Tuesday, July 25, 2017

The Apocalyptic Style of the American Right



Did you know that Hillary Clinton murdered Vince Foster on the Virginia bank of the Potomac river?
that the moon landing and the Sandy Hook shootings were staged by the United States government?




that the Holocaust was staged, that the 9/11 attacks were an inside job, staged by the federal government, that Barack Obama was born in Kenya to extraterrestrials?




 that Timothy McVeigh was framed for the Oklahoma City bombings, that fetal tissues from abortions are sold on the open market in China where they are a great delicacy in Manchurian restaurants?






that Rick Perry is a child rapist, that global climate change is a Chinese plot, that Hillary's various plots to profit from a child porn ring are well documented in those emails she destroyed?



that Barack Obama wants Black boys and White girls to shower together every day in public school locker rooms?             


 that Bernie Sanders wants to take away your guns? 



that ISIS is plotting to load up a huge wooden horse with terrorist soldiers which the Democrats will drag into downtown Omaha, unleashing a YUGE attack on America from within?



that Mexican Muslims are massing on the Rio Grande, poised to sweep across the border and take control of Texas and Arizona--they'll leave their comrades in New Mexico alone--where they will wage war on Christmas and begin a reign of ethnic cleansing across America, targeting White Christians? Oh, and that includes the rape of White women, who those dark skinned men just lust after?




Did you know there is a world conspiracy to subjugate freedom loving people to a world government which will arrive on black helicopters bearing soldiers wearing blue helmets and determined to deprive freedom loving people everywhere of their guns and their religion?


Well, if you didn't know that, then you have not been watching Fox News, listening to Rush and Newt and Mayor Rudolph Giuliani and you are an ignorant twit.







Sunday, July 16, 2017

Meltdown of Our Effete Friends

This morning NPR ran a long segment about Donald Trump, Jr. meeting with Russians during the election. A clip of someone calling this "Treason," was played. Other nasty words like "collusion" and "nefarious" floated by.

Finally, one pundit remarked, "No matter how badly we want there to be a crime here, or something very wrong, that doesn't mean there was a crime."

Ah, finally, someone said it.

This obsession with finding that smoking gun, well actually, with finding the bullet riddled body, is actually harmful.

I am ready to stop listening. It's just too painful to hear (and on TV, to watch) people I had formerly respected (Judy Woodruff, Mark Shields) or been entertained by (Chris Cuomo, Alisyn Camerota, Mika Brzesinski, Rachel Madow) transformed into ninnies. 

Of course, it's much easier and much more fun going after the one guy.
Not going to happen. Move on. Grow up. Think about 2020.Pia


The real problem is they lead with these stories and they never get to the real stories:  DEA agents hanging out at courthouses rounding up undocumented immigrants who have lived in this country harmlessly for decades, some of whom are from Ireland, for Pete's sake. I guess you can say, at least they are consistent and you can't accuse them of racism, if they are sending a white Irish guy back.
Pia Guerra

But, and here's the real problem: there are stories not being told about EPA regulations meant to protect against air pollution, river and ocean pollution being cancelled.

There are stories not being reported about the Koch brothers trying to kill the solar industry with the help of the Department of Energy. Ditto for wind power.

There are stories never surfacing about the deployment of thousands more American soldiers to Afghanistan.

These stories, which will never lead to impeachment, are the real stories.  

Memo to outraged news people:  None of you will ever be Woodward and Bernstein--and, truth be told, neither were Woodward and Bernstein.  Nothing is going to happen that easily.

You have to show the real outcomes of the players in place who are tasked with dismantling the EPA, the Department of Education, Housing and Urban Development, Medicaid, the National Parks, renewable energy projects. Those are the real stories.

Oh, this is so pitiful to watch: We've got villains to fight. But our guys, the guys in the white hats, are just so pathetic. 
Where are the superheroes from the left?

Saturday, July 15, 2017

Deja Vu in the Liberal Mode

As you get older, it's hard to not live in the past.
The thing is, you have so much more past than you did when you were in your 20's, and you see things happening which seem to be repeating what you've already seen once.

I keep trying to search out the new, but the old has this insistent way of reasserting itself, of rising up like a stain through a new coat of paint. 

And there is wonderful, new stuff to be excited about. There are now ultrasound transducers which can be used with a smart phone to ultrasound a thyroid or a heart or a uterus, which make the stethoscope nearly obsolete and the old methods of poking and prodding during a physical exam antiquated.

Of course, one wonders whether some skills are lost along the way. I once could slip in an intravenous line into a vein in a patient in cardiac arrest, when the vessels in the arm constrict, but if you had done enough IV's, you could get a line into a nearly dead patient with your eyes closed at the end of a 36 hour shift--it was like tying your shoe laces. Now even vascular surgeons need a portable sonogram to start an IV. 

C'est la guerre. 

But reading the New York Times, the Washington Post, listening to NPR, watching the News Hour, all of which are peopled by folks who make no attempt to disguise their contempt and dismay over our current President, I find myself thinking about the cultural revolution of the 1960's, when things seemed to be coming apart, and it was said often, "The center cannot hold."

Joan Didion looked at the counter culture in "Slouching Toward Bethlehem" and saw the obvious: walk around Haight Ashbury and you saw clueless twenty somethings, who had no competence, espousing incoherent incantations: "Turn on, tune in, Drop out." The brain dead were in ascendance.

On the other hand, look what they were reacting to:  There was George Wallace, segration now, segregation forever on the Right and one the Left,  Lyndon Johnson sending American boys to kill babies in Vietnam. There were Black revolutionaries like the Symbionese Liberation army who thought they were starting a revolution by robbing banks and there were armies of the Ku Klux Klan who thought they were saving White Protestant America by bombing Black churches and murdering children.

While all this was happening, the sands were shifting under the feet of the nation: The children of the 60's generation grew up no longer believing sex ought to be restricted to the marital bed, in fact, marriage has been largely abandoned as irrelevant by the underclasses--it's a luxury for the upper middle classes.  Racism is alive but not at all well; it's really on a respirator. Racist remarks in all but some segments or the lower classes are not tolerated even by White people. The idea of "career" has changed. Huge parts of the population now understand they will not be following their fathers into a factory or company for a 30 year career. Women now expect to work while they are raising their kids.  In the 1960's women were still mostly tasked with raising kids and men were not expected to contribute more than financial support. 

All that changed in the space of one generation. 

There were multiple forces forging this new Man and new Woman of the post WWII generation.  Hollywood, Playboy all played against the advent of effective oral contraception, which freed women from the fear of pregnancy from pre marital (or extra marital) sex.  Technology freed women to enjoy sex without fear.
The idea of the great white father, the God surrogate, father knows best, Ward Cleaver, dissolved.  Generations had looked to father to be the all knowing, wise being who knew better than you because he was older, wiser, more experienced. But old and experienced visibly did not mean wise when you had Lyndon Johnson, Richard Nixon and Hubert Humphrey and countless other White males telling you we needed to be killing babies in Vietnam.  
George Carlin, with his pony tail and insouciance blew that idea of respectability out of the water. 


Things had changed out there in the heartland, and in the cities, but the old guard who were still in official positions of power did not know it.

Listening to the former head of the New Hampshire Democratic power the other night, I had the same sense of hearing from someone living in thrall to past certainties. She told us the best way to resist is to do the same old things we have done for decades--neighbors talking to neighbors, canvassing. But even in a small town like Hampton, New Hampshire, you might know the neighbors in ten homes on your street, but go a half mile away and you are a stranger at the door. You might as well be from Montana, or, Heaven Forbid, Massachusetts.

The ground shifted from under the feet of the Democratic Party last November and our political leaders, our establishment, the people with the experience, have not understood that. Nor have the journalists I love so: Judy Woodruff, Mark Shields, even David Brooks, who is no longer even pretending to be the voice of the Republican viewpoint are all reduced to clucking and shaking their heads and words like "unprecedented" and "shocking" and "immoral" cascade from their mouths. They react much as the older generation did when viewing scenes of naked or semi naked hippies frolicking in the mud at Woodstock, or flashing peace signs at Haight Ashbury, "Oh, my, my. They are so ill behaved."

Here is the generation which changed the cultural norms of the nation, which rejected the ossified strictures of past thinking, now ossifying itself.

We do have problems with figuring out what to do with immigrants in Europe who flood out of Syria and Afghanistan, unprepared for the liberal societies they find in Germany and Scandinavia. France has been unable to figure out how to assimilate African Muslims. Britain has not faced up to the conflicts which the wave of Muslims now living in the UK brought. It's not racist or Right Wing to acknowledge these are real problems. 

A transgender boy to girl with testicles dangling, stripping naked in the girls' locker room of a public high school presents a problem. It's not reactionary to see that.















The displacement of the under-educated class of coal miners, factory workers in the Rust Belt from their jobs as business has gone global is not just their problem, it's our problem.

Fighting endless war whether in Afghanistan or Africa or Iraq is a failure of intellect and courage on the part of our political leaders. We have to admit, much as we loved him, Obama failed to extricate us from Afghanistan.

The power of Wall Street bankers, of rating agencies like Moody's and others and their failure which became the problem of the American taxpayer without any CEO paying the price of imprisonment is a failure of political leadership: Again, much as I love President Obama, he was too determined to be non confrontational in that instance. 

The success of the Koch brothers in defeating efforts to bring solar power and wind power on line in a massive way undermines our energy independence and our national security and this has been largely ignored by Democratic political leaders.

So, we have to wake up, or we'll be looking not at four years of struggle but of a two term President and a Supreme Court which may do more harm than we can imagine.

Thursday, July 13, 2017

Donald Dubious

All right, I admit it. 
I'm violating my own rule--I exhorted the press to not take the bait, to try to go 24 hours without mentioning the 45th. And now, here I am, already breaking down. But from now, it will be three days before I mention him again. Promise.


Pia g\Guerra


But I think I may be closing in on a proper name.

Consider the definition, one of the definitions, of the word:


du·bi·ous
ˈd(y)o͞obēəs/
adjective
  1. 1.
    hesitating or doubting.
    "Alex looked dubious, but complied"

    synonyms:doubtfuluncertainunsurehesitantMore

  2. 2.
    not to be relied upon; suspect.
    "extremely dubious assumptions"

    synonyms:suspicioussuspectuntrustworthyunreliablequestionable

And, so, going with the second meaning, of doubtful reliability, I think, for now, it has to be Donald Dubious. 


Tuesday, July 11, 2017

Will No One Rid Me of this Vexacious Press?

In its "All Trump, All the Time" coverage of our 45th President, Donald Snowflake, CNN, and in particular New Day's Chris Cuomo and Alisyn Camerota have given Donald just what he's seeking--constant exposure on a level which would leave Big Brother green with envy.






NPR, the News Hour, institutions which should know better, swim along in this current, none of them being smart enough or civic minded enough to resist the easy story which is always out there, right in front of them in the form of a 140 character daily morning tweet.
The essence of the Snowflake--Pia Guerra


Why not just report: "Donald Trump tweeted this morning." End of story
Walter Cronkite brought down Jimmy Carter's Presidency by opening every broadcast with "This is the ...day of captivity for the American hostages in Tehran," and our news people could do the same: "Another tweet," and move on.


I can remember clearly back to John F. Kennedy's presidency when my mother used to race home to see his news conferences, which were held intermittently and were an event.  I can remember every President since but no President has ever dominated the news the way Donald Snowflake does. Every day, every news broadcast begins with the words, "Donald Trump." He is never out of sight or out of earshot.


The decision makers at each show could end this, if they weren't lazy and timid. They could simply ignore him, allow him to have his tantrum, locked up in his room, and visit him only at their discretion.


As it is, they are enablers of the most pathetic sort.

Monday, July 10, 2017

Too Important to be Left in the Hands of Congress

Watching "Prime Minister's Questions" Wednesday nights, I have come to understand why England has universal health care and we, in the United States, do not.


About 25% of all the questions asked of the Prime Minister had to do with health care or the public health. A promised new clinic was behind schedule and the Member of Parliament from that district was indignant. 


Oh, to see our own President in a setting like that every Wednesday, where a 140 character Tweet would not be sufficient, but where the President has to respond immediately to the question on behalf of a Representative's constituents in real time.



When government undertakes a health care system, the people running government find themselves face to face with an aroused public. This is not a question of whether we are going to build a war plane in somebody's home district; this is something which actually affects lives where people live. If the war plane or the border wall never gets built, who cares?  But if your mother hasn't got her hip replacement and winds up parked in your house because she cannot get about, you will care about that.
Pia Guerra


The last thing Mitch McConnell or Jon Cornyn or Paul Ryan wants is to be responsible for something that actually matters in people's lives, something which would require them to be competent or be quickly exposed.


It is said there is no such thing as a mediocre heart surgeon. Either you are excellent enough to get those blood vessels and valves sewn in tight, or you are not and your patient dies. There is no room for second rate, half smart or just okay.
Pia Guerra


Of course, government bureaucrats do things every day which profoundly affect the well being of the public: keeping mad cow disease out of the food supply, doing air traffic control to keep thousands of flights from running into each other, maintaining bridges and levies, treating veterans in veterans' hospitals, rescuing boats caught in storms off the coasts, but most of these things are functions which keep systems which work well out of disaster's way.
Health care is more than watchful supervision--it requires active intervention in many cases; you are not just watching competent people do things right. You are actually one of those well trained competent people, doing the job right.


That, to most Congressmen, is a terrifying thought.

Sunday, July 9, 2017

What Europe has to Teach America About Health Care

NPR ran a story about two of its reporters who live in Europe and what they experience in getting their health care in Spain and Britain respectively.

The woman who lives in Spain said she could be seen the next day for an urgent problem, but for a less urgent visit to the dermatologist, or for other specialties, it took a month. 
She noted there were no cash registers or credit card machines in doctors' offices or hospitals. Prescriptions were generally about $2.  
Hospital wards might not feature single rooms. 
Quality of care was high, as far as she could tell--Spain does more organ transplants than any country in the world, which she used as an indicator of how high tech their medicine is.
British hospital ward

From the point of view of the doctors, a cardiologist makes about $2100 a month, in a country where $1800 monthly is the median. Her friend, a cardiologist, does Botox injections on the side to supplement her income.

The British reporter said that pretty well described British health care, except if you had private insurance to supplement the National Health Service, you could go to the private systems which functions alongside the no frills government service; you could go to a swanky upscale hospital with high thread count bed linens. 
The medical care is the same quality in both private and public and in fact, the doctors are often the same. It is more or less like flying first or business class as opposed to economy class: It is more comfortable for the rich in the private British system, but you are landing in the same place, at the end of the flight.

Upscale American hospital room for the 1%

From the point of view of British doctors, in a country where the median income is about $35,000, a specialist can make $140,000 in the public health system, although most of the GP's (general practitioners) who have only an MB (Batchelor of Medicine), the wage is closer to $40,000. British GP's go to medical school straight out of high school and skip college. They are upper middle class. Competition to become specialists is intense and the rewards get you to the upper 10% in income in the country.

Both reporters said the fundamental difference in Europe is Europeans think health care is too important to be corrupted by the profit motive, where most Americans think health care is too important to be trusted to government.

Americans simply do not trust government, nor any authority. Some wag once said medical care is simply too important to be left in the hands of doctors. What the Right believes, and what they've convinced Americans to believe, is the profit motive and private enterprise are always superior to cooperative group efforts. 

In Britain, about 7% of public spending is on health care. In the United States, if you put together spending on Medicare, Medicare, CHIP and other public health care spending is closer to 17%.  If you are challenged by numbers, that means we spend, from government more than twice as much as our European friends, in the name of keeping our health care system out of the hands of government.

This is no secret and no surprise: Medicare has for decades had an administrative cost of around 3% where the private sector it's said to be over 20%. If those numbers don't mean much to you, think of your doctor's office: How many people are working in the billing and front office vs the number of nurses and doctors you see in the rooms. And those are just the people you see.




Think of those huge health insurance company buildings you see scattered around, filled with people processing bills, fighting with doctors' offices over bills, sending you bills. To pick a number more or less out of the air, somewhere in the neighborhood of 3 million people make a living as employees of the health insurance in this country. (The number of people employed in doctors' offices to deal with the insurance companies could bring the number of people working on health care billing as high as 20 million.)




Those jobs are unnecessary here and do not exist in Europe. 
There are roughly 13 million jobs in actually delivering health care in this country, although who knows what the number really reflects. Is the guy who sweeps the hospital room included in that number, or the woman who works in the hospital cafeteria or the hospital plumber?


Swedish hospital room 

By many measures, American health care is inferior to European health care. In terms of public health, we are clearly inferior, because the upper 10% get excellent care but the rest do not. Infant and maternal mortality and morbidly are better in a dozen European nations and life expectancy stagnant in the US is improving in Europe and beyond ours. There are many other technical measures which all suggest the Europeans enjoy a better health care system and the government runs the show in European health care, even if there are private options swirling around that. 

I can give the worm's eye view, from our annual national medical conferences, where new science is presented:  the Europeans are as good or better than we are when it comes to the medical science they do.

What may be lost in all this is a more difficult, more intangible thing:  If we went to the Spanish system, where doctors' pay puts them into the upper middle class, rather than the British system, where doctors beyond the GP level are in the upper 10% of earners, we would see an entirely different sort of person in the white coat. Like it or not, when you look at 500,000 people making decisions about whether to go down a career track in medicine, you will not find more than 50,000, I would wager, who will choose medicine for the love of the science, the calling of service, even though they could make more money elsewhere. 

On the other hand, even with our profit motivated system, I cannot prove it, but it's my sense based on worm's eye view observations, that that shift has already taken place.  The quality of worker among doctors is not what it once was.  "Good" people, i.e., smart, intelligent, driven people do tend to follow the money. 

What we mean by "good" in doctors would require a dozen blog postings. The qualities you are looking for across that very broad spectrum which constitutes medicine are diverse. What you want in a surgeon is very different from the qualities which make for a good psychiatrist. And even if you could choose the perfect medical school class, the person you get at age 26 will not be the same person 30 years later. 

Look around at your own community. Do the physicians you see look like the top students you went to high school with? Put another way, do you feel comfortable trusting the health of your family to the doctors you see? 

This is not to say the doctors out there in the community are inadequate to the task. You don't need to be Warren Buffet or Zuckerberg or Steve Jobs to practice pediatrics and you don't need to be Einstein or Jonas Salk to practice endocrinology, but overall, the more money you pay doctors, the more you will see competition for those doctor jobs rise. Whether a driven, Type A doctor is going to give you better care is an open question, but it is a question.
But to say, "You get what you pay for" in medicine has proven to be a canard--we have been getting considerably less than we paid for in medical care in this country for decades.