The American Way of Healthcare

Malcom Gladwell was on Meet the Press yesterday, talking about the healthcare system in Canada and opining about the lack of a healthcare system in the United States. He said the Canadians actually had a discussion about 60 years ago and they realized they could not have everything at once: Gleaming hospitals where the sheets had 500 thread count and healthcare for all. They decided they would provide the basics for everyone and they would accept that they might not have the Rolls Royce for every procedure, every medication, but they would have what was required for a reasonable effort.

Drawing by Pia Guerra

Of course, in this country, we have Rolls Royce care for the upper 1-10% and very limited health care or no health care for the rest.

Since the 1950's there have been vested interests which prevented a rational discussion--the American Medical Association acted as a vociferous trade group, bellowing that we were headed straight to Armageddon if we took even a single set toward government participation, which would lead directly to "socialized medicine" which was as unthinkable as "peace without honor" or other fates worse than death.

Since then, various groups have stood between Americans and really good health care, but for the past forty years, far as I can see, it's been the Republican Party, which has, in it's most unvarnished moments, simply said it's intolerable for rich people to have to pay for poor people's health care.  In the most revealing moment, Paul Ryan sputtered that under Obamacare, healthy people had to pay for the care of sick people and that is un-American and unfair and the road to Hell.

It was later pointed out to Mr. Ryan that's the way insurance works--a lot of people who are good drivers pay for all the wrecks those bad drivers cause, and people whose houses burn down get paid by insurance companies who collect premiums for years from all those well behaved people who do not allow their houses to burn down.

England, of course, has a two tiered system: You can fly economy class with the National Health System or you can fly first class with a coexisting private system which has its own upscale gleaming hospitals. Doctors can flit between the two systems, and the quality of care is comparable; both get you to your destination, but one gives you more leg room and a more comfortable ride.

It is on this crucible the real differences between the two parties becomes apparent for all to see: The Republicans really are a party for people who do not like the idea they may be giving their money so that others may benefit; the Democrats say they are willing to pay for others, as long as everyone gets a good deal in the end.

Doubtful the Donald Snowflake crowd sees it this way.

It used to be said there is no more virulent anti Semite than the disaffected Jew; now it is clear there is no more dedicated hater of the underclass than the lower middle class, the next step up on the ladder, the folks who see that with a turn of bad luck, an accident, an illness a lay off, they could slid right back down to that rung below them. 

One nation, under God, indeed.
E Pluribus Unum.

President Snowflake

Snowflake.

Jennifer Granholm, the former governor of Michigan, called President Trump a "snowflake" on CNN, after Mr. Trump frothed fretfully about Mika of "Morning Joe" bleeding from her face (or from wherever) when Mika visited  Mara Largo.
Mr. Trump may have been confusing her with Meghan Kelly, but no matter: It was the Tweet which was important. 

Mr. Trump apparently sees bleeding women frequently, and is much impressed by the sight.

Trump's woman problem--Pia Guerra

But I digress. 

"Snowflake" has been a word much discussed lately.

Of course, it's really a compound word: "Snow," which is white, delicate, easily destroyed and many find beautiful and "Flake" which is commonly used to describe someone of little substance, a zanny person, someone not attached to reality.

Jennifer Granholm

There has been some discussion of the use of the word in the book and movie "Fight Club" in which twenty something men, who feel, if not castrated, at least domesticated, in their sterile offices, where they sit in front of computers and machines and they resort to fist fighting in parking lots after drinking at bars. This makes them feel alive and virile.  They are roused by a member of the club who says they are not "snowflakes" by which he means they realize they are not special--each snowflake is supposed to be unique--and they are durable, not delicate like snowflakes. They live in opposition to the delicate, neutered life they lead at work and  at home.

"Snowflake" was used to deride people who embraced slavery in the 1860's--presumably because snowflakes are white and cover the earth. So it was the white aspect of snowflakes which was being derided. White as snow. Pure as the driven snow. Make the country white. 

All this feeds into the description of Trump as a snowflake: celebrated for his whiteness, attached to people like Kris Kobach who feel whiteness is under attack and needs to be rescued, and snowflakes are delicate, apt to dissolve into a puddle, and flaky, as in irrational, distracted, as in a walking non sequitur. 
Yes, the Donald is a flake. A snowflake. 

And you're special, too

The Tweet which prompted Governor Granholm's remark was classic Trump. Mika was not just bleeding, she was low IQ, and afflicted by low ratings.

Trump's cabinet meeting--Pia Geurra

There has been much discussion about Mr. Trump's own IQ, which, apparently in his case, is a measurement which has entered into the realm of mythology. Presumably, at some point he sat down with a Number Two pencil as an adolescent and took some sort of "IQ" test, the way every child of his cohort did in America and the results must have scarred him in some way.  
His own IQ test scores are as buried in the same misty past as that birth certificate for Barack Obama.  
All these bits of information buried in the pre cyberspace past. 
Reminds me of going to the Department of Motor Vehicles to get my  nifty new driver's license, which is now part of a federal security system: I needed my Social Security card, and I was very proud to have preserved this relic, laminated in my wallet all these years. I got it went I was 14 and it survived over 5 decades in various wallets because I had thought to laminate it. 
But when I arrived, the clerk said laminated cards were unacceptable. 
"But if I hadn't laminated it, it would have been dust by now," I protested.
"I'm just the messenger here," she said, in a voice which sounded like an automaton. "I don't make the rules."
But my point is, some of these things, like IQ test scores and birth certificates are dust in the wind, really. And yet, to some people, like Kris Kobach of Kansas, they matter a lot. They are the most important things about us. 

Our leader--Pia Guerra

For Trump, it's his IQ.

There are, of course, many types of intelligence, we all appreciate now. Mr. Trump has some sort of intelligence which allows him to look for what people--some people--will respond to and to tap into that. At that his intelligence quotient must be very high.

But in terms of being able to collect a set of "facts" or statistics or reports of studies and to assemble these under general headings to support conclusions, he demonstrably scores very low in that type of intelligence.
His talents are more like Ronald Reagan. Nobody ever accused Ronald Reagan of being able to analyze an issue or to organize a coherent argument, but boy could he deliver the message once his script was written. 
Thing is, he was smart enough to let other people write his lines for him.
Can you imagine Reagan with a Tweet machine? 
Well, he could hardly be any worse than Trump.

No Snowflake Her

There are two excellent books about intelligence: "The Intelligence of Birds" and "Are We Smart Enough to Know How Smart Animals Are?" Read these, and you realize how very narrow a stripe the standard IQ test of the 1950's and 1960's were. They were a sort of infant science. So, Mr. Trump, don't feel too badly about how you did on those tests. It was a long time ago, and those tests were made by failed psychologists with low ratings. 

As for the low ratings of "Morning Joe," well, that's like the "failing New York Times." Failure is in the eye of the beholder and neither succeeds in Mr. Trump's eyes.

Then again, this is the man who lined up his cabinet members around a gleaming conference table and demanded each come forth with some adulatory attestations to his wonderfulness, his eminence, his most holy highness and highest excellency. 

Personally, I'm looking forward to the next Tweet. 

Trump Care: It Doesn't Hurt Until 2021

Republicans aren't stupid, at least the Republicans in Congress are smart enough to know they should not vote for any law which will cause pain before they are up for election any time soon.

So the new version of Trumpcare is not going to really hurt until after Trump's 2020 election. 
It's like that cancer in the tip of the colon polyp, it doesn't hurt now, so it's really no problem. It'll take 5 years to work down that stalk and infiltrate into the wall of the colon. Until then. you'll be just fine.
Today's Senate plan  will raise the cost of health insurance to citizens over 50 about 5 fold and it will eliminate health insurance to the really poor--but they don't vote much anyway.  And those 50+ citizens are really past their prime, so who cares really? The fifty somethings in the audience in Iowa were just fine with Trumpcare.


And now the health insurance companies will gradually be able to reject people for "pre existing conditions" in any state which feels strapped for cash, but hey, you can keep your kid on your policy until he is 27, just like Obamacare.


The thing about making insurance companies insure people with pre existing conditions is you were making them do something their whole machine is set up to avoid doing--the last person you ever want to insure is somebody who you might actually have to pay out. Have you never heard of profit?  If you have to spend money on "benefits" that means your profit goes down.


What was Obama thinking?


Fact is, as the customer, you'll never figure out how the law will affect your own particular pocketbook until you actually have to--when you get your bill, but that's what marketing is for.

Fact is, as President Trump realized, health insurance is complicated, at least with a profit driven system like ours. It's that old conundrum: you never want to insure a customer who might really benefit from the product you sell and the customer never wants to spend his money unless he thinks he needs to spend the money.


If we agreed to do what Bernie Sanders suggested: Simply offer "Medicare for All" then it would be simple, in most ways.





Medicare is simple because its mission is not profit. It's mission is paying for medical care, which is exactly what commercial health insurance companies do not want to do.


What would not be simple is what would happen if  commercial insurance companies would had  to compete with Medicare. The commercial insurance company CEO's are smart enough to know they cannot do this and customers would flock to basic Medicare.
That's only about 6% of the market, but the insurance companies have not been willing to allow that.


For most people, who get subsidized "Cadillac" plans through work, Medicare would be less attractive, bare bones coverage, and they would opt for their Cadillacs.


Paying for Medicare for all would be easy if you extended the current system which taxes payroll up to $118,000 but not beyond. If you taxed incomes up to say, $ 4 million, then the money would be there.


But, as Paul Ryan would say: Taxing wealthy people is just so unfair. That's like taxing healthy people, very unfair.  
After all, you are taxing healthy people to pay for sick people, which he only recently discovered is what happens with Medicare and Obamacare, and that isn't just so outrageous.
And now you talking about taxing wealthy people for more money than you ask from poor people.


That's really just about Communism, right there.

National ID Cards: The Kobach Solution

When I was a little kid there were lots of movies about Nazi Germany, and there was always the cold sweat scene where the Gestapo officer looks over the heroine or hero and demands, "Unt vere are your papers?"  The papers are produced, whew, they were not lost but then the Gestapo man inspects them, sniffs them, just about licks them and says, suspiciously, "Vell, your papers appear to be in order."

Mr. Kobach

As a kid, I knew I could never keep anything in my pockets for very long and I just knew I'd have wound up in the Gestapo prison, chained to the wall.


Now we have guys like Kris Koboch of Kansas who believes Hispanic immigrants are not just rapists and drug thugs charging across the Mexican border, but he thinks they are intent up committing "ethnic cleansing" of the White population of the lower 48 and wiping out good, White, Christian Americans.


Given that concern, it's only reasonable to assume anybody who looks like a swarthy Hispanic from South of the Border might be part of this race war and it would be reasonable to demand his driver's license, birth certificate--the long form with the signature of the doctor, his Baptismal certificate, his grade school diploma and his library card to be sure he is legally in this country.


About that long form birth certificate--Mr. Kobach has said he did not accept the birth certificate produced for Mr. Obama because it was a short form and did not have a doctor's signature, which of course is important, because Mr. Kobach intended on tracking down the doctor who delivered Mr. Obama and hauling him before a grand jury to testify unequivocally he remembered delivering Mr. Obama.


Failing that testimony, Mr. Koboch would not be satisfied Mr. Obama was a natural born citizen and would revert to his default suspicion that Mr. Obama was born in Kenya to Martian parents.

He's got his scanner to check you out

Mr. Koboch was no fan of Mr. Obama because:
1/ Mr. Obama is half Black, which makes him un-American ipso facto.
Of course some Blacks were born in this country to slaves.
Now slaves and the descendants of slaves, are they really here legally?
I mean, you can make an argument they arrived here pretty much as gate crashers, like those Mexicans who were brought across the border by handlers and coyotes.
In fact, there was a Supreme Court decision that said Black people (slaves) were not real Americans. It was called the Dred Scott case, which actually held Black people were not human beings, but only property,  which is like saying they are not citizens because only human beings can be citizens, except for therapy dogs, who have official state licenses, which must make these dogs citizens.


2/ Under Mr. Obama, Black people could not be convicted of crimes, or at least civil rights crimes. Someone said that on a radio show and Mr. Kobach agreed that was, in essence, true.

If every American had a national ID card it would be unnecessary to pass  laws Mr. Kobach proposes about police having to demand proof of citizenship whenever they talk to anybody of the swarthy persuasion.


The problem is people don't always have their birth certificates on them, like when they are at the beach or hunting or fishing or walking their dogs.


At one point we considered dog tags, which seemed to work well enough in the Army during the big War, but even dog tags got pulled off or caught on the airplane door when you were jumping out.  Kids were issued dog tags when I was a kid, just in case there was a nuclear attack. Don't ask. It seemed to make sense at the time.  Actually, my father refused to allow me to wear dog tags, and I've been wanting to compensate for that early childhood loss ever since. I wanted to be official. Accepted. American. I was born in Washington, D.C. and that means I could never answer that question all the computer security programs ask: In what state were you born?  I am stateless. But I'm a citizen, I think. I'd feel more secure if I had some dog tags.


Funny thing is, I signed up to get my lab results after my blood was drawn, with Quest lab and to verify I was who I really said I was I had to answer questions about my addresses from 40 years ago, which I had long forgotten but the computer knew. And it knew about automobiles I had registered in 1981, stuff I could not remember but the computer knew. So why do I even need to have dog tags if the computer knows me so well? That's what I'd like to know.


But, wait. There's another solution. Mr. Kobach might be pleased at the latest proposal from Attorney General Sessions ("General Sessions," as the Senators call him. Quite a promotion from "Senator") that every American infant have a computer chip implanted in the delivery room, like those things dogs get at the vet, and this would be an official U.S. government chip which could be scanned and would verify the American citizenship of the person with the chip.
It would also allow the government to follow you, should you feel inclined to cross the border into Mexico and sell your chip down there.

I got my chip. I'm a citizen!

How cool would that be?
There are some details to be worked out, like where would you put the chip? Abdomen? Back? Thigh?
And what would happen if you took a hit during football practice and damaged the chip?  Would you lose your citizenship?
And what if a black market for chips got launched--people no longer knocking you out to get your organs, but they get your chip.


And what if the Russians hacked American chips and made every American an official alien and every Russian a U.S. Citizen?


The possibilities are really intriguing. Watch for this to play out on "The Americans" or "The Leftovers" or "The Beverly Hillbillies."

PBS News Hour Runs Aground

First, I have to say I am a fan of the PBS News Hour, and have been  since it began 30 years ago, when they were still trying to fill time with "postcards" and it wasn't at all clear there was enough daily news to fill an entire hour. Eventually, they discovered there were stories out there which were not about politics, at least not directly, like the one they did last night about a new technology which takes carbon dioxide emitted when burning coal and sending it in a pipeline to oil drilling rigs, where it can be used to liquefy and extract oil in oil fields which would other wise be considered "dry." And there are the stories done by Paul Solman about economics and economic theory.
With the excursion into "long form" journalism, the New Hour can be a sort of TV New Yorker, exploring topics which do not make the front pages of the NY Times or the Washington Post.

Having said that, it must be recognized the New Hour's recent fixation of the "Russia Story" and Donald Trump's "obstruction of justice" appears as a pathetic exercise in wish fulfillment, to imagine  another Watergate story, where dogged journalists uncover a story which leads to the impeachment of the President.

Along the way, other weaknesses of the News Hour surface. The most glaring, recently, is the seat afforded George Terwilliger, who responds, authoritatively, that President Trump has every right to fire the FBI director for pursuing (or not pursuing) any investigation because the President is a "unitary executive."  To her credit, Judy Woodruff stopped him to ask him to explain this and he said the Constitution vests in the President all the executive branch and so he can fire anyone under his control for any reason whatsoever, including displeasing him by pursuing bothersome investigations. ("Will no one rid me of this bothersome priest?")

Having got that statement from Mr. Terwilliger neither Ms. Woodruff nor any of the milquetoast panelists assembled challenged Mr. Terwilliger on the "unitary executive" concept and so that stood as an uncontested truth.


I would have asked where that concept and phrase comes from.
I'm just a humble citizen, not a lawyer, but I've read the Constitution a few times and I went through it again and cannot find that phrase anywhere.
According to Professor Google, this is a concept which is, as you might expect, controversial. It derives from the very scanty description of the President in Article II, but nowhere does it say the President is a monarch, and nowhere does it say anything about firing an FBI director, because, in fact the Constitution never mentions the FBI.
Nor, for that matter does it mention cybersecurity, abortion, atomic bombs, television, microphones or any of a whole variety of things which arose after the 18th century and I have to conclude because none of this is in Constitution we are sort of making it up as we go along and we periodically say, "Well, it's God's will," or actually, not that, we say, "It's in the Constitution."


This problem the News Hour has, of allowing a bully to reign unchallenged is not new, but it's become more acute over the past few years, and especially since Gwen Ifill died. Ms. Ifill was always more capable of sticking her jaw out and getting in the face of a guest.


I'm all for inviting extreme opinions on the show--it affords an opportunity to unmask the monster. But if you are going to have the beast on, be sure you invite somebody who can pound that beast, and if you are worried about comity and decorum and a civilized debate, get out of the way and let them slug it out and all you should do is break them in the clinch and ring the bell.

Kris Koboch, the Kansas bully is the best recent example. There is a guy who deserves careful, patient questioning. If it takes 30 minutes, so be it. That's why you've got an hour.
Mr. Koboch, you say voter fraud is a major and widespread problem. On what do you base this claim? Mr. Koboch, do you consider any voter who votes against you or your candidate a fraudulent voter?
Follow this line of questioning  patiently (and have your intern Googling any reference he gives and expose that right then and there.)
Then:  Mr. Koboch, you have called for a Muslim registry. What problem would this solve? How is this different, in principle, from herding Japanese Americans into internment camps? Mr. Koboch, if you could write and sign into law a new immigration policy what would it say?  You have said the threat to our nation is greater from Hispanic immigration than from radical jihadists. Why?
And all like that.


But most of all, follow the story which  humble, unconnected citizens (like me ) really crave.
To wit:  Is it possible that the Russians, or anyone, could have stolen the election physically, by changing vote counts?


I'm not talking about Russian efforts to "influence" the election. Democracy is always at risk in the hands of  a credulous voting public. We all try to influence the election, every time. I see no more harm in Russians trying to influence the minds of voters than Republicans or Democrats trying to influence people. That's what democracy is. You still, in the end, have to convince people, and you have to find enough people who agree with you to vote for you.


But, if it is technically possible for someone to intercept votes, which are nowadays transformed into electrical bytes and sent down a series of sideroads and byways to a cyber superhighway and collected and tabulated SOMEWHERE, I'd like to know that.

If so, the big story has nothing to do with Comey or Sessions or the FBI.
The big story may be a twenty five year old woman named, improbably Reality Winner, sitting in an orange jumpsuit in prison somewhere for opening the door to this real story.

Sexual Depravity in Georgia: Police Gone Wild

Here's a great story from Georgia. One day before the end of school, as the students were getting ready for their senior prom, a group of local police arrived at school and groped the entire student body, so to speak, systematically, as described by the lawyer for the groped kids:

Georgia Sheriff Who Sent in His Boys to Fondle the Girls and Make Them Cry

“Deputies inserted fingers inside of and pulled up girls’ bras, touching and partially exposing their bare breasts; they touched girls’ underwear by placing hands inside their waistbands or reaching up their dresses; and they cupped or groped boys’ genitals,” the human rights center said in its statement.


The excuse for this mass groping was the police were--wait, let's let you guess:
1. Searching for terrorists
2. Acting out a scene from the movie "Crash"
3. High on marijuana, which is still illegal in Georgia
4. Looking for drugs.


The all purpose excuse for local police actions is #4, so I'd bet on that. But I think #2 might be closer to the truth, where a bunch of 20 something cops got to play out their sexual fantasies as they never had been able to in high school.
One thing you can say for this police department: it apparently is an equal opportunity employer, allowing homosexual police officers to play out their fantasies along side of the heterosexual police who were exploring the recesses of the females.


If this ever gets to the Supreme Court you can bet cases cited will be:
1. Florence v County of Burlington: In which a Black man was subjected to two rectal exams after being arrested, in error, over an outstanding warrant which turned out to be a computer error--the court found for the authorities, who, the Court said, were only protecting the jailers from the likelihood Mr. Florence might have a switchblade or grenade up his rectum which he might carry just in case of such a computer error.
2. Bong Hits for Jesus (Morse v Frederick) in which the Court held students, being minors and having no actual civil rights while they are subjects under the control of adult authority at school, can be treated as chattel and, as in the Dred Scott decision, being less than fully human, have no standing to sue in court.


But we are living in Trumpworld now, where anything done in the name of protecting the innocent against wanton aggression is fine, as long as the fingers belong to guys with badges.


You'all come on down. The peaches are fine. You can squeeze 'em.

Reality the Winner: Did the Russians Change the Vote Count?

Okay, I'm just a yokel out here in New Hampshire, but I gotta ask:  If the NSA--anyone at the NSA--knew there was a possibility that Russian agents hacked into the vote counting and tabulation software in the Presidential election, why do we have to hear this through a leak by someone called Reality Winner?

Russian hackers in late October and early November 2016 planted cookies (attractive, uniquely tailored links) into the websites of 122 American city and county clerks responsible for counting ballots in the presidential election. This means that if any employee of those clerks’ offices clicked onto any cookie, the hackers had access to -- and thus the ability to interfere with -- the tabulation of votes. 

Just asking.

I mean, would this not be considered germane? Would the public have no interest in knowing this possibility exists?
Would an aroused public not ask it's government, namely the Congress, to investigate whether the surprise outcome of the election? Despite polling, despite exit polling, showing Hillary Clinton winning-Donald Trump's computer generated numbers made him the  winner.  Could vote counting have been fraudulent?

Would this be of interest? Or only to the NSA?

I'm always suspicious when I hear someone accuse another of some sin or transgression: And Donald Trump was accusing the Democrats of voter fraud before the election and has since the election.

Of course, I am fully aware I'm engaging in the same sort of magical thinking upon which Mr. Trump has ridden into power--you want to believe it, so it's true. But while I'm floating on this cloud of pixie dust--I'll enjoy it. I'll believe there were, in fact, not enough morons, even in the rural parts of Florida, Pennsylvania, Ohio, Michigan and Wisconsin to tip the balance in the last election, that it was all a hoax.

Which would mean this country is the country I thought it was, as opposed to the Dogpatch swamp land it looked like November 8th.

Oh, and don't you just love the phrases the government careerists all trot out: Reality Winner placed national security at risk.  She committed espionage.

How, exactly, pray tell, was national security endangered by revealing news of Russian hacking? One might argue the people who were endangering national security were the ones concealing all this.

Burr: Are you confident that no votes cast in the 2016 presidential election were altered?
Comey: I'm confident. By the time when I left as director I had no indication of that whatsoever.
The man is confident.  That is so reassuring.
So, now you know, FOR SURE, the Russians did not affect the final vote count, because a Republican Senator has asked the man who torpedoed Hillary Clinton's campaign last year whether the election results can be trusted and as the Director of the FBI, he ought to know. Shouldn't he?  And he would tell us, FOR SURE, if he did.