OBAMACARE: WHO CONTROLS THE NARRATIVE ABOUT HEALTHCARE?

Every day someone tells me he has been screwed by Obamacare: The costs of his medications have risen; the MRI machine was so loud it made his ears hurt; his flood insurance went up; he got a smaller refund on his income tax; his daughter's cheerleading team cannot afford to go to the national competition in Oklahoma City this year. It's all Obamacare, or at the very least government. Government has replaced Satan as the catch-all for what ails us. 

Where does this come from? You know very well: Mr. Limbaugh and fellow travelers including but not limited to Mr. McConnell and Mr. Boehner and all those Republicans federal and local, all reading from the same hymn book. They have seized control of the brains of the masses. They rule the waves, the airwaves that is, and they have as much penetration into gray matters as Big Brother ever dreamed of.

Paul Krugman recently illuminated how wrong Republican doomsday sayers have been about Obamacare, which they have been trying to convince us is a disaster.

He is correct, of course, Obamacare is way better than what we had, despite its bizarre complexity, a chimera of private health insurance and public funding which is a reflection of the way our government works: All the players are payers and as long as everyone gets his cut, the bill becomes law.

So people like my self-employed son in Brooklyn now have really good health insurance for half what really terrible health insurance used to cost him. That means if he gets sick, he may not drag the entire family, his parents and everyone, down into bankruptcy.  So, as far as payment systems go, it has been a success. 

But American healthcare is structurally disordered, and no Obamacare or any system of payment has yet steered its boat away from the rocky hazards toward which it is sailing.

Older doctors have always carped about how the system is going to pot, but there are signs this time their criticisms of current trends are on the mark now.

The structural problems are:
1. Doctors are motivated by profit and profit is generated by fee for service which drives the system into ever expanding services in search of fees.


2.  The English, decades ago, figured out how to use generalists and non physicians effectively. We have not learned from the Brits nor from anyone else who might be doing medicine better than we are,  because, in  our hubris   we have convinced ourselves we have  the "best medical system in the world." That declaration might make John Boehner feel all proud, but it means we have not learned from others. 

3. Innovation, which once came from university medical schools, now comes from profit centers, from drug and device companies and the kind of innovation which emanates from these profit driven sources  is not likely to benefit the public health, no matter how much it improves the bank accounts of those corporations.

Someone once said, "Medicine is too important to be left in the hands of doctors." Our problem currently may be that the hands of the doctors are nowhere felt now, and in their place are the hands of the bankers, the MBA's, the politicians and the entrepreneurs. Not that these people have nothing to offer, but whose hands should be on the steering wheel?

At root, it's a problem of values. The high energy, hard edged entrepreneurs, who think that the world, all parts of the world, ought to be run by dollars look at public health as a soft and fuzzy and inefficient ideal of commonweal and they want to apply principles of natural selection to doctors and patients.  They want "lean and mean" and they abhor socialized medicine and look at healthcare in Britain, Sweden and all those "welfare state"  European nations as failed programs. The Europeans know better: They look at our system and see a system that fails 90% but serves 10% admirably.  

The inner city clinic I ran for 13 years  in Washington, D.C. provided low cost care to people who could not afford to see doctors, during the 1980's and 1990's as a quid pro quo mandated by the DC government. The hospital from which it ran was in a swanky part of town, a maternity hospital which delivered the babies of the affluent. Well, the DC government said, if you are going to make money in this territory, you have to pay the rent.

That, of course, was, as Mr. Limbaugh would say, is just another example of the nanny state taking from you and me and the hard workers and giving to the undeserving slackers.  

Does Ms. Clinton, or any other Democrat, save Elizabeth Warren, have an answer for this? 

Torn: Liberals and Labor Union Militancy

Woody Allen has a famous line:  "The crucial moral dilemma is you are walking by an icy river and you see a man drowning. Would you jump in to rescue him? Of course, in my case, I can't swim, so it's not an issue."

This is essentially the problem for liberals who see members of labor unions drowning in a sea of  icy indifference. Roughly 80% of the American public has no connection to labor unions and likely no real sympathy. John Q. Public, when he thinks of a union worker at all, thinks of that union worker only when he is inconvenienced by a strike or when he sees a picket line.  For the most part, most Americans walk across picket lines the way they walk by Salvation Army collectors on the street, eyes averted.


For my grandfather, who was born in the 19th century and who came to the United States for a better life, only to find he had to fight for that better life, the labor union was an unalloyed good.  Nothing the union did could be wrong. His morality had the clarity of the absolute. The workers were always right, and the owners were venal, selfless and at best indifferent to the suffering of the masses; at worse the owners were heartless, ruthless, destructive, little better than the slave owners of the antebellum South. 

In his day, women working in a shirt factory burned to death because the owners locked the doors to the work shop and a fire at Union Square killed scores of them, some leaping to their deaths to avoid the flames.

Union membership has declined precipitously and public sympathy for unions, always crucial for support of strikers, has evaporated.  Wisconsin voters supported their strike breaking governor and supported a "right to work" law, which is, in fact, a union busting law.

Workers Strike for The Boss They Trust

One exception to all this was the almost unique case of Market Basket, where union workers, believing one boss was good to them, struck to support him in opposition to his hideous cousin, who clearly intended to gut the company, take the money and run, leaving the workers, the stores, the customers to burn.  In what other case had workers actually struck  to support a boss?

The problem is, in the 21st century, the sons and grand daughters of the early 20th century union workers are now reaching management positions in multinational corporations and they find themselves having to fill in as strike breakers, when union workers go out on strike.

My own brother-in-law, a solid, liberal Democrat, worked his way up through the ranks of welders making airplane engines at GE.  The type of welding these guys do is nothing like Rosey the Riveter, but more like a college physics lab.  Once he reached a management level, he was respected and liked by his staff because he knew the job from the bottom up. But when they threatened strike, he knew he would have to stand in and do the jobs of his former mates, or lose all he had worked for. And he had kids in college.

To whom did he owe his greatest fealty: His co workers or his family?

When the nurses at a hospital where I had patients on the wards went out on strike, what was I to do? Cross the picket line and undermine the nurses, or leave my patients unattended in their beds? 

To whom did I owe my greatest allegiance?

These choices are not easy.

The Crime of Being Japanese American

When the Japanese bombed Pearl Harbor, the American government responded by seeing the Japanese-Americans living in California as suspicious, as people of uncertain loyalties.  The American government rounded up American citizens whose only crime was having been born to people who had immigrated from Japan, and threw them into concentration camps.  

Would I have refused to obey the orders to transport those people to the camps if I had been a career Army officer? Would I have become the martyr, done the grand gesture, even though I knew it would not help prevent a single unjust imprisonment?

We are torn because there are good arguments on every side.  

My grandfather would have argued, I risked everything for the workers; you should do the same. But he did not have a mortgage or kids who were in college. His kids went to the almost free City College. But he would have said he still had rent to pay and risked eviction and starvation. He supported a family.  In his case, his co workers had no other choices and no social security or unemployment insurance or re training programs. 

It does seem today's workers have more options and when they lose their jobs, they are less desperate, but that may be only because memories are short or because we are not in the place of today's workers. Many liberals have moved up the socio- economic scale to, if not the ownership class, to the management class, but they look back over their shoulders and they remember where they came from. That can cause some agony. 

The truth is, when the government and big industry array themselves against the workers, the workers cannot hope to win.  Standing with the workers, as a manager would likely be a sacrificial lamb moment.  Nobody in authority would change his mind--they just fire you. What good does that do the workers?

John Oliver Saves New Hampshire From Itself

"New Hampshire, where 'Live Free or Die' is a legitimately difficult choice." 
--John Oliver


https://www.youtube.com/watch?v=nObupsG0Lf4

If this link does not work for you, just go to youtube and enter into search:  John Oliver, Red Tail Hawks, New Hampshire.

The world will little note, nor long remember what Mad Dog has said here about Renny Cushing's effort to nod in the direction of some 4th graders, but it can never forget what John Oliver did to the New Hampshire legislature. 

I am wondering why Mr. Oliver, Mr. Stewart and CNN do not have a field office in Concord. It has got to be as rich a lode as Fox News. The dimwit density has got to be at least as thick as Fox News. 

We need a live feed from Concord to Comedy Central.

House of Cards:The New Hampshire Illusion

"House of Cards" took 4 episodes to get interesting this season, but now the candidates are in Iowa and New Hampshire and the cold states have heated things up big time.

I have to keep reminding myself this is fiction, but the way the staffers and the politicos speak sounds very real to my ear. Granted, I never worked on the Hill, but I certainly heard this kind of talk, as you do when you go to dinner parties, the swimming pool, the gym and all the places you run into people who do work on the Hill. It's more than those wonderful shots of the city and the waterfront which open the show--the voices, the phrases, the culture sounds authentic. 

What I could not  know living in  Washington, was what happened when the politicos got out on the hustings.  What HOC shows you is how the Washington people view the folks in the trenches in New Hampshire. The strivers are testing out lines, the way comedians test out their material, to see what works, to field the embarrassing questions in a small groups before they have to answer these questions in front of a large national TV  audience.

Having spent most of my life in Washington, DC, the only President I ever met in person was George H.W. Bush, and he was Vice President at the time. Up here in New Hampshire, I stand on "visible presence" lines, holding signs with people who've had Obama over for coffee, who have chatted with  Hillary and all the people I could only read about, when I lived in DC. I heard about these figures all the time, but never actually heard them in person. Here, people have direct conversations with the candidates. So you might think New Hampshire folk play a special role in the political life of the nation.

And they do.

But I don't think it's quite the role we'd like to believe we play up here.  We are not so much shaping events as being sampled and weighed. We are not selecting future leaders; we are acting as focus group subjects, as the candidates move on to hone their images and messages.  If we like Claire Underwood as a blonde, well then, we see Claire go blonde, but we are not changing anything substantive. We are constantly being "played" by people whose only real conviction is the conviction they have to be elected, they have to win.  Whatever it takes to get us to say, "I'll vote for you," is what they will say. None of it really means anything to the people who want to be winners. 

Rand Paul may believe in minimal government and Hiliary Clinton may believe in more government, but in the end they will have to compromise enough for the distinction to be without a difference. 

We can chat with the players and think we are backstage, getting a feel for them, but they are never really off stage when they are with us.  They may, at best, try to learn who we are, what matters to us, but they are not going to let us know what they are thinking. 

And if we go door to door and have conversations with our neighbors, we are likely the only ones affected by this exercise. The movers and shapers from Washington are not being changed by our opinions. 

And we are certainly not selecting or culling; we are only a ripple in the pond, not a wave carrying the boat along.

As the story line sweeps HOC along this season an unexpected theme emerges: Personal feelings matter.  Established institutions only constrain, but do not shape how people really feel or behave

There are three parallel stories, relationships: There is Claire and Francis Underwood, who are a "fusion" of power, and their very modern love starts to corrode them. There is Tom, who is writing an authorized biography of the President while bedding his chief antagonist in the media, but when he gets too close to the truth about the Francis/Claire relationship, he is thrown off the bus. And there are those two thoroughly driven, ruthless and absorbing people: Jackie (the ambitious Congresswoman, who marries the "right" man but who longs for Remy, the wrong man) and Remy, who is a consummate professional, who routinely sets aside his personal feelings to serve and protect his boss, until he can do neither.

When Jackie finally shows up at Remy's door, it is the first time over the three seasons you see any one doing the "right" thing, following her heart, and what she is doing is a violation of her obligations, vows and career.

We can learn something here in New Hampshire from "House of Cards." We can be earnest and we can educate ourselves on the issues and we can discuss them with our neighbors and we can blog and we can vote. 

But we cannot know the people we are voting for, not from what we are seeing here. 

For that, we have to  speculate and imagine. 

Admirable Women

Eizabeth Cady Stanton

 Gail Collins, in today's New York Times brings attention to the efforts to replace Andrew Jackson with some admirable woman on the $20 bill. Having read about some of the women who have been put forward, I would suggest we replace Washington and Hamilton as well.  We simply have better, more interesting and inspiring people, who happen to be women. Why should we have a slaver on the $1 bill and Hamilton, who was, after all, the original Wall Street master of the universe, when we can have Elizabeth Cady Stanton, Alice Paul and Clara Barton?

Alice Paul

 Knowing nothing about Ms. Cady Stanton or Alice Paul, I had to resort to Wikipedia, but my investigations will not stop there. These are amazing women. Not just amazing women--amazing human beings.  It's a failing on my part and on the part of the American educational system I have not heard of them before, or if I had heard of them, it was lost on me.

Ms. Barton is an old friend. 

Let me begin with Clara Barton, whose deserves a place on a bill without doubt.  She left her native Massachusetts to care for men from her state when the Civil War broke out and, arriving on the battlefield where next to nothing had been planned for the care of casualties, she set about organizing the basics: bandages, nursing, all the things the men of the era had neglected. Oh, you say we are going into battle where some of our soldiers will be shot? And we ought to have some plan for what to do with these wounded? Well, why should we plan for that? That's like admitting we might be putting our brave soldiers in harm's way!

Eventually, she got President Lincoln's ear and the rest, as they say, is history. 
Her house still stands today, in Glen Echo, Maryland, overlooking the Potomac, just down the road from where I once lived. Eventually, they named the parkway running along the Maryland side of the river "Clara Barton Parkway." It had been called the George Washington Parkway, but the parkway on the Virginia side of the river was also called the George Washington Parkway, which caused all sorts of confusion, so they gave Clara Barton the honor, and in a sense the precedent for replacing old, white male slave owner with a woman who actually worked to preserve the union and save a lot of young men in the process.

And she had to fight a whole lot of entrenched men, who had rank and position to protect, and she had to show they had neglected a basic responsibility to plan for misfortune and to allocate resources and she identified which resources would be needed and she fought relentlessly to get that accomplished.  There was not much political ideology here, simply humanity and moral outrage that men in splendid uniforms and shiny epaulets could be so totally incompetent, when this humble woman in a brown dress could be so efficient and smart.

Clara Barton

As for Elizabeth Cady Stanton, well she had me at her marriage vows, where she insisted the preacher omit the "obey" from the "I will love, honor and obey" my husband bit. If we are equal partners, why should I obey my husband?  She was also an abolitionist and she helped found a movement for getting women the vote. She was so appalled by the fire and brimstone of the evangelical Christian church, she left the church and decried organized religion.  Having attended a revival meeting as a young woman she was so shaken by the descriptions of what awaited her in Hell, she took to bed. When she emerged from bed, she was a firm advocate for a less vicious vision of godliness.  She did oppose the 14th and 15th amendments guaranteeing  black men new rights, but she did this because women did not yet have the right to vote, and she felt the Negro men had got enough with the 13th amendment, and it was the women's turn.  She was, then, something of a tactician, but her heart was, apparently, always in the right place. I like her.

Then there is Alice Paul, who came along after Ms. Cady Stanton, and Ms. Paul had all the advantages, but she fought for the disadvantaged. A descendant of William Pitt, educated at Swarthmore and the University of Pennsylvania and British universities, she could have had a satisfying, comfortable life of wealth, but she joined demonstrations in England for women's voting and she brought that fire back to this country, where she organized, got arrested, paraded and risked a lot to get women's suffrage passed as the 19th amendment and once that passed, she went after an Equal Rights Amendment. 

Her spirit lives today in women who campaign relentlessly to stop power plants from displacing more important things in the community, who do community organizing and political activism while men shrug their shoulders and go off to play golf. 

These are people who make a difference, who pushed the country in the right direction, who were not only on the right side of history, but who made history into something better than it would have been without them. 

RED TAILS FIND NO LOVE IN NEW HAMPSHIRE

Who does Representative Renny Cushing (D-Hampton) think he is, getting 4th graders all stirred up over birds?
When a fourth grade class at Akerman School (Hampton Falls)  tried to seek a hearing for their idea to make the Red Tail Hawk the New Hampshire state raptor, they learned from the Republican Representative Warren Groen (R-Rochester) just what a nasty thing it was they had done:  The Red Tail deals with its prey in a most indecorous way, Mr. Groen objected: it "tears it apart limb by limb." 

And, not content to educate these 4th graders on table manners, he added, "It would serve as a much better mascot for Planned Parenthood."

In Mr. Groen's defense, adult residents of New York City, not an easy crowd to shock, were somewhat unnerved to find pigeon bones raining down on them, when a nest of Red Tails roosted on a ledge started feeding their young without instructing them in urban table etiquette, so the fledgings simply tossed the bones overboard.

So maybe Mr. Groen is not alone.
On, the other hand, Planned Parenthood?
It did turn out to be a teaching moment, as one Hampton Falls parent explained: She had to explain to her 4th grader what Planned Parenthood is, and how it relates to the Red Tail.

I would give a lot to have heard that parent and that conversation.

For my part, I can only imagine Mr. Groen has Planned Parenthood on the mind. Not the first thing which would have leaped to my mind in the case of raptors, but that's why we have representative government--differing perspectives.  Personally, when I think of Planned Parenthood, I think of packages of birth control pills, condoms and things which, ultimately prevent anything from getting torn apart limb by limb. 

But that's just me. 

The fourth graders did respond: "In our opinion, we think that the strongest reason is that both the female and male work together to raise their young. This includes nest building, incubation and feeding. This united approach to parenting is a great example for New Hampshire families."

Talk about precocious!
Show me the kid who tweeted that. Fourth graders go way beyond what I remember. I was into Mad Magazine in fourth grade. These kids can draw analogies.

I would very much like to know Mr. Groen's response to this idea of males participating in nest building. Republicans, at least last I heard, are still trying to wrap their mind around women in the military and men being in the delivery room. 

It has been noted the same New Hampshire House of Representatives voted last week to name the bobcat New Hampshire's state wildcat.
And I've never seen a bobcat in this state.
I have seen lots of wild turkeys, which would be my choice for state bird, albeit no raptor the turkey.
If I hadn't moved to New Hampshire already, I would have packed up and moved here as soon as I saw this story on line. 
Really, with these 4th graders, this state has a future. 
And we can count on Mr. Groen, and all those who sail with him, to challenge these precocious, contraceptive loving, misguided urchins to be even better.

Control Freaks

The March 9 New Yorker carries two articles about  how two very different governments fail to control what they want to control, each in it's own pathetic way.

Peter Hessler describes being escorted around China by his government assigned censor, who is in charge of deleting phrases to pages from a book Hessler wrote about China.  What was most remarkable is that stuff which you might expect  would evoke the wrath of a sensitive authoritarian regimen was untouched--descriptions of the Communist party's manipulation of a village election, bosses hiring underage workers, violating safety laws, damaging the environment, tax officials taking bribes--but when the author discusses a former Premier, Li Peng, and gets the word for "orphan"  mixed up with "bastard" he has discussion with his translator which is pretty funny-that discussion was stricken by the censors, even though it was about the author's own clumsiness. 
The censor explained his bosses simply did not want the name Li Peng connected to the word "bastard."
In the end, the "censors" appear as hapless and timid functionaries, who are simply looking for work, and trying to please unseen masters higher up the ladder, who are, in turn trying to divine the thinking of those above them. 
Hessler develops a friendly relationship with one censor cum translator assigned him and ultimately  Hessler is able to throw enough work in the direction of this censor to establish this man in a career. 
Of course, when you really think about it, what the Chinese government is doing is pretty thoroughly Orwellian--the bureaucrats are trying to control thought, to manipulate free expression, to insure uniformity of opinion. It's just that the actual people you see struggling with this are just as frustrated as the author, because once you start down that path, all sorts of absurdities fly loose. Bribery? No problem. An American who can't tell the difference between an orphan and a bastard--well, get out the scissors. 

Eric Schlosser's piece, "The Break In at Y-12" is far more disturbing. This one is about failures of the American government to exert control, but this is a control most Americans would like to believe is effective. 

  

Schlosser wrote the wonderful Command and Control about the misadventures of American nuclear weapons over the years--a nuclear missile explodes in its silo in the Midwest,  and on several occasions, nuclear bombs slip loose and fall to ground in the United States from B-52's which once were kept aloft, just in case they needed  to fly to Russia to obliterate a few cities. 

In this piece, no missiles explode. It's worse than that.  A couple of  80 year old nuns penetrate the defenses around the storage facilities where weapon grade uranium and plutonium are kept. They did not intend to steal the radioactive stuff. They pour blood on concrete walls and spray graffiti with quotes from the Bible. The disturbing thing is that these dottering nuns were able to follow a not much younger confederate with a bolt cutter and walk right in. 

These "Highly Protected Areas" turn out to be not all that highly protected, mostly because the security has been "privatized."

You remember "privatized."  Like privatizing social security. In case you haven't thought about this concept lately, it's like this--The basic concepts are: A/ The government can't do anything right.  B/ Private enterprise should always lead the way because C/ Private enterprise is always more efficient.

The problem with private enterprise, when it comes to protecting our nuclear material from all those Jihadists who are drooling over the prospect of getting their hands on fissile material,  so they can wipe out New York City or Washington or Chicago, or Las Vegas, roughly in that order, is that what private enterprise is really good at is turning a profit.

So, if you want to turn a profit, you've got to cut expenses. This is the concept of a two sided ledger sheet. You've got expenses on this side and income on the other side.  Now, with respect to expenses: People are expensive. You have to pay them to watch those monitors and to patrol the fences when the monitors show there are two nuns and guy with a bolt cutter cutting through the fence. 

The company in question is, or was, called Wackenhut Services (I am not making this up. WACK-N-HUT!) But then it got sold to a Danish company, Group 4 Falck, then to a British company "G4S." (The Brits always like names which are simply letters and numbers: M4, Double oh seven,  007, you know, as in James Bond.)

So now you've got the nuclear fissile material of the United States of America in these storage facilities run by a private company which last week was Danish, this week is British and next week, who knows? Somali? Syrian? How about ISIS? It's all private enterprise!

Anyway, eventually the nuns get caught and arrested and treated really brutally, considering their age and the fact they are nuns and quoting a lot of Scripture.
But, clearly the guys arresting the nuns are really embarrassed these nuns got to the quarterback when they were supposed to be providing protection, so they keep these 80 year old women sitting on the group with their hands hand cuffed behind their backs for 5 hours. (Try that sometime.)

A word about these protester people: They are not exactly what you would call "practical." They believe it is better to die turning the other cheek than to resist nasty people--even Nazis.  They would not harm the man who is about to detonate a bomb in New York City because they are non violent, to a fault. So, it's not as if you can really embrace their entire approach to policy.

But, they do seem rather harmless to be sentenced to 18 years in prison for smearing blood on the concrete wall and spray painting Scripture on the same wall. 

Oh, but the judge explains, as he sentences the nuns to years in prison: "If all that energy and passion was devoted to changing the laws, perhaps real change would have occurred by today." 

Do you think the judge has ever heard the word, "Gridlock?"

Anyway, the nuns and the bolt cutter guy are now in prison with other dangerous types: rapists, murderers, drug kingpins. It really is straight out of "Alice's Restaurant." You can just see all those rapists and murderers moving away from the bolt cutter when they find out he's in for spray painting Scripture. But then they move back again, when they hear he cut through three fences and took a sledge hammer to a concrete wall, causing malicious mischief.

Contemplating how easily the nuns penetrated the "Highly Protected" complexes where fissile material was stored even some Republican Congressmen found reason to be alarmed: "It is outrageous to think that the greatest threat to the American public from weapons of mass destruction may be the incompetence of the Department of Energy security."  Of course, being a Republican, Rep. Michael Turner made it sound like it was the incompetence of a federal government agency, but the DOE had long ago been stripped of its security funding--that had gone to private enterprise, the infamous company, G4S. 

If Timothy McVeigh had known a few nuns and a guy with a bolt cutter, he wouldn't have had to use fertilizer to make a bomb. He could have leveled Oklahoma City with fissile material.

Schlosser notes Al Qaeda's current leader, Ayman al-Zawhiri has said a nuclear weapon, such as one he could construct with material from sites like the Y-12 site the nuns penetrated, would be blessed by Allah: "If a bomb were dropped on them, destroying ten million of them and burning as much of their land as they have burned of Muslim land, that would be permissible." 

These particular nuns, it must be noted would not like to see that happen, but neither would they stop Mr. al-Zawhiri if that meant blood might have to be shed to stop him.

As Schlosser leaves the prison housing the bolt cutter he looks back at the American flag flapping and he writes, "And a thought occurred to me: the walls of the penitentiary guarding this pacifist were taller and more impenetrable than any of the fences at Y-12."