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    Biden Shows Off a New Accessory: A Walking Boot

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    State Certified Vote Totals

    Election Disinformation

    Full Results

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    No, it isn’t unusual that Kamala Harris is still in the Senate.

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    State Certified Vote Totals

    Election Disinformation

    Full Results

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    After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

    President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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    Trump Raises $170 Million as He Denies His Loss and Eyes the Future

    President Trump has raised about $170 million since Election Day as his campaign operation has continued to aggressively solicit donations with hyped-up appeals that have funded his fruitless attempts to overturn the election and that have seeded his post-presidential political ambitions, according to a person familiar with the matter.The money, much of which was raised in the first week after the election, according to the person, has arrived as Mr. Trump has made false claims about fraud and sought to undermine public confidence in the legitimacy of President-elect Joseph R. Biden Jr.’s victory.Instead of slowing down after the election, Mr. Trump’s campaign has ratcheted up its volume of email solicitations for cash, telling supporters that money was needed for an “Election Defense Fund.”In reality, the fine print shows that the first 75 percent of every contribution currently goes to a new political action committee that Mr. Trump set up in mid-November, Save America, which can be used to fund his political activities going forward, including staff and travel. The other 25 percent of each donation is directed to the Republican National Committee.A donor has to give $5,000 to Mr. Trump’s new PAC before any funds go to his recount account.Still, the Trump campaign continues to urgently ask for cash. On Monday, Mr. Trump signed a campaign email that breathlessly told supporters that the end of November — nearly four weeks after Election Day — represented “our most IMPORTANT deadline EVER.”The Washington Post reported earlier on Monday that Mr. Trump’s postelection efforts had raised more than $150 million. Tim Murtaugh, a spokesman for Mr. Trump’s campaign, declined to comment on the fund-raising.The $170 million figure, raised in less than four weeks, is an enormous sum that rivals the amounts of money brought in at the peak of the campaign. While a breakdown of the money was not immediately available, the deluge of donations would appear to have paid off any remaining Trump campaign debt (in the first days after the election, the fine print showed that contributions were earmarked for that purpose). The money is also likely to provide Mr. Trump with a sizable financial head start in paying for his post-presidency political activities.Despite the influx of cash, both the Trump campaign and the R.N.C. have reduced the size of their staffs since the election.In October, Mr. Trump’s campaign began automatically checking a box on its website so that more donors would make additional, weekly donations from their accounts through Dec. 14 — the day the Electoral College will vote — to create a postelection revenue stream. Donors can opt out with an extra click, but critics called the tactic misleading.Mr. Trump’s team created the political action committee, known as a leadership PAC, in part to capture the influx of postelection money, according to people familiar with the matter.Currently, donors on Mr. Trump’s website are opted in with a prechecked box to make monthly contributions.Rob Flaherty, who served as Mr. Biden’s digital director, said on Twitter that the huge sums raised by Mr. Trump since the election were “plain and simple grift.”On Monday, Arizona and Wisconsin, two key battlegrounds that Mr. Biden flipped this year, certified their election results, formalizing Mr. Biden’s victory as Mr. Trump and his allies have continued to complain without evidence of fraud. More

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    Arizona and Wisconsin Certify Biden’s Wins: ‘The System Is Strong’

    Arizona and Wisconsin on Monday certified President-elect Joseph R. Biden Jr. as the winner in their presidential elections, formalizing his victory in two additional battleground states as President Trump’s effort to overturn the results of the election continued to fall short.Such certifications would be an afterthought in any other year. But in a political environment where Mr. Trump’s false claims of sweeping voter fraud have created an alternate reality among his die-hard backers in the West Wing and beyond, the results have closed off yet another path to victory for him.Although Mr. Trump has infused daily drama into the normal postelection bureaucratic process by urging his Republican allies to push to block the certification of results or to overturn them entirely in battleground states won by Mr. Biden, the proceedings on Monday were staid affairs.In Arizona, Katie Hobbs, the Democratic secretary of state, formalized her state’s results while sitting at a long table with three Republicans who signed the election documents: Gov. Doug Ducey; the state’s attorney general, Mark Brnovich; and the chief justice of the Arizona Supreme Court, Robert M. Brutinel.Ann Jacobs, the chairwoman of the Wisconsin Elections Commission, signed a document during a three-minute video conference in which she narrated herself certifying Mr. Biden’s victory.“I am now signing it as the official state determination of the results of the Nov. 3, 2020, election and the canvass,” Ms. Jacobs said before holding the document up to the camera. Later Monday afternoon, Gov. Tony Evers of Wisconsin, a Democrat, announced that he had signed the state’s Certificate of Ascertainment appointing Mr. Biden’s slate of electors to represent Wisconsin at the Electoral College.Mr. Trump, buoyed by his legal team and supporters in the conservative news media, has held out hope that he could somehow prevail in Wisconsin and Arizona, as well as Georgia, where Republican officials on Monday firmly refused to challenge Mr. Biden’s victory there. In all three states, along with Michigan and Pennsylvania, the other two states that flipped from voting for Mr. Trump in 2016 to Mr. Biden this year, the Trump campaign has sought to undermine the results through legal and public relations efforts aimed at delivering the president Electoral College votes.But as has been the case elsewhere, elections officials from both parties in Arizona and Wisconsin declined to undercut their state laws to overturn the popular vote in their states.“We do elections well in Arizona,” Mr. Ducey said on Monday as he signed documents certifying Mr. Biden’s Arizona victory and awarding him the state’s 11 Electoral College votes. “The system is strong.”In Wisconsin, Ms. Jacobs chose to certify Mr. Biden’s victory there one day before the state’s Dec. 1 deadline to do so.Ms. Jacobs’s certification followed the conclusion of recounts, requested and subsidized with $3 million from Mr. Trump’s campaign, in Dane and Milwaukee Counties that found Mr. Biden had added 87 votes to his statewide margin.Ms. Jacobs, a Democrat from Milwaukee, said that certifying the result of the presidential election came at her discretion and that she expected the move to kick-start legal challenges from the Trump campaign.“The power to do this is vested solely in the chair,” Ms. Jacobs said in an interview on Monday.All states must exhaust legal challenges by Dec. 8. Electoral College delegates will meet in their states on Dec. 14, sending the results to Congress, which is scheduled to resolve any final disputes and certify the Electoral College vote on Jan. 6.Unlike in other states where the Trump campaign has claimed, without producing any evidence, that widespread fraud led to Mr. Biden’s victories, Mr. Trump’s legal strategy in Wisconsin is predicated on an effort to throw out hundreds of thousands of absentee ballots on what amounts to a technicality.The Trump campaign has argued in its recount petition that all ballots cast at in-person absentee voting sites before Election Day should be disqualified. The campaign claimed incorrectly that those absentee ballots had been issued without each voter submitting a written application requesting the ballot, but the top line of the absentee ballot applications that voters filled out at early voting sites read: “official absentee ballot application/certification.”That argument would throw out hundreds of thousands of ballots across Wisconsin, including those cast by prominent Trump supporters, such as several state legislators and a top lawyer for the president in Wisconsin, Jim Troupis, according to The Milwaukee Journal Sentinel.On Twitter on Monday, Mr. Trump called for Gov. Brian Kemp of Georgia, a Republican, to “overrule” Brad Raffensperger, the Republican secretary of state. The president also claimed baselessly that there had been “total election corruption” in Arizona. The Trump campaign has yet to identify any systemic voter fraud in its court challenges.Ms. Jacobs’s certification of the Wisconsin results represents the opening of a window for legal challenges from the Trump campaign, which has argued that the president should have carried the state and its 10 Electoral College votes despite the fact that he lost to Mr. Biden there by 20,682 votes.Two weeks ago, the Trump campaign requested recounts in Dane and Milwaukee, the state’s two largest and most Democratic counties, in an effort to build a legal case against Mr. Biden’s statewide victory. The Trump campaign is also likely to sue to challenge Ms. Jacobs’s certification.Republicans on Wisconsin’s six-member bipartisan elections commission had said that they hoped Ms. Jacobs would wait to certify the presidential election results until after the Trump campaign had exhausted its legal challenges. But the Trump campaign has not filed any lawsuits in Wisconsin; it had nothing to challenge until Ms. Jacobs certified the results of the election.The Trump campaign and Wisconsin Republicans are also expected to challenge Ms. Jacobs’s authority to certify the election results on her own. State law gives her, as the elections commission chair, clear authority and responsibility to certify the election, though other parts of the Wisconsin elections code mention the entire six-member bipartisan commission certifying presidential election results.Glenn Thrush contributed reporting. More

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    ‘We’ve Harmed the Senate Enough’: Why Joe Manchin Won’t Budge on the Filibuster

    WASHINGTON — Senator Joe Manchin III of West Virginia, the most conservative member of his party in the Senate, has a message for fellow Democrats hoping to capture the majority and quickly begin muscling through legislation to bring about sweeping, liberal change: not on his watch.With Democrats mounting an intense, long-shot campaign to win two Georgia Senate seats whose fates will be decided in runoffs in January — a feat that would give them control of both chambers of Congress along with the presidency — Mr. Manchin’s unequivocal stance against ending the filibuster means that President-elect Joseph R. Biden Jr. would still need substantial Republican support, and probably Mr. Manchin’s seal of approval, for any major move.In a wide-ranging interview in his office, Mr. Manchin, 73, a former governor, argued that moderates in both parties needed to assert themselves in a new Senate, no matter which party is in charge. He said that his party had lost rural voters because of an ultraprogressive message that scared them, and he criticized Republicans for selling their “souls” in subservience to President Trump.This interview has been edited for length and clarity.Q: It strikes me that you’re going to be playing potentially an extremely important role if we end up with a 50-50 Senate. Would you agree with that?A: I would think the only reason that people are assuming that — you can tell me if it’s true or not — is because of my independent voting. I’m pretty independent. If it makes sense, I go home and explain it. If it doesn’t make sense, I don’t. Sometimes that’s a real strong Democratic issue they’re really happy with, and sometimes it’s a Republican issue they’re happy with. I think I’m the most moderate or centrist — as far as centrist voting — than anybody else in Congress, 535 people.Q: What do you make of the election results over all?A: I just can’t believe that 72 million people were either that mad or that scared of the Democrat Party to vote for what I consider a very flawed individual. Here’s a person who lost 230,000 lives under his watch, basically denounced the science completely because it might hurt him politically, has a lack of compassion or empathy for humans, and denigrates anybody and everybody that does not agree with him. How 72 million people could still walk in and say, ‘Yeah, it’s better than that,’ I just can’t figure it out.That was a sobering thing for me. My state got wiped out this election. So I would say, I’m just looking at myself, I have not been good at my message. I know why I’m a Democrat. And I know that I’ve never seen the Democrat Party forsake anybody.Q: Why do you think West Virginia and the rural areas have gone so red?A: I can tell you what they said: ‘Listen, I just couldn’t bring myself to vote for another Democrat that might give support to the very liberal wing in Washington that I don’t agree with and have nothing in common with. I don’t have anything in common with people who talk about defunding the police. It looks like they’re condoning riots.’ There’s not a member in the Democratic caucus that condones any of this violence or riots or looting. None.I just would hope that people would start looking at the person that they’re voting for and not the party they belong to. A Democrat who’s a moderate-conservative like myself is much needed to bring other people to that moderate position.Q: The Democratic Party thought it could take back the Senate this year, and there’s still a chance that maybe that can happen if you get both of the seats in Georgia. But in order to pass major legislation, you would have to either get some Republican support or kill the filibuster. You’ve long opposed killing the filibuster. Why is that?A: I can assure you I will not vote to end the filibuster, because that would break the Senate. We’ve harmed the Senate enough with the nuclear option on the judges. We’re making lifetime appointments based on a simple majority. The minority should have input — that’s the whole purpose for the Senate. If you basically do away with the filibuster altogether for legislation, you won’t have the Senate. You’re a glorified House. And I will not do that.Q: So there’s no issue where you would agree to end the filibuster? Let’s say there’s a badly needed new coronavirus stimulus package, and the Republicans won’t make a deal.A: No. If we can’t come together to help America, God help us. If you’ve got to blow up the Senate to do the right thing, then we’ve got the wrong people in the Senate, or we have people that won’t talk to each other. You know, I’ve always said this: Chuck Schumer, with his personality, he’ll talk to anybody and everybody. You can work with Chuck. Chuck is going to try everything he can do to try to engage with Mitch again.Q: Are there any other issues where you would draw a line in the sand and stand up to other members of your party?A: I’ve done that. I was that one vote for Brett Kavanaugh. I thought there had to be evidence, and I never saw evidence. The country was in a feeding frenzy. And there was no Democrat that was going to buck that. I said, ‘I’m not going to ruin a person’s life because there’s no evidence.’And wouldn’t it be so befitting if he votes to uphold the Affordable Care Act? God, oh my. Redemption! Is there redemption here? He and I had a long conversation, and I basically said, ‘I’m pleading with you and your inner conscience, whenever this comes before you, I want you to think about 800,000 West Virginians who couldn’t get insurance before because of a pre-existing condition. I want you to think about 160,000 West Virginians that were so poor, they had nothing.’Q: It does seem like Democrats have won the argument on the Affordable Care Act. Six years ago, Republicans were campaigning on blowing up Obamacare; now they’re running ads saying they’re protecting pre-existing conditions.A: Here’s the thing. It’s 16,000 jobs in West Virginia. Three million jobs in America. You want to be a vote that basically eliminates three million jobs? You want to be a vote that wipes out your state? It’s crazy.Q: Is there any chance of a bipartisan group of moderates — you, Senator Susan Collins, Republican of Maine, and some others — emerging that can advance compromise policy in a new Senate?A: We used to have meetings all the time, either in here or her office. We had 10 or 12 or 13, sometimes as many as 20, working through the fiscal crisis or different things, trying to find a pathway forward. We need to be more vocal with our leadership.Q: What does it mean to be a Democrat in 2020?A: To me, it still means the compassion that we have for people, but also the dignity of work. That has to be our driver. It’s the economy, it’s all about the economy. You can’t help anybody if you have no economy and no resources to help them.When it comes to workplace safety, it’s the Democrats everyone turns to because they know they’ll do something. When it comes time to protect people’s jobs and opportunities, it’s the Democrats who will fight to protect that. We’re trying to give quality health care, so people can basically contribute to society. With that, look at the economy that we created: a billion dollars coming in our state. We don’t say that, and we don’t seem to get credit for that.So I’m back on track. I know why I’m here, and I know why I’m a Democrat, and I’m going to fight like the dickens.Q: You did a video with a mix of Democrats and Republicans asking people to respect the results of the election. Why do you think that so many Republicans are unwilling to acknowledge reality and stand up and say, ‘You lost, Mr. President’?A: I don’t know. I don’t know the value of being a U.S. senator, or a governor, or a congressman or anything that’s worth selling your soul or your convictions. These are all good people who for some reason aren’t speaking up. They’re hoping it just kind of goes away.Why rouse up 70 million people that were willing to vote for all his flaws, knowing he’s a very flawed human being? He instilled something, the anger in people, feeling like, ‘Hey, I’m getting the shaft here, I’m getting shorted.’ So, they just want that to kind of go away and see if it calms down rather than putting themselves in the iron. And I understand that. But it would be so refreshing to have a majority of all of my colleagues and my friends on the Republican side say, ‘Listen. It’s time now to move on.’ More