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The U.S. Fed Just Became The World’s Banker

From Marketwatch

“The Federal Reserve on Tuesday said it was establishing a temporary repo facility for foreign central banks that will help make U.S. dollars available in their jurisdictions. In the new facility, the central banks will be able to temporarily exchange their U.S. Treasurys held at the Fed for U.S. dollars. “This facility should help support the smooth functioning of the U.S. Treasury market by providing an alternative temporary source of U.S. dollars other than sales of securities in the open market,” the Fed said. It should also ease strains in global U.S. dollar funding markets, the central bank said. All central banks and foreign monetary authorities with accounts at the Fed are eligible.”

The “repo market is a lending facility for banks to use collateral for short term loans – simplest explanation; it is like a payday loan for banks.  The U.S. Fed is now trying to manage the worldwide dollar shortage.  Analyst Lyn Alden explains it here; foreign countries own $39 trillion in U.S. assets (treasuries, bonds, real estate, stocks)  and in the last week they sold $136 billion in U.S. treasuries.  The U.S. Fed is trying to prevent a fire sale of U.S. assets by foreigners, so they are providing a mechanism for foreign entities to raise dollars without having to sell U.S. assets.  All because we have gone from being a “creditor” nation to a “debtor” nation – the question is who is going to bail us out when the time comes?

Wall Street Journal: NY Hospital Prepares to Begin Triaging Patients

NYU Langone Tells ER Doctors to ‘Think More Critically’ About Who Gets Ventilators

NYU Langone Health, one of the nation’s top academic medical centers, told emergency-room doctors that they have “sole discretion” to place patients on ventilators and institutional backing to “withhold futile intubations.”

A March 28 email from Robert Femia, who heads the New York health center’s department of emergency medicine, underscored the life-or-death decisions placed on the shoulders of bedside physicians as they treat increasing numbers of coronavirus patients with a limited supply of ventilators.

New York state guidelines, established in 2015, recommend that hospitals appoint a triage officer or committee—someone other than the attending physician—to decide who gets a ventilator when rationing is necessary. The guidelines say that removing the decision from the physician treating the patient avoids a conflict of interest, allows an officer or committee with access to overall ventilator availability to make the call and prevents health worker burnout and stress.

Dr. Femia said in his email, which was reviewed by The Wall Street Journal, that experts and leaders at NYU Langone were creating internal guidance on how to allocate ventilators, which are in short supply across New York City. But the emergency department couldn’t afford to wait, he said.

“In Emergency Medicine, we do not have the luxury of time, data, or committees to help with our critical triage decisions,” he wrote. “Senior hospital leadership recognizes this and supports us to use our best clinical judgment.”

Dr. Femia wrote that decisions about “airway management” and whether to use a ventilator or other respiratory support devices were at the sole discretion of treating physicians, but he told doctors to “think more critically about who we intubate.”

“For those patients who you feel intubation will not change their ultimate clinical outcome (for example cardiac arrests, some chronic disease patients at end of life, etc) you will have support in your decision making at the department and institutional level to withhold futile intubations,” he wrote.

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