Vaccine compliance must be supported with regulatory enforcement

Australia recently instituted rebates for general practitioners who provide counseling about Covid-19 vaccines.  

Patients' medical appointments reimbursement from insurers, including Medicare and Medicaid, must include a question about how the provider counseled the patient about vaccines!

Echo opinion essay published in The New York Times: Doctors and Nurses Are the Key to the Final Vaccine Push by By Saad B. Omer, the director of the Yale Institute for Global Health.

Maine Center for Disease Control (Maine CDC) Director Dr. Nirav Shah, M.D.

America was in the midst of a summer of celebration, with cases and deaths from the coronavirus on the decline. Although the collective relief was well deserved, parts of America remained vulnerable to outbreaks because of spotty vaccination rates, between states and even counties.

Any risk of future surges and loss of life is almost entirely preventable, given the availability of vaccines. 

And yet there’s reason to believe that the plateauing vaccinations will cause the nation to fall short of President Biden’s target of 70 percent coverage before July 4 among eligible Americans. 

That’s despite the fact that an overwhelming majority of COVID-19 deaths are among the unvaccinated.

So, what happens now? There’s no reason the United States should settle for patchwork vaccination rates and easily preventable death. There are ways to overcome low vaccine demand. It starts with doctors and nurses.

Twenty years of research on how to persuade people to get vaccinated shows that health care providers are the most trusted source of vaccine information, even among vaccine refusers. 

In fact, the nation’s doctors and nurses must talk to patients about Covid-19 vaccines at every opportunity.

This may seem obvious, and yet very few providers have been trained in the most effective approaches for talking to people about vaccines.

For example, doctors and nurses may assume they need to offer patients more information about the vaccines in order to persuade them. But, research shows that often a lack of knowledge is not the main problem. Many people refuse vaccines because of their worldview, values or mistrust of the health system. 

While people on the fence about vaccinations may need more information to help make up their mind, at this stage, there’s actually information overload.

Strategies like framing vaccination as the default choice — “It’s time for you to get vaccinated,” versus, “Maybe you should think about receiving the Covid vaccine” — can be effective. It doesn’t take away someone’s autonomy, but still serves as a verbal nudge toward vaccination.

But how can the nation ensure that its doctors use these approaches? There needs to be a continuing medical education program — a tool used by physicians to keep their skills and knowledge of medicine up-to-date and to maintain their license — to train them in effective vaccine communication techniques. Yale started such a program.

Another way to ensure that health care providers spend sufficient time on sometimes challenging conversations about vaccines is to make vaccine counseling reimbursable.

Right now, providers are compensated if they vaccinate their patient; they don’t get reimbursed if the patient ends up refusing the vaccine.

But doctors don’t always know if their conversations with patients persuaded them to be vaccinated or not. They should be compensated for having the conversation in the first place. Many other countries do so. For example, Australia recently instituted rebates for general practitioners who provide counseling on Covid-19 vaccines.

Persuading people to get vaccinated often requires multiple discussions. Ideally, as part of any appointment, physicians will urge unvaccinated patients to get the Covid-19 vaccine, and talk through any concerns. If the physician does so for more than a few minutes (e.g., more than three minutes, similar to the threshold for reimbursing physicians for smoking cessation counseling), the doctor can seek reimbursement. Physicians should be able to bill for multiple counseling sessions with the same patient up to a reasonable limit of three times per year.

Other continuing efforts, such as increasing vaccine access and making the vaccination process simple, remain important. To this day, there are many people who are concerned about the cost of the vaccines even though they are free. Vaccination sites should stop asking for insurance information.

The most effective vaccine message is one that comes from a trusted source and not only leads the listeners to get vaccinated but also motivates them to encourage others around them to do so as well. This is what we need, as people become complacent with the benefits of others getting vaccinated. 

Health care providers hold this sway, and all health workers need to push toward higher vaccination rates together.

Saad B. Omer (@SaadOmer3) is the director of the Yale Institute for Global Health and a professor of internal medicine and epidemiology at the Yale School of Medicine and the Yale School of Public Health.

Unpopular Senator Ted Cruz has four reasons to be unqualified

...."stupid"...."evil"...."crazy"....and "evasive"...in a report by Jonathann Chait.

Ted Cruz experienced candidate fatague when he rambled about "rubbers' as proof that Repubicans don't prevent access to "birth control". Certainly, it was a bad campaign moment, to say the least. In fact, Cruz advocates for "rubbers for all". 

Senator Ted Cruz is likely the reason why Tumpenstine (Mel Brooks says "steen") is leading in the popularity Republcian presidential polls. 

Although  Senator Ted Cruz, the Republican of Texas, is ambitious, he's also unpopular.  People don't like him. Therefore, when Republican voters look for an alternative to "Donald Trump-the-Chump", they see Senator Ted "Cruz.to loose".  Oooooops! Therefore, they clearly prefer "Trumpenstine" to "Cruz to loose".

New York News reports how Senator Cruz is unpopular.

You’d Think Being Crazy and Unpopular Would at Least Free Ted Cruz to Speak Honestly, But No  By Jonathan Chait

“Historically the media's had two caricatures for Republicans — that we are either stupid or evil,” Senator Ted Cruz told John Harwood in a fascinating interview. “They've to some extent invented a third caricature for me, which is crazy.” 

Cruz’s interview seemed dedicated to the proposition that attempting to shove him in just one of the categories of stupid, evil, or crazy is a false choice. You can be all of those things! There’s also a fourth category: evasive. Cruz displays this quality in droves.

Cruz’s dishonesty comes through especially clearly in three portions of the interview. One comes when Harwood brings up reports of his snobbery as a young Ivy League student (a quality that is damaging in the realm of electoral politics, and especially in the modern, populist Republican Party). 

Here’s the exchange:

Harwood: I read an anecdote that said you asked a friend at Harvard Law School her IQ, and then when she didn't know her IQ, asked her SAT score. What was that about?

Cruz: That was a silly story that appeared in a magazine. I have no recollection of ever having had any such conversation. So, I can't respond.

Harwood: And the idea that you wouldn't study with anybody who didn't go to Harvard, Yale, and Princeton?

Cruz: Now that's just a complete lie. It's actually the same magazine, which was one of the more noxious hatchet jobs.

(Oh paaaleeeze Senator Cruz, you can do better than go into denial. You could've said something intelligent like "I studied with smart people and they also studied with me..." or used more enlighted words than saying "noxius hatchet job" - what does that mean?)

There are a couple of dimensions to this dispute. One is that the original report about Cruz refusing to study with anybody who didn’t attend Harvard, Yale, or Princeton was incorrectly phrased. Cruz expressed reluctance to study with any non-graduate of any school whose selectivity fell below his (hilariously self-serving) cutoff line, but ultimately submitted.

Now, that anecdote, along with the story about him asking about a fellow student’s IQ, pits his word against theirs. Cruz denies the reports, and there’s no proof. But his attempt to discredit the reports is clearly wrong. Cruz claims “the same magazine” reported both stories. That’s false. The report about Cruz’s study group came from Jason Zengerle in GQ and was confirmed by Josh Marshall. The IQ story was reported by Matt Viser of the Boston Globe. The possibility that all of these sources are lying seems remote, and Cruz’s factually incorrect attempt to discredit them as all coming from the same source does not inspire confidence.

Harwood also asks Cruz about the monetary and fiscal response to the financial crisis:

Harwood: When historians write 30 years from now, when your kids are grown, your political career might be over by then, when they write that government in the form of George W. Bush, Ben Bernanke, and Barack Obama saved the U.S. and the world from depression, you say what?

​​Cruz: ​I don't think anyone's gonna write that. And— and in fact, if we don't stop the path we're on—

​​Harwood: They're saying it right now. (Hello???? Senator Cruz is stupidly naive to say "I don't think anyone's gonna write that...")

​​Cruz: Well, yes. But— but— but they're the same liberal academics whose Keynesian answer to everything is, "More and more spending— " and, you know, what was really funny, you watch, for example, the stimulus, you know. $900 billion in spending.

So you have Cruz rapidly retreat from his claim that historians will never vindicate the response to the crisis to him conceding that this is already happening. (“Well, yes.”) But then Cruz insists it’s nothing but “liberal academics” who believe “more spending” is the “answer to everything.”

Actually, there is an extremely broad consensus among economists that fiscal and monetary stimulus is the answer, not to everything, but to the specific conditions of the crisis. Economists overwhelmingly believe fiscal stimulus increased economic growth:

Cruz may think economists are just “liberal academics,” but plenty of conservative academic economists share this theory, too (that fiscal stimulus increased economic growth). 

Nor is the consensus limited to academic economists — if anything, the private macroeconomic forecasting field accepts this theory with even more unanimity.

Finally, and most fascinating, is Harwood’s attempts to draw out Cruz’s beliefs about the proper size of the welfare state. The conservative movement has dogmatically and often hysterically opposed every expansion of social benefits in American history, from Social Security through Obamacare. And yet, once in place, those programs have proven too popular for Republicans to uproot.

Harwood asked Cruz about Medicare Part D, an expansion of the welfare state bitterly opposed by conservatives and which subsequently became the primary evidence for their case that George W. Bush abandoned conservative principles:

Harwood: Was [President George W. Bush] right to expand Medicare to cover prescription drugs?

Cruz: ​You know— that was a policy fight I was not engaged in at the time. I had other issues on— on my plate. I'll tell you what wasn't right. When George W. Bush entered office, the national debt was $5 trillion. When he left, it was $10 trillion. That wasn't right.

And, now, Obama has taken that and— and made it much worse. He's taken it from $10 trillion to over $18 trillion. But I respect George W. Bush a great deal. I spent a number of years of my life working for him. I think he is an honorable man. I think he did what he believed was right. But I think domestically, his administration spent far too much money.

Harwood: But specifically on Medicare, was that a mistake? 'Cause that was not financed. That added to the—

Cruz: As I said—

​​Harwood: ​—deficit.

​​Cruz: —I was not engaged in that particular detail—

​​Harwood: ​Sure. No. But—

Cruz: ​—of that legislation.

Harwood: —your judgment of it looking back?

Cruz: My judgment of it as part of the broader element that the deficit— or the debt, rather, went from $5 trillion to $10 trillion. And— and listen, the simple reality, having— having spent a year and a half on the Bush campaign, all right, George W. Bush did not campaign as a small government conservative. ​In— in that sense, he was quite candid about it. He campaigned under the banner of compassionate conservatism. And it was also a different time, you know. When— when he came into office, they were predicting surpluses for years to come. And, so, you know, there was an interesting dynamic on the Bush campaign where periodically, the senior leadership would ask the more junior folks, "Can you come up with specific— programs for us to cut?"

And a number of us would suggest different programs. And inevitably, when they'd get suggested, the response would be, "Well— well, gosh, if we cut this program, this constituency is gonna be unhappy." And I— I remember kind of laughing and thinking, well, you know what? Whenever you're cutting something, the person getting the money is always going to be unhappy.

Harwood kepg asking Cruz if it was a good idea to create a Medicare prescription drug benefit, and Cruz kepg refusing to answer. First Cruz insists “that was a policy fight I was not engaged in at the time,” which, of course, isn't a reason to avoid having an opinion on it and which doesn't stop him from opining on other issues. Then, he changed the subject to the deficit in general. Harwood asked again about Medicare Part D, and Cruz again replied that he was “not engaged” on the issue. 

Then Harwood asked, again, and Cruz replied, “My judgment of it as part of the broader element that the deficit— or the debt, rather, went from $5 trillion to $10 trillion,” which is not a sentence and lacks any coherent meaning. And then, incredibly, Cruz proceeded to boast about how he, as a member of the Bush campaign, proposes all sorts of tough spending cuts, only to be vetoed by moderates — directly after refusing to say what he thought of the biggest domestic spending increase Bush enacted.

Harwood immediately proceeded to ask Cruz about the original Medicare program, which conservatives such as Ronald Reagan denounced as a socialist monstrosity.

Harwood: Now, a third Texas president, L.B.J., created Medicare in the mid-'60s. Your hero, Ronald Reagan, campaigned vigorously against that, saying it would lead to socialized medicine, it would end liberty in the United States. Who was right, L.B.J. or Reagan?

​​Cruz: ​You know, at the end of the day— it's not worth tilting at windmills. And we are at a different point in time than we were in the 1960s. Today, Medicare is a fundamental bulwark of our society.  And there is an entire generation of s—

Harwood: ​So, the philosophical objection just goes out the window?

Cruz: ​At the— I'm— I'm a big believer at focusing on battles that matter and that are winnable. And there is a broad, universal consensus that Medicare is a fundamental bulwark of our society that's fundamentally different. Look, it's one thing to have asked 50 years ago should we have created it. It's another thing when you have a generation of seniors who paid into it 30, 40, 50 years who have been made promises. We need to honor those promises—

Harwood: Fair enough. But—

​​Cruz: ​—and— and— and—

​​Harwood: ​—do you think at the time Reagan as right?

​​Cruz: You know, I don't know. I wasn't alive then. What I do know is that today, we have got to preserve and reform Medicare. But, Cruz dodged the question again; this time he retreated to a defense that he “wasn’t alive,” a fact that hasn't prevented him from expressing strong opinions on other historical controversies. (I would really like to see Cruz use the fact that he wasn’t contemporaneously alive to avoid taking a stand on the 1938 Munich Agreement - ie, the settlement permitting Nazi Germany's annexation of portions of Czechoslovakia.) Obviously, there’s a reason why Cruz avoided stating his opinion on this question; he refused to even endorse the opinions of the sainted conservative President Ronald Reagan.  As Cruz warned about Obamacare, President Obama’s “strategy is to get as many Americans as possible hooked on the subsidies, addicted to the sugar. If we get to Jan. 1, this thing is here forever.” That is, once people see how the program works, they will like it and punish any politician who threatens to disrupt their benefits. Just as Cruz today refuses to own up to the contemporaneous conservative position on Medicare and Medicare Part D, future Ted Cruzes will one day dodge and weave about their intent to destroy Obamacare.

Clearly, Cruz isn't qualified to be president. As a presidential candidate who can't answer questions and, also, an unpopular person, he isn't likely to upstage Donald Trump in his quest to be the 2016 Republican Presidential nominee.

Obviously, the Republican party has a leadership crises and it may be so severere as to destroy our nation's two party political system.

Well, "what goes around comes around".  "you reap what you sow".  "watch who your friends are", "birds of a feather flock together"....all of our mother's proverbs are appropriate. The GOP is now, officially, a do nothing extremist party and their political leaers are totally unqualified to be leaders of the free world.

Hillary Clinton is highly qualified and must be elected to become America's first woman president of the United States.