New York Times to Medicare: You Furnish Me the Pictures. I Will Furnish You the Scandal!

Some years ago, an endocrinologist in Providence, Rhode Island awoke to his morning paper to see his name plastered across the front page: He had collected over $4 million dollars from Medicare the previous year. What a scoundrel! How could he have possibly done enough service to justify such an enormous amount? (In today's dollars that would be about $20 million.)

The endocrinologist happened to be  the Chief of Medicine at Rhode Island Hospital, and all the billing for every intern, resident and for some attendings were billed under his Medicare number. Of course, he did not get a dime of it. He was on salary. The money went to the hospital and to Brown University School of Medicine.

This morning, something similar may have happened to some ophthalmologist in Florida, who found he led all doctors in Medicare payments at $21 million dollars.  Maybe this guy is a scoundrel, but maybe he is injecting a lot of intra occular medicine (Lucentis)  at $2,000 a pop,  to prevent blindness in his patients. Maybe he is paying $2,000 for that medicine and Medicare is reimbursing him. I don't know. I'm just saying. There are all sorts of accounting quirks in any insurance bureaucracy. 

There are other wrinkles in this story: a drug called "avastin" may work as well as Lucentis, and costs only $150 a pop, but the manufacturer and the FDA would have to agree to allow this treatment. Lucentis has gone through the process of proving efficacy and safety. Avastin would have to do the same. But the $21 million dollar opthalmologist would not be in control of any of that.  If the opthalmologist, or his associates did 10,000 injections a year, or 5,000 patients a year or 14 patients a day, that would account for that staggering $21 million. But we do not know, because the New York Times did not do the basic journalism. They did not get answers to the basic questions.

The trouble is, nowhere in the New York Times front page, lead article, above the fold article is there an analysis of exactly what was going on with this $21 million pay out. They clearly just got the number and ran the story, the way, say, The Daily News would have done. Why ruin a great headline with a detailed analysis?

William Randolph Hearst  once sent Frederick Remington  to Havana to gets pictures of Havana in  the coming war with the Spanish. Remington wired Hearst, saying there was no war. "You furnish me the pictures and I will furnish you the war." This newspaper tradition of fanning the flames goes all the way back to Hearst. The New York Times, as great a newspaper as it is, or once was, is not above that tradition.

This all comes at a time when the US Congress has, once again, decided to simply renew Medicare funding for a single year rather than for 5 years, which is what hospitals and doctors' groups want so they can plan ahead. But when the Congressmen and Senators read this headline they are going to think no deeper and they will say, "Well, good thing we didn't give those hospitals and doctors what they wanted--we would have allowed these doctors to rape the system for 5 years. Next year, we can go get those scoundrels."

The system we have is a commercial system. It is based on profit and the game, one might say, is to maximize profit. Maybe the $21 million dollar ophthalmologist just learned how to play Liar's Poker better than everyone else.  He may say, "Hey, I didn't make the rules. I just played the game."

Maybe we ought to think more about the game. Maybe it shouldn't be a game. Maybe we should devise a system which can't be gamed, because it's not about profit, but about service.

Oh, but there I go again. Politically incorrect. 

The New American Doctor and The Single Payer

Lost in all the discussion of Obamacare and the direction health care will take in this country is a demographic change which Mad Dog has not seen mentioned yet: The sea change in the make up of the health care work force in the United States.

In today's New York Times "Sunday Review" are two articles about what the future holds for heath care in this country.  The first, by Molly Worthen, a history professor at UNC, Chapel Hill, is an insightful piece about why Canada was able to follow such a different course with respect to fashioning its health care system.
She notes the difference in the political climates of the two countries:
"Canada inherited something else from Britain besides the Westminster system. It retained the full spectrum of English politics. This includes the socialist left and the Tory right--both traditions that, despite their differences, call for a strong central government and the restraint of individual liberty in the interest of the community.
     The United States, by contrast, is a revolutionary state. The founders feared both kingly tyranny and the rule of the mob, and they bequeathed to us a political spectrum that is the narrowest in the Western world."

 And there was something different about the mechanics of politics: 
     
"American doctors succeeded where Canadian doctors failed (despite multiple doctors' strikes) because the American political system left individual politicians vulnerable to lobbying. They capitalized on the rhetoric of the Cold War, insisting that 'socialized medicine' was on step short of Soviet tyranny."

And there was another factor: Homogeneity in Canada but not in the USA:

"There is also no denying the ugly role that race played in this story: Too many white Americans have rejected reforms for fear that their tax dollars would help black Americans."

She is correct about all three factors, but her most interesting point is about race. Mad Dog would substitute "class" for this idea; here in New Hampshire, where there simply isn't as much race consciousness, because there simply are hardly any non whites here--outside of Manchester.  But you certainly, if you scratch the surface of the white Yankee resistance to Obamacare, find the resistance to the idea that I should help the poor--read that the "lazy"--when I've got problems of my own. 

Europeans cannot understand why Americans reject universal health care, until you ask the Swede, who has universal health care,  whether he'd be willing to support universal health care for all Europe, if that meant his tax dollars would support clinics in Spain, Italy or Greece. The Northern Europeans see themselves much as our New Hampshire Yankees do: We are the hard working, self sacrificing Northerners; they are the lazy, indolent, free-loading Southern Europeans, who sing and dance all night and are too hung over to go to work the next morning. Why should we worker ants support those slackers?

A great deal of the resistance to insuring the uninsured and extending health care to all derives from the resentment of the hard working to the notion of providing for the less enterprising --or less fortunate, depending on how you see the less economically successful.

Ross Douthat notes  we will see:
"A grinding , exhausting argument over how to pay for health care in a society that's growing older, consuming more care, and (especially if current secularizing trends persist) becoming more and more invested in post-poning death."

What neither Douthat nor Worthen focus on is the change in the American medical community, which as been theboiler room of resistance toward movement from a cash and carry system to a government paid system. 

In the 1950's and 1960's, American doctors were, overwhelmingly, white, male and the main if not the sole providers for their families.  Returning from World War II, they rode the post war economic boom, made money easily, built practices by simply hanging up a shingle and enjoyed a dream come true life. 

Even in the early 1970's, when Mad Dog went to London on a medical school rotation, he was struck by the differences in expectations between his American and British medical student friends.  The Brits were younger, just out of high school essentially, about 19 years old, and they expected a life of genteel respectability, but not wealth. They hoped to have a modest car, a flat to start off and, then a house, likely an attached house, in a middle class neighborhood. Their financial prospects were roughly equivalent to what an American kid with a high school education might expect if he were a good machinist and there was work in the factories.  Britain was simply nowhere near as rich as America. Doctors in Britain, if they could successfully emigrate and get past all the hurdles American doctors had erected at the border, could take a leap from modest comfort to dazzling luxury. 

The British students reflected these modest expectations in their modest commitment to patient care. They were out of the hospital at 5 PM, no matter what.  When they became the equivalent of interns and residents (Registrars), they were not up all night the way their American counterparts were. Their days were more contemplative, leisurely and far less filled with effort, management of details. They simply could not order the same range of tests for their patients, so there was less to do for them. They could not command the same range of therapies, so there was less to do.

American students, in those days, thought, "Ah, this is the difference between the rationing and tight budget restrictions in the British system and the more vigorous, incentive driven American system." And that was true, but the implication may not have been true: It may not have been true that the American system, hard driving, piston churning as it was, was better for the patient or for the country. In fact, much of what American doctors and hospitals did for patients may have been worse for patients, and it was most certainly far more expensive for everyone. The Brits, in retrospect, were driving Toyota Camrys and getting where they needed to go, while the Americans were driving fully loaded Mercedes, too fast, and wrecking a lot more often.

But now, decades later, as insurance companies have squeezed the American doctor far harder than Medicare ever did, the nature of the American doctor has changed. And changes have occurred in the demographics:  Virtually half of MD's are now female, and many of these are committed to their families first and their patients second. So, they take time off for pregnancies, choose specialties which allow them to get home early, refuse to take call on nights or weekends, retire in their 40's or 50's and generally spend less time at work. This is not to say they are not good doctors when they are at work; they are simply committed elsewhere.

And just as the Brits realized in the 1950's, it has finally dawned on American payers  that perhaps 50% of visits to doctor's offices for things like sore throats, cough, fever, back pain, injuries can be taken care of by nurses or somebody with far less expensive training than the MD:  a nurse practitioner in a CVS pharmacy, not even a "doc in the box" but a "nurse in the store."  The Brits had GP's doing the screening, referring patients who they had identified with more serious conditions back in the 1950's. Americans would have told you then they would not have tolerated being "pawned off" to a nurse. They wanted to see the doctor.

Now, the American doctor is not paid in the upper 10% any more. The primary care doctor, depending on where in the country she or he practices, makes $80,000 to $160,000.  You can do as well owning a McDonald's franchise. Own two, and you're doing way better than the pediatrician, the family practitioner or the internist.

And 85% of American doctors are not surgeons.  In fact, an increasing number are not MD's--they are "DO's" (doctors of osteopathy.)  The DO's are often among the most business savvy and do as well or better, financially,  than the MD's. They are often masters of marketing.

The surgeons can make $300,000-500,000, and some make millions. But things are changing there. The cardiac surgeons now face a loss of patient volume because angioplasties, stents and other procedures have cut down on the need for the basic heart surgery procedure: The CABG (coronary artery bypass grafting.) Training programs for heart surgeons which once may have had ten residents finishing a year, are now down to two or three. Simply not enough business out there.

So American medicine is now pretty much where British medicine was in 1970--a respectable, relatively secure profession, which promises a middle class life, and can be managed with a family in a decent community. You'll get a house, not a McMansion, and be able to afford a vacation. You'll also likely have significant medical school debt, which will diminish what you can afford for mortgage and you'll expose yourself to significant legal risks the average worker, the McDonald's franchise owner will not have:  Malpractice judgments. 

In short, your mother will be proud. Your father will tell all his friends about his daughter or his son the doctor, but the bloom is off the rose.

And this group of doctors will not, has not objected to the idea of a government salary to replace their commercial insurance company hassles.  Nearly ninety percent of American doctors get W-2 forms now, because they are employees, not the free wheeling, hardy, independent, self-employed doctors of yore.

Single payer?  American doctors now say:  Bring it on. 

And cover my malpractice insurance, while you're at it.

The Best Congress Money Can By: Just Ask the Supreme Court

Dweedledee & Dweedledom

Free speech sounds like such a simple idea.

There's a reason it's the First Amendment in our Bill of Rights.

It's the fundamental right on which all others are standing.

But consider this: You are in a crowded theater and someone stands up and shouts, "Fire! Run for your lives."

But there is no fire. The speaker is just exercising his right to free speech.

Or this: You are gathered in a huge stadium. There are 100,000 people there. You stand up to say, "I think every citizen should be able to use the bathrooms here, regardless of his or her color."  But on the public address system a man says:  "The bathrooms are for whites only. It is God's will. It's in the Bible."  Your voice has carried far enough for maybe 100 people to hear you. The man on the PA system has reached all 100,000.

Or, consider this: The local town police officer stops your daughter daily, on her commute to school, asking her for a date. Finally, one day, she refuses again and he hauls her off to  the police station, where she is stripped searched, has her vagina examined just in case she is carrying any lethal weapons there--we are only concerned about the safety of the jailers and the other prisoners-- and she is ultimately released, with a speeding ticket. The newspaper, which is owned by the police officer's father, prints a story saying she was driving erratically, that she propositioned the officer. The article appears in the paper, which is distributed to the entire town. 

Free speech, 100%. 

Rye Lobsterman, Obadiah Youngblood

If you are an absolutist, decisions become simple:  Limit speech and you violate freedom, and you violate the 1st Amendment. If you tell the Koch brothers they cannot spend $100 million to buy TV commercials for Rand Paul or for the senate candidacy of Rush Limbaugh, then you have violated their rights to express their opinions in a free society. It's really very simple. They have a right to say what they please, publish their opinions, in whatever form they can pay for, and to communicate their ideas to the public as widely as they can afford to disseminate them.

Suppose, in the not too distant future, technology becomes available so the purchaser can slip his message into your cell phone, your computer, your television, your radio and into your iTunes?  If they can afford to do it, is there any problem with that? Is access not one aspect relevant to considerations of free speech?

For Justice Thomas, there should be no limits on the amount the Koch brothers can spend to elect the particular man they want. For Justices Roberts, Alito and Scalia and now Kennedy, there may be no limits, but that will be for the next case. Right now, all they'll say is an individual can give up to $2500 per candidate every two years, but he can give $2500 toe each of  10,000 different PAC's, which are buying ads for that candidate. It's just a matter of book keeping, really.

So, for the United States Supreme Court, buying elections is no problem. It's like the game Monopoly--if you can gather up control of enough blocks, eventually you can control what everyone else is doing.

There is a reason 1% control the wealth.
They can buy the people who make the rules. They can make sure all the office holders are in their pockets.

And our current Supreme Court smiles and winks and says, "Fair is Fair."

Our Constitution, our Revolution was a reaction to the overwhelming authority of a king, of government, so rules were written to limit the power of government. What those bewigged 18th century gentry did not anticipate was a threat from oligarchs, from non governmental rich men who owned the country. Hell, Washington, Jefferson, most of the delegations from the South ruled over their plantations like little monarchs. They were concerned about a government taking from them. They were not concerned about a rich man having too much power. They were the rich men.

Want a definition of "Smug?"  Look at the photo of the Koch brothers above, or, alternatively, go look at a photo of our current Supreme Court.

Call The Midwife: The Possibility of Transcendent Good

Click on this image to Enlarge: It's Worth It

There is no reason "Call The Midwife" should have survived more than one season, at least in America. It has no murders, no hot sex, no car chases, explosions, intrigues, no wickedly delicious villains, no "role model" male hunks, no dashing males at all, no rich people living out lives of fantasy, no flashy cars, no dazzling apartments. 

There is simply post World War II London, which is poor, scruffy, downright squalid, with kids running and playing in dirty streets, families living in tenements with communal bathrooms which reek, dockworkers who get drunk and sometimes beat their wives, children suffering from disease and neglect.  

And yet...this is a mesmerizing rendering of time and place, suffused with values of sympathy, kindness and well meaning, values which guide people who do not have a lot to give, materially, but who give what they can in kindness.

The series presents one of the most remarkable characters Mad Dog has ever met: The head nun who runs the midwifery program, who is so thoroughly kind, wise and intelligent, but who is no Pollyanna and certainly the likes of such an authority figure has not been seen since the early twentieth century.  Imagine a heroic figure who is: A. A nun B. A nurse in charge C. Immensely competent.  No Nurse Wratched this. No Hip Lips Hoolihan. Nothing flashy, nothing dramatic, just simple decency. Mad Dog is in love, unrequited as that must remain.

The greatest wrenching struggle in season one was the decision of one of the nuns, a midwife, to leave the order and to marry the doctor.  Her pain was palpable but not overdone, and her joy at her new life of love was thrilling.

Each character, from the awkward, over sized Chummy, who hails from the upper class but finds meaning and happiness among the poor, who discovers that life as a housewife and mother simply is not enough, and so returns to the calling, and that's what this show depicts better than any before it--the nature of a a calling. 

The whole point of the pre medical running of the guantlet  in college was, and still is, to separate the "dreamers" from the hardcore realists who know that a career in medicine is not for those who are primarily driven by love of humankind but by the spirit of engineering, which places highest value on how things work and how they dysfunction, not on the reaction of human beings to that dysfunction.  Kind hearts are weeded out, unless they are attached to disciplined, tough minds.  Of course, the people doing the weeding out in the undergraduate colleges are not physicians and have only imagined what qualities doctors really need. 

But, for anyone who chose medicine, or nursing, because it appealed as more than a job, "Call The Midwife" brings back all those feelings, which, it turns out, in the end, are nothing to be ashamed of.

From a policy point of view, the depiction of the early history of a system of socialized medicine is fascinating, because it so clearly portrays the modest expectations of the physicians who worked in this healthcare system, none of whom expected great financial reward or even prestige. They enjoyed the social status comparable to a much esteemed auto mechanic--important when you have an emergency, but not someone you invite to the club. There would be no place for Frederic Brandt, the cosmetic dermatologist to the stars,  on "Call The Midwife." He would be the anti-Christ on this show.

What is also apparent is what made the British socialized medicine system so superior to the American for profit system:  Midwives, nurses visited patients where they lived, did so systematically, after deliveries, after hospitalizations, to be sure follow up care was delivered, which was important because less was done in the hospital; patients were sent home earlier and recovered there, which was better for the cost to the system, but also better for the patients.

Well into the 1970's, patients were kept in American hospitals for weeks, for services which could have been rendered at home with less cost and less risk.  While politicians and American health care gurus extolled the high quality of the American system, no real, objective, scientific data was gathered to assess the difference in outcomes between American hospitals and British hospitals.

In Britain in 1972, if you were admitted to hospital with a bleeding gastric ulcer and you had bled down to a certain level of anemia, you got one or two units of blood and were put to bed.  In America, you were pumped full of fifteen units of blood, with an intern following you through the night, doing hourly blood levels and calling in the surgeons for consultation and if you passed that 15 unit mark in 24 hours, you were hauled off to surgery. 

In retrospect, filling that inner tube with so much volume, may have increased the pressure on the weak spot and exacerbated the bleeding. And the hepatitis and other blood borne pathogens conveyed with all those units of blood was no advantage to the patient, in the long run. So the Brits, with their more hard headed and less-is-sometimes-more approach were likely practicing superior medicine than their gung ho American colleagues.  In American medicine, for the second half of the 20th century, "aggressive" was a positive description and "passive" a pejorative.  This worked well for profit driven American health care, but not so well for the patients or for the nation as a whole.

But in America, any consideration of limiting what you might do for a patient has always been met with cries of "Death Panels" from the thundering ignoramuses of right wing radio, and you can always play on a visceral reaction to the word "rationing" from the American electorate. That, too,  works well for the bottom line of many health related American industries. 

Just as America keeps building submarines and fighter jets and bombers which the military no longer has any use for because it's good for a Congressman's district, just as we keep vast military bases open because a Congressman wants those jobs in his district, we indulge in misspending in healthcare in areas which do not improve the public health,  because each project fattens someone's bank account.

When we fund a military hardware system we don't need, that's not welfare, that's keeping America #1.  When we spend money on keeping an ninety year old alive on a respirator for 6 weeks, that's just the world's best medical care. 

But go back and look at England in the 1950's and 1960's, watch "Call The Midwife,"  and see where a really intelligent system came from, as it emerged from a relatively impoverished economy, which required political leaders make difficult choices, and which set a medical system on a better course than the one our own profligate system careened down.

After World War II, America was booming and we spent like drunken sailors on all sorts of things--military contracts, health care, roads, shopping malls. The Brits did not have that luxury. They had to plan with discipline. 

What they got was a healthcare system which is not perfect, but it is lean and effective. What we got was the best for the upper 10% and dismal for the rest.

Hobby Lobby: Forgone Conclusions

Hobby Lobby Upright Citizens 

The Four Horsemen of the Apocalypse et al

The Supreme Court has heard the arguments about whether a company which must offer health insurance to its employees must offer forms of contraception its owners consider forms of abortion.

Justices Scalia, Thomas, Alito and Roberts will vote to allow the owners to do as they please, to deny IUD and Plan B coverage to their employees. 

Justices Sotomayer, Ginsberg, Kagan and Breyer will vote to insist that company owners follow the law of the land, and will not allow the owners of this company to impose their religious beliefs on their thousands of employees.

Justice Kennedy, as usual, will get to decide the case.

One wonders why we bother to hold this circus of oral arguments before the nine justices when the votes of eight of them can be counted from simply reading a synopsis of the case.  Why not just present to Justice Kennedy and let the others mail in their votes, get out for some fresh air--go for a walk along the Mall.

Of course, this case would not ever have arisen if we did not have a health care system tethered to employment. Why should your employer be able to tell you what sort of contraception you should use? Where did employers get that mandate to be the parents of their employees?

Employer based health care insurance began around the time of World War II, when there was a worker shortage and companies needed something to entice workers beyond salaries--wage and price controls were in effect, so they could not simply raise wages.

The Republicans would not allow a "government option" when Obamacare was being formulated. 

So now we are stuck with two Southern Baptists who believe a fertilized egg is a human being and if there is an IUD in the uterus and that zygote cannot implant and gets flushed out with the next menstrual period, that's abortion.

It doesn't matter that IUD's may not actually work that way; it's possible they prevent the sperm from working their way up to the egg and finding the target egg, but that's of little consequence since it is not important what some scientists think--all that matters is what the Greens, who own Hobby Lobby think.

If the Greens believed Whites and Negroes should not drink from the same water fountains or use the same bathrooms, and if that is their deeply held religious belief, then Justices Scalia, Alito, Thomas and Roberts would say, "Amen."

Justice Scalia, always quick with the absurdest analogy, the scathing hypothetical, posed the problem:  "Suppose the government was approached by animal rights activists who felt the method of kosher slaughter is inhumane?  Would the government tell all the kosher slaughterhouses they could not kill their beef in the kosher way, as they have done for thousands of years? Would the kosher slaughterhouse have to set aside the religious standards by which it operates because the government has a rule about animal cruelty?"

Well, actually, if the slaughterhouse was slaughtering human infants, or virgins, as a ritual sacrifice, the government should probably exercise its power to prevent that religious practice, Justice Scalia. You want an absurd what if, see you and raise you one better.

It is curious the court is comprised of five Catholics and Four Jews. Of course, one of the Catholics is relatively liberal. There used to be a "Jewish" seat on the court. May have been time when Catholics were excluded or subject to a quota. But for a country which is overwhelming Protestant, we have an odd complexion to the court.

The fact is, Obamacare, as flawed as it is, is lifting off. The Republicans broke its wings, plucked many feathers, and tried to wring its neck, but somehow, there are now citizens who are insured and an insurance industry which was betraying its customers for years, with fine print, pre existing condition clauses, rules which eliminated all but those who didn't really need health insurance, and now those sleaze ball insurance companies  have been brought to heel. 

But the Republican Party will likely sweep into control of the Senate and the House based on marketing. They will exploit the gullible, as always, and the weak minded shall inherit the dearth. 

College Athletes: Employees? Well, Duh!

Mad Dog begs the reader's forgiveness, but what part of obvious do you not understand?
Is the football player who signs a contract to accept a "scholarship" to a college, which guarantees him room, board, access to the facilities, coaches, travel and all the means to perform for the institution not an employee? 

When he is injured, unable to play, to perform his duties and he is discharged from the team, loses his "scholarship" and "let go" is he not "fired" from his job, without compensation, not to mention workers comp?

It does not take much personal experience at college to see the nature of the employer/employee relationship. There may be some peculiarities to the "student athlete"  relationship, which may more closely resemble that of an apprenticeship, but these kids are working for the college, generating billions in TV, sports paraphernalia income for the college. They have essentially a financial relationship with the institution, and whatever classroom education they get is a perk. But, for the most part, they have no time for "college life." They are at work, going over films with the coaches, lifting weights with their training coaches. Their time belongs to their employers. They are like those Chinese factory workers who live in dorms next door to the factory. They are working nights and weekends and days, too. There are no off seasons. They train year round.

Most college basketball players never graduate because with a 30 game schedule and travel and the lack of academic achievement or ambition of most college basketball players, classroom experience is simply irrelevant to their purpose for being on campus. 

There is the famous story, which dates back to the 1960's about Lenny Moore, a terrific running back for Penn State who was called upon in class by the professor. Moore did not answer; he just stared at the professor. "Uh, Mr. Moore, I asked you a question."
To which Moore responded, "My name is Lenny Moore. I carry the ball. I don't answer no questions."

What Moore was expressing, of course, was his pique with the regulation which in those days required he actually show up physically and attend a certain number of classes, which, in his case, was absurd.   His presence in the classroom was a lie fashioned by bureaucrats. He knew why he was at Penn State and so did everyone else, and going to class had nothing to do with it.

Even the Ivy League is not exempt, although, the Ivies could reasonably argue they could qualify as exceptional,  because they do not offer "scholarships" with cash amounts stated. What they offer is "financial aide" packages for "needy" athletes. But let's examine an anecdote about how this may play out.  

Mad Dog's son was a highly recruited high school wrestler and he was brought to campus by the wrestling coach at Columbia. (Princeton and even the venerable University of Chicago sponsored similar visits to their campuses.)  At Columbia, the coach told the group of hopefuls, "The only places you need to know how to get to are the gym and the library. At the Ivy League, you actually have to pass your classes. But your job is to wrestle and to stay eligible."

In the admission office, Mad Dog talked to an admission officer about another wrestler who had preceded his son. The admissions officer smiled and said, "Well, we were happy we were able to work out the aide package" for this wrestler. And Mad Dog thought, well, that's interesting: This wrestler they were talking about came from Potomac, Maryland, where he lived in a McMansion. His father was an orthopedic surgeon. Both parents drove Mercedes. Somehow, this wrestler, a child of privilege, qualified for "financial aid," which in the Ivy League has to be based on financial need.

Mad Dog's son wound up at Vanderbilt, where he had some football players on his dorm hall. He said he never saw them. They were always at practice, travelling or working out. Vanderbilt's student athletes were, in many cases, actually students, but they had demanding jobs. They were on work study. Of course, their opponents in the rest of the SEC did not have the burden of classwork to distract them, which may explain why Vanderbilt was never very competitive in football.

Duke brags about the high graduation rate of its basketball players, but none of them are engineers, pre medical students or students in any demanding academic area. How could they be, given their work schedule?

It has not always been so. When Mad Dog was recruited to wrestle at Brown University in 1965, he arrived to find that organic chemistry labs were held Tuesday and Thursday afternoons and the wrestling team traveled on Thursday afternoons. So Mad Dog withdrew from the wrestling team. Nobody said a word.

In his dorm, which had a high percentage of athletes, were football players who were engineers, chemistry and physics majors. Several starting football players were pre medical students. One is now chief of Urology at the National Institutes of Health. The starting quarterback is a radiologist.  Brown's football team was competing in those days against Brian Dowling and the professionals at Yale and Harvard and Dartmouth and Brown rarely won a game.  Ultimately, the football coach was eased out and a new regime came in and won more football games, but the physics majors disappeared from the roster.

Those are the worm's eye view stories. From the eagle's eye view, you have only to look at the numbers of players on basketball and football teams who never graduate, whose highest hope is becoming professional athletes, who cannot read, or read much, at the money spent on facilities, travel, coaches' salaries and at the income from football, basketball, and, in the northeast, from hockey to see plainly enough that university sports programs have nothing to do with students, academia or scholarship. As Gordon Gee, the former president of Ohio State remarked, when he was asked whether he would fire the football coach for some transgression, "I'm more worried about him firing me."

The Europeans, the Japanese, of course look at our stadiums our universities in wonder.  What does a stadium at the University of Michigan, with 100,000 fans waving maize and blue banners have to do with a university? To them, it all looks like soccer hooligans. A football team at a university to the rest of the world makes no more sense than an automobile plant turning out Iowa State trucks. In some ways, the truck plant, which would require engineering and business school expertise would make more sense to the core mission of a university than a football team.

But, once again, in America, we have a fantasy--the "student/athlete"--marketed and sold, the Big Lie. And everyone is making so much money (except the workers) for anyone to want to speak the truth--the Emperor has no clothes. He's buck naked. Just don't tell the NCAA. The folks there have big salaries to protect.

Or, as Upton Sinclair observed, years ago: "It is difficult to bring a man to understanding, if his income depends on not understanding."

Here, in America, where the almighty dollar rules, academia has been poisoned. 
Even outside the offices of the football and basketball coaches,  academics have been perverted by the pursuit of money. Professors are bought and sold and their "expertise" and opinions are for sale. Professors get a base salary, but that's not where their real income derives--they are off campus "consulting" most of the time.  "Star" professors get "loans" for summer homes and for mortgages. And what makes them stars? Is it the quality of their scholarship or the effectiveness of their own personal marketing stratagems? 

Even at the university medical schools, the effect of money has contaminated the academic work.  Drug company money supports medical school laboratories and publications carry studies sponsored by pharmaceutical companies. 

And what does academia have to sell?  Unbiased truth, one might say. Harvard's emblem says "Veritas."  But Harvard, all of them, have sold out. "Whose truth?" you ask.

The sponsor's truth.

Obamacare and Republican Chutzpah

The Four Horsemen of the Apocalypse et al

The best definition of the quality of audacity which is captured in the word  "chutzpah" is the man who murders his parents and then throws himself on the mercy of the court,  on the grounds that he is now an orphan.

This is pretty much what the Republicans have engineered with Obamacare. They murdered the only real healthcare bill which would have solved the problem of healthcare in this country--that is, a "government option" or simply put, Medicare for all.  Having cut the democrats off from that road, the only path left open was a sort of gerry rigged private insurance company scheme in which private insurance would still be purchased, but with all sorts of government requirements to be sure nearly everyone who wants to be covered can get covered, and most of it is still routed through employer provided insurance. 

And now the employers are howling, at least the employers who fancy themselves "religions" who just happen to have employees. So the Catholic church which runs a hospital which employs a thousand people, 800 of whom are Baptist or Jewish or Muslim or atheists, refuses to pay for any insurance policy which includes coverage for contraception for their non believer employees, because the Church opposes contraception on religious grounds. They don't object to hiring non Catholics as employees--they couldn't run their hospitals without them--but they object to allowing those non Catholic employees to behave like non Catholics.

Of course, what the Church is really saying is, "If you work for me, you have to follow my rules."  In the dark past, that meant that employers who felt blacks should not mingle with whites could have a rule that blacks use "colored" bathrooms at work--it was part of the employer's belief system, part of his religion, and if you wanted work at his hospital, you had to put up with that. 
But the arguments get more difficult--what if, as Justice Scalia suggested, the government responds to objections from the animal rights lobby and tells a kosher slaughterhouse it cannot kill animal by slitting their throats, as the kosher procedure demands?
The counter to this is, well there the government would be targeting the practices of one religion, not making a rule to apply to all.

But each carve out for a "religious exception" in the Affordable Care Act is simply a pathway to death by a thousand cuts, and the Republicans are gleeful in their pursuit.

None of this would have boiled up, had the Act simply said, "Okay, Medicare for all." 
Then, no employers would have a fight to pick with the government because health insurance would not longer come from employers; it would come from the government. 

But politics is the art of the possible, and a Medicare for all simply did not have the votes. 

When Johnson signed Medicare into law in 1965, the American Medical Association cried "socialized medicine!" and all the right wingers cried creeping socialism, the end of Western Civilization and the first step down the swift slide to a socialist, cradle to grave welfare state, just like Britain, Norway, Sweden, Denmark, France, Germany, Italy and all those leftist European governments which provided healthcare for their people.

Johnson signing Medicare into law 

 Now, of course,  ask any doctor what life would be like without Medicare and he or she will laugh or shudder or look blankly at you because nobody can really imagine life without Medicare. 

But here we are--the Republicans are raging because the law they bludgeoned the nation into accepting is causing an uproar because it forces the private sector into doing things it doesn't want to do, that same private sector the Republicans forced to include in the health care law.  The Republicans have maimed the program and now they complain that it is getting blood all over the fine linen. 

Oh, spare me.