Verdict first, ev­i­dence later

Cecil Whig - - OPINION -

As sum­mer comes to a close, our lo­cal phar­ma­cies will be stock­ing up on flu shots, and are likely to start of­fer­ing shots in the very near fu­ture.

As a pri­mary care physi­cian I write to plead with our pa­tients to hold off on flu shots un­til Oc­to­ber. This is be­cause the in­fluenza sea­son does not re­ally start here un­til about the time of the Christ­mas hol­i­day, and lasts un­til April. The flu shot takes about two to three weeks to take ef­fect; and that ef­fect only lasts about six months. So if you get the shot now, or in the next few weeks, your shot will be wear­ing off right in the mid­dle of the flu sea­son.

Bot­tom line: Please wait un­til Oc­to­ber to get your flu shot! It does of­fer pro­tec­tion from in­fluenza, but you want this to last all the way through April.

LOS AN­GE­LES — Here’s an in­ter­na­tional cri­sis you can, un­usu­ally, put on your cal­en­dar ahead of time: In Oc­to­ber, Pres­i­dent Trump wants to de­clare Iran in vi­o­la­tion of the 2015 agree­ment to limit its nu­clear pro­gram — a de­ci­sion that would al­low the United States to reim­pose tough eco­nomic sanc­tions on any­one trad­ing with Tehran.

It’s a bad idea. The nu­clear deal isn’t per­fect — it doesn’t end Iran’s nu­clear re­search, only lim­its it for a pe­riod of years — but it’s much bet­ter than noth­ing. Be­fore the agree­ment, Tehran was be­lieved to be less than a year from mak­ing nu­clear weapons that would have threat­ened Is­rael and Saudi Ara­bia. Thanks to the ac­cord, that dooms­day prob­lem has at least been post­poned.

That hasn’t stopped Trump from call­ing the pact “the worst deal ever” and or­der­ing aides to sup­ply him with ev­i­dence that will al­low him to de­clare it in­valid. The most likely mo­ment for his de­ci­sion will come in Oc­to­ber, the next time he is re­quired to no­tify Congress whether Iran is in com­pli­ance.

“If it was up to me, I would have had them non­com­pli­ant 180 days ago,” Trump told the Wall Street Journal last month. Next time, he added, “I do not ex­pect that they will be com­pli­ant.”

The pres­i­dent didn’t of­fer any sub­stan­tive rea­son to de­clare Iran out of com­pli­ance with the deal — be­cause there isn’t one. His own aides told him last month that, while Iran has tested the edges of the agree­ment, none of its ac­tions was a “ma­te­rial breach,” the le­gal stan­dard that would al­low sanc­tions to snap back.

When Trump was warned that he couldn’t sim­ply walk away from the deal, “he had a bit of a melt­down,” an of­fi­cial told the New York Times. He chewed out the sec­re­tary of State, Rex Tiller­son, who ap­par­ently brought him the bad news. And he or­dered his staff to be­gin work on a new study — one that will sup­ply him with the ex­cuses he needs.

That’s an Alice-in-Wonderland ap­proach to for­eign pol­icy: Verdict first, ev­i­dence later. And it’s not likely to work.

No mat­ter what the pres­i­dent thinks, the facts will get in the way. U.S. of­fi­cials say Iran has been care­fully up­hold­ing its main obli­ga­tions un­der the nu­clear agree­ment: re­duc­ing its uranium stocks and lim­it­ing its en­rich­ment pro­gram.

And none of the other six coun­tries that ne­go­ti­ated the deal agree with Trump that the ac­cord should be ab­ro­gated.

“The deal ... is work­ing, and we be­lieve it rep­re­sents the best op­tion for the in­ter­na­tional com­mu­nity,” Bri­tish For­eign Sec­re­tary Boris Johnson wrote last month (and his gov­ern­ment is friend­lier to Trump than most).

As a re­sult, if Trump de­clares in Oc­to­ber that Iran is in breach, most of the world — in­clud­ing Bri­tain, Ger­many and France — will blame him for the con­se­quences, not Tehran.

That will cre­ate a ma­jor ob­sta­cle for the next step in Trump’s course, which is to reim­pose U.S. eco­nomic sanc­tions on for­eign busi­nesses that deal with Iran. (The nu­clear deal didn’t af­fect the em­bargo be­tween the U.S. and Iran, which re­mains in ef­fect.)

If the United States is viewed as re­spon­si­ble for break­ing the deal, other coun­tries may refuse to go along with Trump’s uni­lat­eral sanc­tions, mak­ing them largely tooth­less.

“No­body else wants the deal to fail,” said El­iz­a­beth Rosenberg of the Cen­ter for New Amer­i­can Se­cu­rity, who worked on sanc­tions in the Obama ad­min­is­tra­tion. “If the U.S. is the only one that walks away, who is go­ing to en­force new sanc­tions? You could eas­ily see Euro­pean lead­ers de­cid­ing to de­fend their own com­pa­nies in­stead.”

Last month, the French en­ergy gi­ant Total signed a con­tract for a $5 bil­lion nat­u­ral gas project in Iran. If Trump tries to im­pose sanc­tions on deals like that, the re­sult won’t be merely a con­fronta­tion with Iran; it will be a clash with the EU.

There is an al­ter­na­tive Trump could try. It’s called diplo­macy.

He could press for stricter en­force­ment of the nu­clear agree­ment, be­gin­ning with the re­stric­tions Iran has placed on in­ter­na­tional in­spec­tors’ ac­cess to military bases.

He could seek stronger in­ter­na­tional sanc­tions on Iran for its bal­lis­tic mis­sile tests, which aren’t cov­ered by the nu­clear deal.

And he could be­gin ne­go­ti­a­tions to­ward a new agree­ment to main­tain the curbs on Iran’s nu­clear pro­gram af­ter 2026, when the cur­rent lim­its be­gin to ex­pire.

But the pres­i­dent hasn’t pur­sued those op­tions, even though they’ve been of­fered to him by his own aides. In­stead, he ap­pears hell­bent on ful­fill­ing a bad cam­paign prom­ise he should now have the wis­dom to aban­don. (That’s a prayer more than a hope.)

Tear­ing up the deal won’t bring down Iran’s regime — most of Tehran’s rul­ing cler­ics wel­come the en­mity of the United States — but it will set up a col­li­sion be­tween the Trump ad­min­is­tra­tion and most of the world, in­clud­ing China, Rus­sia and U.S. al­lies in Europe.

The most likely losers would be the Western al­liance, al­ready bat­tered by Trump’s dis­dain, and what­ever re­mains of the United States’ tat­tered claim to in­ter­na­tional lead­er­ship.

And the most likely win­ner, oddly enough, would be Vladimir Putin’s Rus­sia, the ben­e­fi­ciary of yet an­other wedge be­tween United States and its NATO al­lies — this one driven by Trump alone, with­out Moscow’s help.

Doyle McManus is a colum­nist for the Los An­ge­les Times.

WASH­ING­TON — Years ago, when my daugh­ter was in the first stages of treat­ment for a brain tu­mor (thank­fully not a glioblas­toma), I went with her to the phar­macy to get 11 pills that were part of a par­tially filled pre­scrip­tion she had re­ceived ear­lier.

When the phar­ma­cist re­turned with the med­i­ca­tion, I asked, out of cu­rios­ity, how much they’d cost if not cov­ered by in­sur­ance. He looked up at the line be­hind us and said very qui­etly, $7,000. I gasped but not as au­di­bly as the woman who was next up. “For 11 pills? Did I hear that cor­rectly?”

“Wel­come to the world of mod­ern medicine,” the drug­gist said.

Such costs, of course, are a big rea­son health care has be­come the thorni­est of all is­sues — and why a so­lu­tion to our na­tion’s health care ills is still pend­ing and will be for some time. More and more life has be­gun to de­pend on chem­istry.

My eyes were fur­ther opened just re­cently when my res­pi­ra­tory prob­lems be­gan act­ing up and I was pre­scribed a drug taken four times a day through a spe­cial in­haler. My car­di­ol­o­gist warned me that the drug and an­other he was giv­ing me were ex­pen­sive. He said he would or­der them through a spe­cial­ized phar­macy. When the phar­macy called me to get some per­sonal in­for­ma­tion, I said I had been told the in­haler medicine would be costly if my in­sur­ance wouldn’t cover it.

“That’s right,” the drug­gist replied. “De­pend­ing on what level you take, it is $13,000 to $15,000 month, or as much as $150,000 a year.”

Af­ter be­ing doused with water and helped off the floor by my sig­nif­i­cant other, I stam­mered around for a few min­utes be­fore weakly croak­ing that if my sup­ple­men­tal in­sur­ance wouldn’t cover it — even if my life de­pended on it — “Don’t bother call­ing me again be­cause I won’t be here for­ever.”

“That’s why I’m call­ing,” he replied. “We need prior ap­proval from your in­surer be­fore we can is­sue the drug. It will take a few weeks and hope­fully the sup­ple­men­tal plus Medi­care will keep you alive and sol­vent.”

For­tu­nately, that was the case. Be­cause there was a med­i­cal de­vice in­volved, the treat­ment was 100 per­cent cov­ered be­tween Medi­care and the sup­ple­men­tal in­surer.

The next drug my car­di­ol­o­gist pre­scribed was a bit eas­ier in cost but still far from af­ford­able. I would have to pay $2,170 for a 90-day sup­ply and then pay $590 for each re­fill un­til the first of the year. Then I would have to cough up (no pun in­tended here) an­other $2,170 so I could cover the next co-pay­ment. If this sounds like gob­bledy­gook to you, it did to me too. One would need a math de­gree to keep up.

At any rate, even my doc­tor was amazed. We’re still work­ing on it. You should know, how­ever, that the cost with­out in­sur­ance runs $11,000.

Mind you, the drugs be­ing men­tioned here are for rare con­di­tions. But what hap­pens if a per­son with such mal­adies doesn’t have in­sur­ance? They don’t get th­ese drugs, one of my doc­tors said.

That, and much more, will ob­vi­ously be dis­cussed in the con­gres­sional de­bates to come. It would seem to me that cut­ting back on Med­i­caid, the state-shared cov­er­age of the in­di­gent, is not the an­swer. A so­lu­tion may lie in ex­pand­ing a pre­scrip­tion plan for those with low in­comes.

Don’t turn blue wait­ing to hear promis­ing news on this front, though. Com­ing up with even par­tial so­lu­tions is sure to take time.

Mean­while, the very ex­pen­sive pills my daugh­ter Lisa re­ceived have played a role in sus­tain­ing her for the eight years since they were first pre­scribed. A pre­cious life still burns brightly.

Dan Thomas­son is an op-ed colum­nist for Tri­bune News Ser­vice and a for­mer vice pres­i­dent of Scripps Howard News­pa­pers. Read­ers may send him email at: thomas­son­ .

www.ce­cil­ Serv­ing Ce­cil County since 1841 Phone 410-398-3311 • Fax 410-398-4044

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