Category Archives: Big Govt

Government Missteps Added to the Problem

You wonder what agencies do with the money allocated to keep prepared.

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WSJ. 6/12/2020.  By Shalini Ramachandran , Laura Kusisto and Honan

Hasty expansion of facilities by state, city and hospital leaders led to grave mistakes.

New York leaders faced an unanticipated crisis as the new coronavirus overwhelmed the nation’s largest city. Their response was marred by missed warning signs and policies that many health-care workers say put residents at greater risk and led to unnecessary deaths.

In the first few days of March, Gov. Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mr. de Blasio tweeted that people should go see a movie.

Only after the disease had gripped the city’s low-income neighborhoods in early March did Gov. Cuomo and Mayor de Blasio mobilize public and private hospitals to create more beds and intensive- care units. The hasty expansion that ensued, led by New York government leaders and hospital administrators, produced mistakes that helped worsen the crisis, health-care workers say.

The virus has hit New York harder than any other state, cutting through its densely populated urban neighborhoods and devastating the economy. New York state’s death toll of 30,575 accounted for 7% of the world’s deaths and 27% of American deaths as of June 11, according to Johns Hopkins University data.

 

The Wall Street Journal talked to nearly 90 front-line doctors, nurses, health-care workers, hospital administrators and government officials, and reviewed emails, legal documents and memos, to analyze what went wrong. Among the missteps they identify:

• Improper patient transfers. Some patients were too sick to have been transferred between hospitals. Squabbling between the Cuomo and de Blasio administrations contributed to an uncoordinated effort.

• Insufficient isolation protocols. Hospitals often mixed infected patients with the uninfected early on, and the virus spread to non-Covid-19 units.

• Inadequate staff planning. Hospitals added hundreds of intensive- care beds but not always enough trained staff, leading to improper treatments and overlooked patients dying alone.

• Mixed messages. State, city government and hospital officials kept shifting guidelines about when exposed and ill front-line workers should return to work.

• Overreliance on government sources for key equipment. Hospitals turned to the state and federal government for hundreds of ventilators, but many were faulty or inadequate.

• Procurement-planning gaps. While leaders focused attention on procuring ventilators, hospitals didn’t always provide for adequate supplies of critical resources including oxygen, vital-signs monitors and dialysis machines.

• Incomplete staff-protection policies. Many hospitals provided staff with insufficient protective equipment and testing.

A spokeswoman for Mr. de Blasio, Freddi Goldstein, and a member of Mr. Cuomo’s virus task force, Gareth Rhodes, said the city and state did everything they could to increase hospital capacity and enhance social distancing once the risk became clear. “Ultimately our hospitals withstood the pressure,” Ms. Goldstein said. Kenneth Raske, president of the Greater New York Hospital Association, defended the state and hospitals’ response as remarkable considering the “wartime conditions,” adding: “We have a large, very sophisticated hospital system. It took us to the breaking point.”

One planning lapse showed up in improper patient transfers. More than 1,600 largely Covid-19 patients in two of the state’s largest hospital systems were moved from overloaded hospitals to ones less hit, according to spokespeople for those systems. Some patients arrived in worse condition than when they left, sometimes without names and treatment information, said doctors and nurses at several hospitals. Under normal protocol, only stable patients typically would be transferred, but these people came in with “one foot in the grave,” said Dr. David Buziashvili, who worked many shifts at Bellevue hospital, part of the city’s public system, NYC Health + Hospitals. On one shift there, he was alarmed to see 10 new transfers in beds with little medical information, he said. “That is not how it should be done.”

A Health + Hospitals spokeswoman, Stephanie Guzmán, said the city’s 11-facility hospital system provided “the highest quality care to all New Yorkers.” Only the least-sick patients were transferred between hospitals and their personal information was in a centralized system, she said.

Avery Cohen, a City Hall spokeswoman, blamed the state for denying a request from the city to establish a centralized hub, called a Healthcare Evacuation Call Center, that would have helped better coordinate transfers between hospitals, whether they were private or public. “We were grasping for every tool at our disposal to save as many lives as possible,” Ms. Cohen said. “The state was not interested.” Dani Lever, a spokeswoman for the governor, said that system wasn’t designed for individual patient transfers. She said a state transfer system was created in late March after hundreds of open beds near harder-hit New York City hospitals had gone unnoticed.

The New York state outbreak was extraordinary, and much of the disarray in its hospitals from mid-March on traced to impacts few had anticipated, including the federal government.

The impact was made worse because the city went into the pandemic less prepared than it could have been. The city hospital system has long been considered underfunded. Private hospitals in the outer boroughs, particularly Queens, had closed over the years. New York hospitals had long ignored alarms by the nurses’ union and respiratory therapists about insufficient staffing levels, according to nurses and respiratory therapists at several city hospitals.

A contributing factor was New York leaders’ delayed reaction. Early signs of the virus’s arrival—including a rise in patients with flulike symptoms visiting hospitals—went largely un-investigated by hospital, state and city officials. Throughout February in calls with hospitals, the city health department played down the possibility the virus could spread through the air or by asymptomatic people.

In early March at Health + Hospitals’ Elmhurst, Dr. Chad Meyers and his colleagues in the emergency room worried they were missing community spread of Covid-19. But when they called the city’s health department to get patients tested, it rejected for testing even many patients who satisfied the criteria, Dr. Meyers said, leading to “often protracted and unproductive calls” with the department.

Hospital, city and state officials said they were relying on the federal government for testing capability and were limited by criteria set by the Centers for Disease Control and Prevention on whom they could test. Jason McDonald, a CDC spokesman, said: “CDC testing guidance has always allowed for clinical discretion. So, while we set guidelines, states and health-care providers have had the flexibility to determine who to test.”

In an April interview, Health + Hospitals Chief Executive Mitchell Katz said the system prepared as best it could, given the difficulties of building additional space in already-full hospitals. In a May 15 city council meeting, he said he should have acted quicker.

While leaders in states like California and Ohio acted quickly to contain the spread, Messrs. Cuomo and de Blasio delayed taking measures to close the state and city even as the number of cases swelled, despite warnings from doctors, nurses and schoolteachers. California issued a statewide lockdown with 1,005 cases as of March 19, while New York remained open with 5,704 cases, according to updated Johns Hopkins data.

Even after New York announced its first coronavirus case on March 1, the city health department was advising New Yorkers they were more likely to get the flu. “I speak for the mayor also on this one—we think we have the best healthcare system on the planet,” Mr. Cuomo said at a March 2 news conference.

Five days later, Mr. Cuomo declared a state of emergency, but medical and emergency-response experts worried the city and state administrations still weren’t taking matters seriously enough. Richard Serino, an adviser to the city, told a senior aide to Mr. de Blasio early on March 13 that he was “concerned about the cavalier attitude of the hospital community” in the city, especially compared with other cities like Boston, according to an email. Officials with the city’s emergency-management agency agreed, according to people familiar with the matter. Mr. Serino in April said he didn’t recall the email and praised the city’s response.

March 13 became a turning point after it became clear there was community spread from one man in a New York City suburb. Two days later, when Mr. de Blasio said known New York City cases had already ballooned past 300, he reluctantly closed schools. Los Angeles closed schools around the same time with about 50 cases, according to Johns Hopkins data.

By March 20, the ICU of the Northwell Health system’s Long Island Jewish Medical Center in Queens was overflowing, and Health + Hospitals’ Elmhurst had to borrow ventilators from a sister hospital to keep up. The governor ordered most of New York be put under quarantine two days later.

On March 23, Mr. Cuomo ordered hospitals to increase capacity to treat Covid-19 by 50%, anticipating the need for 140,000 new beds. When hospital executives asked where they would get staffing, beds and protective gear, state officials told them to “do your best,” said a hospital executive familiar with the conversation.

Ms. Lever, the governor’s spokeswoman, said the state offered every hospital access to 90,000 volunteer health-care workers and to a central inventory system for the resources and equipment they needed to fight the virus.

Once they realized how widespread the virus had become, Messrs. Cuomo and de Blasio were frank about the gravity of the illness in daily public briefings, and Mr. Cuomo’s job-performance rating soared. Mr. de Blasio focused on inequities within the city, establishing a food program and using out-of-work drivers to make deliveries to homebound residents.

‘Absolute crisis’

Among the missteps that would make matters worse after mid-March, health-care workers said, was that government officials and hospital administrators failed to create adequate plans to provide the needed staff as they expanded beds into operating theaters, old auditoriums and lobbies.

“Creating beds isn’t the most difficult thing,” said Northwell CEO Michael Dowling. “The issues that get complicated with the creation of beds is the staffing.”

As Covid-19 patients flooded into NewYork-Presbyterian/Columbia, the private hospital created new pop-up ICUs. The inadequacy of staffing levels quickly became clear in one operating- room-turned-ICU, according to medical staff there and emails residents sent attending physicians. Garbage in the makeshift 80-bed unit overflowed with contaminated needles, masks and gowns.

“The scope of patient needs compared with the training and resources available presented an absolute crisis,” said Julia Symborski, a nurse who worked in the new ICU. “You can magically make an ICU appear, but you can’t make staff appear immediately.”

A NewYork-Presbyterian spokeswoman, Kate Spaziani, defended the hospital system’s response to the “unprecedented challenges.”

It isn’t that there weren’t staff available nationwide: Brian Cleary, CEO of Krucial Staffing, an agency Health + Hospitals tapped to send 4,000 medical staff during the crisis, said it could have sent in 6,000 more “without blinking.”

A Health + Hospitals spokeswoman said the hospital began securing additional staffing in early January and Krucial “does not encompass the full scope of the assistance we sought from outside groups.”

While travel nurses arrived at Bellevue and other locations, “a lot of them had no experience whatsoever,” said Laura Jaramillo, a Bellevue ER nurse.

The Health + Hospitals spokeswoman said new staffers were “formally trained to cover the areas they were posted in.”

In the new operating-room ICU at NewYork-Presbyterian/ Columbia, one respiratory therapist at times cared for over 80 patients a shift, according to workers and emails; seeing about 10 a shift is typical in normal times, respiratory therapists said. Overworked staffers there weren’t able to suction mucus out of patients’ lungs often enough, resulting in patient complications, according to the workers and emails.

NewYork-Presbyterian’s Ms. Spaziani said the hospital system began recruiting additional staff in February and ended up with more than 2,850 volunteers and temporary front-line staff, including 150 additional respiratory therapists. Joji Thadathil, a Health + Hospitals Elmhurst respiratory therapist, estimated that more staffing and better equipment could have saved 30% to 40% of Covid-19 patients who died there. The Health + Hospitals spokeswoman said the system “mobilized quickly to shift staff…and equipment to the hardest hit hospitals.”

Air supply

During the surge’s early days, Mr. Cuomo, Mr. de Blasio and hospital officials often talked publicly about the urgent need for ventilators. That procurement emphasis, some medical workers said, overshadowed staffing and other vital needs like oxygen and oxygen monitors. Supplemental oxygen became especially important to keep Covid-19 patients breathing and off the dwindling supply of ventilators. At least eight New York City hospitals experienced problems with their oxygen supplies, said some health-care workers and state officials.

At Health + Hospitals’ Lincoln in the Bronx, a severe oxygen shortage hit mid-surge, said doctors there, including Dr. Dasol Kang. The Health + Hospitals spokeswoman said the hospital didn’t have a shortage and never rationed oxygen.

With scores of patients needing ICU-level care, hospitals ran short of the vital-signs machines needed to effectively monitor such patients and of the staff needed to keep track of them. Covid-19 patients gasping for breath sometimes weren’t being properly monitored as they lay hooked up to oxygen, and sometimes died without anyone’s knowing, said doctors and nurses from at least eight New York City hospitals.

A big surprise to doctors and nurses was the number of shoddy ventilators, called LTVs, distributed by the state from its own stockpile and by both the state and city from the federal government’s reserve. Several health-care workers, including Mr. Thadathil, the Elmhurst respiratory therapist, and Dr. Meyers, the ER physician, said the government ventilators were old and many patients worsened on them, leading to collapsed lungs and other complications.

The Health + Hospitals spokeswoman said many state ventilators “were not ‘ready to go’ when they came.” She said the system did additional maintenance before they could be used on patients. Ms. Lever, the governor’s spokeswoman, said the state tested every ventilator before sending them to hospitals and received no complaints.

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The Problem With Police Unions

The Democratic Party- a problem with unions?  Oh, say it ain’t so!!

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Remember the furor in 2011 when Republican governors tried to reform collective bargaining for government workers? Well, what do you know, suddenly Democrats say public-union labor agreements are frustrating police reform. We’re delighted to hear it—if they’re serious.

Minneapolis Mayor Jacob Frey on Sunday said police collective bargaining and arbitration have prevented the city from holding officers accountable for misconduct. Derek Chauvin, the officer charged with killing George Floyd, had at least 17 misconduct complaints against him in 18 years. His personnel file provides little detail about how these complaints were handled. But it appears he was disciplined only once—after a woman said he pulled her from a car and frisked her for exceeding the speed limit by 10 miles per hour. He received a letter of reprimand.

Minneapolis’s Office of Police Conduct Review has received 2,600 misconduct complaints since 2012. Only 12 have resulted in discipline, and the most severe punishment was a 40-hour suspension. “Unless we are willing to tackle the elephant in the room—which is the police union—there won’t be a culture shift in the department,” Mr. Frey said.

Jason Van Dyke, the Chicago officer convicted of murdering 17-year-old Laquan McDonald in 2014, had been the subject of 20 complaints—ranking in the top 4% of Chicago’s police department—including 10 that alleged excessive use of force.

A jury awarded a man $350,000 after finding Mr. Van Dyke employed excessive force during a traffic stop. Yet Mr. Van Dyke was never disciplined. A task force on police reform after the McDonald murder found that “collective bargaining agreements create unnecessary barriers to identifying and addressing police misconduct” and “essentially turned the code of silence into official policy.”

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Police have a point that complaints against them are often dubious and they need an advocate to defend them. But collective-bargaining agreements go beyond due process and insulate officers from accountability for egregious and serial misconduct.

Some 40 states require or permit collective bargaining for police. A Duke Law Journal study in 2017 that analyzed 178 police union contracts concluded that a “lack of corrective action in cases of systemic officer misconduct is, in part, a consequence of public-employee labor law” that in most states permits unions “‘to bargain collectively with regard to policy matters directly affecting wages, hours and terms and conditions of employment.’”

The authors found that about half of cities had collective-bargaining agreements that required the removal of police disciplinary records after a certain period of time. Cleveland’s contract mandated expunging disciplinary records from department databases after two years. This makes it difficult for supervisors to assess whether officer misconduct is habitual.

About two-thirds of police union contracts also allow or require the use of arbitration in disciplinary cases. Private employers often use arbitration to resolve complaints by and against employees, but cities such as Chicago, Detroit and Minneapolis allow police unions essentially to select the arbitrator.

A University of Pennsylvania Law Review paper last year found that about half of all union contracts give officers or unions “significant power to select the identity of the arbitrator” as well as “provide this arbitrator with significant power to override earlier factual or legal decisions” and “make the arbitrator’s decision final and binding on the police department.”

The average police department, the paper notes, offers officers up to four layers of appellate review. A quarter of officers fired for misconduct between 2006 and 2017 were reinstated, usually by arbitrators. An Oakland police officer shot and killed two unarmed men within the span of six months, one of whom was fleeing. Oakland paid $650,000 to one of the deceased’s family and fired the officer, but an arbitrator ordered him reinstated a few years later with back pay.

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This lack of accountability is endemic to government collective bargaining. The AFL-CIO’s legendary chief George Meany once said “it is impossible to bargain collectively with the government.” Collective bargaining in business is adversarial. But public unions sit on both sides of the bargaining table since they help elect the politicians with whom they negotiate.

Democratic lawmakers in particular depend on public unions for political support, and disciplinary protections are easy to give away in contract talks. Teachers unions are the most powerful example, as collective bargaining frustrates school reform and protects lousy teachers, relegating low-income and minority kids to failing schools.

If big-city Democrats really want to change police incentives, rather than merely pass reform gestures, they’ll have to address collective bargaining. Let’s see if their social-justice convictions overcome their desire for political backing from public unions.

https://www.wsj.com/articles/the-problem-with-police-unions-11591830984?mod=opinion_lead_pos1

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WHO SHOULD BAIL OUT NY?

WSJ 5/18/20220

Democrats want a $915 billion budget bailout for states and cities, and the leading lobbyist is New York Governor Andrew Cuomo. His main public antagonist on the subject is Florida Senator and former Governor Rick Scott. Both men were first elected Governor in 2010, so let’s do the math to consider which state has managed its economy and finances better over the last decade.

In 2010 New York’s population of 19.378 million was larger than Florida’s 18.8 million. By mid-2019 Florida had grown to 21.48 million, according to the Census Bureau, while New York had barely increased to 19.453 million. Yet Mr. Cuomo recently signed a budget for fiscal 2021 of $177 billion that is even bigger than last year’s, papering over what was a $6 billion deficit before the coronavirus. Florida’s budget for fiscal 2021, not yet signed by new Governor Ron DeSantis, is expected to be about $93 billion.

Democrats in Albany are claiming to be victims of events that are out of their control. But they have increased spending by $43 billion since 2010—about $570,000 for each additional person. Florida’s budget has increased by $28 billion while its population has grown 2.7 million— a $10,400 increase per new resident.
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New York has a top state-and-local tax rate of 12.7%, while Florida has no income tax. Yet New York has a growing budget deficit, while Mr. Scott inherited a large deficit but built a surplus and paid down state debt. The difference is spending.

New York’s spending on worker retirement benefits has nearly doubled since 2010 and is six times greater than Florida’s. Its debt-service payments have also doubled. Albany’s biggest cost driver is Medicaid, which gobbles up 40% of the state budget—twice as much as education. Florida spends about the same on schools as on Medicaid.

Blame New York’s cocktail of generous benefits, loose eligibility standards and waste. New York spends about twice as much per Medicaid beneficiary and six times more on nursing homes as Florida though its elderly population is 20% smaller. Many New York nursing homes and hospitals are organized by unions, which use their political clout to drive generous pay and benefits.

Mr. Cuomo in 2014 expanded Medicaid as part of ObamaCare to able-bodied individuals earning up to 133% of the poverty line. Florida didn’t. While the federal government initially picked up 100% of the ObamaCare expansion tab, New York is now on the hook for 10%, which contributed to this year’s $4 billion Medicaid shortfall.

New York spends about $76 billion a year on Medicaid—three times more than Florida. Swelling Medicaid costs have squeezed spending on transportation, causing Empire State trains and roads to fall into disrepair. Florida has found money to pave potholes and increased transportation spending 10 times more than New York between 2010 and 2019.  Mr. Cuomo pleads poverty by claiming New York is a “donor” state to the federal government. But federal dollars account for about 35.9% of New York’s spending compared to 32.8% of Florida’s, according to the Tax Foundation. New Yorkers pay more in federal taxes than what Albany gets back because the progressive federal tax code hits high earners the hardest and New York still has many high earners. The “donors” are individuals, and the money isn’t Mr. Cuomo’s.

In any case, many high earners are moving to lower-tax states. New York lost $9.6 billion in adjusted gross income to other states in 2018 while Florida gained $16 billion. Workers are following jobs, and vice versa.
The rate of private job growth in Florida has been about 60% higher than in New York from January 2010 to January 2020. Finance jobs expanded by 25% in Florida compared to 9.7% in New York. By our calculations, New York would generate $10 billion more annually in tax revenue if its personal income had grown at the rate of Florida’s over the last decade.
New York’s future has been discounted before, but the coronavirus may be its most serious economic challenge. Many service businesses are learning they don’t need as many workers in the office and can save money by downsizing. Morgan Stanley has said it intends to reduce office space in New York City, and Twitter has told employees they can work remotely as long as they want. Many restaurants were struggling before the coronavirus due to New York’s high minimum wage, taxes, rents and suffocating regulation. Some may now close permanently.
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Mr. Cuomo no doubt realizes all this, which is why last week he cited a repeal of the $10,000 limit on the state-and-local tax deduction as his top request from Congress to keep more high earners from leaving. He also wants $61 billion in budget relief, which the Empire Center’s E.J. McMahon notes would cover projected deficits for four years assuming spending increases by 4% annually.

The policy question is why taxpayers in Florida and other well-managed states should pay higher taxes to rescue an Albany political class that refuses to restrain its tax-and-spend governance. Public unions soak up an ever-larger share of tax dollars, but Albany refuses to change. Mr. Scott is right.

Source: The Wall Street Journal

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Coverup

WSJ 5/11/2020 by Homan W Jenkins, Jr.

Sound bite purveyors will do their best to portray Gen. Mike Flynn as a hardened criminal whom the Justice Department just let go as a favor to Donald Trump. The case unraveled because there was no case, as was revealed partly by an FBI memo asking if Mr. Flynn was being targeted for political reasons. Both Mr. Flynn’s interrogator (Peter Strzok) and FBI chief James Comey never thought he lied about his conversation with the Russian ambassador. The FBI never recommended criminal charges. It was the Robert Mueller task force that ginned up a case and used threats against Mr. Flynn’s son to extort Mr. Flynn’s guilty plea. Why?

As I’ve pointed out, the massive U.S. intelligence establishment had looked and found no evidence of Russia collusion by the time Mr. Mueller was named special counsel. He knew there was nothing there (and laughable was the idea that Mr. Trump could have eluded our professionals).

The Steele dossier was known to consist of silly inventions and scrapings from the internet, likely tainted by Kremlin disinformation. Charges leveled at Trump associates would be limited to lying about noncrimes—no collusion was alleged against anybody.

Then there is the intrigue that hasn’t been aired or disclosed, which remains hidden in a classified report by the Justice Department inspector general. This concerns the alleged Russian intelligence that FBI Director Comey used to justify his unprecedented, improper and insubordinate interventions in the Hillary Clinton email case.

I cannot stress too much the dereliction of the press since the flurry of disclosures in May 2017 by the New York Times, the Washington Post and CNN that Mr. Comey’s doings were triggered by a Russian intercept that his FBI colleagues believed to be false and possibly a plant.

This intelligence appeared to reveal named Democrats and Obama officials discussing a conspiracy to bury the Clinton investigation. Either Mr. Comey ignored this evidence and implicitly became party to the conspiracy’s alleged goal of liberating Mrs. Clinton from her email travails, or he exploited fabricated Russian intelligence to facilitate the same end.

Then, when the Anthony Weiner laptop surfaced, he tried to finesse a new dilemma by reopening the Clinton case in a way that (to Mr. Comey’s later professed nausea) may well have shifted the election to Mr. Trump.

The press and the American public may continue to ignore these events, but it would not have been lost on Mr. Mueller that the FBI’s galumphing actions were likely to become the story of the decade once the Trump collusion story fell apart as Mr. Mueller knew it would.

Rate the travesties as you will: the FBI’s role in promoting Mr. Trump’s victory or its role in promoting the subsequent Russia collusion canard. It’s hard to see Mr. Mueller’s forceful pursuit of guilty pleas from Gen. Flynn and others over trivial matters as anything but an attempt to weave a distracting patina of legitimacy around the FBI’s election-year actions.

Even so, it’s hard to imagine future historians ignoring the truth. Our hugely expensive intelligence establishment made a fool out of itself and our democracy over two likely low-budget Russian intelligence pranks: the Steele dossier and the fake information that sparked Mr. Comey’s Hillary interventions.

Unlike previous disclosures of intelligence- agency skulduggery, these episodes do not emit any faint air of competence or zealousness in the national interest. They involve the FBI messing with the most sacrosanct of our democratic rituals, the selection of a national leader, and so clumsily that it produced the opposite of its intended result.

I have speculated that some patriotic desire to protect America’s faith in its government may be behind the resulting coverup, or simply a desire to protect the FBI, an agency Mr. Mueller once headed. But I doubt our press has any such higher purpose. It has become so besotted with availability bias—a social science term for the need to conform to accepted tropes—that it no longer has a nose for a real story. Instead it relies on leaks, and even whole “narratives,” dropped in its lap by manipulators who assure reporters they are on the side of the angels. This is what accomplished leakers like Mr. Comey have done for years but the William Barr Justice Department apparently won’t. It waits for a supposedly independent press to show up with intelligent questions that never come.

Source: The Wall Street Journal

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