Sunday, September 10, 2017

Medicare for All: Better, Cheaper

This phrase was used by the late Senator Edward M. (Ted) Kennedy, who advocated a system of healthcare financing for this nation that used a single payer.  The government-run Medicare program, established more than half a century ago, is not perfect, but it is well recognized as a remarkably efficient mechanism of paying for the healthcare services provided to seniors and the disabled.

Satisfaction with Medicare among seniors is high and compares favorably with what one finds among those whose health care is covered through any of the companies in the private-sector health insurance industry.

My sense of Ted Kennedy was crystallized by the speech he gave at the Democratic National Convention in 1980.  It was finely crafted and superbly delivered, and it was a grand exposition of the New Deal ideology, a political philosophy that holds out the promise of accomplishing great things by using government as an engine of social improvement.  Lyndon Johnson's Great Society also captured that vision, updated for the 1960s.

But in 1980 the American electorate had become deeply skeptical of government as a means toward the end of making America great, and it resonated with voters when Ronald Reagan told them government was the problem, not the solution.

It is time to rethink that way of looking at things when we consider the financing of healthcare.

We have money to spend on healthcare.  We give it to insurance companies, which are supposed to serve as a conduit, channeling the money to pay the doctors, hospitals, and other providers of health care to patients.  But the business model of the private health insurance industry is such that a portion of that money is not spent on health care.  Instead it is diverted to administrative costs that are substantially higher than we see for the government agency that runs Medicare and Medicaid, as well as marketing, return to investors, and lavish executive compensation.

Everywhere you look these days there are advertisements in the broadcast and print media and highway billboards saying "Aetna, I'm glad I met ya" and telling us that Cigna is in the business of caring.  Especially galling are the TV commercials for the "Medicare Advantage" plans, created to give the health insurance industry a cut of the Medicare dollar.  What was the rationale for that brilliant idea?  That private industry should be given a chance to show how it could do what Medicare does, only better.

Well, I am here to tell you this: it is not better; it is larceny.

Medicare's administrative costs are much lower, there are no investors expecting dividends, there are no executives pulling down millions, or tens of millions, of dollars each in annual compensation, and the marketing consists chiefly of little ads telling seniors to call 1-800-MEDICARE if they have questions.

Meanwhile, patients and doctors spend hours on the phone trying to get health insurance companies to pay for things they are supposed to pay for and jumping through hoops to get them to do so.

As if all this isn't reason enough to ditch the absurdly fragmented non-system we have for financing healthcare in this country, about ten percent of Americans are on the outside looking in, with no healthcare coverage at all.  They don't qualify for Medicare or Medicaid and they either are not eligible for employment-based coverage or cannot afford their share of the premium.  Some are self-employed and cannot pay the eye-popping premiums one finds in the individual market.

And many who do have coverage through the private health insurance industry struggle with copays and deductibles that are large enough to discourage them from seeking health care when they need it, because the costs will be largely or entirely out-of-pocket.

It is time to ditch the private health insurance industry.  It has had more than half a century to show that it can efficiently and effectively cover Americans whose health care is not financed through a government-run program, and it has demonstrated beyond any doubt that it is a failure.

Even for those who have been satisfied with employment-based coverage, that very satisfaction - and fear that something else won't measure up, or there will be a gap - is a barrier to changing jobs when such a move would otherwise be the right decision for career advancement.  Employment-based coverage came into existence at a time when employers were looking for ways to recruit and retain workers in an economy that was abundant in job opportunities.  Now it restricts career mobility and keeps people in jobs no longer satisfying because they cannot risk being without coverage in transition, with the cost of transitional ("COBRA") coverage being exorbitant, and fear that the next company won't cover a pre-existing condition.

We need a system that works like this: you are a human being on American soil, so you're covered. When you are born, you get a Social Security number, and you are also enrolled for healthcare.  For those of us who have already been on the planet for a while, it is easy to sign up.  If we don't take the initiative to do it ourselves, the first time we need healthcare, we get signed up on the spot.

Copays?  Deductibles?  Nope.

Copays and deductibles have two purposes.  The first is to get people to pay part of the cost of services that they already paid for when they shelled out money for premiums.  In a public system financed with public dollars, that rationale goes away, because there is no insurance company using it to boost its bottom line.  The second is to give people "skin in the game."  In other words, if you have to pay something, it will make you more sensible and responsible in your decisions about whether and when to seek health care.

There is no question that there is great variability among us in healthcare-seeking behavior.  Some of us seek professional health care for every little thing, and others do so only when they are very concerned that they have symptoms that could be something quite serious.  In my practice of emergency medicine I see people who have been in a car accident and feel fine, but they think they should come in "just to get checked out," while others are badly hurt and had to have worried friends or family badger them for many hours to persuade them to seek medical attention.

Yet there is abundant evidence that copays and deductibles discourage people from seeking health care that is very necessary, even urgently needed, as much as they are discouraged from seeking care that is of doubtful necessity.  Do we really want the 55 year old woman delaying going to the hospital for hours or days when she is having a heart attack, because the out-of-pocket cost encourages her to hope it's just indigestion?  I cannot begin to tell you how many times I have looked at an EKG and thought, "Well, no wonder the Tums didn't help."

I recently got an email from a conservative group, working to build public opposition to Medicare for All.  "Do you want government-run healthcare?" was the question it posed.

Great question, often paired with the assertion that the postal service - which we all love to ridicule - is an example of how the government cannot do anything well.

But Medicare for All is not "government-run healthcare."  If the government is paying all the bills instead of just the ones from patients currently in Medicare, Medicaid, and other government-based healthcare plans, it doesn't mean the hospital where I work, or the one in your neighborhood, or your doctor's office will be taken over by the government.  It just means they will be sending the bills to Medicare instead of to a slew of different companies, each of which has different rules and varying paperwork and employs an army of people to review claims and say, "No, we're not paying for that."

Imagine how much can be saved in costs by hospitals, doctors, and others who are dealing with one payer and one set of rules that are clearly understood by all.  And imagine a world in which patients get the care they need, and it simply gets paid for without their ever having to do anything except sign a form saying they received the healthcare being billed.

So, you may think, "No, I don't want government-run healthcare."  But you should want Medicare for All.  There is no good reason not to want it.  But the private health insurance industry will fight it with everything they have, because it will replace them.

It is time to replace them - with a system that works for all of us, and does the job right.

In fact, it is long past time.  

Sunday, August 13, 2017

Charlottesville: Erasing History?

Deadly violence erupted in Charlottesville, Virginia yesterday.  White nationalist demonstrators were protesting the possible removal of a statue of Robert E. Lee, the Civil War general who led the Confederate forces.

Charlottesville is the site of the University of Virginia, the institution founded by Thomas Jefferson.  Mr. Jefferson famously said of slavery that "...this momentous question, like a fire bell in the night, awakened and filled me with terror. I considered it at once as the knell of the Union. it is hushed indeed for the moment. but this is a reprieve only, not a final sentence."

Jefferson understood what must happen to the South's "peculiar institution" of forced labor of Africans brought to the Western Hemisphere in shackles under the ghastly conditions of slave ships.

Lee, on the other hand, was one of the men who went to war to preserve that institution.

The statue in Charlottesville is of Robert E. Lee mounted in military splendor upon his magnificent steed, Traveller.  Removal of the statue, according to those who support its being left in place, is an attempt to "erase history."

I know a little something about history - and the history of the South's "peculiar institution."  I have read biographies of all the early presidents who were slaveholders, notably including the four of our first five who were from Virginia.  I have also read extensively on the political history of the decades preceding the War Between the States.

Beyond the thousands of pages I have read on the Civil War itself, my personal library includes biographies of Jefferson Davis, Robert E. Lee, and Stonewall Jackson.

I can assure you, there is no "erasing history."

But there is something to think deeply about: if we do not want to forget Robert E. Lee, how exactly do we want to remember him?  And what sort of monument would facilitate that?

We are not about to forget that Lee led the Army of Northern Virginia against the Army of the Potomac, that he matched wits on strategy and tactics with Union generals and mostly out-generaled them.  Lee's admirers would say that ultimately his cause was lost because the North had more to work with in men and materiel, and in the final analysis it proved to be a war of attrition.

But the grand monument to Robert E. Lee in the saddle on Traveller suggests admiration for what he did on the field of battle, including exactly what it was he sought to accomplish: separation of the Confederate States of America from the United States of America, and the continuance of slavery.

And I believe that a monument to Lee's quest does not belong in Charlottesville, or anywhere else in these United States.

So let us not forget Lee.  If there is to be a monument, let it show Lee together with the Union general who brought Lee's quest to its proper end.  Such statuary is depicted at the beginning of this essay, showing Lee and Grant at Appomattox Courthouse.

In the spring of 2016 exit polling told us many voters in South Carolina thought Lincoln should not have issued the Emancipation Proclamation, and we would have been better off if the South had won the Civil War.  Monuments to Robert E. Lee serve to support such beliefs.  It may very well be that the names of Confederate Generals attached to US military bases, such as Fort Bragg in North Carolina and Fort Hood in Texas, do something similar.

So let us not erase history.  But let us make thoughtful decisions about having monuments to history that reflect today's values, not the shameful dehumanizing institutions of centuries past.

Sunday, July 23, 2017

Ethics in Politics: Reconstructing a Broken System

The year was 1988.  I was serving as chair of emergency medicine at a community hospital in a steel town in the Upper Ohio Valley.  A patient had a complex situation that raised issues in biomedical ethics.  The chair of family medicine was the patient's primary care doctor.  At the end of our discussion we agreed that our hospital needed an ethics committee to deliberate on such cases.  We recruited the director of the ICU, and his wife, a medical ethicist, and we formed a committee.

In the nearly three decades since I have been immersed in the study of ethics: not just biomedical and professional ethics, but the ethics of human societies.

This immersion has convinced me of many things.  One of these is that access to basic health care of high quality should belong to everyone living in American society.  Right now it doesn't.  We have an absurdly fragmented non-system for financing health care.  You can have employer-based health insurance.  You can be elderly or disabled and qualify for Medicare.  You can be impoverished and qualify for Medicaid.  You can be in the military service or a veteran and have access to care in that system.

But you can also have no coverage and no access.  The United States is virtually alone among First World nations in having a significant segment of its population in that last category.

Here is what I think the situation should be in a society with sound ethical values that are put into practice: if you are a member of our species, and you are on American soil, we take care of you when you are sick or injured.  You may worry that the world will flood America's borders with refugees desperately seeking health care, and you may want to find ways to prevent that.  But right now we have nearly 30 million Americans without health care coverage and access, and tens of millions more whose coverage and access are woefully inadequate.

Why don't we have universal health care now?  Is it because most Americans are cruel and heartless?  Is it because most of the 535 Members of Congress, our Senators and Representatives, are unethical beasts who care not a whit about the common man?

We have some among us, and some in Congress, to be sure, who care too little about the have nots of our society.  But a large part of this failure is the result of having a profit-driven health care system.

Think about it.  The most efficient way to take care of absolutely everyone would be to have a uniform system, like Medicare, that covers all Americans.  But that would eliminate the private health insurance industry, an industry that is very profitable.  It would surely clamp down on prices charged by the pharmaceutical industry - an even more profitable sector.  And those industries protect their turf by contributing to the election and re-election campaigns of the people on Capitol Hill who make these decisions.

The middle class family looking at eye-popping health insurance premiums, the struggling single mom who makes a little too much money to qualify for Medicaid, and the down-and-out homeless person living in a cardboard appliance box over a subway grate or sleeping under a bridge - these are all people with no political power because they are not part of the system of campaign financing.

These very same forces keep Members of Congress from doing the right thing in many other areas - including improving the environment and protecting consumers - because on the other side of those issues are corporations and wealthy and powerful individuals with their own agenda.  And their agenda and ours are completely different.

The member of the House of Representatives elected by the people of my congressional district is a fellow named Tim Murphy.  Over the years I have thought of Murphy as a decent and ethical fellow, even if he sometimes voted in a way that I thought was too friendly to corporations, especially those in the health insurance and pharmaceutical industries.

Then along came the American Health Care Act (AHCA) - the House version of the effort to "repeal and replace" the Affordable Care Act.  According to the best available data, the number of non-elderly people in our congressional district who would be tossed out of the Medicaid program, promptly joining the ranks of the uninsured, is 37,000 - among a population of about 700,000.

That's right: more than 5% of the population kicked off their health insurance. And Mr. Murphy voted for that.  I was shocked.  Then I realized I shouldn't be. Those 37,000 people don't make campaign contributions.  Heck, many of them probably don't even vote.

We must bring strong ethical values into our political system.  We want our elected representatives to make good decisions: decisions that are best for all of us; decisions that give us cleaner air and water, that avoid atmospheric changes that will bring calamity to global climate and acidify the oceans; decisions that protect consumers from businesses that, driven by profit, would abuse them in an unregulated free market.

I couldn't help but notice that Murphy had no Democratic opponent in 2016 or 2014.  Why should he vote anything except the Republican party line?  I thought about that question, a great deal.  And I decided I must do something to give him a reason.  I must give the voters of Pennsylvania's 18th congressional district a choice.

And so I have filed with the Federal Election Commission to be a candidate for the Democratic nomination for this seat in the House.  I have gathered smart, energetic, politically attuned people around me, people who are committed to bringing this kind of change to the system.  And, because no race for a seat in Congress can succeed without funding, I have begun raising money.  This is a grass roots campaign.  No money from the corporate world will be flowing into my campaign treasury.  There will be individual contributions and very little else. If a PAC that strongly supports universal healthcare wants to contribute, we will talk.  But I intend to serve the interests of the people, not the powerful, and that is how my campaign will be funded.

In the latter third of the 19th Century this nation attempted a Reconstruction to include in our political system people who were left out by our original Constitution: people who counted as three fifths of a person for purposes of determining a state's representation in the House but who were not themselves citizens and did not have the right to vote.  It is time for another Reconstruction, this time one that will bring back control of our government to all the people, and not only those who have the money to buy a share of it.

For more than three decades in the practice of my specialty of emergency medicine, I have been making human connections with people in crisis caused by illness or injury, from the well-to-do to the destitute, from Americans whose ancestors were among the earliest colonists to immigrants from Africa and Asia doing their best to communicate with me in very rudimentary English.  You will not find many in the halls of government who know the people of the district as I have come to know them.  I have come to know them, and I will do what is right for them in Washington, DC.

Please join me in this effort.  Give what you can, whether it's time, or money, or telling your friends about this candidate and this campaign.

Please visit the campaign's Facebook page to learn more about this candidacy.

Please visit our ActBlue page to contribute.

[The campaign website is under construction at, but it will soon tell you all you want to know about what I am trying to do.]  

Thursday, March 23, 2017

Making Health Insurance Affordable

One of the complaints about the Affordable Care Act (ACA, also known as Obamacare) is that for some people it contributed to an increase in the premiums they had to pay for health insurance.  The observation was made that they were being forced to pay for health insurance that included more "essential health benefits" than they had previously had, and that drove up premium costs.  Metaphorically, they were being forced to buy a Cadillac when they had been perfectly content with a Chevette.

Insurance is a mechanism for sharing risk.  Thus it works best when everyone participates.  If people with low risk opt out, choosing to go without insurance and take their chances, and only people at higher risk (or who are most risk-averse) are in the "risk pool," premium costs will be higher.  The people who are uninsured may get sick or hurt and require care that they then cannot afford.  Most likely that care will be provided anyway, resulting in their financial ruin, and since they will be unable to pay for it, the cost of that care must be spread among all who do buy into the risk pool.

This is the rationale for requiring everyone to play.  This was also the trade-off for getting the insurance companies to drop their exclusion of pre-existing conditions.  If you are not allowed to wait until you get sick or hurt and NEED coverage to buy it, there can be no justification for denying you coverage for a problem you already had when you bought insurance.

So, what about this "essential benefits" package?  Why do we have to do that?  Why pay for coverage we think we will never need and didn't have before?

When you buy auto insurance, there is something called "comprehensive" coverage, which covers everything other than collisions.  So if someone dumps a bucket of red paint on your white car, it's covered.  Likewise if you return to the car you parked in a high-risk neighborhood and find it perched on blocks with its wheels missing, or someone's ex-girlfriend mistook your car for that of her jerk of an ex-boyfriend and carved obscenities into most of the painted surfaces, or she took a baseball bat to the hood and fenders.  Or maybe you parked it under a tree with a limb you didn't realize was dead and which then fell onto the roof while you were in a nearby store stocking up on beer for this weekend's March Madness games.

You wouldn't think the coverage was very comprehensive if, for example, it didn't cover damage to your car caused by someone who didn't like you, and the insurance company thought you had it coming, or the policy excluded "acts of God," and the insurance company, declaring God all-powerful, used that to refuse to pay for just about anything.

So, back to health insurance.  Suppose you were presented with a long list of things that could be covered or not.  You could go through and pick all the things that you thought would be expensive and that you were unlikely to need, and leave them out, thereby lowering your premiums.  The insurance company would then do an actuarial (risk) analysis and charge you an accordingly low premium.  But maybe your assessment of your own risk was wrong, or you were just unlucky, and now you have expenses that aren't covered because of the choices you made.  You are now in the same situation you would have been in if you had been able to decide not to buy insurance at all.

To prevent this, policymakers had to decide what coverage everyone should have to buy.  Inevitably it includes something you will never need.  It may cover expenses related to pregnancy, and if you are a middle-aged widower, you may be quite correct in thinking that is coverage you will never need.  Similarly, you may not want to pay for coverage for mental illness if you have never had one and have no family history of that, but mental health problems are common, and it may be very expensive if you're wrong in your risk assessment.

But many people deride the ACA - especially the "Affordable" part of its name - if it made their premiums go up because they had to pay for coverage they never had before.

Here's a policy you can almost certainly afford: it will cover you for injuries sustained if you step on a land mine near your home in rural Iowa.  No other risks to your health are covered.  Oh, and you are on the hook for the first $10,000 in expenses, but after that the insurance policy kicks in.  I can assure you, the premiums for this coverage will be VERY affordable.  And the value of the coverage to you will be essentially nil.  This will really be the same as having no health insurance at all, unless your Iowa neighbors take a strong dislike to you and start planting landmines along the perimeter of your property.  By reputation, at least, Iowans are not like that.

The now-proposed American Health Care Act (AHCA) will allow people to buy health insurance that is much less comprehensive than under the ACA.  The appeal of lower premiums with such an approach is strong.  The AHCA's critics from the right call it "Obamacare lite."  (Tastes great, less filling, right?)  Because if it still requires you to have health insurance, it's still an unacceptable government intrusion into your life.

Until you find out that what wasn't included in your new policy is something you actually need.  Oh, no!  Why did Uncle Sam say it was OK to buy coverage that didn't include the costs of rehab after the surgery for my broken hip?  Why didn't anyone tell me I should pay for maternity benefits even though I wasn't planning ever to get pregnant because life doesn't always go as planned?

If there is an essential benefits package, that everyone pays for, then there is enough money going into the risk pool, and everyone is covered for all the things the experts say the average American may need.  That's how risk sharing works.

Maybe you think that's just too costly.  There are many other ways of reducing costs.  Skimping on coverage is the wrong approach.

Wednesday, November 16, 2016

Dialogue - Not Plato, But Timely

I have long been intrigued by the give-and-take on social media websites.  Some of it is witty, brilliant, even coruscating.  But some of it is - I hesitate to use this word, given its recent context - deplorable.

To use a clever remark whose originator I wish I knew, I am proud to be an American until I read the comments.

Last week I posted a short essay, the sort I think worth writing but too short for this blog.  The situation: a physician colleague had posted something about her angst, in the post-election period, as a professional woman of color in the toxic atmosphere created by the campaign of the candidate who won election and who made many statements during the campaign that were derogatory about women and about certain minority groups.  This was posted in a professional group, which one might think would be supportive.

Yet some of my colleagues responded in ways that bristled and brusquely rejected her views. And so I offered my thoughts in the closing weeks of the most bizarre year of American political history that I have witnessed in the half century I have been paying attention to American politics:

As I read the comments in this thread I sit here shaking my head. I am looking out through the vast expanse of my family room's picture window at a crystal clear, blue autumn sky and a pasture behind my house where horses frolic when their owner lets them out of the barn.

I live a life of remarkable privilege. Not wealthy, but upper middle class. It isn't the stratum of society in which I grew up, but it used to be relatively easy for a boy from the working class to pursue higher education and a professional degree. Now, sadly, the USA is among the worst in the First World in measures of upward social mobility.

Two of my closest friends in my high school years were African-American. We were brought together by our love for classical music. Throughout my adult life I have been drawn to people who were different: intrigued, fascinated, curious. If they were different in appearance, origin, language, or outlook on life, I wanted to know them.

But this is because I am an intellectual, and we live in a nation in which anti-intellectualism is very much in fashion.

We have just elected a president whose candidacy shone a bright light into the darkest corners of the American psyche, and the reflection that we all saw was shockingly hideous.  We learned that racism, xenophobia, nativism, jingoism, misogyny, and homophobia all had powerful resonance with a frighteningly large segment of our population.

If you believe that racism is exaggerated, or if you believe the same of any other "isms" or "phobias" (whereby phobia is used as a euphemism for hatred), then I urge you to seek out people who are other and ask them to tell you about their experiences being other.  There is a great deal of well-founded fear in their lives, founded in experiences that may not occur every day but occur far too often.

Frederick Douglass
White America's attitude toward black America used to be based on deeply held beliefs that people with black skin, originating on the African continent, were genetically inferior to people of white European ancestry. Now it is based on resentment that blacks refuse to "get over" their outrage about centuries of enslavement in North America followed by another century of oppression, and only in the last half century beginning to make some progress in the direction of justice and equality. Why can't they get over it? we ask. Why are they still an economic underclass living in wretched urban ghettoes? Why will they not pull themselves up by their bootstraps?

And we rail against their sense of entitlement, belittling them as multigenerational welfare families that will never make anything of themselves because they don't want to, because they are too lazy, because they'd rather work the system than work for a living.

We resent Mexican immigrants for "stealing" American jobs, when we know that they are doing things US citizens don't want to do. I do not want to cut my grass. I don't have much free time, and I don't enjoy it. I pay a local company to cut it on a schedule. The workers are Mexican immigrants. They are the people who want those jobs. They are not taking jobs away from anyone. And I live nowhere near the border.

We resent immigrants from India and Pakistan for coming to America and taking high-tech jobs, ignoring the many ways in which these immigrants have enriched our nation. How many doctors from that part of the world are colleagues you admire and whose friendship you enjoy? Ask them to tell you something about their experiences of being the "other" in America, especially outside of their professional setting.

A good friend is a black physician whose experiences of life in dark skin in these United States he has occasionally shared with me. And while I embrace him as a friend, and - thankfully - I long ago shed the hints of racism that inhabited the dark corners of my own psyche because I grew up in a city with near-total racial segregation and absorbed racism from that toxic environment - when I listen to his stories I am deeply ashamed of our society.

So, I implore you: seek out and listen to the stories of our colleagues who are "other" in a nation that calls itself a melting pot yet harbors shocking levels of intolerance. Listen to their stories. Simmer in them. Think long and deep. And learn, from doing so, that we must judge not the "other" among us until we judge ourselves and identify all the ways in which we must work to improve ourselves and our society.

I will begin to judge people of color living in America when I have done all I can to make American society one in which their lives are no more difficult than mine because of their "otherness." That will not be any time soon.

You've been waiting for the dialogue, because the title was a teaser.

So, take a gander at this comment:

"Pure, unadulterated, Leftist bullshit, which you believe sincerely, because all you know is the propaganda fed to you, and don't research the facts directly."

You can imagine what I thought about that.  And remember, you have to be a doctor in my specialty (emergency medicine) to belong to this group. This isn't some skinhead white supremacist writing this.

My reply, admittedly a little thin-skinned:

"You don't know the first thing about me, and what I now know about you is that you are willing to judge a person definitively, absent a shred of insight into that person. I daresay I've read more of this nation's history - political, military, economic, and social - than you and your ten best educated friends combined. So do not presume to call bullshit on me, Sir. That is a right you have not earned."

Our new friend was undeterred:

"It's bullshit on the face of it. Canned, leftist liberal psychobabble talking points. 
You're so brainwashed, and so out of touch with reality that it is a shockingly wondrous thing. 
What I do know is what you posted, which is a presumptious (sic), condescending piece of arrogant tripe.
Do not PRESUME to tell White Americans hat (sic) their attitude toward Black America is, you haughty, bigoted, racist fool. Why is it OK to judge one group based on color, and lump them all together by pigment percent, and assume they're monolithic? 
You, sir, are a blind fool. And an incredibly egotistical one at that. 
I believe my favorite line from your verbal diarrheal event was this :"But this is because I am an intellectual". 
Holy crap. Get on some medication. And get out more."

No, I didn't make this up.

And no, there was no steam coming from my ears as I read that.  Rather, I was amazed at the ideas he found in what I wrote that weren't there.  They weren't on the screen, they weren't in my head, they weren't even between the lines.  They were the product of our correspondent's imagination.  And yet he suggested to me that I should be medicated.  I believe psychologists call that projection.

The main problem seems to be that he is taking statements I made that were obviously generalizations based on observations and interpreting them as though I meant that they were true of all people in a given group.  Any sensible reader would, I think, understand that when I say white Americans want black Americans to "get over it," I am not talking about all white Americans; rather I am talking about a subset who are contributing to the problems I've described.

In case you were wondering what prompted my thoughts about white Americans' attitudes toward black Americans, in the context of the re-election, you might look at some of the exit polling and what Trump voters said when asked such interesting questions as whether Lincoln should have issued the Emancipation Proclamation (a third of South Carolina primary Trump voters said no) and whether the nation would be better off if the Confederacy had won the Civil War (a third of them said yes to that).

Oh, and I couldn't help being amused that he took my statement about being an intellectual out of context, in which it clearly meant that I have intellectual curiosity, and chose to interpret it to mean that I am egotistical about my intelligence.

At that point another member of the group interjected:

"Nasty. Is this how you respond when a patient disagrees with you? We should treat our colleagues with AT LEAST as much respect as we treat our patients."

Not about to accept such criticism, our prickly friend responded thus:

"Hmmm. Nasty. His post was far nastier, and far darker, but veiled in a veneer of inclusiveness and civility, while carrying menace. The typical hypocrisy, and projection of the Left. My post is a bit more straightforward.
In answer to your question: this is how I respond when I'm lectured by a pompous bigot, with deep psychological issues, who hates the country in which I live."

Impressive.  Someone read my original short essay and found it nasty and menacing, and further managed to deduce that beneath my "veneer of inclusiveness and civility" I am "a pompous bigot with deep psychological issues who hates the country in which I live."

Jeepers!  I'll give him credit for getting something right: I do not deny that I am pompous, at least occasionally.  But honestly, I didn't see any of that in what I wrote in my little snippet of social criticism.

Why, you might be wondering, have I chosen to share this "dialogue" with readers of my blog?  Well, I've been blogging for several years, although not much this year, because I have spent so much time trying - mostly on Facebook - to convince my friends, and anybody else who might pay any attention to what I write - that they should vote for Bernie.  Oh, and I did blast Trump rather mercilessly.  I did both of those things here in my blog, but endlessly on Facebook.  Many of my blog essays have been far more provocative than what I wrote that clearly provoked this fellow.  And I have never seen such vitriol posted in comments following any of my blog essays.

But I'm still proud to be an American, even after reading the comments, and even after about half the people who voted chose the Mangled Apricot Hellbeast.  (Oh, my, how I wish I could meet the Scot who tweeted that description and buy him a beer!)

And I hope you are still proud to be an American.  After feeling the way I felt on Election Night, I realized that shame and sadness are quite separate.  Am I ashamed that messages of racism, nativism, jingoism, xenophobia, misogyny, and homophobia resonated with a sizable segment of the electorate?  Of course I am.  But I will not let that make me ashamed to be an American, because Americans like the colleague (yes, that shocks me, I admit) who wrote such blindingly hateful things are, I am convinced, a very small minority.

Thursday, July 21, 2016

Hillary and the Truth

Many people have been posting on social media links to stories about Politifact's finding that Hillary Clinton's public statements have been more consistently truthful than those of most other candidates for president in this election season, showing her in a virtual tie with Bernie.

This is, of course, contrary to the longstanding narrative.  HRC's defenders point to conservative commentator William Safire who, many years ago, called Hillary a "congenital liar" and never modified this appraisal because he never found reason to do so.  Safire is responsible, they say, for establishing this negative perception of her - and, they say, he was wrong.

Let me offer my own judgment of this latest take on Hillary's honesty and Politifact's appraisal of it.

I'm willing to give Hillary the benefit of the doubt and withhold judgment regarding whether Safire's harsh criticism was fair.

Or at least I was willing to do that at the beginning of this electoral process.

Disclaimer: I am a Bernie guy.  Why does that matter?  Bernie is as honest as the day is long.  If he says something, you know he believes it.  Does that make it true?  No, of course not, but Bernie has been in public service for a long time, so when speaking of issues and problems and public concerns of all sorts, he generally knows the facts, and he generally tries to avoid making statements about things of which he knows little.  Contrast that last part with the behavior of Donald Trump, who might never say anything about anything if he followed that example.

I watched most of the Democratic debates, and I saw Bernie consistently talking about the problems facing this nation and his proposed solutions.  His statements were plainspoken, and his facts were accurate.  When he talked about HRC, he said some positive things, and his criticisms were fair and a direct reflection of the record.

Hillary, on the other hand, repeatedly and consistently distorted Bernie's record and sometimes told flat-out whoppers about it.  At the very least she viewed Bernie through a prism that afforded no room for nuance.  Bernie, meanwhile, defended some of HRC's votes in the Senate by explaining to viewers that sometimes one votes for a bill because it has things in it one likes, even when there are other things in it with which one disagrees.  Yes, he was defending himself at the same time, but he said voters should understand this when examining the voting record of any senator.

When speaking of Bernie's record, Hillary deserved Politifact's "pants-on-fire" rating more often than not.  Why didn't she get that rating from Politifact as often as she might have?

She is very artful with the language, parsing words and phrases carefully, producing statements that are quite misleading but can still be rated by Politifact as at least "partly true" - or even mostly true - when a (or even the) key element of the statement is blatantly false.

Here's what I think tells us all we need to know about her honesty.  She was asked whether, if elected, she was prepared to make the same promise Jimmy Carter did in 1976, when he famously said he would never lie to us.  Her answer?  She said she would always do her best to level with the American people.  That sounds like a "yes," doesn't it?  But in fact it is a resounding "no."

What that statement really means is No, I'll be honest when it suits my purposes.  Being charitable, it could mean she believes there are times when it is in the nation's best interests for the president to be less than forthcoming, to shade the truth, or even to say things that are false so as to avoid creating fear or panic or an undesirable public mood or opinion.  ("You can't handle the truth.")

Taken at face value, understanding the plain meaning of the words and exactly why Hillary chose to answer that question that way (as opposed to saying yes), it is clear that she meant for her answer to be interpretable as "yes" - or at least close enough to "yes" to be satisfactory to those who want the president to be honest with the people all the time - while binding her to do no such thing, because the real meaning of her answer is No, I will tell the truth when it seems the best option, and only then.

And so I consider this to be the most honest public statement she has made in the last year, if you understand what it really means.

So, getting back to Politifact: Hillary is mostly honest?  In scientific investigation there is something called "face validity."  A statement or conclusion that is strongly counter-intuitive, or contrary to what we are pretty sure we know to be true based on the available evidence, is said to lack face validity.  That is how I would describe Politifact's finding.  Not that I disagree that her statements are true more often than Trump's - although so many of his statements are false because he is an idiot and has false beliefs - but the idea that she is in a virtual tie with Bernie on the honesty scale is nothing short of preposterous.  Politifact is misled, and thus is misleading us, because they give her credit for partial truths, and her wording is so artful and clever that she gets credit for far more truth than is actually present.

Does this mean you shouldn't vote for her?  Make up your own mind about that.  Historically the American people do not vote in presidential elections for candidates they do not believe are trustworthy and honest.  And polling shows they do not believe Hillary is trustworthy and honest.  But not all of us make our voting decisions with honesty as a paramount criterion.  One of my friends said he wants an effective president, not a Girl Scout.  And she is running against a GOP candidate who, in my assessment, is the least qualified major party candidate for president this nation has ever seen.

Although the election is more than three months away, I will go out on a limb and say that, despite recent polling showing key battleground states are close, Hillary will be our 45th president.  Just don't expect much unvarnished truth to emanate from the Oval Office over the subsequent four years.  Instead, watch press briefings, watch how the White House press secretary chooses words very carefully when answering journalists' questions, and watch how reporters ask follow-up questions to pin down the press secretary and cut through the BS to get a straight answer.  That will help you to understand how difficult it can be to get a straight answer - and to recognize when we get very few of those from the second President Clinton.


Sunday, July 10, 2016

Toward a "Post-Racial" America - A Differing View

Recent events - two more shootings of black men by police under dubious circumstances and the apparent "revenge" shooting of eleven uniformed officers by a sniper overlooking what seemed to be a peaceful protest organized by the group Black Lives Matter in Dallas - have further sharpened the public focus on racism in the United States of America. 

My long-time readers will not, I'm sure, be surprised to know I have a somewhat different view of the current state of race relations in the USA.  Different from what you're hearing from the pundits on television and online.  I posted a somewhat shorter version of these thoughts on Facebook, and a friend suggested it be made into an essay for this blog.

I have many friends who think African Americans should just "get over it" and "take race out of the equation," accepting the notion that all lives matter, and it's really just a matter of embracing the notion that people must stop killing each other.  Effectively, they are declaring that Barack Obama's vision of a post-racial society has been realized, or at least we should all behave as though it has, and somehow by doing that we will make it so.  In other words, it is really all a matter of state of mind, and all we need to solve the problem is the power of positive thinking.

Get over it?  Just take race out of the equation?  These directives reveal monumental ignorance and misunderstanding.

Taking race out of the equation is not something that can happen in a nation in which such a large proportion of citizens of African descent are trapped in an economic underclass by centuries of mistreatment.

African Americans went from enslavement to citizenship as a result of the American Civil War and the subsequent amendments to the Constitution.   But constitutional citizenship was unaccompanied by opportunity, and Reconstruction was ultimately one of America's great sociopolitical failures.

Then, in 1896, the Supreme Court of the United States declared, in its abominable decision in Plessy versus Ferguson, that ours could be a "separate but equal" society.  Never mind that white society was unprepared to allow blacks anything remotely resembling equality. 

Nearly six decades later, in Brown versus the Board of Education of Topeka, Kansas, the high court reversed its shameful stance, but that led to forced desegregation that yielded only intensification of bitter racism among Southern whites and many Northern working class whites.

Then, another decade brought the civil rights legislation of the 1960s that we have been struggling to enforce and to make meaningful for the last half century.  The struggle was severely hampered by two developments in the 1990s: welfare reform, which threw millions of black Americans off public assistance and deeper into poverty; and a crime bill that facilitated, among other things, a war on drugs that was really a war on the black urban underclass, and dramatically increased the number of black men in America's prisons.

And now we have arrived in one of the ugliest places in this nation's history of race relations, in which America's wealthy, in a craven effort to distract attention from their unbridled greed, have created a new class warfare.

Historically "class warfare" has meant everyone else against the rich.  But in the last two generations, the wealthy have pursued a very successful propaganda campaign to reframe class warfare as everyone else against the poor.  The most important part of this construct is setting the lower and middle strata of the middle class against the poor: those who are working hard to build a middle class life for their families are told that the undeserving poor are the economic enemy, living on government entitlement programs.

This is code for the new racism: it is the lazy, shiftless, inner-city blacks who are stealing from hard-working middle class whites.  All you folks in the lower-middle and middle-middle classes, struggling to get a little bit ahead of living paycheck to paycheck, take heed: the undeserving poor are the enemy.  It is they who are wasting your tax dollars and keeping you from achieving a more comfortable lifestyle.

[Never mind that the percentage of the federal budget spent on things like housing subsidies and food stamps is quite small or that many of the recipients of such aid are the working poor.]

This is how the wealthy are using third-millennial class warfare, fueling it with racism, to protect themselves from the next French Revolution.

If the struggling white working class and the black urban underclass ever figure out that neither is the other's enemy, and instead they have a common enemy, and it is the unrestrained greed of the top 0.1-0.5%, there will be blood in the streets, making the Reign of Terror look like a day at a Six Flags amusement park.  The blood will not be the blood of the police or of urban blacks.  It will be the blood of the 21st-Century aristocracy, and it will signal the end of the oligarchy and the return of this country to the people.

The storm is coming.