My daughter and I have a local writer friend who teaches at the elementary school level a local quasi-magnet type school which advertises itself as offering a challenging college prep curriculum, and she is discouraged beyond words over how difficult it is to interest the pupils, especially the boys in her class in reading. Of course, given the run of books generated of late by mainstream establishment publishing, aimed at the YA and young readers and then approved by schoolteachers and librarians … most of them seem to be a grim wallow in social or familial dysfunction, misery, gloom, and despair … plus of late, lashings of sexual confusion as well of the latter, it seems the more explicit, the better.
Elections
A Note on Votes
Parents want to take responsibility, perhaps, but they have (I certainly often did) shirked their responsibility to keep track of the teachers and their good and bad teaching; this new movement is surely restorative, good, appropriate. Our public schools have been examples of the tragedy of the commons – who really was taking care of the children, nurturing their minds? Who respected the students/children enough, the discipline they taught enough, not to give gruel and expect equally watered down responses? For many school boards this Tuesday will be a reckoning – we’ll see how much parents cared, how much others cared.
Looking Back on the Biden Ten Year Plan
(An Ode to Lionel Shriver)
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Back in 2021 President Biden reiterated that his proposals, unprecedented in scope and expense, represented an investment in the future with extraordinary returns that could only be evaluated over the longer, e.g., ten- to fifty-year time horizon. This perspective coincidentally facilitated claims it was paid for without new taxes, while postponing an evaluation of actual returns beyond his term in office, even if he should run and win a second term in 2024 at 82 years old.
Saving American Democracy
But it’s now a decade later and Biden is still in office. Well, not exactly in office, as he had been replaced by a hologram in late 2021, addressing the American people from his estate in McLean Virginia, purchased for $50 million cash (before GSA improvements). Following FDR’s precedent people were told that changing leaders in the midst of a crisis, and these continued to accumulate over the decade, was dangerous.
Besides, he had run virtually unopposed in the 2024 election after all those registered Republicans within a half mile of the Capitol on January 6,th 2021 had been arrested, tried, convicted and jailed for “terrorism and crimes against the State,” after which Republican voter registration plummeted.
The expanded Supreme Court, 29 Justices to accommodate race, ethnicity, gender, etc., had finally ruled on the legal concept of “disparate impact,” concluding that everything from global warming and COVID 19 to voter identification, rent collection, college admission requirements and even law enforcement represented illegal racial discrimination. The expanded Court then called an indefinite recess during the construction of a new edifice to house it.
There was really no point in holding a faux election in 2028 in any event. The progressive campaigns to eliminate the electoral college and voter ID laws to prevent “voter suppression” had both been successful, and the ongoing COVID lockdown still allowed mail-in ballots under the rules in place in 2020, so there was no need to go through the motions. The New York Times and the Washington Post, the only remaining Party sanctioned newspapers, simply announced “the will of the people.” By now, 2031, most people have long since forgotten the promises of that Biden Ten Year Plan.
The Close of the American Century.
The Presidency of Teddy Roosevelt is often considered the beginning of “The American Century.” The Great White Fleet circled the world. The US defeated Spain in the Spanish American War, probably instigated by the US as it fought to “free” Cuba and the Philippines “fell” into our Empire. Our iron and steel production had surpassed that of Europe. Problems began in 1912 when leading “Progressive” Woodrow Wilson was elected President. This came about as Teddy Roosevelt, for reasons that were not clear, opposed his own successor, William Howard Taft. Roosevelt formed his “Bull Moose” party and divided the vote, electing Wilson. In 1916, Wilson was re-elected, promising to keep us out of World War I. In 1917, following Germany’s decision to wage unrestricted submarine warfare, Wilson declared war on Germany, thus disclosing his lie.
America entered the war in 1917 at the cost of 53,000 lives lost. The intervention probably led to the 1918 Armistice and the Treaty of Versailles, which French Marshall Foch called (accurately) “an armistice for 20 years.” Wilson’s Progressive rule included many similarities to Fascism that would be come more apparent in years to come. Harding and Coolidge were elected in 1920 and reversed many of Wilson’s policies. The next 9 years were marked by prosperity and a surge of innovation. The German war debts, plus those of the allies, put pressure on the international economic system, which resulted in the 1929 panic and elected Franklin Roosevelt in 1932 as Herbert Hoover’s attempts to cope with the 1929 crash failed. Roosevelt campaigned on a platform of a “balanced budget,” which was quickly abandoned once elected. Roosevelt’s experimentation with the economy produced no better results until World War II provided the stimulus to spending plus the absorption of millions of unemployed and an economic boom followed. The cost of this war was 407,000 American lives but it left us with the only undamaged industrial system in the world. A real Boom followed until Lyndon Johnson got us involved in the Vietnam War plus The Great Society, both of which brought us close to financial ruin.
Single Payer rears its ugly head again.
A fellow I’ve known slightly for many years is editor of the Alpha Omega Alpha medical honorary society magazine, The Pharos. He has a lead editorial in The current issue It is titled “Now is the time to enact a US Healthcare System.
Now, don’t get me wrong. Dick has had a more successful career than I have. Many years ago I knew him and he read his acceptance letter to USC medical school in my apartment. He did well in medical school, almost as well as I did, but his wife agreed to go to New York for a high status internship and residency, setting him on a path to great success. He became a Professor of Medicine and eventually President of the University of Colorado. I have not seen him in years and suspect very little of his time has been spent in the delivery of primary health care “in the trenches” so to speak.
My wife refused to leave Los Angeles and I have, as a result, had a less prestigious career but satisfactory as anyone who has read my Memoir will see. I did harbor some resentment and the marriage ended in divorce after 18 years.
Now let us consider what this academic authority proposes. First, we are now ten years after Obamacare and some level of practicality has crept in.
The “federalism” response to the COVID-19 pandemic, medicine, health care, and the profession of medicine is not working well and needs to change. A serious societal and public review and plan of action for change is needed with regard to why and how the U.S. must improve overall health care and create a new health care system for all Americans. The U.S. is the only developed country in the world that has not determined that health care is a fundamental human right. Universal health care should be considered by all as a social good and a national priority.
There is, of course, no such promise in the US Constitution of a “right” to healthcare although we do have an Amendment forbidding involuntary servitude. Section 1
All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Shall the federal government have the right to compel doctors and healthcare providers to provide services ? Right now Medicare pays about 13% of billed charges. This produces ridiculous fees on paper but what is the uninsured to do ? Pay 87% higher prices ? At my last understanding, a doctor may not offer a service for less than his/her/xir Medicare price. Anyway, let us see what is proposed.
The long-standing federalism approach to health care is associated with a lack of leadership, the absence of a solid plan, setup, or organization to manage our national health care. Also it is slow to respond to national and international issues. It has not worked well and leaves the country’s health care system disjointed, confusing, and expensive. The federalism approach, in which all 50 states and five territories each have their own rules, regulations, and financing, has been a barrier to providing health care for every U.S. citizen, regardless of where they reside.
I frankly don’t see the Federalism handicap but suspect nationalization appeals to some. Those darned Red States again.
One option that is often discussed is a single payor system in which the government is the only payor through tax and other revenues and manages health care as a public and social good. Currently in the U.S., the Military Health Care System, Indian Health Services, Veterans Health Administration, and Medicare are all government single payor systems. Medicaid and the Child Health Insurance Program (CHIP) are jointly funded by the federal govern-ment and state governments. All totaled, these government funded programs provide health care coverage for nearly 50 percent of the U.S. population.4
The success of the VA and the Indian Health Service is doubted by many. Both have seen repeated scandals.
The other half of the population is covered under their employer-sponsored health plan; is self-insured; or receives coverage through individual market health plans, including ACA-compliant plans; or completely lack any type of health insurance. Through the private health insurance programs, private insurance companies are re-sponsible for paying claims for their members. Hospitals, physicians, pharmacies, and other health care providers each file claims independently. Obamacare is responsible for a significant segment of the uninsured as small group plans were devastated by Obamacare.
According to Jerry Bonenberger of Babb Insurance in Pittsburgh Pennsylvania, “small employer groups with less than 50 full-time employees are experiencing an extraordinary increase in their insurance premiums for 2015. In one case, a professional services firm with 42 full-time employees received an 87% increase in their premiums for next year.”
Through the development of the quasi-independent, apolitical National Health Reserve System (NHRS) pro-posed in the Summer 2020 issue of The Pharos,(1) the U.S. would have a health care system modeled after the Federal Reserve System, allowing for government funded care for half, and private insurance for half. The role of the NHRS would be to govern, integrate, coordinate, and manage a nationwide system of health care, both private and governmental. It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.
Does anyone really believe that ? At least he wants to get rid of Obamacare although it is too late, as I have repeatedly pointed out. Doctors are no longer small business people but employees with the psychology of employees. Those that are opting out to go to a cash practice are a small minority but that seems the only realistic option. I submitted a rebuttal letter to the journal but doubt it will see the light of day. In it I suggested some reforms on the lines of the French system that I described in multiple blog posts ten years ago. I think the French system would have been a better reform but I doubt that will appeal to the academics who want control. When I was at Dartmouth in 1994-95 I met many of the people who designed Hillarycare, and they were also all academics. Pelosi and Reid who wrote Obamacare (I doubt Obama had anything to do with it) at least learned to include the insurance companies in their plan. In fact, I am sure it was written by insurance lobbyists and 25 year old staff lawyers.
The abysmal implementation of Obamacare suggests that big national scale programming projects are not the federal government’s strong suit. The federalism that my former friend, Dr Byyny, opposes allows for incremental reform and some level of experimentation. A national one-fits-all program failed spectacularly. Another one is likely to fail, as well.
That was 2015.