The BulleTin • SaTurday, January 29, 2022 B5
EDITORIALS & OPINIONS
AN INDEPENDENT NEWSPAPER
Heidi Wright
Gerry O’Brien
Richard Coe
Publisher
Editor
Editorial Page Editor
A type of care not
covered in single-
payer health plan
W
hen you hear that Oregon might move to a
single-payer, state-run health plan, you may
think: Yes!
Every Oregonian would get
health care coverage and the same
level of coverage. Equity and qual-
ity might go up. Overall costs may
be held down. You would pay taxes
instead of health care premiums.
That’s the kind of plan the state’s
Joint Task Force on Universal
Health Care is supposed to de-
velop. It met again Thursday, tak-
ing another step toward its goal of
submitting a Health Care for All
Oregon Plan to the Legislature by
September 2022.
Is Oregon going to make such
a momentous shift in health care?
Should skeptical Oregonians,
health insurers, pharmaceutical
companies and others be nervous?
We can’t answer that. We are just
going to slice off one piece of this
issue. That’s a form of care that the
plan won’t cover: long-term ser-
vices and supports.
Long-term services and supports
is medical and nonmedical care
provided to people who are not
able to do things for themselves,
such as cook, dress, bathe or make
it to the bathroom. The harsh re-
ality is that while people can need
that at any stage of life, Medicare
and most health insurance do not
pay for it. People need to “spend
down” their assets to where they
have very little left and keep their
assets low to be eligible for govern-
ment assistance. Buying additional
insurance can help.
That harsh reality would con-
tinue under an Oregon sin-
gle-payer plan, at least as the task
force discussed on Thursday. They
even deleted on Thursday lan-
guage from their proposed recom-
mendation to the Legislature that
highlighted the issue. Struck from
the recommendation was this sen-
tence: “Oregonians who are not
eligible for LTSS benefits will con-
tinue to ‘spend down’ assets be-
fore becoming eligible.” Task force
members weren’t trying to hide
what they were doing. It is just not
something Oregon’s single-payer
plan would do. It’s a state of affairs
in health care that isn’t going to
change.
No state that has been develop-
ing a single-payer plan has found a
simple way to cover long-term ser-
vices. They have all struggled with
it, as Oregon’s task force is. If the
government started paying for that
type of long-term care, it would
increase health care costs substan-
tially for any new health system
because substantial parts of it aren’t
covered now.
It might be that an Oregon
single-payer plan would cover
long-term services and supports
at some point in the future. For
now it’s important to note that a
type of care that many Oregonians
may need at some point in their
lives would not be covered by the
Health Care for All Oregon Plan.
Historical editorial:
Reserving the forest
e
Editor’s note: This historical editorial originally
appeared in the March 15, 1907, edition of
what was then called The Bend Bulletin.
A
number of Western papers
are greatly wrought up over
President Roosevelt’s forest
reserve policy. They condemn in
strong terms his latest additions to
the nation’s reserves. An indignant
article was sent from a western
Oregon town to one of the Port-
land dailies regarding this matter.
The sum and substance of its ar-
gument was in the statement that
“a large number of our citizens
were just ready to make filings on
timber claims” and were thus de-
prived of the opportunity to make
a few hundred dollars. And by
the way, the greatest opposition is
coming from that class of people.
The welfare of the country as a
whole seems not to be much con-
cern to them as far as the forest re-
serve policy is concerned.
During the time of the recent
damaging floods in western Ore-
gon and Washington, it was truth-
fully stated that the cutting of the
timber over large areas was largely
responsible for the high water.
With many miles of land stripped
of its forest protection, the warm
sun and chinooks melted the snow
so rapidly as to cause floods on the
lower streams — floods that caused
in one year, hundreds of thousands
of dollars damage. But it is un-
wise policy that aids in preventing
floods and in doing so hinders a
few hundred people from increas-
ing their personal wealth.....
editorials reflect the views of The Bulletin’s editorial board, Publisher heidi Wright, editor
Gerry O’Brien and editorial Page editor richard Coe. They are written by richard Coe.
Putin’s gamble on Ukraine is wrong
BY CARL BILDT
Special to The Washington Post
R
ussian President Vladimir Pu-
tin has thrown down the gaunt-
let against the West in a way no
Kremlin leader has done since Nikita
Khrushchev brought the world to the
brink of nuclear catastrophe six de-
cades ago.
It’s a huge strategic gamble by the
Kremlin — one that has led to a situa-
tion in which Putin must either climb
down from his extensive demands or
launch a military operation likely to
lead to large-scale war in Europe.
None of the fears the Kremlin’s pro-
paganda play on have any founda-
tion in reality. The last consequential
NATO expansion was decades ago.
No one was seriously contemplat-
ing NATO membership for Ukraine
or Georgia. Plans for U.S. missiles in
eastern Ukraine targeting Russia are
pure fantasy. No sane person sees the
risk of Norway, Estonia, Ukraine or
any other border state planning to in-
vade Russia.
In fact, NATO policy has been
rather careful. Before Putin’s invasion
of Ukraine in 2014, U.S. forces in Eu-
rope had been continuously reduced.
The year before, the last U.S. tank
in Germany had been shipped back
across the Atlantic.
NATO didn’t even have any defense
plans for the Baltic states. There was a
NATO “air policing” operation there,
but that arose from the post-9/11 con-
cern with unpoliced airspace; it was
not a defense operation.
Even after 2014, NATO took care
not to provoke. Its presence in the
Baltic states was battalions rather than
brigades. The United States largely
stayed out of states bordering Russian
territory, and in Norway and Poland,
based troops well away from the Rus-
sian border.
There were irritants, but not more.
A scaled-down ballistic missile de-
fense system, with installations in
Romania and planned in Poland, was
geared to meet a hypothetical threat
from Iran or North Korea, though
Moscow was never entirely con-
vinced. And perhaps the United States
flying strategic bombers close to Rus-
sian airspace wasn’t entirely wise.
So why then this major crisis now?
In 2021, signs multiplied of Putin
taking a more assertive approach to
Ukraine. In May, he made an emo-
tional outburst against the country
at a session of his Security Council.
Then, in July, he published an infa-
mous essay in which he essentially ar-
gued for a restoration of the Russian
Empire — including Ukraine.
His June summit with President
Biden signaled that the White House
wanted no trouble on the Russian
front, so it could focus on China.
When Biden unceremoniously aban-
doned Afghanistan, the message was
even more clear; immediately thereaf-
ter, Russia’s national security adviser,
Nikolai Patrushev, remarked that he
hoped the Ukrainians understood the
futility of relying on the United States.
Step by step, political and military
moves were made to deliberately cre-
ate a crisis and increase pressure, par-
ticularly on the United States. Mos-
cow shelved talks with Kyiv, Berlin
and Paris on Donbas, and treated the
European Union with open disdain.
Formally, Russia demanded the roll-
back of all Western security structures
to prior to the first NATO enlarge-
ment in 1997. In reality, this would
amount to a rollback to the situation
before the 1990 Charter of Paris set
out the principles of Europe’s post-
Cold War order.
Putin is sometimes seen as a master
strategist, but he has a long record of
misjudging Ukraine policy. Emotions
have clearly overtaken rationality, re-
sulting in Russian policy that has pro-
foundly alienated Ukraine.
There is simply no way in which
Putin can achieve the aims he has set
by diplomacy alone. That would re-
quire a U.S. capitulation of historic di-
mensions.
And achieving regime change in
Kyiv, which the Kremlin clearly seeks,
will not be straightforward. For all
his vacillations, President Volodymyr
Zelensky could simply retreat to the
west of the country; if followed there
by Russian forces, he could establish
a government in exile recognized and
supported by the West. Many thou-
sands would be dead in the conflict,
and many millions would be forced
to flee. Weapons would flow into
Ukraine, and the conflict would be
very likely to escalate. Putin’s gamble
on the weakness of the West to roll
back the fundamentals of Europe’s se-
curity order is nothing less than insane
and should be treated as such. There is
virtually no way, apart from the total
capitulation of the West, in which Rus-
sia could achieve a positive outcome.
But we must recognize that the cri-
sis will not be over in a week, or even
a month or two. Putin has made his
calculations, and it will be difficult for
him to retreat. The West must be pre-
pared for the worst. Only thus can we
prevail.
e
Carl Bildt is a former prime minister of Sweden and
a contributing columnist for The Washington Post.
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It’s a pandemic miracle: I’m defending the FDA against Ron DeSantis
BY MEGAN MCARDLE
The Washington Post
W
ASHINGTON — Flor-
ida Gov. Ron DeSantis, a
Republican, truly is some
kind of miracle worker. He is about to
make me defend the Food and Drug
Administration’s decision to keep a
drug off the market.
On Monday, the FDA withdrew
emergency use authorization for two
monoclonal antibodies that don’t
work well against omicron, the dom-
inant coronavirus variant in the
United States. Florida, which has
made monoclonal antibody access
central to its pandemic policy, an-
nounced that it was shutting down its
infusion centers. DeSantis threatened
to sue the FDA.
Alt-right blogger Mike Cernovich
went further, tweeting “The FDA is
trying to make it so that people in
Florida die of COVID. They’ll kill
people to harm Republicans.” This
was retweeted more than 3,200 times,
including by Christina Pushaw, De-
Santis’ press secretary.
I am trying to find a less pejorative
word than “crazy” to describe this
situation. Don’t get me wrong: As a
longtime critic of the FDA’s excessive
caution, I get why conservatives might
want a “right to try.” Moreover I un-
derstand why conservatives assume
that the agency has been politicized;
the decision to delay announcing the
results of vaccine trials until after the
2020 election gave off political over-
tones, even if you think that’s a false
impression.
Yet precisely because I’ve spent
years of watching the FDA with a
gimlet eye, I’m quite sure that this is
not an attack on Republicans; it’s just
the FDA doing what it always does.
Moreover, in this case, it’s probably
doing the right thing.
To understand why, you have to
understand how monoclonal anti-
bodies or mAbs, work, and why ex-
perts believe these ones don’t. It all
comes down to the antibodies. You
can think of a virus as using a kind
of key (such as the infamous spike
protein) which unlocks our cells so
the virus can get inside. Some anti-
bodies glom onto part of that key,
so that it no longer unlocks the
door — as if you’d stuck a bit of clay
onto the notches of your house key.
Meanwhile, another part of the anti-
body “signals to the immune system:
‘Hey, I’ve got a live one’,” says drug
researcher Derek Lowe, who was
kind enough to walk me through the
chemistry.
Your body responds to the virus by
trying lots of different antibodies that
react to different parts of the patho-
gen, with varying degrees of effective-
ness. Manufactured monoclonal anti-
bodies are more focused: Researchers
find the ones with the highest activity
and produce a whole bunch of just
a few of them. The benefit of mAbs
is that unlike vaccines, which do not
help against an active infection, they
can treat patients already infected
with COVID-19.
“The thing with monoclonal an-
tibodies is that you get exactly what
you want and nothing but,” says
Lowe. “But if anything changes,
they’re useless.” That is, if the vi-
rus mutates, a monoclonal anti-
body might be the wrong shape to
lock onto the new variant, while the
broader natural response might still
generate at least a few that work, as
well as other kinds of immune re-
sponses.
This helps explain what we’ve seen
with omicron. Because this variant
has so many mutations, people who
have been vaccinated, or survived an
earlier COVID infection, have de-
fenses that don’t prevent infection as
well as they used to. But why not leave
them on the market for people who
have other variants? Well, omicron is
now estimated to account for 99.9% of
new cases. With those case rates, we’d
need to pump a thousand doses into
COVID patients’ arms — at thou-
sands of dollars a pop — in order to
potentially help maybe one. And even
that one wouldn’t necessarily benefit.
Most people recover from COVID
without monoclonal antibodies, and
some people don’t even if they get
them.
All treatments have side effects,
including allergic reactions. So the
FDA tends to balk if you have to
treat a large number of patients,
most of whom might recover with-
out treatment, to potentially help
one. And that was true long before
COVID-19.
None of this was remotely contro-
versial before the DeSantis admin-
istration attacked the FDA. It was
widely agreed that many previously
effective monoclonals were now of lit-
tle use against omicron. In the case of
the withdrawn treatments, even the
manufacturers, Eli Lilly and Regen-
eron, agree they don’t work. No gover-
nor should want to waste money and
scarce medical resources on pump-
ing useless antibodies into Floridian
veins.
e
Megan McArdle is a columnist for The
Washington Post.