An Unconstitutional War on Preexisting Conditions

Since I am a Medicaid recipient due to having a pre-existing condition called Autism, the issue of healthcare is a very important to me. So much so that during the House of Representatives’ passage of the American Healthcare Act deeply troubled me that I was enraged, anxious, and inconsolable about the whole thing for a good part of 2017 summer. Anyway, one of the most important aspects in the Affordable Care Act are the protections for people with pre-existing conditions who consist of 130 million of the US population under 65. Because before the ACA’s 2010 passage, if a citizen had a pre-existing condition, insurance companies could reject them, charge them more, raise the rate once they’re enrolled, or even refuse to pay or cover for essential healthcare benefits treating that condition. And insurance companies often canceled coverage for people who became ill once the policy year ended. In fact, they often required applicants to fill out long questionnaires about their medical histories and made decisions based on people’s health and how much to charge. This led to so many Americans unable to purchase health insurance on the individual market at all. Obamacare outlawed all these practices and set limits on how much these insurers can charge.

On Thursday, June 7, 2018, the Trump administration filed a court brief arguing that Obamacare’s protections for preexisting conditions should be ruled unconstitutional. This opens another front in the White House’s crusade to roll back the law’s core insurance reforms and some of its most popular pillars. Not to mention, intensify the fight over healthcare just as mid-term elections are months away. Since Republicans and the Trump administration have been behind major efforts to sabotage the ACA, we can expect taking away protections for pre-existing conditions won’t do them any favors. For GOP ideas on healthcare have proven to be obviously and deeply unpopular among the American public. In fact, when the American Healthcare Act was up for debate last year, it faced strong opposition by the Democrats, the medical establishment, disability activists, celebrities, religious groups, civil rights organization, and most of the population in every state.

The brief was filed in a case brought by several conservative states arguing that because Republicans in Congress repealed Obamacare’s individual mandate penalty in last year’s tax bill, rendering it unconstitutional along with the rest of the ACA law. The lawsuit argued that without an actual fine for being uninsured, the mandate should be considered illegal under Chief Justice John Roberts’ rationale used to uphold the law in the 2012 lawsuit. He claimed that Congress can’t order people to buy insurance but it could imposing an uninsurance penalty fee, allowing the rest of the law to stand and take effect. Without the financial penalty, the Republican-led argued the requirement to buy insurance can’t legally stand. And since it’s so crucial to Obamacare, the whole law should be found unconstitutional, too. If you don’t understand this convoluted construct, you aren’t alone since neither do I.

Usually, a presidential administration defends the current law, but the Trump administration agreed with the states that the mandate and with it, the law’s rules prohibiting insurers from denying people health insurance or charging them higher rates should now be found unconstitutional. However, the Justice Department lawyers told the court that the rest of the law could stand, including the law’s massive expansion to millions of the nation’s poorest. Should the Trump administration’s argument prevail, insurers could once again be able to flat-out deny Americans insurance based on their health status. Since no amount of federal subsidies would protect them. Medicaid expansion will remain but the private insurance market would no longer guarantee coverage to every American willing to pay for it. Yet, according to a 2016 Kaiser Family Foundation analysis, a favorable ruling could result in 52 million Americans under 65 finding their access to health insurance at risk because of a wide range of pre-existing conditions like diabetes, cancer, autism, allergies, acne, toenail fungus, domestic violence, tonsillitis, bunions, hemorrhoids, pregnancy, and being a woman. Those who may be affected by pre-existing condition clauses may include police officers, firefighters, stunt people, test pilots, and circus workers. Striking down these provisions would be catastrophic and have dire consequences for many patients with serious illnesses. Not only would millions lose their coverage, but their ability to buy health insurance. If you have individual insurance and have suffered so much as a case of asthma, you have every right to freak out over the choices the Trump administration has made.

Of course, this argument makes absolutely no sense. When Congress adopted the individual mandate in 2010, it was an essential part of a broader scheme. But Congress is always free to amend and omit what they previously thought was essential, which is what they did when they nixed the uninsurance penalty. Sure the move was stupid since the individual mandate’s purpose is to get healthy people to buy insurance to spread the risk across a broader population and help keep prices lower for everyone. Get rid of the mandate, insurance premiums spike. But despite their idiocy to get rid of the mandate, they let the rest of the law stand. For a court to now reject that choice would be the worst kind of judicial activism. The Justice Department should’ve given an easy explanation and had a duty to do so. Since there’s a longstanding, bipartisan tradition defending acts of Congress whenever a non-frivolous argument can be made in their defense, which is certainly the case here. This brief squashes that commitment.

Nonetheless, the brief sends a strong signal that the Trump administration believes the central insurance reforms in the ACA should be totally undone. Already, the administration has taken regularly steps to undermine those rules such as expanding short-term plans that don’t have to comply with the reforms. But it’s now seeking a different avenue, outside Congress, to end them for good. Because we all know how congressional Republicans have failed to pass Obamacare repeal last year despite coming astonishingly close (only to be thwarted by 3 Republican senators). Of course, Donald Trump has promised he’d make sure all Americans get better, cheaper healthcare. Yet, he has done nothing to achieve that despite how his supporters give him credit when they benefit from ACA provisions. Still, we should know full well that Trump frequently makes promises to people to get what he wants only to frequently break them. Since he often has no intention to follow through to begin with.

Luckily, the litigation’s success is far from assured since many legal scholars have long thought the lawsuit is stupid. Because the higher courts who’ve upheld Obamacare against existential legal threats on several prior occasions won’t take it seriously. Besides, protections against pre-existing conditions remains one of ACA’s most popular provisions since 130 million Americans under 65 have them. Openly attacking them might lead to severe political backlash for Republicans during the mid-terms. Since it’s an election year Democrats already want to focus on healthcare. The Trump administration’s position doesn’t really change the legal ground much. Since the Democratic-led states had already stepped in to defend Obamacare in the case. Then there’s the fact several career federal lawyers withdrew from the case shortly before the brief was filed since they thought the Trump administration’s arguments were ridiculous. After all, they’re non-political civil servants whose job is to defend federal programs. These lawyers couldn’t sign the brief in good conscience or in consistent with their professional obligations. They defend programs they personally disagree with all the time.

Yet, health insurers are setting their Obamacare insurance rates for 2019. Some plans are already hiking premiums by 30% or more thanks to what Congressional Republicans and the Trump administration has done. This lawsuit and the administration engenders more uncertainty which won’t help. For any time there’s uncertainty about the future, insurers build an extra cushion into their premiums to make sure they get the profits while they can. In addition, removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, lead to higher rates for older Americans and sicker patients, and make it more difficult to introduce products and rates for next year. Some have even withdrawn from the business of selling individual insurance plans or may exit certain areas entirely. Such actions will harm millions of Americans, especially if they don’t qualify for Medicaid and don’t receive health benefits at work. Not to mention, throw the health insurance market further into chaos while eroding the massive ACA insurance gains.

Although the Affordable Care Act isn’t under immediate threat so far, the Justice Department brief represents a blow to its integrity and independence. Moreover, it also illustrates the Trump administration’s contempt for the rule of law, which isn’t surprising. Laws Congress passes and that presidents sign are the laws of the land. They’re neither negotiable or up for debate. If the Justice Department can just throw in the towel whenever a law is subject to a court challenge, it can effectively pick and choose which laws should remain on the books. That’s a flagrant violation of a president’s constitutional duty to make sure the laws are faithfully enforced. Do you want to live in a country where the Justice Department can use the flimsiest excuse to justify declining to defend or enforce a law? Sure there are cases where the DOJ has deviated from principle, they’re extremely rare.

Is there any precedent for this? I’m sure Donald Trump’s defenders will talk about the Obama administration’s decision not to defend the Defense of Marriage Act. But with DOMA, the Justice Department faced a question about the meaning of the Constitution with deep resonance for the values we share as a nation. As we no longer believe it’s constitutional to deny interracial couples the right to marry, the Justice Department concluded that we as a nation, no longer think it’s constitutionally tenable to deny equal rights to LGBT people. Whether you agree or disagree with that decision, it was rooted in the public’s evolving sense on what the Constitution meant.

However, this case with the ACA pre-existing condition protections can’t be more different from DOMA. The question isn’t whether a penalty-free mandate is unconstitutional. This is a critical question on “severability” which doesn’t represent a clash of fundamental constitutional values or defines who we are as a nation. Besides, the conservative states’ argument is laughably weak. It’s unlikely that the Supreme Court will adopt such a flimsy argument these conservative states have advanced which they pulled from their own ass. For now, nobody needs to worry about losing their health insurance since the Trump administration will keep enforcing the ACA as litigation progresses. Yet, by declining to defend that law, the Trump administration has admitted it doesn’t care about a law passed by Congress and signed by the president. In fact, it has contempt for the law and has a baseless argument for casting it aside. A rule by whim should frighten you.

In any case, regardless of what these conservative states argue in this lawsuit, I sincerely believe invalidating protections for pre-existing conditions is cruel and inexcusable. The guarantee that people should be able to buy health insurance regardless of their health history is a popular provision in the divisive ACA with considerable support throughout the political spectrum. So there’s nothing controversial about them. To say that provisions protecting people with pre-existing medical conditions like myself are unconstitutional flies in the face of logic for me. Considering they protect over 130 million Americans, it’s more likely that revoking provisions on pre-existing conditions would be unconstitutional under the 14th Amendment’s Equal Protection Clause, which provides that no state should deny any person within its jurisdiction equal protection under the law. I’m not sure if it means that insurance companies can’t discriminate against people on health status or gender. Yet, since this clause has been used to determine that businesses can’t discriminate against race or sexual identity, I don’t see why not. Because without these protections, over 130 million Americans would be uninsurable in the individual market. Thus, individual mandate or not, health insurance companies can and should be compelled to cover everyone regardless of pre-existing conditions. Again, I’m not sure if this is a sound legal argument. But since I see healthcare as a civil right the government should protect, I don’t see why attorneys shouldn’t argue that point in court. Since the federal government is supposed to protect Americans against discrimination, in which these pre-Obamacare pre-existing condition clauses certainly fall under that. I mean that’s discriminating against sick, old, and disabled people along with women and LGBT people, especially if they’re poor and unable to pay the costs out-of-pocket. And even if I can’t provide a sound legal argument, I can make a case of basic morality that no American should be denied health coverage for any reason whatsoever since I strongly believe that healthcare is a civil right the government should protect. Sure, this might mean that for-profit healthcare is a morally indefensible travesty like it does for me. But if we should determine that provisions protection those with pre-existing conditions are constitutional, shouldn’t an argument based on simple fairness and decency be enough?

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The Children at the Border

Undocumented immigration has been a contentious topic in the American political landscape. But the more I know about the subject, the less I agree with current US immigration policy. At the end of May, a viral hashtag asking #WhereAreTheChildren sprang up on Twitter after the New York Times reported that the federal government hasn’t been able to make contact with 1,475 minors awaiting deportation hearings who many dub as the so-called “missing.” But despite reports to the contrary, these children aren’t really “missing.”

According to immigration experts, these children aren’t in government custody nor are they supposed to be. In fact, these are unaccompanied minors arriving at the US border without parents or adults who immigration authorities have detained and largely released into the care of parents or other close relatives. The government recently tried reaching about 7,600 of these children with a single phone call each. In 1,475 of these, the phone calls went unanswered.

But immigration advocates don’t find the 1,475 unanswered phone calls to the sponsors of unaccompanied minors particularly concerning. Because there are plenty of reasons why families might miss a phone call like boring logistics and more widespread fears of the federal government. A lot of these families have a pay-as-you-go phone number.

However, immigration advocates aren’t spending a lot of time worried about #WhereAreTheChildren. Instead, they think they worry significantly more about the Trump administration’s new policy of separating undocumented families apprehended at the US border. This policy has already led to more than 600 children being separated from their parents. And they fear it will create traumatic situations for families and overwhelm the very immigration infrastructure put in place to protect these minors.

On May 7, 2018, the Trump administration announced that it would begin separating all families apprehended at the border trying to cross into the US without documentation. An increasing share of border crossers seeking asylum come as “family units” consisting of at least one adult with one child. Though the Trump administration refers to them as “purported family units” as if to imply these people are lying about their family relationship. For it’s much harder for the government to detain whole immigrant families than it is to detain adults. Federal court rulings have set strict standards on the conditions under which families can be detained. Under the Obama administration, courts ruled that the government can’t keep families in detention for more than 20 days.

However, the Trump administration’s solution that’s now codified in policy is to stop treating them as families. This means to take the parents as adults and place the children in the custody of what Health and Human Services refers to as “unaccompanied minors.” In some cases, according to immigration lawyers, parents separated from their children have begged to withdraw their asylum applications. So they can easily reunify their families in their home countries. Attorney General Jeff Sessions has described this as a “zero tolerance” policy. As he noted, “If you cross the border unlawfully, then we will prosecute you. It’s that simple.” When pressed by NPR whether this policy was “cruel and heartless,” (which it is), White House Chief of Staff, John Kelly answered, “The children will be taken care of — put into foster care or whatever.” This is another way of saying, “we don’t give a shit what we do to them. We just want to use them as a bargaining chip to get them and their parents out of the country.”

But for families facing the prospect of “foster care or whatever,” the reality can deeply devastating. The Houston Chronicle once reported of a 28-year-old father separated from his 18-month-old son last summer at the southern border, crossing without documentation. The Guatemalan man mortgaged his land back home to fund his sick toddler’s hospital stay and needed to work in the US to pay off the loan. But border patrol agents arrested him for coming back after having been deported for a felony. They placed the toddler in a federal shelter, “somewhere in Texas” while the father was deported 3 months later. The man still doesn’t know where his child is to this day. Yet, hundreds of these situations play out as we speak for families trying to cross into the United States. The Trump administration estimates that it’s apprehended 638 undocumented adults trying to cross the border since the new separation policy began. They were traveling with 658 children. This is beyond other family separations that have happened. According to the New York Times, before the Trump administration announced the new policy, there might’ve been as many as 700 family separations. Keep in mind these people haven’t been convicted of crimes. Many are coming to the United States seeking asylum from the horrific violence in Central America, particularly in Guatemala, El Salvador, and Honduras, which has increased 16-fold since 2011, according to UN estimates.

Obviously, immigration advocates are worried about what these separations mean for the undocumented minors going into the United States. The most glaring is the trauma of losing parental contact, especially for the youngest kids. For these children in government custody, their main concern is how fast they can get to the person they see as a family member. For young children, it’s all they can think about. And these detention centers can be a tough place for children to live. Sure, they might have a bit of an education program. But even low-security facilities have barbed-wire fencing around them and monitored communication with those outside. This isn’t good for a kid. Most of the detained minors will be released into the care of a close relative as per the goal for those arriving unaccompanied and those separated from their families. Though those separated from their families might face more challenges since their parent is in government custody. According to ICE, unaccompanied children usually spend 51 days in these facilities with 93% released into a guardian’s care like parents and other close relatives.

But even then, separating families at the border could mean this group of children have a worse chance for making a case for asylum in the United States. Advocates worry about 2 distinct hurdles. First, the separation policy leads to more unaccompanied minors in the country and more children vying for limited attorney services from the pro bono firms typically taking their cases. Already, less than half of those kids get representation. That could have real effects on children since those receiving representation are 73% more likely to win in deportation hearings, compared to just 15% of those without. In addition, children are less able to defend themselves against deportation hearings when they can’t contact their parents. Because their folks likely know better why they believe their kids ought to get asylum in the US and be carrying the paperwork to back it up. Because the adults often know the full story since they’re with the kids the whole time as well as carry documents like birth certificates or police reports. But once these kids are separated, obtaining asylum is a lot harder mostly since the parents often face criminal charges in court at the same time.

Nonetheless, immigration advocates are torn on how aggressively should track unaccompanied minors like whether there’s actually a problem that there isn’t more than a phone call made to ascertain these kids’ whereabouts. On one hand, they want to make sure these unaccompanied children are getting the services and support they need like representation as they move through court proceedings on their immigration status. On the other hand, they worry about aggressive monitoring these children if the US means to use that information as a means to surveil unaccompanied minors to get info they could use against them in their deportation hearings. And because of all the other ways the Trump administration is enforcing these types of laws and policies to serve quite restrictive ends. If keeping track of these kids isn’t done with a more holistic goal of keeping these children safe and healthy (which is very likely), then we should be very disturbed by it.

Now the Trump administration didn’t start this humanitarian crisis. But it’s indeed exacerbating it. Members of the administration have framed the new policy as a way to deter families from entering the United States. As Sessions told a disturbed conservative radio host, “If people don’t want to get separated from their children, they should not bring them with them.” Donald Trump and the attorney general have erroneously leveraged the argument that “the law” is responsible for their own administration policies like family separation on the border. In reality they’re using their legal defense as a smokescreen to justify their inhumane immigration policies and to increase immigrant detention and deterrence. They assume that if they frame the policy as being, even if there’s no law requiring it, most Americans will follow.

However, legality isn’t equivalent to morality. The US has a long history of glaringly obvious xenophobic legislation and precedent. Numerous policies have excluded particular groups, most prolifically from Asia with their basic purpose to preserve a white homogenous United States. This systematic oppression and exclusion of immigrants has always been legal. Implementing a family separation policy to deter undocumented immigrants arbitrarily tears the sacred bond between parents and children. Such actions are brutal, offensive and abysmally fail to conform to notions of fairness and decency. The United Nations have formally called out the US for violating human rights standards over policy, which has attracted protestors in more than 2 dozen cities and 40 senators calling the administration out on it. With every single US policy like the Trump administration’s “zero tolerance,” we must ask ourselves: What is this policy’s real motivation? How will this affect those targeted? And is it morally just or unjust? If it’s unjust which I strongly believe, then we have a moral responsibility to counteract. And the first thing we must do is vote out whoever is responsible for creating them and their enablers. Immigration policies tearing families apart should never stand since it’s sheer cruelty. So now I ask my fellow Americans, where is your outrage?

The Clear and Present Danger of Donald Trump

In early June, the New York Times reported a 20-page memo written by Donald Trump’s legal team and delivered to Special Counsel Robert Mueller. In it, they make an unusually frank case for a tyrannical interpretation of presidential power. Its key passage is one where Trump’s lawyers argue that there wasn’t anything shady going on when their client fired then FBI Director James Comey. In fact, there isn’t even any potential shenanigans going on because the president is allowed to be as shady as he wants to be while overseeing federal law enforcement. Thus, he can fire anyone he wants as well as shut down the investigation or open up a new one. As they wrote:

“Indeed, the President not only has unfettered statutory and Constitutional authority to terminate the FBI Director, he also has Constitutional authority to direct the Justice Department to open or close an investigation, and, of course, the power to pardon any person before, during, or after an investigation and/or conviction. Put simply, the Constitution leaves no question that the President has exclusive authority over the ultimate conduct and disposition of all criminal investigations and over those executive branch officials responsible for conducting those investigations.”

Essentially all presidents sooner or later will lawyer up to draw up an expansive view of presidential power. But those lawyers usually argue that they’re not making the case for a totally unchecked executive whose existence poses a fundamental threat to American values. But Donald Trump isn’t that kind of president. Instead, they offer a particularly extreme version of the “unitary executive” doctrine that conservative scholars sometimes appeal to especially when there’s a Republican president. This draws upon the notion that the government’s executive branch, including federal police agencies and federal prosecutors are a single entity personified by the president. However, pushing this logic into such terrain not only gives Trump free rein to persecute his enemies which are many, but also nullify the idea there are any enforceable laws at all.

Of course, Richard Nixon once argued that whatever the president does isn’t illegal which is similar to Donald Trump’s legal defense, making him guilty as sin in the Russian meddling case. However, the United States was built on the very concept that nobody is above the law no matter how powerful that person may be, especially the president which is embedded in the US Constitution. So considering what happened at Watergate, I don’t think this defense will fly because that’s just contrary to American values. Yet, such decision isn’t up to me to decide. Furthermore, Trump has always thought himself above the law even before he was president or at least that the laws don’t apply to him. Call it a rich man’s entitlement, but his rationale has nothing to do with the job he currently occupies.

But should the courts think this memo correct, then there would be nothing wrong with Donald Trump setting up a booth somewhere in Washington DC where rich people can hand him checks in exchange for making any legal trouble they have go away. Think of it as a “Trump Hotel” where corrupt CEOs can check in a room with the legal impunity which has plenty of disturbingly unfortunate implications for the American people. Once Trump cuts these rich guys a check, they’ll have free rein to commit bank fraud, dump toxic waste, or whatever else they want to do at poorer Americans’ expense. A mob boss can get the feds off his case. And so could the perps of the next Enron fraud or whatever else. Since Washington DC’s criminal laws all fall under federal jurisdiction, perhaps most egregiously, Trump could have his staff murder the opposition party senators or inconvenient judges and subsequently block any investigation into what’s happening. Sounds despotic?

Of course, the memo notes to an extent that this kind of power to undermine the rule of law already exists with essentially unlimited pardon power. Such power has never been a good idea which has been abused in the past. George H.W. Bush used it to kill the Iran Contra investigation. Bill Clinton used it to win his wife votes in a New York Senate race. Donald Trump has started using the pardon power abusively and capriciously early in his time in office and in a way that’s quite disturbing. But he has yet to try to pardon his way out of the Russian investigation because this power has one crucial check. That the president has to do it in public and we know Trump doesn’t want to arouse suspicion. Thus, the only limit on his pardon power is a political check which is quite real (explaining why Clinton and George H. did their questionable pardons as lame ducks). Not to mention the theory that Trump can simply make whole investigations disappear would eliminate it.

Nonetheless, much of the argument about Donald Trump and the rule of law rather narrowly pertains to the particular case of Comey’s firing and the potential future dismissal of Robert Mueller. Indeed, these are important questions in the sense that an FBI Director is an important person and a special counsel investigation is an important matter. Yet, the memo is a reminder that they offer too specific view can be easily explained. For one, Trump has always believed that due to his wealth and fame, he can and should be able to get away with whatever he wants. As he told Billy Bush in that bus “And when you’re a star, they let you do it. You can do anything.” Sure he said this in the context of assaulting women. But he’s also carried that philosophy in regards to running his businesses. Since his list of power abuses and unethical business practices is simply mindboggling and staggering. And I’m sure he sees himself above the law in regards to the presidency as well. Thus, looking at his life, Trump doesn’t see himself above the law because he’s president, but because he’s Trump.

But more importantly, one of government’s main purposes is protecting the weak from exploitation at the hands of the strong by making certain forms of misconduct illegal. Donald Trump’s assertion that he can simply waive away investigations into misconduct over worries that they may end badly for his rich friends and family is toxic to the entire scheme. Like most presidents, Trump has plenty of rich and powerful friends and a much longer list of wealthy and influential people who’d like to be his friends. At any rate, in the most unlikely scenario, if Trump really does have the power to make anyone’s legal troubles go away when he feels like it, we’re all in deep trouble.

Chindogu Made in Japan

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Whenever I do posts on strange gifts or other products for certain things and occasions, I’ll always find weird stuff from Japan. After all, this is a country known for its innovation, especially in fields you really can’t imagine or didn’t think were necessary. Not to mention, it’s a very crazy place. Since you’ll find plenty of outrageous stuff pertaining to this Asian island nation called “the land of the rising sun.” There are articles pertaining to its strange food combinations that would make you barf. There are some stuff on an annual phallus ceremony that you wouldn’t want to take your kids to. Sure, I’m positive every country has some degree of weirdness as I’ve talked about Russia’s playgrounds that seem straight our of horror movies to their clearly photo-shopped wedding photos. But Japan seems more associated with craziness than most countries since they’re quite wealthy, known for innovation and technology, and have some bonkers ideas on how to apply it. Not to mention, they have a penchant for cuteness and bright colors. Sometimes this can go well since the country doesn’t have a lot of landmass and densely populated cities. But sometimes it doesn’t. In fact, the Japanese have a word called Chindogou, which is the Japanese art of inventing gadgets that are seemingly useful but too absurd to use. So for your reading pleasure, I give you a treasury of crazy products from Japan.

  1. When it pours, best to go out with an umbrella dome.

Now you don’t have to worry about coming in soaking wet again. Though you might receive a lot of attention from onlookers.

2. This Kenzan scalp massager will provide you with sweet relief.

Not sure if I’d want to put that on my head. Those spikes might just mess up my hair if I use it.

3. Take your produce with you in this Wondrous Bra.

Look, there’s no harm in making farming sexy. But I’m not sure if you can easily pull this off.

4. With this zebra crosswalk, you can stop traffic wherever you go.

Though I’m not sure if that’s even necessary. Besides, you can just look both ways to cross. Then again, this might be for city dwellers.

5. Now you can apply lip gloss with these toilet key chain dispensers.

Well, it might serve a practical purpose. But why would you want to get lip gloss from a toilet? That seems gross.

6. These training heels will ease your way to adult footwear.

So they’re just high heels with wheels. I don’t know about you. But I don’t see how walking in high heels is like riding a bike.

7. You will always stun with this Japanese makeup mask.

And by “stun” I mean turn men into granite a la Medusa style. Or receive compliments for your Stepford Wife Halloween costume.

8. Let your kitty relax in this cooling cat bowl.

From Trend Hunter: “The cooling pet product looks like any other bowl, but it’s equipped with refrigerant-like equipment that makes sitting in it far more refreshing than the average pet container. It’s designed to be extremely comfortable and with the recent heatwaves hitting Japan, it’s hardly a surprise that this cooling cat pot is already selling out fast.” Not sure if that’s even necessary.

9. Tone your boobs with this Breast Gymnastics Hand Massager.

Okay, this is kind of disturbing. Not sure if I’d want to use a grabby hand to massage my breasts.

10. These smartphone umbrellas will keep your iPhone dry at the beach.

Well, I guess this could be quite useful. After all, people use their smartphones all the time.

11. Don your fingers with these adorable hedgehog rings.

Hey, I told you about the Japanese obsession with cuteness. Though I’m sure to gag at the opossum ones since they’re ugly.

12. Smooth eye wrinkles with this Eye Recovery Anti-Aging Heating Cooling Gadget.

Yes, I know we all get wrinkles when we live past a certain age. But come on, an eye wrinkle gadget is just a rip off.

13. With this inflatable smartphone holder, you never need to set yours down for a bath.

Man, Japan is really cashing in people’s smartphone addictions. Yet, at least this one goes with a pillow. Though I’m not sure how many people take baths these days.

14. Exercise your lungs with these horns.

You know those horns from birthday parties. Well, Japan has a long one to exercise your lungs. So go ahead and blow your heart out.

15. Keep your skin fresh at to monster mash with these monster masks.

If I want a Halloween mask, I’ll just buy one at a party store. It’s cheaper. Not slather one on my face to keep out black heads and pimples.

16. Anyone could adore these hamburger monster lamps.

Turn it on in the dark, you can see its eyes and teeth. Not sure if it was tested to frighten babies.

17. Smell like a whopper with some Burger King perfume.

I don’t know if I’m like most women. But I don’t find the smell of cheeseburgers sexy. Quite the contrary.

18. Have hours of fun with this Tutti Bako finger game box.

From Incredible Things: “Each stage features something you interact with by poking it. Stick your finger in the box and a digital representation appears on the screen mimicking your motions. From what we can tell the various stages of the game include terrorizing a tiny stick man, poking a girl in the face and flicking a tiny panda.”

19. Nothing spells fun like Hex Bug Robot Cockroaches.

Available in an array of bright colors. Guess this was in an attempt to make these disgusting creatures cute. Not sure if it works.

20. Want to know what’s inside a horse or a fish? Get these Gotichi Dissection animal toys.

From Incredible Things: “The Gotochi Dissection animals display a diagram of the muscles and organs inside of a variety of animals including fish, pigs, cows and even a panda. All the parts are labeled, in Japanese of course. We suppose they could be used as tiny “cheat sheets” in Japanese biology classes, but we can’t figure out any other possible reasons to want one.”

21. Keep your kid’s soul in line with this God Jesus robot.

From Incredible Things: “Because literally everything in Japan is actually a robot… This strange all knowing Japanese toy debuted in the 80’s and answered your questions in a magic 8-ball style. God-Jesus robot only knows what the designers of this toy were thinking when they made it.”

22. Help your little one go to the bathroom with a Shimajiro Toilet Training Tiger.

From Incredible Things: “Maybe it’s us… maybe the way we approach potty training in the US is a bit conservative, but on the other hand Japan seems to have the weirdest approach we could possibly imagine, complete with animated poop and talking toilets. The Shimajiro videos feature an animated tiger struggling with potty training and his animated personified waste. The accompanying toy attaches to the toilet paper roll holder and yells out encouraging phrases while you go.”

23. Keep your skin dewy and healthy with the Panasonic Beauty Premium Booster Mask EH-XM10.

So you can kick back and relax as this mask does the work. Still reminds me of something from a sci-fi movie.

24. Now men can slim their faces with this Germanium Kogao Sauna Mask to avoid plastic surgery.

You mean they have these Hannibal Lecter masks for men? Great for any beauty conscious psychopath with a penchant to serve man. And I don’t mean in the brotherly sense.

25. Your chests will change color when you wear these Frozen bras against each other.

Okay, this is just messed up. Frozen lingerie that changes color when people bump against each other? That’s crazy.

26. Now you can rest your eyes and head while traveling with this King Eye Pillow Mask.

Because when you travel, you got to have a pillow over your eyes. Though I normally don’t have one when I’m sleeping.

27. Make bath time fun with the Chat Tororin Bathing Toy.

From Neatorama: “Do you find yourself wishing you had someone to talk to while you bathe? Now your bath time can be blather time with the Chat Tororin Bathing Toy, a talking buddy for your tub.” Not I’d think that would enhance the bath time experience. But whatever.

28. Show your kids how to brush their teeth with this  Jaws-Kun Puppet for Toothpaste Guidance.

From Neatorama: “Teaching kids how to properly brush their teeth is hard since we don’t have flip top heads, and that set of plastic choppers sitting on your dentist’s desk is downright creepy, so a puppet with a full set of teeth makes sense. But did the final product have to be so creep-tastically adorable? I don’t know if I want to brush its teeth or burn it with fire!”

29. Let your child spend hours of fun at Russian Roulette with Kappa Kick.

Gives your child all the fun of Russia Roulette without the mess and lethality. Yes, it seems to make this kind of deadly action you might see from The Deer Hunter like fun and games.

30. Love cats and got cat allergies? Get this The Yume Neko Venus Robotic Cat.

From Digital Trends: “For those who have cat hair allergies, and don’t mind the cold dead stare of a machine, you’re in luck. The Yume Neko Venus Robotic Cat will give you the sensation of petting a tuft of moving, purring fur with none of the added benefits of owning a real cat whatsoever. No shots required.”

31. Now you can bring a baby doll to tears.

From Digital Trends: “Can’t you imagine the enthusiastic commercial voice over for this toy: ‘Arm puncturing action! Cries real tears! Satisfies your child’s deeply disturbing desire to inflict pain on another being!'”

32. Keep cool at work in this air-conditioned shirt.

Though to be fair, most workplaces already use air conditioning. Though it’s great for wearing when you’re working outdoors.

33. Keep track of your kids with Docotch.

From Lifebuzz: “Docotch – a smart watch specifically for your kids to wear that lets you know where they are at all times along with what condition they may be in.” Whether you’re a free range or helicopter parent, this is for you.

34. Help your feet to a nice hot spring sauna bath with this wooden box.

You can take it anywhere where there’s an outlet. You can even use it near the bed or in the living room.

35. Everyone can use a hand rest now and then.

This is especially the case since the Japanese are known to take naps at work. Yet, this guy seems like he’s relaxing.

36. Finally, you can now print stuff from your iPhone.

I’m sure you didn’t know you need this. Still, you wonder why they don’t make these all the time. Oh, wait, this one only prints in black and white.

37. Keep quiet during shut eye with some snoring tape.

Yes, this is snoring tape which you put on your mouth. Not sure how that works.

38. Know when an earthquake’s coming with this home seismograph.

To be fair, Japan gets a lot of earthquakes, some of which are devastating. Still, if you live in California, this is for you. If I have the money, perhaps I might want to send some of these to my favorite celebrities.

39. With these glasses, you can capture HD camera photos.

So these glasses have tiny cameras on them. Wonder if spies use them or not.

40. Friend Zone tent is the perfect one for a couple who’s not quite willing to cross second base.

From PC Mag: “The Friend Zone Tent is billed as ‘the perfect outdoor accommodation for a couple who might not have reached that intimate stage yet.’ It is said to be super easy to put up and then take down, unlike the actual friend zone.”

41. See the words of your favorite song float with Lyrical Gangster.

From PC Mag: “You might know all the words by heart, but it’s still something to see them float by on the LCD of the Lyric Speaker. You have to be making rock-star money to afford it, though, since it’s $4,000.” Okay, seemed great while it lasted.

42. Hide the sweat in your pits with this Thanko Electric Armpit Clip-On Cooling Fan.

From PC Mag: “If tensions or temperatures get too high, consider the Thanko Electric Armpit Clip-on Cooler Fan, which will save you from unsightly sweat stains.” Still, I’m sure it doesn’t come cheap.

43. Ward off mites with this special futon dryer.

From PC Mag: “Did you know that in Japan people use special futon dryers to ward off mites? WHY DID NO ONE TELL US? How long have you had that futon? Throw it out! Buy a new one. And 1,000 futon dryers. Buy all the futon dryers.”

44. Turn the beat down with a silent karaoke machine.

From PC Mag: “Do you love to karaoke but don’t want anyone to hear you? Wait, what? With the Noiseless Karaoke Mute Mic 2, only you are subjected to your rendition of ‘Natural Woman.'” Still, isn’t the part about having everyone hear your rendition part of the point of karaoke?

45. Tired of hard butter destroying your toast? Try the butter grater.

Since why do you need to grate butter? It’s soft enough to use on bread for God’s sake.

46. If you’re not sure whether it’ll rain or not, take this tie umbrella.

For when you have to walk to the office and keep in mind about the weather. And yes, you can wear it around your neck.

47. Keep your eyes moist with these eye drop funnels.

That way, you won’t have to worry about missing your eyes again. And yes, it looks incredibly ridiculous.

48. If hearing aids can’t do the trick, try these hearing enhancers.

Because how else are you going to hear anything and look like a moron. Seriously, I don’t think anyone would want to be caught dead in these. Still, you can pick up satellite signals from space while phone reception is great, too. Though yelling would make your ears bleed.

49. Keep yourself dry with this rain-proof umbrella.

For those rainy days when you have a nice business suit that you don’t want to get wet. Because if rain isn’t what you need to worry about, it’s those pesky cars running through puddles.

50. Want to know what your ear looks like inside? Try this Ear Explorer.

Of course, you don’t want the inside of your ear to resemble a nativity scene. Cue Radar from M*A*S*H.

51. Relieve stress with this bubble wrap keychain.

That way, you won’t have to worry about popping all the bubble wrap. Fits into any purse for your convenience.

52. This 360 degree camera gives you panoramic shots.

Though you just have to put it on your head and use the controls. I know it’s ridiculous. Seriously, if you want a panoramic shot, there’s software for that.

53. Protect your shoes with a pair of shoe umbrellas.

Because you can’t have your shoes dirty by cars running into puddles. Still, you can always wear galoshes or wear different shoes on the street.

54. Need a friend to scratch your back? This T-Shirt should help.

Just use the card to point to where it hurts. And then have your friend scratch at that spot on your shirt.

55. A mobile toilet paper roll is always there when you need it.

Did I say it goes on your head? Sorry about that. Though this girl uses hers to blow her nose.

56. Fallen asleep on the subway while standing up? Use this chin strap.

Not sure if that’s practical on the subway. But then again, it seems to work for her.

57. With this sound catching pillow, may you always hear the TV when you lie down on the floor.

That way, you don’t have to worry about missing a thing. Still, I don’t think lying down in front of the TV is a big deal, hearingwise.

58. Know when your noodles are hot with Cupmen.

As it cooks, part of it turns white and eventually falls down. I’ve seen a diagram. Still, cup guy kind of reminds me of a pose from Flashdance for some reason.

59. Go green with your smoking with this solar energy cigarette lighter.

It’s just a magnifying glass you hold to the sun to light your cigarette. So you can get all the goodness of a cardiac and respiratory diseases along with an early death.

60. Fall asleep on the subway? Use this public transportation helmet.

Contains a sign telling everyone when they should wake her up. So she doesn’t miss her stop. Includes suction cup for window.

61. If you’re a man and you’re too tired to pee standing up, this knee rest is right for you.

Whether you need to go on the toilet or the urinal, this rest will help you. Yet, they don’t have a similar one for women, I have no idea. Oh, wait, we pee sitting down.

62. With this splash protector, you won’t have to worry about food getting in your hair again.

You wear it around your face to keep your food from splashing. Guess this happens when you’re eating with chopsticks. Not sure about eating with a fork. Though a pony tail holder is just as handy.

63. Count down to the big day with this pre-wedding lingerie.

Not sure why anyone would need this. I mean it’s lingerie. It’s not like anyone would see it. Guess it goes with an Everlast chastity belt.

64. Wear this dress, you won’t need to worry about stranger rape.

Knowing that you’re more likely to be raped by someone you know, I don’t think this disguise will protect you from rape. But the vending machine get up is clever.

65. Why keep a shed when you can have a Swiss Gardening Tool.

Yes, it’s a Japanese invention. But it’s inspired by the Swiss Army knife with garden implements. So hence the name.

66. Cutting your toenails is a breeze with this device.

From Picuno: “How much time have you wasted clipping one toenail at a time? You’ll never get those minutes of your life back. But you don’t have to waste any more. Have you ever clipped your toenails too far and they hurt for like forever? That’s going to happen a lot more now. You may even lose some toe meat. It will be worth it though. You’ll be able to take one more cat nap with the minutes you’ll save over a lifetime.”

67. Wash while you walk with these shoes.

From Picuno: “Wish that your washing machine wasn’t so stationary? Now you can take your laundry on the go. All jokes aside, why on earth would you need this? We’ve all forgotten to do Sunday-night laundry. But what would be the point of washing on your way to work? And how would you dry them? We’re not even going to talk about the fact that there’s only room for underwear in there. These give a whole new meaning to the walk of shame.”

68. You don’t want to mess with these tacked gloves.

From Picuno: “It’s universally human. When we’re bored at work, we put our chins on our fists. This device will make sure you never do that again. If you forget, you’ll get a few friendly spikes to the face. That seems reasonable. We’re actually thinking of giving this to our employees. We’ll definitely make them mandatory. They’ll never doze off during our meetings again. And anyone who does will wear facial scars of shame.”

69. Now they have those denim jean shorts for men.

From Picuno: “We didn’t know there were never-nudes in Japan. This is great news. No one should have to resort to jorts in the shower.
These blue jean underpants promise to chafe like the real thing. You don’t even have to butcher your favorite pair of jeans. Has any one told Dr. Funke about this? We think he’ll be excited. We’re going to wear ours while watching Arrested Development re-runs.”

70. Stretch out those wrinkles with this mouth exerciser.

From Picuno: “No, this is not a photo from a ransom note. It’s a mouth exerciser. It’s for those pesky wrinkles around your mouth. You just cram it in your gob and fight the urge to panic. And then you squeeze on the tube to tighten your…mouth muscles. Try not to think about the fact that you look like a blow-up doll. Laughing with this in your mouth can be dangerous. And you do not want to have to explain yourself to the EMTs.”

71. Want to sleep and make people think you’re awake, try these eyes.

From Picuno: “These are stickers for sleeping at work. On the bright side, your boss won’t think you’re asleep. On the other hand, he may think that you’re a dangerous sociopath. Could you imagine walking by this guy’s desk? “John? John?!” If John’s not careful, he’s going to wake up to a security detail at his desk. Or an EMT. These belong firmly in the bad idea box. Unless you’re going to use them at home. That’ll teach them to wake you up in the morning.”

72. Keep yourself warm with this huggable microwaveable pug.

From List 25: “The super umbrella may protect you from the rain but what are you going to do when it gets cold? Forget blankets, Japan has this adorable pug to heat you up. Stick in the microwave and Voila! Out comes a toasty hot dog.”

73. Don’t go to the bathroom without these toilet shoes.

From List 25: “Japanese are famous for their strict hygiene habits and sanitary precautions so it should come as no surprise they have something like toilet slippers which are used to minimize contact between the unclean toilet floor and the clean floor of rest of the house.”

74. Keep your ass clean with Washlets.

From List 25: “Washlets or, as many people tend to say, “crazy Japanese super toilets” are electric toilet seats with a water spray feature that cleans your bum hole and genitalia. While the Japanese are totally used to this zesty feeling, foreigners getting a shot of water up their butts are usually startled to say the least.”

75. This Barack Obama action figure came with his samurai store.

Man, I miss this guy as our President so much. Luckily he has a katana to slice the Cadet Bone Spurs one apart.

76. Look stylish and block out noise with these ear plug earrings.

From Web Urbanist: “Wearing these earrings might just serve as a warning to those around you that if they start to bore you with their irritating stories or demands that you file those TPS reports right away, you can block them out within seconds.”

77. Reach out for more food with this Extendo Spoon.

From Web Urbanist: “Here’s an invention that’s truly almost useful – can’t you imagine needing something like this when camping, for example? The spoon extends so you can reach the bottom of a tall jar.”

78. Like to wipe off food from your pants. Get napkin pants.

From Web Urbanist: “Since you’re too lazy to use a real napkin anyway, you might as well spare your pants the grease marks and get yourself a pair of classy Napkin Pants.”

79. Get a thumb on things with an Extra Nail.

From Web Urbanist: “You can almost hear an infomercial excitedly telling you that you’ll never break another nail. Need to peel an orange? Open a letter? Pierce someone’s jugular? Why carry around ice picks or letter openers when you can wear a Halloween prop?”

80. Keep your runny nose in check with Booger Keepers.

From Web Urbanist: “Perhaps this is the alternative to the Toilet Roll Hat: plugs for your nostrils.” Kind of resembles a couple of screws inside to me.

81. Keep your hands out of harm’s way with this handy chopper.

From Web Urbanist: “Don’t cut your own fingertips off when you could sacrifice someone else’s.” Let’s hope it’s not from a strangler or a serial killer.

82.  Color Me Shave allows you to shave with any color of cream you want.

Though I’m not sure if a guy would want to shave with hot pink shaving cream. Seems more appropriate on women’s legs.

83. Bleach your asshole with Pinky Wink Butthole Bleach.

From Topick Craze: “Butthole bleach MyPinkWink – This product does not need any explanations. But ‘MyPinkWink’? Seriously, Japan?”

84. Cool yourself outside with a pair of air-conditioned pants.

The kind of pants worn by construction workers. Comes with an air-conditioned jacket.

85. Wear fan glasses so you won’t have to cry when cutting onions.

This pair has fans on it. Sure it might help you cut onions. But will make you seem ridiculous in the kitchen.

86. Save energy with this foot hairdryer.

Unfortunately, you probably won’t get your hair dried in time for work. So you’ll be wearing this thing on the street for onlookers to laugh at.

87. Record your baby’s sound with this womb monitor.

Look, I understand that parents want to record special moments in their kids’ lives. But this is a bit too soon so to speak.

88. Brush your teeth with this finger brush.

So how does brushing your teeth with your finger work exactly? Because I don’t get it.

89. Wake up to a pair of alarm earphones.

You can program it to vibrate whenever you want. Though you’d be hitting the snooze every 5 minutes when it does.

90. It always helps to have a pillow on you at all times.

Sure she might seem like she’s straight from your nightmares. But at least she’ll be comfy.

91. Know what you’ve burned when you need a cab with a Taxi Walker.

From Kick Vick which says it’s, “A device that not only tells you how many calories you burned at the end of your walk but also how much money your journey would have cost in a taxi.”

92. Keep your office supplies in one place in this tie.

That way, you’ll have everything on you. Literally. Still, might weigh you down.

93. This will collect all the rainwater you need.

Consists of a pipe, upside down umbrella, and a large water bottle. Now you can collect water as you walk.

94. Snap a picture in the rain with this camera umbrella.

Seems like the Japanese have an umbrella for everything. Even for cameras and iPhones.

95. Look far in the sun with these long-range sunglasses.

Comes with telescopes you can look through. And yes, people will think you’re crazy wearing these. But you can watch your neighbors in the shower and don’t have to worry about the sunlight blaring.

96. Keep your feet cool with these air-conditioned shoes.

With all these air-conditioned clothing stuff, you’d think the Japanese live in their outfits. Yet, this guy seems happy.

97. Don’t have room to sit on the subway or bus? Use this stool.

Well, you have to sit somewhere. And I can see where a stool like that comes in handy.

98. Guys, keep your money safe in your wallet tie.

That way, nobody will steal your wallet. But you’ll have to change it sometimes.

99. Work out a sweat in this water walker.

I’m sure this doesn’t come cheap. It’s basically a combination between a treadmill and a swimming pool.

100. Use your pee for these urine batteries.

Yes, these are a thing. And no, I’m not making this up. Because this wouldn’t be something I could come up with. And yes, it’s disgusting.

Blood on Shameless Hands

While most of the media was fixated on ABC canceling the Roseanne revival show over its star, on Tuesday, May 29, 2018, the New England Journal of Medicine released a study by Harvard and other institutions suggesting that Hurricane Maria’s ultimate fallout was over 4,600 “excess deaths” Between September 30 and December 31, 2017. This is twice the mortality of Hurricane Katrina and makes Maria the deadliest disaster on US soil for more than a century. The only other US disaster with a higher death toll was the Galveston, Texas hurricane which resulted in 6,000-12,000 people dead. Yet, the real tragedy here is that these deaths were largely due to delayed medical care as well as lack of necessities such as electricity, water, and cellphone service. Nevertheless, this new finding stands in stark contrast to the government official count of 64 which is a gross underestimate that has remained unchanged for months. But the new research validates previous analyses of mortality data and reports from the ground by journalists and other researchers who found the death count well above 1,000.

When Donald Trump visited Puerto Rico nearly 2 weeks after the storm hit on October 3, 2017, the official death count was just 16, compelling him to insist that Puerto Rico wasn’t a “real catastrophe” like Hurricane Katrina. As he said, “Everybody watching can really be very proud of what’s taken place in Puerto Rico.” But since then, multiple media outlets have found evidence of hurricane deaths not included in the official death count. These investigations prompted members of Congress to request an audit of the hurricane deaths and led social science researchers to take a closer look at the data. In December, they published an analysis of mortality data from the Puerto Rico Vital Statistics System to compare the historical death averages for September and October deaths that year. They found that the storm death rate was closer to 1,085 while a New York Times analysis of similar data found the death toll being 1,052.

The latest study shows that even these estimates were very low. This makes sense since these studies relied on the Puerto Rican government which provided an unreliable mortality picture in the months after Hurricane Maria. With George Washington University’s help, the government’s recount of the death toll is still in the works leaving the people of Puerto Rico a long way from closure from Hurricane Maria. Now they’re preparing for the 2018 hurricane season set to begin on June 1, even as thousands of Puerto Ricans are still without power. As disasterologist Samantha Motano tweeted, “We have the technology to see them coming. We know how to mitigate and prepare for disasters. The United States has the money to prevent these deaths. We are choosing not to act.”

To come up with this new estimate, the NEJM researchers surveyed some 3,300 randomly chosen Puerto Rican households in January and February. They asked each one about deaths in their family between September 30 and December 31, 2017 and factors that might’ve contributed to them. They also asked about damage to their homes, whether they were displaced, and if they had access to food, water, healthcare, electricity, and cellphones. The researchers then compared the results with the island’s official death statistics from 2016 and found a 62% increase in the mortality rate in 2017, which added up to an estimated 4,645 deaths linked to Hurricane Maria (ranging from 793 to 8,498 deaths). About 1/3 of these deaths were attributed to delays or interruptions of healthcare, which in many cases was due to widespread power outages across the island for weeks and months after the storm knocked out 80% of the island’s power grid. And they wrote that the total death estimate “is likely to be conservative since subsequent adjustments for survivor bias and household-size distributions increase this estimate to more than 5,000.”

Obviously, a survey like this has its limitations. There’s always some inherent bias in who volunteers to participate and who doesn’t. Not to mention, we have possible bias in people’s memories of events. But it’s certainly the most exhaustive attempts so far to quantify Hurricane Maria’s death toll. And according to Puerto Rican demographer Alexis Santos, the study’s methodology was consistent with how other scholars have tried to measure the death counts as he told Vox, “Under the level of devastation experienced following Hurricane Maria it is very difficult to separate deaths from the environmental or contextual conditions, one may even say that Hurricane Maria impacted all of the deaths that occurred during that period. That is why approaching it through the perspective of excess deaths provides a figure that excludes the deaths that would have happened under normal conditions.”

Puerto Rico’s government has stopped sharing mortality data with the public in December 2017 and refused to provide it to researchers who conducted the study without its help. But the lack of transparency is no surprise since it’s been a key factor in the inaccuracies surrounding Hurricane Maria’s deadly impact. At the same time, Governor Ricardo Rossello ordered a death recount which public health researchers at George Washington University are doing right now and is still underway. But his office did respond to the NEJM report with this statement: “As the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities. We have always expected the number to be higher than what was previously reported. That is why we commissioned The George Washington University (GWU) to carry out a thorough study on the number of fatalities caused by Hurricane Maria which will be released soon. Both studies will help us better prepare for future natural disasters and prevent lives from being lost.”

Of course, suspicion will remain for years between Donald Trump’s habit of weaponizing anti-Latino hysteria as his political centerpiece and the unfolding of an essentially unprecedented human tragedy in a Spanish-speaking US territory. Sure we can’t dismiss that Trump and his team simply don’t know what they’re doing. But Hurricane Maria’s impact on Puerto Rico is the only real crisis we’ve had to see Trump wrestle with which has been a total fiasco with a high human cost.

Puerto Rico’s catastrophe has a 3-fold origin. First, the situation is objectively difficult since Hurricane. Maria was a large storm. But before then, Puerto Rico’s infrastructure was shitty and its economic conditions were unfavorable. Second, under Donald Trump’s “leadership,” the federal government wasn’t prepared for the hurricane and failed to properly place supplies and provide full use of military assets. And last, Trump was never willing to admit that the initial response went poorly and try to improve. Being the narcissistic sociopath he is, admitting wrongdoing and taking responsibility isn’t part of who Trump is. Because as far as he’s concerned, such actions are for losers. So instead, he resorted to defensiveness and counterpunching. Last fall, he wasted no time turning a disaster response into a culture war pitting heroic first responders against indolent Puerto Rican officials. On September 30, 2017, he tweeted: “The Mayor of San Juan, who was very complimentary only a few days ago, has now been told by the Democrats that you must be nasty to Trump. …Such poor leadership ability by the Mayor of San Juan, and others in Puerto Rico, who are not able to get their workers to help. They…. …want everything to be done for them when it should be a community effort. 10,000 Federal workers now on Island doing a fantastic job.”

Obviously, this didn’t convince any skeptic that Donald Trump was handling the disaster well. More like far from it, in fact. But it did accomplish what Trump is good at while cornered: driving politics back to the baseline question of how you feel about the guy overall. Soon enough, the news cycle moves on. However, this made no difference and is the wrong way to respond to a natural disaster crisis. The recovery itself didn’t move particularly quickly either. On average, Puerto Ricans went 84 days without electricity, 68 days without water, and 41 days without cellphone coverage after Maria. That long-term persistence of lethal conditions is how we ended up with thousands dead from a storm that, by the official count, killed “only” 64 people through direct damage. But that wasn’t on the TV news, so Trump didn’t care. As the study’s authors wrote on the revised death toll, “These numbers will serve as an important independent comparison to official statistics from death-registry data, which are currently being reevaluated and underscore the inattention of the U.S. government to the frail infrastructure of Puerto Rico.”

While Donald Trump and his administration aren’t entirely responsible for the Hurricane Maria disaster. But it will be difficult, perhaps impossible, to assess how much it had to do with the federal government’s indifference or ineffectiveness, how much it was the current Puerto Rican officials’ fault, and how much was the effects of long-term Puerto Rican poverty and structural conditions. In any case, Caribbean assistance and recovery weren’t going to be easy since Maria would’ve been devastating under the best of circumstances. Even so, Trump’s reaction was terrible. He picked fights with local government. And he focused more on congratulating himself than doing something worth bragging about while visiting the island. Worse, he didn’t follow up. Puerto Rico and the Virgin Islands simply vanished from his public statements and there’s no reporting to indicate anything was different behind closed doors. There’s no record of FEMA officials or anyone else being summoned to the White House and urged to do more. No evidence of high-level White House coordination of efforts from various agencies involved such as they were. In fact, even the best reporting on the government response shows it was botched from the beginning. As the government went all out to assist Houston, not Puerto Rico.

Donald Trump’s failure to act is extremely important because without presidential involvement, executive branch departments and agencies aren’t likely to mobilize despite that many people involved are professionals who care deeply about doing their jobs well. We’ve seen other times the effects on agencies when they know they have to answer to the president. If a Homeland Security secretary knows she’ll have to make a daily report to the president on what he department did about any acute problem, she’ll make sure she has an answer. And that’s exactly when bureaucrats find solutions for intractable problems. When a president declares something mission accomplished and moved on, then even a disastrous continuing situation slides down the list of priorities. This is especially true for the Puerto Rican people’s urgent needs who don’t have their own congressional representatives to put pressure on those agencies. If the impetus doesn’t come from the president, it’s not going to happen. Thus, the best long-term solution for the island probably is statehood, but that won’t help Puerto Rico right now. Though it would be a fitting consequence of the failure to help these citizens when they needed it the most.

Unlike Barack Obama, Donald Trump was lucky to inherit a stable and improving an economic system thanks to a competent, conventional Federal Reserve policymaking. There have been no domestic terrorist attack or major wars. So we should be grateful for the baseline conditions of peace and prosperity. But where Trump’s tested, he’s failed bigly. In the diplomatic crisis between Qatar and the United Arab Emirates, Donald Trump’s decision making is largely driven by his various corrupt associates’ personal financial interests. He’s left the US isolated on Iran while gaining nothing. He’s focused on the atmospherics of a potential summit with Kim Jong Un on Korea while leaving US allies baffled on who’s making decisions and why. The opioid crisis has apparently gotten worse in 2017 and shows no sign of abating.

The carnage in Puerto Rico illustrates the most severe manifestation of Donald Trump’s presidential unfitness despite being far from the only one. Yet, the media focus on Donald Trump’s various antics has the unfortunate tendency to detract from the basic reality that he doesn’t put in the time or the work to solve problems when that’s really the issue’s core. Put a telegenic demagogue in office, you’ll get some memorable demagogic moments that’ll boost news ratings. But you won’t get an adequate hurricane response, meaning a sky-high death toll as a result. For some Americans, Trump’s constant stream of invective and controversy is just another form of reality television. Except that it’s not unless you’re making comparisons to the Hunger Games, which involved people actually killing each other in a post-apocalyptic hellscape. However, frighteningly so, Trump isn’t a reality TV star anymore but an elected official with real and important responsibilities that he shirks on a regular basis. What he does or doesn’t do has huge practical consequences for all Americans, which will be negative for most of us. And sometimes those consequences are the difference between life and death as what went on with Puerto Rico in the wake of Hurricane Maria. To hear about the deaths of 4645 people in any disaster would be heartwrenching enough for any president to hear. But Trump doesn’t care and as long as he’s in office our country’s problems won’t get better and more likely exacerbate in the years to come.