Immigration and the Starship Enterprise

Never much into Star trek,  but I vaguely remembered the image of the crew of the Enterprise being very multi racial, which in the 1960's and 1970's seemed pretty unusual and cool--everyone seemed to function smoothly and to accept one another. Looking at images of the crew now, it looks pretty tame and you can see more variety at my office today.

Very Diverse, for their day.

Nevertheless, I always liked the idea of a melange of people in America, strength through diversity.

How we could get there, seemed pretty clearly, immigration, but I have not been able to get my head around where all the people have come from, are coming from. Seems like for the past decade most of our immigrants are from South of the border, but then there's Africa and the Middle East.

One thing which the numbers show is the porportion of the nation which is immigrant, i.e. not born here is not at an all time high, but it is hovering around the vicinity where we've been at peak immigrant decades, roughly 13%. When I was a kid it was in the 6% range, which might be one reason I thought I was living in Leave It to Beaver land, and everyone was White.

I do know that between 1890 and 1965 the policy of the United States was to restrict the largest number to specific countries, so people from England and Germany and Scandinavia were preferred and the rationale was mostly racial: We Whites settled this continent (ignoring those non White folks who were here before them) and we want to keep our country looking just like us.  Then, the Italians and Southern Europeans got in, then some Jews, then some Poles and Slavs. 

Ideal Immigrant. We need more of these. Or from Norway

But then in 1965, Congress decided to give preference to people who already had relatives living in the USA, the idea being we could say we just were pro family, but the real idea was if you had mostly White families here, then the folks allowed in would also be mostly White. 

Didn't work that way.

So what do the numbers show?

click to enlarge

Here are a few graphs. The best visual is the link showing where people came from over the decades and usually, they seemed to come from places where wars or famines or other disasters motivated people to leave their SHC's and gamble on a future in the USA.

click to enlarge

Here's a very cool link which shows the sort of dynamic ebb and flow and notice where the immigrants come from tend to be from where on the planet the greatest trouble has been fomenting:


http://metrocosm.com/animated-immigration-map/

Disruption, Qualifications and Competence

Easy writing's damned hard reading.

Free associating yesterday, I wrote about Trump's SHC remark as part of a rumination on politically correct thinking, or thinking which hews to the rules laid down by the prevailing authorities. My most enduring experience with highly qualified authorities laying down rules was medical school and subsequent medical training, and my conclusion was that the powers-that-were misled us, the grunts in the field, and we were fools to have bought into the notion the system they set up was worth slogging through.

Reading the Patrick O'Brian series about the British Navy sea captain, Lucky Jack Aubrey and his intrepid friend, Dr. Stephen Maturin, is another portal into a world where competence matters, or should matter, but the people at the top are the least competent, although they reap the richest rewards. Jack Aubrey is supremely competent but the admirals above him are self serving fools.

Watching again, for the umpteenth time, "The Wire" is another window into organizations where the people at the top are venal, self serving, fundamentally incompetent. 

Reading "Grant" you see how much generalship is dependent on fundamental competence to organize all the details, to get supplies, men and mules moving on sodden roads and to bring soldiers to the firing line in time.

In all these lines of work there have to be high levels of craft and competence--medicine, commanding warships or armies, dissecting out crime scenes and figuring out whodunit--and typically, if there is any competence at all, it flourishes far down the chain of command, not at the top.

Recently, I've had conversations with people who get paid in the $500K range to be health systems executives, and I've been astonished by the profundity of their incompetence, in the very areas where you'd expect them to be most knowledgeable.

So when Trump appoints Ben Carson to be head of the Dept of Housing and Urban Development or Rick Perry to head the Dept Energy, or Betsy DeVos to head Dept Education or Scott Pruitt to head EPA, you see a statement that the people at the top do not have to have command of the details which constitute competence. 

They are simply like the captain of the ship who says, "This ship is going to India" and then hands off the execution of that goal to others, people who actually know how to sail a ship. 

Problems arise, however, when the captain, sailing from Spain, does not know (or care to know) that between him and India is a nexus of continents (the Americas) which will block his way. 

Lincoln was an amateur when it came to military matters, but he could see clearly enough that his armies were not fighting, and his generals were incompetent. As the war progressed, he felt compelled to fill that leadership gap and showed up at McClellan's camp to urge him to pursue the enemy.  
When Mead repulsed Lee at Gettysburg, he failed to pursue Lee and destroy Lee's army. Lincoln, who was not qualified to lead an army, was outraged. 
When he finally found a general in Grant who would do what Lincoln saw the army needed to do, Lincoln was delighted to back off. 
Reports of Grant's drunkenness reached Lincoln and the apocryphal story was Lincoln said, "I'd like to know what whiskey he drinks. I'd send a bottle to all my other generals." Lincoln later said he wished he had  actually said that. 
Accusations that Grant won despite his own incompetent generalship elicited from Lincoln the simple  judgment: "He fights."

And that is what Trump's acolytes are saying now. Trump may not be "competent" in a variety of ways, but as the man at the top, he doesn't need to have command of the details.  

He fights. 

Trump's Genius of Cupidity

Not like the brazen giant of Greek fame,

With conquering limbs astride from land to land;

Here at our sea-washed, sunset gates shall stand

A mighty woman with a torch, whose flame

Is the imprisoned lightning, and her name

Mother of Exiles. From her beacon-hand

Glows world-wide welcome; her mild eyes command

The air-bridged harbor that twin cities frame.

“Keep, ancient lands, your storied pomp!” cries she

With silent lips. “Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!”

--Emma Lazarus at the Statue of Liberty, Ellis Island

Of course, I shook my head and smiled ruefully when I hear Dick Durbin's recitation of Trump's expostulations, "Why do we need people from these shithole countries?" and "Do we really need more Haitians?"  and "Why can't we have more people from Norway?"
(Has anyone asked the Norwegians?)

I knew he was saying what a lot of people are thinking but most people have a filter on what they say.

Later, I started thinking about things I hadn't thought about for years, and I couldn't understand why, at first.

When I was a medical intern, fresh out of medical school, I was poor, came from what we might now think of as genteel poverty, or at best, modest middle class circumstances, but I was entering a promising apprenticeship, which I had been assured would be the next step toward the gravy train: the medical profession.

I had taken on faith a lot of stuff: for four years I had memorized meaningless things, spent countless hours at my desk studying and learning organic chemistry, comparative anatomy, calculus, physics which had about as much meaning for me as memorizing Latin poems or Greek. But I had done it and sure enough, I was rewarded by being admitted to the next phase of absurdity, medical school, where more of the same with more assurances the reward is in sight. Then internship, and more stuff to do, only more repulsive this time.

I loved that wonderful movie, "The Karate Kid" where the aspirant kid comes under the tutelage of a karate master, an old coot who makes the kid wipe and clean his wooden backyard fence, but in a very particular way, with circular arm movements. Finally, the kid rebels and screams, "I wanted to learn karate, and all you do is make me wash your fence!" Then the master shows him how everything he had done, all those circular motions with his arms are part of the circular exercises of karate moves. It was all relevant, after all!

We all kept telling each other, all the medical students, that medical school was like that: We'd understand someday how it all had actually been part of making us medical karate masters, not simply cleaning other people's fences.

It was a lie, of course. We had been used, exploited. If we had really been taught what we needed to know to practice medicine or  surgery, it would have taken half the time and we would have been better trained.

But we awakened to this in stages, and each person at different times.

One of my fellow interns finally bucked and refused. His resident told him to find some toenail cutters and to cut the toenails of a patient. This intern, George, simply refused, "No way. I'm not cutting anyone's toenails."  All the other interns looked at each other thinking, "Uh-oh, George is in trouble."  Each year along the three year training sequence, they cut about a third of the young doctors from the program, and George was insubordinate.

We all had to do stuff  we hated: My favorite was "disimpacting" constipated patients whose colons, from rectum up miles north, were packed with stool, and you had to put on a rubber glove and stick your finger up the rectum and haul out yard after yard of stool until the patient could actually have relief. 
The smell was enough to knock a buzzard off a shit wagon, as they said then.

But we each accepted these interminable, disgusting tasks. We were used. The older, more experienced doctors had done their time and were at home in Westchester.

So what does that have to do with Donald, the Slithole President Trump?

Well, he was like George, who simply said "No."  Trump is insubordinate. You will ask how can a President be insubordinate? He is at the top. But even the President is supposed to bow to certain gods--the idol of racial tolerance is right up there with patriotism, respecting the flag and honoring our valiant servicemen and veterans.

What we didn't know back when, was George had already got an ophthalmology residency in his pocket and he was back in Baltimore after a year of abuse;  he escaped and got trained as an ophthalmologist and made more money in a shorter time than any of us and he retired at age fifty four. George had said, "Stick it in your ear," and he he walked off, unscathed. 

George got indoctrinated into a certain way of thinking, just like the rest of us. He was told the exploitation was necessary to improving ourselves.  The ruling elites who ran medical schools and training told us to jump and we asked how high. We did not question enough. George was not fooled.

Now we have Mr. Trump, who was born rich. Trump never had to slog through any apprenticeship, never had to fear he'd be cut, never had to do everything he was told to do.  He could listen to prevailing authority and say, "Screw that!" He don't need no frigging system. 
And all those lowlife people living in trailer parks are watching him and they don't care if he was born on third base; all they care about is he is sticking it to the man.

In fact, there is much about immigration which should be examined.

From SHC

Most of my friends and I accept the idea of immigrants as suffering people who will work harder than the rest of us and build their families and our country and we can all congratulate ourselves about how wonderful we are for allowing them to work three jobs and die young so their kids have a better chance at "The American Dream" whatever the hell that is.

We love that poem by Emma Lazarus and we feel all noble embracing that.

Heart warming, no?

But Trump looks at the other sort of immigrant, the exception to be sure, the MS-13 gang member and he says, "Hell, no. I don't like poor people and if they are going to misbehave or if they are going to even look like that, I don't want them in my club."

He is doing what he was elected to do: He is disrupting embedded liberal belief.

Long Island

His idea of good immigration is not pulling drowning people out of a roiling sea, but inviting Miss Universe pageant nubile creatures over to his house for a party. Or getting smart Indian doctors or Ukrainian computer geeks to come live in America. Why should the Norwegian doctor have to get in back of the line when a bunch of Salvadorans have sneaked in ahead?

Ellis Island

He puts it crudely: Why do we need more Haitians? That is, why do we want to admit more poor people or Black people when we could go for more Melanias? 

But this is what more refined people are saying, in more acceptable phrases, when they talk about eliminating "chain immigration" i.e., allowing family members to come in ahead of Indian doctors who have no relatives already here. They are saying we should put our own needs and desires ahead of the needs of the suffering poor who seek   refuge here.
In fact, the idea of making reuniting families a priority is a relative new idea in American immigration thinking and policy. It dates back less than fifty years. Before that, we admitted people based on country of origin and the preferred countries of origin were, you guessed it, a lot more like Norway than Tanzania.

Now that's what I'm talking about. Good immigrant.

And the fact is, we always do weigh our own needs and desires in this formula. We could not possibly allow every person who wants to come from the Subcontinent or from China or from Central America or from a combination of all these into our country without accepting the fact that we would quadruple our population and we would likely have English speaking people in the distinct minority and Chinese would like become our lingua franca. 
We all accept we want immigration to occur in a way which costs us the least, personally. We're all okay with allowing in poor people,  as long as we don't have to think much about them or see them much, beyond clearing dishes at the restaurant, or working in the factories or the fields.

Out of sight. Out of mind.

And what really upsets all us liberals is we know that what Trump is expressing perfectly expresses what 49% of Americans actually believe. They are quietly, safely, nodding in agreement. Even some of our own liberal friends inwardly agree.

That's the rub.

Miss Universe Meets Shithole Countries

Maybe he really is a Very Stable Genius, after all. 

At a conference with Senators who were trying to work out some immigration policies, the President of the United States asked which immigrants from which countries would be benefited by various provisions of the proposed laws and, when told Haitians, Africans and some Salvadorians would be allowed to stay, he asked, why we, as Americans, would want to invite people from all these "shithole" countries?

Are we getting the best people here? 

Now, that may sound like a typical Trumpian eructation, and it was, but you know they were cheering it down at the bars in South Carolina, white Baltimore, Texas, Alabama, Mississippi etc. 

Now there's a guy who tells it the way it really is, our Slithole President.

Definitely Shithole-esque, although not Black

What we want, Trump added, is more immigrants from Norway.

The image, if it wasn't clear from the original expostulation, was unmistakable when he threw in Norway.  Africa, Haiti, uh, Black.  Norway: Could you get much whiter?

Now THAT'S what I'm talking about in an immigrant. 

Well, maybe Slovenia.

After the War

One of my favorites from the "Band of Brothers" was  a wonderful episode called "Points" which covers the time after the Wehrmacht surrendered.

The American soldiers, were, of course, euphoric, but for many of the officers, there was the problem of "what next?"  For the enlisted men, the citizen soldiers who had no desire to make a career of the Army, the return to civilian life beckoned. 

But some of the officers had never had such good training, so much responsibility, such a fulfilling job, and they considered staying on.

One of the best combat officers, Capt. Speirs, says he is going to "stay with the men" because the Army is such a valuable resource, and it would be a shame to allow it to go to waste. In one sense, you can see it's his career he does not want to go to waste. What can these men do after the fighting which could possibly seem as meaningful as what they did during the fighting?

But of course, that's exactly what happened after WWII and after the Civil War. All those hundreds of thousands of troops just quit, vanished, melted away, "ain't gonna study war no mo'."

After the Confederate Army surrendered and officers like Phil Sheridan and William Tecumseh Sherman and Ulysses S. Grant faced the great void of "peace."  None of these men had ever achieved anything close to the success in civilian life they had as military officers. 
Sherman had been a failure as a banker. Sheridan and Grant were more or less aimless non entities.

But following the surrender of the armies, these generals discovered the South may have surrendered its armies but it had no intention of accepting the defeat of the racist, murderous values by which it had always lived. Freed slaves, Freedmen, and Whites who were against slavery or against secession were murdered in astonishing numbers, thousands a month, hundreds at a time.

Over 300,000 Freedman tried to go to schools set up by the Freedman's Bureau, staffed in large part by Northern abolitionists who came South much as the Freedom Riders did 100 years later. But the would be students, the Freedman and their teachers were murdered systematically and methodically by Whites who had no intention of seeing Blacks learn to read, write, learn math and live free. 

Kept Killing with the Klan

Nathan Bedford Forrest, a Confederate general who oversaw the massacre of unarmed and surrendering Black Union soldiers at Fort Pillow and elsewhere established the Ku Klux Klan and continued his murderous ways. 

In Georgia, local police were uniformed in gray, to remind Blacks and Whites alike the war may have been lost, but the police still enforced White Power.

Phil Sheridan was put in charge of the military district of Texas and Louisiana and when the trolley company in New Orleans insisted on Blacks riding in separate cars from Whites, he said he'd close the company down unless they integrated the ridership.  He became an integrationist  long before Rosa Parks. He was pugnacious enough to declare martial law in Texas and to fire the governor of Louisiana. 

Grant saw that the generous terms he gave Lee to induce Lee to surrender were exploited as Southerners decided to oppose the end to slavery, to White rule by other means. 
The Southern states refused to accept the 14th amendment which guaranteed everyone the right to vote regardless of race and which guaranteed equal justice under the law. In Southern courts justice was not intended to be equal for Blacks. White men accused of murdering Blacks feared no punishment, and were virtually never found guilty, if they were charged at all.

Blacks were rarely even brought to trial: They were simply lynched.

I'm now into the last third of "Grant" and this is actually proving to be even more fascinating than the war years. I've read about Grant's war career so often, but not much about his years following the war, his gradual radicalization as he saw the foul injustices befalling Blacks.  
It is curious to consider how much more effective the Americans were in "rehabilitating" the Germans after defeating Nazi Germany, where at least outward contrition over the Holocaust seemed pretty pervasive.  Of course, they had to pass a law forbidding the publication of photos of Hitler for a few decades, for fear they would be framed and hung in every home and bar, but at least superficially, Germany seemed to have rejected fascist hate. Nothing like that ever happened in the South. There were never any Nuremberg trials in Richmond. Of course, the Southerners could never claim they were unaware of slavery. In Germany, as the American soldiers noted in "Band of Brothers", they never could find a single Nazi as they rolled through German towns. Everyone was "nicht Nazi." 

So far, Sheridan is looking even better than he did during the war, and that is a tall order. No Union general was braver or more effective or more important, not even Sherman. 

I used to drive past Sheridan's statue in the middle of "Sheridan Circle" on Massachusetts Avenue once or twice a week, when I lived in Washington, and never really thought more about him. I knew he had won the Shenandoah Valley campaign, but I was only dimly aware of the critical role he played in trapping Lee, at the end.

Sheridan married a much younger woman, and when he died at age 57, his widow was still young, attractive and much pursued. She lived another 50 years after his death, dying in 1938. When asked why she had not remarried, she replied, "I'd rather be Phil Sheridan's widow than the wife of any living man." 

That is hardly the sentiment one hears in the 21st century, but looking at 21st century men, and comparing them to Phil Sheridan, and for that matter, to Ulysses S. Grant, one might say, little wonder.

The Trouble with History: The Case of William Tecumseh Sherman

Five hundred pages into "Grant" I'm still enjoying it, although, truth be told, being 500 pages into "Grant" is like being 250 pages into a well edited book.
The same paragraph about whether or not Grant was drinking on a given day, or during a given journey appears over and over.

Mr. Chernow desperately needs an editor.

It's pretty obvious Chernow sat down with piles of books and files on every given major battle, every journey, journals from Grant's friend, Rawlins, books from historians Bruce Catton, James McPherson, and others and then pasted their comments into his paragraphs for that event. 
The same sources keep getting quoted, often nearly the same quotes about whether or not Grant was drinking.

That being said, the picture which emerges of Grant and of those who mattered most to him, and to us--Sherman, Sheridan and Lincoln-- is worth the slog.

I have photos of Sherman on my walls, on coffee mugs, I like the image of him as implacable, and unwilling to accept the fantasy of war as something chivalrous.

One has only the excerpts from letters, the reports of historians, friends, adversaries, but it's not like you can see Gwen Ifil interview him on TV. It's not like you actually can have him over for dinner and judge for yourself.

On the other hand, there are enough reports of things he said at dinner parties, things he wrote, which line up.  You can draw some tentative conclusions. 

On thing seems pretty clear: William Tecumseh Sherman was a white supremacist.  
He believed Negroes were simply inferior, lacked intelligence and courage, could not be taught.  He said, on more than one occasion, when it came to Whites and Negroes there could only be a master/slave relationship. He said whenever you have Negroes, they destroy things; Whites build things.

As slaves left plantations in the wake of Sherman's march, and as they trailed after their savior--and many saw him as just that, the second coming of the mesiah--Sherman clearly considered them to be a nuisance, a rabble to be dealt with. Unlike Grant, who with more exposure to Blacks began to see them as human beings, and witnessing their valor in combat, Grant gained increased respect for them, Sherman was, from all we can see, unmoved.

And yet...There's always the "but." Sherman did plan to provide freed slaves in liberated Southern lands, plots of land from plantations now wrested from control of the slave owners; he gave individual slaves 40 acres each to farm, for the practical purpose of allowing them to support themselves without further government aide and also as a way of bringing imperious White plantations owners to the realization their claims to land were null and void. (This was later reversed by Lincoln's successor, Andrew Johnson.)

But where  other Uninon generals embraced the idea of recruiting and using Negro troops--in particular Generals Thomas and Grant--Sherman would have none of it. The Negroes might be capable of farming but not soldiering Sherman apparently believed.

In the run up to the War, at a dinner party and among friends, Sherman opined that Blacks were better off as slaves than they had been in Africa, better off as slaves than they could be on their own.  For the most part, the slaves were well treated Sherman told his dinner party companions, and  the slaves were and ought to be happy. 
All that was said just before the war. That was before his march, before he saw the joy of the newly freed slaves. 
But even seeing their joy in liberation, Sherman took this as the expostulations of silly children.

All this may seem at odds with Sherman as one of the three major forces which ended slavery, but Sherman was, in fact, the embodiment of that Unionist who really did not give a hoot about the people involved, the slaves or even the slave owners. What animated him was the idea.  The idea of "Union."

Union was tied up in the idea of order and loyalty and patriotism for Sherman, at least as far as you can discern from the records historians unearth.

 While Lincoln and eventually Grant understood you could not have Union without an end to slavery, Sherman seemed to ignore this. 


Whenever defenders of "The Lost Cause" want to sanitize the idea of exactly what that cause was, they refer to people like Sherman who, like so many Northerners entered the war simply because the idea of breaking up the Union was an anathema. And it was true, in the beginning many if not most of the Union soldiers had little sympathy for slaves. But, as Lincoln so famously described, whatever got people to join the war initially, ultimately everyone knew, in the end, slavery was the real cause of the war, if not for people like Sherman, for the people of the South and for enough of the North.


That mythological eminence, Robert E. Lee, was clearly a thorough going racist, who was appalled to see a colored officer on Grant's staff at Appomattox, and took his presence at the surrender ceremony as a personal insult. Sherman would have understood completely.

Where Grant was canny enough to refuse to allow Southern officers to take their "property" back home with them after they surrendered at Appomattox--because slaves were property--Sherman made no such order when he signed the surrender agreement with Johnston.
Lee had already surrendered in Virginia but Sherman had to chase down Johnston and demand the surrender of the Army of the Carolinas. Sherman attempted to allow the officers to keep their slaves and to leave slavery in place in the Carolinas. 

Grant had to rush down to Durham, to  nullify the agreement.  

Oddly, Johnston had asked Sherman only for what Grant had given Lee, a pardon for his soldiers so they would not be tried as traitors and a promise not to molest them or prosecute them. But Sherman wanted to go beyond the simple surrender of an army; he wanted to settle the outstanding political issues which might threaten the peace after the army was disbanded, so he tried to guarantee the slave caste system would remain intact in the South. 

After the Civil War finally wound down, after the last small Confederate armies scattered around the South had disbanded and only scattered guerrilla resistance remained, Sherman replaced Grant as commander of the Army and he pursued the Indian wars, and he was just as remorseless in his pursuit and subjugation of the American Indians as he had been of the Southern rebels. 

Indians, after all, were not White.
So, once again, there are no heroes. No role models. There are only men who do heroic things and the same men often do despicable things.

We can look at them and understand the "Jungian thing," as Joker says in "Full Metal Jacket" when a stupid, officious colonel confronts him about the "Born to Kill" stenciled on Joker's helmet and the peace button on his collar. "The duality of man," says Joker. "You know."

The World's Best Medical System: Medicare For All v For Profit Medicine

Next time someone tellsyou about what a  calamity socialized medicine would be, and how much more efficient the free market system is, with all its incentives, think about this story.

An executive at one of the big pharma companies told me over lunch his company had cut 4,000 sales jobs, but some of those folks could be retrained to be billing reps.

Let's not talk about him

What does a "billing rep" do? Well, when a group of oncologists sets up an infusion center in their office, or when a hospital sets up such a center, where cancer patients are given intravenous chemotherapy drugs, the doctors or the hospital buys the drugs, not the patient. The patient's insurance company then pays the doctor for the drug, and pays him a fee to start the IV and administer it. This is all quite apart from the fee the insurance company pays the doctor for the office visit, where the doctor decides what drug to give the patient.

The doctor then has to bill the insurance company for payment for the drug, and that's where the drug company billing rep comes in: The drug rep knows exactly how to bill the insurance company, so the number of milligrams administered fits the profile in the insurance company's computer for the disease the patient has. There's a whole elaborate system with numbers corresponding to diagnoses and another for procedures. The drug company helps the doctor maximize his reimbursement from the insurance company.

Iceland has a national health care system

Now, why would the drug company be so kind to the doctor as to guide him through the reimbursement system? Why would it it be worth the salary of a drug rep? 

Because the doctor has choices among several "me too" drugs, made by different drug companies, and there's often not a hair's breadth of difference among these competing drugs, save, perhaps, for the amount of money the doctor might pocket. 

"In the good old days, the doc could get 25% of the cost of the drug, which for a drug which costs $10,000 a month is $2500, multiplied by 100 patients, thats $250,000 a month. "A lot of beach houses got built on cancer chemotherapy," the drug guy laughed.

Some sort of bird on Batchelder's pond, Hampton, NH

"But now, it's not so good. They only get 6%, typically. That's only $600 a patient or $60,000 a month. 
Still, a mortgage payment, I thought.
It made me think of that old quip, "More people make a living off cancer than die from it." And it made me think of all those other blatant conflicts of interest our commercial system has fostered, like doctors who own the laboratories which run the tests they order on patients. The more tests they order, the more money they make. 

But, in the case of cancer drugs,  look beyond just the drug company and the doctor. The doctor has an office staff, a big office staff, often four or five ladies doing the billing, and the insurance company has its staff of folks receiving and entering the bills into their computers and issuing payment checks and the insurance company has its CEO and his staff. 

If we had a Medicare-for-all health care system, tomorrow all those jobs would evaporate over night.

Land of the free, home of the chumps

And with them, of course, so would all the expense built into our bloated system.

The cancer patients would still be going to the infusion centers, getting their drugs. But, of course, the choice of drug might not depend on which drug company offered the doctor the biggest paycheck.

Oh, but that would be the ruin of the best medical care system in the world!
Oh, its so sad to be ruined.