Vaccinated – Done

Round two of the Pfizer vaccine is complete. Only side effects are a sore shot area and some body aches and tiredness. Other than that, it seems all is OK.

Today ran smoothly. It was a mass event like my first one, both through the hospital system. I got there around 3:45 pm and was on my way after a 15 minute rest by 4:15 pm.

Thirty minutes plus thirty minutes of drive time round trip. So, I only invested one hour of time, a little gas money and $5 parklng. With only a few minor side effects.

If you are waiting, please do yourself a favor and help yourself, your family and everyone else.

Internal Bleeding – Be your own Health Care Advocate

The following post was written about nine years ago. Since that time, some of the changes noted below have taken shape, but the message remains important. Be your own health care advocate.

A few years ago, two doctors looking to improve the quality of health care in the US, wrote a book called “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes.” Since Drs. Robert Wachter and Kaveh Shojania wrote their book, improvements have and continue to be made, but with the concern over the US’ 38th position in health care quality, while being the most expensive system in the world (according to the World Health Organization), I think it is appropriate to belabor a few of their key points, in particular, being your own health care advocate.

In today’s world, we must be the navigators of any customer service we receive whether it is at a bank, the driver’s license office or in a retail store. We must be diplomatically relentless in trying to gain the service we expect and need to resolve an issue. Service providers, in particular those in a Call Center, need to stay on script as much as possible. When your problems get them off script, then your navigation diplomacy skills are needed the most.  I mention this as context for what we also must do in gleaning good health care service.

A few years back there was a study conducted by a combined group called the “Leapfrog Group” to improve the quality of health care in hospitals. Leapfrog came up with three major ideas – (1) Electronic orders were a must (poorly written prescription orders were killing people), (2) Intensive Care units need to always have a doctor on site and (3) Medical procedures of import need to be done in centers of excellence, not where a hospital may have done only a handful of surgeries in this area. “Internal Bleeding” echoes many of these same issues, especially the one on electronic order taking. Yet, they also go beyond these Leapfrog issues.

They noted that often times in hospitals, fewer critical questions are asked closer to the time of the procedure. Sometimes, the critical mistake may have occurred very early in the process. They used the analogy of all of the holes in Swiss cheese aligning to allow a mistake to pass all the way through. They used the example at Duke University where a famous heart transplant for a minor child occurred. The doctors at this very fine medical center, one of the best, were so excited when a heart of a young deceased donor became available, that they assumed others had checked that the type of blood of the donor matched the patient. It did not and the patient died. Similar examples occurred when doctors operated on the wrong leg, arm, kidney, lung, etc. The doctors failed to ask the very basic of questions and assumed these issues had been resolved.

In addition to the above and related to the Rx orders, the authors advocate the patient understand fully what is being done to them in the hospital or before they get there. They recommend you introduce yourself to every care giver who comes into the room, ask questions of them relative to medications you are being given and make them fully aware of other medications you are taking. They recommend if you cannot speak for yourself or are uncomfortable in so-doing, to delegate this important role to someone you trust. In other words, they are recommending being your own health care advocate. This will help minimize mistakes.

Health care is both a science and an art. It also is a trial and error business, so the doctors may not know for certain what is wrong with you and have to figure it out. They will do their best, but they do not know you very well or at all. So, you have to play the role of information provider and advocate.  Using the authors’ recommendation supplemented by other sources of information and experience, you must be your own health care advocate and do the following to get the care you expect and need.

– Write as good a summary of your and your family medical history as possible. Make it available to others you trust who may need to speak on your behalf.

– Before you see the doctor, write down your symptoms and questions as you may get stage fright when you see the doctor’s white coat.

– Do not be scared to ask questions, especially if you do not understand the diagnosis or remedy – he or she is there to serve you. I tell my kids you show your intelligence by asking questions, not by failing to ask.

– Get a second opinion on major diagnoses. For example, it takes a lot of practice to read a mammogram correctly and a non-inconsequential percentage of misdiagnoses occur. Using this example, computers cannot take the place of human fingers in doing a self-test. If you feel a lump and the first mammogram shows negative, get a second opinion.

– Make sure you inform your doctors and pharmacists what drugs you are taking. There are a number of drugs that contraempt the drug you need (make its use less effective) and some which are toxic when taken together. I ask my pharmacist questions all the time about some over counter drugs that may be harmful when taken with the prescriptions my family is taking, including me.

– Take your medications as prescribed and through the dosage. Many people stop taking their meds when they start feeling better.

– Be truthful with the doctor about your drinking and extra-curricular drug use. Doctors tend to believe patients understate their drinking, so help them out and tell them the truth. You drink more than you say you do.

– Make sure you get treatment for a major problem at a place that does a lot of what you need – a center of excellence. This is especially true with back or spinal surgeries and surgeries on any major organs. If you are having heart surgery, do you want it done where they have done 25 in the past year or 250, e.g? I have two friends who are having major back complications after spinal surgeries were done poorly.

– Get all the information you can around procedures to make informed decisions. In some cases, living with a mild discomfort with medication may be better than invasive surgery. Ask the doctor what are the options, what are the chances for success and what are the risks. If he/ she doesn’t know, ask him/ her with whom you can speak.

– Be diplomatically relentless with Call Center personnel at insurance companies. Mistakes do occur and sometimes you may be allergic to a substituted generic prescription. So, you can appeal a claim if you feel under-served.

– This one comes courtesy of Dr. Sandra Steingraber, an ecologist, biologist and cancer survivor. Family history needs to recognize your environment as well. She was adopted, but her bladder cancer at the age of 21, also occurred in other family members who lived nearby (as well as other cancers). Bladder cancer is a bell-weather cancer. It is largely caused by environmental toxins. If your family, neighbors or community has some longevity in an area and more than one or two bladder cancers have occurred, start doing some fact-finding. It may be more than a coincidence. Since people move around, showing environmental causes is difficult as the exposure may have occurred years before.

– Finally, take care of yourself in a sustainable way. Walk more. Reduce portions. Eat more slowly and ingest more calories earlier in the day. These measures can be sustained whereas diets cannot.

These are just a few ideas, but the key message is be your own health care advocate as you are the only constant in any equation about your health. If you feel you cannot serve this role well, please take a trusted friend or family member with you. Doctors and nurses are marvelous care givers, but they are not perfect. You have to improve their service by being present in the conversations. It is only your or your children’s lives.

Conservative pundit David Brooks – How Democrats Won the War of Ideas

As an independent and former Republican (and Democrat), David Brooks is one of my favorite conservative pundits and authors. He is a regular participant on PBS Newhour’s Friday recap show with the more liberal Mark Shields. Like other key conservative pundits, MIchael Gerson, George Will, Ross Douthat, Eric Erickson and Max Boot, he is hoping that America votes out the incumbent president.

In his usual articulate and even-handed fashion, Brooks penned the following editorial last week called “How Democrats Won the War of Ideas.” The link is below, but I will highlight a few paragraphs for your review and comment.

“Over the last 100 years, Americans have engaged in a long debate about the role of markets and the welfare state. Republicans favored a limited government, fearing that a large nanny state would sap American dynamism and erode personal freedom. Democrats favored a larger state, arguing that giving people a basic economic security would enable them to take more risks and lead dignified lives.

That debate ebbed and flowed over the years, but 2020 has turned out to be a pivotal year in the struggle, and it looks now as if we can declare a winner. The Democrats won the big argument of the 20th century. It’s not that everybody has become a Democrat, but even Republicans are now embracing basic Democratic assumptions. Americans across the board fear economic and physical insecurity more than an overweening state. The era of big government is here.”

Brooks cites a few survey facts from last week’s New York Times/ Siena poll.

2/3 of Americans support allowing people to buy health insurance through the federal government

2/3 support Joe Biden’s $2 trillion plan to increase renewable energy and build efficient infrastructure

72% of likely voters and 56% of Republican voters favor another COVID-19 relief package

59% of Americans think government should do more to solve problems

2/3 think government should do more to fight climate change

60% support increasing the minimum wage and providing tax credits to low income workers

82% of voters and 70% of Republicans would like to expand requirements for paid family medical leave

Brooks also cites a study by the Mercatus Center which notes that Republicans are also moving left, just not at the pace of Democrats. This is contrary to what is believed by the media.

I have long said that more than 1/2 of the Republican voters are voting against their economic interests and do not know it. This survey indicates many do favor policies that would help them, but are sold a bill of goods packaged to woo their votes, but mask the purposeful deterioration of rights and opportunities.

A great example is the Affordable Care Act. When people are surveyed about the features of the act, the features receive high marks from all, including Republicans. The only feature that did not was eliminated – the mandate to buy coverage. Ironically, this elimination is the basis for 25 Republican Attorney Generals who have case to declare the ACA unconstitutional in front of the Supreme Court after the election, which should not occur as the case is not solid, but one never knows with these things. Sadly, the White House chose not to defend the law, which affects expanded Medicaid, exchange and employer-provided benefits.

Please read Brooks article below. It is very well done, as per usual.

Two articles speak volumes

Two articles are worth noting as we head into the election. The first is “Trump’s handling of coronavirus pandemic hits record low approval: Reuters/Ipsos poll’ by John Whitesides of Reuters. Here are a few paragraphs.

“Americans are steadily losing confidence in President Donald Trump’s handling of the coronavirus pandemic, with his net approval on the issue that has dominated the U.S. election hitting a record low in a new Reuters/Ipsos poll.

The poll taken Tuesday through Thursday, after Trump’s COVID-19 infection and weekend hospitalization, found 37% of American adults approved of the president’s handling of the pandemic and 59% disapproved.

The net approval rating of negative 22 percentage points is the lowest in the poll dating back to March 2 and has steadily declined over the last 10 days, as Trump’s illness and his return to work in the White House dominated news headlines.”

The second article was reported by Randy Tucker in the Cincinnati Enquirer is called “Mitch McConnell says White House’s lax COVID rules are why he hasn’t visited since August.”

“U.S. Senate Majority Leader Mitch McConnell Thursday said he hasn’t visited the White House in two months because of what he saw as lax coronavirus practices. “‘ haven’t actually been to the White House since Aug. 6 because my impression was their approach to how to handle this (pandemic) was different from mine and what I insisted we do in the Senate, which was to wear a mask and practice social distancing,” McConnell said during an appearance in Northern Kentucky.“

These excerpts and articles speak for themselves. To be frank, while bad, I am surprised the disapproval rating of Trump’s handling of the COVID-19 response is not higher. We are just shy of 218,000 deaths in America, yet that does not seem to be a problem or a debate question worth answering. It just shows how little news actually gets to people that need to see it. That is what this independent voter thinks.

https://www.msn.com/en-us/news/politics/trump-s-handling-of-coronavirus-pandemic-hits-record-low-approval-reuters-ipsos-poll/ar-BB19Q8zM?ocid=msedgdhp

https://www.msn.com/en-us/news/politics/mitch-mcconnell-i-havent-visited-white-house-recently-because-of-lax-covid-rules/ar-BB19PyTp?ocid=uxbndlbing

Just a quick refresher on the ACA animosity in the Republican Party

Our friend Scottie asked me why the Republican Party detests the Affordable Care Act (ACA) so much and wants to kill it. I have written many posts about this, but here is quick refresher.

The Republican party has spent about ten years nay-saying the ACA. This is in addition to actual efforts to sabotage it by Senator Marco Rubio and President Donald Trump and the fourteen states who still have not expanded Medicaid. Rubio and Trump’s actions caused premiums to increase. Blue Cross and Blue Shield of North Carolina (BCBS of NC) said it was geared to have a 0% increase in 2018, but after Trump de-funded reimbursing insurers for co-pays/ deductibles for people making less than 2 1/2 times the poverty rate, BCBS of NC said it would have a 6.6% increase. Not only did Rubio’s action cause premiums to go up, it drove some insurers out of the exchanges lessening competition which also hurt consumers. *

So, to me the Republicans are so far down the path of killing something that is working pretty good (it still needs improvements), they cannot stop. And, it is apparent that Trump has an Obama obsession that he must kill everything that Obama did regardless of its level of efficacy. As a retired benefits consultant and former actuary, what the GOP came up with in 2017 to replace the ACA was god-awful. It was throw-against-the-wall planning. The fact the Republicans did not follow due process was a key reason Senator John McCain voted it down. Mind you, I fault Obama for the terrible roll out of the exchanges in 2013, but he at least involved Republicans in the planning process in very public sessions (although they were told not to vote for it).

And, here is the rub. The reason the GOP does not have a plan is the ACA is largely based on a Republican idea set in motion by Mitt Romney for Massachusetts, when he was governor. It worked so well, that Senator Jim DeMint, the leader of the Tea Party, advocated its national use in writing to President George W. Bush. And, DeMint politicked with Romney on stage in 2008, Romney’s first run for president. I recognize the ACA is not exactly the same as Romneycare, but there are a number of similar constructs.

Everything I mention above, including the DeMint piece can be found by Googling. But, here is the major concern I have. Employers have been going to more part-time and contract work forces even before the pandemic. Why? – to avoid providing subsidized health care benefits. So, to survive in this gig and part-time employment world, the ACA is essential.

Plus, the ACA imposes requirements on employer based plans as well that may go away if SCOTUS rules unwisely with the court case. Those include pre-existing condition protection, guaranteed renewability, no deductibles on wellness visits, and limitations on insurer margins in pricing, e.g. So, a bad SCOTUS ruling could impact over 200 million Americans not just those in the exchanges and Medicaid.

* Note: The reason for the premium increases are complex, so I will mention them here. Rubio led a Republican move to defund 89% of the payments to insurers for adverse selection (pent up demand for new policy holders) for the first few years, a process used when Medicare Part D was rolled out. Insurers were forced to increase premiums and some left the market with the US owing them money that was promised. The Trump change is more complex. By stopping the reimbursement to insurers for this extra benefit for low paid policyholders, the insurers still honored their commitment to the policyholders. This drove up premiums. Trump said this would only impact insurer profits, but that was not true. The CBO said it increased the annual deficit by $10 billion because the premium subsidies went up as well. The people who ultimately got screwed were those who did not get a full subsidy.

Letter to editor – health care actions speak loudly

I have written longer posts on the actions of Donald Trump, Marco Rubio and Republicans to sabotage the Affordable Care Act. What many do not know, after the election, a court case will decide its fate, brazenly brought forward by several Republican state AGs after Congress stripped away the coverage mandate during a budget vote. The following is a brief letter I sent to my newspaper.

The truth matters. Actions matter. Four years ago, Trump said we had to wait and see his healthcare plan. None existed and still does not. Three years ago Trump cut payments to insurers to fund their payment of co-pays and deductibles for ACA members making less than 2 1/2 x the poverty rate and then lied about its impact – it actually increased premiums and the deficit per the CBO.

After the election, SCOTUS will be hearing a case to rule on the constitutionality of the ACA premium subsidy after Republicans stripped away the coverage mandate, which would severely hamper the law and may lead to its end. The White House chose not to defend the law. The ACA impacts both exchange and employer benefits, three key provisions of which are allowing pre-existing conditions, requiring guaranteed renewability and requiring wellness doctor visits not be subject to deductibles.

Sadly, beyond the nay-saying, there has been more sabotage of the ACA which increased premiums (Google Marco Rubio and risk corridors), repeal and replace efforts which were fortunately defeated, and fourteen states (including NC and SC) who still have not expanded Medicaid, a key part to help people in poverty. Health care coverage access is a major issue this coming election so says this retired benefits consultant, benefits manager and former actuary.

Eliminating the ACA which which may impact over 200 million Americans  (including the ACA requirements on employer plans) is unwise in my view, in general. But, doing so in the middle of a poorly handled pandemic by the White House with over 200,000 and growing American deaths, is plain asinine and mean-spirited.

Please feel free to adapt and use. Actions speak louder than words and my former party, the GOP, has purposefully sabotaged the right for Americans to have access to health care coverage. This is why your vote matters.

Is this what a president for the common man does?

Many of the Trump base have no idea they are voting against their economic interests. This advertised populist, common man president, fails to let folks know the following:

– in his first two hours of being president, he repealed a regulation that would have reduced homeowners insurance premiums for securing mortgages with the less than 20% down, that was scheduled to go in effect February 1, 2017. This would have helped about one million low income homeowners.

– he has hobbled the Consumer Financial Protection Bureau that was very successful, but banks and credit card companies did not like it. The CFPB penalized these companies for fraudulent and aggressive lending practices, with 95% of the fines going to cheated consumers. In short, the CFPB helps folks who are targeted.

– he eliminated a new requirement that said all investment advisors have to be fiduciaries, meaning they must put your interests ahead of their own. This was done to help investment advisors, paid by the transaction, to encourage sales that may not be in your best interests.

– he passed a tax bill that favored the elites and businesses, under the guise of helping everyone. To keep the bill down to costing only $1.5 trillion in debt, he had to have some pay higher taxes – a sneaky requirement noted that state and local tax deductions were capped at $10,000, so if you owned a house and lived in a state where income tax occurred, your tax bill may increase. Note, folks who do not itemize deductions, tended to come out ahead with the change.

– he failed to tell people (actually lying about the impact routinely) the tariffs would be paid for by consumers when importers passed along the cost. He has routinely lied saying China will pay the tariffs, but that simply is not true. Each time he said this, economists would rebut his lie.

– he also lied about an ACA change he made that increased premiums for people, saying it would only impact insurer profits. In essence, he ceased the subsidy to insurers to repay them for paying deductibles, copays, etc. for members making less than 2 1/2 times the poverty rate. Insurers honored their written commitment (Trump did not) and subsidies went up to pay for the resulting increase in premiums. BCBS of North Carolina said premiums the next year were going to increase by 0%, but with the Trump change, they went up by over 6%. The CBO said the increase in subsidies increased the deficit by $10 billion per annum and unsubsidized folk saw premium increases.

– he has advocated a COVID-19 relief bill which will prevent employees from suing employers for endangering them with COVID-19 exposure.

– finally, environmental deregulation hurts those in poverty more, as they have fewer choices as to where to live.

There is more. With his attacks on the ACA, with a pending lawsuit that would harm it, more of Trump’s base will be harmed. Plus, with his misinformation and mishandling of the COVID-19 pandemic, more people are being harmed and dying. Of all that I mentioned, his callousness and negligence in COVID-19 handling is the most prominent failure that impacts people.

So, in turn for getting protection over gun rights and attacks on abortion access, the president has largely screwed over his base and they have no idea he has.

Supreme Court rules against a GOP effort to renege on owed payments to health insurers

On Monday, the US Supreme Court ruled against an effort of several years ago led by Senator Marco Rubio to shortchange health insurers money owed to them for accepting higher risk claimants early on under the Affordable Care Act. In essence, Rubio led GOP Senators to eliminate 89% of the funding under a risk corridor agreement to tie insurers through initial adverse risk (due to pent up demand from folks who were not previously covered).

The following excerpt from an article called “Supreme Court rules government must pay billions to Obamacare insurers,” by Susannah Luthi of Politico, may be of interest.

“The Supreme Court on Monday ruled the federal government owes health insurers massive payments from an Obamacare program shielding them from financial risks after the companies accused Washington of reneging on its funding promises.

The 8-1 decision could open the floodgates for federal cash to the insurance industry. Insurers who accused the government of a ‘bait and switch’ claimed they’re owed $12 billion from the Affordable Care Act program.”

The lone dissenting vote was from Justice Samuel Alito who said the insurers were getting a “windfall.” No, Justice Alito and Senator Rubio, they are getting what was promised in writing.

People could easily dismiss this as a fight that does not concern them. That would be a misjudgment. The Republican Senators led by Rubio screwed Americans to win a political argument in attempt to sabotage the ACA. Why do I say that? As a consequence, these insurers had to raise premiums that impacted unsubsidized folks and caused an increase to the offsetting premium credit under the ACA for the subsidized folks. That subsidy increase in turn increased our budget deficit. It also forced some insurers to exit the ACA with the US government owing them money, which hurt competition.

Sadly, all of the efforts noted above, which the Supreme Court just overturned, are true. That is a reason for the near unanimous vote. I encourage you to Google “Marco Rubio and ACA Risk Corridors” and read as much as you like. What frustrates this retired benefits consultant, manager and actuary is very few people know they got screwed. The following links to this article and one of my many pieces on shoring up the ACA are below.

https://www.politico.com/news/2020/04/27/supreme-court-rules-government-must-pay-billions-to-obamacare-insurers-211184

https://musingsofanoldfart.wordpress.com/2019/07/19/please-stabilize-the-affordable-care-act-now-to-help-americans/

Near universal health coverage achieved in six states and DC

An article by Michael Rainey of The Fiscal Times (see link below), called “How six states achieved near universal coverage” noted the success of covering at least 95% of their people. These six states are Hawaii, Iowa, Massachusetts, Minnesota, Rhode Island and Vermont. The District of Columbia also fits the bill. Per the article:

“A half-dozen states and the District of Columbia have health care insurance rates of over 95%, achieving near-universal coverage. Three researchers at the University of Pennsylvania — including Ezekiel Emanuel, a key architect of Obamacare — said Monday that the Affordable Care Act has everything to do with those results.

Here’s how the states achieved such high insurance rates, according to the authors:

Expanding Medicaid: States that expanded their Medicaid programs as allowed under the ACA had about half the uninsured rate (6.6%) in 2018 as states that did not do so (12.4%). ‘Nearly 5 million people would gain health insurance if the remaining 14 states expanded Medicaid,’ they write.

Extending enrollment periods: High-coverage states countered the Trump administration’s efforts to shorten enrollment periods and reduce informational assistance.

Lowering premiums: States enacted additional subsidies and reinsurance programs to keep premiums low, a crucial factor in maintaining insurance coverage from year to year.

Simplifying options: Some states limited the number of options available to counteract “choice overload,” which can reduce signups through consumer paralysis.

Maintaining individual mandates: Five low uninsured states maintain some kind of individual and employer mandates, which may help persuade healthy people to sign up.

The lesson, the authors say, is that near-universal health coverage can be achieved without national legislation. ‘While it is easy to dismiss the ACA and focus on the promise of Medicare for All, there is a more straightforward path to universal coverage,’ they write, ‘adopting a handful of relatively simple policies and programs at the state level can ensure health insurance coverage for nearly all Americans.’”

This article echoes what can be achievable if Medicaid is expanded and the other above steps are taken. The three states who drag the results down for the country – Texas, Florida and Georgia – did not expand Medicaid nor run their own Healthcare exchanges. Of the six states over 95%, it should be noted Iowa and Hawaii use the federal Healthcare Exchange, while the other four run their own exchanges.

I have long said Medicare for All is something to be explored, but it requires detailed analyses (and time) of its costs and impact. In the interim, I have strongly advocated improving the Affordable Care Act. The goal is access to care, in my view. The employment paradigm has been changing for some time, where fewer full-time workers are being used than before. We are seeing several industries move to a largely part-time workforce, such as in the retail, restaurant, and hospitality industries. We have seen contractual employment continue as well as the growth of gig economies. Health care access needs to come from somewhere.

What I do not care for is the hyper-politicization of this topic. Republicans (including the president) have actively sabotaged the Affordable Care Act, cutting funding to insurers, not mentioning the negative talk about it. It has still survived. Some Democrats choose to throw progress out and go full bore with Medicare for All. Again, that is a detailed undertaking and no candidate can accomplish this without buy-in from both parties.

So, let’s improve what we have. States who have not expanded Medicaid have been economically short-sighted and harmed their citizens. I have argued for repaying insurers who were harmed by the reneging on funding commitments, inviting them back into markets. Where choice is not available, introduce a Medicare option. I would also lower the eligibility for Medicare to age 60 or 62.

These are practical options that may move the needle upward like in those six states. Let’s talk about that.

https://finance.yahoo.com/news/6-states-achieved-near-universal-224827646.html

Two rising sea stories from today

In my newspaper today, two articles caught my eye about the impact of rising seas. The first is an editorial entitled “Rising seas eroding coastal property values,” written by Orrin Pilkey, the co-author of a study of this subject.

The other is an article called “Highest tide in 50 years swamps Venice,” by Elisabetta Povoledo of The New York Times. Beginning with the sensational, per Povoledo, “The Mayor of Venice, who said that the city ‘was on its knees’ has called for a state of emergency and the closing of all schools after the Italian city was submerged under…an exceptionally high tode – the highest in 50 years.”

At six-feet, the rising sea level in Venice waa the most since 1966. Yet, per the article, “Last year, as severe weather in Italy killed 11 people, ferocious winds drove the high tide in Venice to more than five feet above average sea level.”

In Pilkey’s editorial, the study was reported in his book with Keith Pilkey called “Sea level rise: a slow Tsunami on America’s shores.” “The First Foundation, a non-profit research group with flood risk, analyzed 13.3 million real estate transactions, and compared the results to 25.6 million properties along the east coast and Gulf coast of the US. They concluded that there was a $15.8 billion loss in home value appreciation between Maine and Texas from 2015 to 2017.”

Pilkey made reference to increasing “sunny day flooding.” They note the sunny day flooding will increase even more until it becomes more permanent. In essence the sea water comes up through the storm drains in the street leaving standing water. A key quote toward the end of the article is a warning. “I know that if my family were living in or near a sunny day flooding area, I would urge them to sell and leave.”

Low lying coastal cities are at great risk. Global climate scientists have long said the City of Miami is the most at risk city in the world. Miami Beach is already seeing many more days of sunny day flooding. The state that had the most property loss in value is Florida. I would hope the leaders of that state would be banging the drum the loudest. As for Venice, they rely so much on tourism. Yet, that future looks to be at grave risk given its low sea level status.

Note: Below are two links to these articles:

https://www.newsobserver.com/opinion/article237245139.html

Note further: A famous climate change “denier” in words does not match his rhetoric with his actions. Per a Politico article in May, 2016 entitled “Trump acknowledges climate change — at his golf course:”

“The New York billionaire is applying for permission to erect a coastal protection works to prevent erosion at his seaside golf resort, Trump International Golf Links and Hotel Ireland, in County Clare. A permit application for the wall, filed by Trump International Golf Links Ireland and reviewed by POLITICO, explicitly cites global warming and its consequences — increased erosion due to rising sea levels and extreme weather this century — as a chief justification for building the structure.” These actions support the concerns of the Pilkey study of property values being at risk due to sea level rise.