The Rule of One!

People, a small minority, took to the streets, protesting, demanding that the governors open up the states so that they can go back to work, get a haircut, drink at the local bar, or eat in a local restaurant. You can’t blame them for being frustrated. Thirty-nine million people are out of work. Once stable businesses, especially the small ones, are closing for good. Hospitals are going broke. Families are lining up by the thousands at food banks because they have no money for food. Many people want to get back to the synagogue, the temple, the mosque, or the church.

The governors capitulated. The foolishness began immediately, the conundrum wrapped in the enigma thing. The beaches were overcrowded. Bars were jammed. People lined up to enter the malls. Barbers operated without masks. Old people walked the streets without masks. People protested against wearing masks. Late-night cable news fretted about the scourge of the virus while another channel called it a hoax.

At the same time seventy percent, roughly, of people are worried that we are trying to open the country too fast and that we will have another outbreak, which might be worse than the current epidemic. The President is urging states to open up quickly, in defiance of his own guidelines and those of the CDC. David Brooks pointed out in a recent article in the NYT that the people are making the decision about opening, not the government. And yet …

Governor Cuomo of New York recently spoke about what he called the rule-of-one. The epidemic in the US started with one person who had contacted the virus. In his state, the outbreak started when one infected person, in New Rochelle, attended a small birthday party. As a result thousands of people have died.

Most of the states that are opening up quickly are still experiencing increases in infections and a rising number of deaths. The numbers are published every morning by Johns Hopkins Coronavirus Resource Center. New York is starting to see a rapid decline in cases and deaths. If you exclude New York’s numbers, the number of new cases and deaths is rising in almost every state. The rule of one …

It only takes one person to start the infection process. One infected person in a nursing home can cause massive numbers of deaths. One infected person in a meat processing plant can cause massive outbreaks and many deaths. One person, asymptomatic, in a restaurant can cause many deaths.

Standard mitigation techniques have worked for centuries when an unknown virus breaks out: separate people, identify those with whom they have come in contact, and quarantine them as well, and test a large sampling to identify who carries the virus and where outbreaks may occur.. It is simple, and it is effective. Why do so many, though still a minority, refuse to adhere to simple efforts to reduce deaths and provide for the common good?

Failure of the system didn’t happen overnight. The Center for Disease Control and Prevention (CDC) has been the gold standard to which the world’s governments relied upon to lead the charge against pandemics. In the last decade or so, politics crept into the management of the agency, reducing its credibility. The current administration is exacerbating that situation, directing its output and advice. Cable news outlets with specific agendas have helped divide the nation along political fault lines to the point, unbelievable to most, that strongly held beliefs about the virus outbreak are conditioned by one’s political persuasion. One poll after another points out the divide between Republicans and Democrats. The diasporas from rural areas to large cities and to the coasts in recent years have increased the distance between educated elites and fly-over states where too many experience and feel the forces of being left behind.

It is also many administrations at the federal and state levels that failed to provide adequate financing for research, planning, and material stockpiling. Our scientists knew the pandemic was coming months before it hit us hard. We were not prepared; the administration refused to believe the experts, and it tried to convince people that the problem would be over in a matter of days. And the days went on and on; one more person infected another, and they infected others, and the others infected many more. The rule of one …

When a pandemic hits a country it doesn’t infect only people of one political persuasion, or the people led by governors of one political party, or educated vs. less educated. It goes after anyone in its path. When it hits, it is a health issue, it is not a political issue. It is not reality TV. It is the job of the federal government to implement a national response, to have a national strategy, to implement best practices. The current administration has done the opposite to a fare-thee-well. There still is no national strategy, the states are left to do as they please and to compete with each other for vital supplies, and scientific recommendations are declared unacceptable.

The nation has been slow to test people for the virus. Test kits were and are in short supply and reagents needed to do the test were and are unavailable. The administration at first discouraged testing in large numbers. On May 15, 2020, in Allentown, PA, while visiting the Owens & Minor distribution center, the President said, “Don’t forget, we have more cases than anybody in the world. But why? Because we do more testing. When you test, you have a case. When you test you find something is wrong with people. If we didn’t do any testing we would have very few cases.” We are getting better at testing, but we lag too many countries when you look at the number of tests per capita. Remember the rule of one!

So does any of this matter? Does our insistence on self-indulgence make a difference? To most of us, the answer is a loud yes. To others, not so much. As of today, however, the data shows that it is important.

The United States has about 4.25% of the world’s population, but we have 28% of the world’s deaths attributable to the COVID-19 virus. The US, with all its money, with all its scientists, with all its communication systems, with its history of stepping up the plate in times of crisis surely can do better.

Remember the rule of one!

America BC & AC

 “If one virus can wipe out the entire economy in a matter of weeks and shut down societies, then that is proof that our societies are not very resilient. It also shows that once we are in an emergency, we can act and can change our behavior (sic) quickly.” [ii] If America, the world, is not different after the COVID-19 pandemic ends, then we will not have learned anything from the experience. The most realistic timelines for starting the trek back to a working economy and normal lifestyle are months away. Some political leaders would like to declare the country open within a week or two.

There is good reason to want the country to open again: the economy is likely in a recession, stores are closed, factories shuttered and twenty-two million people have filed for unemployment. We have heard warnings for years that most families could not withstand a $400 emergency expense. Many thought that to be hyperbole at best. Now we see thousands of cars lined up at food banks because they have no money to feed themselves and their families, much less to pay the rent and make the car payment. The government has punched trillions of dollars directly into the bank accounts of millions of people, created forgivable loans for businesses that will keep people on the payroll, and it isn’t nearly enough. Trillions more are needed, and quickly. It will take years for the economy to recover to its former all-time highs. In a matter of weeks, the virus created an abyss not seen since the Great Depression.

The pandemic shines “a very bright light on the real weaknesses and foibles in our society.”[iii] What we see is a nation unprepared for large-scale surprise events. We see hospitals, overrun with patients, lacking basic protective equipment for nurses and doctors. We see a lack of tests to determine who has the virus. As the sickness and death spread from large cities to the less densely populated urban and rural areas, we wonder how they will handle the coming tsunami of cases. In the last fifteen years, 170 rural hospitals have closed, 19 last year, and eight this year, even during the height of the virus attack. We see nursing homes and assisted living establishments that are overrun by the virus and deaths mounting quickly but not counted in the statistics. We see Veteran Administration hospitals with mounting deaths each day. We see governors adlibbing fifty-plus approaches to contain and mitigate the spread of the virus. We find sick people holding off going to the emergency room because they have no health insurance. We see a nation where healthcare insurance is tied to employment, and with a loss of work, comes a loss of insurance.  We see patients wanting to try untested and dangerous drugs they hear about on television. We see Blacks contacting the virus and dying from it at six times the rate of Whites. We see nursing homes and senior living facilities become Petri dishes for the virus resulting in a high percentage of deaths. We see the fragility of our nation.  

Emergencies require quick, almost automatic responses, the result of good planning and consistent training. We all remember the fire drills when we were in school. After a few drills each fall, we all knew where to go when the alarm rang. If a real fire had occurred, the effort would have saved lives. Would that we could have that level of security when an epidemic starts to take over our country. How will we react if there is a chemical attack on the country? How will we behave when we are told to shelter in place? How will our government react to the next national crisis?

We knew this pandemic was coming. We had US scientist in China telling us about it. We saw the results of China taking six days to tell their people about the virus and to take action to confine it to Wuhan. The city of twenty million people was shut down almost immediately. Warnings about the spread of the virus came from military intelligence, the CIA, the WHO, and a number of US security agencies, and several health agencies, including the CDC and NIH. At the highest levels, the warnings were ignored for 27 days or more.

Dr. Fauci[iv] held a closed-door-session with most of the nation’s governors at their annual meeting in January, at which he warned them of the oncoming invisible enemy. Many left the meeting acutely aware that they must take immediate action in their states. Others chose to ignore most of the warnings and failed to implement recommended actions. One has to wonder why a national crisis is limited to state action rather than a federal response. A key step to dampen the spread of a virus is to keep people at least six feet away from each other and keeping people at home. Some governors refused to take even that simple step to protect their citizens even as hundreds and thousands of deaths mounted. This everybody-on-their-own approach to a national emergency is ill-begotten. The result of our haphazard approach is that the US has the most confirmed cases of the virus, has tested less than two percent of the population, and has more deaths than any other country. We blew it!

The Federal government was not ready for this pandemic. The stockpiles of supplies were inadequate, some were out of date, and the current administrations closed down, refused to fund, the office charged with worrying about pandemics, reduced funding for the CDC, and ignored well-published warnings. Our leaders were reluctant to mount a quick attack on the virus. They are still arguing over the role of the states and the national government, over the use of what national stocks we have in storage. After pleas from governors, the Army Corp of Engineers, specialists in doing big things well and in a hurry, was allowed to help the states set up field hospitals. They did it in a matter of days, not months. When one hospital was no longer needed, they moved it to another state. They showed what a good government agency can do when they are allowed to do it.

Our nation has debated, gently for the most part, about the type of healthcare system we should have. Some believe strongly that a universal single-payer system is the best choice. Others believe just as strongly that our current system is better. The pandemic encourages us to think about what is, what should be, and what could be.

The large hospitals in the virus-centric areas are overwhelmed. We have all seen what happened in New York, Washington, and California. We watched the epidemic move to the Big Easy, on to Mississippi and Georgia, and now into other rural areas. What will happen when the virus starts spreading into areas that have no hospitals or doctors? Rural hospitals are usually small, maybe 25 rooms, with smaller staffs. They have stopped a lot of non-emergency operations and doctor visits. They encourage people to stay at home except for emergencies. These hospitals rely on low paying Medicare and Medicaid payments to survive. We expect hospitals, private or non-profit, forced to exist only if they are commercially viable. Why doesn’t the richest country in the world ensure that people in rural areas have doctors and hospitals?  

A surgeon from New York who recently spent time in a third world country working with Doctors Without Borders was interviewed on TV. He works in an NYC hospital where he tested positive for the virus. He quarantined himself for fourteen days and is back to work. He spoke about the lack of PPEs (Personal Protective Equipment). He said his hospital in New York City resembled those in the third-world conditions, and sometimes worse.  

The federal government has taken the position that they are simply a back up to the states, that the states are responsible for buying their own protective equipment on the world market. At the same time, however, we read story after story about the federal government commandeering planeloads of PPEs purchased by states and cities when they arrive at local airports or other ports of entry. We read about FEMA outbidding states and cities on the open market. We read about a fire department in Massachusetts that was raided by the FBI who took all of the recently acquired PPEs. We read about countries that manufacture PPEs closing their borders to exports. PPEs are essential materials in the fight against novel viruses. If the medical staffs get sick, who will take care of everyone else?

The pandemic is illustrating, every day and in every way, that healthcare is a human right. Doctors and nurses, and first responders, the best in the world, are risking their own lives to help stricken patients who have a right to live. Hospitals are opening the doors to patients regardless of insurance coverage because they were told that the government would reimburse them for their expenses. This scourge lays bare the need for taking a new look at how we distribute healthcare in America. It shows the weaknesses of a commercially driven system rather than a medically driven system. It shows the results of healthcare and healthy living distributed on an income level basis, or a racial basis, or on an age basis.

We want to open the country back up as quickly as possible. The President has encouraged the governors to act as prudently as possible. The problem that exists in every town in the country is that we don’t know who is infected, who is likely to be seriously ill, who had the virus and now has the antibodies to help others get well. We don’t know because the government has not made testing a priority. We should not open any section of the country before we have tested large percentages of the population. Think about the kids returning to school in the fall. Would you let your child enter a classroom of untested kids? Would you let your son or daughter go back to college and live in a virus laboratory dorm? Some governors indicated that most parts of their states should not fully open for business until we have a vaccine for the virus. The list goes on. There is reason to be paranoid.

The President has proposed a framework for opening the economy that is based on good science and medical advice. Not one state in the nation can meet the criteria that must be met before Phase One of three phases can begin. We just don’t have the test kits to measure the degree of the virus in the population. We don’t have a vaccine. We don’t have the measured indicators that we need to go willy-nilly about the next move. For this reason, the President asked the governors to make a judgment about the best time to open their states, if they bothered to close them in the first place. Let’s hope for the best!

We need a deep-dive analysis of our health system and its outcomes. America deserves better than it has and that the lobbyists on K Street are willing to pay our Congress to deliver. It’s not a political party issue anymore, or an economic issue anymore. It’s a healthcare issue, a medical issue, a science issue, and a human issue. We can’t go back to the BC way of doing things.

                  

---

[ii] Greta Thunberg was Time Magazine’s Person of the Year at age 16. She has been a leader in the drive to improve the climate

[iii] Dr. Anthony Fauci – CSPAN – Interview April 7, 2020

[iv] Dr. Anthony Fauci, MD, is the Director of the National Institute of Allergy and Infectious Diseases, a part of the National Institute of Health. He was appointed in 1984. He is the leading American expert on diseases, including epidemic  Dr. Anthony Fauci, MD, is the Director of the National Institute of Allergy and Infectious Diseases, a part of the National Institute of Health. He was appointed in 1984. He is the leading American expert on diseases, including epidemic management and control. management and control.

Let's See How It Plays Out!

COVID-19 has killed a lot of people in the last couple of months, it is killing people right now, and will kill more people in the months ahead. It is an invisible enemy. We have two choices: we can follow the advice of the experts or we can ignore them. If we follow scientific advice, fewer people will die in the US.

Twenty plus governors chose to ignore the advice of scientists, and continue to put their citizens at high risk. Some governors acted quickly by shutting down their state. New York City put out the warning early, and it still is suffering hundreds of deaths each day. It is hard to comment on this epidemic without getting a bit wonky. Tolerance appreciated.

We know for sure that the virus spreads from one person to another because of coughing, sneezing, or just breathing. The most effective way to keep the virus from spreading is to keep people away from each other. Duh! And yet, some governors and the national government’s strategy seems to be:  “Let’s see how it plays out.”

The Governor of Florida refused to issue shelter-in-place orders for the entire state until April 1st, when the warnings have been out there since at least early January. His new order exempts religious services from the stay at home order. In New Rochelle, NY the onslaught of cases was traced directly to one infected person who attended synagogue one night. Nearly a third of the cases in Sacramento County, CA are from members of one church. While it canceled church services, it encouraged small group meetings in parishioners' homes. On April 2^nd, the Governor of Georgia announced that he was closing down the state because he just learned, the day before, that the virus could spread from one person to another. The Governor of Mississippi says his state is not China and he will not close it down like a communist country. Devin Nunes, a reactionary member of congress from California, went on Fox News to state that closing schools, restaurants, and bars was ridiculous and that we should get people back to work, and kids back in the classroom. Who are these people?

 President Trump extended the call for social distancing until the end of April. He took the recommendations of the scientist who advise him. Their advice is based on their years of experience and the predictions of various statistical models at their disposal. Obviously, the CDC and other governmental agencies and the military have great modeling expertise. But the most frequently mentioned model was developed by the University of Washington’s Institute for Health Metrics and Evaluation (IHME)[i]. The model assumes that if every state in the Union enforces a strict shelter in place rule, closes all restaurants and bars, and closes all non-essential businesses, it will reduce the death toll. That is if we did everything perfectly. We haven’t!

Because the Governor of Florida didn’t close all non-essential businesses, order restaurants, and bars closed, close the beaches, or enforce a state-wide shelter in place rule, the model predicts that the number of cases and deaths will peak on May 3^rd. It predicts that the state will be short 2,000 ventilators, nearly 1,000 ICU beds, and it points toward 179 deaths on that one day, and 7,000 souls lost by August 4, 2020. Mississippi is projected to have 40 deaths on April 22^nd, and over a thousand deaths by August 4^th. Georgia cases are predicted to peak on April 25^th when the state will be short 1,224 ventilators, 900 ICU beds, and will have 96 deaths that day. It predicts 3,232 deaths by August 4, 2020. The best news we can hope for is that the model is inaccurate on the high side.

Another way to look at it is that Florida will have one death for every 3,000 people in the state, Mississippi with have one death for every 2,987 people. Georgia will have one death for every 1,234 people. California, which shut down early, will have one death per 7,750 people in the state. States that took early action should be more successful flattening the curve of virus cases and deaths.

This epidemic lays bare the underbelly of an inadequate national healthcare system and congers up discussions about the role of government at the national and state levels. Difficult as it may be to imagine, it is not a time for political finger-pointing or blame gaming. That can wait a few months.

The virus hit Wuhan, China with a bang last year. After some fits and starts, the government shut down the city of twenty million people. The US Army, the CDC, NIH, and other medical groups warned that the epidemic was coming. They were basically ignored for months. Most immunologists tell us that when a coronavirus hits, it needs to be dealt with quickly and with a shock and awe strategy at the outset, not months down the road. We didn’t go into immediate shutdown and the virus spread. The President took some important first steps, such as closing the borders to people from China, and then many parts of Europe. But there still is no national strategy to fight the spread of the virus. If there was ever a time when we needed a countrywide strategy, it is now.

While people are sick, hospitalized, and dying, what are the rest of us to do? If we ignore the science we put ourselves in jeopardy. If we follow the science, we shelter in place. What does that mean? The CDC has posted its recommendations. CNN has an informative site on how to coronavirus-proof your home. [ii]

If you are over 70 years old, stay in your house, period. Everyone else should stay at home as well if they are not required to be at work. It is suggested that every house has a disinfecting station outside or in the garage. We use the garage. Anything coming into the house is first wiped down with a Lysol sheet. If it a box from Amazon, it is sprayed with Lysol. Each package of food is wiped down before being taken inside. If you have to go shopping for food or other items, designate one person to be the shopper. It reduces the opportunity for the virus to infect the second person. If you must go outside the house, wear plastic gloves and wipe the handles of the shopping cart. Wipe your credit card or ATM card after each use. Wipe down the inside of the car after you use it. Try to shop at stores that will take an online order and put it in the trunk of your car so that you don’t come in contact with people. Don’t let anyone in your house that doesn’t live there, even your kids and never your grandkids. The list of suggestions goes on. It feels like overload. It is the minimum we should be doing, according to the CDC. Dr. Fauci said that if at the end of the next two or three months we think that they asked us to do too much, and we are still alive, their request was just about right.

The clubhouse in our development is closed, the pool is closed, the gym is closed, the library is closed, the game room is closed, all the meetings are canceled. The local Senior Center is closed for another month or two, at least. All schools are closed for the rest of the year. All the local parks are closed as well as all the equipment in them. All of the state parks are closed as well as the parking lots. The beaches are closed. The streets are pretty much empty. Doctors and other healthcare workers are available by phone, email, or Zoom. It goes on and looks like it might last another couple of months.

We can talk about economics later. We can talk about the response at the county, state, and national level later. We can talk about job loss later, We can talk about the six million people who lost their health insurance in the last two weeks. Right now, our primary job is to not be one of the 240,000 potential deaths between now and August.

---

[i] https://covid19.healthdata.org/projections.

[ii] Scottie Andrew, CNN – How to coronavirus-proof your home – March 2020

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!

---

[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.

---

[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.  

---

[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.

1