Monday, February 26, 2018

Mass Shootings Same Old Same Old in USA

So, read this little vignette and tell me which of the mass shootings you think it's describing. I know, I know, they all blur together and sound the same.





With one exception, they are all male and except for one Asian male, they are all white. Exceptions that prove the rule.
It's a white male thing, basically.


So here goes: Where and which shooting is this report describing? Extra points if you can name the year. 

He then drove to a hardware store, where he purchased a Universal M1 carbine, two additional ammunition magazines, and eight boxes of ammunition, telling the cashier he planned to hunt wild hogs.At a gun shop he purchased four more carbine magazines, six additional boxes of ammunition, and a can of gun cleaning solvent. At Sears he purchased a Sears Model 60 12 gauge semi-automatic shotgun before returning home.
Whitman sawed off the barrel and butt stock of the shotgun, then packed it into his footlocker, along with a Remington 700 6-mm bolt-action hunting rifle, a .35-caliber pump rifle, a .30-caliber carbine (M1), a 9-mm Luger pistol, a Galesi-Brescia .25-caliber pistol, a Smith & Wesson M19 .357 Magnum revolver, and more than 700 rounds of ammunition.

--Wikipedia

Fact is, this was 1966 and it was the University of Texas clock tower shooting where a man named Whitman shot random people, 15 in all, dead.

When it comes to mass shootings, there seems to be a theme: These guys buy guns fairly close to the time they use them.  And they definitely buy up lots of ammo. So a law making purchase of said armaments might help to prevent mass shooting, which is all we seem to care about lately with respect to gun deaths.

Little kids at home shooting their siblings, people shooting their wives at home, men shooting citizens during robberies don't seem to bother the public all that much. Americans are willing to live with that. This America, man.



Thursday, February 22, 2018

The Itch of Inequality

A woman visited my office today and she had not started a drug I had added to her diabetes regimen because Blue Cross refused to pay for it and it would have been $900 a month out of pocket. But, she said brightly, "I just got Mass Health."  So she asked me to re write the prescription; it'll be covered now.


Mass Health is Medicaid.


This is a common story in Massachusetts, but not in New Hampshire, where the people's representatives do not believe in government.  In Massachusetts, the government sponsored health insurance covers just about every drug. In New Hampshire, you're lucky if your doctor's visit is covered.


Reagan's welfare queen 


I don't know how many times a week I hear someone, usually a white person with no more than a high school education, if that, grouse about how her company sponsored health insurance would not cover a drug or a procedure, and then add indignantly, but my neighbor, Juanita Diaz, she gets it for free from Mass Health.


If that white lady found her drug was covered by her own health insurance, likely she not feel angry at all that Ms. Diaz got her drug paid for by Medicaid. What bothers the white working stiff about Ms. Diaz is the sense that Ms. Diaz is getting something unfairly, when the working stiff is being denied it.  


What really riles the patient, that white lady, working two jobs--one cleaning offices and one at the car wash-- is that while she works hard, she manages to earn just enough to disqualify her from Medicaid coverage, while Ms. Diaz sits homem watching TV, and gets the drug paid for.


So it's two things:
1/ The inequity: she gets it when I don't 
2/ The idea that by working hard, I pay the taxes to pay for Ms. Diaz and I don't get what my taxes pay for Ms. Diaz is getting--the worst of both worlds.


Did she not rape the system?


Of course, there are layers here:
1/ Why does the white guy's health insurance not cover the drug?
2/ Why is the drug $900 a month in any universe?
3/ Why does Medicaid get a sweetheart contract for the drug but not Blue Cross?


In our for profit, profit driven American health care system, the drug company can charge whatever it  wishes, whatever the market will bear. 
The best health care is consistently provided by the government run programs and the commercial programs are niggardly.
The working stiff never directs his resentment toward the inadequacy of the commercial programs; he is only angry at the perceived profligacy of the government run program.



It's the old Ronald Reagan "welfare queen" driving her Cadillac, wearing mink, raping the government welfare programs which were  supposedly devised to assist the poor and needy but instead get exploited by the lazy, undeserving "poor" who are growing rich and fat on the government's teat.

Why is she not a welfare queen?

If we had healthcare for all, Medicare for all, if everyone got the same basic benefits (with perhaps a little extra for people who added company health insurance on top of what the basic government plan offers) then we would likely hear no complaints about Ms. Diaz who is getting her drugs for free, because everyone gets them for free.


Of course, as Lester Freeman of "The Wire" noted, "Ain't no such thing as free in this country."


But at least we'd all perceive the situation differently. It's not bad if you don't have something until you see someone else gets it when you are denied it.


Perception of inequality.



Monday, February 19, 2018

Russian Trolls

Here's a little oddity to explain.
He's a chart of views of last week's blogs on Mad Dog:

Russia
283
United States
169
France
17
Germany
9
Canada
6
United Kingdom
6
Ireland
6
Ukraine
5
Algeria
2
Spain
So, do you really think Russians are just such fans of some rabid New Hampshire Democrat? 

Do you, as you look over last week's blogs, think there is much of interest to the average Russian?

Is Mad Dog a star in Russia?
Or does Russia have a lot of paid eyes looking at the American blogosphere?
Troll


Does that hurt the USA?
How could it hurt us?
Actual Intervention, American Style

"Russian meddling" means zilch to me. 
Everyone was trying to influence, intervene in and change our last Presidential election: Hillary, Democrats, Bernie, France, Germany, England, Ukraine, Israel, Syria. Everyone had skin in the game.

If the Russians put out fake news and a lunatic from Virginia jumped in his truck with his AK-15 and burst into a pizza pallor in Washington, DC, looking for the pedophile ring run by Hillary Clinton, because he believed the stuff he read on the internet, is that Russia's fault? 

Until and unless you can show me the Russians somehow got into the computers and changed votes or vote counts, and that Hillary actually won Pennsylvania, Wisconsin, Ohio and Michigan, then I do not care how hard Russia tried to elect Trump.

They wanted the sanctions against Russia ended and so they tried to help the guy they thought would do that.
The Supreme Court says corporations can spend unlimited amounts trying to elect Senators and Congressmen they like. 
We muffle no voice here in the USA.
Not even Russian voices. 

Has the CIA not done more nefarious things than that routinely in other countries?
Playing the Game

I don't know. I'm just asking to be educated here.
The basic question is: Why should I care about what Russia did in 2016 to influence our election?


Thursday, February 15, 2018

Massacre Du Jour: The 2nd Amendment Blues

A well regulated milita, being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed. --Second Amendment, United States Constitution.


Let's see, where are we? Oh, this week it's Florida.
Fourteen dead kids?

President Slithole says it's the fault of:
1. Democrats (who have not built his wall)
2. Local officials, who did not see the warning signs or better yet, the FBI for not swooping in on this kid
3. Unarmed students and teachers who failed to defend themselves.
4. Barack Obama, because, well, you know.
5. Hillary Clinton, because she is crooked.
6. Ted Cruz, who must be related to the shooter, who was also named "Cruz" and so, you know.


Thoughts and prayers are working over time.
It's not appropriate to discuss laws at this time of mourning, or morning.

Truth be told, Mad Dog, were he President would have no clear plan for dealing with this mayhem, other than perhaps agitating for legislation to restrict ammunition.
Trying to eliminate guns is a losing proposition--that ship has sailed. You can bury guns in your backyard. There are more guns floating around this nation than there are people.
Probably not a good idea to sell any more AR-15's, especially to kids, especially to kids who hear voices.
This kid, we are told lived with an adult who allowed him to keep his AR-15 locked in a gun locker in the house,and they told him he needed permission to unlock the locker. 
These people, the Sneads,  seem like nice people, but why do nice people allow a kid who had been expelled from school to keep an AR-15 in their house? 
Mr. Snead is said to be a "military intelligence analyst."  Now that is a thought provoking detail.
In this country, we probably should not be selling attack rifles and bump stocks to anyone, or at least we should make it just a little tougher for the next boy/man who hears voices telling him  he has to kill all his classmates.


But, you know, this America, man.

England was once a very violent place, lots of murders and beheadings. Somehow, they got past it. Same for a lot of Europe, although some places in Europe still haven't got past it--like Ukraine.

Add guns to the list of things government cannot likely solve all by itself; the list includes:
1. Opioid deaths
2. Opioid addiction
3. Women wanting abortions who should never have gotten pregnant in the first place
4. Illegal immigration by people who want to leave their horrible, "shit hole" countries
5. Global warming
6. Crime
7. Terrorism
8. Cancer
9. Death
10. Taxes.

Other than that, government can do a lot of good things to make life better, to enrich communities and improve life and health and education and foster new knowledge and the advancement of mankind.
But some things will always be with us. But that doesn't mean we should stop trying.
All we can do about those 10 nasties is try something, anything, and keep on trying.


So, I ask you: who, in his right mind can read that frigging 2nd Amendment, the only sentence in the entire Constitution which provides an explanation for the right it is about to confer, who could possibly read this and not understand this is not a right for individual ownership of guns? 

Monday, February 12, 2018

The New Medicine

This morning I spoke with a nurse who is in the University of Massachusetts Lowell nurse practitioner program. She is 25 years old and has been working on a ward at a community hospital and says, "I can't see doing that at age 40. I'm exhausted when I get home at night."


She is taking course work at the university and expects to have her NP certification in two years, 2020.
She got her BA in nursing in 2017.
I asked where she will do her clinical training and she smiled and said, "That's the problem. I have to arrange for my own."
"What? You mean with a doctor?"
"Or with another nurse practitioner."
"But how do you know if they are any good?"
"That's what I'd like to know," she said.
The clinical rotation covers 6-9 months, sometimes a year, but it is not clear how many hours a day this means. As a working floor nurse working 8 hour shifts, presumably the clinical rotation will not be 8 hour days.


At one of our clinics, all the primary care doctors quit and the manager, a thirty something woman with a MBA told me that really would not be a problem. They can always find nurse practitioners or physicians assistance to see patients. The doctor who signs off on their patients does not have to be on the premises, in fact will be about 10 miles away seeing his own patients.



I considered how I learned about patient care. It's true, I did not have much direct training dealing with patients who were not critically ill. We had a weekly outpatient clinic which most of my fellow residents thought a waste of time because the patients really didn't have much wrong with them, as opposed to the patients we saw in the hospital who often had several things wrong with them, each competing to see who could kill the patient first. I didn't mind the clinic, though. I got to see the patients I had seen in the hospital in follow up and it was amazing how healthy and normal they looked. Gratifying really. Some of those folks we wondered why we were working so hard to save, they looked so damaged, but then, six months later they looked like normal human beings.


Being exposed to people who turned out to have leukemia, or colon cancer or lung cancer or serious vascular disease or heart attacks or new onset diabetes for four years taught me a lot about how innocent sounding symptoms could be the harbinger of serious underlying illness.


It also made me respect influenza, strep pharyngitis and pneumonia, which occasionally landed a patient in the hospital where sometimes we could not save them.


How a nurse with 6 months of "shadowing" another nurse practitioner could step into the world with that kind of preparation, I could l only imagine.
She will look like a doctor, with a white lab coat, a stethoscope around her neck and many of her patients will not actually understand she is not an MD but she will know.


Fact is, she will be "cost effective" for the MBA who manages the clinic: Her salary will make those Excel spread sheets for the clinic's income and overhead look good.





Sunday, February 11, 2018

New Hampshire At Risk? Merrill, Childs and Francese

The gathering storm which is New Hampshire demographics was explored in a 2008 documentary by Lorraine Stuart Merrill, Jay Childs and Peter Francese, called "Communities & Consequences" which depicted the state as aging--we are the second oldest state in terms of age of the people living here, and we have a problem  of young people moving away rather than settling here.

I have not seen the original film nor the sequel which is in production, a follow up exploring the lack of affordable housing, land development abuses and decline in school, health care and effective local governance.
3 bridges over Piscataqua at Portsmouth

I've only lived in the Granite State 10 years, a veritable new comer, but most of the problems I see seem to be problems of scale. Only 1.3 million people live here, and they are not evenly distributed, being mostly clustered near the Massachusetts border or along the seacoast.
Tugboats at Portsmouth

This is a state which until recently has been mostly rural, apart from the mill towns of Manchester and New Market and its legislature is decidedly and determinedly amateur. It is only of the largest legislatures in the free world, 495 Representatives, for a state of diminutive size. 
North Church, home to Daniel Webster

If the people of New Hampshire wanted to improve health care, they would have to recognize that given the cost of health care, they simply do not have enough people to support a first rate system. Even Vermont, which tried to create a state run health care system found it simply did not have enough people to support one.
Fall stream 

For problems like health care, likely New Hampshire would have to form a consortium with other states--the obvious partners Vermont, Maine and possibly Massachusetts. Then the folks of New Hampshire would have enough market clout to buy itself a better system. Unless, of course, Bernie Sanders got swept into the Presidency with enough legislators to put in a National Health system.
Lake Winnipesaukie 

But what really draws young folks to a state and keeps them there is an educational system.  

New Hampshire will never have an adequate supply of really well trained doctors until it has university hospital training programs here. Young doctors tend to stay close to where they are trained as interns, residents and fellows. 
Rte 1A Rye, NH

Rhode Island does not have a problem attracting young folks because it has three thriving universities, only one of which is a public, state university. 

The University of New Hampshire has attracted to its mother ship a faculty with glittering credentials, and the colleges at Keene and Plymouth have stars, but to really bolster community building, a lot more money would have to pour into these institutions. 
White Mountains

Until 2017, one could always say, "Never gonna happen." Nobody is going to allow the kind of spending which would be needed to prime that pump. Republicans would shout down spending with the dreaded, "Deficits, Debt and Doom!" 

Now, of course, none of that dreaded triple D seems to matter. As long as the deficit emanates from cutting corporate taxes, it's all good. Apparently, the deficit is not the problem. Debt is not a problem. It's the moral significance of how you got there.

Or something. I don't quite understand. 
Portsmouth from the Piscataqua River

There are some very smart people living in New Hampshire, but they have not, thus far, outweighed people of the other variety: the entrenched, the ignorant and the fearful. 

As Rhode Island discovered some years ago, the solutions have to originate from within, from long time Granite Staters who have street cred with the folks from Bedford, Kingston and Franconia.  
Plaice Cove, Obadiah Youngblood

New Hampshire is one of those places that has so much going for it, you wonder how the folks here have managed to resist becoming the most gentrified state in the union: Gorgeous lakes, a splendid coastline, proximity to the cerebral cortex of the nation, good connections to rail, sea and land transport. Two airports which could burgeon if allowed--one in Manchester and one on the seacoast. 

The wonder is how we have managed to remain somnolent when the world has been clamoring all around us. 
Rte 1A North Hampton, NH 

Wednesday, February 7, 2018

Where Are the Winners for Democrats?

One of the wonderful things about New Hampshire is it is small enough so you feel involved; you are not swept aside by crowds.

There are 7 contestants for the Democratic nomination for Carol Shea Porter's United States House of Representatives seat. 

So far, I've listened to  two. 
So far I've seen placidity and passion, but where is that one with the cunning and the smarts to be able to beat the Republican?
Less Than a Year in New Hampshire 

Last night, at the Hampton Dems meeting, Maura Sullivan and Chris Pappas spoke.

I had heard Pappas before but was disappointed when he was challenged with a question about how he would answer the Trump-hole candidate who would say we need a Republican to build the wall and keep dark skinned illegals from flooding in from Mexico and raping our white women. 
Pappas replied he didn't want to get into "food fights" about that. 
When that was followed by a moment of pregnant silence, he explained that he was offering the alternative of civility and it was his judgment that more New Hampshire voters are offended by the nativism and hate than are drawn to it.


Not Up For a Fight

Thinking about the razor thin margin of the 2016 elections in New Hampshire, I remained unconvinced. 
I think we have to win not only the open minded Democratic base, but we have to appeal to the Republican voting sorts who might vote democratic if they thought they had someone who had some spine. 
Chris Pappas is thirty something, owns and runs a family restaurant and is warm and fuzzy. 
I don't think warm and fuzzy can win this time.
But Can She Fight on the Floor of Congress?

Maura Sullivan is another thirty something, but she has something different to sell: She was a Marine Corps captain and I was hoping for a steely eyed killer from the sands of Iraq, but what I heard was an emotional appeal, short on detail.

In one telling exchange, she was asked about the "#Me Too" movement. She was clearly caught off guard and asked the question to be repeated, as if she had never heard of the #Me Too movement or, if she had, she could not see how it would be relevant to a Congressional campaign. 
Well, Elizabeth Warren has endorsed it; lots of Congresswomen have embraced it,  but what do you think about it? 
What followed was a prolonged expostulation about how appalled Cpt. Sullivan is to have to even address the issue of sexual harassment. How very appalling it is that women who have to struggle with the deployments of their husbands might be sexually harassed around the Paris Island base.

The problem with all this is what it revealed about Cpt. Sullivan: 
A/ She was unprepared for an au currant question for which she should have been well prepared.
B/ She showed no capacity to explore both sides of a question.

She is young, blonde, has been a Marine officer and she is trying to sell that as the reason she should represent New Hampshire in Congress, but you are not going to be carrying an M-16 in Washington. 
You have to serve with your mind. 

What I was looking for was the requisite statement about Ms. Sullivan's basic sympathy with the women who have been unjustly violated, either physically or mentally, but then a discussion of the risks of giving up on legal remedies, the risks of simply dismissing the right of the accused to face and cross examine his accuser, the risk of this movement degenerating into vigilante lynch mob mentality.
Anyone who has read the New York Times or any of a variety of sources would have seen the full discussion of this topic with comments supporting and attacking #MeToo.

But she showed no capacity, no preparation for that sort of analysis. 
Sullivan would be chewed up and spit out by a truly cunning and pugnacious Republican, who would say, "Hey, I'm all for protecting women. There's no way we can have a work force which is half women being subjugated by dim witted men hitting on them. 
But, on the other hand, there have been famous instances of false accusations and miscarriages of justice--the Duke Lacrosse team, the Rolling Stone fake rape at UVA are only the two most famous. 
As the feminist author, Margaret Atwood, has said, there can be no women's rights without rights, period. When you get to the point where accusation by itself is tantamount to conviction, then you have accepted mob rule."

If that happened in a candidates' debate, Ms. Sullivan would be toast.

So, we have two down and five to go. So far, the prospects have not been encouraging.


Tuesday, February 6, 2018

"Me Too" and the Logic of the Vigilante



Women have been harassed in many ways at the workplace, from outright rape to far less aggressive ways, comments about their bodies, their scents, or simply comments from men about their own desire for those women who have to work with them every day.
Atwood


The "Me Too" movement has succeeded in raising awareness of this serious and pervasive problem.


But "Me Too" has also embraced a mode of the vigilante--punishment without trial.
The argument made by "Me Too" advocates has been the legal system, and corporate systems run by Human Resources, have failed to protect women and failed to deliver justice, and given the failure of established institutions to redress their grievances, women are justified in going to the press, to social media to exact revenge by public shaming.


This is always the way with the vigilante: The argument almost always involves at least three elements:
1/ The established process of judges, juries and trials is too slow.
2/ The legal system often fails to convict guilty parties, who get off "scot free."
3/ Women need protection, but the legal system in its failure to protect is complicit in the crime.


"The Oxbow Incident," written decades ago, shows how this can play out. In the end, three innocent men are hanged for a crime which, it turns out, was never committed.


As Margaret Atwood has asked: "Do Good Feminists believe that only women should have such rights?"  She adds, "I believe that in order to have civil and human rights for women there have to be civil and human rights, period, including the right to fundamental justice."


Yet, that is exactly what the "Me Too" women would deny the men they've accused.
Atwood outraged "Me Too" by referring to a witch hunt.
"There are, at present, three kinds of "witch" language. 1/ Calling someone a witch, as applied lavishly to Hilary Clinton during the recent election. 2/"Witchhunt," used to imply that someone is looking for something that doesn't exist. 3/ The structure of the Salem witchcraft trials in which you were guilty because being accused.  I was talking about the third use."
Accusation is Final Judgment


She goes on to note that Me Too is a symptom of a broken legal system. I would add that it is the symptom of the perception of a broken legal system. Doctors and many swept up into the criminal justice system have known for decades our justice system is any thing but.


"All too frequently, women...couldn't get a fair hearing through institutions including corporate structures--so they used a new tool: the internet...This has been very effective, and has been seen as a massive wake up call. But what next? If the legal system is bypassed because it is seen as ineffectual, what will take its place? Who will be the new power brokers?"


Will we have tumbrils rolling through the streets of Hollywood and New York and Madame Dufarge knitting names into her cloth?
Duke Lacrosse Falsely Accused


Examples of false accusations have been noted: The UVA fraternity rape that wasn't; the Duke lacrosse team rapists who committed no rape and no crime; the comedian whose accuser went home with him, got naked and didn't like what followed.
Lurid detail. Lies.


And then there is the case of Al Franken, who was likely boorish, stupid, unfunny but hardly a rapist or even much of a bully. More a stupid adolescent who has no idea how to approach women in a way which they might find attractive, not to mention acceptable.


The very range of complaint, from the man who puts up a Playboy pin up at his work station next to the work station of his female coworker, is hardly the same sort of harasser as  the TV star who has a button on his desk which locks the door to his office, so the woman cannot escape and he can rape her. Those are two very different offenses in my mind, but not, apparently in the mind of Me Too.


Some Me Too folks say it's not even the individual man who is the problem but the systematic oppression of women by a patriarchy. Really? Where are we now?


Those who argue the airing of accusations in the press is just, argue that in the respectable press, the accused are given the opportunity to respond, but thus far most of those accused have not denied the accusations, which proves they are guilty. Of course, those who refuse to comment have likely been admonished by their lawyers to say nothing, presumably because even the innocent in denying inexpertly may open themselves up to new charges.


In the case of Harvey Weinstein, we had that old "I'm entering therapy" which is in fact, an admission of guilt,  at least to some of the charges. But in the case of Al Franken his denial was that he remembered things differently, and that was taken as an admission of guilt as well.


Hardly.


The other Me Too trope is while there have been some clear instances of women bearing false witness and accusing men who had not wronged them, those unjustly strung up in the court of public opinion are "collateral damage," and their fate is justified by the need for revenge on the part of all those women who have been wronged for whom there was no other option to seek justice.


The result has been, to my eye, something akin to mob justice. That is the alternative to a dysfunctional legal system.


An accusation of harassment must be taken as a substantial act, an act of aggression. It may be warranted, but it is aggressive. It should be subject to question, to cross examination. In any system of adjudication, the punishment and judgment should fit the level of offense: The rapist belongs behind bars; the guy who puts up the Playboy pin up is a jerk, but does not belong behind bars.


What you have to ask yourself is this: Can a legal system be fixed, improved, righted? 


Then ask: Can mob rule ever be made just?


So it comes down to this: Do you prefer law or the mob?