”

It’s unclear how the proposed rule would affect long-standing regulations for product safety and standards, said Betsy Booren, senior vice president of the food lobbying group Consumer Brands Association. “The idea that these regulations would be sunset because a regulations timer went too long is not acceptable,” she wrote in comments on the proposed rule.

Subscribe to KHN’s free Morning Briefing.

Trump appointees protest politicization of the pandemic now — but the GOP has long distorted science

Wednesday morning, the New York Times published an exposé documenting the complaints of two Trump appointees at the Centers for Disease Control (CDC) who witnessed “the White House’s slow suffocation of the agency’s voice, the meddling in its messages and the siphoning of its budget.” It’s an important and well-researched piece — but it’s hard not to feel bad for the journalist, Noah Weiland, whose hard work will undoubtedly be met with a familar chorus of “no duhs” from liberal readers and “fake news” from conservatives.

It’s important to document the atrocities of the Trump era. That said, man, it’s frustrating that the whistleblowers in question — Kyle McGowan and Amanda Campbell, former Republican congressional staffers who were appointed to the CDC before quitting in protest earlier this year — appear to be under the illusion that it was Trump who somehow invented Republican lying about public health care for political ends. 

“Every time that the science clashed with the messaging, messaging won,” said McGowan, a lifelong Republican who was brought on by former Health and Human Services (HHS) Secretary Tom Price, after working for Price during his stint as a GOP congressman from Georgia. “What was so different [under Trump], though, was the political involvement, not only from H.H.S. but then the White House, ultimately, that in so many ways hampered what our scientists were able to do,” Campbell, who was also brought on by Price after working for his congressional offices, added. 

This is flat-out nonsense, and both Campbell and McGowan should know it, as they spent years dutifully working for Price, an avid purveyor of misinformation about sexual and reproductive health care. Indeed, it’s likely that the reason Price got his appointment to HHS in the first place is because he was a reliable opponent of scientifically sound policy regarding health care that affects women and LGBTQ people. Their old boss was such a fan of lying about health care that he was a member of the Association of American Physicians and Surgeons, which sounds like a nice group, but is in fact rabidly anti-science and devoted to spreading lies about abortion, HIV, vaccination, and other hot button medical issues. 

The GOP has politicized medical science for years. Trump’s approach to the coronavirus pandemic — to lie, distort, and minimize — was merely following the approach that Price, and indeed the entire Republican party, has taken to sexual health care issues for decades.

For instance, Price defended his opposition to including birth control coverage in women’s health insurance plans by saying pro-choice advocates couldn’t find “one woman” who needed such coverage to afford birth control. In fact, about a third of women struggled to afford contraception at the time, which is why the Affordable Care Act’s mandate that insurance cover contraception led to more birth control use and lower abortion rates. 

Price also backed the outrageous lie that Planned Parenthood is involved in the “harvesting and sale of baby parts,” a claim which stems from a right-wing hoax so ridiculous that it should have been self-evident at the time. Truly, it’s up there with Trump suggesting that bleaching people’s lungs might cure the coronavirus, but because it involved the taboo topic of reproductive health care, the outrageous lie got a pass that Trump’s lies about the coronavirus didn’t get from the media. 

Even Price’s wife, Betty, a Georgia state representative, was caught on video in 2017 opposing condoms for HIV prevention. “What are we legally able to do?” Price asked. “I don’t want to say the quarantine word, but I guess I just said it.”

“Leper colonies” HIV positive people was a popular idea among the homophobic right in the 80s, and apparently still rots the hateful brain cavities of the people the GOP has put up as experts on health care long before Trump took up the art of denying the science behind epidemiology.

Unfortunately, this behavior isn’t limited to the Prices.

On the contrary, the entire GOP has been consumed with lies about sexual health care for decades. They lie about abortion, falsely claiming legal access “hurts” women, when in fact, research shows time and again that it’s an important part of women’s health care. Before he was lying about the coronavirus, Trump — under advisement from the rest of the Republican party — was installing health care officials who promoted lies about birth control being “dangerous”. Vice President Mike Pence was chosen to be a soothing “normal” Republican under Trump, and, like a normal Republican, Pence had a long history of lying about condoms, falsely claiming they are “very, very poor protection against sexually transmitted diseases” and too “modern, liberal” to be acceptable as a way to prevent disease. 

Why should anyone be surprised that these same people apply the same false logic to mask-wearing to prevent coronavirus transmission? 

Nor is this the first time that the work of the CDC has been distorted by Republicans with a political agenda.

During the George W. Bush administration, the White House strong-armed the CDC into putting out false or misleading information on all manner of sexual health issues. The CDC was pressured into distorting research findings on abstinence-only programs to conceal the fact that they don’t work to prevent teen pregnancy. Government websites were strong-armed into pretending abortion causes breast cancer, which is simply not true. And information about condom usage and efficacy were taken down from CDC websites. On top of the abuse of CDC messaging, the Bush administration also pushed abstinence-only programs into the majority of American public schools, exposing millions of young people to misinformation about sexual health, such as lies about the efficacy of contraception or the dangers of abortion.

Bush also politicized the FDA, forcing the agency to avoid authorizing the sale of over-the-counter emergency contraception, not because the drug was dangerous — it’s perfectly safe — but because Republican officials were furious at the idea that women might avoid unwanted pregnancy. 

For decades, Republicans have made it clear that they are willing to sacrifice people’s health and lives to bolster their hard right-wing views on sexuality. But because the primary victims of previous Republican lies are women, LGBTQ people, and young people, this sort of widespread medical disinformation campaign has been shoved down the memory hole. Now that the same strategies of lying about health care have been employed by Trump in his quest to minimize the coronavirus pandemic, the results have been catastrophic for the nation, with over 300,000 dead and the number of infected quickly approaching 17 million. But no one should be allowed to pretend that Trump invented this kind of lying about medical science. He’s just doing to the rest of the nation what Republicans have done to women and LGBTQ people for decades. 

Kidney dialysis is a booming business. Is it also a rigged one?

Jo Karabasz knew her dialysis clinic well. Before switching to at-home treatment this summer, the former high school English teacher spent five and a half years visiting some of the dozens of DaVita dialysis clinics that dot the Northern California landscape. Her beige chair in the front corner of one clinic, where she attended appointments three times a week, quickly became her home away from home.

Since she was diagnosed with kidney failure in 2015, Karabasz has had around 820 in-center treatments, where a hemodialysis machine does the job her kidneys no longer could, filtering waste and excess fluid from her bloodstream. (She says she nicknamed her machine “Rocco, My Robot Kidney.”) Each treatment takes about four hours, which translates to around 4.5 months of Karabasz’s life spent in a dialysis clinic chair.

Holidays, wildfires, earthquakes — she says none are as important as her dialysis. Even a single missed dialysis treatment can create major health problems. If Karabasz were to miss two treatments, she could be dead before the third, as fluid would accumulate in her body and make it hard to breathe. In her last days, she could experience vomiting and confusion before her heart eventually stopped beating.

Karabasz says she’s handled a lot in her 58 years of life, but when it comes to her dialysis, she needs things to go smoothly. “Just don’t fuss with me,” she said.

So when one of the DaVita staff told Karabasz in the spring of 2019 that a new California bill could jeopardize the financial assistance she received from the American Kidney Fund (AKF), the nonprofit that helps to pay for her treatments, she felt the floor drop out from under her. “I just sat there in stark terror. Like, you have got to be kidding. Why are they doing that?” Karabasz said. “Why does the California Legislature care if the Kidney Fund helps me?”

They cared, proponents of the bill say, because they believed companies like Denver-based DaVita were gaming the system. Gov. Gavin Newsom signed Assembly Bill 290 (AB 290) in October 2019. The bill requires dialysis centers to charge Medicare rates, or a rate determined by a dispute resolution process, for those receiving financial assistance from the American Kidney Fund. It also mandates that the charity furnish the names of all the people it is supporting to insurers. Shortly after the bill passed, Karabasz received a letter from the AKF saying that it would no longer be paying her premium assistance because it viewed AB 290 as being in conflict with its federal operating guidelines.

According to a January 2019 press release from legislator Jim Wood, the Santa Rosa Democrat who introduced AB 290, the bill was designed specifically to prevent companies like DaVita from “increasing their already excessive corporate profits through a scheme to bankroll patients’ health care premiums.” Democratic Sen. Connie Leyva proposed a similar bill in 2018 that was vetoed by then-Gov. Jerry Brown.

The scheme, according to Wood and other critics, works something like this: Nearly everyone in the U.S. with end-stage renal disease is eligible for coverage by Medicare, even if they are under age 65. The federal program pays a fixed cost of about $240 per treatment. Patients receiving Medicare pay an annual deductible, after which they continue to be responsible for a 20 percent co-payment, or about $48, for each visit.

Patients with private insurance, however — including those with health benefits paid for by their employers — are a different story. Those insurance companies must negotiate payments with for-profit dialysis centers, and research has suggested that the centers have an edge in those negotiations — one they use to jack up prices. One research letter, published last year in the Journal of the American Medical Association, Internal Medicine, found that private insurers paid, on average, over $1,000 per treatment — roughly four times Medicare’s fixed costs.

One possible reason: More than 80 percent of dialysis patients receive their treatments from either DaVita or Fresenius Medical Care, which is headquartered in Germany, giving the two companies upwards of 80 percent of the $24.7 billion American dialysis market — and significant influence over the prices charged to private insurers. What’s more, both are widely known to donate hundreds of millions of dollars to the American Kidney Fund, covering the vast majority of the nonprofit’s budget. That’s a problem, according to Wood. With the help of the American Kidney Fund, after all, more patients are able to stay on private insurance longer, so both companies have an incentive to keep the AKF well-funded. More patients with private insurance means DaVita and Fresenius can bill much higher prices for their dialysis services — and pad their own bottom lines.

Jo Karabasz and her husband Larry, at their home in Sacramento, California.

Karabasz undergoes home hemodialysis in a small spare room containing a lounger, a TV, and a dialysis machine.

Due to kidney failure, Karabasz left her teaching job and began paying $835 per month to continue coverage with her existing health insurance.

Karabasz is now one of more than 80,000 low-income Americans who receive help from the American Kidney Fund each year.

Karabasz is a caretaker for her two grandsons, Rewia and Anthony, and is able to continue teaching by helping with remote schooling this year.

According to Wood, for every dollar DaVita or Fresenius donates to the American Kidney Fund, they get roughly $3.50 in return from private insurers. No wonder, then, that the two dialysis giants, which together earned about $2.2 billion in net income in 2019, reportedlydonated $247 million to the nonprofit organization in 2018 — roughly 80 percent of the fund’s annual budget that year. (AKF’s own financial documents do not name the companies outright, instead referring to two unnamed corporations. When asked to confirm the identity of these donors, Tamara Ruggiero, a spokesperson for the organization, said the AKF was barred from doing so by rules established by the Inspector General of the Department of Health and Human Services — ironically to “ensure that patients are not unduly influenced in their choice of dialysis providers.”)

Wood has called this an all-out scam, but Fund representatives have pushed back against such characterizations, saying that the new law would make it impossible for them to aid California residents. Only an 11th-hour preliminary injunction — granted in December of 2019 by a U.S. district court in response to motions from the Fund, as well as from DaVita and Fresenius, among other petitioners — saved Karabasz’s monthly assistance.

Representatives of both Fresenius and DaVita declined repeated requests to make company officials available for an on-the-record interview for this story. In a prepared statement supplied by Alicia Patterson, a DaVita communications manager, the company suggested that Wood’s bill would deny thousands of Californians crucial health care assistance. “We will continue to advocate against this harmful law, while at the same time remain focused on providing high-quality care for our patients,” the company said. And in a statement attributed to Fresenius spokesperson Brad Puffer, that company said it aims to provide care to all patients regardless of insurance provider, and that the injunction blocking implementation of AB 290 was instrumental in allowing patients to continue accessing the care they need. “The ongoing focus on this issue does nothing to help improve overall patient care,” Puffer added, “and our goal to help more people gain access to transplant and home dialysis treatment.”

No final ruling on the legislation has yet been made, leaving the ultimate fate of the American Kidney Fund’s financial support in California in limbo — something that LaVarne Burton, the president and chief executive of the American Kidney Fund, suggests is part of the problem. Burton said that her organization had repeatedly asked the legislators, “If you don’t want the American Kidney Fund to assist these patients, what are you going to do to make sure that they get access to health care?

“There was never a plan,” she said.

 

For patients like Karabasz, these concerns are far removed from the ongoing, immediate need for dialysis. Karabasz says she doesn’t deny that DaVita might be benefitting from their donations to the Kidney Fund, but then, so is she. And she could not, she insists, afford her insurance premiums without their help, meaning that losing American Kidney Fund assistance would be a matter of life and death.

Health economist Paul Eliason of Brigham Young University argues that remedying the conflicts of interest inherent in the relationship between the Fund and for-profit dialysis clinics would clearly benefit society at large in terms of lower health care costs, at least in the short-term. But he added, it remains to be seen whether these conflicts actually harm patients.

“I do think that by limiting profits to these companies, you’ll actually probably see less growth of the big chains — DaVita, Fresenius — in California,” Eliason said. “And that’s going to be good in some ways and bad in some ways. I think that will probably mean there will be less access to care and patients may have to travel farther and be treated in more crowded facilities.”

* * *

In 2016, nearly 125,000 Americans started treatment for end-stage renal disease. Whether due to a genetic disorder like polycystic kidney disease or the result of damage from diabetes and high blood pressure, a diagnosis of chronic kidney disease means that the kidneys struggle to filter waste and extra water from the blood. Until the kidneys fail completely, many people have no symptoms that anything is wrong. At this stage, chronic kidney disease can only be diagnosed by a blood or urine test.

For Bernard Zachary, 51, of Modesto, California, who spent his adult life working in construction, heading to the doctor when he was feeling fine seemed like an invitation for trouble. “I was always working and I was always told to get a doctor’s appointment, and I didn’t want to create a doctor bill or anything,” he said.

But in February 2016, after dealing with persistent swelling in his feet, Zachary headed to the hospital. Tests showed he had high blood pressure and that his kidneys had failed. Zachary needed dialysis right away. He opted for a treatment called peritoneal dialysis, which uses the blood vessels in the abdomen and a cleaning fluid called dialysate. This allows Zachary to do his treatments at home every night while he sleeps, rather than going to a clinic several times each week.

DaVita provides the equipment and medical support for his dialysis.

Studies suggest that somewhere between 23 and 38 percent of people with kidney failure “crash” onto dialysis like Zachary, meaning they start it in an unplanned way, with little or no prior care from a kidney specialist. Many of these individuals are too sick to work full-time at this point. Others, like Zachary, could potentially remain employed but dialysis gets in the way. The physical labor of his construction job would dislodge his dialysis catheter, so he had to quit. Karabasz knew for years that her kidneys were failing and left her job preemptively to pursue tutoring with her husband. As it does for so many Americans, the loss of their jobs meant the loss of employer-sponsored health insurance.

Now 51, Bernard Zachary discovered he had kidney failure after seeing a doctor for persistent swelling in his feet in 2016. Zachary goes to bed each night hooked up to a dialysis machine that he sets up himself.

Peritoneal dialysis accesses blood vessels in the abdomen through a catheter. Zachary had to leave his construction job because the physical work would dislodge the catheter.

Zachary spends about an hour each evening before bed prepping the dialysis machine, logging his weight and vitals, and attaching the machine to an abdominal catheter.

Patients like Zachary, who have to start dialysis immediately with little prior care from a kidney specialist, make up about 23 to 38 percent of people with kidney failure.

Indeed, because end-stage renal disease was so often accompanied by unemployment, Congress passed a law in 1972 that made patients who also qualified for social security eligible for Medicare three months after diagnosis, even if they were under 65, the age when Medicare typically kicks in. An amendment to a later act required that everyone with end-stage renal disease use Medicare as their primary insurance 30 months after diagnosis. Given that only one-third of those on dialysis survive for five years, those first 30 months are where companies like DaVita and Fresenius earn their profits — and it’s the key window they spend millions fighting for. According to data supplied by AKF, roughly a quarter of its insurance assistance recipients were on employer-provided or otherwise private insurance in 2019.

At first, Karabasz and her husband managed to scrape together nearly $835 per month to continue with her existing Kaiser Permanente insurance from teaching, but the financial strain caused her depression to spiral. Maybe, she says she began thinking, her family would be better off without her. A social worker at her dialysis center noticed her low moods and increasing despondence, and Karabasz eventually confessed everything. The social worker paused, then asked if she’d heard about the American Kidney Fund.

Founded in 1971, the AKF began as a small group of people raising money for a friend who needed help paying for dialysis. In the nearly half-century since, it has become one of the country’s largest nonprofit organizations, providing funds to dialysis patients to defray the costs of insurance premiums and other associated expenses. To date, Burton says, the organization has been able to assist everyone who meets its eligibility requirements, which is currently households whose income doesn’t exceed expenses by more than $600 per month, and whose assets total no more than $7,000, not including a patient’s primary vehicle and home, retirement accounts, and basic household items.

Karabasz easily met those requirements and began receiving help almost immediately. To her, it changed everything. “I was very grateful to them and felt confident and secure with them,” she said. “So it seemed that getting help to pay that bill was what was going to work for me. Thank God that that help was available.”

Karabasz is one of more than 80,000 low-income Americans — 3,700 of whom are in California — who receive help from the American Kidney Fund each year. On the surface, the arrangement seems copacetic: a charity helping low-income chronic disease patients receive life-saving treatment. But both lawsuits and the California legislation have challenged this rosy view of the Fund and its work.

* * *

In the 1970s, when the AKF was founded, outpatient dialysis was fairly new and the industry was small. Medicare coverage expanded the number of people who could afford dialysis, and increases in the prevalence of diabetes and hypertension, along with an aging population, meant that the number of people who needed dialysis also rose. In 2018, more than 500,000 Americans were receiving some sort of dialysis treatment, according to data from the United States Renal Data System (USRDS). At first, many providers were small and independently owned. Beginning in the late 1990s, two early leaders in dialysis, DaVita and Fresenius, began to buy out smaller clinics.

By gobbling up individual clinics, one by one, the companies could avoid federal oversight of corporate mergers, which generally only kick in when an acquisition is valued over a certain amount. Before 2001, that threshold was $15 million. Today, it sits at $94 million.

The problem, points out University of Chicago economist Thomas Wollmann, is that dialysis clinics serve a local clientele. Plenty of competition in New York doesn’t tell you anything about the situation in South Dakota. Wollmann says he knows of one area in Texas, for example, that has two dialysis clinics right next to each other but nothing else for 60 miles in any direction. Each clinic may only be valued at $3 million or $5 million, which is far below the number the Federal Trade Commission is worried about.

But “if one buys the other one, that’s devastating to competition because it’s basically a merchant monopoly,” Wollmann said. According to a recent National Bureau of Economic Research working paper he authored, of the 4,000 facility acquisitions dialysis providers proposed between 1997 and 2017, about half were exempt from reporting.

As large chains, DaVita and Fresenius have more ability to negotiate prices down for drugs and other needed supplies. This has increased their profit margins and made them able to buy up even more mom-and-pop clinics. Today, the two companies own some 70 percent of U.S. dialysis clinics.

The dramatic drop in competition, research suggests, was amplified by declines in quality of care. An analysis of 1,200 acquisitions over 12 years, conducted by Brigham Young’s Eliason and colleagues, showed that large chains replaced high-skilled and high-cost nurses with cheaper technicians and increased the patient load of each employee by 11.7 percent. That analysis, published in November 2019 in The Quarterly Journal of Economics, showed that the number of patients treated at each dialysis station also rose by 4.5 percent. As a result, patient care quality dropped. They found fewer kidney transplants, higher rates of hospitalization, and lower rates of overall survival among dialysis patients at for-profit clinics.

“What we’re seeing in the market, I think, does have an influence on the care patients receive,” said Kevin Erickson, a nephrologist and health policy expert at Baylor College of Medicine in Houston.

Dialysis centers acquired by large chains, Eliason and his colleagues’ research found, also used larger amounts of expensive, injectable drugs used to treat anemia, as most chronic kidney disease patients have a reduced ability to produce new red blood cells. Like all drugs, these injectables can have side effects, including increased risk of heart attack and death, especially when patients receive too high of a dose. According to a 2005 financial document from DaVita, these injectables, along with vitamin supplements, formed 40 percent of the company’s total dialysis revenue. Eliason and colleagues found that the doses of one such drug, Epogen — or epoetin alfa, as it’s called generically — increased by 129 percent after an independent clinic was acquired by a large chain.

“We’re able to look at the same patient in the same facility before and after it’s acquired by one of these big companies, and we see that for that patient, their [Epogen] doses just skyrocket,” Eliason said.

But in 2011, when Medicare implemented a system that lumped payment for dialysis in with the drugs used during treatment (thus removing the financial incentive to over-prescribe), dosing of epoetin alfa plummeted.

 

The need for and use of expensive prescription medication is just one reason that treating end-stage renal disease is so costly. In 2018, according to the USRDS, Medicare paid $31.3 billion in fee-for-service expenditures — where the government pays providers separately for each service provided — to treat the more than 500,000 dialysis patients in the U.S. Although kidney failure patients comprise just around 1 percent Medicare’s fee-for-service population, they represent 7.2 percent of such Medicare expenditures. The high medical costs of people with kidney failure is one of the reasons that Burton suspects the insurance industry supported AB 290, since it would mean they had to pay less to dialysis centers. And of course, offloading expensive kidney disease patients onto government insurance would increase their own profit margins.

When insurers set their premiums, she said, “they’ve already factored in that they will have people with kidney failure, with cancer, with heart disease who are more expensive. If they can factor that into their premium and then get those people off of their insurance, their profits go up even more.”

But it was the use of American Kidney Fund assistance to potentially bolster the profit margins of the dialysis companies that first triggered the fight in the California legislature.

* * *

There are currently more outpatient dialysis clinics in the United States than there are Burger King restaurants, and the prevalence of these clinics confirms to critics like Wood that dialysis is a massive and, from his perspective, inordinately profitable business. “Profiteering at the expense of patients and the public is immoral and it should be seen only for what it is — a self-serving scam,” he noted in a press release in January of last year.

In that release, Wood stated that the donations DaVita and Fresenius make to the American Kidney Fund are used to steer patients toward higher-premium commercial insurance plans. Since these insurance plans give dialysis clinics like DaVita and Fresenius more money per treatment than Medicaid and Medicare, getting as many privately insured patients as possible directly benefits their bottom line.

Erickson had a similar perspective. “My guess is there is a large, strong incentive for any dialysis organization, whether it’s profit or nonprofit,” he said, “to attract patients who are privately insured, where they can potentially receive those higher private insurance reimbursements for up to 30 months.”

It doesn’t take a lot of people to make a big difference. A 2019 analysis in JAMA Internal Medicine by researchers including Gerald Kominski, a health policy professor at UCLA, showed how even a small number of privately insured patients could bolster the industry. In 2017, commercial insurance paid DaVita an average of $1,041 per dialysis treatment, compared to $248 for government insurance. That adds up to $148,722 each year for a privately insured patient versus $35,424 for one on Medicare or Medicaid, the study showed. Although this study didn’t look into financial assistance from the AKF and why dialysis corporations might donate, Kominski suggests that the motivation is apparent. “My guess is that they get a very large return on their investment,” he said, “— many, many dollars back for every dollar they spend in premium support.”

Having to pay providers so much extra money for the same care should leave commercial insurers in the red, but that’s not the case, Kominski explains. Private insurance also wants to maximize profits, but they can use different strategies to increase revenue, such as increasing premiums. Reimbursing at higher rates isn’t a problem for commercial insurers because they don’t face the same pressures as public insurance to keep costs low. Instead, they can just extract more money from their customers in the form of higher premiums.

Noting the rising cost of health care as a persistent problem, Wood’s communication director, Cathy Mudge, wrote in an email that the assembly member has worked on other legislation to curtail it. With AB 290, she wrote, the aim is to rein in the excessive profits that dialysis corporations like DaVita and Fresenius are making at the expense of the general public.

The legislation would force everyone to play by the same rules by requiring recipients of American Kidney Fund grants to have their dialysis reimbursed at Medicare rates, even if they have private insurance. Although AKF says dialysis clinics have no influence over which patients receive its assistance, a whistleblower lawsuit unsealed in Massachusetts in August 2019 supported Wood’s assertions that DaVita, Fresenius, and others were using AKF for their own financial gains. And with so much of the dialysis market controlled by these two large corporations, they don’t need to do very much to benefit from their AKF donations. Simple probability says that anyone on dialysis is likely to be served by a DaVita or Fresenius clinic because they control so many facilities, Eliason says.

Of AB 290’s stalling, Wood wrote in a statement provided to Undark: “This injunction and the year-long delay of the court case are consequential because it emboldens the corporate duopoly of Fresenius and DaVita to continue to gouge the health care system to increase their profits.”

The high financial stakes of California’s efforts to regulate the dialysis marketplace have been apparent in the amounts spent by lobbyists. Records from the California Secretary of State showed that dialysis corporations forked over upwards of $110 million via the California Dialysis Council in 2018. The spending spree began with 2018’s Proposition 8, which sought to cap dialysis profits at 15 percent above the cost of care, and continued into the debate over AB 290. They provided even more by bankrolling an industry-backed group called Dialysis is Life Support, which created videos and ran ads on CNN and other outlets.

Kathy Fairbanks, a spokesperson for the organization, says that the companies were just looking out for their patients. When asked whether corporate lobbying could really be motivated by goodwill alone, Fairbanks suggested the question was “cynical,” adding that “if the end result is that patients will be better off with the defeat of AB 290, that really from our perspective, that’s the end goal.”

Whatever the reality, the relationship between the American Kidney Fund and major for-profit dialysis providers seemed destined for greater oversight in the passage of AB 290 — though the Fund and its supporters saw at least one avenue to fight back: When former President Bill Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) into law, it included rules that barred treatment providers from waiving co-insurance and deductible costs for patients on Medicare or Medicaid, or providing “items and services for free or for other than fair market value,” while allowing for various exceptions. To ensure that grant-making organizations like the AKF didn’t run afoul of these new rules, the Fund asked the Department of Health and Human Services’ Office of Inspector General to review its practices. In a 1997 advisory opinion, the OIG stated that the Fund could continue to accept donations from dialysis providers as long as it didn’t use information about donation amounts, nor which company’s clinics a patient was utilizing, as criteria for distributing assistance. The AKF says it has strictly operated under this guidance since it was issued and does not provide the names of patients who receive assistance to its donors or to insurers.

When AB 290 required the AKF to provide a list of grantees to health insurance companies, Burton said this would directly violate the advisory opinion guidance and so they would have to stop helping California residents. “The legislature by their action gave us no choice,” Burton said. “In order to protect patients in California, and to protect the patients that we serve throughout the country, we had no choice but to go back and to file suit against the state of California.”

The problem with the 1997 guidance, according to Rep. Katie Porter, a congresswoman for California’s 45th District, is that the dialysis market looks vastly different now than it did back then. In a July 2019 letter, she urged Joanne Chiedi, then-acting inspector general for HHS, to suspend its guidance and conduct an investigation into the AKF’s relationship with dialysis providers. Some insurers already do know which of their customers receive premium assistance from the AKF, since the AKF directly pays the bills for some of its grantees. The organization says that this is done with patient knowledge and consent, unlike the list that would be required under AB 290. (The bill specifies that it would ensure its provisions are not in violation of any federal privacy law.)

In granting the preliminary injunction against AB 290 — two days before it was set to become law — Federal Judge David Carter of the Central District of California was apparently unconvinced. The state had not shown that American Kidney Fund assistance increases health care premiums, Carter held, nor had it shown any evidence of patient steering. The initial trial, scheduled for late spring, has been postponed and no final verdict has yet been reached.

* * *

All of this has left patients like 41-year-old Brian Carroll feeling caught between the AKF’s assistance and AB 290. Unable to work because of his kidney disease, a rare condition called focal segmental glomerulosclerosis that causes scar tissue to form in the kidneys, Carroll lost access to his private insurance. After going on Medicare and later seeking out his own secondary insurance, he was forced to move back in with his parents in December 2016 to afford his premium.

Carroll has since received a kidney transplant and hopes to soon be healthy enough to go back to work. While the assistance he receives from the American Kidney Fund will run out at the end of the month, he said, “every little bit helps.”

Although Carroll is grateful for the funding he’s received, the idea that DaVita and Fresenius can pad their bottom lines using the American Kidney Fund makes him livid. Unlike Karabasz, who blames AB 290 and those behind it for the uncertainty of her position, Carroll says some responsibility falls on the American Kidney Fund. “If you can still support 49 other states and dialysis patients, and you can’t support California, I don’t understand,” he said.

Brian Carroll, a recent kidney transplant patient, at home recovering from surgery. Carroll waited for a kidney for almost five years while on dialysis.

Unable to work, in order to pay for secondary insurance Carroll moved in with his parents four years ago.

Carroll has a rare condition called focal segmental glomerulosclerosis. He carefully manages a multitude of medications and follows a strict diet. 

To continue receiving financial assistance from the American Kidney Fund through the end of the year, Carroll has had to submit paperwork every few months.

Carroll enjoys playing the coronet and goes on limited outings a couple of times a week. He hopes that soon he will be healthy enough to go back to work.

Even with the preliminary injunction in effect, Carroll says the fund had begun requiring more frequent paperwork to verify his income and dialysis status. Whereas he used to fill out forms once a year, he says he began having to complete the documentation every few months. “You always have that dark cloud of ‘Is this going to be the last time that they do this?'” he said reflecting on the assistance he’s received.

In DaVita’s emailed statement, the company said “Should Assembly Bill 290 be implemented, it will affect nearly 4,000 low-income, primarily minority, California dialysis patients who rely on charitable support to pay for their health care costs. We believe the law threatens to harm California citizens who need dialysis to survive and that it is unconstitutional; due to this we joined a legal challenge and are pleased the court issued a preliminary injunction preventing the implementation of AB 290.”

Erickson, meanwhile, argues that no decision around AB 290 will result in a perfect system. “As the government comes up with policies to try to regulate private insurance markets to keep prices down, there are trade-offs,” he said. “And, in this case, if a law like this does keep the prices of private insurance down, it might do so at the expense of some of the patients who would benefit from this financial support that they no longer have access to.”

Karabasz says she has no problem with DaVita making a profit. “I don’t have time for them to reorganize and rethink how it’s done,” she said. “I have two days. And if I don’t get my treatment in two days, my life is on the line.”

This story was produced in partnership with Scientific American.

* * *

This series was supported in part by the National Institute for Health Care Management Foundation.

Carrie Arnold is an award-winning freelance science journalist based in Virginia. In addition to Undark, her work has appeared with Scientific American, STAT, National Geographic, Wired, and The New York Times, among other publications.

Larry C. Price is a two-time Pulitzer Prize-winning documentary photographer and multimedia journalist based in Dayton, Ohio. He previously produced award-winning photography and video footage for Undark’s Breathtaking series on air pollution, which won a George Polk Award for Environmental Reporting in 2018.

This article was originally published on Undark. Read the original article.

This gooey-cheesy chickpea bowl is me at my laziest

Big Little Recipe has the smallest-possible ingredient list and big everything else: flavor, creativity, wow factor. That means five ingredients or fewer — not including water, salt, black pepper, and certain fats (like oil and butter), since we’re guessing you have those covered. This week, we’re turning a can of chickpeas into dinner.

* * *

There are many ways to make mac and cheese, from baked to stovetop to box, but it’s safe to say that all of these, despite their differences, include mac, aka macaroni, aka tubular noodles. This Big Little Recipe does not.

It starts with a step that, somehow, is even easier than pouring a box of pasta into salty boiling water: opening a can of chickpeas.

You don’t have to worry about undercooking or overcooking because they’re already cooked. You don’t have to worry about underseasoning or overseasoning because they’re already seasoned.

Like macaroni, chickpeas are starchy, chewy, cute (!), and eager to dive in to a melty, gooey cheese sauce. Who are we to stand in their way?

Though I’m an admirer of baked mac and cheese — see this iconic Martha Stewart recipe, with its Mornay sauce and buttered bread crumbs and, I can’t stress this enough, over one and a half pounds of cheese — it’s not the sort of thing I’m whipping up on a Tuesday night.

Stovetop mac and cheese, on the other hand, couldn’t be simpler. While some versions, like this one from Serious Eats, call in evaporated milk, I’m a fervent follower of Melissa Clark’s Genius strategy: just heat heavy cream until bubbling, stir in grated cheddar, and, um, you’re done. Think of it like instant fondue.

This is when you’d add your boiled noodles or, in our case, canned beans. Naturally, chickpeas in cheddar sauce (chick ‘n’ cheese? no?) is the sort of meal that invites a couch and blanket and episode of The Bachelorette (I know, I know, let’s chat in the comments). Yet things get even more comforting if you throw in an extra step — it’s a quick one, promise:

Instead of macaroni-ifying all the chickpeas, reserve a handful, give them a rough chop, and toss into sizzling oil. In the time it’ll take to listen to “Gimme! Gimme! Gimme! (A Man After Midnight),” the chickpeas transform from tender to crackly — like panko or those itty bits at the bottom of a bag of potato chips. Crumble on top and crack open a really cold beer.

Chickpeas & Cheddar Sauce With Chickpea Crispies

Prep time: 5 minutes

Cook time: 10 minutes

Serves: 2

Ingredients

  • 1 (15-ounce) can chickpeas, rinsed, drained, and dried
  • Neutral oil, such as vegetable or canola
  • Kosher salt and freshly ground black pepper
  • 1/2 cup heavy cream
  • 4 ounces cheddar, grated (preferably a younger, not super-aged variety)

Directions

  1. Separate out 1/4 cup of chickpeas and roughly chop. Heat a glug of oil in a skillet over medium heat and, when hot, add the chopped chickpeas, plus a pinch each of salt and pepper. Stir so all the beans are coated, then leave them alone and let them crisp for about 5 minutes, until frizzled and browned. 
  2. Add the cream to a pot over medium heat and cook until it begins to simmer. Drop the heat to low and add the cheese, stirring until a smooth sauce forms. Mix in the larger portion of chickpeas and season with salt and pepper to taste. 
  3. Divide into 2 bowls and evenly top with the chickpea crispies.

DeSantis faces renewed scrutiny following discovery of mysterious gap in Florida’s COVID death tally

A newly uncovered gap in Florida’s coronavirus death data suggests that the state may have manipulated the numbers to create more favorable death counts ahead of November’s election.

While coronavirus deaths are often recorded days or weeks later, Florida abruptly stopped including deaths that occurred more than one month earlier in its daily count on October 24, ten days before the election. Older deaths had consistently been included in the earlier data. The change came after Florida Gov. Ron DeSantis’ administration announced that it would review every suspected coronavirus death before it is reported. The state began to include the older deaths in its daily counts again on November 17.

The discrepancy was discovered by a University of South Florida professor, according to The South Florida Sun-Sentinel. Jason Salemi, an epidemiologist at the University of South Florida, said he was “surprised” by the gap but “drew no conclusions,” according to the report, noting that Florida’s death data “continues to be a bit of a black box.”

The death data between September 23 and October 20 included 1,128 deaths that had occurred at least a month earlier, or 44% of all reported deaths during that span. When the state resumed reporting the older deaths after the election, a large number of deaths had occurred more than two months earlier, according to an analysis by Salemi.

Prior to the gap in the death data, Florida Surgeon General Dr. Scott Rivkees announced that the state would conduct an additional review of the reported deaths before releasing them publicly “to ensure the accuracy of COVID-19 related deaths.”

Salemi told the Sun-Sentinel that he initially believed the gap may have been caused by the change that took reporting responsibility away from medical examiners or the state’s vow to review the deaths but grew suspicious when the state started to record older deaths again in mid-November.

“I’m starting to wonder what’s going on,” he said.

Health experts have long warned that coronavirus deaths are likely being underreported but DeSantis and state Republicans have alleged that the Florida deaths are overstated. Florida health officials did not respond to questions from the outlet, leaving the cause of the mysterious gap unclear. 

“It’s hard to know if there was a limitation around election time or random other things were happening,” Scott David Herr, a data scientist who tracks the daily reports, told the Sun-Sentinel. “The Department of Health hasn’t explained why lags have been inconsistent. When they keep changing whatever is going on behind the scenes, when the lags keep changing, that is where it gets confusing.”

The DeSantis administration has repeatedly changed the guidelines on the reporting of pandemic deaths, drawing outcry from public officials. Medical examiners sounded the alarm in the spring after the state stopped publishing real-time death data reported by local health officials, which showed a higher death total than the state’s reports.

In August, as medical examiners dealt with a massive backlog of deaths stemming from the state’s outbreak, the administration allowed attending doctors to determine and report coronavirus deaths. The state had also released summaries of death certificate data from county medical examiners through the summer but stopped releasing the data after the change.

State House Speaker José Oliva, a Republican, slammed the state’s death reporting in October as “often lacking in rigor” and undermining “the completeness and reliability of the death records.”

DeSantis, who has tried to downplay the threat posed by the pandemic for months as it killed more than 20,000 Floridians, has repeatedly been accused of manipulating and concealing data to justify a coronavirus response that the White House coronavirus task force labeled “inadequate.”

A task force report obtained by the Center for Public Integrity showed that the Trump administration urged the state to take tougher measures to curb the “unrelenting community spread” earlier this month. Instead, the state stopped releasing the task force’s reports and DeSantis barred cities from enforcing mask requirements and limited their ability to contain the spread. On Tuesday, he broke with public health recommendations and announced that all of the state’s bars and restaurants will operate at full capacity for the rest of the pandemic.

Earlier this year, the state also ousted Rebekah Jones, a data scientist who helped build the Florida Department of Health’s coronavirus data dashboard. Jones claimed that the firing was retribution for her refusal to “manipulate” the coronavirus data to justify the state’s early reopening in the spring, which DeSantis has denied. Earlier this month, armed state police raided Jones’ home with their guns drawn to seize her computer and electronic devices that she claimed contained evidence of “corruption.”

State officials claimed that DeSantis was unaware of the raid before it happened and that Jones was suspected of improperly accessing the state’s internal emergency communication system to urge first responders and others to “speak up before another 17,000 people are dead.” Jones denied the allegation and alleged that DeSantis was behind the raid, noting that the judge who approved the warrant was appointed by DeSantis just weeks earlier.

“They took evidence of corruption at the state level. They claimed it was about a security breach. This was DeSantis. He sent the gestapo,” she wrote on Twitter. “This is what happens to scientists who do their job honestly. This is what happens to people who speak truth to power.”

Despite repeated denials from the administration, the incident led to the resignation of a Republican DeSantis appointee on a judicial selection panel, who called the police raid “unconscionable” and DeSantis’ denials “fantastical” and “not credible.”

He resigned, he said, to draw attention “to the plight of the people of Florida who I feel are not being told the truth about COVID.”

How to store mushrooms so they stay fresh and slime-free

Time and time again, I’ve found myself in the same situation: reaching into the back of my fridge to find a forgotten package of mushrooms, slimy to the touch and absolutely not appetizing. Tossing them in the compost, background fading to the black-and-white of an infomercial, I shout: But I bought them less than a week ago! How! Why! There’s got to be a better way to store mushrooms.

And there absolutely is. Just as there’s a recommended way for storing greens and potatoes and tomatoes, there is a method for mushrooms.

Here’s how to store mushrooms, from button to enoki and everything in between.

Because of their high water content, mushrooms should be stored in the fridge to keep them as fresh as possible. You can probably get away with stashing them on the counter for a day or so, but if you want to keep them for several days, or even up to a week, place them on a shelf in the fridge.

Store-packed method

If you buy mushrooms pre-packaged, your work is done. The package’s perforation will let in air to dry out any moisture the mushrooms release, so simply pop them in the fridge. When you’re ready to use them, wipe any dirt off of the mushrooms and get cooking. If you don’t use all the mushrooms at once, cover them back up with plastic wrap punched with a couple holes.

For loose mushrooms, follow the instructions below:

Paper bag method

If you buy loose mushrooms at the grocery store or farmers market, the best way to keep them fresh for as long as possible is to stash them in a paper bag. As mushrooms age, they may begin to release water; the paper bag will absorb that moisture, keeping the mushroom’s surface slime-free for longer than if they were, say, packed in an airtight container.

Freezer method

If you find yourself with a surplus of mushrooms (you never know what the CSA will throw your way), and there’s no way you’ll use them up in time, clean the mushrooms well, then transfer them to a freezer-safe bag or container. Keep in mind that freezing mushrooms will likely compromise their texture, so it’s best to use these thawed mushrooms to flavor stocks or chop them into veggie burgers, as opposed to trying to fry them into a crispy pasta topping.

To use up those mushrooms quickly, here are some recipes we keep on deck:

Mushrooms With Caramelized Shallots & Fresh Thyme

This recipe calls for four pounds of mushrooms, so if that doesn’t take care of most of your haul, you’ve simply bought too many.

Cream Of Mushroom Soup

This creamy mushroom soup is easily doubled, making it ideal for dinner tonight plus a couple days of leftover lunches.

Nutty Veggie Burgers

Though the recipe calls for shiitake, nearly any chopped mushroom will work in these (vegan and gluten-free!) nutty black bean burgers.

Savory Mushroom Bread Pudding

Whether you call it savory bread pudding or stuffing, this cheesy dish would be welcome on my table any time the weather’s a bit chilly.

Bill Barr was Trump’s biggest enabler and top servant — but his real legacy is even darker

Poor Bill Barr.

After all that he did for President Trump, Barr was still forced out of his job as Attorney General for failing to hurl himself over a cliff as a human sacrifice. Trump wanted him to use the Department of Justice to help overturn his election loss which even Barr wasn’t able to finesse. Adding insult to injury, Trump just couldn’t forgive him for failing to “pull a Comey” by using a DOJ investigation of Hunter Biden to sabotage Joe Biden’s campaign.

Not that Trump’s unceremonious dumping stopped Barr from debasing himself even more ostentatiously than usual by offering a “resignation letter” that he obviously cribbed from one of those flowery love notes North Korean Dictator Kim Jong Un used to write to Trump during their passionate bromance. I’m guessing that was the price of getting out without being fired via an insulting tweet which seems to be something Republican men fear even more than thermonuclear war or feminism. It just goes to show that no matter how much people are willing to prostitute themselves for Donald Trump, they are only as good as their last bad deed. As Amanda Marcotte pointed out, Trump even stabbed his old mentor Roy Cohn in the back when he no longer had use for him:

Barr, who publicly lobbied for the job, proceeded to spend the next two years as a loyal flunkie for Trump, leveraging the power of the attorney general’s office to shield Trump from any accountability for his various criminal and ethical violations. Barr covered up for the Russian collusion. He tried to fix the Ukraine scandal. In the last days of the campaign, he even bolstered Trump’s lies about “voter fraud”, obviously an effort to support a conspiracy to steal the election. 

To that list I would add his blatant political interference in the Michael Flynn and Roger Stone cases as well as his personal interest in the Durham probe all of which created massive turmoil in his department causing several career prosecutors to leave in disgust.

Barr never even tried to hide the fact that he considered it his duty to protect the president and his cronies from prosecution. He holds a political philosophy about the imperial presidency honed by decades of fulminating about the allegedly poor treatment of Richard Nixon and Ronald Reagan by congressional upstarts and special prosecutors. Barr’s infamous, unsolicited memo asserting that Robert Mueller could not charge the president with a crime, echoing those famous words of Richard Nixon — “if the president does it it’s not illegal” — was what got him the job in the first place. The inane pretense that he is adamantly opposed to “politicizing” the department of justice, even as he politicized it more than any Attorney General in history, was a true triumph of gaslighting.

He is also a right-wing culture warrior who believes in authoritarian policies to ensure that the nation subscribes to his definition of “order” (he rushed to reinstate the federal death penalty and immediately began executing prisoners in a hurry) and has argued forcefully for a dismantling of secular society  And yes, he is a hard-core partisan zealot whose so-called principles are applied solely for the benefit of the Republican Party. Frankly, I also think in his private moments he is probably a lot closer to the 1970s Archie Bunker style of old-fashioned bigot that he is willing to let on. He’s barely able to hide his revulsion for anyone who doesn’t conform to his idea of respectability and it’s more than obvious that he is hostile towards Black people. We saw that play out in his reaction to the George Floyd protests and the grotesque militarized responses in Lafayette Square and Portland, Oregon. It’s not hard to see why he was so keen to join up with Donald Trump.

However, Barr seems to have realized that Trump’s loss means that he’s done all he can to create the precedents for future Republican imperial presidents to consolidate their power. He successfully protected his president by exerting his own power while ensuring that the norms he broke are still available for Republicans to use against Democratic administrations. His work is done.

As I mentioned on Monday, there has been some chatter that after Barr took the unusual step of making John Durham into a Special Counsel, which somewhat insulates him from a Biden Department of Justice, Trump wanted Barr to appoint other Special Counsels to investigate the baseless election fraud claims and, of course, Hunter Biden. Presumably, Barr declined to lay these landmines on Trump’s behalf because the AP reported on Tuesday that Trump is still obsessing on this idea and has been discussing it with numerous other people including White House counsel Pat Cipollone, Chief of Staff Mark Meadows and personal lawyer Rudy Giuliani. His aides are all pushing him hard to do it because they believe “that a special counsel probe could wound a Biden administration before it even begins.” And Trump is still debating whether he should pressure Barr’s replacement, Jeffrey Rosen and if he can’t persuade him, whether to replace him with someone who will do it. This could end up making the Saturday Night Massacre look like a schoolyard squabble. Trump has even suggested that he might be able to appoint the Special Counsels himself. (Bill Barr’s many lessons on the unlimited power of the Imperial President  — “I have an Article II!!”— seem to have penetrated.)

It’s good to see that Trump has his priorities straight, as usual. Sure, we may still be in the throes of a deadly pandemic and facing logistical complications in getting the vaccines to everyone who needs them. And yes, Congress is flailing about under Mitch “Grim Reaper” McConnell’s malevolent desire to make people suffer instead of offering necessary relief. Oh, and the federal government seems to have been the victim of a massive cyberattack by Russia which Trump has not bothered to discuss even once. But that’s because he’s still busy blustering about voter fraud and plotting to sabotage Joe Biden.

Bill Barr, his obsequious “resignation” letter notwithstanding, is obviously making a break for it before the whole thing explodes. Perhaps he thinks that by getting out now, before Trump could fire him and replace him with someone who would do even more dirty work to subvert the incoming administration, he will have saved his reputation. But it’s way too late for that. Barr will forever be remembered as Donald Trump’s Roy Cohn and nothing more. 

Tom Cruise tears into “Mission: Impossible 7” crew for not following COVID-19 safety protocols

Tom Cruise expressed his frustration with crew members on the set of “Mission: Impossible 7″ after he saw them breaking COVID-19 guidelines, two sources close to the production confirm to Variety.

As first reported by The Sun, after Cruise saw two crew members standing too close to one another in front of a computer screen, he told the crew: “If I see you do it again you’re fucking gone.”

In audio obtained by The Sun, Cruise can be heard saying: “We are the gold standard. They’re back there in Hollywood making movies right now because of us. Because they believe in us and what we’re doing. I’m on the phone with every fucking studio at night, insurance companies, producers and they’re looking at us and using us to make their movies. We are creating thousands of jobs, you motherfuckers. I don’t ever want to see it again. Ever!”

Read more Variety: Ann Reinking, Tony Winner and Star of Broadway’s ‘Chicago,’ Dies at 71

Cruise has been strict about enforcing COVID-19 guidelines on the set of the film in Britain, and scolded the crew for taking advantage of the safe environment that the team in place helped create.

“You can tell it to the people who are losing their fucking homes because our industry is shut down. It’s not going to put food on their table or pay for their college education. That’s what I sleep with every night – the future of this fucking industry!” Cruise said. “So I’m sorry, I am beyond your apologies. I have told you, and now I want it, and if you don’t do it, you’re out. We are not shutting this fucking movie down! Is it understood? If I see it again, you’re fucking gone.”

Read more Variety: Death Cab for Cutie’s ‘Georgia’ EP Raises $100,000 for Stacey Abrams’ Fair Fight Action Organization

Cruise pointed out specific members of the crew, telling one “you’re going to cost him his job.”

“Am I clear? Do you understand what I want? Do you understand the responsibility that I have? Because I will deal with your reason, and if you can’t be reasonable and I can’t deal with your logic, you’re fired,” Cruise continued. “That’s it. That is it. I trust you guys to be here.”

Read more Variety: Sam Jayne, Frontman of Love as Laughter, Dies at 46 After Being Reported Missing

“Mission: Impossible 7” was recently hit with delays in October when 12 people on set in Italy tested positive for COVID-19. Production resumed a week later and returned to the U.K. two weeks ago. “Mission: Impossible 7” is directed by Christopher McQuarrie and set to release on Nov. 19, 2021.

Listen to the full audio here.

Adam B. Vary contributed to this report.

Bernie Sanders, Joe Biden and the progressive movement: A winter of discontent

Bernie Sanders is not in a good political position right now. Yes, he continues to speak vital truths to — and about — power. His ability to reach a national audience with progressive wisdom and specific proposals is unmatched. And during the last several decades, no one has done more to move the nation’s discourse leftward. But now, Sanders is in a political box. 

After a summer and fall dominated by the imperative of defeating Donald Trump, progressive forces are entering a winter of discontent. Joe Biden has offered them little on the list of top personnel being named to his administration. While Sanders wants to maintain a cordial relationship with the incoming president, he doesn’t like what he’s seeing.

“The progressive movement deserves a number of seats — important seats — in the Biden administration,” Sanders said last week. “Have I seen that at this point? I have not.”

Sanders foreshadowed the current situation back in mid-November, when he told the Associated Press: “It seems to me pretty clear that progressive views need to be expressed within a Biden administration. It would be, for example, enormously insulting if Biden put together a ‘team of rivals’ — and there’s some discussion that that’s what he intends to do — which might include Republicans and conservative Democrats — but which ignored the progressive community. I think that would be very, very unfortunate.”

At this point, Sanders and avid supporters of the Bernie 2020 campaign have ample reasons to feel frustrated, even “enormously” insulted. It’s small comfort that Biden’s picks so far are purportedly “not as bad as Obama’s” were 12 years ago. That’s a low bar, especially to those who understand that Barack Obama heavily corporatized his presidency from the outset. And given the past decade’s leftward political migration among Democrats and independents at the grassroots, Biden’s selections have been even more out of step with the party’s base.

Reporting on Biden’s overall selections as this week began, the Washington Post found that “about 80 percent of the White House and agency officials he’s announced have the word ‘Obama’ on their résumé from previous White House or Obama campaign jobs.”

Biden conveyed notable disregard for Sanders by nominating a budget director with a long record of publicly expressing antagonism toward him. The Post reported that “the transition team never reached out to” Sanders about “Biden’s decision to tap Neera Tanden as director of the Office of Management and Budget, according to a person familiar with the lack of communication, despite Sanders’s role as the top Democrat on one of the committees that will hold Tanden’s confirmation hearings.”

Away from Capitol Hill, many progressive organizations are regrouping while “the Bernie movement” evaporates. Coalescing in its place are a range of resilient, overlapping movements that owe much of their emergent long-term power to his visionary leadership.

Nationally, Sanders became a shaper of history in unprecedented ways. Unlike almost every other major candidate for president in our lifetimes, he has always been part of social movements. For 30 years, Sanders not only continued to have one foot in the streets and one foot in the halls of Congress; somehow, he often seemed to be relentlessly in both places with both feet.

Bernie Sanders has fulfilled what the legendary progressive activist and theoretician Saul Alinsky described as a key goal of political organizers — to work themselves out of a job — so that other activists will become ready, willing and able to carry on.

At this juncture, while Sanders is ill-positioned and disinclined to push back very hard against the evident trajectory of Biden’s decisions, many progressives are starting to throw down gauntlets against the corporate and militaristic aspects of the incoming presidency. While the lunacy of the Trumpian GOP is nonstop and corporate Democrats have control of party top-down power levers, the broad democratic left is now stronger, better-funded and better-networked than it has been in many decades, with greatly enhanced electoral capacities as well as vitality of its social movements.

Those electoral capacities and social movements have long been intertwined with the tireless work of Bernie Sanders. But a crucial dynamic going forward into 2021 and beyond will be the resolve of progressives to methodically challenge the Biden administration. Sen. Sanders is unlikely to have the leverage or inclination to lead the fight.

Sanders has tried to call in some political chits, but Biden — probably figuring that Sanders won’t really go to the mat — does not seem to care much. Days ago, Sanders said in an interview with Axios: “I’ve told the Biden people: The progressive movement is 35-40 percent of the Democratic coalition. Without a lot of other enormously hard work on the part of grassroots activists and progressives, Joe would not have won the election.”

Bernie Sanders was the catalyst for galvanizing the grassroots progressive power that propelled his 2016 and 2020 presidential campaigns. His deep analysis, tenacity, eloquence and bold actions created new pathways. As this century enters its third decade, the torch needs to be grasped by others to lead the way.

Should hospitals reuse medical supplies? A new study says yes

In 2015, a marine biologist filmed her team removing a plastic straw from a sea turtle’s nostril. The video went viral, and a few years later, the global campaign to eliminate single-use plastics was in full swing. Companies like Starbucks, McDonald’s, Evian, United Airlines, and even Red Lobster vowed to cut down on plastic waste. But even the most stringent anti-straw advocates among us know that sustainability has its limits. When it comes to the tools doctors use to poke, prod, test, and treat us with, human safety, not the safety of the planet, is paramount.

But the two aren’t always in conflict, according to a paper in the December issue of Health Affairs — the first-ever issue on the intersection of climate and health. There’s a way to cut down on medical waste and the emissions produced by manufacturing new medical supplies, according to the analysis, which notes that the supply chain is responsible for 80 percent of the emissions from healthcare sources in the U.S. The solution is called medical device reprocessing.

Medical device reprocessing, a little-known industry in the global health care sector that cleans, inspects, and repackages used hospital equipment, has doubled in size every year for the past 20 years, the Association of Medical Reprocessors says. In 2018, medical device reprocessing diverted 15 million pounds of medical waste from landfills and saved healthcare institutions an estimated $470 million.

This industry isn’t in the business of reprocessing things like syringes, catheters, and needles — the authors of the study recommend recycling those products for their base materials instead of reprocessing them. The study, a review of previous research published last Monday, focuses on “mid-range complexity” medical devices, equipment like ultrasound probes, blood pressure cuffs, some kinds of forceps, and laparoscopic tools, all of which can be cleaned and reused. The analysis was funded by the Association of Medical Device Reprocessors, an industry group, and was conducted by professors working in medical schools at a number of top universities around the world.

“There are opportunities to reduce emissions without sacrificing health care quality,” Jodi D. Sherman, an associate professor of anesthesiology in the Yale School of Medicine and a member of the research team that worked on the study said at a press conference last week. Not to mention, investing in systems that encourage reusing products will help avoid the kind of system-wide shortages hospitals experienced this year during the COVID-19 pandemic. For example, it’s possible to safely decontaminate and recirculate N95 masks, a crucial piece of personal protective equipment that has been in short supply throughout the pandemic. But a couple of obstacles stand in the way of reducing waste and emissions from the medical supply chain.

For one thing, manufacturers of original equipment have found ways to undercut the reprocessing industry by doing things like slapping single-use labels on devices that can safely be reused, slashing the “best before” dates on products to shorten their shelf life, designing flimsy products that won’t last long, putting unnecessary holes in devices to make them more difficult to clean, and even covering “critical pieces of the device in glue to prevent disassembly,” the study says.

And the Food and Drug Administration (FDA) and the Centers for Disease Control, the two federal organizations that set the regulatory protocols for safety and sanitation in hospitals, make it easier for manufacturers to produce single-use rather than reusable devices. The FDA requires marketers of products that can be reused to prove that the device in question can be safely reprocessed. Companies that market devices as single-use don’t have to meet that requirement. “This creates a regulatory incentive for manufacturers to label devices as single use to avoid the time and financial resources required to validate a reprocessing protocol,” the study says.

Dr. Lori A. Hoepner, an assistant professor at SUNY Downstate’s Health Sciences University School of Public Health who was not involved in the paper, told Grist that the study takes a rather broad look at the waste coming out of health care institutions and doesn’t fully account for the downstream costs of reprocessing. For example, one of the studies this new study relies on only assessed disposable wipes as a method of cleaning reusable blood pressure cuffs, which in turn creates its own environmental burden. One thing the study could have done, Hoepner said, is “explore more environmentally friendly decontamination methods.” It also could have acknowledged that “the methods we use to sanitize medical devices can lead to adverse health effects that may impact the economy from the burden of costs associated with illness,” Hoepner said.

Doctors and governments have an incentive to cut down on greenhouse gas emissions — more and more research shows that climate change threatens health outcomes and life expectancy around the world. Just last week, a landmark report in the medical journal The Lancet showed that rising temperatures and other consequences of burning fossil fuels threaten to undo the past 50 years of gains in public health. “If you work in health care, there is a role in not just responding and adapting but preventing the emissions that lead to climate change,” Alan Weil, editor in chief of Health Affairs, said on Tuesday.

In order to reduce emissions from medical equipment, the Health Affairs study says that we need to transform the linear health care economy, the current raw-material-to-landfill pipeline in many hospitals, into a circular one instead. That means designing durable products, teaching various industries within the health care sector to use one another’s used materials, finding new ways to use old materials, and, perhaps most importantly, writing new regulations that actually encourage manufacturers to make reusable products.

Trump-related vendors got millions in COVID aid — while still getting paid by his campaign

More than a half-dozen Trump campaign vendors received in excess of $7 million in coronavirus small business aid — despite collecting more than $60 million from the campaign.

The Small Business Administration released previously undisclosed Paycheck Protection Program (PPP) data earlier this month, in response to lawsuits from multiple news outlets and government watchdogs. Though the PPP was designed to help small firms, more than half of the funds went to larger businesses, including some linked to President Trump and his son-in-law, Jared Kushner. The data also shows that at least seven Trump campaign vendors, more than previously reported, were awarded $7.5 million despite being paid more than $68 million by Trump committees.

“This program was intended to be a lifeline for mom-and-pop small businesses struggling to keep the lights on and meet payroll,” Kyle Herrig, president of progressive government watchdog Accountable.US, said in a statement to Salon. “These companies took millions in tax dollars while lining their pockets with millions more from the Trump campaign. They used PPP as their pandemic piggy bank while those in real need lost out.”

Harder LLP, the law firm of Charles Harder — who represented Trump in lawsuits brought by Stormy Daniels, the former adult film star who alleged an affair with Trump, and Alva Johnson, a former campaign aide who accused Trump of forcibly kissing her — received $214,000 under the PPP on April 9. A week later, Harder’s firm received a payment of $226,972 from the Trump campaign, FEC records show. The firm has received nearly $3.7 million from Trump’s campaign since 2018.

“Harder LLP is a small business that was heavily impacted during the early stages of the pandemic,” Harder said in a statement to Salon. “Our revenue dropped and we were forced to cut costs — but because of the PPP loan, we were able to keep everyone at our firm employed. That was the purpose of the PPP loan program. We have since recovered. We will repay the loan, with interest to the American taxpayer, as required by the loan terms.”

Harder alleged that many larger law firms who “likely performed work for Democratic Party candidates and campaigns” have received bigger PPP loans while laying off employees.

Cali-Fame, a company that manufactures “Make America Great Again” hats, received $786,000 under the PPP on April 28, according to SBA data. The aid was granted one day before the Trump Make America Great Committee paid the company $30,000 in two payments, according to Federal Election Commission records. The company has received $13,669,340 in payments from the Make America Great Committee and Trump’s campaign since 2015, according to FEC records.

Jamestown Associates, a Philadelphia-based consulting and media firm, received roughly $353,000 under the PPP on April 8, the same day Trump’s campaign paid it $29,000. FEC data shows that the company has received $11,978,379 from Trump’s campaign and the Make America Great Again Committee for video production and media services.

Another communications consulting firm, Virginia-based Proactive Communications, received just under $20,000 under the PPP. The aid came about two weeks after the Trump campaign paid it over $73,000 for consulting services. The firm has collected about $2.69 million from the campaign since 2017, according to FEC records.

Some of the loans have been previously reported. Phunware, a Texas-based digital technology company that collects smartphone location data, received an unusually large $2.85 million loan under the PPP, which CBS News noted was “nearly 14 times” larger than the average loan of $206,000. The firm received the loan two days after submitting its application, raising questions about why it was processed so quickly. The loan was granted after the company received nearly $3 million from the Trump campaign last year. It previously earned most of its $31 million in revenue in 2018 from Fox Networks.

FLS Connect, a conservative communications firm based in Minnesota, received a $1.67 PPP loan in April despite collecting more than $5.5 million from the Trump campaign and the Make America Great Again Committee since June, according to FEC data.

The Communications Corporation of America, a Virginia-based direct mail company, received a $1.59 million PPP loan on April 10, about a week before it received two payments from the Make America Great Again Committee totaling more than $800,000. The company has raked in $28,495,181 from the committee and Trump’s campaign since July 2016, according to FEC records.

Though the PPP has drawn bipartisan support, data released by the SBA has prompted calls to reform the program if Congress approves another round of funding. A Washington Post analysis of the data showed that more than half the funding for the program went to just 5% of recipients, mostly to big companies and national chains. Meanwhile, smaller firms quickly ran out of money as their loans expired and were forced to lay off workers. Businesses that received PPP loans cut an estimated 900,000 jobs as the funding dried up, according to an analysis by the payroll company Gusto.

An NBC News analysis of the SBA data showed that more than 25 PPP loans worth over $3.65 million went to companies linked to Trump and Kushner, including 15 that reported the loans saved one job or no jobs — or did not report a number at all.

“Many months and broken promises later, the court-ordered release of this crucial data while the Trump administration is one foot out the door is a shameful dereliction of duty and flagrant mismanagement of a program that millions of workers and small businesses needed to get through this pandemic,” Herrig told NBC News.

The SBA defended its handling of the program.

“SBA’s historically successful Covid relief loan programs have helped millions of small businesses and tens of millions of American workers when they needed it most,” an agency spokesperson said in a statement.

But watchdog groups argued that the Trump administration opted to prioritize helping wealthy corporations over small firms.

“The data shows that this program primarily benefited the well-banked and well-lawyered at the expense of the small businesses it was supposed to benefit,” Liz Hempowicz, director of public policy at the nonpartisan watchdog group Project on Government Oversight, told the Post. “Businesses in that top 5% likely have access to other capital. These are not the ones you would traditionally think of as a small business. It really raises questions about what the priorities of this SBA are. … Is it to help small business, or is it to return money to the top segment of the economy?”

The program has been widely criticized by small business owners since its inception. A group of small business owners filed a lawsuit in the spring accusing banks distributing the loans of prioritizing bigger existing corporate clients over the program’s intended recipients.

“This new data verifies what we have heard directly from our small-business members — that the PPP program advantaged big businesses over small and exacerbated long-standing disparities in access to credit and capital for underbanked communities,” Amanda Ballantyne, executive director of the small business advocacy group Main Street Alliance, told the Post.

Ashley Harrington of the Center for Responsible Lending added that the program’s fees for banks “incentivized loans to larger businesses because banks could bring in larger fees from those firms. … Funneling the loans through existing SBA-approved lenders, banks and credit unions disadvantaged businesses of color, which have historically lacked access to credit.”

Sen. Marco Rubio, R-Fla., and Sen. Ben Cardin, D-Md., have called for the program to be reformed in the next round of coronavirus relief to cap the loans at $2 million instead of $10 million and limit the loans to businesses with up to 300 employees, down from 500, according to the Post. The next round of funding is also likely to require businesses to show they have lost income in order to qualify.

Congress is “certainly in agreement that you want to limit the amount that can be given to these large organizations,” Cardin told the Post. “We learned from the first round that [the program] was very effective at getting money out quickly, but those with established banking relationships got to the front of the line, in some cases at the expense of underserved businesses.”

Herrig urged the lawmakers to ensure the next round avoids the “mismanagement” and “malpractice” of the first round.

“Only now — after its hand has been forced, hundreds of thousands of small businesses have gone under, and millions of taxpayer dollars were wasted — has this administration pulled back the curtains to reveal the malpractice going on behind the scenes,” he told NBC News. “Americans deserved an open, transparent small business aid program when this pandemic started, and any new small business relief program must take a lesson from the abject failures of this one.”

Of course, Trump takes a bow

We know two things for sure: If there is a COVID-19 vaccine spotlight for Donald Trump to take credit, he will, even while ignoring the effects of the pandemic itself.

And, he’s likely to take the occasion to issue some executive order about it all that will settle nothing about the distribution of the emergent two vaccines.

Yep, he did both on Tuesday, scheduling his “vaccine summit” with private contractors at exactly the time that President-Elect Joe Biden was introducing his own health team. It was an appropriately two-face stand-off, splitting live cable television and punditry.

The summit saluted contractors’ participation in what seemed to be Trump’s  own rapid development of a coronavirus vaccine, and Trump used the event to sign an order to insist that all Americans who want a vaccine will get it before any is shipped overseas to inoculate non-Americans and to once again endorse “herd immunity.”

Just to watch it, one had to set aside questions about how Trump can take the credit when scientists have done the work, or even how he can now show up—maskless—at the last minute before the Food and Drug Administration gives the official okay without taking responsibilities for the spiraling contagion across virtually every state. Meanwhile, the Biden group, including a video by Dr. Anthony Fauci, was more sober than celebratory and talking about the issues we still face.

To savor the Trump show, one also had to overlook the fact that Pfizer and Moderna, the first of the emergent vaccine makers (Pfizer was the one who did not take federal research and development money from Trump), declined to participate at all.

And viewers had to agree not to consider any open questions about what the order is supposed to mean, when the real meaning is that the Trump administration decided last summer to pass on ordering more than 100 million doses from each manufacturer, thus guaranteeing that we will have less than we need in the next couple of months. Instead, we got some more sprinkling of Trump election fairy dust, that it will be Trump who is inaugurated on Jan. 20.

On MSNBC and Fox, you could choose opposing news of the day, rather than a handoff between two administrations that both want Americans to use the vaccines.

What was the point?

Even Dr. Moncef Slaoui, chief science adviser for Operation Warp Speed told Good Morning America and other news outlets yesterday that he frankly does not understand the import of Trump’s executive order. Basically, Slaoui said he just wants to distribute vaccines and avoid politics.

Fat chance. This is the same administration in its self-congratulations yesterday declined to say that it ordered 100 million doses from each of six manufacturers since they did not know which would prove successful; former FDA chief Scott Gottlieb, now on the Pfizer board, confirmed that the Trump administration was given and rejected several chances to buy more.

And yes, therefore there may be delays in getting more Pfizer doses because they have sold them outside the United States.

In that light, the executive order is, well, meaningless and has nothing to say about lifting more than a Sharpie pen to ease distribution among the states.

Still, Slaoui believes Americans should have injections they need by June or July – long after Trump has promised, and, presumably, long after Trump has departed from the White House. Slaoui noted that other manufacturers, including Johnson & Johnson and AstraZeneca, are right behind Pfizer and Moderna.

CNN and others have been saying that the signing was intended to allay fears that there will not be enough doses of the vaccine to go around. White House officials described to CNN the order as a “reaffirmation of the President’s commitment to America first.”

Meanwhile, important questions including the proposed distribution priorities, requirements for identification and the sharing of personal data, whether employers or even arenas and restaurants can require vaccination, and the lingering medical questions were unresolved. Yesterday, the Centers for Disease Control and Prevention instructed states to sign so-called data use agreements that commit them for the first time to sharing personal information in existing registries with the federal government. Some states, such as New York, are pushing back, either refusing to sign or signing while refusing to share the information, said The New York Times.

A new administration that actually will be carrying out the distribution may just throw out this executive order.

Hey, it’s politics

Even calling the “vaccine summit” to be political—an effort for the administration to claim credit for the rapid development of a Covid-19 vaccine and to pressure the Food and Drug Administration to move quickly on an authorization. The agency’s commissioner, Stephen Hahn, was twice called to the White House to explain the FDA’s slower-than-desired timetable for issuing emergency use authorizations for Pfizer and Moderna’s vaccines, though it is due this Thursday.

Companies involved in vaccine distribution logistics, but not in vaccine development itself, did attend, including FedEx, UPS, CVS, Walgreens and McKesson. Many, sending lower-ranking executives as opposed to their CEOs.

In recent weeks, Trump has accused the very same drug manufacturers of delaying the results of timed and closely watched clinical tests to delay any positive announcement until after Election Day.

We don’t need a vaccine to recognize a stupid political trick for what it is.

Bearing witness to a war against detained children

Last year Elora Mukherjee described for the House Committee on Oversight and Reform what she witnessed at the migrant detention center in Clint, Texas. “I saw children who were dirty. They could not wash their hands with soap because none was available,” the Columbia University law professor said. “Many had not brushed their teeth for days. They were wearing the same clothes they had on when they crossed the border.” The same day of Mukherjee’s testimony, Vice President Mike Pence declared that the two Border Patrol facilities he had visited in Texas were “providing care that every American would be proud of.”

Mukherjee has clocked hundreds of hours recording interviews of families and children detained at the U.S.-Mexico border. Her testimony before Congress was reinforced by their stories, which she collected a month prior with a team of lawyers and a doctor at the border detention centers at Clint and Ursula. Lee Sunday Evans, the artistic director of Waterwell, a New York theater company, later assembled a group of lawyers, activists and prominent public figures to video record readings of the transcripts.

The migrant children’s accounts are now part of The Flores Exhibits, an audiovisual narrative project conceived and directed by Lee and produced in partnership with the Broadway Advocacy Coalition. Nearly 70 videos exist as narrative-based advocacy and serve as powerful evidence of human rights violations. Speakers read out transcripts that were redacted to protect the interviewee’s identities, and their distress is palpable on camera.

“Two hours after we crossed [the river], we met border patrol and they took us to a very cold house,” read Jeff Chase, a former immigration judge, as he scanned the declaration of a 16-year-old mother.

“We slept on mats on the floor, and [they] gave us aluminum blankets. They took away our baby’s diapers, baby formula and all of our belongings,” he continued. “I am frightened, scared and sad,” declared another interviewee who was 5 years old. David Gomez, the president of Hostos Community College read his transcript: “I’ve had a cold and cough for several days. I have seen no doctor and I’ve not been given any medicine.” The camera lingered on each speaker for a few extra seconds at the end, catching the fleeting but tense moment as the full meaning of the story washed over them.

The Flores Exhibits are named for the Flores Settlement Agreement of 1997, a federal class-action lawsuit that won immigrant children basic health care and privacy rights. The ruling also declared that unaccompanied minors could not be detained for more than 20 days, and a 2015 revision by U.S. District Judge Dolly Gee ruled that the Flores requirements applied to children apprehended with their parents as well.

But in August 2019, the Trump administration announced its plans to scrap the Flores agreement. Moreover, the White House wanted to replace the 20-day cap with “an indefinite limit, as well as creating detention centers without court oversight that can be licensed by third-party agencies contracted by Immigration and Customs Enforcement,” stated a timeline created by the exhibit organizers. Soon, 20 states united to sue the administration over the proposal. The Flores Exhibits act as proof of grave neglect towards migrant children and families.

The decision to use narration as advocacy wasn’t a conscious one, said Evans. Rather, the testimonies themselves were natural stories. “We saw this overlap between the legal function of the testimonies—they were being used as evidence in a lawsuit—and the stories as windows into a very personal experience of each of these young people who… fight for their survival and endure extremely difficult, degrading, dehumanizing conditions,” she told Capital & Main.

Evans credited artistic influence to Marshall Ganz, a well-known public policy lecturer at the Harvard Kennedy School. Ganz highlighted personal stories as a cornerstone to the foundations of grassroots organization and movement building. “Theater is often at its best when it is not didactic, or presents one clear indisputable morality,” said Evans. “But these…stories can complicate and change our ideas about what is right and wrong when we have mainstream political debates about immigration.”

Waterwell utilized its partnerships to spread the word about the exhibits. Due to the onslaught of COVID-19, live audience screenings were swapped for webinars conducted through Zoom. One Waterwell partner, Church World Service (CWS), is a faith-based global network whose members help migrants and refugees find safe havens. Its East Coast Faith Community Organizer, Christine Baer, believes that storytelling heavily rooted in reality can shape people’s minds in a robust way.

“Faith calls people to compassionate action,” she said. “When we face the examples of injustice done against children, we need to reconcile with our faith and act in some way.”

Rev. Noel Anderson, CWS’s national grassroots coordinator, claimed that educating oneself is the greatest change a community can bring about at an individual level. Both he and Baer vouched for the impact of the exhibits’ audiovisual style. “Usually you read such accounts. So watching them being read is powerful,” said Baer. “When you have the story coming from the impacted people themselves, then you are able to create empathy,” said Anderson. “When people hear those stories, they start to reflect. I’m a new father, and I guess I would also do the same thing: Flee to protect my family if our lives were threatened.”

Zachary Marino, a University of Pennsylvania law student, was another partner who screened some of the videos as a panel discussion through the Penn Law Immigrant Rights Project. “It’s hard to look away and even harder to not feel anger and compassion,” he said.

* * *

Beatriz Maya, the director of La Conexion, a Latinx immigrant-based organization, was responsible for drawing over 300 people in Bowling Green, Ohio, to view the exhibits. The group’s interactive virtual screening, titled “Children in Captivity,” focused on trauma as immigration policies. “2020 is a special year. We are facing a pandemic, police brutality and racism all at once. So, with all this happening, the issue of immigrant children has fallen off the radar,” she said.

Many of the panel of narrators are themselves immigrants. Actress Morena Baccarin (Gotham, Deadpool) arrived in the U.S. as a Brazilian immigrant and was deeply influenced by her mother’s women’s rights activism. Her ongoing participation with the International Rescue Committee concerning the Venezuelan refugee crisis in Colombia is a precursor to her involvement with The Flores Exhibits as a speaker (Exhibit #18). “We recorded it twice or thrice because I couldn’t get through it the first time,” said Baccarin.

Her reaction to the transcript is quite visceral, and there are times when she took pauses to collect herself. “I kinda knew what I was in for,” Baccarin said. “I remember thinking about the little things that the rest of us don’t really wonder about: not having a place to shower.”

Baccarin’s assigned transcript narrated the account of a 17-year-old mother from Honduras who was separated from her husband. Her baby had thrown up on herself, and there was no place to clean up. “Being a mother myself, experiencing that through someone else’s eyes was really awakening,” said the actress.

Baccarin and the organizers and partners of The Flores Exhibits are bracing themselves for further damage as the Trump administration races to set more immigration policies before Inauguration Day. As recently as two days before Thanksgiving, Immigration and Customs Enforcement (ICE) expelled 33 Guatemalan children who came to the U.S. without their parents, on the same day a federal judge issued an order against it.

But, said Evans, “The new administration will spark new conversations about immigration. We will be keeping our antenna up about how these stories can be a useful resource for people who are engaging in this issue. Essentially, we want the Biden administration to end a human rights problem with a humanitarian solution.”

Copyright 2020 Capital & Main

Progressives push for people’s bailout as McConnell holds out for corporate immunity

As Senate Majority Leader Mitch McConnell’s unrelenting effort to give corporations immunity from coronavirus-related lawsuits threatens to undermine ongoing relief talks, a coalition of lawmakers and progressive advocacy groups is holding a virtual rally Tuesday evening to demand a “people’s bailout” that prioritizes the needs of the millions of Americans on the verge of destitution.

“Mitch McConnell and the Senate Republicans refuse to support a real relief package, demanding instead that the government protect companies who force people to work in unsafe conditions during the pandemic,” Sondra Youdelman campaign director for People’s Action, said in an email Tuesday. “That’s unacceptable, and we need the Senate to act now.”

Slated to begin at 7:00 pm ET, the event will feature leaders from People’s Action, Center for Popular Democracy, Indivisible, the Movement for Black Lives, and other advocacy groups as well as Sen. Bernie Sanders (I-Vt.), Rep. Nydia Velázquez (D-N.Y.), and Senate Minority Leader Chuck Schumer (D-N.Y.).

“Time is running out for millions of families facing hunger, eviction, and health crises,” said Youdelman. “Join us tonight as we demand real relief for people, not giveaways to corporations.”

The rally will take place as congressional negotiators scramble to strike a coronavirus stimulus deal before the end of the year, when more than two dozen federal relief programs are set to expire amid a worsening pandemic and economic crisis.

A major sticking point in the ongoing bipartisan talks continues to be the Republican push for a liability shield to protect corporations from an “epidemic” of lawsuits from workers and customers who contract the coronavirus. According to analysts, the supposed “epidemic” of litigation is not happening.

The Washington Post reported Tuesday that while McConnell (R-Ky.) is advocating a five-year liability shield for corporations, Sen. Mitt Romney (R-Utah)—part of the bipartisan group of lawmakers behind a $908 billion relief plan—has “proposed that immunity from federal lawsuits only last for 2020.” McConnell has not said whether he would be willing to support Romney’s proposal.

“McConnell is holding hostage the Covid relief that Americans desperately need, demanding as ransom a grant of immunity to corporations for coronavirus-related wrongdoing,” Robert Weissman, president of consumer advocacy group Public Citizen, said in statement Tuesday. “Americans need Covid relief, but we shouldn’t have to pay for it by sacrificing our health and worsening the pandemic.”

Sanders, who is expected to speak at the People’s Bailout rally Tuesday, has vowed to vote against the $908 billion bipartisan proposal if it reaches the floor without significant improvements, specifically the removal of corporate immunity provisions and inclusion of another round of direct stimulus payments to U.S. households.

In a “Dear Colleague” letter on Tuesday, Sanders and five Senate Democrats warned that the corporate liability shield would encourage companies to “to avoid implementing the common sense safety standards needed to protect workers and consumers—and make a bad situation worse.”

Dave Chappelle called out HBO for streaming “Chappelle’s Show” after rejection — now he’s pulling it

HBO and HBO Max chief content officer Casey Bloys has confirmed with Variety that “Chappelle’s Show” will be removed from HBO Max at the end of the month at the request of series creator and star Dave Chappelle. Per Bloys’ statement: “We had a conversation with Dave. I won’t get into it, but it’s very clear that it’s a very unique and specific and emotional issue he’s got. So at the end of the year, at the end of this year, December 31st, we’re going to honor his request and take the show down.”

Read more from IndieWire: Best Christmas movies to stream with your family

The decision to remove “Chappelle’s Show” off HBO Max follows in the footsteps of Netflix pulling the sketch comedy series from its streaming platform at the end of November. Chappelle urged his fans not to stream “Chappelle’s Show” on various platforms because series owner ViacomCBS has not paid him for licensing out the Comedy Central hit. With Netflix no longer streaming “Chappelle’s Show” and HBO Max soon to follow, only the ViacomCBS-owned streamer CBS All Access will feature the program in its library.

Read more from IndieWire: “House of the Dragon”: Everything you need to know about HBO’s upcoming series

Chappelle posted a Instagram video at the time Netflix pulled “Chappelle’s Show” to explain his reasons for requesting companies to remove the series off streaming. The comedian said, “People think I made a lot of money from ‘Chappelle’s Show.’ When I left that show I never got paid. [ViacomCBS] didn’t have to pay me because I signed the contract. But is that right? I found out that these people were streaming my work and they never had to ask me or they never have to tell me. Perfectly legal because I signed the contract. But is that right? I didn’t think so either.”

Read more from IndieWire: The 2020 Black List presents the year’s best unproduced scripts

In the same video, Chappelle reflected on how it was ironic that HBO Max was profiting off “Chappelle’s Show” when so many years ago HBO rejected the comedian’s pitch for the TV series. As Chappelle explained, “They said, literally, ‘What do we need you for?’ That’s what they told me as they kicked me out of the office, ‘What do we need you for?’ And here we are all these years later and they’re streaming the very show I was pitching to them. So I’m asking them, what do you need me for?”

“Chappelle’s Show” will continue to stream on HBO Max through Dec. 31.