Map of life expectancy at birth from Global Education Project.

Monday, June 26, 2017

Where I'm at

I'm in New Orleans for the Academy Health Annual Research Meeting. Academy Health is the weirdly named health services research society. I had a poster presentation this morning, now I'm just going to be hanging out and listening to people, mostly.

If anything exciting comes up I'll let you know. But for now I'll just say that health services research is especially wonky and boring and weird in this country because of our irrational, fragmented, wasteful, incoherent health care system. We have such an inefficient and ineffective system because of freedom, unlike those totalitarian dungeons in Europe where they spend half as much, get better results, and cover everybody. But that's slavery, which we won't allow to happen here.

Thursday, June 22, 2017

Is a fourth grade education a requirement to be a reporter?

Apparently not. An Ecuadorian couple claimed that they live without food or water, from the "universe's energy." Numerous newspapers and highly recognized web outlets published this as unquestioned fact, including Yahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro and many others. (This story appears on CNN, so admittedly there's a bit of a pot and kettle thing going on here.)

The excuse is that it was too hard to go to Ecuador to fact check. This is a really wicked problem. Many people do not believe the news in the corporate media, which means for example that they do not believe that Russia interfered in the recent U.S. election. It is hard to explain why they should believe that and not believe this. I knew that the Bush administration's claims about "weapons of mass destruction™" in Iraq were bullshit, and I argued for that extensively on this very blog; but the New York Times was enthusiastically promoting it.

So no, you can't believe everything you read in the paper or see on TV, but you need to apply critical thinking. Not everybody is good at that, unfortunately, and once they have built up a coherent alternative reality it is very, very hard to extract them from it. In order to have a  workable consensual reality, we need a smart, knowledgeable press corps with critical thinking skills that we can depend on. We do not have that. 

The result may well be catastrophe for human civilization.
ahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro - See more at:
Yahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro - See more at:
Yahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro - See more at:
the universe's energy

Tuesday, June 20, 2017

Weather Report

Here's the current forecast for Phoenix. This is pretty much applicable to the entire southwest.

Patchy blowing dust after 5pm. Mostly sunny and hot, with a high near 120. East southeast wind around 5 mph becoming calm.
Patchy blowing dust before 8pm. Mostly clear, with a low around 93. Breezy, with a northeast wind 5 to 15 mph becoming southeast in the evening. Winds could gust as high as 20 mph.
Sunny and hot, with a high near 116. East wind 5 to 10 mph becoming west in the afternoon.
Wednesday Night
Mostly clear, with a low around 89. Breezy, with a west wind 10 to 15 mph becoming light and variable after midnight.
Sunny and hot, with a high near 114. Breezy, with a southeast wind 5 to 10 mph becoming west 10 to 15 mph in the afternoon. Winds could gust as high as 20 mph.
Thursday Night
Mostly clear, with a low around 87. Breezy, with a west wind 10 to 15 mph becoming southeast 5 to 10 mph after midnight. Winds could gust as high as 20 mph.
Sunny and hot, with a high near 113. South southeast wind 5 to 10 mph becoming west in the afternoon.
Friday Night
Mostly clear, with a low around 88. West wind 5 to 10 mph becoming east southeast after midnight.
Sunny and hot, with a high near 115. Light and variable wind becoming west 5 to 10 mph in the afternoon.
Saturday Night
Mostly clear, with a low around 89. West wind 5 to 10 mph becoming southeast after midnight.
Sunny and hot, with a high near 114. Southeast wind 5 to 10 mph becoming west southwest in the afternoon.
Sunday Night
Mostly clear, with a low around 89. West wind 5 to 10 mph becoming southeast after midnight.
Mostly sunny and hot, with a high near 112. Southeast wind 5 to 10 mph becoming west southwest in the afternoon. 
The region would be uninhabitable without air conditioning. And it's just going to get worse.  Note those overnight lows barely dipping below 90. With the jet stream getting loopier, these sorts of blocking patterns will become more frequent. It's here folks. It's for real.

Friday, June 16, 2017

Breathing is Fundamental

The new BMJ has a lot to say about air pollution, starting with this editorial. Everything they say about the UK applies to the US, if not more so. Nowadays the most important source of exposure to polluted air in the industrialized countries is motor vehicle exhaust. Two components, ultrafine particles and oxides of nitrogen, cause the most damage to human health. Ultrafine particles are less than 2.5 microns in diameter -- microscopic, invisible, and odorless. They are in highest concentration near highways, which also happens to be where the nearby residents are likely to be low income people. A favorite place to site low income housing is next to highways.

As the BMJ editorial says, air pollution is the world's fourth leading cause of death. We had mass hysteria over the Ebola outbreak that killed fewer than 12,000 people in West Africa and precisely nobody in the United States; while almost nobody seems to care about air pollution to which about 40,000 annual deaths are attributable in the UK and something like 200,000 in the U.S. Now, this is a little bit misleading in that everybody dies. Attributing these deaths to air pollution means that they are accelerated, the person dies earlier than they would have if they hadn't been exposed. So the years of life lost is not as great as, say, motor vehicle crashes that affect many young people. Still, it's a way of looking at the problem that gives us a sense of its magnitude.

There is also disability associated with air pollution and it has deleterious effects on fetuses and children's development. As the linked essays states, "Although we are familiar with the effects of summer and winter pollution episodes on asthma, pneumonia in older people, strokes, and heart attacks, the wider effects of air pollution are less known. Chronic exposure impairs lung growth of the fetus and throughout childhood, increasing the risk of developing asthma and contributing to impaired cognition, type 2 diabetes, various cancers, and skin ageing and even serving as a risk factor for obesity."

Since the same exhaust pipes and smokestacks that spew out these toxins also spew CO2, which is changing the climate and destroying the oceans, we probably ought to do something about it. Instead, we are now furiously "de-regulating," because the Koch brothers want to continue to murder you for profit and the president works for them. 

Wednesday, June 14, 2017

Democracy in Action

This is actually quite bizarre. Mitch McConnell isn't just concealing the specifics of the Senate health care bill from the public and from Democrats; he's concealing it from his own members:

While there have been thrice-weekly meetings on the legislation to repeal and replace the 2010 health care law, those have mostly focused on broad policy. And while complete legislative text has not yet been drafted, leadership has begun initial conversations with the nonpartisan Congressional Budget Office on several proposals. But GOP senators say they do not know what those are. "While I haven't seen the language, I am hoping that it stays within the confines of what we've discussed within the caucus," Sen. Joni Ernst of Iowa told Roll Call.
Evidently they're committed to voting for it anyway, because they don't actually care what it does. Well, if it's anything like the House bill, one thing it will do is cause sick old people in nursing homes to be tossed out into the snow to die. The state of public discourse in this country is so debased that most voters literally do not know that the bulk of Medicaid spending goes to disabled and elderly people, and particularly for long-term care. And they have to spend all their money first and become destitute before it kicks in. This applies to lots of formerly middle class people whose savings don't outlast the ravages of age.

By the way, I am arguing public policy here. If you happen to notice an implication that conservatives are horrible people, that occurred to you on your own, I didn't say it.

Monday, June 05, 2017

Intelligence test

Republican congress returns to DC with repeal of the Affordable Care Act still on their agenda. They may not get it done, we'll see. Below please see a representation of the key accomplishment of the ACA. Can you spot the supersecret mysterious reason why Republicans don't like it?

Sunday, June 04, 2017

The Greatest Story Ever Told

The Energy Expansions of Evolution, by Olivia P. Judson, in Nature Ecology.

Do read it -- you'll enjoy it and you'll learn something. Then read my commentary.

This is the story, in part, of how Gaia got her cloak of green; and subsequent major developments. It also helps us to think about the so-called Fermi paradox -- why don't we see any evidence of extraterrestrial technological civilizations, when there's no particular reason to think we're unique or special? Finally, it's just a story of awesome grandeur that should make us focus very, very hard on overcoming the present crisis facing humanity. We are incredibly lucky to find ourselves on such an unlikely planet, let's not kick it away.

Life is believed to have appeared on earth some time before 3.7 billion years ago. But for a long time, it didn't amount to much. Extraterrestrial visitors to our we rock likely wouldn't even have noticed the microscopic  self-replicating polymers encased in oily bubbles, that were probably found only near deep-sea geothermal vents and possibly some other isolated locations. Our old idea of life originating in shallow, sun-lit tidal pools is probably wrong, because the earliest life couldn't exploit sunlight as an energy source. The sun warmed the rock and water, which radiated the heat back into space. In between, it didn't do anything.

About 3.7 billion years ago, organisms emerged that could exploit the energy of sunlight. But they didn't split CO2 and water to make hydrocarbons and emit oxygen. The early forms of photosynthesis were less efficient and required access to existing organic carbon. So one-celled organisms became more numerous, but no major transformation resulted. (They probably emitted methane, which helped warm the planet.)

Then, about 2.4 billion years ago, oxygen began to build up in the earth's atmosphere. This was because a group of organisms called cyanobacteria had evolved oxygenic photosynthesis. Actually they had  evolved a few hundred million years earlier; it took a while for the oxygen build up to get going. But cyanobacteria could now inhabit a far wider array of niches and create far greater biomass. A consequence was that it was now possible for other organisms to make a living just by eating others, but another unlikely event had to occur before that became a major industry.

Then an unlikely event occurred. An organism called an archaeon acquired a bacterium as an endosymbiont. The bacterium was very efficient at converting oxygen and nutrients into ATP, the cellular fuel. The resulting organism, called a eukaryotic cell, could grow big and complex, and they started making a living by engulfing and digesting smaller cells. Then, one of them acquired as a second endosymbiont a cyanobacterium, and the plant cell was born.

Because of the way they reproduce, eukaryotes could form complex multicellular organisms. We started to see big things that could move around and seek food. They even started eating each other. This happened around 575 million years ago. As Judson tells us:

[W]ith animals would soon come a powerful new force of nature: the acquisition of energy through the active hunting and eating of other life forms, especially, other animals. This would produce a radical shift that, within a mere 40 million years, transformed the Earth. Before this epoch, ecosystems were microbial. The advent of widespread flesh-eating launched the Phanerozoic, triggering an enormous increase in organism size85, a new tempo of macroevolutionary change86,87, new kinds of ecosystems86,​87,​88, and an increased impact of life on the fabric of the planet87.
The collective term for these critters is metazoa. A million years ago or so, one of the metazoans started to deliberately set fires in order to cook its food and perhaps ward off predators. Then it started to use fire to extract metals from ores, and shape them into highly effective tools. Then it discovered abundant fuel in the ground that could be used to power machinery -- you know the rest.

If you really think about it, this chain of events seems quite unlikely. Maybe it isn't really and it would happen sooner or later on any properly situated planet. Who really knows? But we shouldn't be surprised if it is very rare in the universe. We really need to start appreciating it.

Thursday, June 01, 2017

Bad Science

This is not really news -- there have been less rigorous critiques before -- but this research letter in NEJM has gotten people's attention. In 1980, Jane Porter and Hershel Jick of Boston University published a one paragraph letter in the Journal. They said they had reviewed the medical records of 11,882 hospitalized patients who received opioids, and found evidence of addiction in the files of only four of them.

Note that these are hospitalized people who presumably receive only a short-term course of opioids; and that there is no reason to think that subsequent addiction or opioid use disorder would wind up in the records of that particular hospital, where most of the people will very likely not be seen again once they make their way into the world.

Nevertheless, this single letter to the editor -- not peer reviewed, not even really research -- was cited 608 times. Most of the citations were used to support the proposition that prescribing opioids for chronic, long-term pain, was not dangerous. More than 80% of the citations did not even say that the patients were hospitalized. The authors of the new letter give some examples, e.g. "The medical evidence overwhelmingly indicates that properly administered opioid therapy rarely if ever results in 'accidental addiction' or 'opioid abuse.'" This assertion is based on the single citation of the 1980 letter.

What they don't tell us is that this all happened in the context of heavy promotion of the long-acting opioid OxyContin by Purdue Pharmaceuticals, which was spending lots of money to promulgate these claims. They turned out to be false, and the result is the epidemic we face today.

So yes, science can be corrupted, by money as in this case, and in other ways. I spend a lot of time on this blog complaining about it. The good news is that the truth comes out in the end, but sometimes it takes too long. I should also make it clear that some scientific findings are simply not in doubt. Climate science is not corrupted by money -- on the contrary, the big money has been trying to corrupt it, and failing, for decades. So don't draw the wrong conclusions. But we need to keep our critical thinking faculties sharp.

Update:  I should have noted that the state of Ohio is suing Purdue and four other drug companies for causing the opioid epidemic.

Tuesday, May 30, 2017

The Merchants of Death

It's been a while since I've written about tobacco, but the UN has provided a good occasion with the release of a new report on the eve of No Tobacco Day, which is tomorrow.

Smoking has been in long-term decline in the U.S., although tobacco addiction continues to afflict 15% of the adult population. So the psychopaths who get rich by murdering people have concentrated their efforts abroad -- specifically, they target poor and low-income people in low income countries.

The UN reports that tobacco now kills 7 million people every year. (It killed my father and my grandfather, by the way. In my father's case, starting with a stroke that put him on a decade-long course of dementia and decline.) To quote the press release, that's just for starters:

Tobacco use causes serious disability and significantly increases the risk of a number of additional diseases not immediately linked to it such as tuberculosis.  However, it is the wider economic and development impacts of tobacco that must be better understood.  With the tobacco industry doing all it can to increase tobacco consumption in low- and middle income countries, we must all take action to bring tobacco use to an end,” says Dr. Vera Luiza da Costa e Silva, Head of the Convention Secretariat.
Global estimates show that every year tobacco use costs the global economy USD 1.4 trillion, nearly 2 percent of global gross domestic product, but take into consideration only medical expenses and lost productive capacities. In addition to the health and economic consequences for individuals, families and nations, tobacco growing causes up to 5 percent of deforestation worldwide and results in biodiversity loss and soil degradation, as well as water and soil pollution from pesticide use.
“Effective tobacco control through the implementation of the WHO FCTC is essential for development. Saving lives, while growing economies, protecting the environment and providing resources for other sustainable development efforts is exactly the type of win-win action that can help countries achieve the Sustainable Development Goals,” says Magdy Martínez-Solimán, UN Assistant Secretary-General and Assistant Administrator and Director of UNDP’s Bureau for Policy and Programme Support.
We imprison people who are addicted to other drugs, while tobacco company executives make millions. They should be in prison.

Wednesday, May 24, 2017

No, Obamacare is not collapsing (wonky)

The Republicans are justifying their effort to strip millions of people of health insurance in order to fund tax cuts for rich people by claiming that the Affordable Care Act is "unsustainable" or, in the words of Donald of Orange, "collapsing."  The Urban Institute has done a thorough analysis of the state of the ACA. Since people nowadays have short attention spans, I'll give you the pistachio shell version.

First, some background. As you can read in my banner, the U.S. spends far more on health care (which I would prefer to call medical services but that's a lost cause) than any other affluent country. Yet they all cover everybody, and they are healthier! How can this be? We're less healthy in part because we don't cover everybody, but also because we have greater inequality, gun violence, and other social determinants of health are generally worse here.

What is more, prior to the ACA, the situation was getting steadily worse. The growth in what the Urban Institute calls National Health Expenditures (again, they mean medical services) exceeded growth in GDP by about 2.5% a year, in other words health care was gobbling up more and more  of the economy. At the same time, the number of uninsured people was growing.

The ACA put a stop to that. Obviously, it extended coverage to millions of people; yet the growth in National Health Expenditures actually slowed way down. This was partly a result of the recession and slow recovery, but also because of the ACA. The Act included Medicare payment reforms that reduced overutilization; the managed competition structure of the exchanges; and yes, reductions in Medicare payments to providers.

So what about the claims that premiums on the exchanges are skyrocketing? Actually in most of the country they are fairly stable or even declining. They are going up in places where insurers may have set premiums too low initially, and where there is no competition between insurers. They are really spiking in Arizona where state law allows for the sale of policies that aren't compliant with the ACA, which draws healthy people out of the risk pool. These problems could be fixed by regulations that pull in more competition and by getting more people to enroll. It's most difficult in rural areas. But the bottom line is that Obamacare premiums in most states are similar to, or even lower, than premiums for employer-provided insurance.

Finally, what about growth in Medicaid spending? Medicaid enrollment grew not only because of the Medicaid expansion under the ACA, but also because of the aging population, which means more people who are eligible because they are over 65, and more disabled people under 65. (The rate of disability rises with age well before age 65.) But Medicaid is the most efficient insurance there is! It costs less per enrollee than private insurance or Medicare, even though it's good, comprehensive insurance. And the cost per enrollee is growing more slowly.

So the Republicans want to drastically slash Medicaid. Who are we talking about here? Welfare queens? No, mostly elderly people who need long term care. What they want to do is kill your grandmother, to pay for tax cuts for rich people. That's because they are good Christians.

Sunday, May 21, 2017

You don't need a weatherman . . .

To know which way the wind blows.

I often maintain that I am reticent to prognosticate. However, the excitement over the "when does the residency end" pool is just too great for me to resist.

So no, I don't think he can survive till the mid-term. One major reason for my conclusion is that he is too ignorant, stupid, and crazy. Actually the stupid and crazy are weirdly intertwined, so it's often hard to know which is really operative in a given brain fart.

The second variable in my equation is the nature of Trumpism. There in fact is no such thing. He managed to sell himself as the champion of disaffected white racists who knew they were mad about something but weren't sure exactly what it was. The only concrete promises he made are either impossible to keep or already totally abandoned. (Yes, we're fine with cutting Medicare, Medicaid and Social Security. No, you aren't getting a $35 and hour job in a steel mill.) There is no organization, no movement, and no ideology behind the "movement" Trump claims, but only a bombastic, vulgar and bullying pose. Which means there is no real base and nobody to save him.

Third, it is by now obvious that the campaign was a tool of a hostile foreign power. Some degree of this claim is already publicly established. Whether Cheeto Benito was really involved, or is just a dupe, is not entirely clear. I think he kind of knew what was going on, or was at least exposed to the information, wasn't really an active participant, but didn't think it was any sort of a problem. Oh, we're getting help from my friend Vlad? That's nice.

Whether the Republicans in congress would ever find the cojones to impeach him I don't know, but a totally ineffective presidency will not be helpful in advancing their incredibly unpopular legislative agenda. So yes, I think they'll find a way to push him out. But the wreckage from this catastrophe will endure for decades.

Thursday, May 18, 2017

A couple of press releases about the so-called American Health Care Act

A lot of stuff hits my in-box that I should probably share. This from Avalere is a finding that Trumpcare would cut Medicaid funding for non-disabled children by $43 billion over 10 years. Children are the largest group covered by Medicaid, although disabled people and elderly people in long-term care account for the majority of actual spending. The whole thing is long and wonky but the bottom line is:

Avalere also examined the impact of per capita caps at the state-level, and found that all 50 states and the District of Columbia would lose Medicaid funding for traditional children. The reductions ranged from $59 million in North Dakota to $5.1 billion in Texas.
 Meanwhile, the Robert Wood Johnson Foundation finds that Dumpcare would cause a sharp increase in premiums for lower income older adults, who currently receive much more generous subsidies under the ACA.

"Age-related tax credits, while easy to understand, do not target subsidies most efficiently,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. “Tax credits that don’t reflect differences in ability to pay and geographical variation in the cost of health care will lead to significant loss of coverage, as suggested by the most recent CBO score of the AHCA.”
The reason the Republicans want to do this is to provide a huge tax cut to wealthy people. That is the only reason. In every other way, it makes things far worse for the American people, and particularly the people who voted for the current Resident. Don't let you representatives in congress lie to you about this.

Oh yeah, and this just in: the "high risk pools" which are supposed to cover people with expensive pre-existing conditions are underfunded by 3-5 times. In other words, the Republican solution is indeed "let people die."

"Traditional high-risk pools are symptoms of poorly regulated and inadequately subsidized insurance markets," said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. "To properly finance them is extremely expensive, which is why they tend to be underfunded, resulting in inadequate access to coverage for those who need health care the most."

Wednesday, May 17, 2017

Idiot wind

Blowin' every time you move your teeth.

Two stories from Daily Kos, one about the upcoming world tour, the other on Republican attempts to defend Cheeto Benito in the Comey affair.

It turns out that our Resident has too short an attention span, and is too ignorant, to participate in a standard NATO meeting, so heads of state are being encouraged to limit their speeches to 2 to 4 minutes. Also, it seems he doesn't understand the Israel-Palestine conflict, even though he's about to visit both countries.

Meanwhile, the new talking point about the White House scandals is that he is too stupid to know what he's doing, so you can't blame him.

This has long been obvious. He evidently really thought that he could replace the Affordable Care Act with some policy that would cover everybody, be cheaper than the status quo for consumers, and come with a big tax cut. Then he discovered, much to his surprise, that health care is complicated. (Actually, it isn't all that complicated. It costs money so if you want everybody to have it, wealthier and healthier people have to subsidize poorer and sicker people. That's called arithmetic.)

Here's Tony Schwartz, official biographer, who has spent many a long hour with the man:

Trump was equally clear with me that he didn’t value — nor even necessarily recognize — the qualities that tend to emerge as people grow more secure, such as empathy, generosity, reflectiveness, the capacity to delay gratification or, above all, a conscience, an inner sense of right and wrong. Trump simply didn’t traffic in emotions or interest in others. The life he lived was all transactional, all the time. Having never expanded his emotional, intellectual or moral universe, he has his story down, and he’s sticking to it.
A key part of that story is that facts are whatever Trump deems them to be on any given day. When he is challenged, he instinctively doubles down — even when what he has just said is demonstrably false. I saw that countless times, whether it was as trivial as exaggerating the number of floors at Trump Tower or as consequential as telling me that his casinos were performing well when they were actually going bankrupt. In the same way, Trump sees no contradiction at all in changing his story about why he fired Comey and then undermining the explanatory statements of his aides, or in any other lie he tells. His aim is never accuracy; it’s domination.
That doesn't work when you are president of the United States. I think there is a limit to how long the congressional Republicans can play this game; one way or another he'll be gone before the midterm election. We just have to hope that World War III doesn't come first.

Monday, May 15, 2017

Do not consume the flesh of tetrapods

Well, maybe birds are okay, it isn't entirely clear. The horrific harm to the planet from human meat consumption doesn't seem to be motivating very many people to stop it, but maybe the risk of death will.

With a total of more than 7.5 million person years of observation, further analyses by Etemadi and colleagues (doi:10.1136/bmj.j1957) now show an association between high intakes of red and processed meat and elevated total mortality and mortality from most major causes: cardiovascular disease, diabetes, cancer, and hepatic, renal, and respiratory diseases.
As the BMJ editorialist goes on to remind you of what you already know or should know -- even though you have been carefully avoiding thinking about it -- 30% of the earth's land surface is now pasture, or devoted to growing animal feed, which means:

Damage to planetary health includes depletion of aquifers15 (producing 1 kg of meat protein requires more than 110 000 L of water22); production of 37% of anthropogenic methane (with 23 times the global warming potential of CO2) and 65% of anthropogenic nitrous oxide (almost 300 times the potential of CO2); groundwater pollution; and 64% of anthropogenic ammonia emissions, which contribute significantly to acid rain and acidification of ecosystems.15 The combination of rainforest destruction for livestock and the production of greenhouse gases by livestock contributes more to climate change than do fossil fuels used for transport.15
There is also antibiotic resistance, recombinant influenza (from pig farms), and human hunger -- 95% of soybean is fed to animals. Contrary to common belief, our hunter-gatherer ancestors prior to the last ice age consumed much less meat than we do. So did people in Europe right up until the 20th Century. Our meat based diet is unprecedented in human history. So just stop it.

Wednesday, May 10, 2017

What we already know . . .

is more than enough. Here's another tl;dr for you, from the editor of Foreign Policy, David Rothkopf. I'll just give you a few pull quotes:

On a daily basis, Republicans watch their leader violate not only the traditions and standards of the high office he occupies, but through inaction they enable him to personally profit from the presidency, promote policies that benefit his cronies and his class to the detriment of the majority of the American people, and serially attack the principles on which the country was founded — from freedom of religion to the separation of powers. . .

America looks like a country it has never been. Trump is a laughingstock in the best of circumstances, a disgrace based on his known behavior to date, and a threat to global order and security with each action he takes. He discredits the office he holds and the government he leads. . . . 

Only if an independent prosecutor is appointed will America be seen as being the nation of laws it has long represented itself to be. Only if a thorough investigation takes place that includes an examination of Trump family ties in Russia (and elsewhere) and how these may have compromised the United States will the message be sent that America is the nation that has for so long been seen as an example to the world.
Well sure. But the problem is really worse than that. The institutional failures that brought us to this point are so massive, so pervasive, that there may not be any way out. The Republicans in congress still show no convincing signs of the slightest interest in the truth. They know that their policy agenda will be catastrophic for the people who voted for them, and they need to ram it through now. The continual degradation of political discourse and democratic institutions is in their long-term interest, because it was necessary for them to come to power and will have to grow more profound in order for them to keep it. I do not foresee a single patriot emerging from the Republicans in the senate.