“They think modern medical care and hospitals are fine—but only for people who can afford them.”—President Harry S. Truman, from a speech describing his view of the Republican Party, October 13, 1948.

I used to read the Wall Street Journal.  It’s been one of the oldest and most respected newspapers in the country (especially back in the days when people actually read newspapers).  The Journal has vigorously covered world events and featured a broad range of information.

Yes, they always had a passionately conservative bent, such as the time back in 1914 when they suggested Henry Ford was guilty of treason when he raised his workers’ wages.  But on balance, their coverage was for the most part reasonable.

Then along came Rupert Murdoch.

One of the world’s wealthiest men, Murdoch got his start publishing tabloids that often sold like hotcakes by featuring topless women.  He kept expanding his approach of sensationalism into mainstream news, with SKY news in the United Kingdom, FOX news in the U.S., and more recently, the Wall Street Journal (WSJ).

That’s when things began to change at the paper.  And from my perspective, and that of many others, it’s now gone completely off the rails. 

I’ve previously commented on a WSJ piece that claimed that Congress had no right to question the pharmaceutical industry about sky-high drug prices in the U.S.  But now, in an editorial that goes even further, the WSJ claims that any effort to shield one’s credit score from being pounded by medical debt is tantamount to “forgiving” that debt.

For those of you who’d like to read it and can manage to get past the firewall, here’s a link to the piece’s publication as it was reprinted in our local paper, the Omaha World Herald.  For the rest of you, here’s a quick rundown.

The Consumer Financial Protection Board (CFBP) has proposed excluding medical debt from consumer credit scores.  To me, that seems reasonable.  If you get in over your head buying a Cadillac when you can only afford a Chevy, that’s your choice, and your credit rating should reflect that.

But health care’s a different story.  Nobody “chooses” to get sick.  No one “chooses” to have surgery.

According the WSJ piece, though, somehow not including medical debt in a credit report is no different from “forgiving” debt.  This isn’t just false, it’s egregiously false.  Regardless of the credit report, you’re still stuck with the debt.

The WSJ goes even further.  It claims that if you have health insurance you are “protected” from debt.  Again, this simply is false.  Over half of all Americans who become bankrupt because of medical debt  had insurance when their medical problems began. 

Later in the piece, the WSJ claims that removing debt from credit reports will discourage people from buying insurance in the first place.  I’m not going to say this is the most asinine statement I’ve ever heard, it’s just that I’m not quite sure what else might be.

But the WSJ is just getting started. “A credit-report blemish,” they claim, “is the only tool health care providers have to encourage payment.”

Sorry, but that’s also nonsense.  Ask anyone who’s struggling to pay off medical bills and getting nonstop calls from collection agencies.

Further in the piece, the WSJ argues that medical debt is really no big deal to begin with, since “only” 15 million Americans have to deal with it, and the debt “only” averages $3,100 per person.

Maybe that’s not much to the editors of the Wall Street Journal, but for many of the patients I cared for, it was a hell of a lot of money.  Perhaps the folks at the WSJ should try living in the real world for a while.

There’s plenty more.  The WSJ tries to make the looping argument that since reducing a credit score is the same as forgiving debt, that it will therefore create more debt, that people will stop buying insurance (because they only care about their credit scores, right?), which will in turn drive up costs, which will in turn cause hospitals to charge more, which will in turn cause more uninsured.

I’ll describe this sort of thinking in two words.  Pure Fantasy.

Don’t take my word for it.  Instead, ask yourself this question.  If your child desperately needed an operation, or needed an expensive medication, would you really stop and say, “But wait, will this affect my credit score?” And then forgo the treatment?

Would you really?  Would the editors of the WSJ?  I doubt it.

So let’s get back to the real world.  Not being forced to include medical debt on your credit report is not the same as “forgiving” debt.  People don’t say, “Woopie!  Now I won’t buy insurance if my credit score’s OK!”  any more than they would say “Sorry, kid, no insulin for you this week because I don’t want to screw up my credit score.”

This brings up an interesting question.  Just who is the Wall Street Journal trying to protect with this sort of bizarre logic?  Lending institutions?  Private equity?  Who knows?  But it’s certainly not the American people.

Because as the WSJ well knows, we’re already hammered by the highest medical costs—as well as the highest levels of medical debt—in the world.

And if the Wall Street Journal doesn’t have an issue with that, then it’s clearly out of touch with reality.

Human beings have a strange relationship with rules.  Basically, we hate them.  Try to tell someone what they should do, and they’ll most likely insist on doing the opposite, even if it means jumping off a cliff.

Parents know this.  Want your kid to go to bed at 9?  Tell them they can’t go to bed at 9.  They’ll do it just to show you they can.

In the legal system, these rules are called laws.  Societies need them to function, thrive, and basically ensure that we don’t kill each other off.

But whose laws?  Some laws are Federal and passed by the U.S. Congress.  Many more exist at the state level and are enacted by individual State Legislatures.  And that’s where the rub comes in.

Many states chafe at the idea of Federal oversight.  They prefer their own laws, and want nothing to do with the (as they view it) Evil Federal Government—unless, of course, the issue is Federal Aid coming in from another state’s tax dollars.  They insist that decision-making is best done at the local level, and that State Legislatures are better attuned to local needs.  Keep the Feds out of our laws!

Yet in the next instant, these same State Legislatures and Governors who insist that the Federal Government shouldn’t mandate what the state should do, turn around and tell local cities and counties what they can and can’t do. 

Don’t tell me what to do, Washington!  But I can sure tell Blair (if we’re talking about politicians in Lincoln, Nebraska) or Weston (if we’re talking about politicians in Jefferson City, Missouri) what to do.

To say this smacks of hypocrisy would be an understatement.  In state after state, local laws regarding everything from guns to masks to books have been struck down by the same State officials who would throw a fit if Washington were to say the same thing to them.

No question, the U.S. Congress has passed some dumb laws.  Many states, however, have passed laws that are even dumber.  Here’s a quick rundown.

In Florida (of course we have to start with Florida), lab grown meat is now outlawed.  There’s no evidence it’s bad for you in any way, but that doesn’t matter.  Florida still says you can’t have it.

So much for consumer choice.

And there’s more.  This is the same state that once passed a law that would lock up any Doctor who asked parents if they kept a gun in their house.  Something about the First Amendment got that overturned.  We don’t need to go into the “don’t-say-gay” laws, “which-bathroom-you-can-use” laws, “what-you-can’t-teach” laws, and “don’t-see-drag-shows” laws.  In each instance, what an individual Florida city might want for its citizens is irrelevant.  It’s only the State that can decide.

But if you need a C-section, Florida says it’s now perfectly legal to have one performed outside of a hospital.  Sound incredible?  It seems a venture capital group in Great Britain that invests heavily in American outpatient services has more influence in Florida than doctors.  Maybe political contributions play a role.  Regardless, such an asinine law would never pass in the U.K. itself.  So much for the superiority of Florida health care.

What about other states?  Tennessee has a law on the books outlawing “chem-trails”—mind-altering gases released from jets flying over the state.

The problem is, chem-trails don’t exist.  When you see a jet with a white line trailing behind, it’s called a contrail—essentially a linear cloud trailing behind a hot engine speeding along at high-altitude.  It’s nothing new, and has nothing to do with jets.  World War II pilots could spot them trailing behind propellor driven planes, too.

What other nonexistent things could Tennessee ban?  Cell phone calls with extraterrestrials?  Dinner dates with Big Foot?

Don’t try wearing a mask on the streets of North Carolina.  It’s illegal now, health consequences be damned.

Louisiana is considering legislation that would prohibit the state’s motor pool from having more than 3% of its vehicles run by electricity.  What if an EV becomes cheaper, more efficient, and less costly to the taxpayers?  Apparently, that wouldn’t matter.

Wyoming tried to go one better.  There, the Legislature nearly passed a bill outlawing the sale of Electric Vehicles entirely.

In Texas, the Legislature thinks it should tell the state’s Universities what they can and can’t teach when it comes to race relations.  Is quantum physics next?

In Nebraska, a city used to be able to ban weapons in its public spaces.  But no more.  Only the sages in Lincoln can make such decisions.

Oh, and then there’s Iowa.  For over 100 years, Iowa refused to pass a law legalizing the sale of raw (that is, unpasteurized) milk.  The rationale was simple.  Pasteurization kills germs.  Around the world, the process has been credited with helping stamp out tuberculosis and other diseases.

But once the Centers for Disease Control (the dreaded CDC) warned of the dangers of spreading H5N1 Bird Flu in raw milk, the Iowa legislature promptly passed a law legalizing it.  After all, giving a middle finger to Washington is far more important than protecting the lives of Iowans.

I could go on and on.  In state after state, the same legislators who decry being told what do by Washington have no qualms about telling cities and localities what they can do.  Whether it’s restricting voting rights or health care, states suddenly feel empowered to go far beyond the Federal government in telling you how to run your life.

And sometimes, even when the people of the state clearly oppose a law, the Legislature still insists on cramming it down their throats.  Exhibit A is again Nebraska, where the Legislature passed a law allowing tax credits to help fund private schools, even those with clear religious biases.

The people stood up and mounted a massive petition drive to overturn it.

What did the Legislature do when it became obvious that the effort to nullify the law would succeed?  They revoked the law, and immediately passed a slightly altered version of the law that the petition drive hadn’t addressed.

So much for listening to the will of the people. 

As I asked in my last post just who are we in America?  Where are we headed?  A stronger UNITED STATES?  Or a weaker set of STATES who are (sort of) UNITED? I don’t’ know, but perhaps Texas is going to be the trendsetter.  Earlier this year, the Texas Republican party approved a Legislative platform that included Plank 203, which states: “The Texas Legislature should pass a bill in its next session requiring a referendum in the next General Election for the people of Texas to determine whether or not the State of Texas should reassert its status as an independent nation. “

Could this really happen?  Déjà vu Fort Sumpter, 1861?  Who knows?  It would certainly put a smile on the face of every dictator from Budapest to Pyongyang.

But Texas might just be in for a surprise itself.  Despite all its current wealth, ego, and self-righteousness, how long would it be before the Nation of Texas realized that New Mexico, Oklahoma, and Louisianna were building walls at their borders? 

And for those just now reading this post–my apologies. I missed one other important dumb state law, that I’ll add to this post now. In 1993, Alabama banned Yoga from being taught as a part of physical education in K-12 Schools. Recently though, they had second thoughts, and decided maybe Yoga was OK after all.

But not to worry. You’re still not allowed to utter the traditional Yoga greeting “Namaste” in class. Gotta keep those kids from thinking, right?

“My biggest problem with the two major political parties is that every four years they seem to go on some kind of national scavenger hunt to see who can come up with the biggest goober to run for President.”—Dave Barry, circa 1990

It’s 1786, and America is pretty much a mess.  Just 10 years after declaring independence, and 3 years after a victory over the powerful British military, the 13 colonies-turned-states don’t seem capable of doing much of anything.  The central government is a joke.

Each of the states is primarily concerned with looking out for themselves.  Individual states can print their own money, sign treaties and trade agreements with foreign countries, and raise whatever taxes they choose.  Basically, it’s every state for themselves.

It’s likely that every other western nation is licking their chops, waiting for America to fail.

What passes for a federal government is only a quasi-legislative body modeled after a shaky Continental Congress.  There’s no President.  No judicial branch.  The government has no means to raise money, nor means to support legislation.

Not that it really matters.  Each state gets only one vote in the legislature.  And nine votes are needed to pass anything.  Not surprisingly, little moves forward.  The process makes our current-day constipated Congress look free-flowing by comparison.

All of this was set in motion when a loose set of guidelines called “The Articles of Confederation” was enacted in 1776. It called for forming a nation of sorts, with almost all power in the individual states.

America limped along for a while, but in in 1786 disaster struck.  An armed uprising in western Massachusetts threatened the state.  It was the first rebellion against the new country.  People were shocked.

There were no federal troops to restore order.  Instead, a group of wealthy businessmen paid for a private militia to put down the uprising.

George Washington and James Madison, among others, saw this as a harbinger of what might come next, and decided they’d had enough.  They concluded that, independent of any state, the federal government needed a stronger set of rules to replace the Articles of Confederation.

After much rancor, the U.S. Constitution was written and adopted.  It was not zapped down from on high.  Much arguing, gnashing of teeth, anger, and fatigue (and probably a fair amount of drinking) had to occur before the compromise document was adopted.  Parts of it are clear, and parts of it are clearly ambiguous.

But one question was always at the forefront of the wrangling—how much power should be in the hands of the federal government, and how much in the hands of the individual states?  Not surprisingly, big states with lots of power wanted to keep it, and smaller states with fewer resources were more willing to share.  70 years later, the question of state power versus federal power nearly tore the country apart.

Just like it threatens to do today.

Even the basic question of who gets to elect the President was angrily debated.  Some delegates wanted each state to have a vote, others said it should be the American people—with each person having one vote, no matter where they lived.  Count up the votes, and you’ll have your President.

No, the first group countered.  The average American doesn’t have the smarts to make such a decision.

A compromise was reached.  Instead of voting for President, the individual voters would select Electors—people they knew and trusted—to choose the next head of state.

But how many Electors should each state get?  Most felt that population should be a consideration; that is, unlike under the old Articles of Confederation where each state got one vote, the number of Electors allocated to each state would be determined by the state’s population.  This would mean states with larger populations would have more say in the government.

Then came the rub.  What counts as “the population?”  34% of those living in southern states were slaves (in Virginia and South Carolina, it was over 40%).  Even though slaves were denied the right to vote themselves, southern states still said they should be counted in the overall population, thus increasing the state’s number of Electors.

Northern states (especially Massachusetts and Vermont, which had outlawed slavery by this time) were furious. How can you use people who can’t even vote to increase your share of the electoral pie?

Once again, it was settled by compromise.  Slaves would be counted as 3/5’s of an actual person for purposes of determining electors.  No, I’m not making that up.  Southern states would thus have more electors than if slaves were not counted, but not as many as they wanted.

Any accurate portrayal of the early days of the Electoral College system in the U.S. must acknowledge that it was a triangulation of states’ rights, individual rights, and slavery. It set in motion a squirrely system that persists to this day.   

And it continues to leave us with a basic question—who should elect the President?  The people?  Or the states?

Most of the founding fathers had a low opinion of the concept of political “parties.”  They envisioned a future where individuals would run for President on their own, and there would be multiple candidates.

But in short order, that vision fell apart.  Political parties rose in power and influence, and for nearly two hundred years we’ve had only two basic parties to choose from.  Both have ruthlessly promoted their own interests, and determined their own candidates.  The American people, much to their dismay, have only two basic choices when a Presidential election occurs.

The focus of the electoral college likewise mutated.  Individual Electors became a perfunctory issue. Instead, States (with the exception of Nebraska and Maine) allocated all of their Electoral votes to whichever candidate won the vote in that state.  Win a state by a million votes, and you’ll get all of their Electoral votes.  Win a state by one vote, and you’ll get all of their Electoral votes.

The President is elected by the states, regardless of how the overall American people vote.

I first learned about this when I was in grade school.  I thought it sounded pretty dumb.

So I asked my teacher to explain it.  She really couldn’t, at least not to the satisfaction of a 6^th grader.  (Hint to all non-parents:  When kids don’t understand something a grown-up says, they’ll repeatedly ask “why?” or “how come?” until they either get a reasonable answer or the adult goes nuts).  So I persisted.

She did her best to explain, telling me about the importance of regional interests and state representation.  It still didn’t make any sense.

“But that’s not how we do student council elections,” I said.  “We just count up the votes.  We don’t let the first row count their votes, and they get one vote, and the second row counts all of theirs and gets two votes because they have more desks in the second row.  Why do we do it for President?”

My exasperated teacher hemmed and hawed for awhile and finally said, “Donnie, it doesn’t make any difference these days, because whoever wins the popular vote is going to when the Electoral vote anyway.  Winning one and not the other is all in the past.  It just doesn’t happen anymore.”

Some 40 years later, I found out how wrong she really was.

The Electoral College is just one more reason why government is becoming farther removed and further disconnected from the people it serves.  Are you a Republican who lives in Connecticut?  Sorry, you vote really won’t count.  The Democratic candidate is going to win the state and get all of the Electoral votes.  The same is true if you’re a Democrat and live in Wyoming.  The Republican will win, regardless.

For more and more people, the feeling is why bother to vote at all?  American voter turnout is one of the worst in the world.  It’s time we consider whether the Electoral College may be a part of the problem.

In every election, the focus is on “swing states,” states that could possibly go either way.  Those are the only places candidates focus their time, and the only ones that seem to matter.

And here’s yet another absurdity of the electoral system.  The vote of the “Electors” must be formally certified by the Vice-President.  In the past, this was no big deal.  But in 2020, a mob of insurrectionists, egged on by the President, descended on the Capitol and threatened to hang the Vice-President if he didn’t refuse to certify the election.  It didn’t work.

But what if it had?  What if the will of the people—as well as the will of the states—had been gutted?  Would we even have a democracy today?

When I was in grade school, I thought those things only happened in banana republics.  Is that where we are today in America?  

For the record, a state-by-state pushback against the Electoral College has emerged.  The National Popular Vote Interstate Compact (NPVIC) consists of 17 states who’ve had enough of this nonsense.  They’ve pledged to give all of their Electoral votes to the candidate who wins the popular vote, regardless of whether that candidate wins the state’s vote are not.  This move away from a slave-state-protecting, elitist Electoral voting process that favors states over individuals is long overdue.

Hopefully, this idea will take hold, but who knows?  In the meantime, vote.  Vote as if your life, your country, and your democracy depends on it.  Because it does.

I’ll be back next time with more thoughts on whether we are truly a unified nation, or just a collection of self-interested individual states.  In the meantime, feel free to comment.

Without getting into details, I’ve had to deal with some health issues this past month.  I haven’t written a damn thing.

Any Midwesterner can tell you that once you’ve lived through a drought, those first drops of rain that hit your face feel so good they almost make you dizzy.  So it is with writing, I guess.  I don’t know when I’ll write again.  But right now, it feels pretty good.

My home state of Missouri has produced an array of authors. Langston Hughes, T.S. Eliot, Tennessee Williams, Dick Gregory, and of course, Chuck Berry.  Most came from the more cultured Eastern side of the Show-Me State.  My own Northwestern corner, in contrast, is better known for Harry Truman, Walter Cronkite, and everyone’s favorite outlaws, the James boys.

But of all the Missourians who ever touched their pen to a page, none could really hold a candle to Samuel Clemens, aka Mark Twain. 

Volumes have been written about Twain.  They sit alongside the volumes he himself wrote.  There’s no need to recapitulate his life here.  Suffice it to say he ranged from Hannibal, Missouri to Nevada to California to Connecticut to New York and eventually throughout the world.  From the time he could walk, he soaked up everything he saw.  And in his work, he spilled it all out like a flood.

He wrote compulsively, page after page.  Editing carefully, he never minced words, but never strung them out either.  In language as plain as worn denim and manure-stained boots, he threw the world at his readers.  The joy and the pain.  The humor and the tragedy.  The humane and the inhumane.  The racism and the kindness.  The people who were beaten down and the people who were incredibly wealthy for no other reason than just being lucky as hell. 

Yes, he made damn good money doing it.  Much of it he blew.  But in the end, he was someone who simply had to write.

And all of it in longhand, thousands of words each day.  As he aged, his dominant right arm became so arthritic he could barely use it.  So he forced himself to learn to write with his left.

Faulkner called him the Father of American Literature.  Hemmingway went further. “All modern American literature comes from one book by Mark Twain called Huckleberry Finn,” he declared. “It’s the best book we’ve had. All American writing comes from that. There was nothing before. There has been nothing as good since.”

And Twain did it all with no formal training in the art of writing.  No classes in literature.  No creative writing courses.  He was forced to drop out of school in the fifth grade to support his family.  All he could do was devour every book he could get his hands on.

He’s often remembered for a sarcastic wit that could to make you fall out of your chair.  But beneath it all, was the pain of someone who’d seen tragedy after tragedy after tragedy.

“The source of all humor,” he wrote, “is not laughter, but sorrow.”

He hated racists, colonialists, and imperialists.  He raged against the Spanish-American War.  He insisted Teddy Roosevelt was a bag of hot air, who didn’t do nearly enough to reign in turn-of-the-century Wall Street financiers. 

His words could cut down the high and mighty like a scythe through ripe wheat.  “What if I were an idiot?” he once asked.  “And what if I were a member of Congress?  But I repeat myself.”

Later it was “First God made idiots.  Then he made School Boards.”

Wouldn’t he have a field day with those two institutions today.

The human ego was likewise his target, as was religious pomposity.  “I believe the only reason God created man was because he was disappointed with the monkey,” he quipped.

He travelled to Hawaii, and couldn’t understand why Christian missionaries couldn’t just leave the Islanders alone.  In Australia, India, and South Africa, he was outraged at how Europeans treated native peoples.  “Man is the only animal that loves his neighbor as himself, and then cuts his throat if his theology isn’t straight,” he grumbled.

In what many consider the greatest novel ever written, a young boy named Huckleberry Finn rafts down the Mississippi River with a runaway slave named Jim.  Over time, they bond, and Huckleberry learns the reason Jim has run away–he learned that he was about to be sold down river, and possibly separated forever from his wife and daughter. 

Jim misses his wife and daughter terribly and worries about their future. The pain is so powerful Jim sometimes cries himself to sleep at night. He’s determined to somehow gain his freedom, find a job, and save enough money to buy his family out of bondage.

But Huckleberry is terrified by what his religious upbringing has taught him.  Preachers in Missouri insisted that slavery was ordained by the Almighty, and to assist a runaway slave was sure to bring about the wrath of God.  Hell and damnation would be waiting.

This makes Huck tremble.  An eternity in hell?  He’s torn as to what to do.  Finally, while Jim is sleeping, Huck writes out a letter to give to the authorities explaining that Jim is a runaway.

But after the most intense soul-searching a young boy can do, Huck makes his decision.  He tears up the letter, and refuses to betray Jim.  In what may be the most profound seven words ever written, Huck says simply, “All right, then, I’ll go to hell.”

In an era of hypocrisy, extreme nationalism, and wild-eyed religiosity, how many today would have the courage and insight of that scruffy kid from Missouri?

Since his death, Twain has been both praised and scorned, his books sometimes promoted and too often banned.  He’s been called a saint, a sage, and a genius by some and a scoundrel, a blasphemer, and a hypocrite by others.

But through it all, his words still stand.  Plain, often unsophisticated, sometimes vulgar, and frequently uncomfortable.  Just like he was.

We could only wish that another like him would emerge at time when this world needs them most. 

And if any of you would like to respond, and have your own favorite quote(s) by Twain to add, feel free to do so.  

WHY ARE WE OVERPAYING FOR OUR MEDICATIONS?

Our local newspaper, The Omaha World-Herald, sometimes runs editorial pieces from other publications.  These pretty much run the gamut from liberal to conservative, and each one usually gives someone something to disagree with.

Recently, the paper published an opinion piece that had appeared in The Wall Street Journal, essentially mocking an effort by a U.S. Senate committee to investigate drug prices in the U.S.  It was my turn to disagree.

Most Americans have become so accustomed to hearing about how expensive our medications are compared to the rest of the developed world, that such information just goes in one ear and out the other.  But these costs are a real hardship for many Americans.

So here’s the original editorial Bernie Sanders Wants a Pharma CEO Show Trial , as well as my response below, published today in the Midland’s Voices column of the World-Herald.  I use an analogy that previously appeared in an earlier post Guns, Drugs, Geezers, and Money but it’s still relevant.  You might keep it in mind the next time you pick up your prescriptions.

Oh, and I did add an editorial comment here on the singer Jelly Roll that didn’t appear in the paper.  Feel free to disagree if you’d like.  It’s not meant to take away anything from his testimony about the dangers of Fentanyl, but his appearance isn’t exactly a textbook promotion of sobriety. . .

And no apologies for the Ron DeSantis comment, either.  Anyway, the extended version is below, and you can see the original newspaper piece here: https://omaha.com/opinion/column/midlands-voices-americans-deserve-to-know-why-their-drugs-are-so-expensive/article_a81f4576-ccfb-11ee-855b-eb6f1532d92e.html

AMERICANS DESERVE TO KNOW WHY THEIR DRUGS ARE SO EXPENSIVE

Donald R. Frey, M.D.

The author is Professor Emeritus of Family Medicine at the Creighton University School of Medicine.  His comments do not necessarily reflect the views of Creighton University.

Let’s say you need to pick up a few things at your local grocery store.  You grab the items, toss them into your cart, and head to the check-out line.  A couple of your neighbors are in line ahead of you, and you notice they have exactly the same things in their carts, too.

The cashier rings up their individual purchases, and charges them each $49.  But when your items get rung up, your bill is $108.

You’re stunned.  You’ve just been charged over twice as much for precisely the same things your neighbors bought.  You’re confused, hurt, and angry.  Don’t you at least deserve some answers?

Apparently not, if you believe the recent Wall Street Journal (WSJ) piece, carried by the World-Herald on January 25, 2024.

As has been well documented by multiple sources, Americans pay over twice as much for prescription drugs as citizens of comparable countries.  We’re talking about the same drugs, manufactured in the same way, by the same companies, and used to treat the same diseases.

Over twice as much.  Why?

That’s the question the Senate Health, Education, Labor and Pensions Committee is seeking to ask pharmaceutical CEOs on behalf of the American people.  But according to the WSJ, this is somehow all just a “socialist show trial.”

Really?  At a time when we’ve seen a parade of Congressional witnesses ranging from university presidents to UFO buffs, public health officials to a guy who changed his name to “Jelly Roll” (who looks to have about a half-gallon of ink sitting under his skin, and enough metal on his teeth to build a lawnmower engine), asking those responsible for high drug prices to explain their actions hardly seems unreasonable.

What kind of money are we talking about?  According to research by the Peterson Institute and the Kaiser Family Foundation, Americans pay $1,126 per year for prescriptions.  Other developed countries average $552—for exactly the same drugs.

All of this has real life consequences.  The same Peterson research also revealed that one out of every three American adults has forgone taking prescribed medication due to costs.

Most other countries use their collective purchasing power to manage drug costs.  By negotiating directly with the manufacturer, these countries can drive a harder bargain and bring down prices for their citizens.

And it works.  Europeans, Canadians, and Australians all buy the same drugs for half as much.  And it doesn’t hurt the drug companies one bit.  They still reap gross profit margins more than twice those of S&P 500 companies.

Research and development (R&D) costs are often used as an excuse for high drug prices.  But this argument doesn’t hold water.  All major companies have R&D costs, regardless of their industry.  And if pharmaceutical research really is so expensive, why is it that only Americans are being asked to pay the price?

The good news is that our government is just beginning to conduct direct price negotiations with some pharmaceutical companies.  These carry the real possibility of reducing prescription costs for hard working Americans.

Yet, this is precisely what the WSJ derides as “sham negotiations behind closed doors.”

Whether these negotiations, along with the Senate hearings, produce results remains to be seen.  But political ideology should not be an excuse to shut them down.

After all, if the Ron Desantis-led state of Florida is resorting to importing drugs from Canada, the reality of this problem should be obvious to all of us.

The only question is whether we have the collective national courage to address it.

THE LONG SHADOW OF NUREMBERG

“The thing we learn from history is that no one ever learns from history.”—Otto Von Bismark, German Chancellor, 1815-1898.

“Where one burns books, one will soon burn people.”—Heinrich Hein, German poet, 1797-1856.

It is impossible to visit the city of Nuremberg, Germany and not come away shaken.

At the eastern edge of the city, you can walk around the Nazi Congress Hall, a huge semi-circular structure that, once completed, was intended to look like a Roman Coliseum and seat over 50,000 people.  Once you’ve huffed and puffed your way around the half-finished stadium, you realize you’ve only scratched the surface of what once stood here.  The rally grounds, the Zeppelin Field, the crumbling reviewing stand, are all yet to be seen.  Over six square miles in all.  It would take you a half day to walk around all of it.

Hitler himself gave some of his most terrifying speeches here, to crowds of over 300,000.

300,000 cheering admirers.  A regular Nazi Woodstock.

It was here that the German Reichstag put into place the Nuremberg Laws, officially known as the “Law for the Protection of German Blood and German Honour,” which forbade relations between Germans and Jews, Blacks, and Roma (“the Gypsies,” to some people), as well as the “Reich Citizenship Law” which outlawed citizenship for anyone other than ethnic Germans or those of “German blood.”

It was here (as in 34 other cities) that Nazi adherents marched with torches and burned books that were deemed “decadent,” “immoral,” and “anti-German.”  This included texts describing homosexuality and transgender issues—along with the works of such nitwits as Albert Einstein.

If some of this makes you feel a little uncomfortable in light of current events—good.

Nuremberg was neither the headquarters of the Nazi Party (that was in Munich, Hitler’s old stomping grounds) nor the seat of German government (centered squarely in Berlin).  However, it was a city known as a hot bed of antisemitism and German ultranationalism.

How did Germany wind up with the Nazis?  It’s a complex question, and one that we ignore to our own peril today.  It begins with World War I.

The First World War, the conflict that was supposed to end all wars, took place between 1914 and 1918.  Four long, tortured years.

Most of the fighting took place in trenches in France and Belgium.  Hundreds of thousands of young men would charge out of the trenches, incurring enormous casualties.  They’d gain a few yards of ground, only to be driven back days later by the opposing side, who’d suffer an equal amount of carnage.

Incredibly, no fighting occurred in Germany.  No bombs fell on German homes.  No enemy was at the gate.  Other than food shortages, Germans had absolutely no way of knowing first hand their nation was losing.

When it was over, 9 million soldiers had been killed, 23 million others wounded for life, and over 5 million civilians were dead.  It was a war of attrition, and Germany gave up first. But to many, their nation’s surrender came as an absolute shock.

One of these shocked German was a non-descript army corporal (and failed street artist) who was recovering from a Mustard Gas attack.  He would later claim he was so dumbstruck by the surrender that he went temporarily blind.

In his view, there was no way the German army could have been defeated.  They had to have been sold out by traitors, foreigners, and corrupt officials.  He would later come to personify this group with an age-old scapegoat.

Jews.  They had screwed Germany.  And he was going to by-God do something about it.

Historians still argue about when Hitler’s antisemitism evolved into mass murder (it had been a Jewish German officer, after all, who’d earlier recommended the corporal for military promotion).  But there’s no question that it was Germany’s surrender—and its humiliating aftermath—that further incited his rage for Jews, Roma, Communists, Socialists, immigrants, and anyone not of German stock.

That is, anyone who wasn’t a “real” German.  No way were those outsiders going to “replace” real Germans.

The aftermath of World War I was a gut-punch to the German people.  Besides losing all of their worldwide colonies, much of their European territory, and most of their self-esteem, they were forced to pay off both their own war debt, and that of the France and Great Britain.  The economy began to crumble.

Germany had no choice but borrow money.  Lots of it.  And through a series of missteps, the nation entered one of the worst episodes of hyperinflation in history.

How bad was it?  At the end of the war, it would take 8 German Marks to buy one U.S. dollar.  By 1923, it took 4.2 trillion.  Go to work in the morning, labor all day, and get paid in money that was essentially worthless.

Slowly, the economy stabilized.  But in 1929, the Great Depression hit.  A hungry, humiliated nation was desperate for new leadership.  Most of the poor and working class supported far-left groups, such as the Communists.  This horrified the business community.  They coalesced around a small group of right-wing radicals called the National Socialist German Workers Party, and poured money into its political machine.

The Party also went by another name.  The Nazis.

Perhaps they greatest error we can make in trying to understand the Nazis is to believe they were somehow unanimously elected on a platform of “Let’s go out and kill all the Jews and take over the world!”  Instead, it was much more basic.  Something that hit home to an angry and demoralized nation.

The world is trying to destroy our German values, the Nazis warned.  We are the true guardians of western civilization, and the world is trying to water down our traditions with decadence and vulgarity.  Non-Germans are poisoning our blood and threatening to replace us.  Jews, communists, homosexuals, Poles, Slavs, and (of all people) Jehovah’s Witnesses are vermin, and a threat to our nation.  We’ve been bullied, laughed at, and disrespected long enough.  It ends now.

We’re going to Make Germany Great Again. 

And once they were in power?  The Nazis devolved into utter madness.

Nuremberg learned this, too.  On January 3^rd, 1945, over 500 British Lancaster bombers reduced most of the city to rubble.  Five months later the war was over.  The gigantic Swastika atop the Nazi reviewing stands was blown to pieces  

Of course, Nuremberg’s story doesn’t end here.  One of its few major public buildings to survive the bombing was the Palace of Justice.  The Allies selected it to house one of the most famous trials in history.

Over the next three years, a parade of Nazi defendants were brought to trial in Nuremburg.  Many were found guilty.  Some were executed.

For the first time, a new legal term was introduced to the world.  Crimes Against Humanity.  Crimes so heinous they were described as “deliberate acts, typically as part of a systematic campaign, that causes human suffering or death on a large scale.”  If you have not seen the award winning 1961 film Judgement at Nuremburg, it is well worth your time.

The judges and witnesses at Nuremberg hoped this would be the last the world would see of such crimes.  Of course, they were wrong.  The long shadow of Nuremberg still touches humanity today.

The year 2023 has seen its share of Crimes Against Humanity, and its perpetrators should be brought to justice.  Mohammed Deif, military commander of Hamas, and the terrorists who murdered and mutilated innocents in Israel should be tried as war criminals. 

So too should Benjamin Netanyahu and the Israeli commanders who have murdered innocents in Gaza and the West Bank by indiscriminately bombing homes, refugee camps, and schools, and even blocking food shipments while malnutrition worsens. 

Don’t forget Vladimir Putin, whose cruel war against Ukrainian homes and hospitals has left thousands dead, wounded, and freezing.

Will these criminals ever be brought to justice?  Who knows.

But let’s look closer to home.  The shadow of Nuremburg reaches our own country, as well.  When presidential candidates describe fellow humans as “vermin” who are “poisoning the blood of our country” it should send a chill through our hearts. 

When you hear immigrants and political opponents derided as “replacing real Americans” you should know what’s coming next.  Governors of Texas and Florida are already rounding up immigrants, shipping them to northern cities, and dumping them on the streets like so much garbage.

This is America 2023.  Not Germany 1935.

Or is it? 

Think about that when you cast your vote.

If one day you have the opportunity to visit Nuremburg, I hope you take it.  The city’s lessons will stay with you forever.

And just for the record, their beer and sausages are pretty good, too.

Happy New Year, everyone.  Here’s hoping 2024 will be a step forward for all of us.

CHRISTMAS 2023

For the past couple of years, I’ve penned an imaginary letter from Jesus (Christmas 2021) and Christmas 2022).  This year’s no exception.  Believe whatever you want about the guy, but his teachings seem to get more relevant with each passing year.    

So at the risk of upsetting anyone, let’s check in again.  And remember, this isn’t meant to promote Christianity nor deny it.  It simply tries to look at what Jesus might be saying in the context of our present-day world.

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Hello everyone.

Well, it’s me again.  And it’s Christmas.  The day when you claim to celebrate my birth.  The season when you decide whether you give your money to help the less fortunate, or send it off to Jeff Bezos in exchange for a cardboard box of transient items that someone’s just going to steal off your porch anyway.

I guess that’s your choice, isn’t it?

For some reason, midnight seems to be a big deal for you folks.  Midnight Mass, midnight Services, prayers at midnight.  I’m not sure where you get this stuff.  I certainly didn’t say anything about it.

But if you’re going to offer prayers at midnight, at least be decent about it.  Forget about praying for yourself.  Forget about praying for a new car, a new house, or that the Royals win another World Series (like that’s ever going to happen).

Pray for something that matters.  Like the hostages in Gaza who are hungry and terrified.  Like the people of Gaza and the West Bank being killed by the thousands, some outright, others from thirst and starvation while they’re buried under rubble, calling out to their loved ones.

Send a few prayers for the people of Ukraine who try to survive amidst bombs, freezing weather, and war.  Don’t forget the Uyghurs, the Rohingya, the Haitians, the Sudanese.  The millions fleeing terror, murder, and poverty in Central and South America, running a gauntlet of violence, rape, and fear, who still may be turned away at America’s southern border.

Pray for the thousands of American children killing one another with guns each year.  Pray for those imprisoned in China, Iran, Russia, and North Korea for saying the wrong thing at the wrong time.  Pray for their families who may be imprisoned, tortured, and killed for what their relative said, and not for anything they themselves did.  Pray for the people of Palestine who are having their houses and farms bulldozed and leveled, leaving them homeless, for no reason other than living in a spot someone else covets. 

Pray for the 110 million people who are refugees because of war, famine, or natural disasters.  Maybe pray that some of your more self-righteous pundits will accept responsibility for what you people are doing to your earth and its climate, and quit blaming it on me all the damned time.

O.K., that’s a lot to pray for.  And I think you know I could keep going on and on.  But the clock is going to strike, the service is going to end, and you’re going to want to go home.  Now comes the hard part.

Start working to make those prayers actually happen.  Prayers are fine, but they don’t mean much if you just say “Amen” and then go back to doing just the opposite of what you prayed for.

I was never that big on public prayer, anyway.  I never taught that Congress, school meetings, and worst of all, political rallies, should be opened with prayer.  If you paid attention, you’d know that I taught that prayer was a private thing—between you and God.  It was never meant to draw attention to yourself or your new clothes.

In fact, I was never that big on organized religion, period.  Or even governments, for that matter.  Kings, Queens, Emperors, Presidents, Popes—they never impressed me much.

Which brings us to this whole thing that Americans call “Christian Nationalism.”  I’m not going to say much about it, because if I think about it too long, I’ll probably get so pissed I’ll knock your whole world right off its axis (for those science deniers out there, yes, that would be a bad thing). 

Just let me say this:  any political “movement” that attaches my name to an agenda of hating your neighbors, belittling others, promoting violence, or promoting oppression, is no “movement” of mine.

Call it “Self-Righteous Nationalism,” “Bigoted Nationalism,” or even “Ethnic Nationalism.”  But keep my name out of it.

But let’s get back to the more important issue—I care a lot more about your actions than your prayers.  So what you do this Christmas season means a lot more to me than what you pray for.

You know what I mean.  I’ve already talked about this.  There are plenty of people all around you who are hurting.  Plenty of people in need.  Spend some time with them.  Listen to them.  Touch them.  Give them something extra.  An extra tip.  An extra bit of time.

Do that and see what happens.  See how they smile.

Now go do it the rest of the year, too.  And think about all of this when you go to work, when you come back home, when you’re out with your friends.

And yes, when you vote, too.

And as far as that Hallelujah Chorus thing. . .  Well, you already know what I think about that.

See you down the road.

Jesus      

“The only function of economic forecasting is to make astrology look respectable.”—John Kenneth Galbraith, 1908-2006.

One of the most enduring myths when it comes to health care is the notion that if we just increase the supply of medical services—that is, if we just had more doctors, more hospitals, more scans—health care costs will come down.  In other words, those same “market forces” that restrain costs for lemonade, toilet paper, and bubble gum would operate no differently when it comes to health care.

I was reminded of this a few weeks ago when I overheard a couple of friends talking.  “You know,” one said.  “If we just had more doctors there’d be more competition, and health care cost would come down.  The American Medical Association (AMA) knows this and that’s why they restrict the number of doctors.  This is all the AMA’s doing.”

There are a lot of misconceptions in this statement, maybe more than can be addressed in a single post, but I’ll try.  First, the AMA isn’t exactly a powerhouse organization.  Barely 15% of American doctors even belong to it (I sure don’t).  The number of doctors America produces is dependent on the number of students who graduate from medical school, and the AMA has nothing to do with that number.  Instead, a group called the Liaison Committee on Medical Education (LCME) accredits medical schools, and must approve the opening of new schools and the expansion of existing schools.  The LCME’s job is to ensure that new and/or expanded schools have the resources to properly educate physicians.

I know all about this.  While I was Vice President for Health Sciences at Creighton University, we expanded our medical school to include a campus in Phoenix, Arizona.  It wasn’t easy.  We had to satisfy the educational requirements of the LCME, the Higher Learning Commission (the HLC—more letters, I know, but who’s counting), as well as the Arizona State Board of Education.

It was meetings, paperwork, and hours and hours of documentation.  But nowhere along the line were we ever told “don’t do this because it might increase the number of physicians.”  In fact, for the past thirty years medical schools have been encouraged to grow and expand.

But during the 1980’s, it was a different story.  Why?  We’ll get to that in a minute.

For now, though, let’s look at the competition issue again—the idea that the more lemonade and hot dog stands you build, the more prices will come down, and that same concept should also apply to doctors and hospitals.

I describe this competition fallacy in Chapter 2 of my book (if you don’t have a copy, see if you can steal one somewhere.  If you buy it on Amazon, I’ll only get a couple of bucks anyway, and the rest will just go toward Jeff Bezos’ next yacht or spaceship).  In a nutshell, the decision to buy or not buy hot dogs and lemonade is pretty straightforward, and the market works fine.  Besides, it’s not like you’re going to die or something if you don’t buy a hotdog.

But that’s no true in health care.  If you don’t get it, you may die.  That puts the patient (or the “consumer,” if you will) in a pretty powerless position.  And because health care involves expensive technology, combined with complex decision-making that even many doctors struggle to understand, those hotdog stand-style market forces of increasing the supply to bring down costs simply don’t work.

You want examples?  Exhibit A—Kearney, Nebraska.  Exhibit B—Grand Island, Nebraska.

For those unfamiliar with Nebraska geography, Kearney and Grand Island are towns of about fifty thousand, about an hour apart, smack dab in the middle of the state.  Both have had active, community-based hospitals for decades.

Then things began to change.  Ownership of both facilities transitioned to a huge national corporate entity.  Some doctors got angry.  So did some of the public.  And in both communities, a competing investor-owned hospital was also built.

For the record, these were full scale, competing facilities, each with their own operating rooms, emergency departments, and medical beds.  Each with its own nursing staff, administrative suite, facilities management, human resources, and overhead.  If we were talking about hot dog and lemonade stands, this competition should bring down prices, right?

But it didn’t.  If you don’t believe me, try this.  Go up to someone who lives in Kearney or Grand Island, and ask them, “Gee, now that you have two hospitals, isn’t health care in your community a lot less expensive?” 

That person will probably stare at you for a moment, then either laugh out loud, or punch you in the face.

No, there’s no evidence that bringing in competing hospitals has improved the quality of care or reduced prices in these Nebraska cities.  What has happened is that resources have been stretched thin, overhead increased, and costs simply shifted or expanded.

Those vaunted market forces failed to deliver.  Just like expanding the number of doctors alone won’t deliver lower costs, either.

But let’s get back to that earlier question of how many doctors do we really need.  And are we doing everything we can to meet that need?  Let’s look at some basic numbers.

From 1950 to present day, the population of the U.S. has basically doubled.  But during that same time, the number of physicians has increased five-fold, because starting in the 1960’s, medical schools expanded significantly.

This expansion occurred so rapidly that by the 1980’s, some economists began to worry that, at the rate numbers were growing, the country might be heading toward a doctor glut.  An excess of doctors, as we’ve seen, doesn’t bring down the cost of health care.  In fact, evidence was showing that by ordering more tests and performing more procedures, a physician glut would add to the already spiraling health care inflation.  You could understand the concern.  Remember, from 1960 to 1980, the percent of US GDP needed to pay for health care doubled.

As a result, medical school expansion dropped off.  Again, this wasn’t because of the AMA or some sort of deep state doctor conspiracy.  Rather, it was an attempt to slow a rapid expansion in physician numbers.

By the 1990’s, though, it was clear that societal need for health care was expanding faster than physician production.  Medical schools started expanding again, and that continues to this day.

So let’s get back to the original question.  Will simply cranking out more doctors and building more hospitals bring down the cost of health care?  No.

But several other questions remain.  How many doctors do we really need?  And what kind of doctors?  Where should they practice?  What should they practice?

How long should it take to train them?  Today, almost all medical training takes at least 8 years after high school, but a few schools have reconfigured their curriculum to do it in 6.  During the second world war, with a need for more military doctors, some schools successfully cranked them out in 5.  

Should we be doing that now?  Could we?  How might that affect our overall health care quality?  And how about those medical school tuition costs?  Why are they so expensive?

Along with many others, I’ve written about the similarities and differences between the U.S. health care system and those of other countries, including what we can learn from one another.

But can we also learn from other countries’ systems of medical education, as well?  Are we really convinced that our doctors are “better” than those of other countries?  Why or why not?

What evidence do we have one way or another that our medical schools are better?  How do other countries compare?  What can we learn from them?

More questions than I can answer in one post.  Maybe more than could be answered in several posts.

I don’t know.  Maybe someone should write a book. . .

___________________________________________________

As some of you may recall, last year in the middle of America’s most painful season, the “Oh-gee-call-our-toll-free number-no obligation-we really-really-want-to-help-you, just-look-at-all-of-our-great-benefits, and-whatever-you-do-don’t-look-at-all-the-stuff-we-don’t-cover-if-you-do-happen-to-actually-get-sick” Medicare-Advantage enrollment period, I wrote a post about this stuff.

And since we’re now in the middle of our current 2023 Ho-Ho-Medicare Advantage season, I could certainly warn you about all of that again.

But I don’t have to.  My friend and colleague Dr. Josh Freeman, long-time Professor and Chair of Family Medicine at the University of Kansas, has recently posted a devastating article on the significant risks of signing up for Medicare-Advantage titled The Insurance Company Mafia and Medicare Advantage:  Taking Your Money and Denying You Care   I’d urge you to read it.

See you next time with a new 2023 Christmas letter.

IS AMERICA LURCHING TOWARD BECOMING A FAILED STATE?

“I do not expect the Constitution to last for more than 20 years.”—George Washington, Virginia delegate to the Constitutional Convention, 1787, and later First President of the United States of America.

“It does me no injury for my neighbour to say there are 20 gods or no God. It neither picks my pocket nor breaks my leg.”—Thomas Jefferson, Third President of the United States of America.

“There is a Providence that protects idiots, drunkards, and the United States States of America.”—Otto von Bismark, Chancellor of Germany, 1871-1890.

Listen to some current politicians, and they’d have you believe that the United States is perfect.  We can do no wrong, we’ve been chosen by God, and we can’t possibly fail, because the Constitution was handed down directly from heaven, like Moses and the Ten Commandments.

Sorry, but it didn’t work that way.  The Constitution was developed by men (that’s right, no women—that may have been its biggest mistake right off the bat) who were flawed, combative, and often petty and vindictive.  It wasn’t zapped down from on high.  According to Washington, if it got us twenty years down the road, we’d be lucky.

Of course, it’s gotten us a lot farther.  On balance, it’s held us together through wars, depressions, and catastrophes.  And for many, that means that the United States is therefore destined to last forever.

In reality, nothing lasts forever.  And to say we’re currently in a precarious and threatening time would be an understatement.

On January 6, 2021, a mob of thousands, egged on by a defeated President, stormed the American Capitol, threatening to hang the Vice President and do harm to sitting members of Congress.  It didn’t work.  Officers laid their lives on the line, and eventually the mob dispersed, but only after they’d vandalized and defecated on the Capitol itself.

Any rational observer understands the whole thing could have been much worse.  The occupation could have easily grown into an armed conflict that could have split the nation apart. 

Yet some still maintain that the rebellion’s failure was proof that “the system worked.”  Well, maybe.  Or maybe we just got lucky.  Damned lucky.

In science and industry, when a disaster is barely averted, we have a term for it.  It’s called “a Near Miss.”  Two planes nearly collide.  The wrong surgery almost happens.  The wrong drug is nearly dispensed.

It’s not a time to celebrate and say, “See, the system worked!”  Instead, it’s a time for some clear-headed analysis of what went wrong, and how to insure it never happens again.

If we think that the January 6^th insurrection was no big deal, and that the Constitution will always magically protect us from disaster, we’re wrong.  Next time we may not be as lucky.  The Providence Bismark described may run out.

And the Constitution alone won’t save us.

Let’s start with some basics.  The Constitution established a legislative branch that consists of two bodies, a House of Representatives and a Senate.  Both must agree on a piece of legislation before it can move on for the President’s signature and become law.

Even then, just five life-time appointees to the Supreme Court can still declare virtually any law unconstitutional, based on whatever convoluted reasoning they can concoct.  History has revealed this to be the case for both previous left-leaning Courts as well as our current far-right batch.

The legislative body with the most power, though, is clearly the Senate.  Made up of two Senators from each state, regardless of how large or small the state happens to be, it gives remarkable power to individual Senators to block legislation, and stall progress.

I won’t go into detail, but there are numerous historians that maintain that the configuration of the Senate was a compromise (remember those flawed, combative men I mentioned earlier? Yes, sometimes even they compromised) to appease southern slave-holding states.  In any case, we still see its impact on our Nation today.

Currently, one Senator is holding up 300 promotions of military personnel.  In a time when threats are growing throughout the world, ex-football coach Tommy Tuberville of Alabama is blocking critical appointments within our armed forces.  Was this really what our founding fathers had in mind when they created the Senate?

And the House doesn’t seem to be doing much better.  The Republican majority can’t seem to maintain a consistent Speaker, and the one currently in office (at least as of today) is an adherent to an extremist philosophy known as “Christian Nationalism,” which maintains that Christianity alone should shape our laws.  It’s tenets regarding women, gays, immigrants, and non-Christians (along with any Christian who isn’t “their kind of Christian”) are frightening.

Speaker Mike Johnson also aligns himself with the election-deniers who promoted the January 6^th insurrection, and to this day denies the reality of democratic elections.  I wonder what Jefferson would think of someone of Johnson’s persuasion?

Keep in mind, Johnson is second in line to the presidency.  Anything happens to the current President and VP?  Then an election-denying far-right fundamentalist is in charge.

The current two-party system, where a candidate is nominated, usually by a mere fraction of eventual voters, and is then shooed into office simply because of their party affiliation, hasn’t helped.  Extreme candidates tend to turn out primary voters.  General election voters usually follow party lines.

This has led to a deeply divided nation, and a deeply divided government that is bordering on incompetence.  Former Speaker John Boehner has called members of his own party “political terrorists.”  It probably doesn’t matter.  Over the last few years, political moderates from both parties have been leaving Congress in droves, either because they were “primaried” out, or because they just couldn’t take their colleagues’ crap any longer. They’ve been replaced by voices far more extreme.

Forget about changing the Constitution any time soon.  An Amendment requires passage by a two-thirds majority of both Houses, as well as ratification by at least 30 states.  In today’s environment, an amendment that said apple pie tasted good couldn’t run that sort of gauntlet and pass.

There are a few glimpses of hope, however.  In the 2022 election, a smattering of extreme candidates on both sides who had primaried out more moderate Congressional members were defeated.  And in Colorado, the radical gun-worshiper and Pee Wee Herman wannabe, Lauren Boebert, was nearly defeated by a more moderate political unknown.  This time she may not be so lucky.

The best we can hope for is that an epidemic of common sense will hit the country sometime soon.  Under Speaker Johnson, Congress seems clueless as to how to pass a budget, thus raising the possibility of our nation defaulting on its obligations.  The criminal invasion of Ukraine is entering its second winter, and the Israeli-Hamas War is creating shocking casualties in Gaza and the West Bank, which Russia, China, and Iran are keen to exploit.

If there ever was a time for American leadership, it is now.  Yet we can’t even get our act together around passing a budget.

Washington harbored no illusions about the future of the Constitution, or the country. He knew both could easily fail—whether in 20 years or 235 years.  If he could see us now, what would he be thinking?

And don’t forget Bismark.  When he made his sarcastic remark about America, Germany was at the peak of its power.  Yet just a few years later, the German Republic would collapse under the weight of war and infighting.  In its place, a demoralized and angry nation put into power a man who promised to Make Germany Great Again.

You know the rest of the story.  For God’s sake, let’s not repeat it.

Editor’s Note:  The comment regarding Lauren Boebert was not intended to be an insult to the distinguished deceased actor and comic Paul Reubens, AKA Pee Wee Herman.  Rather, it was simply to note similarities in the theatre-going behaviors of Boebert in comparison to those of Mr. Herman.

Piling up Bodies

There are a lot of things happening here in America.  Another Ho-Hum-Yawn-What-Else-Is-New mass shooting in Maine, brought to you by The Friends of the AR-15.  The election of an extremist Speaker of the House of Representatives who now stands second in line to the Presidency.  And of course, the opening of the annual Medicare enrollment period, when private insurance companies spend small fortunes trying to convince you (if you’re a geezer like me) to turn your tax dollars over to them in return for inadequate health coverage.

I’ll have plenty to say about all of those things.  In the meantime, the ongoing killing in the Middle East grows more critical by the day.

Yes, I know I wrote about this in my last post.  But now things are even worse.

First, the recap.  Over three weeks ago, Hamas unleashed a brutal, immoral, and horrifying attack on Israel.  1400 Israelis were killed, including non-Jewish Bedouin tribesmen.  Hundreds of Israelis were taken hostage.

In response, Israel has dropped 4,000 tons of bombs on Gaza, killing over 8,000 Palestinians in Gaza, while hundreds more have died in the occupied West Bank.  Of course, this is just the tip of the iceberg.

Gazan hospitals are running out of medicine, food, and electricity.  According to one Pediatrician, dead children are piling up so fast in a makeshift tent-morgue it threatens to contaminate drinking water.  How many additional bodies are buried beneath the rubble is unknown.

Israeli tanks and troops are pressing into Gaza, and Israel is advising the al-Quds Hospital to evacuate immediately.  How do you evacuate hundreds of sick and injured in the middle of a war?  How do you run ventilators and operating rooms without power?

Officially, the purpose of Israel’s upcoming invasion is to defeat Hamas.  Unofficially, Israel has threatened to “turn all of Gaza into rubble.”  Israeli Prime Minister Netanyahu has declared this will be “a long war.” Hamas continues to fire rockets at Israel.

At that rate, there’ll be a lot of rubble—and a lot of bodies.  And to what end?

Hamas may get wiped out, but the anger, frustration, helplessness, and humiliation of Palestinians will continue.  History is clear—keep a people beaten down long enough, and bad things will happen.  The next confrontation will be even worse—for everyone.

Is there a way out of this?  Certainly Palestinians should be entitled to their own homeland.  But just saying this will upset many.  Some supporters of Israel maintain that Palestinians should be assimilated into other existing countries, and all territory controlled by Israel permanently annexed.  Some Palestine supporters maintain that because Israel was carved out of Palestinian land, it’s only fair that they, and not the Israelis, should have all of their original land returned.

Neither of these approaches will work.  Nor will maintaining the status quo.

All nations should demand an immediate ceasefire, the return of hostages, and the withdrawal of Israeli forces from Gaza.

Of course Palestine needs to be recognized as an independent nation.  Argue all you want about what the specific boundaries should be.  But it must happen.

Israel must be recognized by the Palestinians.  Just like most everyone else reading this piece, I live on land that was stolen from its rightful owners—the American Indians.  Restoring that now would be impossible. 

West Bank Israeli settlements, though, are a different matter.  They must be dismantled, and the region restored to Palestinian control. No Israeli soldiers, no checkpoints, no roadblocks.

Hamas leadership must resign immediately, as should the extremist government of Netanyahu.  Can Hamas transition to a purely political entity?  That certainly seems doubtful.  But in Northern Ireland the Sinn Fein militants who carried out bombings and terror attacks to drive out the British eventually made peace with England, while Northern Ireland still remained British. 

The United Nations should provide security for Palestine, but also be empowered to arrest terrorists and confiscate rockets.  New elections should be held and monitored by the U.N.  All countries, including the United States, should fund the rebuilding of Palestinian homes and businesses, much like the Marshal Plan at the end of the second world war (which, more than any American military action, stopped the spread of Communism in its tracks).

All countries should recognize, support, and promote the success of both nations.  This will mean extensive work to unwind the hatred, and the belief that the “other side” is always responsible.

Can this occur?   I don’t know.  But I do know that the status quo will only insure more war, more death, and more bloodshed.  And it will only get worse.

Many Palestinians don’t support Hamas and the terror attack on Israel, just as many Israelis do not support the invasion and indiscriminate bombing of Gaza nor the settler attacks in the West Bank.  Can both groups coalesce around a solution?  I don’t know that either.

What I do know is that the current situation is headed toward a terrible conclusion for the entire world.  It is already further tearing apart a deeply divided America.  Attacks on both Muslims and Jews have increased dramatically here in the U.S. in the past month.

If not extinguished soon, the flames of this war will continue to burn for decades.  The destruction those flames can wreak are far greater than any of us can imagine.