Health Policy – Page 2 – The Wrongologist

Biden’s Plan To Cut Drug Prices

The Daily Escape:

Mars on left, Earth on right – image by alofeed

The Biden administration released its list of 10 prescription medicines that will be subject to the first-ever price negotiations by Medicare. This is a big deal because Medicare covers 66 million older Americans, people who routinely take very expensive drugs.

Until recently it was illegal for Medicare to negotiate prices with drug companies. But the Inflation Reduction Act (IRA), passed last August, gives Medicare that power. It also forces companies to pay a rebate to Medicare if their drug prices rise faster than inflation. The Congressional Budget Office estimates that price-capping measures will reduce Medicare expenses (and the federal deficit) by $96 billion by 2031.

The list includes drugs for diabetes, arthritis, and Crohn’s disease, and could sharply lower medical costs for patients. Reuters says that the US Centers for Medicare & Medicaid Services (CMS) spent $50.5 billion between June 1, 2022 and May 31, 2023 on these 10 drugs. That was about 20% of the total cost of drugs in the Medicare prescription drug program known as Part D.

The WaPo had an opinion piece by David Goldhill, CEO of SesameCare.com, a digital marketplace for discounted health services: (brackets and emphasis by Wrongo)

“The pharmaceutical industry earns almost 50% of its worldwide revenue here [the US], as do medical information-technology firms. [Medical] Device makers earn 40% of their money in the US. And this understates things, because US revenue is generated from higher prices, so margins are greater. If the US accounts for half of a company’s revenue, it probably contributes at least 75% of its profits.”

This has always been the business plan for Big Pharma: Make your money in the US and take whatever scraps of profit you can get in other markets.

That market subsidy is paid by American taxpayers generally (through the funding of Medicare) and by US pill-takers specifically when they pay higher co-pay prices for the drugs that help with their chronic conditions. The Economist points out that prescription medicines in America cost two to three times more on average than in other wealthy countries:

The blue dots are the price paid in the US for brand name drugs. The grey dots are prices paid in the various countries for all US drugs sold in those countries. The comparison of brand name to generics shows how much greater the cost is to an American. It also follows that US patients’ out-of-pocket expenses, (the slice of drug costs not covered by insurance), are among the highest in the world.

It’s understandable why Biden’s move to start negotiations on some of the most expensive drugs has been fiercely opposed by the pharmaceutical industry. Essentially, high US drugs costs underwrite what amounts to a subsidy for buyers of the same drug sold when it’s outside the US.

Many of the Big Pharma have jumped on the legal bandwagon, challenging price-setting provisions in the IRA. More from the Economist:

“Since the law’s passage over 50 companies have blamed the IRA in earnings calls for clouding their prospects.”

A quick primer on drugs. Most medicines are either small-molecule drugs or large-molecule drugs. The former are the kind of pills that line our medicine cabinets. Large-molecule drugs, (also called biologics), are more complex and must be injected. The IRA grants biologics 13 years of pricing freedom after a drug is approved, while small-molecule drugs get only nine years post-approval before they must face Medicare’s bean counters. The industry estimates that small-molecule brands could lose between 25% and 40% in overall revenue due to the earlier cap on prices.

PhRMA, the pharma Industry’s lobbyist argues (and Republicans back them) that high US prices reflect the high cost of drug development. The pharmaceutical manufacturers are, of course, suing to stop the price negotiations. They say that allowing the government to negotiate lower bulk prices for drugs will stifle innovation, and will cut funds for research.

One thing that Big Pharma wants to avoid showing us is that they rely on smaller, more agile biotech firms for ideas. Between 2015 and 2021, 65% of the 138 new drugs launched by Big Pharma originated mostly from smaller firms. So, while innovation isn’t totally gone from the big firms, what they’re mostly doing is marketing the intellectual property of small pharmaceutical firms.

It didn’t take long for Republicans to jump on the decision to allow Medicare to negotiate drug prices. From Politico:

“Piggybacking on the pharmaceutical industry’s strategy, Republicans are working to persuade Americans that the Biden plan will stifle innovation and lead to price controls.”

Politico quotes Joel White, a Republican health care strategist:

“The price control is a huge departure from where we have been as a country….It gets politicians and bureaucrats right into your medicine cabinet.”

Politico says that the GOP effort to reframe the drug price debate may hurt them, since they plan largely to run on inflation, while the Biden plan will lower drug prices. Also they quote a new poll from the Kaiser Family Foundation (KFF) that shows 58% of independent voters trust Democrats to lower drug costs compared with 39% of Republicans.

Our politicians and pundits have bleated at us for years about being an “exceptional nation” – but what we really are is exceptionally gullible. As long as the large healthcare and pharmaceutical companies insist on standing between American consumers and their health needs, maximizing their profit will always come first.

We also continue to elect leaders who lobby for keeping corporations unleashed so that they can make as much profit as possible, while saying that the “market” will decide where the public good is prioritized. This keeps us hopelessly mired in a grossly expensive, and often ineffective healthcare system.

We continue to let ourselves be convinced by corporations and our politicians that reforming healthcare is impossible. That the solutions and methodologies used by other developed nations are substandard, and/or somehow immoral.

The Hill reported that the 14 leading US drug companies paid out more in stock buybacks and dividends from 2016 to 2020 than they spent on research and development. Those firms spent $577 billion from 2016 to 2020 on stock buybacks and dividends, $56 billion more than the $521 billion they spent on R&D. So, it’s oblivious how Big Pharma could easily fund their R&D with lower drugs prices.

It is also useful to remember that America has more healthcare billionaires AND healthcare bankruptcies than any other country. Those two things are inextricably linked.

As long as the pharmaceutical companies can maximize profits by buying politicians rather than by charging higher prices in other countries – the American people are the ones who will continue to get screwed.

Rural Hospitals Are No Longer Providing Maternity Care

The Daily Escape:

Perseid meteor shower, from Mt. Evans, CO – August 13, 2023 photo by Paul Blais Photography

Welcome to our Saturday Soother, but first, Wrongo intends to spin you up before eventually letting you slow down.

There’s a crisis in rural healthcare in America. Rural hospitals are closing at a rapid rate. Our county (Litchfield) in Connecticut has one of three remaining hospitals that are designated as rural in the state (Sharon Hospital).

A problem for rural hospitals is that many are closing down their labor and delivery services in order to try and remain economically viable. WSHU, a CT-based NPR affiliate, has covered the impact of these closures to Connecticut. They quote Peiyin Hung, a researcher on maternal and rural health at the University of South Carolina:

“My team has been tracking nationwide, hospital-based obstetric unit closures since 2008 up to 2022,…. Almost 300 hospitals closed their OB units.”

WSHU points out that more than 60% of those closures were in rural areas. Why are so many hospital groups moving away from delivering babies in rural locations?

WSHU quotes Dr. Robert Roose, chief medical officer at Johnson Memorial, a hospital in rural Stafford Springs, CT that closed its obstetric unit. He said that it’s a safety issue. Hospitals with fewer than 200 deliveries a year, like Johnson Memorial, are considered low-volume birthing centers:

“There is a clear and critically important correlation between volume and quality of services provided when it pertains to labor and delivery and maternity care…”.

Three years ago, Hartford HealthCare’s Windham Hospital in Willimantic, CT stopped delivering babies, citing the same concern.

Also, malpractice insurance rates go up for low birth-volume hospitals because insurers feel the risk is higher if doctors aren’t getting sufficient practice with birthing. Hung says another problem is the level of reimbursement:

“Medicaid…pays half as much on average [as] private insurance pays for labor and delivery across the country”.

That’s important because about four in 10 of all Connecticut deliveries are covered by Medicaid. Simply put, delivering babies doesn’t pencil out for many rural hospitals.

There are other factors: Rural America’s demographics skew older. Young families in general prefer living in the suburbs or exurban areas. Couple that with America’s lower birth rate and rural hospitals really can’t maintain the birthing volume they need to remain economically viable.

The Center for Healthcare Quality and Payment Reform, (CHQPR) a Pittsburg-based health policy group published “A Crisis in Rural Maternity Care in the United States” which shows the problem:

“Fewer than half (45%) of the rural hospitals in the US currently offer labor and delivery services, and in 9 states, less than one-third do. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies”.

“Hundreds of additional communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing….More than 1/3 of the rural hospitals that still have labor & delivery services have been losing money on patient services, so their ability to continue delivering maternity care is at risk.”

CHQPR reports that more than half of small rural maternity care hospitals lost money in 2021-22.

They suggest that a primary reason rural hospitals are losing money is that private insurance plans pay them less than what it costs to deliver many of the services they offer patients, not only maternity care. They point out that while rural hospitals are losing money on uninsured patients and Medicaid patients, the losses from private payers have the biggest impact on their overall profit margins.

CHQPR suggests that a potential solution is to require that health insurance payments actually cover the cost of rural maternity care. With more than 40% of births (on average) in rural communities paid for by private health plans, having the private insurers pay more would help keep rural maternity care viable:

“Payment amounts must be higher in communities that have difficulty attracting staff, and payments must also be higher in communities with smaller numbers of births to ensure that revenues cover the fixed costs.”

This means that the fee-for-service model isn’t working in low-volume hospitals. Rural hospitals are only paid when they actually provide a service, but a small hospital has proportionally higher overheads than larger hospitals, since they must be staffed and ready to deliver a baby at all times, even if there are no deliveries at all. Read CHQPR’s report “A Better Way to Pay Rural Hospitals”.

Back to Connecticut, Sharon Hospital has proposed closing its labor and delivery unit. There will be a public hearing to consider the closure later this year. But Sharon is about an hour from its affiliated hospital (Danbury Hospital) that has a fully-staffed labor and delivery facility. Sharon may actually be closer to two other unaffiliated hospitals in New York state than it is to its own parent facility.

It’s now time for our Saturday Soother. Litchfield County is having beautiful weather this weekend. We’re taking advantage of it by going to a live Baroque music concert, and possibly heading off to the annual fair in a local town.

To help you relax and zone out from all of the Trump indictment analysis, grab a chair outside in the shade and watch and listen to “Gortoz a Ran” (I’m Waiting) sung by Denez Prigent and Lisa Gerrard. The language in the song is Breton, spoken in Brittany, France. It is closely related to Cornish and Welsh, and all three are Celtic tongues. When the Angles, Saxons and Jutes invaded Britain in the fifth century (400-500 AD), many of the Britons in Cornwall, Devon, and the West Country fled across the English Channel to France. Because of the influx of Britons, the region became known as Brittany.

Most of the images in the video are of Scotland, England, Wales, and Brittany. Lisa Gerrard isn’t singing in any language; she’s just vocalizing. The Uilleann pipes, an Irish instrument, are heard at 3:50:

Lyrics: English Translation

I was waiting, waiting for a long time
In the dark shadow of grey towers
In the dark shadow of grey towers

In the dark shadow of rain towers
You will see me waiting forever
You will see me waiting forever

One day it will come back
Over the lands, over the seas

The blue wind will return
And take back with it my wounded heart

I will be pulled away by its breath
Far away in the stream, wherever it wishes

Wherever it wishes, far away from this world
Between the sea and the stars

The song describes waiting, possibly forever: Aren’t we all waiting? What are we waiting for? For whom are we waiting? Happy Saturday!

Sunday Cartoon Blogging – May 21, 2023

Top negotiators for Biden and Speaker McCarthy resumed talks Friday evening after the Republicans said the negotiations had to go on a “pause”. Roll Call reports that:

“After a nearly daylong setback, White House Counselor Steve Ricchetti, White House budget director Shalanda Young, Rep. Garret Graves, R-La., and House Financial Services Chairman Patrick T. McHenry, R-N.C., resumed talks at the Capitol shortly after 6 p.m.”

Time is running out for Congress to raise the debt ceiling. If not, the consequences are stark. Keeping the lines of communication open and giving away the store are two different things entirely. On to cartoons.

McCarthy’s toll booth:

The North Carolina legislature overrode Governor Roy Cooper’s veto of a bill imposing a ten-week abortion ban. Will this ensure Democratic victory in North Carolina in 2024?

Texas has sued the Biden administration 29 times in a Texas Federal District Court. Now after banning mifepristone, Texas judges have new careers:

Durham’s report:

Disney’s Bob Iger asks DeSantis: “Does Florida want our jobs and taxes or not?” This is a severe kick in the balls:

Wrongo’s old enough to have seen Jim Brown play in Yankee Stadium against the NY Giants:

Trump’s one note:

Sunday Cartoon Blogging – March 12, 2023

Let’s talk about Silicon Valley Bank (SVB). The tech industry’s go-to lender just became the second-largest bank failure in US history. The bank’s customers withdrew $42 billion from their accounts on Thursday. That’s $4.2 billion an hour, or more than $1 million per second for ten hours straight.

We ancient, moss-covered former bankers call this a bank run. That occurs when a large number of customers of a bank withdraw their deposits simultaneously over concerns about the bank’s solvency.

Nearly half of all venture-backed US companies were SVB customers. We’re unsure why the run started, but on Thursday, several Venture Capital firms started telling their client companies that pulling cash from SVB was prudent, and the run began.

While bank deposits are insured by the Federal Deposit Insurance Corporation (FDIC) up to $250,000, few of SVB’s deposits, by value, were FDIC insured, since its customers were overwhelmingly corporations with much more than $250,000 in the bank. By Friday, there was no cash left in SVB’s coffers. In fact, the cash on hand was negative, to the tune of $958 million.

Do you remember when Trump and Republicans rolled back some of the regulations Dodd-Frank placed on regional banks?:

“Some banking experts on Friday pointed out that a bank as large as Silicon Valley Bank might have managed its interest rate risks better had parts of the Dodd-Frank financial-regulatory package, put in place after the 2008 crisis, not been rolled back under President Trump.”

Trump signed the bill despite a report from Democrats on Congress’s joint economic committee warning that under the new law, SVB and other banks of its size:

“…would no longer be subject to nearly any enhanced regulations”.

This also affects ordinary people. Wrongo has a California friend who banks with SVB. Here’s a quote from her:

“While I’ve been waiting to sign the purchase contract on a condo, I woke to the news that my lender Silicon Valley Bank has been closed and taken over by regulators. That concludes literally 8 months of working on this….and the end of my effort to buy a home.”

So don’t listen to the pleas for another bank bailout. Wrongo would be okay with bailouts if they were accompanied by personal accountability by management. Like, we’ll rescue your institution, but none of the bank senior management can ever work in finance again. On to cartoons.

Tucker’s mendacity:

It takes two teams to play:

Walmart’s OK with pills for boners, but not for pregnancy:

GOP wants to regulate Trans not Trains:

GOP loves doormats:

Most appropriately named movie of this or any year:

What To Do About Social Security and Medicare

The Daily Escape:

Lupine and poppies, near Glendale, AZ – March 2023 photo by Marion Cart

From Joe Perticone:

“Social Security and Medicare are headed for insolvency—that’s just a mathematical, demographic fact. But when it comes to addressing the problem, there’s virtually nothing the two parties actually agree on. For years, Republicans have waffled between proposing cuts and kicking the can down the road.”

Republicans are correct that Social Security (SS) and Medicare (M) are marching toward insolvency. But they trip over their own feet with their proposals to save them. Republicans are wrong to think they can solve the solvency questions without raising taxes. Once the Republicans take taxes off the table, they’re left without any real solutions to propose.

The Biden administration has done a good job in pre-emptively going after Republican’s ideas about cuts in Social Security and Medicare benefits. The result is that the GOP is squabbling between themselves and scrambling to come up with a plan they could take to the public.

It’s not just the federal debt that should be discussed. Dr. Donald Berwick head of Medicare and Medicaid during the Obama administration wrote in JAMA: (emphasis by Wrongo):

“A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10,000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.”

The WaPo explains why people who live in the American South have bad credit scores. It turns out that neither race nor poverty were the deciding factors. It was medical debt:

“Of the 100 counties with the highest share of adults struggling to pay their medical debt, 92 are in the South, and the other eight are in neighboring Oklahoma and Missouri…”

But why the South? Yes, as a region, it’s unhealthy. But there are several Northeastern states where residents struggle with chronic health conditions but have good credit. One thing that stands out is the lack of Medicaid:

“…a recent analysis in the Journal of the American Medical Association…found that medical debt became more concentrated in lower-income communities in states that did not expand Medicaid after key provisions of the Affordable Care Act took effect in 2014.”

So bad health and bad credit are because of Republican governors’ refusal to expand Medicaid to cover more poor people. Leave it to the south to show a MAGA future for all of us: undereducated, unhealthy, and neck-deep in debt.

Saturday Soother – January 14, 2023

The Daily Escape:

A view from Shenandoah NP near Keezletown, VA – January 1, 2023 photo by One Man’s Outdoor Journey

Wrongo and Ms. Right live far enough out in the country that we have no city water, sewer, or gas lines. But the cooktop in our recently remodeled kitchen runs on propane while our ovens are electric. We have a well and septic. Our hot water is made by propane as well.

So what are we supposed to make of this week’s controversy over the Biden administration’s Consumer Product Safety Commission (CPSC) possibly banning future sales of natural gas stoves and cooktops? The reason for this is that burning gas stoves put their partially burned fuel, including nitrogen dioxide (NO²) in the air, which causes asthma. And older stoves with pilot lights instead of electric igniters also push NO²into the air.

On Monday, Bloomberg reported that the CPSC was considering new regulations around gas stoves, given growing concerns over indoor pollutants. Commissioner Richard Trumka Jr. said:

“Any option is on the table….Products that can’t be made safe can be banned.”

The proposal by the CPSC followed a December study by scientists finding that gas ranges that burn natural gas account for almost 13% of childhood-asthma cases in the US. Advocates have long argued against gas stoves, saying the pollution they emit makes them inferior to other options, such as electric or induction ranges. But the asthma statistic breathed new life into the debate.

OK, Wrongo knows the difference between propane and natural gas, but when he first heard about the debate, it was unclear whether his gas of choice was also a health problem and had to die.

Bloomberg neglected to say that any CPSC regulations, like other proposed state and local-level bans of gas stoves, only applies to new construction. But that didn’t keep Republicans from evoking visions of a 2023 filled with government agents busting down doors and ripping out stoves. That tentative regulation conversation about how to best mitigate the health hazards of gas stoves morphed into a Right Wing campaign to convince Real Americans that the Government is coming for their gas stoves:

Rep. Ronny Jackson, (R-TX) tweeted:

“If the maniacs in the White House come for my stove, they can pry it from my cold dead hands,”

From Sen. Tom Cotton,(R-AK):

“Democrats are coming for your kitchen appliances,”

From Rep. Byron Donalds, (R-FL):

“Get your hands off our gas stoves!!!!”

From Rep. Jim Jordan,(R-OH):

“God. Guns. Gas stoves.”

God, Guns, and Gas stoves! All because one appointee in the administration discussed it. But this controversy isn’t about facts; like always, it’s about feelings. Over 30 years ago, the Clean Energy Act was easily renewed on a bipartisan basis. Since then, the environment has become part of the culture wars.

The reflex to position gas stoves as the last redoubt of traditional American life threatened by big government, is just stereotypical of the American Right wing. It’s difficult to see the fight about gas stoves as something that will move the needle since gas is far more common in cities and blue states. So, let the Republicans keep on cooking up the outrage du jour. It’s doubtful that the voters will be eating it up.

Remember their past freak-outs, like when former Rep. Michele Bachmann tried to build a political career around preserving incandescent light bulbs? Another useless freak-out.

In retrospect, it’s honestly shocking we were able in 1975 to ban leaded gasoline in America, although there were lots of dissenters at the time. And now, since we’ve gotten all their guns, it only makes sense that Democrats go after their gas stoves.

Let’s leave these partisan debates in the kitchen where they belong and embrace our Saturday Soother, that special time when we stop thinking about Biden’s secret document stash, or why Jim Jordan dresses like a gym teacher, and spend a few minutes contemplating nearly nothing.

Start by brewing up a big mug of Wilton Benitez Orange Bourbon ($19.00/8 oz.) from Wisconsin’s JBC Coffee Roasters. Apparently the coffee cherries for this variant turn orange when they ripen rather than the typical red and tend to be even more fruity than their red counterparts. The roaster says it is super creamy with flavors of candied ginger, pineapple, and cream soda.

Now grab a seat by a south-facing window to watch and listen to “Fandango” from the Guitar Quintet in D-major, G.448 by Boccherini, performed live in 2015 at the Schubertiade in Hohenems, Austria. Boccherini was an Italian composer and cellist who died in 1805. A fandango is a Spanish dance:

Monday Wake Up Call – January 9, 2023

The Daily Escape:

Kennebunk, ME – January 2023 photo by Eric Storm Photography

Buried in the McCarthy debacle last week was some good news on the abortion front. From the NYT:

“For the first time, retail pharmacies, from corner drugstores to major chains like CVS and Walgreens, will be allowed to offer abortion pills in the United States under a regulatory change made Tuesday by the Food and Drug Administration.”

The online magazine STAT asked an interesting question: (emphasis by Wrongo)

“When the Food and Drug Administration lifted some — but not all — of its restrictions on an abortion pill this week, it raised questions about why these rules were there in the first place. Mifepristone, the drug in question, has been used by over 3.7 million Americans to end early pregnancies since its approval in 2000, is more than 97% effective, tends to have only mild side effects such as cramping, with severe ones occurring in fewer than 0.5% of patients. So why was it on a list of prescription drugs requiring extra precautions and red tape, alongside opioid painkillers?”

Sunday Cartoon Blogging – August 14, 2022

(Tomorrow’s Monday Wake Up Call will appear on Tuesday)

Let’s talk about the religions that are implicated in two news items this week.

First, the attempted assassination of Salman Rushdie in upstate New York on Saturday. He was hospitalized after suffering serious injuries in a stabbing attack. We don’t know for certain that this was someone carrying out the death threat that Iran’s then-leader Grand Ayatollah Khomeini put on Rushdie in 1989. But it seems to be the most likely explanation.

Police detained a suspect named Hadi Matar, 24, who is California-born, but moved to Fairview, New Jersey in 2014. NBC NY News reported that a review of Matar’s social media accounts showed he is sympathetic to Shia extremism and Islamic Revolutionary Guard Corps causes. One of Matar’s former high school classmates told The Daily Beast that Matar “was a very devout Muslim” who participated in debate and had several friends.

If religion is behind this, the attempted revenge has occurred two generations later.

Second, Polio was found in wastewater samples from New York City. Polio has been eradicated in the US since 1988. Finding it in NYC water samples follows a confirmed case of Polio in Rockland County, NY, just 35 miles north of the City. The County announced that an analysis of more wastewater samples revealed that the polio viruses have been circulating in the area since May.

Worse, the 20 positive samples detected in the two counties are genetically linked to the virus that paralyzed the unidentified man in Rockland County.

The broader context of both stories is that religions played a part in each. The Polio case in Rockland was found in a resident of one of the orthodox religious towns where a predominantly Hasidic Jewish community lives. Rockland County currently has a polio vaccination rate of 60.5% among 2-year-olds, compared to the statewide average of 79.1%. This same group had a measles outbreak (312 cases) in 2019, and low COVID vaccination rates.

There is a strong anti-vaxx mentality in this community, and that helps create fertile conditions for a formerly eradicated disease to be revitalized. Polio is entirely preventable, and yet, many parents remain hostile to vaccination.

In the Rushdie attack, we’re speculating about the influence of religion. Saying the attacker is sympathetic to Shia Islam isn’t sufficient to make it a religious attack. But Wrongo would be surprised if it turned out to be solely either personally or politically motivated.

On to cartoons. Despite the above, most of the news this week was about the FBI search.

The truth is revealed:

Trump explains:

Beach reading is different this year:

Reactions to IRS have changed:

GOP policy wonks are thinking they may need to change:

Run On Roe And Reform

The Daily Escape:

Perkins Cove, Ogunquit, ME – July 2022 photo by Adam Silverman Photography

From the Kansas City Star:

“The right to an abortion will remain in the Kansas Constitution. In the first ballot test of abortion rights in a post-Roe America, Kansas voters turned out in historic numbers to overwhelmingly reject a constitutional amendment that would have opened the door for state lawmakers to further restrict or ban abortions across the state.”

Kansas voters showed that the Supreme Court’s decision in Dobbs doesn’t sit well, even in one of the country’s most conservative states. Democrats should adjust their 2022 Midterms messaging and strategy accordingly, to make it clear that Roe and Reform are what they’re running on.

Across party lines, abortion rights remain popular while the Supreme Court’s ruling is not. The most recent CNN poll found that 63% of Americans disapproved (51% “strongly”) of the court’s decision.

The NYT reported about Kansas:

“From the bluest counties to the reddest ones, abortion rights performed better than Mr. Biden, and opposition to abortion performed worse than Mr. Trump,”

The NYT had several observations:

Abortion opponents under performed even in conservative areas. In Hamilton County, which voted 81% Trump in 2020, less than 56% chose the anti-abortion position. In Greeley County, which voted more than 85% for Trump, only about 60% chose the anti-abortion position.
Kansas’s swing areas swung left. Wyandotte County, (where Kansas City is located), voted 65% for Biden in 2020, but 74% for abortion rights. Neighboring Johnson County, the state’s most populous, voted 53% for Biden but more than 68% for abortion rights.
Turnout was high. Before the election, the Kansas secretary of state’s office predicted turnout of about 36%. But anecdotal evidence indicated turnout might hit 50%, an extraordinary increase over what was expected.

Here’s TPM’s Josh Marshall’s Twitter thread on what Kansas means to the Democrats’ Mid-term road map: (emphasis by Wrongo)

2/ When a result is this lopsided & this unexpected for most political observers it’s not only a political earthquake but a sign many political professionals have seriously mistaken the political terrain. When there’s a political backlash as strong as the one against Dobbs …

3/ and one party is as firmly tied to it as Republicans are here, clearly the opposing party needs to grab on to it with both hands. Abortion rights will be central to numerous races this fall. But Democrats need to make the connection as explicit and tangible as possible.

4/ The way to do that is to make a firm pledge that if Democrats hold the House and add two Senate seats they will make Roe into federal law in January 2023. They are at present kinda sorta suggesting something like that, maybe. But clarity is everything. Give us this …

5/ specific result and this is specifically what we will do. Kansans didn’t turn out in these lopsided numbers to make a statement about Dobbs or Roe. They did so because they knew that the outcome of this one vote would immediately and dramatically affect the right …

6/ to a safe and legal abortion in the state. Democrats need to approximate the same clarity at the federal level, both to undo Dobbs and also to secure their hold on Congress. The way to do that is to get all 48 (non-Sinema/Manchin) senators to make a firm pledge that …

7/ if the House is held and two Democratic senators added they will vote for a Roe law in January 2023 AND suspend the filibuster rules to guarantee that bill gets an old fashioned up or down majority vote. So far 31 Senate Democrats have said they’ll do that (though not …

8/ yet on the specific date). All but two of the 17 are basically there but still refuse to say it clearly. There are two potential hold outs. Angus King of Maine and Mark Warner of Virginia. They will all certainly fall in line quickly if constituents apply pressure now.

The Kansas vote shows that the anti-abortion Republicans have misjudged how deeply this issue resonates for voters. When a Constitutional right simply disappears, apparently, the voters will turn out.

The polls have consistently shown that the majority of this country is pro-choice. The rejection of the Kansas amendment shows that if the election were to be a referendum on pro-choice, Democrats will win.

The Republicans should be afraid that they have gone too far. Let’s hope this is a bellwether for the midterms.

(Hat tip to long-time blog reader and Kansas resident Monty B. for keeping Wrongo apprised of the Kansas fight to turn back this amendment).

Sunday Cartoon Blogging – July 31, 2022

Q: Why do people take an instant dislike to Justice Samuel A. Alito? A: It saves time.

Alito spoke in Rome dismissing criticism from foreign officials who he said “lambasted” his opinion that overturned Roe v. Wade. Alito spoke at a conference promoting religious liberty, saying:

“I had the honor this term of writing I think the only Supreme Court decision in the history of that institution that has been lambasted by a whole string of foreign leaders who felt perfectly fine commenting on American law…”

Alito called out Prince Harry as making a particularly hurtful comment. What Harry said at the UN:

“This has been a painful year in a painful decade….Climate change wreaking havoc on our planet, with the most vulnerable suffering most of all. The few weaponizing lies and disinformation at the expense of the many. And from a horrific war in Ukraine, to the rolling back of constitutional rights here in the United States, we are witnessing a global assault on democracy and freedom, the cause of Mandela’s life.”

Alito said in response:

“But what really wounded me…was when the Duke of Sussex addressed the United Nations and seemed to compare the decision…with the Russian attack on Ukraine…”

To quote Charlie Pierce: