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Smarter disclosure of hospital data may be a sovereign remedy for price gouging

If knowledge is power, ignorance is impotence. Citizens, consumers, investors, and patients all need trustworthy information when we vote, making purchasing decisions, buy stocks or other assets, or choose a surgeon, medical device, nursing home, or dialysis center.

That’s why transparency in elections, marketplaces, and stock markets is a fundamental expectation in modern democratic states, codified into law by legislatures and embodied in regulators backed by the rule of law. 

Transparency is not just a “nice to have” condition in democratic states of, by, and for the people. It’s necessary for people to make informed decisions in the most important decisions of our lives, from elections to education to housing to healthcare. 

Transparency into public utilities and common carriers is critical for regulators to ensure consumers are literally not left in the dark, disconnected, without water, or Internet connections during or after an emergency — or by design, due to unjust housing or unconstitutional discrimination for goods or services. 

People trapped in monopolies or duopolies or dysfunctional bureaucratic systems who cannot make other choices provided in regulated marketplaces are stuck relying upon transparency about outages and complaints about service quality or delivery to drive action by regulators.

In practice, residents may have to resort to protests and direct action where powerful telecom and utility companies capture those entrusted with the power to sanction them. Recent initiatives around equity in service delivery and investments in infrastructure by the Biden Administration are relevant to better outcomes as well: populations without high speed Internet access won’t be empowered by knowledge they cannot access.

The slow march towards improved disclosure of hospital pricing data in the United States over the past decade is a canonical example of just how difficult it is to codify the principle of transparency into practice.  In a rough parallel to the Security & Exchange Commission’s disclosure requirements for publicly traded companies and the Federal Election Commission’s disclosure requirements for campaigns, the Centers for Medicare and Medicare Services (CMS) began requiring hospitals to post the prices of procedures online. The rule was well-conceived, but poorly executed. Years on, compliance with the Hospital Price Transparency Rule still mixed, if steadily improving. 

But if regulators and elected officials do not invest in ensuring that knowledge empowers consumers when, how, and where we make decisions, “smart disclosure” won’t have the impact policy makers intend.

As with disclosures of the contaminants in excess water from fracking sprayed on highways, if hospitals are allowed to disclose data in thousands of rows of files with obscure medical codes, zombie data will sit inert, neither living or dead, helping no one.

That’s the information gap that a private, venture-backed startup named Turquoise Health is trying to bridge. Turquoise is trying to make the hospital pricing data the federal government mandated be disclosed structured and more meaningful.

At present, Turquoise is providing free and paid access to the open data they’ve structured: The public can search for free, academics and researchers get a discounted rate, and Turquoise launched with tiered plans for healthcare industry. You can search for providers in your state through their engine. Turquoise publishes “transparency scorecards” that show how healthcare providers are complying with disclosure rules, highlights providers that have not done so yet, and enables patients and caregivers to search for the price of a given procedure in an area, like “total knee replacement.”

This took considerable time and resources, as Turquoise’s head of platform growth, Joe Wisniewski explained in a briefing.

“Building a system to aggregate 4,000+ machine readable files from hospitals is not easy,” he said. “Our team first built a script to go through every hospital website and download these files automatically. After that, we run 700+ scripts on each one to process the hospital data (which can come in different formats) into one standardized database for members of the public or the healthcare industry to use.”

In the world’s most expensive marketplaces for private health care, if patients and caregivers don’t have meaningful choices between limited health care providers in a region or can only seek care or procedures at the providers their insurer improves, transparent pricing data is a moot point. 

But while millions of Americans receive health care where our insurance companies allow us to seek it — or be faced with ruinous bills by paying out of pocket — patients and caregivers do have some elasticity around where we go for pharmaceuticals or services, like dialysis. That’s where more health data empowers people.

Most of what Turquoise is using isn’t open government data: it’s open corporate data that a government mandated to be opened. It’s also a strong signal from a future that’s already here.

This is not an uncomplicated dynamic: a private company has positioned itself as a key infomediary for disclosures that directly benefit consumers.

The database that Turquoise has built must be constantly updated.

“Each year, hospitals release new files, so our system needed to adjust to any changes,” Wisniewski went on. “If you write a script to process a hospital in 2021, you may need to go back to the drawing board for 2022 as hospitals release more information. Each file has the potential to be its own puzzle that our usual scripts can’t standardize. Our team will then investigate it manually to get it into our data platform.”

While nonprofits may not prove to be sustainable stewards of key data sets, profit-driven firms may not be, either, should ownership change or commercial incentives lead executives to try to capture more value than they create.

Congress and regulators should be carefully monitoring and where and how the benefits of disclosures pass through to patients and caregivers, along with continuing to evaluate if this data supply chain remains open and accessible.

Transparency is always complicated and mediated by context and power, but it’s the sovereign remedy to secrecy that masks gouging, profiteering, corruption, or simple greed.

Transparency can be a blunt tool, where disclosures are used like a maul to batter corrupt or incompetent officials or executives who fail to winterize a power plant, scale a website to meet surging demand, or contaminate shipments of medicine or vaccines.

Transparency can be corrupted and applied to pollute public discourse through weapons of mass distraction, where weaponized disclosures target marginalized populations to create the public appearance of greater threats.

But transparency also can be a great disinfectant, as Justice Brandeis famously observed: insider trading based upon secret information is criminalized in modern democracies, even if law markers may carve out exceptions for themselves and their families. Corporations face steep fines or shutdowns if they deceive consumers about the quality or safety of their goods and services. Political campaigns and candidates face sanction from law enforcement and election regulators if they conceal donations from foreign states or fail to disclose their fundraising and spending.

In practice, what happens inside of the powerful institutions and obscure entities that govern elections, consumer products and services, financial markets, and healthcare — one of the most regulated marketplaces on Earth — is often not transparent to everyone, because people in power prevent disclosure or the creation of records and data in the first place.

Whether powerful people and institutions that break regulations or violate laws by keeping information secret varies by state and governance system. “Authoritarian blindness,” in which a state withholds crucial information about public health or environmental safety during a pandemic or emergency from the public or world, is the inverse of the free flow of information people in healthy democracies expect and need in order to be self-governing.

Here’s hoping the USA doubles down on getting trustworthy health information into the hands of all of its people, when and where we need to make life and death decisions about our care and that of others.

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Letter to the White House on #SunshineWeek 2022

Last week, I wrote to the White House. The following is the email I sent to Press Secretary Jen Psaki and White House officials. I have received no comment or statement from the President in reply to date.

Thank you all for your assistance a year ago — and your service in the historic year since. US leadership on freedom of information, public access to information, open government data, and press freedom is irreplaceable, at home and globally.

Many actions taken since I first wrote you have shown the president‘s commitment to transparency in word and deed, most notely in declassify and disclosing facts regarding Russia’s intent to invade Ukraine, but also on wh.gov/disclosures.

I checked the wh.gov briefing page, but haven’t found a statement or release from the president, vice president, or any the administration’s open government champions yet about Sunshine Week.

I didn’t find anything on OpenGovWeek in May either, or how the White House will be meeting its commitment to engage all Americans in co-creating the fifth national action plan for open government.

Please let me know if I’ve missed statements or briefing or fax sheets that should be added to the public record of agency statements and participation by the end of Sunshine Week.

Attorney General Merrick Garland‘s new FOIA memorandum, setting the default to a presumption is openness, is welcome. The Justice Department’s improvements to foia.gov are genuine achievements, too, but there’s so much more that needs to be fixed that has been broken over the last four years — or that was at issue before, from overclassification to archaic technology.

As you know, President Barack Obama and (then) Vice President Biden championed open government, FOIA, and the public’s right to know on Sunshine Week for many years: https://search.archives.gov/search?query=Sunshine+week&op=Search&affiliate=obamawhitehouse

They catalyzed a worldwide movement towards 21st century democracy, collaborating with Tim Berners-Lee & the UK government & democracies everywhere, leading by example by digitizing & publishing public information online in open formats — work that continues to this day — and co-founding the Open Government Partnership.

But for four years, that leadership was absent.

In December 2021, President Biden called on all nations — including our own — to “stand with those in civil society and courageous citizens around the world who are demanding transparency of their governments” & “work together to hold governments accountable for the people they serve.”

I hope the administration will now reify transparency, accountability, civic participation, & collaboration as pillars of 21st democracy.

At stake is rebuilding broken public trust in government, & with it the question of how long our government of, by, and for the people will endure.

As always, thank you for your service, help, & dedication to getting trustworthy information out to the public, press, & our allies around the world: it has mattered.

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Rebuilding trust in the USA is crucial for national security and public health

As a Quaker growing up, I learned:
There is that of God in everyone.
All humans are equal.
Love your neighbors, & enemies.
Respect other faiths.
Simplicity, & integrity.
Forgive trespasses, & those who trespass against us.
Be a good steward of Earth.

My formative experience of Christianity, as a religion & practice, was fundamentally about love. Forgiveness. Grace. Humility. Tolerance. My community set an open door to all those who sought sanctuary & would abide there in peace. But cruelty, exclusion, & lies were not welcomed.

In the wake of our most grievous war, fought to end our union’s original sin of slavery, Lincoln said “with malice toward none, with charity for all, with firmness in the right as God gives us to see the right.”

Politicians would help heal wounds by embracing that ethos today.

After a grievous pandemic and insurrection, our union feels more divided and angry than any time since the Civil War.

The angels of our better nature are being drowned out by the demons of our worst selves and the trolls of our ugliest sewers, polluting public discourse with elements of the same hatred and vitriol that justified slavery and genocide in past centuries.

Our faith in the reason and wisdom of our fellow humans has been reasonably shaken by participatory delusions nurtured and spread by weapons of mass destraction, driving political violence and waves of death as people reject the public health measures that would end a pandemic from a preventable disease.

Millions of Americans have embraced a twisted form of medical freedom, conspiracies, and poisoned lies about vaccines that leaves the weak, sick, disabled, and immunocompromised at greater risk so that the healthy are not inconvenienced nor asked to sacrifice or for a greater good.

In 2022, we haven’t just lost trust in government but in one another. We’ve lost trust in our elected representatives, civil servants, and local officials to make safe decisions, wield power without abusing it, put patriotism before party, administer the vote, or prioritize public health before corporate profit or partisan advantage.

If we don’t find better ways to rebuild the bonds of fraternity and sorority around shared civic principles and moral values at the local level over the course of the year, I fear worse lies ahead next winter and the years ahead.

The threat of wars in Europe and Asia will put a premium on national cohesion, as the enemies of democracy everywhere will use our glaring weaknesses to divide us further, amplifying our domestic merchants of doubt, denial, fear, & hate, flooding our beleaguered institutions with lies and lunacy.

Previous generations navigated civil wars and world wars that posed existential challenges to what the United States would be and to whom.

Our parents and grandparents and great grandparents suffered and sacrificed and redefined a nation to become something closer to its founding principles through wars, universal suffrage, and civil rights movements enabled our union to became a fragile, flawed multiracial, pluralistic democracy in 1965.

Today, we endure as a decadent superpower, able to destroy the planet many times over but corrupted by wealth and power and burdened by the legacy of slavery.

We are still unable to provide for the health, welfare, and education of all of our families, uphold equal justice under the law for all of our people, regardless of race, religion, gender, or creed, or come together to suppress a pandemic.

Poverty and hunger endure not because we don’t have the resources or capacity to ensure no one goes hungry or unhoused or deprived of life and liberty or the vote without due process, but because we lack the national will to defend the Constitutional rights of every person in our states.

May we find our way back to the grace, generosity, and decency that embody the best of my neighbors as we go forward into whatever this year holds.

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“Merry Christmas to all, and charge your devices tonight!”

Photo by cottonbro on Pexels.com

Twas the Night Before Christmas, and all around the house

Our robots were stirring, uncontrolled by a mouse

The dockings were hung by the chimney with care,

In hopes that St. Nicholas soon would charge there;

The children were nestled all snug in their beds;

While visions of Candy Crush danced in their heads;

And Mom in her slanket, and I in my gown,

Had just tapped our smartphones to go power down,

When out on the lawn there arose such a clatter,

I sprang from my bed to see what was the matter.

Away to the window I flew like a flash,

Tore open the shutters and threw up the sash.

The moon on the breast of the new-fallen snow,

Gave a lustre of midday to objects below,

When what to my wondering eyes did appear,

But an electric sleigh and eight big robodeer,

With a little old driver so lively and quick,

More rapid than drones his deerbots they came,

And he whistled, and shouted, and called them by name:

“OK, Google! Hey, Siri! Alexa, on Prancer and Vixen!

OK, Cupid! On, Comet! On, Donner and Shenzhen!

To the top of the porch! To the top of the wall!

Now flash away! Flash away! Flash away all!”

As tweets that before the wild hurricane fly,

When they meet with a firewall, spread far and wide;

So up to the rooftop the deerbots they flew

With the e-sleigh full of toys, and St. Nicholas too—

And then, in a twinkling, I heard on the roof

The crunching and tapping of each deerbot hoof.

As I drew in my head, and was turning around,

Down the chimney St. Nicholas came with a bound.

He was dressed all in fleece, from his head to his foot,

And his clothes were all tarnished with silicon and soot;

A bundle of toys he had flung on his back,

He looked like an eBay merchant just opening his Slack.

His iGlasses—how they twinkled! His dimples, how merry!

His cheeks were like roses, his nose like a cherry!

His droll little mouth was drawn up like a bow,

And the beard on his chin was as white as the snow;

The stump of a stylus he held tight in his teeth,

And his Oculus, it circled his head like a wreath;

He had a broad face and a little round belly

That shook when he laughed, like a bowl full of jelly.

He was chubby and plump, a right jolly old elf,

And I laughed when I saw him, in spite of myself;

A wink of his eye and a twist of his head

Soon gave me to know I had nothing to dread;

He spoke not a word, but went straight to his work,

And filled all the stockings; then turned with a smirk,

And laying his finger aside of his Bose,

And giving a nod, up the chimney he rose;

He sprang to his sleigh, to his team said “OK, GO”

And away the bots pranced like real deer in slo-mo

But I heard him exclaim, ere he drove out of sight—

Merry Christmas to all, and charge your devices tonight!”

Adapted from “A Visit from. St. Nicholas,” by Clement Clarke Moore.

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Testimony to the Council of DC on improving school health and safety in a pandemic

My name is Alexander Howard: I’m a good governance advocate and digital democracy analyst. Today, I’m testifying as a DC Public Schools parent: my daughter is a third grader. Thank you for the opportunity to testify again before the council — and for your service and attention to these issues, which I know affects you and your families and neighbors.

Let’s step back.

Imagine if there were a dire airborne virus that left kids and adults sick and incapacitated. Parents and kids were afraid, but there was no Internet to work from home or do school learning.

With no virtual option, schools had to adapt differently to tuberculosis & the flu pandemic of 1918: kids moved to ferries, parks, roofs, & were bundled into classrooms with windows wide open to the cold with radiators.

How did a generation a century ago do so much more with so much less? How could we do the same, or better?

Let’s imagine DC classrooms had been full of bad air from gas or mold or fire in July. Would the council have stayed in recess in August and hoped DC government would fix it?

What would we as a city and community have done?

Here are 8 ideas for the days and months ahead: please adopt, adapt, improvise, & overcome!

1. Call on the DC National Guard to build field hospitals, but for learning. They have tents, strength, and motivation: the guard are our neighbors. Treat it like a barn raising for every school in national parks, & invite parents. If safety is an issue for outdoor field schools, keep the Guard on site, or bring park rangers & DC police in to watch over our kids as they do construction sites & national monuments. Don’t forget sanitation: DCDPW will have to support this frequently.

2. Engage the White House & Department of Education to make hybrid DC schools a model for the nation by using national parks and gardens. Presidential praise without public school progress isn’t moral. Use their praise for DCPS for access to federal spaces, support, and cover from rain & cold: winter is coming.

3. Issue all teachers and staff special permits for dedicated street parking, & accelerate permitting for parking lots, playgrounds, & roofs. Tap into libraries, grounds too!

4. Close side streets and sidewalks to expand outdoor space! How can restaurants possibly be higher priorities while our kids eat unmasked indoors? Other cities have done this. Why not DC? Ask for help from parents to supervise & take kids for walks. We will help if it means safer schools! Surge teams for permitting! No excuses: this could & should all have been in place in fall of 2020.

5. Over 1000 kids are quarantined as we speak. Support remote learning! Why wasn’t there virtual learning set to scale for kids in quarantine or sickened to begin! Why aren’t we ready to do this for sick days? Everyone had to know this would happen. Dedicate capacity to support them: devices, MiFi cards, paramedics to help & visit to make sure students have what they need.

6. Adopt test to stay! Rapid, on-site tests administered by school nurses should be a norm.

7. Hard vaccine mandate: get all staff & teachers vaccinated ASAP & disclose percentage. Hold DCPS accountable to keep our kids & communities safe.

8. What YOU can do as a council is mandate (and enforce) transparency, & hold agencies & the Mayor accountable for fixing infrastructure! Do performance issues suggest it’s time to make DC schools much more independent from the Mayor’s office?

There should be a DC pandemic dashboard for schools, full of open data on testing, quarantine, cases, outdoor space & HEPA filter status. Build it with OCTO, Code for DC & the open government advisory committee. Make that Salesforce data on work orders open and put it online! Hold weekly press conferences with the chancellor updating us all on status of outstanding issues. Make social media responsive, not broadcast press releases. Stop spending money to advertise propaganda to frustrated parents & ignoring our replies: work with us.

What’s missing is not resources or ideas in September 2021: it’s leadership, action, transparency, and accountability. Higher risk environments persist because we allow it.

Let’s fix it, together, & keep everyone as safe & healthy as possible.

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The pandemic showed us why the USA needs paid family leave and child care

A girl and her puppy attend virtual class

After March 13, 2020, I started counting backwards from the inflection point caused by our school going virtual. Just over a year later, I’m still counting the Days of “pandemic time” based upon the status whether my child is back in school, her family vaccinated, & this novel coronavirus has been suppressed — the Holy Grail of no new cases for a week here in DC. (It’s now Day 370.)

That light at the end of the tunnel is now in sight and plausible, born upon vaccination, but I do not expect my daughter to be back inside that school this term.

Screens were already ubiquitous in her life in March 2020, but over the past year they’ve become present and relevant in a way our smartphones, tablets, and laptops were not before, windows onto the rest of the world, from FaceTiming with grandparents do virtual classes and recitals to hanging out with friends.

We are far from alone, as this Washington Post story relates. We’re rolling with it, as we must, but I’ve been reflective today about what has been lost or gained for millions of kids & their families, particularly those who were left behind by lack of access or computing devices.

Heather Kelly, author of the Post story, encapsulates the dynamic: “Since U.S. schools began closing down roughly a year ago, the country’s children have been adapting, learning and getting creative with how they use technology. The realities of their day-to-day lives vary wildly, as have their relationships with screens. For some, technology is a savior — the lifeline keeping them in touch with friends and helping them maintain social skills; a welcome alternative to in-person school. For others, it’s a failed promise — unable to make up for the gaps in their education, their parents’ lost wages and their own mental health.”

Kelly’s reporting distilled a truth about this moment: a “year of everyone turning to screens has shown us the worth, or danger, of devices has less to do with screens themselves & more to do with how they’re used. What appears to matter most is the support systems children & their parents have”

The gross inequities and inequalities laid bare by the last year show that the digital divide isn’t the fundamental driver here. It is not just about the tech, though Internet accesss and modern computing devices are obviously essential to remote learning and virtual classes: it’s the missing social safety net for families.

The USA is the only country in our peer group of developed nations without paid family leave and child care.

As former OECD ambassador Karen Kornbluh said in February, “the US is off the charts among OECD countries in our social insurance, labor & family support funding. Other countries’ education systems counter socioeconomic differences. Ours exacerbate them.”

Whatever else can be said about its strengths and deficiencies, the American Rescue Act is the most significant legislation for children’s poverty in generations.

It will come too late to prevent generational harms for many of the innocent kids and teens who endured unprecedented stresses when their schools closed, borne disproportionately by those who had the least.

The USA should catch up with our peer nations and invest in paid family leave & child care. These social safety nets will unlock a LOT of talent & help tens of millions of Americans survive the next pandemic.

We cannot bring back those we have lost nor make up the time with family, friends, and teachers, but we can ensure there are more lifelines, life jackets, boats, & supplies to aid those caught up in the endless tides of disruption from wars, disasters, and climate change.

If we do not build in more resiliency, more will drown in the swift, rising waters ahead.

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Now is the winter of our discontent

I composed an homage to Shakespeare’s “Richard III” on a dark, chilly December night, using a famous network anchor’s quote as my muse to extend an earlier thought exercise on Twitter.

Image Credit: Katherine Streeter, Chronicle of Higher Education

I thought it would be worth pulling together the tweets and editing them into single document of bowdlerized verse after Dan Rather and other folks on Twitter praised it.

My timing feels apt.

As Peter Baker observed in the New York Times, President Trump’s final days “railing-against-his-fate outbursts seem like a story straight out of William Shakespeare, part tragedy, part farce, full of sound and fury.” Just so.

Jeffrey R. Wilson, a Shakespearean scholar at Harvard, told Baker that “this is classic Act V behavior.”

“The forces are being picked off and the tyrant is holed up in his castle and he’s growing increasingly anxious and he feels insecure and he starts blustering about his legitimate sovereignty and he starts accusing the opposition of treason.

If there are these analogies between classic literature and society as it’s operating right now, then that should give us some big cause for concern this December. We’re approaching the end of the play here and that’s where catastrophe always comes.”

And now, the final act begins.


Now is the winter of our discontent
Made inglorious bummer by this son of Queens;
And all his tweets that low’r’d upon the House
Impeachment charges by the Senate buried
Now are our brows bent to funeral wreaths
Our bruised hearts debate traitorous monuments;
Our schools and work changed to virtual meetings
Our protests and marches to indoor pleasures.
Grim-visaged Death hath smooth’d his dark shroud
And now, instead of heart attacks & cancers
To fright the souls of fearful Americans
He capers nimbly indoors
Borne by the promiscuous breathing of our youth
But we, that are not used to pandemic restrictions,
Nor bade to mask our plagued breaths;
We, that are rudely cramped, and in want of love’s tragedy
To dance before a wanton ambling nymph;
We, that felt curtail’d of our fair proportion,
Cheated of life by a dissembling cretin
Sickened, uninformed, sent before our time
Into this breathing world, alternative facts made up,
And so lame and irrational
That dogs bark as they halt by them;
Why, we, in this bleak time of plague,
Have tried to vote away the crimes,
Hoping to drive away shadows with the sun
And return our union to normalcy:
Therefore, since he cannot prove widespread fraud
We must not entertain these baseless lies
He is determined to invent villains & rages against the displeasures of his days
Plots has he laid, inductions dangerous
By conspiracies, libels & dreams
To overturn the election & become king
In deadly hate set one against the other
And if our union be as true and just
As he is subtle, false, and treacherous
This day should he be mew’d up
About a conspiracy, which says that ‘Q’
One of his heirs shall be fascistic
Dive, tweets, down here
Winter comes

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Practice good information hygiene by “sifting” social media

Offline, we wash our hands so we don’t catch or pass on a disease. We emphasize physical hygiene to our kids.

Online, we need to practice information hygiene and teach everyone how to use social media responsibly, just as we do cars, guns, water, & fire.

It takes 20 seconds to wash your hands properly.
It takes 30 seconds to check info before you share an update.

How? “SIFT” the content: https://infodemic.blog/

Stop.
Investigate the source.
Find better coverage.
Trace claims, quotes, & media to original context.

Whether we wash our hands or scrub our feed of viral misinformation, we can stop the spread to our friends, families, & communities as others become vectors for infection.

The more social interactions someone has, the more responsibility they have not to pass on a disease.

The bigger a platform someone has, the more responsibility they hold. (Mark Zuckerberg, for example.)

But this isn’t just about media in 2020: every politician & member of the public has to help.

Always verify before you trust or amplify.

Deny lies oyxgen.

Attention & trust are 2 of the most precious commodities today.

Whether it’s algorithms suggesting politicians & content, taking $ for ads, running op-eds, or broadcasting a tsunami of lies or a protest live, tech companies, media, & the public all give speech reach.

What we amplify or damp shows our ethics.

Please don’t pass on disinformation or 🦠

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Politicizing masks cost American lives and jobs

If everyone had worn a mask since March, tens of thousands of Americans might be alive.

President Donald J. Trump bears direct responsibility for that, as well as the absence of the testing and contact tracing capacity we must have to reopen safely.

Why have European and Asian counties been able to suppress this pandemic while the USA has not?

The public health playbook for a pandemic is not a secret: universal masks, robust, rapid testing, contact tracing, & supported isolation & treatment — quarantine — for infections.

It’s the *only strategy* that will help us reopen in a safe way until we develop an effective vaccine, vaccinate 70%+, and have effective antivirals and therapeutics.

Masks are about protecting other people, & them protecting you, while scientists work on a safe, viable vaccine.

The key exception is someone who needs to gear up with a N95 as a healthcare worker or first responder to treat infected patients, in which case they’ll need that respirator, face shield, gloves & gown.

But that better mask would help on a subway or bus or plane or office. If we had manufactured tens of millions of N95 masks & distributed them this spring, Americans would be safer — like South Koreans, who did exactly that, distributing inexpensive masks around their nation.

We should have them, and all be wearing them.

Republicans seem to have realized they are on the wrong side of public opinion, the global health consensus, and history, shifting to saying everyone should mask up, with Speaker McConnell, Leader McCarthy and Rep. Cheney all speaking out in favor of wearing them last week.

But President Trump hasn’t just refused to wear a mask himself or tweet his *own administration’s guidance” on people wearing a mask: He has used his bully pulpit on Twitter and White House events to mock people who mask up & cast doubt on their effectiveness.

After months of anti-mask messaging, he finally reversed himself last week.

Why?

Republicans in Congress and Governors finally decided to support this crucial public health intervention — like their peers in the rest of the world’s developed nations and democracies — to stop the spread of COVID19.

“‘I’m all for masks,’ Trump lied, adding that he would wear one himself if he were in a crowded room (he hasn’t) and noting that he had a black one on recently. “I sort of liked the way I looked.’”

And then he hosted two large public events where people close together were not required to wear masks.

His defenders should ask why that didn’t happen in March, April, May, or June, and how many lives were lost as a result.

Every preventable death is a tragedy and I’m not willing to lose my parents or friends or neighbors to malign negligence.

President Trump is the first President in modern US history that has not tried to extend beyond his political base, governing all Americans.

His example carries outsize importance for his supporters — which goes to the importance of him wearing one and supporting their use — and negative valence with anyone else.

The public record shows that President Trump holds significant responsibility for the politicization of masks in the USA and thereby actively undermined a basic public health intervention that would have made a huge difference in the R value (infection rate) of a deadly disease.

God may have mercy on his soul, but historians will not be kind.

Americans will keep dying on his watch until our nation masks up, tests, traces, isolates & treats every case.

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Unwiring in upstate

Here in upstate NY, driving miles of country roads to go hiking in an ancient gorge and plunge into the cool depths of the natural swimming pool is well worth the trip.

Visiting Stony Brook takes me back nearly 4 decades, to looking for fossils in the ancient walls, waterfalls, and the indelible memory of chilly, clear waters dappled with sun.

As forest baths go, this was restorative.

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