Obamacare and Trumpcare: The Trouble with Facts

This morning on NPR some voice mentioned that only 9% of Americans get their insurance through Obamacare.  This stunned me because, to listen to President Trump talk about it, to hear the Republicans rant, as they voted over 60 times to kill Obamacare, I thought for sure this must be the dominant form of healthcare insurance in this country, like the National Health Service in England.

So I asked Professor Google about this.

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And, it turns out, the voice was correct, but actually I heard it wrong. She must have said "3%" not "9%."  It's 9 million people.  Somehow we always hear the number 22 million will lose their healthcare if ACA were killed today.
Either way, we are only talking about insuring a small segment of the population.




Now, I realize 2.9% still comes out to be a big number--9 million--but that 2.9%/9 million includes my son.
Still, we are not talking a program the size of Medicare here.
Maybe we should be. Maybe, as Bernie Sanders suggests, we should be offering Medicare for anyone who wants to sign up for it. 
You might see a stampede away from employer based health insurance. Or maybe not.   People might see they get better coverage through private insurance,as some unions have negotiated "Cadillac policies" for their members. But private insurance companies are scared to death of having to compete with Medicare, which is, for the most part, beloved because it serves its beneficiaries well.

But these substantive arguments, about numbers of people affected, dollars and cents, costs and benefits are tough to keep in mind. 

Trump simplifies things. The Republicans sympathize things. Of course, they have had that luxury because governing is complex; complaining is simple.
Trump doesn't get caught up in all those difficult numbers. He just emotes.

I've been reading Jacob Hacker's and Paul Pierson's  wonderful book "Winner Take All Politics" in which they  note most people cannot retain in their minds the numbers and evidence which policy wonks, politicians (except Trump) marshal to substantiate their arguments.  Most people can only retain the conclusions. That's all President Trump gives us:  Oh, it'll be great. It'll be great coverage for less money and you'll be so happy.

On the other hand, some liberal politicians have been able to crystallize their points effectively; some liberals can avoid getting bogged down in details and give the summary in understandable language, like this speaker:

"For too many of us the political equality we once had was meaningless in the face of economic inequality. A small group had concentrated in their own hands an almost complete control over other people's property, other people's money, other people's labor--other people's lives. For too many of us life was no longer free; liberty no longer real; men could no longer follow the pursuit of happiness. Against economic tyranny such as this, the American citizen could appeal only to the organized power of Government."

This is not Bernie Sanders. This is Franklin Delano Roosevelt speaking.
We need someone like him now, or we will have Trump, McConnell, Ryan, Rand Paul and Rush Limbaugh.

The Widow Owens and the President

Was I the only one in the entire nation who was totally creeped out by President Trump and widow Owens the other night?

I used to enjoy watching some of those tele-evangelists with their rapturous crowds out of the same sick pleasure one takes in watching really freaky things.  Truth be told, I still pause while channel surfing when I get to those channels where the preacher is telling you to send him money and the scrawl across the bottom of the screen tells you where, and the audience is getting more and more worked up, from great broad grins, to tears of joy streaming down their cheeks, and you sit there watching saying to yourself, "Are there really people in the world who are actually like this, or are they just on TV?"

And somehow the preacher always has really creepy hair, lots of it, and the hair, somehow is important, because it is show business hair, not like normal hair, thin in spots or uneven but somehow over the top hair. Big hair. 

And there on TV was the President in his spotless white shirt and his navy blue tie with the white stripes, looking more or less like a normal President, but he's looking Heavenward, up toward the gallery and having this extended exchange with this woman who is getting more and more worked up until she his clasping her hands in prayer and looking up to Heaven, where you just know she can see her dead husband up there, smiling down at her in the gallery as the President of these United States talks to her, just like God, or someone.

And everyone's clapping, just like that scene from the Elephant Man, where this deformed creature stands up and everyone in the audience turns to look at him and they applaud, as if the applause somehow washes him clean of his immense suffering and he has his Hollywood moment, which is going to sustain him until one night, trying to sleep, his head snaps forward and severs his spinal cord.

Gotta love Hollywood moments. They end all the best movies, where everyone in the control room at the space center or wherever is applauding and having a group hug, metaphorically speaking. 

And there we were watching it all, in real life, or as real as life gets in Trumptopia, where, after all, we are all living in Fantasyland. 

Unecht Kompetant

This morning we got a request in the office for me to sign a form.  The form of uncertain origin said that as a licensed physician in the state of Massachusetts I certified that Mrs. Jones should be given a "cardiac meal" plan from Meals on Wheels.

I was not asked to provide evidence that I have certification to make judgments about clinical nutrition, but you know that is coming: Certification in Clinical Nutrition for physicians and nurses so we can order various diets for hospitalized patients or home bound patients receiving services. The certification will need to be renewed annually at a cost of $250 but first you will have to pass a certifying exam ($850) and if you are serious about passing the exam, you'd better take the one day course at the local Holiday Inn to prepare you for the exam ($1,000)--lunch provided, parking not included.


The fact is, there is no such thing as a scientific "cardiac diet."  We used to be most offended when we made rounds on the Cardiac Care Unit and eggs were on all the meal trays for the patients. How could we be feeding high cholesterol eggs to patients who had cholesterol plaques blocking their coronary arteries?  It turned out, of course, dietary cholesterol is probably irrelevant to blood cholesterol. When we finally understood the role of the liver in pumping cholesterol into the bloodstream and we got the statin drugs to address this and we saw patients eating omelets every morning and running nice low blood cholesterols we realized the "cardiac diet" was a fraud.


That news has not caught up with Meals on Wheels in Massachusetts.


In fact, the patient in question has diabetes, not known heart disease. But there is no diabetes diet on the Meals on Wheels list so they make do with the cardiac diet.


We have decided to create a new word for this sort of request, which we get nine times daily from agencies requesting signatures on their forms certifying a patient is safe to go back to work after having had a runny nose, or forms requiring a signature testifying that a patient can walk down her driveway to the mailbox.

So far we have two candidates:  whenever we get such a request my assistant will say, "We have another Unecht kompetant form-"-that's the German or We have a request for a Faux autoritie' --that's the French.


So far my assistant likes the German. She thinks when it comes to words related to authority, German is best. The French pretend to reject authority, but actually they cling to it. The Germans embrace authority.


Suggestions for your candidate phrases are encouraged.  The winner will be announced at the Press Club dinner for President Trump.

Why I Love New England

Saw an eighty-three year old woman in my office today who came in for her hypothyroidism.

She's feeling fine, goes ballroom dancing three nights a week and bowls two nights a week, and the other two nights are "date nights."
She lives off in the New Hampshire woods at the end of a long driveway which she snow blows with a blower which is not self propelled, so it's something of a work out for her.
She met a man in Florida a year or two ago ,but when he came up to shack up with her in New Hampshire he told her he could not take another New Hampshire winter.
She told him she liked snow and maybe she'd call him when she popped down to Florida in the future. She took out her snow blower, cleared her driveway and called him a taxi.
"The truth is," she told me. "I've had better. Of course, at my age, I can't remember them all, but I know I have."
Our front office lady, Cathy, who checks her out never gets her signed out in under half an hour, because she asks this lady about her latest adventure and there is always an adventure.
"I wish I had her life," Cathy says. "If my husband ever leaves me, I'm going to go live with her."

This morning, a patient cancelled, leaving us with a half hour more or less free, which everyone in the office uses to catch up on paper work (really, now, computer work) and we dispatched Cathy across the street to the Dunkin Donuts in the hospital lobby.
Every place in New England has a Dunkin Donuts. They are in hospital lobbies, office buildings, every town square, along the roads, at the docks. If Dunkin Donuts were discovered to have lead in their water New England would have a nervous breakdown. It's part of the fabric of life.


Of course, even a town the size of Salem, New Hampshire has two specialty coffee shops with exotic blends.

Last night, I got down to the local hardware store after closing hour. It opens at 7:30 AM and closes at 6 PM, and I'm off to work before that and home after. But the light was still on so I tried the door which was still open, and poked my head in. The guy who works there was still there.
"Oh," I said. "I know you're closed, but the door was open."
"I'm here, so I guess we're open. What can I do for you."
I had bought a clock there a week earlier and it stopped working and the battery is new.
"I'm sorry, I lost the receipt."
"I know this clock. We sell it. We back it."
He fiddled with the battery, convinced himself the clock was a dud and went in back and got me a new one.
"Bring it back if it stops," he said.
People here enjoy acts of daily living. They talk politics all day long, but they have lives.  And they don't think of politicians as any different, any smarter, any more or less ethical than the guy who sells used cars.


Every town has some version of a breakfast diner.


Real people live here. 

Murder by Any Other Name

Talk about political correctness.
An American border guard  shoots dead an unarmed 13 year old boy who was taunting him, standing on the Mexican side of the border, and Republicans rush to defend the guard who they insist should be immune from prosecution. They take that stand because they want to be seen as defending our borders; they are for always standing with police and the forces of authority, even when the policeman is a cold blooded murderer, captured on video.


Given that political belief, that authority is always to be endorsed, Justices Thomas, Roberts, Alito will likely side with the Right, and they will vote to hold innocent the murderer who happened to wear the badge of United States border control. Because the murderer is on our team, on the American side of the political border.


Kennedy, as always, is a wild card, but will likely side with the conservatives and Ginsberg, Breyer, Sotomayor and Kagan will vote for the dead kid, and  his parents.

The facts of a case are, of course, where you begin in trying to make a decision.
In this case the reality appears to be the 13 year old was playing touch-the-fence with his friends, running up and touching the wall or fence and then running back to the Mexican side and laughing. The Border patrolman, Officer Mesa, shouted to stop that but the boys continued to taunt him. So the policeman shot the boy in the head and then claimed he fired because he felt his life was in danger.


Of course, that's what police always say when they fire their guns, even if the guy they shot is running away as fast as he could.


In this case, there was a video.


The Obama administration refused to extradite the homicidal cop to Mexico, which surprises me.


The Trump administration is saying the murderous cop is a hero in the war on Mexican rapists.


Someone has argued before the Supreme Court the protection for the child ended at the border because the Constitution doesn't apply in Mexico. 

If the German concentration camp guard, who was not violating the German constitution, or any German law, by murdering children at Auschwitz can be tried for crimes against humanity, i.e. for doing something which you do not need to be a lawyer to know is wrong, namely shooting a child in the head, do we really need arguments about where we draw lines in applying the U.S. Constitution?

The Daily Donald

Here it is, hot off the presses, so to speak. President Donald speaks:

1.  "You want good high paying jobs for yourselves and for your loved ones and for the future of your families."

Now, how did he know that? And why hasn't any other President tried to do that?




2.   "You want a health care system and by the way, we are going to be submitting in a copule of weeks a great healthcare plan that's going to take the place of the disaster known as Obamacare. It will be repealed and replaced. For those people, the people put into rooms where Republicans are talking about the plan, and it wouldn't matter what they say, for those people just so you understand, our plan will be much better helath care at a much lower cost. Okay? Nothing to complain about. Obamacare remember, it is a disaster."


I'll remember that:  Obamacare is Disastercare,: Got it--although, you know, before I couldn't find any insurance and then with Obamacare I had 15 choices and my policy cost half of my previous policy and it covered three times as much. Best health insurance I ever had, but that's just me, personally. I must have been the exception. But this new Trump Care is going to leave me with nothing to complain about. I am really looking forward to that. And it's all coming in a couple of weeks.


I just hope this new healthcare is going to make me twenty years younger and twenty pounds lighter; then I really will have nothing to complain about.


3. "You want low cost American energy also, which means lifting the restrictions on oil, on shell, on natural gas."


Wait, you mean there are restrictions on oil and natural gas now? Restrictions! That can't be good. Nobody likes restrictions!


4. "And clean, very clean coal.  We're going to put the miners back to work. The miners go back to work. "

Lucky guy. He's getting his job back!

CLEAN COAL!
VERY clean coal! What a great idea!  And all this time I thought there was no such thing as clean coal. I'm so glad those coal miners can go back down into the mines again. Are they the same guys would cut the tops of mountains in West Virginia?  They really do need a break.  If Hillary had won, she'd have retrained them all to make windmills and solar panels. What a jerk.




5. "You want us to enforce immigration laws and defend our borders."

Muslims in that horse, as Sweden has discovered!

Absolutely! We all need borders.  Who can disagree with that?


6. "You want lower taxes. Less regulation."


Now you're talking. The President was too smart to pay income tax the last 20 years. He said the government would have just squandered the money. Paying taxes is for little people. I don't like taxes.
Also regulations. Don't like regulations either, like speed limits on roads and limits on how much I can drink before getting behind the wheel and regulations on how much interest the same day loan guys can charge me for my loan, or how big a bank can get before it's too big to fail, and all like that.

I'm so glad we finally got a guy in the White House who listens to me.

Donald Trump: Channels Archie Bunker

Listening to Donald Trump and, most importantly, watching his fans standing behind him, I've drifted away from the odious image I have heard from my friends toward a more benign view of the man. He doesn't strike me as really hideous so much as very simple, and his fans are, well, just really knuckleheads.

When you think of the really nasty, pathologic leaders visited upon the face of the earth, you think of Hitler, whose pathology was so manifest, the shrieking hate spraying out from his lips. That guy, like his admirers, Henry Ford and Charles Lindbergh, among others, were real haters.  They put their hate down in writing and broadcast it unequivocally. 

Trump is not like them.

In fact, I was impressed by his handling of the professional Jew who attempted to ask him a question during his press conference. Trump did not indulge him; he treated him as he would any other reporter who offended him. The man promised a simple, friendly question and instead launched into a prolonged statement about a rise in anti-Semitism which Trump took as an attack on himself because so many have said Trump's intolerance of one religious group, the Muslims, unleashes intolerance against all minority religious groups.

Trump could have used the fact his own daughter converted to Judiasm to marry a Jew as an argument about his own tolerance, but he did not. He instead insisted he is the least anti Semitic person on earth and you have to take him at his word there.


Even his anti Muslim rhetoric lacks the sort of animus we would expect in a real hater. He does not say Muslims are evil or conniving or that they should be expunged from our society.


The trouble is, his is incapable of drawing well crafted distinctions. He says there are bad people out there and some of these are Muslims and some of these Muslims are motivated by what they think is their Muslim faith to want to do us harm.
If you pinned him down, and I haven't seen anyone do this, I suspect he would say the problem is not Islam, nor even the majority of the billions of Muslims on earth but a small radical fringe--those who follow what he calls "radical Islamic extremists" and we ought to be focusing on these.


Those two bozos standing behind Trump's left shoulder at Melbourne do not understand fine distinctions. They just want something to cheer about. They lost interest in what he was saying by minute 50 and one realized he was on national TV and started calling his friends on his cell phone and waving at the camera, behind Trump, making hand signs with his fingers. He did everything but hold up rabbit ears behind Trump's head. He was 20 something, with the mental age of a 10 year old, to look at him.  That's where so many of Trump's fans seem to be.


Trump's problem is, he hasn't the foggiest idea of how to do what he wants to do. He wants to stop attacks by radical Islamists on America.  His first attempt, to simply exclude Muslims from entering the United States, is an approach which got the brain dead throngs cheering. But, of course, this simple minded solution won't work any better than declaring the United States a bomb free zone, putting up signs outside every elementary school and airport. No bombs allowed.


What he has said is it is possible to be too magnanimous and to allow "the wrong people" or "bad people" across our borders as we attempt to help the huddled masses. He is correct that the flood of Middle Eastern men into Germany was followed by Middle Eastern Men groping women in German cities, and this was not a random sort of malfeasance, but was born of a culture in which women unaccompanied by protecting male relatives are considered whores and fair game.

Trump points to the one Mexican who rapes an American woman and says this one event justifies excluding all Mexicans from American soil. He did not say this man was also a Catholic. So are we excluding all Catholic Mexicans?  Because,  you know how they are.  And, of course, that sort of thinking is what devolves into bigotry. One guilty person is identified as a member of a feared group and thus all members of the group are tarred with the same brush.
Trump is not a Hitler spewing hate; he's more like the frightened grandmother, who fears people not from her own group. She is not so much a hater, as an individual possessed by fear.


Wouldn't we all love to have a machine which could identify radical Islamists intent on blowing up Americans? We could have everyone coming in from an international flight step through the machine, as we do for the scanners now, and when the terrorist steps in, the machine would detect the malevolent thoughts emanating from his brain and the doors would snap shut and we would extract him in a can and send him off to some place, not in the United States, hopefully not Gitmo. Somewhere safely away from us. Maybe Somalia.


Would we not like a similar machine for the Mexican border, which would detect rapists and people intent on overstaying their visas?


The problem with human beings is they are deceptive. Say what you will about those 19 terrorists on 9/11--they were cunning.   And effective.


But the problem is our Presidents tend to be not cunning. And they are not effective. 


 George W was simply not very bright. His response to 9/11 was to send in the troops, and it didn't much matter to him if they did any good.   He simply wanted a good show for the folks back home. And he provided part of the theatrics by flying his own plane onto the aircraft carrier where they hung up that "Mission Accomplished" banner.


Trump will eventually face the same problem: Either he'll replace Obamacare with something better or he will not. Either he'll bring back coal mining jobs and factory jobs or he will not. Either he'll prevent the next terrorist attack or not. Either he'll stop the flow of illegal immigrants across our southern border or he will not.


Right now, it's all wishful thinking. Those miners are going to mine CLEAN COAL. Oh, now why didn't we think of that before? All that dirty coal polluting our skies and air. Why didn't we just go for the clean stuff?


Right now, it doesn't look as if Trump actually has engineered solutions to any of these problems. He's got his staff writing memos about rounding up immigrants.  Meanwhile, cities are declaring themselves sanctuary cities. Sounds like a plan.

Ronald Reagan managed to fool most of the people all the time--and they named an airport after him and still revere him today, even though he was a dismal failure as a President, tripling the national debt by cutting taxes and increasing spending, putting 280 marines in  a building in Lebanon and they were blown to smithereens by a truck bomber, over seeing the Challenger explosion.  He couldn't get the government to do much of anything right, but he could sure play the part of the guy who would drain the Washington swamp.

Trump does not have script writers Reagan had. But he does not burn with the black venom of a Hitler. He is the worried, panicky old woman from Queens, who sees the world as a threatening and dangerous place and who sees no point in drawing distinctions between those who mean us harm and those who are simply different.