Common Sense on the Caravan

A group of desperate migrants walking toward the Texas border is not a threat. We have laws to protect
us — and them.
The caravan of people slowly making their way on blistered feet and thin hopes toward America’s
southern border sometimes seems like an election gift to President Trump, giving him fresh meat to
throw to his base on the eve of fateful midterm elections.
The Central Americans, estimated at about 3,500 people, many of them women and children, have
morphed in the president’s immigrant-bashing demagogy into an “onslaught of illegal aliens”
concealing “criminals and unknown Middle Easterners,” all enabled by Democrats and, Mr. Trump
“wouldn’t be surprised,” by George Soros, a favorite villain of far-right conspiracy-mongers.
Mr. Trump is not sitting back and letting the barbarians in. He has ordered the Army — which is barred
by law from performing police functions within the United States — to bolster the frontier, saying he
will authorize soldiers to shoot if the trekkers start throwing rocks “viciously and violently.” “This is an
invasion of our Country and our Military is waiting for you!” tweeted Mr. Trump on Monday.
Mr. Trump, perhaps counseled by someone who understands the military’s longstanding rules of
engagement, dialed back the threat a bit on Friday. “They won’t have to fire,” he told reporters. “What I
don’t want is I don’t want these people throwing rocks.”
Most of Mr. Trump’s description of the migrants is untrue or unwarranted. But none of it is surprising.
Demonizing immigrants is his go-to move, from his “big, beautiful wall” to his call to end birthright
citizenship. Not to mention the race-baiting campaign ad he tweeted featuring a Mexican immigrant
who was convicted of killing two police officers.
The Democrats have come back with a resounding response. Resounding silence, that is, apart from a
few potshots at deploying the Army, which Barack Obama, stumping in Florida, assailed as a “political
stunt.” More typical was the retort of Nancy Pelosi, the House Democratic leader, when confronted by
Mr. Trump’s talk of revoking birthright citizenship. “Clearly, Republicans will do absolutely anything
to divert attention away from their votes to take away Americans’ health care,” she said.
Clearly, Representative Pelosi was doing some diverting herself. No doubt health care is a more
comfortable campaign issue for Democrats than the minefield of immigration policy, but the caravan is
not simply a political sideshow concocted by Mr. Trump. Anyone who wants to defeat his bigoted
politicking needs to do better than to try to change the subject.
The right way to deal with the caravan crisis is to make clear that it is no crisis. The marchers pose no
threat. The United States has clear laws governing refugees and well-funded agencies to enforce those
laws, and it’s an embarrassing waste of money to send troops to the border. In fact, illegal border
crossings have significantly declined in recent years. The country must and will continue to enforce the
laws that control its borders, as Mr. Obama himself did as president during an earlier, actual surge of
Central American migrants, when he took the difficult step of dispatching National Guard troops to the
border and detaining many mothers and children.
Longer-term questions about how to put the country’s approach to immigration back on a rational,
moral foundation are more difficult. Republican hard-liners defeated bipartisan attempts at
comprehensive immigration reform in 2007 and 2014. In the Trump era, Democrats have found the
issue of immigration even more confusing; a couple of Democratic senatorial candidates have even
lined up behind Mr. Trump.
Mr. Trump’s cruel treatment of immigrants and race-baiting about nonexistent threats do not amount to
a solution. Managing the entry of refugees and other immigrants, and creating a fair system to deal with
the millions of undocumented immigrants within the borders, are serious matters in need of common
sense and elemental humanity.
The country needs to streamline the asylum system and establish generous quotas of immigrants and
refugees from around the world. To be effective, any immigration plan has to include serious
development aid to Central America’s troubled states. Cutting off what little aid they get, as Mr. Trump
has threatened to do, will only create more caravans.
People seeking to partake of the American dream have always been central to America’s identity and
strength. How the country treats them goes straight to its core values. The Democrats cannot sit this
one out, especially when the Republican leader is so blind to the true sources of America’s greatness.

WASHINGTON POST

Republicans’ claim of health-care protection

flies in the face of reality
The Washington Post's Paige Winfield Cunningham and Paulina Firozi analyze why candidates are
touting protections for preexisting conditions in their campaigns
President Trump and Republicans repeatedly say that they are protecting Americans with preexisting
medical conditions.
It’s a false claim that flies in the face of the reality of the past eight years.
The Trump administration is part of a lawsuit to invalidate the Affordable Care Act’s core protection for
people with preexisting conditions such as cancer, diabetes or even a pregnancy.
Many House Republicans have voted more than 70 times to scrap or undermine the 2010 law, which
for the first time forced insurers to provide coverage to people who already had medical problems.
But faced with the fact that the protections are wildly popular among voters ahead of Tuesday’s
midterm elections, some Republicans have copied Trump’s approach, insisting that they will support
what they once opposed with no acknowledgment of their about-face.
“I voted to protect people with preexisting conditions,” Rep. Martha McSally (R-Ariz.), who is running
for Senate, said at a recent debate. In fact, McSally voted in May 2017 for a bill that would have
weakened the core protection.
Democrats are pummeling Republicans running for House, Senate and governorships over their
rhetoric and record on repealing the law. Former president Barack Obama recently accused
Republicans of making up the claims that they will ensure coverage for people with preexisting
conditions.
“Now that it’s election season, [Republicans] are out there saying, ‘Well, actually we’re going to
protect people with preexisting conditions even though we’re going to cut health care,’ ” he said at a
rally in Las Vegas, adding: “I can tell you that they have no way of protecting preexisting conditions
with anything they propose. They’re just saying it. They’re just making it up.”
Trump’s vow to protect people with costly medical conditions contradicts his words and actions. On
Friday in West Virginia, Trump told rallygoers that his administration was “decimating” Obamacare
“strike by strike.”
He had promised repeal of the law on the first day of his presidency, though Congress was incapable of
acting that quickly. Months later, when House Republicans were forced to pull a repeal bill or face
defeat, Trump told The Washington Post that “the best thing is to let Obamacare explode and then go
make a deal with the Democrats and have one unified deal.”
After the House GOP muscled through a repeal bill in May 2017, Trump celebrated in the White House
Rose Garden with Republicans, then weeks later called the measure “mean.”
This summer, Trump’s attorney general, Jeff Sessions, backed an effort by 20 states suing to invalidate
the law, arguing in a legal brief that its coverage guarantee is unconstitutional. The basis for the lawsuit
from Republican attorneys general is last year’s GOP tax law that eliminated the individual mandate. A
federal judge in Texas heard arguments in the case in September but has not issued a ruling.
His administration’s support for the lawsuit has not stopped Trump from trying to convince voters that
Republicans will enact their own protections for sick people. “We will always protect Americans with
preexisting conditions — always,” Trump said recently at the White House.
Republican candidates in West Virginia, Missouri, Tennessee, Arizona and North Dakota have made
similar commitments as they seek higher office, drawing challenges from Democrats.
Last month, Missouri Attorney General Josh Hawley (R) cited his young son’s “hip, bone and joint
condition” to argue that he would protect those with preexisting conditions. Hawley is locked in a close
race with Sen. Claire McCaskill (D-Mo.) and has said he wants to do away with the Affordable Care
Act but find other ways to cover people who are sick.
Hawley, as state attorney general, backed the lawsuit seeking to invalidate the ACA.
“He made a conscious decision to do that knowing there was no backup,” McCaskill said.
West Virginia Attorney General Patrick Morrisey (R), who signed on to the same lawsuit, is
encountering similar attacks in his race against Sen. Joe Manchin III (D-W.Va.). “It’s wrong for Patrick
Morrisey to want to take away coverage from West Virginians like me,” said a woman in a Manchin
campaign ad who said she had a kidney transplant.
To parry the attacks, Morrisey tweeted, “We all agree pre-existing conditions need to be covered.”
Democrats are seeking to turn the tables on Republicans after the GOP used Obamacare for years to
shape its message and energize voters. The issue has dominated advertisements in federal races, with
the Wesleyan Media Project calling the 2018 vote the “Health Care Election.”
Republicans, especially in the House, have a long history of trying to repeal, dismantle or change the
ACA. The party came closest to enacting a replacement plan last year, when the House narrowly
approved a bill that would shift power to states to set key insurance rules and substitute tax credits for
the law’s subsidies to help people afford coverage.
The final measure would have allowed states to let insurers charge some people with preexisting
conditions more for their plans, which is not allowed under the ACA, and provided funds to help defray
their health-care costs.
The Congressional Budget Office later estimated that the bill would leave 23 million more people
uninsured by 2026, including many with preexisting conditions whose coverage would become
prohibitively expensive.
The issue has loomed large as House Republicans run for Senate seats this election. In October, Sen.
Heidi Heitkamp (D-N.D.) challenged her opponent, Rep. Kevin Cramer (R-N.D.), on his votes for anti-
Obamacare bills during a debate. Cramer had called the law an “unmitigated disaster.”
“You’ve voted five times to repeal the Affordable Care Act,” she said to Cramer. “. . . As we begin the
discussion on health care, we have to remember that these patient protections are critical to the life of
so many North Dakotans.”
Cramer responded by reading a section of the Republican bill stating that “nothing in this Act shall be
construed” as allowing health insurance companies to limit access to coverage for people with
preexisting conditions.
In Arizona, McSally has sought to fend off attacks from Rep. Kyrsten Sinema (D) over her health-care
votes. Sinema accused McSally during a debate of voting in 2017 to “repeal existing law, [which]
would have eliminated the protections for people who live with preexisting conditions in our country
today.”
McSally, who told Fox News’s Sean Hannity in October that she’s getting her “a-- kicked” for voting
for the GOP bill, called the charge a “flat-out lie” and “classic fear tactics.”
[The Health 202: Arizona’s Senate race illustrates Republicans’ health-care bind]
Sen. Dean Heller (R-Nev.), who is facing a challenge from Rep. Jacky Rosen (D-Nev.), has similarly
been put on the defensive.
“I wrote the bill, the repeal and the replacement bill for Republicans, that specifically added preexisting
conditions to it, because that’s how I feel about it,” Heller said at a debate.
“I have two children, two grandchildren with preexisting conditions,” he added.
Heller voted last summer for the GOP repeal bill that fell one vote short.
Wisconsin Gov. Scott Walker (R), whose state is helping to lead the anti-ACA lawsuit, said this week
that the charge that he wants to eliminate protections for preexisting conditions is the “biggest lie of the
campaign.”
Walker has long said he wants to get rid of Obamacare but find another way to cover sick people. But
on Thursday, he told reporters that he wants to enact the “same language” from the Affordable Care Act
to cover sick people in Wisconsin.
“No matter what happens in the courts or in the Congress, in Wisconsin we’ll codify that, the exact
same language that’s in the Affordable Care Act,” Walker said. “We’ll make sure everyone living with a
preexisting condition is covered here in the state.”
Democrat Andrew Gillum, who is running against former congressman Ron DeSantis (R-Fla.) for
Florida governor, has accused DeSantis of voting “over a dozen times” to repeal the ACA.
“He voted repeatedly to allow insurance companies to deny people with preexisting coverage. . . . That
is a fact,” Gillum said.
DeSantis has defended himself by pointing to his vote for the Republican bill. “If for some reason
something changes on [the] individual market protections, the court does something, I will happily
sign a bill to help folks with preexisting conditions here in the state of Florida,” DeSantis said during a
recent debate.
FDA approves powerful opioid despite fears of
more overdose deaths
The Food and Drug Administration approved a powerful opioid Friday for use in health-care settings,
rejecting criticism from some of its advisers that the drug would inevitably be diverted to illicit use and
cause more overdose deaths.
The opioid is five to 10 times more potent than pharmaceutical fentanyl. A tiny pill that is just three
millimeters in diameter, it is likely to worsen the nation’s drug crisis, according to critics and the head
of the FDA’s advisory committee on painkillers.
FDA Commissioner Scott Gottlieb issued an unusual statement saying he would seek more authority
for the agency to consider whether there are too many similar drugs on the market, which might allow
the agency to turn down future applications for new opioid approvals.
“We need to address the question that I believe underlies the criticism raised in advance of this
approval,” Gottlieb wrote. “To what extent should we evaluate each opioid solely on its own merits,
and to what extent should we also consider . . . the epidemic of opioid misuse and abuse that’s gripping
our nation?”
As the worst drug crisis in U.S. history has accelerated, agency critics and some public officials have
clamored for a holistic approach to narcotic painkillers, instead of the FDA’s practice of evaluating
each opioid application on its own.
Gottlieb has pledged the FDA would do more to balance efforts to curb the epidemic — which killed a
record 49,000 users in 2017, according to preliminary data — with the needs of people who need
strong pain relief. But Friday’s statement is the first detailed indication of how the FDA might use its
drug-review process to tackle the problem.
Gottlieb said he would bring a plan to the FDA’s Opioid Policy Steering Committee and perhaps
Congress. The guidelines would allow the agency to consider a narcotic’s benefit to public health, its
risk of being diverted for inappropriate use or abuse and its unique benefits to groups of people in pain
before deciding to approve an opioid.
“In this way, [drug companies] would know up front where the opportunities are for developing new
drugs that meet the FDA’s standards for safety and effectiveness,” he wrote.
A spokesman for the Pharmaceutical Research and Manufacturers of America said the organization
shares the “FDA’s commitment to reducing the risk of addiction and combating the opioid crisis while
also ensuring new treatments reach patients in need.”
The drug approved Friday is a 30-microgram pill form of sufentanil, a powerful, 34-year-old opioid
commonly used after surgery and in emergency rooms. Each pill, placed under the tongue for quick
absorption, would have the same impact as five milligrams of intravenous morphine. Each would come
in a plastic applicator that looks like a syringe.
The drug is intended for use within health-care settings and perhaps on the battlefield. It would not be
available in retail pharmacies.
The manufacturer, a California company called AcelRx, will market the drug beginning in early 2019
under the name Dsuvia, at a wholesale price of $50 to $60 per dose. A spokeswoman said the company
is not providing information on expected sales.
AcelRx already has approval for 15- and 30-microgram versions of the drug in Europe.
An FDA advisory committee recommended approval of the new drug in a 10-to-3 vote on Oct. 12. But
Raeford Brown, a professor of anesthesiology and pediatrics at the University of Kentucky who chairs
the committee, then took the rare step of publicly condemning that decision and urging the FDA to
reject the drug. Brown missed the meeting because he was speaking at a medical conference that day.
Brown, four U.S. Senators and the advocacy group Public Citizen have predicted Dsuvia will be
diverted to illicit use and cause more opioid overdose deaths.
“It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” Sidney Wolfe,
founder of Public Citizen’s Health Research Group, said in a statement. “It will be taken by medical
personnel and others for whom it has not been prescribed. And many of those will overdose and die.”
Brown added he has personally tried to resuscitate health-care providers who abuse sufentanil, “some
successfully.”
“Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts
to obfuscate and misdirect,” Brown said in his joint statement with Public Citizen.
The FDA says controls on drugs inside medical facilities are tight and the greatest risk of diversion is
among medical personnel themselves.
A 2016 survey conducted by the federal Substance Abuse and Mental Health Services
Administration(SAMHSA) shows narcotics are rarely stolen from doctors’ offices, clinics, hospitals or
pharmacies. Fewer than 1 percent of people said they acquired opioids that way.
The rate of overdose deaths among health-care workers is relatively high, however, according to an
August study by the Centers for Disease Control and Prevention, with 876 succumbing to prescription
opioids between 2007 and 2012.
Hundreds of millions of doses of prescription painkillers have been diverted from the pharmaceutical
supply chain to illegal users over the past 15 years. In many cases, illicit users obtain them from
friends, relatives or rogue doctors and pharmacists, according to the SAMHSA survey.
One factor that weighed heavily in the Dsuvia decision is military interest in the drug, Gottlieb said in
his statement. The military wants to explore whether the pill can be used as a battlefield painkiller that
is less cumbersome than liquid analgesics. The Pentagon has spent millions of dollars helping to fund
AcelRx’s research, public documents show.
“The FDA has made it a high priority to make sure our soldiers have access to treatments that meet the
unique needs of the battlefield, including when intravenous administration is not possible for the
treatment of acute pain,” Gottlieb wrote.
Pamela Palmer, an anesthesiologist, said she founded AcelRx to reduce the number of deaths caused by
opioid dosing errors in hospitals and ambulatory care centers. She said caregivers can make these
mistakes as they calculate the amount of clear liquid painkillers such as morphine to administer
intravenously.
“The FDA approval of Dsuvia is the culmination of nearly 15 years of research to improve the standard
of care for managing acute pain in medically supervised settings,” Palmer said in a statement.
Including brand name and generic drugs, there are nearly 400 opioids on the market.
The psychology of how someone becomes
radicalized
Before he walked into a Pittsburgh synagogue with three handguns and an assault rifle, authorities say,
professed his desired to “kill Jews” and opened fire, Robert Bowers was radicalized. He became an
angry white nationalist who authorities say killed 11 people in an act of hate.
Since the attacks of Sept. 11, 2001, and the rise of the Islamic State, researchers have intensively
studied what makes someone a terrorist and how people become radicalized. Arie Kruglanski, a
research psychologist at the University of Maryland, has found that although the subject matter of their
extremism may be different, the way in which neo-Nazis, the Ku Klux Klan and members of the
Islamic State evolve from merely disgruntled to violently angry is the same.
“It’s the quest for significance,” Kruglanksi said. “The quest to matter.”
For radicalization to occur, there are three necessary ingredients, according to Kruglanski’s research.
The first is the universal need to live a worthwhile life — to have significance. People usually satisfy
this need through socially accepted means, “like working hard, having families, other kinds of
achievements,” Kruglanski said. Radicals instead tend to place significance on their gender, religion or
race.
The second is “the narrative,” which gives someone permission to use violence. Kruglanski said the
narrative is usually that there is an enemy attacking your group, and the radical must fight to gain or
maintain respect, honor or glory.
The third necessary component is the community, or the network of people who validate the narrative
and the violence.
Bowers had all three pillars of radicalization, Kruglanski observed.
Before the attack, “he had very little significance — odds and ends jobs,” and no family, Kruglanski
said. His neighbors never interacted with him and he did not seem to have many friends. He does not
appear to have finished high school, and classmates barely remembered him. “But he was a white male,
and that made him part of a white majority.”
Kruglanski said that the immediate threat to Bowers’s significance, his white majority, was the caravan
of immigrants on its way to the United States, which prominent conservatives linked to the Jewish
community by suggesting that George Soros, a Holocaust survivor, was paying for and organizing the
caravan.
When someone or something threatens to take away “the only kind of significance these people have,”
Kruglanski said, “they are ready to sacrifice all other considerations and engage in a violent act, and
pay a very dear price for it.”
[Perpetrators of hate crimes see themselves as heroes, researchers say]
Tony McAleer, a former skinhead and organizer for White Aryan Resistance, said Kruglanski’s model
is “spot on.” Not only did he experience the search for significance, narrative and networking that got
him into hate groups when he was young, but he sees the pattern play out in the stories of other
“formers” as well.
“Although, there is some nuance,” McAleer said. “Everybody wants to belong, and sometimes there’s a
little serendipity to who you meet and who accepts you.” In some cases, the group itself might help a
person determine what their significance is.
Hate crimes are on the rise, hitting a new high in 2016, according to the Federal Bureau of
Investigation, which recorded more than 6,000 incidents that year. An independent study found a spike
in hate crimes specifically around the 2016 election. When someone with radical or conspiratorial
notions enters a position of authority, Kruglanski said, it can be a game changer.
“These politicians, like [President Trump], are giving the ideas credibility,” Kruglanski said. “It
legitimizes the narrative. It’s no longer a despised, fringe group — it’s part of the mainstream.”
And once someone is radicalized, it becomes significantly more difficult to reason with the person. At
that point, McAleer said, ideology and identity are intertwined. If you attack the ideology, you’re
attacking the person.
Instead, McAleer said, the person has to first disengage from the community before deradicalization is
possible. That’s how he went from an active white nationalist to a father of two and co-founder of Life
After Hate, a nonprofit that helps people leave radical groups. The small organization has just three
full-time employees in addition to its volunteers, and has been overwhelmed by the number of people
reaching out for help in the past year.
“Since Charlottesville, we’ve helped about 125 people,” McAleer said. The group is working on a
three-day training course to teach medical professionals and law enforcement about white nationalism
and give them tools to interrupt the process before violence happens.
Deradicalization, Kruglanski said, requires exposing the person “to a different, more pro-social
narrative, and particularly getting them attracted to alternative networks that give them respect.” He
said it’s not enough to shut down extremist websites and attempt to isolate a group’s members, because
that “allows them to stew in their own narrative."
Preventing radicalization also requires a decline in incendiary, hateful rhetoric, especially from people
they admire.
“There are many miserable people who have this quest for significance,” Kruglanski said. “Without the
narrative and without the group, they would be just that. Miserable.”