Wednesday, April 26, 2017

The Longest 100 days.

One of the key problems today is that politics is such a disgrace, good people don't go into government.

Donald Trump

Donald Trump, has been President for about 100 days.  These days have been schizophrenic exercises of surrogates and sycophants walking back his tweets, and a series of lies, misinformation and Orwellian newspeak.

Trump has told so many lies, received so many Pinocchio awards his staff has constantly battled to shut down his Twitter feed, when he often wanders the residence of the White House in his bathrobe at 3am generating them.  His television presidency starts off with Fox and Friends and ends with Sean Hannity.
But it seems, after a series of disasters, he has appointed some adults to supervise him and that is a good thing.  At Defense, State and a new non-conspiracist National Security Adviser, replacing Michael Flynn, currently under congressional investigation for his Russian patrons and their alleged connection with his campaign.   All of that will drip out of the faucet little by little as soon as the congressional Republicans learn that their constituents want to know.  But perhaps not.

Trump was going to repeal Obamacare the first day he was in office.  He was going to build a big “beautiful wall” along the Mexican border and the Mexicans were going to cough up the money to pay for it “one way or another, believe me.” He was going to do a “massive tax cut” for the rich in order that jobs were going to be created.  The newly introduced corporate tax reduction from 38% to 15% will swell the deficit if the projected growth of 2% in GDP remains as economists predict at perhaps .08%..  Trickledown economics never worked, despite the recent emergence of Arthur Laffer.  Voodoo economics remains in play.

Trump's magical thinking was going to restore coal industry jobs, never mind that there are now more jobs in solar, wind and hydroelectric that there are in an industry that is now being displaced by new 21st century technologies. Coal miners oozing gratitude could descend into the bowels of the earth, get black lung disease and earn a living.  In fact, coal companies were already replacing those jobs with digging, blasting and drilling robots Natural gas is cheaper, cleaner and more efficient. The wall costing billions, running along the Texas border is questioned by Texan Republicans who fear the loss of net income from trans-border trade.  Much of the wall area is owned by Native Americans, who already robbed of their land by a murderous Andrew Jackson whose portrait adorns the oval office as a populist Trump hero  (Jackson is soon to be replaced on the $20 bill by Harriet Tubman).  Placing the wall on our side of the Rio Grande would cede the entire river to Mexico!  Maybe the President did not think of that during the campaign.  And his move to stick the wall on the budget bill has been rethought as a non-starter in congress since the chance that Mexico will pay for the wall is about the same as the sun being replaced by a coal fired plant.

Trump, in these first 100 days, was going to slap a 35% tariff on Chinese goods, having labeled the Chinese as currency manipulators.  Now that has changed.  “Why would I want to label them manipulators when they are going to help us with North Korea," now becoming an existential threat to cities like Portland, San Francisco and Los Angeles? Tariffed goods might become doubly priced at Wal Mart, where most of his gullible base shop.  By the way folks, I am not making this up. The Chinese have had to revalue their currency upward to stop its decline.    Trump originally asserted that they were keeping it artificially low so that they could sell their goods here more cheaply.

And what about the massive infrastructure spending Trump promised?   That has not happened.  Instead, the administration spends its time and capital trying again to repeal Obamacare, cut Medicaid, Education, deny climate change as a Chinese hoax, abolish the EPA, repeal the clean power act, and defend itself from congressional and FBI investigations.  Ah, for the days of going bankrupt and stiffing workers at his casino.  

He needs some wins, and another shot at repealing Obamacare will not pass the Freedom Caucus (formerly the tea party).   And if he puts items in the bill that will pass muster, it will not pass the Senate or keep faith with Republican moderates.
The Republican Party is in unprecedented disarray.  Trump faces more problems with them than the Democrats.   It will be interesting to watch over the coming months,
unless Kim Jung Un snuffs us.  A second Korean War would divert the public's attention for sure.

Trump, they say, is learning how to be President of the United States, and he has hired some adults around him to guide him in issues for which he essentially remains clueless.  That is true.  He has competent generals running the Defense department and gave the insane conspiracy theorist Michael Flynn the boot in favor of H.R. McMaster, a sophisticated West Pointer, a highly decorated and dedicated patriot and author of a prescient history of the US involvement in Vietnam.   Trump did very well in those choices, since he realized he knew less about international affairs than even George W. Bush.  Eureka!  NATO is no longer obsolete, said Trump recently. 

Our President, adroitly tapping into the anger of his base, disaffected, unemployed and undereducated voters, never realized what he was getting into, but still has not been able to say he was wrong on anything, his narcissism overruling his sense of patriotism and concern for the American Public.  He has still not released his tax returns and it is doubtful that he will, unless they are subpoenaed as part of a congressional investigation.  But it is doubtful that the Republican congress will ask for them and so the Presidency has become a shamefully self-promoting business enterprise rife with conflicts of interest, and perhaps Russian monies.   Vlady Putin thought he was getting a good deal by messing with Hillary’s election.   Maybe he is not so sure now, with a possibly demented President in the White House, who fires tomahawk cruise missiles, in this instance, impulsively, but correctly.  One wonders if he really thought it out.  Even a blind squirrel finds an acorn now and again.

I have Republican friends who are still drinking the Kool Aid.  One told me that I would be happy with the Trump Presidency, however, I have not yet found a pleasant sensation, a warm and fuzzy feeling that everything will be all right.   All I do feel is pain every time I turn on the news.  Some argue, “you lost the election, get over it.”  Trump now enjoys an over all approval rating of about 38%, the lowest of any President at this point in his term, in US history. Seems to me, that was what Scalia said in an interview after the Supreme Court stopped the recount in Florida, handing the election to George W. Bush.   To Bush’s credit, when he left office, he returned to Crawford Texas to paint, perhaps fancying himself another Winston Churchill, who in his essay, “Painting as a Pastime, extolled the virtues of putting oil on canvass.  At least W had an acceptable hero.   T

The Republicans voted 62 times to repeal Obamacare before the Donald was elected (or got more electoral votes) in a distorted system created in the 18th century to protect slave states from being placed in a majority as new states entered the Union.  This ossified system has allowed a person with the minority of the votes to be elected president 5 times in our history.   We need direct popular election of the President.

In France, for example, a publicly financed election is over in 6 weeks.  Spending is limited, and candidates do not have to raise billions to advertise in swing states until those of us who have the misfortune, or fortune to live in them want to stick pins in our eyeballs not to listen or watch the commercials.   The system has been distorted by Citizens United, allowing corporations and billionaires to form super PACs with no spending limits as long as they do not coordinate with the candidates and they are “transparent.”   This is almost like insider traders who illegally do not tell their friends to buy before companies beat earnings prognostications.

Trump’s new acolyte Supreme Court justice, only confirmed when the loathsome Mitch McConnell did away with the 60 vote majority needed to confirm him.   This insured that a political partisan could be seated, further eroding the independence of the court.  Trump counts this as his major accomplishment for the first 100 days.   And it is true, he accomplished the goal of life tenure of a 49 year old that can make decisions for the next generation.  His first vote was to put someone to death.  Gorsuch refused to answer any questions before the senate committee on his positions, and defended his 10th circuit court of appeals decision to vote against a fired truck driver who almost froze to death and had to move his truck, resulting in his being fired.  Gorsuch’s logic was that he applied the law. So did dictators, Nazis and other authoritarian leaders such as Erdogan who has now consolidated his power with new anti-democratic legislation.  Gorsuch’s decision was reversed unanimously by the Supreme Court.  Now he sits there himself, a young  relic, threatening to civil liberties,  the working class, and modern society, probably even to the right of the late Antonin Scalia and even Clarence Thomas.  Trump lists this as his signal achievement of the first 100 days.

Cheer up folks, the horizon does have a bright sunrise.  Bill O’Reilly, serial sexual harasser, has joined Roger Ailes in a richly deserved hinter world of opprobrium.   Not that Rupert Murdoch has had an epiphany.  He just saw 50 of his largest sponsors jump ship.  President Trump said O'Reilly was a "good person."

Tuesday, April 11, 2017

A Trial Lawyer's and Patient's Perspective on Doctors and Health Care.

"Molière saw through the doctors, but he had to call them in just the same."

"It is not reasonable, to expect doctors in private practice to be impartial when confronted by a strong pecuniary interest."

George Bernard Shaw

As one who has had either the fortune or misfortune of being a personal injury litigator, depending on one's altruism or lack thereof for over 43 years, I have reached some inevitable conclusions concerning the individuals who could stand the sight of blood and therefore embarked upon a course of deriving a benefit from the maladies of others.

How this exalted professional status has struck social observers over the years varies with the intensity of their individual experiences.  George Bernard Shaw's outlook was somewhat malign toward the medical profession, observing that, in the "Doctor's Dilemma,"

"...when doctors as competitive tradesmen were replaced by a medical profession that had been brought under responsible and effective public control. Until this body of men and women were "trained and paid by the country to keep the country in health it will remain what it is at present: a conspiracy to exploit popular credulity and human suffering".

In other words, Shaw was looking forward to the creation of a National Health Service."  These words were written in 1903.

Not that lawyers are not calculating; however, they are constrained by the law and by their profession itself to simply presiding over the transfer of wealth from one party to another, providing the oil for the cogs of either justice or of criminality to function or not.  Many are just as greedy as anyone else, but generally, people's lives do not depend upon their behavior.  Their fortunes, yes, their freedom, often, but, except in rare criminal cases, not their lives.

Much of the angst that Doctors suffer, depending upon their conscience, individual character, or profit motive, fear of being sued, or other governmental intrusion upon their fiefdoms depends upon how motivated they are by greed. Often the ones who are greedy usually occupy large private medical groups and are judged within that group by how many patients they see, or how much revenue they generate.  Usually the ones affiliated with Universities and are academics are somewhat less motivated by such obsessions.  Some doctors are so greedy that they refuse to write prescriptions for patients who do not come in for a visit at which time they can be prescribed almost anything they want, as long as the doctor can bill either Medicare or a private insurer for an office visit.   If a patient calls and asks for a renewal, the doctor insists that they visit or get no prescription, blaming the government in most cases, of non-esistent governmental scrutiny.  Some will not even fill out a form without a fee being charged to the patient.  Patients resemble a stack of Benjamin Franklins to them.
Questions concerning such matters with the doctor often evokes an aggressive, "find another doctor" rebuke.   Such an enormous ego or insecurity does nothing for the doctor-patient relationship.  One doctor was offended by my asking for test results after waiting 10 days.  No concern for the patient's anxiety evident at all. "That's normal for this office, if we are not meeting your needs, find another doctor."

In addition, my individual experiences with doctors who testify in court enjoy more popularity if they are the most convincing witness no matter the mendacity of their testimony.  Some doctors who specialize in forensic medicine, charge highly extravagant fees, based upon the rationalization of loss of net patient visits when they are obliged to visit the courthouse or to give deposition testimony.  Every fundamental lesson of cross-examination of these doctors requires questions of how much they are paid for their testimony, what percentage of their practice is dedicated to treating patients, and how often they are in court (often more than in the office) and for which side they testify, how many patients they actually treat, etc.

 Some have robotic administrative staffs specifically geared to make sure the doctor is or will be paid before he or she even consents to treat a suffering patient.   They have insufferable office managers trusting no one, their jobs set by the culture of the office promulgated by the greedy doctor rather than the needs of the patient, affirming the 1903 Shaw philosophy that doctors should be working for a National Health Service.  Illness should not be profit driven and insurance companies whose motives to collect premiums and not pay claims remain insidious affronts to a decent society.  The same rule should apply to physicians who run their offices as though they were branches of the Bank of America.

Some argue that health care needs physicians profit motivated to make decisions concerning the patient's health and that it attracts people of quality to this profession.  Studies in European nations like Sweden debunk this notion.  Compounding this error is the health insurance industry, stories about which circumlocutions to a avoid legitimate claims are often featured by investigative reporters and on "60 Minutes."

Doctors who seek fabulous wealth should be in business, not clinicians; they deserve to earn a good living commensurate with their hard work and training.  But a profit motive for a clinician simply works to the detriment of the patient.  And a profit for a health insurance company is the same evil on steroids.

No possibility of great change in this system is possible unless the public is disabused of the notion that clinical medicine is a business.  Clinicians perform great service to society, but usually perform no research and development.  If they do, they are entitled to patents for their work.
Then they can reap the rewards of entrepreneurship.   Otherwise, let them earn a good salary, live in a nice home and stop acting like they do not belong to a noble profession, dedicated to their patients, and not to large boats and McMansions.  Leave that to the titans of industry, or as Theodore Roosevelt aptly put it, to the "Malefactors of Great Wealth."