Captain Heel Spur Morphs into President Trump

Before he was President Trump, he was the Donald and before that he was a celebrity and before that he was Captain Heel Spur.

He had this wonderful uniform in high school, and as he noted during the campaign, he was almost a soldier, and had more military training than most officers who actually did go to war, so...you know, now he's commander in chief.

He knows more than the generals now, he says. He knows more than the doctors, too. And he knows way more than any Congressman or Senator. Plus, he knows more than those captains of industry who are trying to move their factories across the borders.
And he was never captured.
And he most definitely knows more than those so called judges who any bad high school student knows more than. And he should know, because he was one of those bad high school students.
He's our guy.

Oh, The Fraud: No Legitimate Voters in New Hampshire. They're all Crooks!

President Trump will have you know that the only reason he lost New Hampshire was all those Massachusetts voters who were bused in to vote for Hillary, after they had voted for Hillary in their home state.

He got this idea from Governor Chris Sununu, who pointed to Martha Fuller, a state senator who had three Democratic workers living in her house before the 2008 and 2012 elections who claimed "domicile" in New Hampshire and voted there.

Governor Sununu is just sleazy enough to extrapolate this instance into a general case, questioning the credibility of any electoral results from New Hampshire.

Having said all this, even Mad Dog finds it surprising to learn
1. You can vote in New Hampshire if you have any sort of address, even, presumably, a motel, or a winter rental down at Hampton beach.
2. There is not length of residence requirement, so those election workers would have been legal voting in New Hampshire.
3. To be legally "domiciled" in New Hampshire you have to sleep most of your nights in the state or you have to intend to return there after an absence, as a soldier posted to Afghanistan might.
4. To vote you do not need a picture ID--you need only have your photo taken at the polls and if the Secretary of State challenges your vote, you have to answer for that later.

Of course, Republicans talk about voting fraud as a pretext to prevent voters from voting, because, at least until this past election, it was pretty clear most voters would vote against Republicans if given the chance, so the technique, which was used as long ago as post Civil War has been to throw up enough obstacles to intimidate, humiliate and thwart voters who may not be very literate, who feel intimidated by government officials in general, from voting.

On the other hand, no duration of residence?  Virtually anyone crossing the border and getting a hotel room or crashing a friend's couch can vote in this highly contentious state? 
No evidence such a loosey goosey approach has actually resulted in bus loads of Massachusetts Democrats crossing the border to throw New Hampshire elections to the Democrats, but really.

As a New Hampshire resident, do I want somebody who has spent three days in the state voting for my governor, my state representatives and my President?

Having said all this, do we really believe Mr. Trump that 3 millions voters voted fraudulently for Hillary?  Do we really want to believe a man who offers no evidence for his claims, who claims the lady in the parking lot, who told him vaccines cause mental retardation also told him about the massive voting fraud, finding in Mr. Trump, a receptive audience for the voting fraud charge, which explained what he could not comprehend or accept--that he is actually a minority President, which is to say, a so called President, or put another way, a fake President, a fraud.

Pocahontas and President Heel Spur

Pocahontas was actually quite a remarkable woman, as I understand it.  Of course, how much we can know about any figure of antiquity is always an open question, but whether or not she saved John Smith's life, Peggy Lee  immortalized the real woman with the legend with her smoldering version of the song, "Fever." The story takes on a reality of its own, whatever the actual woman was like.

Donald Trump tried to shame Elizabeth Warren by referring to her as "Pocahontas," alluding to the story that Ms. Warren falsely claimed American Indian blood as a ruse to get into Harvard, when anyone can plainly see, this blue eyed, blonde could not possibly have a single drop of Indian blood in her, because, as we all know, anyone with dark blood cannot possibly have blue eyes or blond hair. 

Mr. Trump apparently has never met Vanessa Williams or any of the many people who are descendants of slave owners and their slaves, who I met every day in Washington, D.C.--people who clearly had significant Africans genes, but who also had blue eyes and blond hair. Those slave owners, and even their nonslave owning descendants (like Strom Thurmond) clearly fathered progeny who were, on occasion, to the eye, not very Black.
"Passing for white" was easy for many Americans who had some African genes. 
"Pinky" was a movie I grew up with; apparently  Mr. Trump missed that one. 
As for Indian blood, I knew many people who were told they had Cherokee blood or some other tribe's blood who did not look like Hollywood Indians.  You can't even do 23 and Me genetic analysis to see if Ms. Warren has Indian ancestry because of the way the statistics have been gathered for that sort of scientific analysis. So, if the lady heard from her family members she had Cherokee blood--nobody can gainsay it with any assurance.

Genes are funny things

At any rate, The Donald tried to humiliate Senator Warren by insisting,  in his ignorance, that dark blood is like a drop of India ink  in a gallon of clear water: it stains and is always apparent to the eye.

Make believe soldier: Look at that star on his collar

Trying to think of how Senator Warren should respond, I can only think "Captain Heel Spur," would do nicely.  Or maybe, "General Heel Spur," or "Commander Heel Spur," or "Commander in Chief Heel Spur." 

A President who was a real soldier: He earned those stars

Talk about feigning to be something you are not. Just look at that photo of the boy playing soldier, who claimed, as a Presidential candidate, that he had virtually been a soldier because he went to a military school for high school, and so he had more training in military things than some of the graduates of officer's candidate school who had actually served in Vietnam and Afghanistan. 
You see, Captain Heel Spur was really more of a soldier, despite the fact he was not allowed to wear the uniform of his country, as he so dearly desired, because of his incapacitating heel spurs.
No matter, as he later informed us, he knows more than the generals who did serve. 
Reminds me of a corporal who told the generals he knew more than they did, and since he was Der Furher, people believed him.  Lucky for us.  He made some fatal mistakes playing at general.  

I like it, though, Captain Heel Spur. 

Healthcare Quality: Dr. Cruz and Professor Sanders

Ted Cruz told Bernie Sanders and a national audience he knows what good health means for the United States of America.

He told us good health means doing more MRI exams than the English do.
He told us superior health care in the United States has insured more American women deliver their babies by C-Sections.
And he told us mammograms are unalloyed benefits to all the women who get them.

Doesn't he clear this stuff with anybody?

The plain fact is C-sections benefit the obstetrician more than the mother--he can get that baby out and not be late for dinner, not have to wait up all night with a laboring mother and he gets to charge a lot more. 
The mother, of course, has to heal from a significant incision and may have to have all subsequent babies by C-section. Not such a good deal for her.
Of course, there are other "facts" Mr. Cruz did not mention: Infant mortality and maternal mortality in the United States places us behind almost every industrialized nation, more in with third world nations.  These measures of public health don't fit with the tale Senator Cruz has to sell. 

And MRI's. Oh, there's a scandal, if you really want to know.  MRI's cost around $3000 in the USA, but only $75 in Europe. Same machines, different systems.  So we get to pay way more for the same care, and the outcomes for the patients are no better. 

Mammograms are trickier, but the reason we do more mammograms than they do in Europe is the Europeans are more critical about assessing the value of every test they do, and it's still an undecided case about whether or not we do too many mammograms, on women who are too young or too old or whether we do them too often. But when there's money involved, the one thing you can be sure of is the analysis is not going to be objective. Profits are at risk.

It's hard to imagine Ted Cruz, who apparently fancies himself an expert on health care would not have talked to enough people to be aware of these basic public health issues, which, to paraphrase Mr. Trump, a bad first year medical student knows. But, evidently, he has not talked to the right people, which is to say, people who know what the Hell they are talking about. 

Of course, look at the setting:  A town hall meeting, with all its drama, its testimonials from patients in the audience meant to "give a human face" to the dull issues of whether or not we spend health care dollars wisely in this country.

Why should we face the really difficult, statistics dense issues when we can have such a dramatic moment with television producers running the discussion on screen?

And poor Bernie, who knows only that it's the rich screwing the poor with healthcare. It's all about class warfare, don't you know?  If Bernie had taken even fifteen minutes to be briefed by that bad first year medical student before the debate, he might have sunk Cruz's ship easily enough.

But, no. This is America. Where we don't believe in facts or analysis or wonky technical stuff. We're all about feelings, not thought. 

So, now we have the government we deserve. We are about to get the health care we deserve.

Vaccines and Faith

When I was still in college, I had a summer job at the National Institutes of Health in Bethesda, Maryland and the project I worked on in a genetics lab was to track down kids who were born in Baltimore during an outbreak of measles which occurred in the 1960's.  A lot of those kids born to mothers who got exposed to measles were born deaf or with a variety of other congenital defects.  Measles. I had measles as a kid, and I got it again as a doctor in my 30's, a very attenuated illness. Didn't seem like a fearsome disease, but it did a lot of nasty things to a lot of people.

When I was in medical school, we occasionally got a kid who needed a transfusion to save his life, or we had a mother in labor who hemorrhaged who needed a transfusion to save her life but they were  members of the Seventh Day Adventist church and so we had to simply watch some of them die.  Faith.

HMONG CHILD

There is a disturbing, maddening book called, "The Spirit Catches You and You Fall Down" about a Hmong girl who has a severe epileptic (seizure) disorder and she lives in Davis, California where her parents bring her to the Emergency Room at the UC Davis Hospital and they revive her, stop her seizures and send her home with anticonvulsant therapy but the parents do not give the girl her medicine because they believe, as Hmong do, that illness is caused by a disturbance in the universe, so the girl goes on seizing and suffering. The doctors called this child abuse and fight it through the courts. Those parents are not doing what's best for that child.

Michelle Bachmann and Donald Trump hear from a lady in the parking lot or from some other equally reliable source that vaccinations cause autism or mental retardation or cerebral palsy or who knows what and on the basis of that scientific analysis they advocate for vaccine free babies.

Yersin

Alexandre Yersin, a student of Louis Pasteur goes to Vietnam around 1900 and he gets a telegram from Pasteur telling him of an outbreak of bubonic plague in Hong Kong.  Yersin does not ask the lady in the parking lot what is causing the Black Death. He has been trained in science. He gets on a boat and gets to Hong Kong, where the British, who are then in charge, dismiss him because he doesn't speak English and he looks pretty scruffy to them and they have their own expert, who totally fails to identify the causative organism, but Yersin, using the techniques of SCIENCE, actually identifies the beast, and not just that--he raises a vaccine to Pasterela Pestis (as he names the organism) and when Plague breaks out back at his home base in Vietnam he is uses his vaccine to save hundreds of patients.

Oh, what we do to children

Throughout the centuries, we have had to chose whether to believe in science we do not fully understand or to put our faith in people "of faith."

Mr. Trump clearly rejects scientists because, well we can only guess why. I suspect he rejects science because it doesn't allow him to believe what he wants to believe and it's a power thing with him.

In some African countries Presidents have denied HIV causes AIDS.  They think its a Western plot to gain control of Africa. Mr. Trump believes climate change is a Chinese plot.

We are back in the Dark Ages now. And soon, we will see what pestilence looks like, when the anti vaccine people have their way.

Ted Cruz on the Joys of Cesarean Sections

Tonight I tuned into CNN to watch the debate on Obamacare between Ted Cruz and Bernie Sanders, hoping to see some substantive argument.

I've recorded it and will try to bring myself to watch the whole thing later, but 15 minutes was all I could take tonight.  I did not throw anything at the TV. 

Ted, of course, thinks he's the world's greatest debater. He did everything but bring out his high school debate trophies. 
Bernie has only one note to hit: We got class warfare, people. The rich get good health care; the poor do not.
It's the fox and the hedgehog--but in this case the fox does not know many things; he knows very little and the hedgehog needs to know more than one thing.

Neither one of these men has the faintest idea what they are talking about.  If these are the men who will direct thought on our healthcare system, then we are all in big Trouble in this country.

Ted rolled out the same tactics Republicans have rolled out since at least 1965, when Medicare was first introduced. 
Here's the drill, in case you haven't been listening: 
1/ The Democrats want socialized medicine.
2/ Socialized medicine means government control of your health choices, of your doctors and your illnesses.
3/ Government control means rationing and poor health care, health care denied when you most need it and when you are older. 

He presented some "facts" to bolster his case:
1/ A litany of sob and horror stories from the socialized medical wards of the United Kingdom, stories of people waiting hours for an ambulance to arrive, people waiting three months for a hip replacement surgery, people being kept on gurneys waiting hours in emergency rooms.  Oh, the humanity! Oh, the suffering. And Ted is just so appalled on their behalf, and outraged at the thought all this may someday be visited upon his American brethren, if the Democrats get their wish.

And Bernie failed to rejoin: All these anecdotes happen all the time, and worse in America,  right now. Every day. The commercial, for profit system we have now generates daily dysfunction. If you want horror stories about what happens in a healthcare system, you need look no further than our own. 

2/ A recitation of numbers of all the Canadians who have come to the US for health care. Oh, it's like the Berlin Wall, all those Canadians trying to leap across the border trying to escape Canadian health care. He actually invoked that image of machine guns on the border pointed inwards toward Toronto to keep all the Canadians from escaping to good American healthcare.

And Bernie never replied saying that it's actually the Americans who now embark on medical tourism, flying to Thialand and elsewhere because it's less expensive to pay for the flight and the hotel room than to pay what you must after your commercial insurance welches out on your hip replacement in the States.

Bernie started to say that the fact is most Canadians and most Brits are very satisfied with their systems and would not trade theirs for ours. But all the polls and surveys when it comes to "happiness" necessarily deal in soft data and can be manipulated, so it's a worthless argument to have. 

3/ Then there's the MRI/C section/Mammogram ploy: 
Cruz rolled out numbers to show that more mammograms, more  MRI's and more Cesarean sections are done in the USA than in the United Kingdom. And this shows conclusively how superior American healthcare really is. 

Of course, we are a nation four  times the size of the UK, so you might expect we would do more MRIs/mammograms/C sections. 
But setting that aside,  the fact we do more of these tests is given as proof of the superiority of the American system which denies nothing to anyone.   All these wonderful things would be denied under a socialized healthcare system is what Ted says.

Bernie never replied that Ted's own argument refutes his premise: If these tests were done for the past 6 years under Obamacare, then what Cruz is saying is Obamacare has been superior to the UK system, providing Americans with more care than the UK's National Health.  So Obamacare did something wonderful, this disaster Ted wants to repeal. 

But let's get past the sophistry, the debater's points to the truth: The very fact that so many more MRI's, C-sections and mammograms are done in the US is evidence of the inferiority of our profit driven system, not proof of its superiority.

The reason these tests are done in such profusion in the United States is not that they are good medical care or even necessary: The MRIs are a cash cow for radiologists and hospitals. An MRI in the United States costs $4,000; in the UK it is $75. Is there any wonder why so many more MRI's are done in the USA than in the UK?  
The incentive for the American doctor is an irresistible temptation; not so in the UK. The smaller numbers of MRI's in Britain tells us they are doing better medicine there, not worse.

As for C sections, the fact the UK does so many fewer C sections is evidence of the superiority of the medical system in the UK, not the contrary. All too often, we do C-sections here in the States not because it's best for the mother and child, but  for the convenience  and  profit of the obstetrician.  "Call the Midwife" is a British show, not an American show. Both Bernie and Ted should watch it. 

 As for mammograms, we think of these as wonderful, life saving tests, but over the past few years as data as been analyzed, it has turned out they, too, are probably overused and result in detection of "lesions" which are over treated and which may not actually need to be removed. Yes, they can be life saving but the profit motive and well intentioned desires may have clouded our visions about the virtues of mammograms.  
In fact, the old joke that more people live off cancer than die from it may be illustrated by the overuse of mammograms. The issue is not settled, but it is not a good example of how much better we do in the USA, but how we may oversell tests which add expense but not quality to care. Too often in the US, we squander resources on things which do not benefit the public health in America.

We spend more money in the last 8 weeks of life doing things like putting people on respirators and putting in feeding tubes which is money poorly spent. The patients aren't thanking us for it. Sometimes the families insist on it, but the patients aren't thanking us. Yes, a national health care system might tell us what we don't want to hear, but it is a good thing it tells us what we need to hear.

Bernie, did not address the problem Ombamacare ran into because of the rule that patients could not be denied because of pre existing conditions: Insurance companies quickly discovered with all those sick people on their ledgers they were losing money. This was predictable.  
This truth allowed  Cruz to make his one good point--there are five states with only one insurance company left offering health insurance in the state:  insurance companies have fled the health care field.  Forced to take on people who really need healthcare is the ultimate nightmare for any commercial insurance company serving its stockholders:  the last thing an insurance company wants is people who actually need health care.

Obamacare was so injured in childbirth, it was doomed to a short life. The wonder is, it did as much good as it did. Costs fell nationwide and care expanded. (A portent of things which might be, if a single payer system ever emerges.)  Obamacare was killed by a thousand cuts, by the health insurance industry most of all. It became not the instrument to rescue the national health and well being but the tool to rescue health insurance companies.  

The only way to make a system work which will accept all the sick people,  is to require all the healthy people, who outnumber the sick, are paying premiums, as happens with Medicare. 

Health insurance as a commercial enterprise is a bad bet looking for a way out. The mission of a national health insurance plan like Medicare is to provide care. In that sense, it's mission is to spend money, not make money. This is exactly the opposite with commercial health insurance which Ted extols as the best possible option for healthcare and the public health.

Bernie did say the solution was Medicare for all. He did say we ration medical care by class--the rich getting good care and whatever care they wish, while the poor go without because they have lost insurance. 

But Bernie never made a coherent cogent argument that medical care is the one part of our economy for which the profit motive is poisonous and destructive rather than something which drives innovation and higher levels of effort.  And to make any health care system work, the entire nation has to accept it wants to create it, as it has decided with Medicare.  

The Swedes do not want to pay for health insurance for the Spaniards. The Brits do not want to pay for health care for the Greeks. This is because the Swedes don't like the Spaniards all that much and the Brits aren't crazy about the Greeks.  Americans do not want to pay for other Americans. They have to be made to do it. They are forced to pay Medicare taxes.  But, in the long run, Americans are glad they paid into Medicare and into Social Security.

Sometimes, you have to force people to do what's good for them, because you do not want to wind up supporting people when their luck runs out. 

That's the argument Bernie Sanders should have made.

Ted Cruz had nothing new to say. He just enjoyed himself with a slick version of Green Eggs and Ham, thinking he'd scored lots of points by telling horror stories about unfortunate patients which have no relevance to formulating policy for systems of medical care. 
Well, actually, he did have one new thing to say: Cesarean Sections are the new measure of quality of care in the American health care system. You can't say the Republicans do not break new ground on public health.
These stories are the Obamacare version of Trump's stories about the rapist Mexican immigrant or the kid who became autistic after a measles vaccine.  
Is this really the best the Republicans have to offer?
If these two are really in charge of guiding thinking in Washington about shaping a workable health care system, Heaven Help Us All. 

Talking to the Low Information Voter

So I'm sitting with a guy who tells me he wants to build a wall around his house to protect himself from radical Islamic terrorists.

He's an IT guy, who works with cybersecurity for VISA or MasterCard or one of those, and they have some of their hardware in "silos" which are nuclear hardened or something like that, just in case the Russians decide to launch a nuclear strike on our real vulnerability. The Russians aren't going to worry about taking out our missile silos with our ICBM's with the nuclear war heads--no, they are going after our credit cards, cause if we cannot charge things, the Russians know, our world wide power is just so caput. Finito. Gone. Take out those credit card systems and we are on the ash heap of history.

So this guys believes in walls and I don't know if he voted for Donald. I didn't ask. But it sounds as if he's taken a deep gulp of the Donald flavored Kool Aid (tangerine colored) and he's a wall believer.

Donald in his element 

So I tell him about my wife's recent trip to Saigon, excuse me, politically incorrect, Ho Chi Minh City and she has emailed me from there saying she's been touring through the 25 miles of underground, fortified tunnels just outside Saigon.
These things were extensive:  the Viet Cong had ammunition dumps, hospitals, post offices, spas with swimming pools, sun tanning parlors, fingernail salons.
The American Army, Air Force and Marines had no idea. This whole system was right under their noses. Americans were flying very loud, roaring airplanes overhead, off to drop bombs, spread Agent Orange, make big sounds. All totally ineffective. 

But whenever they wanted, the Viet Cong popped out, shot a few American soldiers or ambushed a whole column of American soldiers and then disappeared underground. It was something called surprise. Kind of like the 9/11 attackers who concealed their intentions until they actually emerged to do their nasty, murderous thing. One thing you could say about those terrorists: They were smarter than George W. Bush.

The Cong were smarter than the American President. My wife said, "There's no way we could have won that war." 
She saw, with the clarity of hindsight, how dug in those Viet Cong were She could not see how ineffective our tactics were. We had faith in big American things that go bang. Sent them a message, we did, with our loud bombs.  Just make them tremble and they will all run away.
The thing is, when we are fighting an asymmetric war with people who are not as big as we are, who do not have big nuclear missiles, big armies, big wheeled trucks, the enemy tends to say to himself: I cannot beat these Americans by slugging it out--so I'll be more clever, which, given what the Americans are like, is not  too difficult.


So, why, I asked are Americans so stupid?


The IT guy laughed. 
Did you read about the Mexican cartel guys who dug tunnels under the wall on the border with Texas and just went under the wall?  I asked him that. He remembered hearing something about that.

But we've got a fine wall going up, pretty soon. Those Mexican rapists will get to that wall and just give up.

It's going to make all the difference. Keep those rapists on the other side of that wall.

And as for those radical Islamists, we're going to intercept them at the airports, because they would never be clever enough figure out another way into the country.
(Hint, long, undefended border with a country to our north, begins with "C" and almost rhymes with stamina, which is what these maniacs have got plenty of.)

This would take a long tunnel from Mexico, but there are daily flights

We are just going to seal America up tight, see.  We build this long wall along the Southern border so nobody gets over that.

Ad in Mexico City Daily News: Visit Canada. It's all downhill from there.

Then we look at the East Coast and at the West Coast and at the Gulf Coast and we say, hey we don't need no frigging wall there, because Islamist radicals can't swim. They're basically desert rats: afraid of the water. 

You can walk across it, and the weather's great!

And nobody's coming from Syria and crossing in from the north, because it's cold up there in Canada and those desert dwellers can't take the cold. 

So, there you are. We are tight as a tick. Nobody can hurt us. 

Hey, Live Dumb or Die.