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Same. Must be temporarily broken, mick.
You're right. Johnson remains a far-right religious zealot. Still at the time, on that issue, Johnson measured up. Credit where credit is due, i always think, no matter how hard it is to feel it. Surely, the fact it's an election year was at least a tiny factor too.
LOL My talent must have been innate. Imagine, after all these years i finally know.
LOL nice thoughts but .. but .. butt .. hot air from her.
Agree, his mind would be on himself, I was thinking he would be picturing himself as Buddha.
I get it that you see even thinking the name would be a stretch for him. It is a hilarious image.
Our leader Albanese not in so many words has labelled Musk an arrogant billionaire 'going to court for the right
of allowing violent content on X.' It's a stoush. Sometime today will connect an article to one i put up earlier .
The Zurich is on this week. Can't see your week off there.
Looks our Diehard site has problems, check out the schedule folder beside
RBC Heritage .. https://fantasygolf.pgatour.com/roster/29064?league=156 ..
there. At least my folder just now only shows Sept-Oct. And is stuck.
RBC too close to call until it's official from Eli here. Except my guys, 'cept Scheffler, ouch, limped home.
LOL Trump would be thinking, Buddha beautiful. Can see the sign on his forehead.
Trump now sees an election on his highway. That's why now he is saying Ukraine is worthy of American aid. Could even be why Johnson shifted. Trump's most vocal admirers still have his ok to oppose. Just days ago Trump was still saying Europe should be giving more, even to the extent of him lying about European countries having large surpluses.
Don't forget Trump's catering to his base by preaching his U.S.A. isolationist line. Back to 2020
Decision
Matter of: Office of Management and Budget—Withholding of Ukraine Security
Assistance
File: B-331564
Date: January 16, 2020
DIGEST
In the summer of 2019, the Office of Management and Budget (OMB) withheld from
obligation funds appropriated to the Department of Defense (DOD) for security
assistance to Ukraine. In order to withhold the funds, OMB issued a series of nine
apportionment schedules with footnotes that made all unobligated balances
unavailable for obligation.
Faithful execution of the law does not permit the President to substitute his own
policy priorities for those that Congress has enacted into law. OMB withheld funds
for a policy reason, which is not permitted under the Impoundment Control Act (ICA).
The withholding was not a programmatic delay. Therefore, we conclude that OMB
violated the ICA.
DECISION
In the summer of 2019, OMB withheld from obligation approximately $214 million
appropriated to DOD for security assistance to Ukraine. See Department of Defense
Appropriations Act, 2019, Pub. L. No. 115-245, div. A, title IX, § 9013, 132 Stat.
2981, 3044–45 (Sept. 28, 2018). OMB withheld amounts by issuing a series of nine
apportionment schedules with footnotes that made all unobligated balances for the
Ukraine Security Assistance Initiative (USAI) unavailable for obligation. See Letter
from General Counsel, OMB, to General Counsel, GAO (Dec. 11, 2019) (OMB
Response), at 1–2. Pursuant to our role under the ICA, we are issuing this decision.
Congressional Budget and Impoundment Control Act of 1974, Pub. L. No. 93-344,
title X, § 1015, 88 Stat. 297, 336 (July 12, 1974), codified at 2 U.S.C. § 686. As
explained below, we conclude that OMB withheld the funds from obligation for an
Page 2 B-331564
unauthorized reason in violation of the ICA.1 See 2 U.S.C. § 684. We also question
actions regarding funds appropriated to the Department of State (State) for security
assistance to Ukraine.
OMB removed the footnote from the apportionment for the USAI funds on
September 12, 2019. OMB Response, at 2. Prior to their expiration, Congress then
rescinded and reappropriated the funds. Continuing Appropriations Act, 2020,
Pub. L. No. 116-59, div. A, § 124(b), 133 Stat. 1093, 1098 (Sept. 27, 2019).
In accordance with our regular practice, we contacted OMB, the Executive Office of
the President, and DOD to seek factual information and their legal views on this
matter. GAO, Procedures and Practices for Legal Decisions and Opinions,
GAO-06-1064SP (Washington, D.C.: Sept. 2006), available at
www.gao.gov/products/GAO-06-1064SP .. http://www.gao.gov/products/GAO-06-1064SP ;
Letter from General Counsel, GAO, to
Acting Director and General Counsel, OMB (Nov. 25, 2019);
Letter from General Counsel, GAO, to Acting Chief of Staff and Counsel to the President, Executive
Office of the President (Nov. 25, 2019); Letter from General Counsel, GAO, to
Secretary of Defense and General Counsel, DOD (Nov. 25, 2019).
OMB provided a written response letter and certain apportionment schedules for
security assistance funding for Ukraine. OMB Response (written letter); OMB
Response, Attachment (apportionment schedule). The Executive Office of the
President responded to our request by referring to the letter we had received from
OMB and providing that the White House did not plan to send a separate response.
Letter from Senior Associate Counsel to the President, Executive Office of the
President, to General Counsel, GAO (Dec. 20, 2019). We have contacted DOD
regarding its response several times. Letter from General Counsel, GAO, to
Secretary of Defense and General Counsel, DOD (Dec. 10, 2019); Telephone
Conversation with Deputy General Counsel for Legislation, DOD (Dec. 12, 2019);
Telephone Conversation with Office of General Counsel Official, DOD (Dec. 19,
2019). Thus far, DOD officials have not provided a response or a timeline for when
we will receive one.
[...]
CONCLUSION
OMB violated the ICA when it withheld DOD’s USAI funds from obligation for policy
reasons. This impoundment of budget authority was not a programmatic delay.
Page 9 B-331564
OMB and State have failed, as of yet, to provide the information we need to fulfill our
duties under the ICA regarding potential impoundments of FMF funds. We will
continue to pursue this matter and will provide our decision to the Congress after we
have received the necessary information.
We consider a reluctance to provide a fulsome response to have constitutional
significance. GAO’s role under the ICA—to provide information and legal analysis to
Congress as it performs oversight of executive activity—is essential to ensuring
respect for and allegiance to Congress’ constitutional power of the purse. All federal
officials and employees take an oath to uphold and protect the Constitution and its
core tenets, including the congressional power of the purse. We trust that State and
OMB will provide the information needed.
Thomas H. Armstrong
General Counsel
https://fm.cnbc.com/applications/cnbc.com/resources/editorialfiles/2020/01/16/OMBDecisionJan16.pdf
LOL Never knew i was cooking such sophisticated, fancy foods. pasta al dente. cool. Thanks. Have a top night.
I've explained before, nothing to work on. No teeth ('cept 3-4 upper left) and no bone to implant in and no ridge like normal heads have for bottom denture to grab on to. That ridge teeth grow out of. A gentle bump is all, no ridge. Nothing to work on. Only thought is since it's been awhile since i got the dentures and have chewed on gums only heaps since, no doubt their shape has changed so a new set of dentures might help a bit. Might. Pretty sure i told you before that a head transplant would be the best route.
Oh no! Looks terrible. I was talking about an AUSTRALIAN pork roll. LOLs. One bought in Sydney, Australia from a Vietnamese shop.
Question; What is the difference between a Banh mi and your pork rolls? They are pals too. I mean the people in the shop.
Now back downstairs, i forgot to take scissors to open the spaghetti pkt.
LOL That hard white stuff and carrot, and the semi-hard cucumber (i have to take all that out 'cuz can't bite on it; take out and gently chew on separately from the end, like a nibbling little rabbit) and the rest in the picture sure all looks damn close to a pork roll. Some put some paste looking stuff like that in the picture on too. That would be the cruncher am guessing whether it's a Banh mi, or not. . Will ask.
Now down to check on spaghetti. Gonna eat soon then go to bed. It sucks so early but the body i do always listen to.
Will check, boss. "banh mi" Pork rolls are popular here with people who have a decent set of teeth, dentures or friggin' not. The Banh mi dee looks an awful lot like a pork roll. That's without going inside .. https://www.google.com/search?client=firefox-b-d&q=+banh+mi .
Have just done a simple hour sitting on a chair weeding and my lungs are fucked. It's ridiculous, it is the best word for it. Being a reformed smoker i don't preach, but once is a while gotta say to anyone listening -
Surely any smoker with an ounce of brain will listen to that sweetie.
Banh Mi Dee .. maybe is a pork roll. Betcha it's close. Banh Mi looks different, will ask.
OT: Rain suspended RBC Heritage Golf resumes in a few hours. Goodie, a real possibility winner on the horizon.
there once was an elephant stuck in a tree
a mouse looked up and said, "lol, look at thee"
the elephant said, "Yikes, don't talk to me!"
the mouse said, "oops sorry, you looked so free!"
We understand why a Trump supporter's worst nightmare is being asked to incorporate
logic, reason and a factual basis into any response they make on a board like this one.
Yep, Should be 'to be used..' , same as the "will get" in, will get the crap squeezed out of him in his Jan 6 criminal trial.
""Supreme court appears divided over obstruction law used to prosecute tRump, jan 6th rioters""
Trump’s Trial Challenge: Being Stripped of Control
"Prosecutors Want to Ask Trump About Attacks on Women
"[...]BREAKING: Prosecutors to deal first MAJOR BLOW to Trump at trial""
The mundanity of the courtroom has all but swallowed Donald Trump, who for decades
has sought to project an image of bigness and a sense of power.
By day’s end on Friday, Donald J. Trump appeared haggard and rumpled. Maansi Srivastava/The New York Times
By Maggie Haberman
April 21, 2024
“Sir, can you please have a seat.”
Donald J. Trump had stood up to leave the Manhattan criminal courtroom as Justice Juan M. Merchan was wrapping up a scheduling discussion on Tuesday.
But the judge had not yet adjourned the court or left the bench. Mr. Trump, the 45th president of the United States and the owner of his own company, is used to setting his own pace. Still, when Justice Merchan admonished him to sit back down, the former president did so without saying a word.
[Insert: Trump in defiant, ill-considered act, gets up. Tromp is admonished, curbs defiance, sits down.]
The moment underscored a central reality for the presumptive Republican presidential nominee. For the next six weeks, a man who values control and tries to shape environments and outcomes to his will is in control of very little.
Everything about the circumstances in which the former president comes to court every day to sit as the defendant in the People v. Donald J. Trump at 100 Centre Street is repellent to him. The trapped-in-amber surroundings that evoke New York City’s more crime-ridden past. The lack of control. The details of a case in which he is accused of falsifying business records to conceal a payoff to a porn star to keep her claims of an affair with him from emerging in the 2016 election.
Mr. Trump in court on Friday. Maansi Srivastava/The New York Times
Of the four criminal cases Mr. Trump is facing, this is the one that is the most acutely personal. And people close to him are blunt when privately discussing his reaction: He looks around each day and cannot believe he has to be there.
The Criminal Trial of Donald Trump in Manhattan
Card 1 of 7 https://www.nytimes.com/2024/04/21/us/politics/trump-trial-analysis.html" rel="nofollow" target="_blank" >,, inside ..
Asked about the former president’s aversion to the case, a campaign spokeswoman, Karoline Leavitt, said that Mr. Trump “proved he will remain defiant” and called the case “political lawfare.”
He is sitting in a decrepit courtroom that, for the second half of last week, was so cold his lead lawyer complained respectfully to the judge about it. Mr. Trump hugged his arms to his chest and told an aide, “It’s freezing.”
For the first few minutes of each day during jury selection, a small pool of still photographers was ushered into Part 59 on the 15th floor of the courthouse. Mr. Trump, obsessed with being seen as strong and being seen generally, prepared for them to rush in front of him by adjusting his suit jacket and contorting his face into a jut-jawed scowl. But, by day’s end on Friday, Mr. Trump appeared haggard and rumpled, his gait off-center, his eyes blank.
The indictment unveiled on Tuesday centers on a hush-money deal with a
porn star, but a related document alleges a broader scheme
to protect Donald J. Trump’s 2016 campaign.
Mr. Trump has often seemed to fade into the background in a light wood-paneled room with harsh flourescent lighting and a perpetual smell of sour, coffee-laced breath wafting throughout.
Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or
political causes. That includes participating in rallies and donating money to a candidate or cause.
Learn more about our process.
Our Jury Coverage
We take the safety of the jurors very seriously. Because this jury’s verdict could have tremendous consequences, we believe readers are entitled to know some details about its makeup. Our coverage has been cautious and in line with the judge’s orders. We are reporting generally on the jurors’ line of work, their personal interests, the area of Manhattan they live in, the social and news media they follow and their opinion of the defendant, if any.
How The Times Is Covering the Trump Hush-Money Trial
April 11, 2024
https://www.nytimes.com/2024/04/11/insider/how-the-new-york-times-is-covering-the-trump-hush-money-trial.html?pgtype=Article&action=click&module=RelatedLinks
His face has been visible to dozens of reporters watching in an overflow room on a large monitor with a closed-circuit camera trained on the defense table. He has whispered to his lawyer and poked him to get his attention, leafed through sheafs of paper and, at least twice, appeared to nod off during the morning session. (His aides have publicly denied he was dozing.) Nodding off is something that happens from time to time to various people in court proceedings, including jurors, but it conveys, for Mr. Trump, the kind of public vulnerability he has rigorously tried to avoid.
Trials are by nature mundane, with strict routines and long periods of inactivity. Mr. Trump has always steered clear of this type of officialism, whether by eschewing strict schedules or anyone else’s practices or structures, from the time he was in his 20s through his time in the Oval Office.
The mundanity of the courtroom has all but swallowed Mr. Trump, who for decades has sought to project an image of bigness, one he rode from a reality-television studio set to the White House.
Mr. Trump’s only political event this week was a stop at a bodega in Manhattan on Tuesday. Anna Watts for The New York Times
When the first panel of 96 prospective jurors was brought into the room last Monday afternoon, Mr. Trump seemed to disappear among them, as they were seated in the jury box and throughout the rows in the well of the court. The judge has made clear that the jurors’ time is his highest priority, even when it comes at the former president’s expense.
Mr. Trump’s communications advisers or aides who provide him with a morale boost have been sitting at a remove. Natalie Harp, a former host on the right-wing OAN news network, who for years has carried a portable printer to supply Mr. Trump with a steady stream of uplifting articles or social media posts about him, is there. But she and others have been in the second row behind the defense table, or several rows back in the courtroom, unable to talk to Mr. Trump during the proceedings.
It is hard to recall any other time when Mr. Trump has had to sit and listen to insults without turning to social media or a news conference to punch back. And it is just as hard to recall any other time he has been forced to be bored for so long.
People close to him are anxious about how he will handle having so little to do as he sits there for weeks on end, with only a handful of days of testimony expected to be significant. It has been decades since he has had to spend so much time in the immediate vicinity of anyone who is not part of his family, his staff or his throng of admirers.
Who Are Key Players in the Trump Manhattan Criminal Trial?
The first criminal trial of former President Donald J. Trump is underway. Take
a closer look at central figures related to the case.
https://www.nytimes.com/interactive/2024/nyregion/trump-manhattan-criminal-trial-witnesses.html
Over the next six weeks or so, Mr. Trump will have to endure more, including listening as prosecutors ask witnesses uncomfortable questions about his personal life in open court. On Tuesday, he’ll face a hearing over whether the judge agrees with prosecutors that he has repeatedly violated the order prohibiting him from publicly criticizing witnesses and others.
Most of the time, Mr. Trump has been forced to sit at the table, unable to use his cellphone, and listen as prosecutors have described him as a criminal, as jurors have been asked their opinions of him. Some of those opinions have been negative, with one potential juror made to read aloud her old social media posts blasting him as a sociopath and an egomaniac. The only times he has smiled have been when prospective jurors have referred to work of his that they have liked.
The highly telegraphed plan was for Mr. Trump to behave as a candidate in spite of the trial, using the entire event as a set piece in his claims of a weaponized judicial system.
But last week, in New York, Mr. Trump’s only political event was a stop at an Upper Manhattan bodega to emphasize crime rates in the borough. The appearance seemed to breathe life into him, but it also felt more like a stop a mayoral candidate would make than a presumptive presidential nominee. Some advisers are conscious of Mr. Trump appearing diminished, and they are pressing for more — and larger — events around the New York area.
Many in Mr. Trump’s broader orbit are pessimistic about the case ending in a hung jury or a mistrial, and they see an outright acquittal as virtually impossible. They are bracing for him to be convicted, not because they cede the legal grounds, but because they think jurors in overwhelmingly Democratic Manhattan will be against the polarizing former president.
But the shared sense among many of his advisers is that the process may damage him as much as a guilty verdict. The process, they believe, is its own punishment.
Maggie Haberman is a senior political correspondent reporting on the 2024 presidential campaign, down ballot races across the country and the investigations into former President Donald J. Trump. More about Maggie Haberman
https://www.nytimes.com/2024/04/21/us/politics/trump-trial-analysis.html
He's been underwater most all his life so submarine grey would be perfect.
Not braggin' for Bragg, he only nudged you to lean away from the conspiracy
crowd even more. than you do now. Proving you stupid would be beyond him.
3. Stress
Excess stress can affect your farts. Stress can make you gulp and swallow more air without intending to do so.4
American Psychological Association. Stress effects on the body.
You might also experience more farting due to the relationship between stress and irritable bowel syndrome (IBS). Stress can contribute to the development of IBS, but research has also found that people with IBS report having more stress.56
You can practice de-stress techniques like mindful meditation and deep breathing, which can keep you from swallowing excess air.
https://www.health.com/condition/digestive-health/what-farts-say-about-your-health
If i were his bowel i'd be irritable 24/7>!%$#*%$@!!!
Yes, noooowww .. it's a lengthy pause..
Good post. Sorry it is so pricey for all Americans using it. Warafin rings a bell. OOi will ask dr. about it. I relate to your cousin's stuff as i knew many mds as a youngster, both as friend and as patient. None both, except an uncle i used to con sometimes by taking any number of deep breaths before going into his surgery for a stethoscope session. Even a slight wheeze and he'd stick me in the hospital. Wasn't bad, enjoyed the nurses. And played chess with a dr.
Correction: My "We used to be on another board in iHub somewhere Most posted on... something like that. Then some power that is decided no... " i've just learned was out-of-date. It did happen as stated, just looks now (perhaps because of the site tech changes)
https://investorshub.advfn.com/boards/most_post.aspx .. we are back on it. At #1 this moment. Haven't wandered iHub's bottom blue for awhile and just clicked on it. We didn't know Tornado Alley was back in the fold.
LOL 157 to 151. Be funny if there was now a post spurt on Trump Media..., at #2 now, to get ahead of us. Pause here, puleeze .. haha
Your "don't give a shit" comment confirms you know the place well.
Well at #4 we obviously are there so i don't know what you mean by your top
"Congrats on the new view/breakout boards status when it happens, if it happens.
I don't see many people coming to your board in the foreseeable future. I know I won't, I'd rather be out Mt biking gardening."
Ok , thanks again for your sagacity. We flow. And ebb. Yep, no doubt your outside stuff is a much better fit for you.
Lime Time, Oh don't worry we know exactly what and where the listed Assts are. Mostly anyhow. One is here every day reading and working, just has many other things to do so doesn't post as much as some others. A very interesting, knowledgeable and genuine no bs guy. Smart. You obviously miss much of what he has.
Knowing we are on the Breakout Boards lists occasionally is no big deal, just a little extra fun thing to know. We used to be on another board in iHub somewhere Most posted on... something like that. Then some power that is decided no non-stock board, or maybe it was no board of our status lol would be on it so we disappeared from it. Being on the Breakout Board feels a consolation prize. haha And it got us you, with all your insight. Super!
You too, sire.
LOLOL I didn't think he was lying, it felt true, but couldn't understand why as had never heard of us being there before. It's good news, LOL, or not. Whatever, it's more fun. Anyway, had to go to google to get that link. Still haven't gotten around to going to the blue below to figure how to get it without shooting into net space. The About Us et al in that bottom blue i mean for any who mightn't get it. Guessing it's in About Us or FAQ or Handbook.
"lmao--- you just made me click on that board which I have never ever had the slightest reason or interest
to ever do in my entire time here.I thought it wasn't possible and he was lying. I'll be dipped in shit."
Breakout Boards. lol Could be a dance.
It is. Food for thought not seen on the menu before.
"This is really interesting, and I think it proves beyond a shadow of a doubt
that shittypants is not only a narcissistic egomaniac but also deranged."
Not that we hear -- here ffing here -- have had a shadow of a doubt about the extent of his malignant narcissism for years, but that doesn't matter. Your video is a beaut. Am halfway, at 8. It also confirms his analysis of himself, that he really hasn't changed much since first grade.
Updated: Lime Time, Thanks. It's time someone as wise and up on all as you had the courage to say what you have
said there. It's really good you have seen it's such a shit place that you will resist visiting again. Thank you.
Update: Oh, forgot to thank you for the news we were on the Breakout Boards list ..
https://investorshub.advfn.com/boards/breakoutboards.aspx . #4, and above Trump
Media at #8. LOL. Cool. Would have never ever imagined we could ever be .. .. there.
As per so many other post on this board, yours reflects knowledge. It reads smart. The gold standard was an accident from it's inception:
A gold standard is a monetary system in which the standard economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the early 1920s, and from the late 1920s to 1932[1][2] as well as from 1944 until 1971 when the United States unilaterally terminated convertibility of the US dollar to gold, effectively ending the Bretton Woods system.[3] Many states nonetheless hold substantial gold reserves.[4][5]
Historically, the silver standard and bimetallism have been more common than the gold standard.[6][7] The shift to an international monetary system based on a gold standard reflected accident, network externalities, and path dependence.[6] Great Britain accidentally adopted a de facto gold standard in 1717 when Sir Isaac Newton, then-master of the Royal Mint, set the exchange rate of silver to gold too low, thus causing silver coins to go out of circulation.[8] As Great Britain became the world's leading financial and commercial power in the 19th century, other states increasingly adopted Britain's monetary system.[8]
The gold standard was largely abandoned during the Great Depression before being re-instated in a limited form as part of the post-World War II Bretton Woods system. The gold standard was abandoned due to its propensity for volatility, as well as the constraints it imposed on governments: by retaining a fixed exchange rate, governments were hamstrung in engaging in expansionary policies to, for example, reduce unemployment during economic recessions.[9][10]
According to a survey of 39 economists, the vast majority (93 percent) agreed that a return to the gold standard would not improve price-stability and employment outcomes,[11] and two-thirds of economic historians reject the idea that the gold standard "was effective in stabilizing prices and moderating business-cycle fluctuations during the nineteenth century."[12] The consensus view among economists is that the gold standard helped prolong and deepen the Great Depression.[13][14] Historically, banking crises were more common during periods under the gold standard while currency crises were less common.[2] According to economist Michael D. Bordo, the gold standard has three benefits that made its use popular during certain historical periods: "its record as a stable nominal anchor; its automaticity; and its role as a credible commitment mechanism."[15] The gold standard is supported by many followers of the Austrian School, free-market libertarians, and some supply-siders.[16]
https://en.wikipedia.org/wiki/Gold_standard
See again, from May 2011 -- chloebware .. Gold At $14,172 An Ounce?
Brian Bloom .. 15 November 2008
There are those who have been arguing vociferously for some years now that the world will be better off under a gold standard.
These people may or may not be correct, but we need to understand the implications of what a gold standard will bring with it. .. continued ..
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=34774397
And it's a poor tradesman who leaves a mess.
"It's a poor craftsman who blames his own creations. 🤨"
Yep. Jeff knows.
Updated: Reading that post of yours was a real tonic for this guy. Yesterday afternoon just before 6:00 pm i went out to get bread. A few days ago, the last time, i got the bread then into the pub where $10 turned into $100+. I told you. Yesterday, with the bread snugly in my old green bag (with a tiny sugared doughnut the young lady tossed in as a treat -- i said, lol, i'm supposed to give you a tip, not the other way 'round. We don't tip here like you do, but she understood and laughed - Vietnamese they are, with sketchy English but they know how to laugh) i looked at the pub, and thought haha no way you're gonna get me today. LOLs Your post there with your zoo news made me feel just as good. The feeling i'm talking about you know well. Simple good, healthy--in-control-quietly understanding. The kind of feelings that keep depression at bay. Yessireeeeee. Loved your post with your zoo news.
This from the list you gave me is labelled "Unsure". I say it works for Balance - too. Thanks heaps.
OT: Shucks, last day of the RBC Heritage golf has been suspended ..
https://www.usatoday.com/story/sports/golf/2024/04/21/pga-tour-2024-rbc-heritage-leaderboard-weather/73406198007/ .
Right. All up-to-date now. Sweet.
livefree_ordie, Since the system is basically the one used in every country in the world i suggest that's the case because it's basically the one that basically works best. But what would i know. I know not much compared to guys like you who know what's best so much better than experts in every country in our world know.
We all agree the tax system in the US could be much fairer, more like it is in some other countries, but your umm solutions are sorta Ron Paulish-way- out- there, not agreed by many experts on both the left and the right of the political spectrum, eh.
Your therapist, your zoo people, all the children who love you, your latest lady and your zoo animals all appreciate you. Your therapist thinks you're nuts, lol, that's a good recommendation if i've ever heard one. You will be there to help many long after i'm gone and i'm planning on 10 years plus, barring foreseen, of course. No doubt in my mind. One secret is not to want too much. Look what happened to Trump. He's just one of so many who was never satisfied. Had to be, 'the man!.' Take it from me, it's much more satisfying to be just an ordinary, decent guy. You're good, mate. Oh, and your other friends too.
Howard Dean: ‘At last, Congress proposes drug pricing reform that works’
I can't find anything to help me with your comment. An article would have helped.
And i don't know if this is related, it could suggest Dean agrees with Biden's efforts.
Fortune· Tom Williams - CQ-Roll Call, Inc - Getty Images
Howard Dean
Wed, Sep 20, 20234 min read
When I worked as a family physician in Vermont, I wrote countless prescriptions to help patients manage their health. If I were still practicing, I'd undoubtedly be worried sick about my patients' ability to pay for their medicines. Too often, patients today fail to fill scripts because of high out-of-pocket costs.
Lawmakers have worked hard to expand access to medicines over the years, most recently in last year's Inflation Reduction Act. However, price-based access problems remain. One big reason is the predatory practices of middlemen in the drug supply chain–pharmacy benefit managers (PBMs). It's high time for our lawmakers to bring their profiteering to heel.
In theory, PBMs negotiate rebates and manage prescription drug benefits for insurers, securing the lowest possible prices from drug manufacturers, which is supposed to make medications more accessible and affordable.
In reality, PBMs have crafted a system that leads to higher drug prices because their revenues are based in part on a drug's list price. Drug companies raise sticker prices in the knowledge that they will also be offering large discounts. Because of the link between list prices and PBM compensation, PBMs tend to favor higher-priced drugs with bigger discounts when selecting which drugs get preferential treatment on insurer formularies.
That's fine with insurers, for two reasons. First, PBMs and insurers are one and the same. The three biggest insurance companies either own or are owned by PBMs, and they control 80% of the market. It's an oligopoly.
Second, insurers collect co-insurance from their customers based on list prices, not the actual prices PBMs negotiate. Thus, insurance companies similarly have a positive incentive to keep list prices high. Since there are no federal rules in place to require discounts from list prices to be passed on directly to the patients taking the medication, so they aren't.
It gets worse still. Many drug makers offer patients assistance with their co-insurance through coupons for the medication they produce. Outrageously, PBMs/insurers don't have to count those coupons toward the patient's deductible or out-of-pocket cap. They can claw patient savings right back that way.
The unscrupulous practices don't end there. In an effort to pad their bottom lines, insurers and PBMs increasingly employ "utilization management" strategies that make it more difficult for patients to access the medicines their doctors prescribe.
Many insurers require doctors to obtain "prior authorization" before they agree to cover certain medicines and procedures. Another technique is known as "step therapy," in which insurers refuse to pay for certain medications until a patient has tried lower-priced alternatives.
As a doctor, a policymaker, and a human being, I find all this not just unethical, but also appalling. I've listened to the pain in the voices of patients who have to skip doses or abandon treatment altogether because of these harmful practices.
Non-adherence to treatments takes a tragic toll–one that has been well-studied by researchers, who estimate non-adherence accounts for roughly $495 billion in additional medical spending every year–and causes more than 275,000 premature deaths.
In other words, the problem of unaffordable drugs isn't abstract–it has a body count.
PBM abuse is so bad it has managed to bring Democrats and Republicans together in support of a reform bill in the Senate called the Patients Before Middlemen Act. It would delink PBM fees from drug prices, striking directly at the heart of the matter.
This reform would force PBMs to finally compete to negotiate genuine savings, not just shuffle rents around and exploit loopholes. It is easy to implement and requires no new bureaucracies or complicated rate-setting schemes.
We have evidence that PBM reform can work to meaningfully bring down costs. Following a report showing cost overruns by PBMs in the Ohio Medicaid program, the state enacted legislation requiring PBMs to pass along 100% of rebates and discounts to health plans–delinking PBM revenue from discounting. Per an analysis by the state, these reforms saved taxpayers $128 million in 2022 and are projected to save $184.4 million in 2023.
Alarmed by escalating prescription costs, West Virginia also took on PBMs. In 2017, state officials broke up consolidated PBM functions, assigning key tasks like claims processing to specialized vendors. According to the West Virginia Department of Health and Human Resources, the PBM carve-out generated savings of $54.4 million per year by 2018.
The Senate legislation provides a solid federal foundation for further state reform initiatives. As a doctor, I know this policy's tremendous life-saving potential, and as a former governor, I know how leadership in Washington can spur more state reform. This bill achieves both.
Howard Dean is the former chair of the Democratic National Committee and former Governor of Vermont.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
This story was originally featured on Fortune.com
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