RUTHFULLY YOURS

The Republicans have started fixing the Obamacare disaster. For Trump, doing something about this failed program is critical, since it was a central issue he campaigned on. As his consigliere Kellyanne Conway says, there is a “binary choice … you’re either making good on the promise to repeal and replace Obamacare or you’re not.” Failing to deliver on this promise will have serious repercussions for the 2018 midterm elections and Trump’s own reelection

But right now, the Congressional bomb-squad trying to defuse this political IED are squabbling among themselves. Some claim that the changes proposed so far are a good start, for a complex and flawed entitlement like Obamacare will take time to fix. Others say what Paul Ryan et al. have proposed is merely “Obamacare lite,” Republican lipstick on that budget-busting entitlement pig. Dems on the sidelines are piling on, desperate to preserve Obama’s “legacy,” which also happens to be a big step toward the Holy Grail of progressives–– government-run, single-payer health care on the European model.

But the real problem continues to be ignored––the success of the progressive movement in addicting Americans to getting something for nothing because that “something” is defined as a “right.” And voters don’t like their rights messed with.

That’s the political conundrum facing the Republicans. Those in the Paul Ryan camp defend their adjustments to Obamacare by pointing out the greater participation of the market in their reforms. Here’s Ryan making the case:

It’s something that we as conservatives have always said if you really want to get free market principles injected into the health care system, you need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health care services, be they insurers, doctors, or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome. You don’t get that if you don’t have a viable individual free market.

All true, except the one thing Ryan doesn’t mention, and that’s the individual’s responsibility for his free choice. Whenever we talk about freedom of choice in the free market, we have to be clear that making the wrong choice, or a bad choice, will have consequences. Freedom without responsibility and accountability for how we use our freedom is a recipe for disaster. We all know, for example, that a lot of health-care money is spent on ailments related to lifestyle choices. About 28 million Americans have type-two diabetes. Obesity, poor diet, and lack of exercise are mostly responsible for this rising epidemic. In 2013 we spent $250 billion treating this disease, including the cost of lost productivity. The government paid 62 percent of this tab, and one in three Medicaid dollars was spent on diabetes. These costs will increase significantly as an aging, longer-living population becomes more vulnerable to the disease. And everyone expects the government to foot the bill.

Alfred Hitchcock’s black comedy The Trouble with Harry bombed at the box office when it was first released in 1955; it has now achieved the status of a classic. Today, a bizarre melodrama playing in all the major political theaters, which might be called The Trouble with Barry, has become an overnight smash hit. Starring Barack Obama, a prodigy of the art of surveillance and Teflon-like resilience, it will eventually run its course. However the plot may develop, one thing is certain: it will not be regarded as a classic.

The trouble with Barry, like Hitchcock’s moribund Harry, is that he never seems to go away, constantly emerging at the most inopportune moments. Unlike every other president in American history, Obama has dedicated himself to the practice of what the Washington Examiner has described as “post-presidential meddling.”

He has thrown himself fully into Alinsky-style “community organizing,” stirring up resistance to the Trump administration in every way conceivable: installing, according to the New York Post, a “shadow government,” dubbed Organizing for Action, comprising more than 30,000 agitators and 250 chapters across the U.S., in order “to sabotage the incoming administration”; renting a dwelling and setting up command headquarters around the corner from the White House; cooking up the Russian hacking fable; and most recently, allegedly wiretapping Trump Tower, which seems disturbingly probable following the salient remarks of Ret. Army Intelligence Officer Tony Shaffer on Fox and the revelations from Breitbart News. Mark Levin’s accusation that Obama is orchestrating a “silent coup” against Trump rings true. As Daniel Greenfield points out:

There is now a President and an Anti-President. A government and a shadow government. The anti-President controls more of the government through his shadow government than the real President.

Obama and his Deep State have engaged in “a criminal conspiracy of unprecedented scope.”

And yet, even today, few media outlets are willing to investigate the innumerable instances of lying, lawbreaking, corruption, broken promises and cronyism for which Obama is clearly answerable. That he is likely involved in a wiretapping operation against a political opponent should not come as a surprise to anyone who has observed or researched the man. As Matthew Vadum comments in FrontPage Magazine, “It might be said that every day of his presidency he committed at least one impeachable offense” — whether abusing executive powers, bypassing Congress, leaking classified information, misrepresenting Obamacare, being ultimately responsible for the Fast and Furious and Benghazi infamies, and more.
Hugh Hewitt Presses Trump to Fire Obama Holdovers

The wiretapping affair is only the latest in a vast and ongoing sequence of misdemeanors, scandals and illegalities — a list compiled by Doug Ross runs into hundreds of such instances of impropriety and malpractice. No matter. The list will only grow. The editor of a prestigious conservative site wrote me calling this latest outrage a “game changer.” That remains to be seen. I would have thought, for example, that Obama’s first Executive Order (13489) on January 21, 2009, sealing his vital records would have been the game changer we were waiting for, but Barry sailed on unscathed.

There have been weak presidents, deluded presidents, and harmful presidents before him, but never has there been anyone as sinister or questionable as Obama, not excluding even the malefic Jimmy Carter or the sleazy Bill Clinton. What J. R. Dunn writing in American Thinker has said of Hillary, “the most repellent and corrupt American presidential candidate since Aaron Burr,” is equally true, in my estimation, of Barack Obama. Meanwhile, it is Trump who faces a barrage of threats, calls for impeachment and acts of disobedience that would have been more explicable if levied against Obama for his historic deceptions and malfeasances. Under the pestilential reign of Obama, and indeed years of Democratic incumbency, the shining city on the hill has become a murky city in the swamp.

Again, unless there is real tort reform the FDA will have a permanent problem, and so will the pharmaceutical companies…..rsk
The Food and Drug Administration is the nation’s most ubiquitous regulatory agency, overseeing everything from syringes and CT scanners to drugs, vaccines and most foods. These products account for more than $1 trillion annually, or about a quarter of U.S. consumer spending. This slow, dysfunctional agency needs drastic reform of its requirements, procedures and attitudes.

One reform Scott Gottlieb, President Trump’s nominee to lead the agency, will likely embrace is “right to try”—that is, giving terminally ill patients access to unapproved medicines. He could remove the FDA from judgments about “compassionate use” of unapproved drugs. There is already a trend in this direction: Thirty-three states have passed laws aimed at providing easier access to experimental treatments that are still in the earliest stages of human testing.

The right to try unapproved drugs has the potential to be compassionate and sound public policy—but there are dangers. The concept must be implemented in a way that takes into consideration the realities of drug testing.

According to the libertarian Goldwater Institute, right-to-try legislation would allow “terminally ill Americans to try medicines that have passed Phase I of the FDA approval process and remain in clinical trials but are not yet on pharmacy shelves.” It would also expand usage of “potentially life-saving treatments years before patients would normally be able to access them.”

But here’s the rub: About three-quarters of drugs that pass Phase I will never be accessible. They ultimately won’t be approved, because of either safety concerns or lack of efficacy. Most legislative proposals, including the one recently introduced by Sen. Ron Johnson (R., Wis.), would enable patients to request the drugs after only the most meager safety testing.

Phase I testing, often the first time a new drug has been administered to humans, provides extremely limited information. These trials are performed on between 20 and 100 patients and last only a short time. They’re usually administered to paid, healthy volunteers, who may not provide a good representation of how the drug will affect terminal patients. Such trials essentially exist to determine what doses of the drug are tolerated without causing gross safety problems such as seizures, organ failure or death.

The determination of efficacy starts in Phase II, when the drug is administered to volunteers who suffer from the disease or symptom for which the drug is intended. If the results of Phase II are promising, the drug moves into still larger Phase III trials—the most extensive and expensive part of drug development.

A physician at a large health insurer, who spoke to me on the condition of anonymity, recently raised concerns about right to try. He wonders “where liability will ultimately lie when and if something goes wrong.” Even trickier: “Who is the deep pocket if and when the treatment fails and the patient’s family is looking for someone to blame?” He warns that the right to try could become an “unfunded mandate” and raises questions about who will pay for the drugs and how their prices will be determined. Medical insurance as we know it was never designed or intended to cover unproven treatments of last resort. CONTINUE AT SITE

America’s sheriffs have given President Trump a woefully inaccurate view of civil asset forfeiture—the process through which police seize, and prosecutors literally sue, cash, cars and real estate that they suspect may be connected to a crime. “People want to say we’re taking money and without due process. That’s not true,” a Kentucky sheriff told the president last month at a White House meeting. Critics of forfeiture, the sheriff added, simply “make up stories.”

In fact, thousands of Americans have had their assets taken without ever being charged with a crime, let alone convicted. Russ Caswell almost lost his Massachusetts motel, which had been run by his family for more than 50 years, because of 15 “drug-related incidents” there from 1994-2008, a period through which he rented out nearly 200,000 rooms.

Maryland dairy farmer Randy Sowers had his entire bank account—roughly $60,000—seized by the IRS, which accused him of running afoul of reporting requirements for cash deposits. Mandrel Stuart had $17,550 in receipts from his Virginia barbecue restaurant confiscated during a routine traffic stop. A manager of a Christian rock band had $53,000 in cash—profits from concerts and donations intended for an orphanage in Thailand—seized in Oklahoma after being stopped for a broken taillight. All of the property in these outrageous cases was eventually returned, but only after an arduous process.

Photo: istock getty

This kind of abuse has united reformers on all sides of the political debate: progressives, conservatives, independents, even a few former drug warriors. Since 2014 nearly 20 states and the District of Columbia have enacted laws limiting asset forfeiture or increasing transparency. Nearly 20 other states are considering similar legislation. Last week a reform bill passed the Indiana Senate 40-10. It would require a criminal conviction before a court can declare a person’s assets forfeited.

Another good step for state and federal legislators would be to bar agencies from keeping the money they seize. Today more than 40 states and the federal government permit law-enforcement agencies to retain anywhere from 45% to 100% of forfeiture proceeds. As a result, forfeiture has practically become an industry.

The Institute for Justice, where we work, has obtained data on asset forfeiture across 14 states, including California, Texas and New York. Between 2002 and 2013, the revenue from forfeiture more than doubled, from $107 million to $250 million. Federal confiscations have risen even faster. In 1986 the Justice Department’s Assets Forfeiture Fund collected $93.7 million. In 2014 the number was $4.5 billion.

Allowing police and prosecutors to keep part of what they confiscate gives them an incentive to target cash instead of criminals. In 2011 a Nashville TV news station investigated seizures on nearby interstate highways. Drugs usually came in on the eastbound lanes, while the money would flow out on the westbound lanes. The reporters found that police made “10 times as many stops on the money side.” They were less focused on stopping the drugs than on grabbing the cash.

On Capitol Hill last week, lawmakers began rolling up their sleeves to investigate the two components of the controversy that has embroiled Washington since Donald Trump was elected president on November 8: Russian interference in the election and what is now called FISAgate. The two components are interwoven . . . and antagonistic.

If, as Democrats suggest, the Russian interference was significant and there was evidence of Trump-campaign collusion in it, it would have been irresponsible for the Justice Department and the FBI not to investigate, including by monitoring communications under the Foreign Intelligence Surveillance Act (FISA). But if, as Republicans counter, Russian interference was immaterial (some say nonexistent), and there was no real proof of Trump-campaign collusion in anything nefarious, then the “hacking conspiracy” was just a pretext for the incumbent administration to investigate the opposition party’s political campaign, a stunning abuse of power.

Where does this all end up? I suspect it goes nowhere.

There is simply too much gray area of disagreement about what happened and what would have been an appropriate response to it. And our thinking is clouded by politics and its inevitable hypocrisy.

For example, during a campaign debate, Donald Trump vowed that if he were to win, he would have Hillary Clinton investigated. At the time, I thought (and said at NRO) that the torrent of condemnation — from the right as well as the left — was ridiculous. This was not, as overwrought critics said, tin-pot dictator stuff; nothing Trump said signaled an intention to use the executive’s awesome police powers to persecute political opponents. The critical fact was that there was patent evidence of felony misconduct on Clinton’s part — criminality that materially damaged national security and that had nothing to do with opposing Trump politically.

Now comes FISAgate, with its indications that while Trump was merely (and apparently emptily) threatening to investigate his Democratic rival, the incumbent Democratic president was actually investigating Trump, the Republican nominee.

Since some are now backpeddling from the assertions — matter-of-factly made over the last four months — that there really was an investigation, let’s be clear. This is not speculation. We know an investigation happened (and may still be ongoing). The only real questions concern the scope and the investigative tactics that have been used: Was there FISA wiretapping or, significantly, its functional equivalent in other forms of monitoring?

The deputy commandant for programs and resources of the Marine Corps, Lt. Gen. Gary Thomas, says that budget sequestration has cut into the Corps’ readiness for combat, with less than half of their aircraft ready to fly. General Thomas said that number should be 75 percent, meaning the Marines’ ability to meet challenges is severely restricted.

Washington Examiner:

The service’s goal is to have 75 percent of its aircraft on the flight line ready to go, a number he called “reasonable” since routine maintenance will always take some aircraft out of commission.

But the actual number now is just 45 percent, mostly due to aircraft exceeding their planned service life, Thomas said. The statistic seemed to shock Rep. Michael Turner, R-Ohio, chairman of the House Armed Services Tactical Air and Land Subcommittee.

“I’m sorry, can we go back for a second,” Turner said. “That’s pretty abysmal. To have that be closing the gap, we must have been in dire straits.”

Thomas also said the service has identified a capability gap when it comes to keeping forces safe in vehicles.

“If you look at some of our current vehicles, they no longer are adequate for the types of threats that they face in terms of protecting our Marines,” Thomas said.

Oshkosh Defense is building a new Joint Light Tactical Vehicle for the Marines that Thomas said will help better protect troops from current threats.

Other capability gaps include counting an emerging threat from drones, and coping with a fleet of amphibious vehicles that is 40 years old, Thomas said. CONTINUE AT SITE

The New York Times is again making hay of the fact that President Trump has not nominated any assistant secretaries of state, and Trump has been giving mixed signals on whether he thinks they are even necessary.

It turns out there are six undersecretaries of state and 22 assistant secretaries of state who report to them. If you factor in those with equivalent ranks, there are actually more like 33 assistant secretaries of state, each making an average of $155,000 a year, plus benefits!

Seven of the assistant secretaries cover different regions of the world, which makes some sense. You can’t have all ambassadors reporting directly to the secretary of state.

Assistant Secretary of State for African Affairs

Assistant Secretary of State for East Asian and Pacific Affairs

Assistant Secretary of State for European and Eurasian Affairs

Assistant Secretary of State for International Organization Affairs

Assistant Secretary of State for Near Eastern Affairs

Assistant Secretary of State for South and Central Asian Affairs

Assistant Secretary of State for Western Hemisphere Affairs

But after these posts it makes less and less sense. Let’s go over the rest of the list.

Assistant Secretary of State for Intelligence and Research

The State Department has an intelligence branch? I have never heard of it. Well, except maybe this guy (paragraph eight).

Assistant Secretary of State for Legislative Affairs

Why does a congressional liaison need to have the rank of assistant secretary?

Assistant Secretary of State for Administration

Assistant Secretary of State for Consular Affairs

Assistant Secretary of State for Diplomatic Security

The assistant secretary of state for administration deals with administering what? The consulates, I’ll bet! Why then do we need another secretary for consular affairs? And since diplomatic security is so integral to consulates, why can’t this all be wrapped into one job, rather than three?

cott Gottlieb may have landed the toughest job in Washington: President Trump has selected the physician and policy expert to run the Food and Drug Administration, where a culture of control strangles innovation. An iron triangle of interest groups, the bureaucracy and the press will resist change, but Dr. Gottlieb could save lives by renovating FDA’s drug-approval processes.

Mr. Trump deserves credit for picking a pragmatist who understands the agency: Dr. Gottlieb served as a deputy commissioner at FDA during the George W. Bush Administration, and he has also worked at the Centers for Medicare and Medicaid Services. He is a resident fellow at the American Enterprise Institute and his many contributions to The Wall Street Journal include insights on doctor autonomy, drug prices, antibiotic development and more.

One of Dr. Gottlieb’s priorities will be moving generic medicines to market, and competition is the best way to reduce the price of treatments like the now infamous EpiPen. About 10% of 1,300 branded drugs “have seen patents expire but still face zero generic competition,” Dr. Gottlieb wrote in the Journal last year. “New regulations have, in many cases, made it no longer economically viable for more than one generic firm to enter the market.” Now he can roll back such arbitrary directives.

Dr. Gottlieb has also suggested that the FDA should explain its reasoning when declining to approve a drug. FDA does not release a rejection notice known as a complete response letter. The rule ostensibly exists to protect manufacturers, but the silence allows the agency and a company to peddle divergent tales about what happened. The public is left with minimal information and FDA can operate without fear of accountability.

The press is overcome with relief that President Trump didn’t pick Jim O’Neill, a Peter Thiel pal who supports making drugs available to patients after testing for safety, though not for efficacy. But that idea is far from crazy, especially for drugs that treat rare diseases when no approved options exist. Why should desperate patients have to take a sugar pill so the FDA can satisfy its demand for 100% certainty that a drug works?

Laws in 2012 and 2016 directed FDA to include patient data in reviewing such orphan drugs, but the agency has refused to modernize or rely on anything but exhaustive placebo trials. Dr. Gottlieb should make the most of this legal flexibility, though he’ll be unfairly accused of lowering standards.

Most important is that Dr. Gottlieb understands that the fundamental problem at FDA is cultural: Staff reviewers think they are the “lone bulwark standing between truth and chaos when it comes to prescribing drugs,” as he put it in a 2012 piece for National Affairs. The agency delays approvals for therapies to search for remote risks, and the cost of this method is human lives lost from excessive delays in approving new medicines.

This culture has meant “that trials continue to get longer, larger, and harder to enroll,” he wrote. The average length of a clinical trial stretched to 780 days in 2005 from 460 in 1999, and median number of procedures (such as X-rays or blood draws) on patients in trials grew to 158 from 96. To speed approvals, Dr. Gottlieb has proposed that such decisions be made by a central committee of the agency’s most senior scientists, not the same reviewers who collect and analyze the data.

Dr. Gottlieb must win Senate confirmation, and some on the left are flogging that he has consulted for pharmaceutical companies and invested in health-care ventures, which they call a fatal conflict of interest. In other words, he’s disqualified because he’s qualified.

Dr. Gottlieb will have to adhere to government ethics rules, and the irony is that if he had never worked with the industry he’d be accused of inexperience. His understanding of entrepreneurship would be a valuable addition to an FDA that has for too long pretended its decisions have no influence on research or private investment.

One last credential: Dr. Gottlieb is a cancer survivor, which means he understands the urgency of helping treatments and cures reach the patients who need them. Dr. Gottlieb can expect relentless political and bureaucratic resistance, but he also has a tremendous opportunity to unleash medical progress in this era of rapid biological discovery.

Obama is a coward.

Trump will call someone a name while Obama will anonymously source a smear through three levels of staffers, political allies and reporters.

Trump called CNN “Fake News” on camera. Obama sourced Operation Rushbo, targeting Rush Limbaugh, through a variety of White House people and left-wing allies. Trump will boot reporters he doesn’t like. Obama authorized secretly hacking the emails of a FOX News reporter. Trump had an openly hostile conversation with the Prime Minister of Australia. When Obama wanted to call Netanyahu “chickens__t”, he did it by having one of his people anonymously plant it with a reliable media sycophant, The Atlantic’s Jeffrey Goldberg, before later having a spokesman disavow it.

Poultry ordure doesn’t smell any worse than that.

But Obama is very careful to launch dirty attacks without getting any on his hands. The insults are anonymously sourced. The retaliation comes out of the bowels of the bureaucracy. And he only finds out about it from the media. That allows him to retain what he cares about most: his popularity.

Obama and his people like to think that their dishonesty is a superpower. They pat themselves on the back for stabbing everyone else in theirs. Sometimes their smugness over how well they use the media to lie and smear gets out of control. Like the time Obama’s Goebbels, Ben Rhodes, boasted to the New York Times about how easy it was to fool everyone about the deal to protect Iran’s nuclear program.

After Trump won, it was business as usual.

Obama put on his best imitation of decency while his people went on preparing to undermine Trump at every turn by smearing him, wiretapping him and doing everything possible, legally and illegally, to bring him down. It was the same phony act that he had pulled for eight years, bemoaning the lack of bipartisanship while ruling unilaterally as a dictator, destroying the Constitution while hectoring us about our values, denouncing racism while organizing race riots, complaining about the echo chamber while constructing one and lecturing us on civility while smearing anyone who disagreed.

Trump’s killer instinct lies in understanding that hypocrisy conceals weakness. That is what powered him through the primaries and then through an election. His instinct is to grapple directly with a target. That is also the source of his popularity. Meanwhile the source of Obama’s popularity is his hollow likability. He’s likable only because he is almost always too cowardly to say what he really thinks.

Americans have seen the real Trump: because he is, in his own way, always real. Obama is always unreal. When Trump and Obama have appeared together, Obama seemed less real. He is a brand wrapped in all sorts of images that have nothing to do with who he really is.

Trump has always understood that Obama’s bravado was hollow. Obama boasted that he would have defeated Trump. Then he went on to try to do that with attacks from behind the scenes routed through government loyalists and media operatives while pretending that he had nothing to do with any of it.

But Obama and his people had learned nothing from how Trump had won the election. When Trump is attacked, his response is to go directly for the attacker, no matter what the argument is or how it’s sourced. Trump doesn’t get bogged down in debates or befuddled by media echo chambers that are so totally enveloping that they resemble reality. He just smashes past them to the source of the smear.