I Don't Get It!

None of my high school or college science teachers would remember me as a top student. I’m more on the other side of the brain, whichever that is. I did learn about the scientific method. I learned to trust science. A class in plane geometry taught me about postulates, theorems, and proofs, using a prescribed methodology. It irks me a bit when people try to replace science with personal opinion. I subscribe to the notion that you can have your own opinions, but not your own alternative facts. The nation’s approach to the COVID-19 has me flummoxed.

Our leaders at the national, state and local levels don’t have a united plan to conquer this silent enemy. That is not totally unexpected; lots of politicians often have lots of opinions. What I find appalling is the degree to which they ignore science, from one precinct to another. In some cases, leaders simply ignore the facts in front of them. The devil is always in the details, but at a macro level, the solution to this pandemic is relatively simple, and we have the data to prove it.

This virus, for which there is no cure, no vaccine, no anything, spreads from one person to another. The solution is obvious. Limit interactions between people, separate people from each other. The progress of the virus in other countries indicates that early intervention is needed, and it needs to be at a Shock-and-Awe level. We don’t have a national plan to fight the virus because we ignored the science. We were late implementing a national task force. We have scientist who has to correct the President during his press conferences. We have a few flat-earth governors who refuse to implement minimum requirements for distancing, for testing, for a scientific approach. We have a Lt. Governor of Texas that urges older people to go to work and be willing to die so that the younger cohorts can have a future. Glen Beck, a former talk show host called on the old to sacrifice their lives for the young. The owner of one of the largest home-goods chains in America is staying open because his wife had a vision that this curse will be over in a few days or weeks. Liberty University has called its students back for the rest of the semester. The Governor of Florida has yet to shut down the state, a place teeming with older people and rising hospital stays. Mississippi’s Governor refuses to shutter the state because “we are not China.” The President has called for crowded churches on Easter Sunday, with people shoulder to shoulder. What don’t people get?

China quickly shut down the city of Wuhan, all 20 million people, and the death rate slowly began to slow down. Italy shut down the northern part of the country, but too late. The entire country is now in lockdown and the death rate is still rising, hundreds each day. Iran was slow to shut down and its death rates are rising exponentially. The US death rate, and we are at the start of the epidemic, matches Italy’s increased death rates. In other words, it has only just begun. There is no way that any scientist, health expert, or doctor would recommend opening the nation for business-as-usual as early as two or three months, certainly not in weeks.

This crisis opened our eyes to how unprepared the nation is for a crisis. The President will have to take his lumps for his management of the crisis and for his mixed messaging, but it’s not all his fault. We have never experienced an event that closed the nation in a matter of days, and we were overwhelmed. Part of the problem is economics and part is logistics. The last twenty years or more has seen an almost religious reliance on technology to manage inventory to a finite degree, whether in companies or in hospitals. If a hospital uses 1,000 surgical masks a month, why would it buy and store 5,000 masks? The business plan does not allow for surpluses. If a drug store sells 12 items of a product each week, its inventory management system will tell it to buy five more when it has sold seven. It is so ingrained in our processes that the idea of a surplus just isn't thought about anymore. The states and the federal governments are supposed to have the large surpluses to be dispersed as needed. But we don’t provide the money for that either. The states don’t have the equipment they need to fight the virus, and the federal government is slow to send relief. New York needs thousands of ventilators and the federal government sends them 400. Hospitals are filling up quickly, but it took weeks to dispatch the Army and Navy to lend a hand. Why?

The governors of the states and territories have taken the leadership in this crisis. Maybe that is as it should be, but I question the efficacy of 55 different approaches to a national crisis. Let’s look at the simple issue of isolating in place. If we had uniform guidelines, every restaurant in the country would be shut down except for take-out; all non-essential businesses would be shut down including bars and weed shops. Schools, colleges, and universities would be shut down, gatherings outside the home of more than two people would be prohibited, and all transportation systems would be shut down to all by essential workers. If we had uniform guidelines, we would not have college kids celebrating spring break on the beaches. It wreaks havoc with the economy, but it saves lives.

Those returning home from spring break need to shelter in isolation for two weeks because they have all been exposed to the virus, simply by being that close to so many people. A lot of people are leaving New York City in an effort to avoid contamination. Whichever state they move to should require them to isolate for two weeks. Why is it so hard to convince people to do the right thing? Why don’t they listen to the scientists and doctors and take the situation seriously? The United States is increasing the number of virus cases faster than Italy.[i] Italy cannot handle the increase in deaths, which is growing exponentially. Yet, governments and individuals ignore the warnings, calling them a hoax, an effort by the Democrats to make Trump look bad and false news. It is none of those.

I don’t get it!

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[i] https://www.vox.com/future-perfect/2020/3/20/21179040/coronavirus-us-italy-not-overreacting

Chink in the Armor?

When we have a crisis, big or small, we learn how to do things better. When there is a lost-time accident at work, we look for the root cause and rework our processes. When we get in a financial bind at home, we analyze the reasons and implement plans to avoid a repetition. Occasionally, the crisis forces us to come face to face with the myths we have about our circumstances.

The coronavirus, COVID-19 is a health crisis unlike any experienced in our history. We knew it was coming yet we were not prepared. I don’t know if we could have been prepared for the onslaught of pandemic proportions. Our systems aren’t designed for this big of an outbreak. Our economy is not prepared for a total shutdown in a matter of weeks if not days. Our society doesn’t expect schools to shutter for months on end on a day’s notice. And, yet it happened.

The crisis is not a time for political posturing, for cable news to be blaming the outbreak on one politician or another. It is not a time for inaction. At some point, perhaps months from now and after a shocking number of deaths, the crisis will pass.

So what shall we do then? Will we go back to life as usual? Will we do a deep dive into what worked and what didn’t? Will we be willing to confront some of our basic beliefs about the role of government? What are we wont to do?

I’m out on a limb here, but I suspect that the government at all levels, corporations of all sizes, the medical profession, and community leaders will all have a go at assessing what worked, what didn’t work, and how we prepare for improved performance when the next crisis hits; not if but when. As part of the gargantuan navel-gazing, I would like answers to some basic questions.

When the ripple effect of school closings spread across the country, it exposed 30 million children in the US who depend on the schools for one or two meals each day for basic nutrition. The schools closed, but the cafeterias stayed open to provide grab-and-go bags of food so that our children would not go hungry. How did we get to this point?

Our nation’s economy was, by many measures, booming. We had record unemployment; the markets soared to new highs, home loans were at historic lows. Through all of this, hundreds of thousands of people all over the country are homeless, living in tents along riverbanks, using the streets as toilets, going from one charity to another for food. Every year we spend billions of dollars to help the situation, only to see the problem grow. How did we get to this point?

The health professionals counsel us who are older to stay inside, to stay away from younger people, to call the doctor rather than visit his/her office, and stay away from the ER. Local and State governments are telling everyone to shelter-in-place, in an effort to control the spread of the virus. The real fear is that hospitals will be swamped with contaminated people and overwhelm capacity. Our country spends twice the percentage of GDP per capita for healthcare compared to other industrialized nations, yet we have fewer hospital beds than 36 other first-world nations. While this is happening, rural hospitals cannot afford to stay in business, so they are closing. We don’t have enough hospital beds and we don’t have enough hospitals. How did we get to this point?

The government agencies responsible for public health are overwhelmed with work and understaffed. The CDC, NIH, NHS, etc. are agencies devoted to science, yet their funding is reduced on a regular basis. The current administration even eliminated the White House office responsible for focusing on pandemic prevention. The agencies in which we rely on a health crisis were short of test kits, short of almost all required medical equipment. How did we get to this point?

There is a general malaise across the continent when it comes to the trust level of government and its role in society. There is an undercurrent of distrust for science. There is a distrust of information coming from the government or from the media. An Axios/Ipsos survey just released indicates that only 23% of Republicans are highly concerned about COVID-19, while 51 percent of Democrats are highly concerned. The pandemic’s seriousness, the health of our citizens, is seen through a political prism. How did we get to this point?

There is an undercurrent of distrust of government in general, even when we need it to be at its best. We have always had a high-level discussion about the role of government. Even those who think that there should no government at all don’t think we should close the national parks. There is suspicion of a deep state within the government, often defined as people who support a party other than that of the sitting president. Yes, we do have a deep state in our local, state, and federal government, and thank God for them. They are the experts who make the railroads run, who work among those with poor health, nurse patients in our hospitals, lead our military, and process Social Security checks. They are not the enemy. How did we get to this point?

The American myth is that we are the best country in the world, and I won’t argue the point even though the data indicates that other countries may be just a smidgen better in some areas. But it’s not uncommon for the best to have room for improvement. Sometimes getting better requires us to think outside of the box, to question our assumptions and to question the myths on which we were raised.

Why don’t we have enough hospital beds? How do we change the hospital business model?

Why don’t we have enough hospitals in all parts of the country? Does the government need to nationalize the rural hospitals to guarantee their existence and survival? Do we need to do away with for-profit hospitals? Do we need to force non-profit hospitals to take in more non-paying customers in order to keep their tax status?

Why don’t we have enough emergency medical supplies to accommodate a pandemic? Why aren’t these supplies stored in regional centers around the country?

Why do 30 million children need to rely on schools for their meals each day? Or the libraries in the summer?

Why do we have cable news channels and radio talk shows trying to spew hate and division through the country?

We are a strong nation, but emergencies like this pandemic show us the chinks in our armor. How did we get to this point?

The Ides of March?

We are in the midst of a worldwide health pandemic according to the World Health Organization. The President asked Vice President Pence to lead a blue-ribbon task force to manage the outbreak. He gathered agency heads, healthcare professionals, and others to help him. He holds daily briefings to keep people up to date. The experts, not the politicians make the major presentations and appear on the Sunday morning news shows. I give them the benefit of the doubt. I think they are trying to be as helpful as possible within the limits of their political world.

The task force does a much better job when President Trump doesn’t participate. What we do with the information is interesting. In the worse health scare in American history, our beliefs, and actions are dictated by which political party we belong to instead of facts and science.

According to a national poll published this morning[i], 45% of voting Americans approve of how Trump is handling the pandemic. Only 51% disapprove. A deeper dive into the data, however, indicates that 81% of Republican voters approve the administration’s actions and 84% of Democrats disapprove. The divide is wide and deep.

How did we get to the point where our party affiliation influences our acceptance of facts, data, science, health warnings, and general overall behavior in the midst of a major health outbreak?

The health scientists, Dr. Anthony Fauci, and others are telling elderly people, anyone over 60 years old, to stay home, to isolate themselves, to stay away from other people who might be carrying the virus without knowing it. They are discouraging young people from visiting their grandparents and other elderly.  

The poll also indicated that 56% of Democrats expect major changes in their lives because of the virus. Only 26% of Republicans think the outbreak will result in major changes in their lives.

Schools are closed, college students won’t return from spring break, the Fed reduced interest rates to 0%, MLB is shut down, the NBA is waiting it out, March Madness is canceled. Even pro golf is in a hiatus. If you have seen all the classic movies three times, can’t watch one more reality TV program, and there are no sports on the screen, it’s safe to say that our lives are changed.  

We are told that this coronavirus has the potential for killing thousands of people if we don’t hunker down. Its not the flu and should not be taken lightly. We, unlike many other countries, do not have working test kits to measure how bad the situation really is. We do know that the virus doubles its attacks every two weeks. Much of the leadership in combating the virus is coming, not from the federal government, but from the states and local governments who are relying on the science to take action. The governors of Illinois and Ohio closed all restaurants and bars today. The Governor of California ordered all wineries, brewpubs, and bars to close, and for restaurants to slash seating by half. At the same time, Congressman Nunes[ii] was on TV encouraging people to ignore the health experts, and get out to the restaurants and mingle with crowds. As we get more facts, day by day, the recommendations for self-isolation are expected to increase, hospitals will be overwhelmed with sick people, and supplies will be in short supply. The mixed messages from political toadies and the scientist are confusing.

The President made a major speech to the nation from the Oval Office last Wednesday night, trying to calm the panic, bolster recognition for the work he had done to date, and to tell the people that this too will pass. At best, he fumbled it. It was poorly written, and it was poorly delivered. It created uncertainty. The markets hate uncertainty, and they tanked the next morning as never before.  

Rachel Maddow on MSBC interviewed experts who had managed pandemic situations in the past, who knew something about testing and why we didn’t have kits, and filled in most of the blank spaces with opinion unfavorable to the speech and/or the administration. In an attempt to be fair and balanced, I switched to Fox News.

Hannity was extolling the outstanding job President Trump had done to curb the virus and how test kits were available all over the country for those who needed them. He said you could not expect a greater response than what the administration had done. He suggested that if anyone had any suggestions for improving the response they should email him.

On Friday afternoon I experienced another surprise on Fox News. One of the shows was talking about the coronavirus in the same way that other cable channels reported the news. That’s when I remembered that there are two Fox News if you will: the news department and the talking heads. Then my head spun again when Tucker Carlson, not the most unbiased right-wing commentator, warned people that the pandemic is real, and not a conspiracy by the leftist socialists.

Most Republicans trend toward Fox News and most Democrats lean toward CNN and MSNBC. In a time of crisis, like the one we are experiencing, we should expect that cable news outlets could take the politics out of the equation and report the news: who, what, where, when. This is a time when scientists should be the guests on interview shows, not politicians, or those with a political bias.

Its time to stop the flat-earth approach to science, health, and well-being. We could use some more leadership from Fox News and MSBC, the two cable outlets who have done more than most to divide the nation.

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[i] NBC News/Wall Street Journal Poll – March 15, 2020

[ii] Devan Nunes – California 22^nd District – Sometimes referred to as the poster boy of Trump sycophants?

Senator Sanders Needs to Explain!

To the U.S. variety of Americans, the word socialism is like fingernails running across a blackboard. It runs contrary to our image of the rugged individual. It smacks of equal opportunity morphed into the quest for equal results. We saw what it did to Russia and the other Socialist Republics of Eastern Europe, to Cuba, and to countries in South America and Asia. It often turns into communism, and that ain’t good and most of us do not like it.

In spite of our natural antipathy for the concept, we have a Democratic-Socialist running for President for the second time. Bernie Sanders got beat four years ago and it is too early to call this year’s result. Why the attraction to the aversion?

Bernie Sanders self-labeling himself a Democratic-Socialist is very scary to the Democratic Party elites; a non-Democrat is running for the top spot on the ballot. If he wins, we will choose between a right-wing ultra-conservative populist and a left-wing democratic-socialist populist. George Will, anything but a quintessential liberal, deems it “the most repulsive presidential choice in US history.”[i] Sanders, like Trump, sees an opportunity to speak to the heart and the heads of marginalized people in the richest country in the world.

Senator Sanders has not changed his views on the role of government since he was mayor of Burlington, Vermont back in the ‘80s. He believes in universal healthcare. That is not socialism. He advocates free college. That is not socialism. He thinks rich people should pay more taxes. The rich think that is socialism. And he goes on. His supporters, mostly younger have seen the results of unfettered capitalism; to borrow a bit from Churchill, capitalism may not be the best economic system, but it is better than whatever is in second place. Sander’s supporters see too much going to the oligarchs and not enough to the working stiffs. Only a few people own 90% or more of the country’s wealth, the middle class is decimated, college is out of reach without the weight of stifling loans, healthcare is too expensive for millions upon millions, and low skill jobs disappear daily. He has a built-in audience for whom the aversion is an attraction.

Most people I know strongly support the idea of universally affordable healthcare for all. A whole bunch of the people I know have very good affordable healthcare, generally for two reasons: their employer offers insurance at a reasonable monthly premium, some pay for all of it, or they are retired and use Medicare as their primary health insurance. Most retirees also purchase an insurance plan that pays for the costs not covered by Medicare. They fear any plan that might take their insurance away. So where is the disconnect?

Senator Sanders has not done a good job of explaining how we will pay for his programs. He and millions of his supporters want universal health care; he fulminates about it, with arms raised, every chance he gets. I agree that we should have it. He has not done a good job of telling us how we will pay for his planned changes. Not one of his proposals, irrespective of how much he wants it, can get a veto-proof vote in the Senate or the House. He needs to tell us the numbers, what step he will take in each of the next four years, and how he will get it implemented.   

  

What the Senator proposes is not very radical: healthcare for all; we are the only first-world country without it; free college; we essentially had it until the 1990s; Harry Truman once said that any program designed to help all the people is called socialism by the opposition. Social Security was called socialism. Federal Deposit Insurance was called socialism. Medicare was called socialism. Free education is called socialism. Chief Justice Warren put it another way when he suggested that people think the things government does for them to be social justice and what the government does for others to be socialism.

If Medicare is socialistic, then nearly every retired person in the US has good socialistic healthcare insurance, universally available for anyone 65 years old or better. A number of friends tell me they support Medicare-for-all, but only for those that want it, and they don’t want anyone taking their insurance away. I’m not sure how one follows the other. I do understand, however, even the thought of losing a health insurance plan is spine-chilling. Bernie’s proposal is a plan that provides full coverage for everyone for everything, with no deductibles, no copays, and no premiums. Sounds too good to be true and it is. Sanders and his strong abettors don’t tell us that “socialized medicine” in most other countries is not free, generally comes with copays and very high taxes. He just won’t tell us how the money works out. Logic is on his side on one issue, which is that the total overall cost should be lower, since we pay so much for our insurance.

People in the US already pay twice the GDP for healthcare compared to any other country in the world, for less desirable outcomes. We do not have bad medicine; we have an ineffective delivery system. It surprises some people that other countries have better health systems with better results than we do, at half the cost. Any movement to a universal healthcare system requires more than shutting down the insurance industry. We will have to change dramatically how we deliver healthcare.

We have independently owned non-profit and for-profit hospitals that control their own pricing, because they can. Today drug companies charge what they want for their product because they can... The government has little if any control over those prices of the two biggest collectors of healthcare money. Even laisse-fair free-market adherents know that market supply and demand don’t influence hospital and drug pricing. A universal healthcare system will require a multi-year disruption of the entire healthcare delivery system. Proposals akin to 1960 Nordic socialism, which nearly destroyed the economies of those nations, are far from the reality of 2020. France’s healthcare system is ranked among the best by the WHO. It isn’t cheap!

If you studied the French language in school or college, you know there are at least ten exceptions for every grammatical rule. Their healthcare industry has worked that cultural anomaly to a fare-thee-well. Nevertheless, let us try. Healthcare coverage is mandatory in France and the healthcare tax is 21% of income. It covers about 70% of medical charges. Employers generally pay for half or more of that premium for their employees. People can also purchase a private plan to cover the other 30%. A person making $35,000 per year income will have a charge of almost $7,300 for health insurance, half of it paid by the employer. Seniors over 65 years old are fully covered. But in France, the cost of healthcare is much less than in the US. A doctor's visit is about $30, of which the patient pays about $9.00. A Root canal costs $100, so the patient pays $30. One of the ways France keeps its costs under control is by owning many of the hospitals and setting the payment schedule, and regulating the costs of prescriptions. They have 5.98 hospital beds per 1,000 persons compared to the US, which has only 2.77 beds per 1,000 persons, ranked 32^nd in the world. Most doctors are in private practice but are paid by the national health plan. In other words, the universal health scheme determines the costs and reimbursements for all medical charges.

We could also learn from South Korea, which the OECD[ii] ranks as the best healthcare system in the world. Most folks pay 5.08% of their income to a single-payer insurance plan. South Korea spends about 7.1% of GDP for its outstanding health scheme compared to 12-15% in the US depending on the year and the source of the data. Nearly all of South Korea’s hospitals are private but paid by only one plan. It works.

Our current spending on healthcare is out of control, and our outcomes, after spending outrageous amounts of money, don’t rise to acceptable levels. We are a large, rich nation. We should have the best healthcare at the lowest price, but we don’t. Are we ready for real disruption over a ten-year period to change the system? I’m not sure. But we need to start somewhere.  

I don’t want Senator Sanders to stop pushing for acceptance of his plan. We need reform. I want him to tell us how it will work, and how we will pay for it and how long it will take.  

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[i] George F. Will – Washington Post Writers Group – March 9, 2020

[ii] Organization for Economic Cooperation and Development. Most modern countries belong and share data on a regular basis. It is the gold standard for information about economic issues across the globe.

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Warren Drops Out!

Warren Drops Out!

Elizabeth Warren dropped out of the presidential campaign after a poor showing on Super Tuesday, consistent with the previous three states that the candidates contested. I think she was qualified to be the president. She was certainly smart, Harvard law professor and all. She had good experiences as a Senator, was a good debater, and all that aside, she had a poor showing.

               

I’m told that she lost because she was a woman. I heard that at home, I heard it on late-night pundit shows, and I read it in the opinion section of the newspaper. Men, you see, simply won’t vote for a woman for president, I’m told. Hillary Clinton, however, won about three million more individual votes than Trump in the last election. Don’t tell The Donald! Ergo, men will vote for a qualified woman. Don’t tell the pundits

I considered writing a commentary about why women aren’t elected. It is a great topic for a blog. It is also an express ticket to perdition!

It’s safer to write about opening day for the local Little League baseball league. The great-grandson starts Tee Ball this year, dressed in a Red Sox uniform. How bad can that be? The Coronavirus reached pandemic proportions this week. The President has a new Chief of Staff. The Eagles had a massive concert in Houston last night. Austin’s SXSW festival was called off. Schools are closing down for a few weeks and crowds are discouraged. A friend recommends that we all buy one of those cones you put around a dog’s neck to keep you from touching your face. I wonder if sales of Corona beer are down too.

Anyone of those topics is safer to write about than why men do not vote for women or why Warren dropped out.

Don’t forget to wash your hands!!!