Can Your Physician Use Telehealth To Treat You When You're Out Of State?

 I was out-of-state when my doctor's office called to set up a telehealth appointment for me.  The date they wanted was when I was going to be back in Alaska.  I thought, wow, this is great.  If I'm out-of-state, I can still have an appointment with my doctor if needed.  

But they said, "No, you have to be in Alaska."  

For me, that makes no sense.  If I need a doctor when I'm not in Alaska, I'd rather see my doctor than a one I don't know.  [Of course if there's a need for physical contact or tests, it's not going to work as well.]  

So when I had my appointment, I asked, "Why can't we do this if I'm out-of-state?"

The nurse, the doctor, and the doctor's supervisor (this is through Providence) weren't exactly sure.  They'd been advised that it had to be Alaska only.  Licensing seemed to be a possible reason, but they weren't sure.  And they couldn't cite any documents I could see for myself.

Whether this was a state law, regulation, Providence policy or something else, they didn't know.  

So I decided I would try to track this down.  Here's what I've found out so far.

• During COVID emergency health declarations waived some interstate telehealth barriers, and much of what first pops up in searches are pandemic era webpages, some of which have dates on them.  
• A big issue IS the need to be licensed in the state where the patient is located
• Another issue has to do with payment for patients on the state medicaid or other health programs
• Some states allow out-of-state doctors to have telehealth appointments in their states, but the rules aren't easy to figure out for individual doctors.  There are various conditions one has to meet, and one has to be sure the source of information reflects the current law, that no changes have been made

Interactive at the site which appears
to be updated frequently

CCHP (The Center for Connected Health Policy) has some of the best information I've found so far.  Their Out Of State Providers page has a map that links to the policies for every state.  And they seem to keep it up to date.  One was updated this month.

For instance, here's what it says for Arizona:

"Arizona

Last updated 11/07/2023

A provider who is not licensed within the State of Arizona may provide Telehealth services to an AHCCCS member located in the state if the provider is an AHCCCS registered provider and complies with all requirements listed within A.R.S. § 36-3606.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Approved 8/29/23. (Accessed Nov. 2023)."

AHCCCS refers to Arizona Health Care Cost Containment System. The link isn't really that complicated, but if I were a physician, I'd want an attorney to read it.  

From HHS:

"Some states have temporary practice laws to support existing provider-patient relationships and minimize gaps in care. These laws allow a provider to practice for a limited amount of time, usually less than 30 days, in another state if their patient is temporarily visiting that state for business, a family visit, or other reasons."

This includes what I would be after - treating one of their regular patients who happens to be temporarily out of state. 

What states clearly or not so clearlyseem to allow out of state doctors not licensed in the patient's state to provide telehealth services to patients located in their state?  Go to the CCHP map page to get details for each state.

• Alaska
• Arizona
• Connecticut
• Georgia - "Physicians with licenses in other states may be licensed under the Interstate Medical Licensure Compact"  You can read more about this Compact here.  They also have a map that shows which states are in various steps in the process of joining the Compact.  
• Indiana - "Out-of-state providers can perform telehealth services without fulfilling the out-of-state prior authorization requirement if they have the subtype “Telemedicine” attached to their enrollment.  See Module for requirements."
• Kentucky - this one seems particularly liberal.
• Maryland
• Minnesota
• Oklahoma
• Oregon - Looks like a liberal policy
• South Dakota
• Vermont
• Washington
• Wisconsin

Most of the concern seems to be with the State reimbursing for services to Medicaid patients.  There are various conditions placed on out of state providers.  Note that I said 'appear to allow out of state" providers.  And there were some states that might allow out of state providers who are not licensed in the patient's state, but I couldn't really tell for sure.  

So, the problem doesn't seem to lie with the State of Alaska. 

The issue is 

• with other states - some do and some don't allow it, and those that do have different requirements
• with Providence for making a blanket policy rather than tailoring it to the states that allow for out of state doctors.  Providence should know which
• which states do not allow out of state doctors to have telehealth appointments with people in their states, 
• which states do allow it, and 
• what the requirements are for those that do
• with doctors who have licenses to practice in other states letting Providence know that

I would like to think this is simply policy that hasn't caught up with technology changes and not simply stodgy hospital administrators not wanting to change or lazily using the law as an excuse

But I also understand that collecting all the necessary data and keeping it up to date is somewhat of a challenge.  But I was able to do this in less that four hours, so someone in the Prov administration should also be able to do it.  Especially since Providence serves Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington.

Who Pays For It Scam? The Propaganda Campaign

This video is good.  It will take about 30 minutes of your time.  It's better to watch it, but go ahead and listen to it while you are doing other mindless tasks you can do without thinking.  Kneading bread, putting away dishes, working out, or if that's not your thing, baking a cake.  

I'm not even asking you to listen to the whole thing, because I think once you start it you'll watch the rest.  

He takes fairly complex stuff and makes it pretty simple.  BUT, since we all have been so programmed, you do have to think a little bit to understand the programming - Who Pays? - and how the question is only asked for social welfare issues and not for military spending or tax cuts, particularly tax cuts on corporations and the wealthy.  

Some key themes that come up:

• Long term programing through repetition of "Who pays?" and "What about the debt?"
• How this programming evolved - from trying to convince average folks (didn't work) to convincing news media and members of Congress (works).  
• How media then use the fake think tank 'experts' as 'experts' on news programs.
• How news media are either unable to counter these ideas or bought and paid for so the won't.  Even PBS and NPR get caught up in this.  

All done with humor.  Ideally, when you watch or read news, you'll think about this video and not be taken in so easily.  He's talking about the relentless attacks of "Who Pays For It?" for social programs but not other government expenditures.  But you should be thinking about framing on all the other issues as well.  

One thing that emerges in the video is how little viewers actually know about the background of the guests on most media news programs - don't know their past or even current involvement with organizations that have a vested interest in the topic.  So here's Maza's Wikipedia page to start your awareness of who he is.  

OK, Carlos Maza is no Hasan Minaj*, but probably if he had Minaj's budget, staff, and researchers, he might get there.  If you don't know who Minaj is, you can watch his Patriot Act series on Netflix which picks a national issue and gets rid of the smoke and mirrors so you can see the wizards behind each scam he covers.  More recently he did The King's Jester on Netflix - also fantastic.  Maza covers some similar ground, but technically at a much more basic level.   No Netflix?  Here's a bit of The King's Jester on Youtube.  Well, I just watched it so I wouldn't be steering you wrong.  This appears to be a show where he worked with some of the material for King's Jester, but didn't really pull it all together into the show that talks about the importance of standing up to powerful people. And the personal risks.  The King's Jester is terrific.  This Youtube piece is, well, okay.  

*I realize there is some talk online about Minaj not treating some staff well. But the reports are really vague. I'm not saying there is nothing there, but given the kinds of people Minaj takes on, one can also see them doing campaigns like this to cut off his message. Patriot Act was not renewed by Netflix.

Chinese Disciplined Doctor For Emailing About Corona Virus - What Will Happen Here?

A close Chinese-American friend showed me this document recently.  He explained it was the 'confession' letter of Li Wenjiang, the doctor who first notified his colleagues about the new virus.  He was 'confessing' to this act and promising to obey the laws.   I asked for an English translation which my friend has now provided.  (See below)

This has been on the internet a while, but I think it's important considering our president's assurances that (from the Hill)

"Trump said he was “not at all” concerned about the possibility of a pandemic.
“We have it totally under control,” Trump told CNBC. “It’s one person coming in from China, and we have it under control.”
“It’s going to be fine,” the president continued.
“We do have a plan, and we think it’s going to be handled very well,” the president told reporters. 'I think China’s in very good shape also.'”

The concern also arises from the message that Dr. Fauci at the CDC and an infections diseases expert sent to colleagues that he was told that all communications he makes about the virus go through the White House for approval.  I would note that Fauci and Trump have both denied that Fauci is being muzzled.



(If it's not clear, those red smudges are fingerprints.)

Translation:

Wuhan City Police Bureau, XXX Branch, Zhongnan Road StationLetter of Coaching and WarningName of the person whom is coached and warned: Li, WenliangSex: Male DOB. XXXIdentity card category and number: XXX Address (Location of the Official Household Registration): Wuhan City XXXXEmployer: Wuhan City Central HospitalIllegal behavior (time, location, participants, number of participants, issues on hand and consequence): On December 30, 2019, in the Wechat Group named “XXX”, announced the fabricated fact about 7 confirmed, diagnosed cases on Coronavirus from Huangnan Fruit and Seafood Market. Now, we follow the law to give you coaching and warning on your making false/fabricated statements on the internet. Your behavior seriously disturbed social order. Your behavior overstepped what the law permits, violating the regulation stipulated in the “People’s Republic of China Penalty Provisions on Security Management.” Your behavior is illegal!XXX [this is a name] hope you to cooperate and obey XXX’s coaching and advice. Can you stop your illegal behavior from now on?Answer: Yes, I can. We hope you will calm down and deeply reflect, and seriously warn you: if you stubbornly insist your opinion, do not show remorse, but continue to conduct illegal activities, then you will be sanctioned by the law! Do you understand?Answer: Yes, I understand. Name of the person whom is coached and warned: Li, Wenliang (signed). January 3, 2020.Name of the coach: XXX [this is a name]   Employer: Wuhan (Public Security) Bureau, XXX District, XXX Branch (Official Stamp). January 3, 2019 [2019 should be a typo]

I had some questions about the authenticity of the original document, even though I trust my source completely.  But this document is out there for many to see.  Here's a Business Insider article that includes the document.  

Today's LA Times has a long article about how the delay in dealing with the virus helped increase the death toll and how the lack of preparation led to medical workers dying - from the virus or from exhaustion caused heart attacks.  

It also mentions the doctor in this document - Li Wenjiang.  

Medical workers’ love for the motherland, Communist Party membership and self-sacrifice have become major propaganda themes after the death of a whistleblower, Dr. Li Wenliang , prompted unprecedented calls for transparency and freedom of speech in China.  (emphasis added)

 And how the government's praising of 'martyred' health care workers has met with a backlash on the internet.

"But some Chinese feel state media have turned medical workers into props.
One article by the Wuhan Evening News praised a 28-year-old nurse who went back to front-line work 10 days after a miscarriage, calling her a “warrior.” Many online commenters objected.
“Stop this type of propaganda! Stop putting unprotected medical workers on the front line,” one user wrote.
State channel CCTV also aired a report about a pregnant nurse only 20 days from her delivery date but still working in an Wuhan emergency ward, calling her a “great mother and angel in a white gown.”
Internet users, feminists and academics were furious.
“Hospitals should not be allowing a nurse who is nine months pregnant — or the one who’d had a miscarriage — to work. Their immune systems are weakened, and it’s highly possible that they will be infected with the virus,” feminist writer Hou Hongbin told the South China Morning Post.
Both nurse stories were deleted after the public backlash."

With all the intentional misinformation production in the US and elsewhere these days, it becomes harder for anyone to know what is

• True
• Speculation
• Misleading
• Intentionally misleading 

This sort of suppression of bad news behavior is very typical of authorities.  It certainly happened with Chernobyl, but it isn't limited to authoritarian governments.  The movie Jaws is a good illustration here.  As was Lyndon Johnson's hiding of US provocation that gave him the excuse to go to war against North Vietnam.  

This is an era where critical thinking skills are, well, critical.  

Exposing Trolls -BotSentinal: Easy Way To Check For Twitter Bots

There's a lot of fake news out there.  Even misinformation campaigns.  Knowing what is true or false is getting harder.

So we must be ever vigilant about any bit of news - on the mainstream media, on Facebook, Twitter, Instagram, or in real life.  Here are some questions to embed in your brain for filtering out the crap.

• Is it believable?
• Does it support what I would like to believe? (Then I need to be especially careful)
• Is it too strange to believe?
• Is it so believable I accept it as true without thinking?  
• Is it true?
• Use fact checkers like Politifact or FactCheck.org  (UC Berkeley has a good list.)
• Who said it?  (What bias do they have?  What's their record for lying?) 
• OpenSecrets.org shows who funds organizations and their biases.  You can also just google the organization (Natl XYZ reputation) to find sites like media bias fact check to give you additional information about the media or organization
• How can you verify it?
• Google the basic idea and see if others are reporting it?  Are they all of a certain bias?  
• Are there links to verify what they say?  Go to the links and see if they are reputable

So that's general advice.  But to specifically check on Twitter I'm recommending that you check out BotSentinal.  This link takes you to the BotSentinal page below.   Then go to the green link in the upper right hand

Then you get a popup window which let's you insert a Twitter account. (They use light grays which aren't showing up well in these screen shots, sorry.)  So, you put the Twitter handle you want to analyze in the box and hit submit.

Very quickly you get a response, like this one:

OK, so how do they figure this out?  They tell us that they aren't necessarily looking for actual bots.  They are looking for Twitter users who post like bots.  From their About Us page:

"We trained Bot Sentinel to identify specific types of trollbot accounts using thousands of accounts and millions of tweets for our machine learning model. The system can correctly identify trollbot accounts with an accuracy of 95%. Unlike other machine learning tools designed to detect “bots,” we are focusing on specific activities deemed inappropriate by Twitter rules. We analyze hundreds of Tweets per each Twitter account to determine if an account exhibit irregular tweet activity, engaging in harassment, or troll-like behavior."

For them, 'troll-like behavior' means behavior proscribed by Twitter.

"Researchers rarely agree on what someone considers a troll or what constitutes harmful bot activity, so we took a different approach when training our machine learning model. Instead of creating a model based on our interpretation of a troll or bot, we used Twitter rules as a guide when selecting Twitter accounts to train our model. We searched for accounts that were repeatedly violating Twitter rules and we trained our model to identify accounts similar to the accounts we identified as “trollbots.” Note: Ideology, political affiliation, religious beliefs, geographic location, or frequency of tweets are not factors when determining the classification of a Twitter account."

What do the scores mean?

"We rate accounts based on a score from 0% to 100%, the higher the score the more likely the account is a trollbot. We analyze several hundred tweets per account, and the more someone engages in behavior that is troll-like, the higher their trollbot rating is."

When benefit of this is:

"We feel since trollbot accounts are likely violating Twitter rules, most Twitter users would want to report and avoid these accounts because they offer little value to meaningful public discourse."

So that leads us to ask:  What are Twitter Policies here?

Twitter policies are complicated.  I couldn't find a simple list. Here's a link to their General Guidelines and Policy page.  It's just a set of links to other pages which give more specific rules for what you shouldn't do on Twitter.  I'm trying to bring what seem like some of the more important ones together here.

1.  Violent threats policyWhat is in violation of this policy?
Under this policy, you can’t state an intention to inflict violence on a specific person or group of people. We define intent to include statements like “I will”, “I’m going to”, or “I plan to”, as well as conditional statements like “If you do X, I will”. Violations of this policy include, but are not limited to:

• threatening to kill someone; 

• threatening to sexually assault someone;

• threatening to seriously hurt someone and/or commit a other violent act that could lead to someone’s death or serious physical injury; and

• asking for or offering a financial reward in exchange for inflicting violence on a specific person or group of people.

Probably they should add "encourage other people to do any of these things."  There's a lot more nuance on the page, but this is the gist of the Violent Threats Policy.

Next has to do with the content of your Twitter name and profile.

2.  Abusive profile informationTwitter Rules: You may not use your username, display name, or profile bio to engage in abusive behavior, such as targeted harassment or expressing hate towards a person, group, or protected category.
Rationale
While we want people to feel free to express their individuality in their profile names and descriptions, we have found that accounts with abusive profile information usually indicate abusive intent and strongly correlate with abusive behavior. The high visibility of profile names and descriptions also means that people might involuntarily find themselves exposed to threatening or abusive content when visiting a profile page.
When this applies
We will review and take enforcement action against accounts that target an individual, group of people, or a protected category with any of the following behavior in their profile information, i.e., usernames, display names, or profile bios:

• Violent threats

• Abusive slurs, epithets, racist, or sexist tropes

• Abusive content that reduces someone to less than human

• Content that incites fear"

3.  Glorification of violence policy   (You can see the bullet points here (I hope using the term bullet point isn't considered a glorification of violence) seem to be a collection of ideas from different people, and not carefully edited)

• You may not threaten violence against an individual or a group of people. We also prohibit the glorification of violence.
• Glorifying violent acts could inspire others to take part in similar acts of violence. Additionally, glorifying violent events where people were targeted on the basis of their protected characteristics (including: race, ethnicity, national origin, sexual orientation, gender, gender identity, religious affiliation, age, disability, or serious disease) could incite or lead to further violence motivated by hatred and intolerance. For these reasons, we have a policy against content that glorifies acts of violence in a way that may inspire others to replicate those violent acts and cause real offline harm, or events where members of a protected group were the primary targets or victims.
• What is in violation of this policy? 
• Under this policy, you can’t glorify, celebrate, praise or condone violent crimes, violent events where people were targeted because of their membership in a protected group, or the perpetrators of such acts. We define glorification to include praising, celebrating, or condoning statements, such as “I’m glad this happened”, “This person is my hero”, “I wish more people did things like this”, or “I hope this inspires others to act”. 
• Violations of this policy include, but are not limited to, glorifying, praising, condoning, or celebrating:
• violent acts committed by civilians that resulted in death or serious physical injury, e.g., murders, mass shootings;
• attacks carried out by terrorist organizations or violent extremist groups (as defined by our terrorism and violent extremism policy); and
• violent events that targeted protected groups, e.g., the Holocaust, Rwandan genocide. 

4.  How Twitter limits what content shows up in your searches.  Actions Twitter doesn’t like from accounts

(Current Twitter limits  These are not about what you say, but about how often you do things.)

"Please do not:

• Repeatedly post duplicate or near-duplicate content (links or Tweets).

• Abuse trending topics or hashtags (topic words with a # sign).

• Send automated Tweets or replies.

• Use bots or applications to post similar messages based on keywords.

• Post similar messages over multiple accounts.

• Aggressively follow and unfollow people.

Current Twitter limitsThe current technical limits for accounts are:

•  Direct Messages (daily): The limit is 1,000 messages sent per day.

•  Tweets: 2,400 per day. The daily update limit is further broken down into smaller limits for semi-hourly intervals. Retweets are counted as Tweets.

•  Changes to account email: 4 per hour.

•  Following (daily): The technical follow limit is 400 per day. Please note that this is a technical account limit only, and there are additional rules prohibiting aggressive following behavior. 

•  Following (account-based): Once an account is following 5,000 other accounts, additional follow attempts are limited by account-specific ratios."

For non-Twitter users, direct messages (DMs) are where you send a non-public message to another Twitter account.  I think they have to be following you to do that.  1,000 a day seems like a pretty high number for a human.

And 2400 Tweets a day also seems way too high a limit for a human.  That's 100 Tweets an hour - assuming you never sleep.  Most people can only do this pace if they have programmed their computer to automatically retweet other Tweets, I imagine.  As I tried to find the thoughts of others on this, it appears much of this is about using Twitter as a marketing tool.  Or propaganda tool.

In any case, those are the behaviors that BotSentinal says it's more-or-less trying to track to determine its scores.

There's A LOT more rules and guidelines.  This link will get you to something like a Table of Contents of Twitter Rules.

Oh, one more thing.  I checked on Donald J. Trump's Twitter feed.  This raises questions about how well BotSentinal works.  Or maybe they just give the President a lot more leeway.

Stephen Miller - Trump's Fanatic Racist Aide

I thought I had put up a post on Stephen Miller long ago, but I couldn't find it.  Eventually, I looked in my drafts - started posts I never posted and there was one just after Trump's inauguration that offered links to background on Steve Bannon, Stephen Miller, and Roger Stone.  I eventually covered Stone in one post, and Bannon.

The link on that page for Miller looked at his high school days and beyond.  He was clearly troubled already then.

I was reminded of that by this new piece from the New Yorker which looks at how he leads the extreme and cruel immigration policies.

"One participant in the November meeting pointed out that El Salvador didn’t have a functioning asylum system. “They don’t need a system,” Miller interrupted. He began speaking over people, asking questions, then cutting off the answers.
As the meeting ended, Miller held up his hand to make a final comment. “I didn’t mean to come across as harsh,” he said. His voice dropped. “It’s just that this is all I care about. I don’t have a family. I don’t have anything else. This is my life.”
Miller, who is thirty-four, with thinning hair and a sharp, narrow face, is an anomaly in Washington: an adviser with total authority over a single issue that has come to define an entire Administration. “We have never had a President who ran, and won, on immigration,” Muzaffar Chishti, of the Migration Policy Institute, told me. “And he’s kept his promise on immigration.” Miller, who was a speechwriter during the campaign, is now Trump’s longest-serving senior aide. He is also an Internet meme, a public scourge, and a catch-all symbol of the racism and malice of the current government. In a cast of exceptionally polarizing officials, he has embraced the role of archvillain."

"He asked to head the Domestic Policy Council, an influential but amorphous group inside the White House. The position gave him proximity to the President and insulation from congressional scrutiny; he would issue, rather than implement, orders. “The rest of us have to testify before Congress. That’s a check. If you’re going to have your ass hauled before Congress, you’re not going to feel comfortable breaking the law,” a former top Administration official told me. 'Miller will never have to testify for anything.'”

"In the days leading up to Trump’s Inauguration, Miller and a close associate named Gene Hamilton, another former Sessions staffer in his mid-thirties, drafted an executive order called “Protecting the Nation from Foreign Terrorist Entry Into the United States”—the travel ban.
When Trump signed it, none of the top officials at the Department of Homeland Security, which was in charge of enforcing the ban, had been notified in advance. Travellers with valid visas were suddenly trapped at American airports, unable to enter the country; refugees who, after years of waiting, had been vetted and approved for entry were turned back. Thousands of protesters and civil-rights attorneys began congregating at airports across the country, and Senators Graham and McCain issued a statement saying that “we should not turn our backs on those refugees who . . . pose no demonstrable threat to our nation, and who have suffered unspeakable horrors.” Jared Kushner, the President’s son-in-law and senior adviser, was enraged. The next day, when the President’s senior staff assembled in the Situation Room, Miller told John Kelly, the head of D.H.S.; Tom Bossert, the President’s homeland-security adviser; and officials from the State Department, “This is the new world order. You need to get on board,” according to an account in “Border Wars,” by Julie Hirschfeld Davis and Michael D. Shear."

While many of Trump's appointees have either seen themselves as people who could hold Trump back, or people just happy to be able to put their Trump service on their resumes, Miller is one who clearly has Trump's ear and pushes Trump towards his worst decisions on immigration.    

Article Not Quite Accurate When Comparing California And Alaska [Pot] Taxes

This might seem like a post on pot, it's really a post on journalism and packaging information.  A chart comparing pot taxes and a sentence referencing Alaska caught my attention in this Los Angeles Times article

"One year of legal pot sales and California doesn’t have the bustling industry it expected. Here’s why"

LA Times reports marijuana business in California is below expectations.

The second paragraph offers a list of reasons:

"But as the first year of licensed sales comes to a close, California’s legal market hasn’t performed as state officials and the cannabis industry had hoped. Retailers and growers say they’ve been stunted by complex regulations, high taxes and decisions by most cities to ban cannabis shops. At the same time, many residents are going to city halls and courts to fight pot businesses they see as nuisances, and police chiefs are raising concerns about crime triggered by the marijuana trade."

The article also has this chart comparing taxes in various states.

Chart from LA Times article

It's not clear from this chart exactly how Alaska's cultivation tax translates into a way to compare with California's sales and excise tax and its cultivation tax (1/5 of Alaska's) impact on prices.  It also leaves out the fact that local governments may add their own tax on marijuana.

• So I did a quick comparison to an Anchorage store and an LA store to see their on-line prices.  :

  Anchorage - Alaska's Green Light District

  Sativa

   Headband - By Parallel 64                       1G  $18

  1/8

  $55
• Cinderella Dream - By Parallel 64  

  1G

  $15

  1/8

  $50
• Pineapple Dream - By Parallel 64   

  1G

  $15

  1/8

  $50

LA's The Pottery offers:

Happy House (s) - KNBIS  1/8 = $52   (says it includes all taxes, though there's a 10% charge for credit cards)

Cherry Sherbert - Passiflora (S)  1/8 = $50loc

Cherry AK (S/H)  Glass House  1/8 $50


[I just picked a store online near me where I'm staying in LA, and an Anchorage store that popped up online. Alaska stores have to use Alaska grown pot so I really don't think I can compare 'brands' like I could with, say, soft drinks.  But I picked Sativas.https://www.leafly.com/news/cannabis-101/sativa-indica-and-hybrid-differences-between-cannabis-types    These links probably won't last long as products and prices change.  Here's a guide to the quantities pot is sold in.]

There's one reference to Alaska in the text:

"With nearly a tenth of the population of California, that state has more licensed cannabis shops — 601. On a per capita basis, Alaska has also approved more pot shop licenses than California, — 94 so far. The state imposes a tax on cultivation, but there is no retail excise tax on pot."

First, Alaska approved pot in 2014, it went into effect in February 2015 and the first pot shop opened in October 2016.  

California voters didn't legalize pot until two years later.  The first legal recreational pot shop didn't open until January 2018.


So Alaska had a two year head start on California.  So it should have more licensed shops.  Also it took nine months longer than California to work out its regulations and have the first shops open, so maybe that meant fewer problems.  Though a less populated and more isolated state is probably easier to regulate.

I'd also point out that last sentence, while factual, may leave the sense that the lack of retail taxes might make a difference on prices.  As my quick comparison shows, if there is a difference, it's probably not significant.  It also doesn't mention that in Alaska local jurisdictions may tax marijuana.

What's notable about Alaska (state) marijuana taxes is that it is based solely on volume, not price.  

The other issues listed in the article - local resistance, excess regulation, the illegal market - probably are bigger issues than the taxes in California.

About Pulling Out Of Syria

[I'm thinking out loud here, trying to bring disparate thoughts together.  Bear with me.]

It's not at all clear to me the costs and benefits of the US having troops in Syria.  I think finding ways to pull out of places like Syria, Iraq, Afghanistan, and ending support of the Saudi war in Yemen are important goals.

Ro Khanna, a Democratic member of congress from California, in this Washington Post piece,  supports President Trump's instinct to pull out of Syria, though he argues we need to do it in a way better coordinated with our allies, and in a way that uses leverage over Turkey's Erdogan that keeps him from massacring Kurds in the area.

He also mentions,

"We have spent more money in Afghanistan than we did in the Marshall Plan and continue to spend more than $40 billion each year."

The Marshall Plan helped Western Europe rebuild after the destruction of WW II.  It help lift their economy so Western Europe could help us defend against the Soviet Union as the Cold War ramped up and so they could buy American products, which helped repay what we spent.

Imagine $40 billion a year.  What could the US have spent that money on?  Helping with education and economic development in Central America so that the people there could make a living and build safe lives, so they wouldn't feel the need to flee over the US border.

Think of the US veterans who wouldn't be suffering from PTSD and other serious ailments, not to mention missing body parts.  War is only good for people who make money selling guns, planes, tanks, technology, and all the support items needed for soldiers to live and fight and die.

Think about all the fossil fuel that would not have been used. And how global warming would have been a little bit slower.   The Union of Concerned Scientists write:

"The U.S. military is the largest institutional consumer of oil in the world. Every year, our armed forces consume more than 100 million barrels of oil to power ships, vehicles, aircraft, and ground operations—enough for over 4 million trips around the Earth, assuming 25 mpg."

According to Wired, $40 billion a year is only 2/3 of what's needed to rebuild our infrastructure.

" $1 trillion sounds great, but it ain't enough, not if the country wants to keeping fixing roads ten years down the line. According a US Department of Transportation report, just maintaining current highways and bridges through 2030 will cost a cool $65.3 billion—per year. That’s being conservative."

You get the point.  If the Soviet Union, which borders Afghanistan could take control, how can the US do it from half-way around the world away?

Unfortunately, few people, and I know this includes many members of congress, don't have a comprehensive understanding of the factors involved in wars like the ones we're involved in.  We originally went to Afghanistan to punish those who killed 2,955 people on 9/11, 2605 of whom were American citizens.

Brown University's Cost of War study offers this summary of what we've unleashed* in return:

SUMMARY

• Over 480,000 have died due to direct war violence, and several times as many indirectly

• Over 244,000 civilians have been killed as a result of the fighting

• 21 million — the number of war refugees and displaced persons

• The US federal price tag for the post-9/11 wars is over $5.9 trillion dollars

• The US government is conducting counterterror activities in 76 countries

• The wars have been accompanied by violations of human rights and civil liberties, in the US and abroad

READ ALL FINDINGS

*I say 'unleashed' because the US forces didn't kill all these civilians, but the wars we've engaged in have.

Saddam Hussein was a ruthless leader.  Getting actual figures of the number of people his regime killed - civilians and and conscripted soldiers - is not easy.  As I look, numbers range in the hundreds of thousands - at least 300,000 and probably significantly more than that.  Some sources:

• State Department Summary
• The Scotsman
• Wikipedia

Surely, there are people alive who wouldn't be if we hadn't invaded Iraq.  But there are also people who are dead, who wouldn't be if we hadn't invaded Iraq.

I'd note this Brookings Institute (a liberal leaning think tank) prediction from 2002 about the costs of getting into a war with Iraq which I found while getting data for this post:

An invasion to overthrow Saddam Hussein would likely cost the United States about $50 billion, though it could plausibly range from $25 billion to $75 billion or so, with likely annual U.S. costs of maintaining order in Iraq ranging from $5 billion to $20 billion for a number of years thereafter. The latter costs of winning the peace, and associated wear and tear on American military personnel, may actually turn out to be a greater concern than the one-time cost of winning the war.

If only it had been so 'cheap.'

My point is, again, that the number of people who actually have looked closely at all the costs and benefits - economic, human, political, opportunity costs - is relatively few.  I'm not in that group.

It's clear to me though, that the money spent "fighting terrorism" could have been better spent creating opportunities for human beings - education, health care, economic development.  These kinds of initiatives would have created positive changes in people's lives and put the United States and the world in a much better place than it is now.

It's time people went back and read some of the old stories we were supposed to learn simple truths from.  For instance the story of B'rer Rabbit and the Tar Baby might be an apt story for the United States' war on terrorism.





I'd note that many such old stories are seen today as sexist or racist.  I suspected people hadfound reason to question the Uncle Remus stories.  So  I checked and they have.  But it's hard not to be racist if you grow up in the United States even today.  Joel Chandler Harris was born just before the Civil War in the South, so surely he had lots of racist tendencies.  But all that considering, it seems he was pretty progressive for his times, and the Uncle Remus stories seem to be a tribute to an old black slave Harris looked up to.  See this Pittsburgh Gazette article on Harris' life.

In The Unbelievably Racist World of Classic Children's Lit,   Malcolm Jones writes:

"The case of Joel Chandler Harris is particularly relevant in this regard. A lifelong southerner and an Atlanta newspaper editor (and incidentally a friend of Twain’s), Harris was probably as enlightened as a white person could be in his time and place. If you read his Uncle Remus stories, you’ll see that to Harris, Uncle Remus was a hero. He’s certainly the smartest and kindest person, black or white, in the narrative that frames the folk tales collected by the author from former slaves.
More important, had Harris not collected those folktales, we almost surely would have missed much of a vast trove of oral storytelling (“our most precious piece of stolen goods,” Twain called them—so that’s what we were getting away with!), because before Harris, no one else had the sense to realize how wonderful those stories were, much less that they should be recorded for posterity. Whatever sins he may have been guilty of, Harris knew at least that much. James Weldon Johnson called the 185 stories published by Harris 'the greatest body of folklore America has produced.'”  

He's not as kind to Disney's Song of the South, from which this clip was taken.

None of this changes my belief that the sooner we get Trump out of the presidency the better for the world and the United States.  And the Republicans who have had control of both houses of Congress since Trump became president, share the blame, because they haven't done their job as a check on the criminal* who is in the White House.

*I think that anyone who looks at the Trump organization and Trump objectively has to acknowledge that he has abused our laws repeatedly.