Government Good Deeds List

This morning one of my co workers came in all excited because she was walking her dog along the Merrimack River and she saw a bald eagle.

Which reminded me they are now seeing bald eagles near Lock 8 on the C&O Canal along the Potomac near my former home there. When I was growing up in the 1960's along the Potomac, nothing but carp and catfish could survive in that river, which was really scummy and smelled bad.

Government made industries clean up their acts and the rivers were born again. If libertarians or big business Republicans of today had their way, those rivers would still be cesspools. 

So this is my first item on the list of "Good Things Government Does."

Of course, state government failed to keep the water non toxic in Flint, and the villains there were not industrial miscreants but old and unsafe infrastructure. The trouble in Flint was government failed to do its job. Of course, when the government does it's job and enforces regulations, that is not something we think of as a good thing: It's just like functioning sewers and water treatment--it's just there.

So, I invite my legions of silent readers to raise their voices, or click their mouses and add to my list of Good Things Government Does, in no particular order: 
(NB:  Libertarians will argue some or all of these things could be done by private enterprise, e.g. road building and road maintenance, but what is on this list are things I would argue for structural reasons are better done, more efficiently done by government.)

#1  Clean Rivers. (Environmental Protection.)

#2 FAA traffic control.

#3 Coast Guard rescue.

#4 Public schools (when they work.)

#5 Social Security

#6 Medicare

#7 National Defense

#8 Parks and recreation (e.g. Central Park New York City, Mountain Major, New Hampshire, and all the National Parks)

#9 Prisons (hard to think of prisons in a positive way, but it's one of those things somebody has to do)

#10 Police (as in "Serve and Protect" as opposed to "Shoot and Stomp.")

The Hillary/Trump Debate of My Dreams

Dime Store Bully

Here's the debate I'd love to see.
The Donald, in his full insult mode confronts Madame Secretary Clinton.

She does have a high voltage smile

Donald (looking down at Ms. Clinton): Well, they had to adjust that podium so the TV cameras could find you down there.

Hillary:  I'm just about exactly the same height as your friend, Vladimir Putin, but I guess you knew that.

Donald: I didn't. He looks taller.  But he's got way more energy than you. I don't see you riding horses shirtless.

Hillary:  At my age, one expects to get tired at the end of a long day, but the next day I wake up, refreshed raring to go.

Donald:  No, you're low energy all day.

Hillary: You pride yourself on animal strength, in which wild swine are your equal and the jackass infinitely your superior.

Donald:  You calling me a swine?  

Hillary:  Well, it was the jackass where the invidious comparison obtains. And I wouldn't want to be unfair to the swine.

Donald: You know, you were the worst Secretary of State in history.  You just couldn't keep up, which is why you had to bail out the night of Benghazi, had to go home to catch your beauty sleep. Well, as President, you've got to be on the go all day and night.

Hillary: So by late at night, I will be tired, but the next morning I will awaken rejuvenated and you, sir, will still be an imbecile. 

Donald: You've never made an honest dollar. The only power you've every had has been given to you by men, first your husband, then Obama.

Hillary: And you would know all about being handed power, as opposed to say, earning it. You are this country's closest approximation to Joffrey, the feckless son of the Lancasters, from Game of Thrones.  Born to the throne but not brave enough or smart enough or strong enough to actually wield power effectively.

Donald:  And you fashion yourself as a champion of women, but you were the enabler who helped your husband abuse women.

Hillary:  Do you know who Phil Sheridan was?

Donald: Never met him, I don't think.

Hillary: Well, he was a Union general in the Civil War. He was a man of many failings, and he was short, rather homely, but he had the qualities his country needed to save it--courage, decisiveness, understanding the big picture. He died young and his much younger wife was asked who, among her many suitors, she would choose to replace him in her life and she said, "I'd rather be Phil Sheridan's widow than any living man's wife." People didn't understand that. I do. Anyone who reads the tabloids knows my husband has his  faults, but I consider myself lucky to be his wife, for all our troubles.  You don't have the character to even carry water for him.

Donald: Yeah, and he came hat in hand to me for money. I carried him. 

Hillary:  You know, I think I know men. You are the guy who might be fun at the frat party Friday night, but  what woman would ever want to wake up the next morning and see you there, in the light of day?

Donald: Oh, a lot of women would.

Hillary: Well, I've heard you brag about the size of your male organ, it's true. But it's not so much that organ where your real problem resides: It's the two other organs we all should worry about in your case: Brain and heart.  The one doesn't light up and the other's too small.  

The National Health

When Bernie Sanders says he thinks we need a revolution in politics in this country and then says the United States should define health care as a right not a privilege, he really is talking about a revolution in values.

When you hear any politician, any Congressman, Senator say the United States has the best health care system in the world, the envy of the world, with foreign doctors coming here to learn the most advanced techniques, you know one thing for sure: That politician hasn't the faintest idea of what he or she is talking about.

Yes, foreign doctors come here to train, from Pakistan or India or third world countries, but we send plenty of American doctors to Europe to work with and learn from English, French and German doctors. CT scans were developed in England, laporoscopic surgery was pioneered in Europe. And most Europeans will say the United States may have the best medicine for the richest 10% but for 90% of Americans, medical care is far inferior to European and particularly Scandinavian health care.

When Bernie Sanders says every other industrialized nation offers universal health care and asks what is wrong with America for not being willing to do this, he is suggesting we ought to have a radically different set of values than what we have had in the past.

I really don't know whether you get better care in England or France or Germany vs the United States, but I do know when I watch "Prime Minister's Questions" from Parliament in London, at least 25% of all questions relate to complaints about health care, about a clinic which hasn't been built or refurbished. 
Clearly, the reason so many Senators and Congressmen don't want an expanded government role in medical care is they know that would put them in the position of having to answer constituents' health care complaints, and they already get enough phone calls about Medicare and Social Security--Health care is one more responsibility they do not want anything to do with. 

Not my job! 

Congressmen right now have lots of things on their plates: constituent services, fundraising, committee meetings, dialing for dollars, political meetings, fundraising, trips home to the district every week, dialing for dollars--the last thing they want is the nightmare specter of actually having to solve real problems for real people, like how to get Mrs. Jones the CT scan her doctor says she needs but the federal health care system denies.

Reading about healthcare systems in other countries, it's clear they have faced all the same problems we have faced when it comes to providing services for which there is greater demand than capacity to provide.  Just as we have found in the USA, when access to healthcare has been freely provided the service providers are quickly overwhelmed by demand so in France and Germany, steps had to be taken to reduce access.  

Just as the public abuses the 911 emergency call in number, calling for a ride to the hospital for a routine clinic visit, calling an emergency number for non emergency reasons, the public, given access for free, will always abuse and drive a service into uselessness. 
For years, patients have had free access to their physicians on the weekend for "emergencies," and they have abused this service by calling for prescriptions they hadn't bothered about during the week,  because they knew they could always call the on call physician on the weekend, or patients who haven't been seen for a year calling to have their blood pressure medications renewed at night, after office hours, or patients calling demanding antibiotics for what they insist is a sinus infection, because they don't want to pay the co pay and take time off work to see the doctor during office hours.  

So, the public can drive providers into defense mode. Charge $5 for the after hours phone call and you cut down on that emergency need for the prescription by 80%. Suddenly, not so much of an emergency.

The French have explicitly decided that health care ought to be offered free to all citizens, to all human beings who seek care within their borders, and they have decided doctors' first responsibility is to the patient, not to the government or the health care system, but this has caused them to face the results of this generosity--systems which are quickly overwhelmed and the money runs out.

In Germany, the average citizen can expect to pay 10% of his annual income on a health care assessment tax--how many people in the USA making $200,000 would be willing to pay $20,000 for their health insurance, even if drugs are included? 

Americans will vote for an aircraft carrier with a smile, but they howl bloody murder about their Medicare taxes. 

France has faced the same problems distribution of physicians we have in the US-- getting doctors to live and practice in rural areas, which are typically economically depressed and not at all where people who have been trained in big city hospitals want to live. So, as in the US, the French have found rural hospitals closing, and a deficit of doctors in less desirable towns and communities.  

As doctors' salaries have fallen into the $80,000 range, the medical workforce has changed to 2/3 female physicians, who are often the second salary in their family and who refuse to work long hours or to be on call who say they have more important responsibilities at home with their children.

Both France and Germany have had to deal with poor people and the unemployed, whose healthcare cannot be supplemented by employers, and have had to level taxes upon the well insured workers who have both government and private insurance and who are taxed to support those with only bare bones government insurance.

In England, France and Germany, health care facilities are often operating in the red and special efforts have to be made to shore up these public institutions.

So, when Bernie speaks in dulcet tones about the wonders of universal health care elsewhere in the world, he does not dwell on the problems in those systems. 

By many objective measures, these countries succeed in providing more care than we do, but they pay more for it. They have decided to spend money on health care. They do not have our defense budget. They may economize in other areas. But even if health care is a right, it is definitely not for free.

Flint and the House Oversight Committee: Republicans Rampage in Alternate Reality

"Oh, you should resign."

Definition of chutzpah:  The man who murders his parents and asks the judge for mercy, on the grounds that he is now an orphan.

Mark Twain:  "Consider a pack of jackasses. Now consider the United States Congress. But then, I repeat myself."

If  they say he should resign, we say you should resign

Yesterday the House Committee on Oversight (what a name!) had before it the governor of Michigan, a Republican who likely  ignored the lead in Flint water, and who many Democrats have called upon to resign.  Republican members of the committe, not to be outdone, demanded a Democrat from the EPA testify, so they could point accusatory fingers at her and demand that she resign!

This is one of those moments when you'd like to see a little Donald Trump in some Obama appointed official. What you would have give to have seen that EPA Democrat simply junk that stupid deferential tone government officials adopt when testifying before Congressional committes, that pseudo tone of respect and civility. Who needs civility when you are dealing with barbarians?

Here's the script I'd have written for her teleprompter:

Just once, say what is really happening

"Mr. Chaffetz, you accuse the EPA of having failed to protect the citizens of Flint, which is the height of irony in that you and your Republican colleagues and candidates at every opportunity have  called for the abolition of the Environmental Protect Agency,  which you consider anti-business, and you and your Republican colleagues have attempted to eviscerate the EPA, have limited its authority, have defunded it. Disband the EPA: This is the hymn every Republican from mayor to Senator has sung in unison.

 And now we have a perfect example of how important the EPA is, or could be, you howl with indignation the EPA:  the very agency you so revile,  did not save a Republican governor and his administration from itself, from the very policies and philosophy which drives your hatred of the EPA.  

You have day in and day out complained that protecting the environment is a waste of  money and no Republican wants to spend money to protect the environment, or the people whose lives depend on it, especially if it benefits poor people or people of color.

So now you have been caught aiding and abetting the poisoning of the well, and you complain that the EPA didn't do a better job protecting the citizens of Flint from your own policies. 

Where were the police, where was the security after I did my best to remove them? 

Where do I begin with such hypocrisy? How do I answer such absurdity?

At long last, sir, have you no respect for truth, no respect at all?"

Or words to that effect.
Wouldn't that have been just so gratifying?

Much as I love President Obama and his people, they just are too reserved for the current tempestuous times; they simply wimp out and quake when attacked. That's the one thing missing. 

I cannot imagine Mr. Trump accepting the vitriol spewing out from the Republicans across the hearing room floor.
I cannot imagine Mr. Obama or any of his kith and ken speaking like this.
That is disappointing. 
If only.

Trump is Not a Problem

Okay, here's Mad Dog's forecast:  Donald Trump will not become President. 
In fact, he will not get the nomination. 

He will  simply lose interest.

For the Donald, running for President has been like opening presents on Christmas day for the average four year old: The real fun was in the wrapping and once he's got that off, playing with the boxes the toys came in, but the actual stuff inside, not so much fun.

My over riding read on the man is he is really just doing this because he enjoys the attention, but he really does not want to be President.  
He may not have realized this yet, but sooner or later he'll sit down and watch a few episodes of "West Wing" and he'll realize he really is not interested in the actual problems of governing.

He'll arrive at the convention and he'll look for a way not to win which will be maximally dramatic and the most fun. 

Then he'll go home and throw a party for himself, maybe on some roof tops in New Jersey.

He could, of course, storm out and run as a third party candidate, saying the Republican Party done him wrong, but on some level he'll be relieved he doesn't have to take the job and he can play the Sarah Palin card, and simply grab the limelight whenever he wants it because as a potential future candidate, people will still be interested in him.

That will mean he can continue to be as outrageous as he pleases and 40% of the American public will continue to love him, which would never happen once he actually became President, because as soon as you become President you will start disappointing people.

So that's Mad Dog's take, and he's sticking to it. 
No Trump.

That's the good news.

The bad news is we may well have to deal with President Cruz.  

Dirty Secrets: Corruption and the American Way

When Bernie Sanders rails about our "rigged" economy,something deep inside me  resonates with that, likely for reasons Bernie cannot know, except in the general sense, but from the specifics of my experience, a rage wells up. He has tapped into that.

The best Congress money can buy

When I ran a small business (a solo practice of medicine) I tried to buy health insurance for my secretary.  This was an eye opener into the deep seated corruption/perversions pervasive in the American way of doing business, a corruption abetted by the government agencies we would expect to restrain misbehavior.  

As we tried to choose among the different health insurance companies (back in the early 1990's) we tried to be intelligent consumers, and we read through the thick directories of participating physicians and saw her doctors listed in Blue Cross Blue Shield of the National Capital area,  and we thought, great, she can keep her doctors if we go with this plan. 
But then we phoned the doctors' offices listed, and one by one it turned out her physicians no longer participated;many had stopped accepting this company's insurance years before.  So we went on to the next company and then to the next: same story with each.  

"This is false advertising!" my secretary said. "They tell you if you buy this insurance you get this benefit, care from Dr. X or Y or Z but you do not. You actually have only three or four choices and none of them are doctors I'd want to see on a dare."  
When I phoned the insurance companies they said, well, those doctors once did participate but have stopped and the companies said they  simply hadn't had a chance to update their catalogs of participating physicians. No chance, you understand over the past 10 years.  They did not update their catalogs every year because it was too expensive, they said. But clearly, when they did, they never bothered to delete physicians no longer on their "plan;" they only added names.

It isn't your father's healthcare any more

It was institutionalized bait and switch.  Every health insurance company in the Washington, DC area published bogus catalogs of participating physicians which listed every doctor who had ever had a contract with those companies, even though those doctors had bailed out years before. Every company, in effect, was claiming it offered you wide choices while in fact offering only very narrow choices.

So I called the department of Health and Human Services to protest this was a form of deception and all the companies seemed guilty of it and I was bounced around various agencies and none of the government employees wanted to hear about it. It was like talking to cops who didn't want to take the rape report because it was just so much paper work for them.

Only one thought counts

Corruption is not new

Another instance:  Examining my 20 page office phone bill I discovered a $15 monthly charge from a company I did not recognize. Calling the number provided, it turned out to be a company which was charging me for internet services to the office, and this fee  was part of my phone bill. 
Trouble was, we did not have internet services in those days and I had never purchased this, never authorized it. 
Calling the company collecting the charges they claimed my secretary "Donna" had approved of the contract.  Donna, of course denied every having talked to them and said she would never approve such a thing and would have put that on my desk. "Oh, but we have a recording!" the company man said and he played back a recording, obviously doctored,  in which you hear Donna's voice saying, "Donna," and then the company man asking if she wants to approve this contract and then you hear Donna's voice, shopped in, saying, "Yes." Of course, what they had done was to call the office and ask who they were speaking to, and recorded that and then some other "yes" and there you had it.

So I called the FCC and a variety of government agencies and they said that the phone company was powerless to remove the charge from my phone bill and there nothing anyone could do about this case of fraud. In effect, the government, the phone company, a utility, were complicit in the scam. They knew this company was engaging in theft but wanted nothing to do with the complaint. 


More recently, I confronted  a more complicated but no less noxious example of how the rich bilk the poor and good people just stand by and let it happen.

I sent a patient to Walmart with a prescription for insulin. There are only 2 companies who make insulin: Lilly and Novo. Walmart has done a huge service to the nation by buying insulin, pasting the Walmart label on the bottles and selling the insulin deeply discounted.
  But recently, Walmart switched from buying from Lilly to buying from Novo. When you write a prescription with your electronic medical record program you cannot order insulin as just "insulin." You have to order it by the brand name, Lilly insulin called "Humulin" or Novo insulin, called "Novolin." 
It's as if you send your kid to the grocery to buy milk and he calls back and says, "They won't sell me milk. They insist I pick Hood Milk or Stoneyfield milk."  
"And you say, 'Any milk will do.' And the clerk at the register says, "You have to choose a brand."
For some years I had written "Humulin" because I knew that's the brand Walmart sold. But I forget Walmart has switched to Novolin recently, and write for Humulin and when the patient arrives at Walmart, she is handed her two bottles of insulin and she has her precious $50 in her hand, but she is handed a bill for $300, which is about half of her monthly rent. 

The fox is very clever and knows many things

I get a frantic phone call from the patient . I call the pharmacist and the pharmacist says, "Well, you ordered Humulin."
 I say, "But until today that was $25 dollars a bottle." 
"Well," the pharmacist says. "We switched to Novolin, and you didn't write for that."
"So you couldn't just give her the Walmart insulin you knew I wanted and she wants?"
"Not if you wrote for Humulin."
"And you know they are exactly the same insulin, just made by different companies. It's like Market Basket milk vs Hannaford's milk."
"They are not designated bio-identical by the FDA. We have to follow FDA rules."

So I phone the FDA and I'm told:
1/ In the first place:
The FDA has not determined the two are "bio-equivalent" or "bio-identical" whatever that means.  The FDA spokesman would not comment on my assertion there's not a whiff of difference between the NPH insulin made by each company.
 Insulins do differ by "type" depending on how fast the insulin works, how fast it dissipates: R insulin starts working quickly and disappears quickly; NPH starts slowly and hangs around all day. But both Lilly and Novo make NPH and R and they are exactly the same.  You can use a 1/4" wrench and whether it was made by Sears or Home Depot, it works the same.


2. In the second place, the FDA lady tells me: 
"The state of Massachusetts writes the applicable laws which prevent the pharmacist from substituting,  so stop phoning the FDA to complain. This is a state issue."
"But the pharmacist told me it was an FDA rule."
 "Well, the pharmacist was wrong. Everybody blames the federal government for everything."

Tea party Republicans in charge: You're on your own

"This is what makes people angry about government," I told the FDA lady.
"Well, I can't help that," she said. "Anyway, it's the companies who make the insulin."
"And it's the companies who make the rules, apparently," I said. "And the FDA hasn't stopped the states from screwing things up."

A hedgehog

So Bernie Sanders is on to something when he talks about how what is "legal" in America is all too often,  immoral.
 It used to be legal to refuse to serve a Black person who walks into your restaurant or who tries to sit at your soda fountain. 
It used to be legal to own another human being.  
Those laws never made it right.

She fights alone

Did the cream rise to the top or was the game rigged?

Elizabeth Warren has tried to make an issue about what is done to "consumers" daily by big corporations but she cannot change things from the Senate. And she cannot change things alone.

The image of the executive offices at Lilly and Novo, lined in mahogany, occupied by men in thousand dollar suits, who have second homes in Hilton Head or wherever, who live lives of luxury, while my patient stands at the counter at Walmart, clutching her $50, which is a lot of money to her, and suddenly, she is faced with a bill for 6 times that amount, which is half a month's rent, because of some "rule" which was made to protect the profits of drug company executives, just makes my blood boil.

Big guys sucking the blood from the little guys, draining them pale.

Doesn't bother me to see our country go from white to brown. Doesn't bother me to hear a cacophony of languages around me at the mall or on the street. Diversity is just fine with me. Makes us stronger.

What bothers the hell out of me to see people who were born poor and who stayed poor but who worked hard and did the best they could to be treated this way by rich people.

Pretty clear who the cops work for and who the law does not protect

These are just three instances in which corporations injure the little guy and the government stands by like cops watching protesters beaten to a pulp by thugs.


You just want to say, "At long last, sir, have you no sense of decency. Have you no sense of decency at all?"

The hedgehog knows only one thing, but he knows it very well

Demographics are Destiny in New Hampshire

Plaice Cove

Tomorrow, I will participate in that peculiar  New Hampshire rite called the "warrant vote," which involves walking into Winnacunett High School, where an election worker will hand me a paper package no thicker than the Encyclopedia Brittanica and I will get to vote on whether or not Mrs. Lamprey should be allowed to plant mums on the other side of the sidewalk in front of her house, which is actually town land. 

In the Live Free of Die state I seem to have more say over my neighbors than I ever had in the anonymous environs of Montgomery County, Maryland, where none of my neighbors seemed to care what I planted or where and where my neighbor demolished his house and erected a McMansion which towered over my house and cast it into shadow over mine and I never got to vote on that.

New Hampshire's demographics tell a lot about what ails the state. There are 1.3 million people living in the state.  It's population is the 2nd oldest in the nation and its rate of aging is tops.  Of that 1.3 million people over 500,000 are over 50.  Many of these people are making less money than they did 5 years ago.

A State Rep Who Knows What Good Is

In Montgomery County, Maryland, there was one school district. In New Hampshire there are 289.  In Montgomery County a single police force policed the 1 million inhabitants. In New Hampshire, Rye, Hampton, North Hampton, Stratham, Exeter each has its own police force. Towns so small you hardly know you have driven through them have their own police and fire departments. 

There are 54,000 people between 15 and 17 in New Hampshire. There are 110,00 people between the age 50-54 and 95,000 between ages 55-59. 

Which is to say, there are a lot more folks around or approaching retirement than there are high school age kids in the state. People over 65 are 150,000 which is roughly three times the number of high school age kids.

Where there's art, there's hope

The wonder is that high school kids get any money at all in New Hampshire, and yet New Hampshire spends $15,283 on each student while Montgomery County spends $15,421, which does not sound like much of a difference, but that places Montgomery County 3rd in spending behind only New York City and Baltimore. What all this means is the dollar amount spent in New Hampshire is not all that different from other municipalities around the country, but the resources available to a kid at Winnacunet or Exeter cannot compare to what kids at Montgomery County schools have. Which is to say, the money somehow seems to buy more outside New Hampshire.

The hedgehog knows one thing, but he knows it very well

The public high school down the street from me in Montgomery County was built 50 years ago, then demolished and rebuilt 25 years later. Nobody bothered to ask the taxpayers; the county has a schedule for infrastructure.   Now there is a warrant article about refurbishing the middle school in Hampton and the town gets a vote.

The high school in Montgomery County has courses in music theory, a jazz band, an orchestra, a wind ensemble, a marching band and a music program which might match up with Julliard in ambition if not realization.  There are advance placement courses taught by recruits from the Bronx High School of Science faculty and 97% of graduates go to college.

When my son went there,  roughly a third of the teachers were uninspiring and just waiting for retirement, a third were stars and the rest somewhere in between. The curriculum was increasingly directed and delivered from the central planning and curriculum office in the County.  It was by no means a perfect  school system, more competition than cognition, but it was a system which delivered a lot more for the buck than we see here locally in New Hampshire, likely because sometimes economies of scale work, but mostly because the demographics of the county are much younger and the citizens fully committed to the idea of bragging about what great schools they have.  It is true ads for real estate feature the phrase, "Whitman School District" or "Churchill School District." 

I am not sure why New Hampshire prefers to atomize government. Does having a local police department, fire department and high school actually improve quality or does it mean that local selectmen or school board members can distribute favors with more discretion?

I do know that even in a senescent state, still, one of the most important things going on is the care and feeding and education of its young. I suspect local government with local control is not always better. Sometimes, it means local parochialism can be enforced to the detriment of kids who have to go out and compete in a more global world. 

In the South, local control wasn't such a good thing.