A SPEECH I WON’T BE GIVING

“For everything, there is a season. . .a time to keep, and a time to cast away. . .”—Ecclesiastes 3:1, 3:6

“It’s time.”  –Cal Ripkin, Jr., September 20, 1998, on his decision to stay out of the Baltimore Orioles’ starting line-up after playing a record setting 2,632 consecutive major league baseball games.

In the spring of 1994, Dr. Bill Hunter, the Associate Dean of Creighton’s Medical School, asked me to give a talk titled “The Art and Science of Medicine” to the incoming first year medical students. I shrugged and thought sure, why not?

I’d barely arrived at Creighton and was new to the academic world.  My previous practice had been in rural hospitals, either caring for patients or trying to pass on practical information to future small-town docs.  I was the last person to be giving this talk to a bunch of medical students.

So I agreed.  It was no big deal.  Besides, it would just be one year.  Instead, I wound up giving the talk to incoming students for the next 29. 

But I won’t be giving the speech this year.  Or the next.

And not because I wasn’t asked.  Once again, my friend and colleague Dr. Mike Kavan requested that I speak.  This time I said no.

Why?  Because like Cal Ripkin, I realized it was time.  Time for someone who was younger.  Time for someone more relatable to the students.  Time for a new face and some new energy.

I’ve often wondered how many students—now practicing physicians, some of whom may have even retired themselves by now—actually remembered my talk.  A mix of humor and seriousness, it was meant to set students on the right track as they moved forward in their careers.  I hope it did just that.  And I hope whoever gives a similar talk in the future will do the same.

I usually gave the speech “live” each year to the new students.  But fumbling around in some old computer files, I found a copy of my talk the year of the pandemic.  It was delivered to a computer screen, recorded, and later viewed by students.

I hated doing that.  I’m not much for talking to screens.  I just hope I got my message across.

Many of the issues I touched on—social justice, caring for others, competing with yourself instead of getting wrapped up in competing against others—also apply to life in general, and not just to medicine.  If you happen to listen to the link below, there might be a little something there for all of us.

Be forewarned.  If appearances are a big deal to you, you’ll be disappointed.  I was getting some serious dental work done, and my teeth looked pretty bad.  The lights also go off in the middle of the speech, and I had to get up and figure out where the switch was.  Hopefully that didn’t detract too much.

So if you have the time, and want to listen/watch some of the presentation, the link is below.  I’ll be back in a few days to talk about one of the deadliest and most neglected health care risks in America.  It’s called pregnancy.  See you then.

Art & Science of Medicine with Dr. Frey (panopto.com)

CHINA AND FLORIDA:  WHERE TRUTH GOES TO DIE

“There is a price to pay for speaking the truth. There is a bigger price for living a lie.” -Cornel West, author and philosopher

“Truth-tellers are not always palatable. There is a preference for candy bars.” -Gwendolyn Brooks, poet and journalist (1917-2000)

“Once a country is habituated to liars, it takes generations to bring the truth back.” -Gore Vidal, writer (1925-2012)

The question was simple enough.  The Americans had just stepped out onto the huge open expanse of gleaming concrete that stretched from the Forbidden City past the Monument to the People’s Heroes all the way to the Chairman Mao Memorial Hall.

“So this is where it happened?  Right here?”

The gracious Chinese host smiled, and seemed excited to answer.  “Yes!” she said, “Here is where Chairman Mao announced the formation of the People’s Republic of China in 1949, to a throng of many thousands.”

“No, I mean the protests.  Where so many people died.”

The host looked puzzled.  “What protests?” she asked.

“Well. . .when thousands of people marched and protested against the government. . .”

Now the host seemed utterly baffled.  “I’ve never heard of any protests here.  You must be mistaken.”

There was a long moment of awkward silence.  Then the group turned and began to walk out across “The Gate of Heavenly Peace,” otherwise known as Tiananmen Square.

All of that was over ten years ago.  And to this day, I don’t know if the host’s appearance of being completely baffled was because of a well-rehearsed denial strategy, or whether she honestly didn’t know what had occurred.

Not that it really matters.  Either way, the result was the same.  The actual truth was buried for political and nationalistic reasons.

Suppressing the truth.  It’s been going on for years.  And in so many ways, it keeps getting worse.

Let’s look first at history.  Someone once said “experience is the ability to not make mistakes, and the only way you gain experience is by making mistakes.

All countries, no matter how noble, have made mistakes.  Some have learned from them, others have not.  But you can’t learn from mistakes if you erase them and pretend they never happened. Like June 4, 1989.

Go back in time a moment.  Protests against the Chinese government had swelled to a massive crowd in Beijing’s Tiananmen Square.  Despite orders to disperse, the gathering only grew.

The government had had enough.  Martial law was declared, and on June 4, troops attacked the protestors.  To this day, no one really knows how many were killed.

But you won’t find this in any Chinese school book.  In fact, just mentioning June 4^th could get you arrested, which has led some government critics to sarcastically call the date “May 35.”

Nationalism, conformity, and don’t step out of line.  It’s not only happening in China.

In India, publishing a map showing the disputed region of Kashmir as “disputed” is illegal.  So is any other depiction that isn’t in line with the government’s official cartography.  India’s nationalistic tilt has also impacted its schools, where science texts no longer feature the Periodic Table (developed by a Russian), evolution (described by an Englishman), or magnetism (also discovered by an Englishman).

Don’t expect to find anything critical of government policy in Russian textbooks, either, nor any mention of Stalin’s deliberate starvation of millions of Ukrainians. 

Article 301 of the Turkish Penal Code makes it a crime to “insult the Turkish nation.”  You can guess how that impacts Turkish textbooks and how they cover, among other things, the Armenian genocide.

Be careful what you say about the Holocaust in Poland, home of Auschwitz, the most infamous of all Nazi concentration camps.  There, the official party line is that the killings were carried out solely by Germany, and that Poland played no role in the death camps.  In truth, some Poles did actively support the murders.  But say that now, and you can go to jail.  

Germany is a different story.  All German school-aged children are required to learn about the Holocaust.  Their nation’s role in perpetrating millions of murders isn’t denied.  Neither is its history of supporting the Nazi regime.

But alarmingly, this obvious issue of educational importance is being threatened by the far right.  The Alternative for Germany (AFD) party openly opposes teaching the Holocaust.  One AFD leader dismisses the Nazi killings as merely “a speck of bird poop on an otherwise glorious history.”  Others have derided Berlin’s monument to those murdered in the Holocaust as a “monument to shame.”  Still others have openly supported Holocaust deniers.

Some of the AFD will end up in government positions.  Others will become teachers.  Imagine the impact they could have on Germany’s future generations.

In his chilling book 1984, George Orwell wrote “He who controls the past controls the future.”  Which brings us to Florida.

I’ve already written my opinion on Florida overall , but education in Florida, America’s third most populous state, is entering a time of peril.  Under Governor Ron DeSantis, laws have been enacted that don’t just threaten educators, they put teachers in a straightjacket.

If you are a teacher, you are breaking the law if you teach anything about race that might make a student feel guilty or embarrassed by their own race.  That’s right—it doesn’t matter that you didn’t tell a student they should feel guilty, just the possibility that they could feel guilty means you are a criminal. 

The world should be glad that DeSantis is only screwing up Florida.  If he were Chancellor of Germany, he’d probably oppose teaching about the Holocaust, because it might make those German kids “feel bad.”

Just a note on hypocrisy here.  If a student from a liberal family felt offended by something they heard at school, what would the DeSantis crowd be saying?  “Snowflake!  Suck it up, Buttercup!”

But when it’s a sensitive little conservative Johnny or Suzie, it’s a different story.

Of course, “teaching critical race theory” is also out, even though there’s zero evidence that it’s ever been taught in Florida schools.

Somewhere north of 350 books have been banned from Florida school libraries.  DeSantis bristles when this is brought up, and insists that the state itself hasn’t banned any.  But in truth, the state legislature set in motion the process that allows individual schools to deep-six books on the basis of parental complaints.  In Duvall County, don’t try to find biographies about Hank Aaron or Roberto Clemente—they were removed because parents complained.

Ditto Beloved and I Know Why the Caged Bird Sings in several counties.  The Kite Runner is unavailable in still others.  Of course, The Handmaiden’s Tale is out, along with The Life of Rosa Parks.  Apparently, in the Duvall Counties of the world, not having your feelings hurt is way more important than whether you can think critically.

What is critical thinking?  It’s the ability to take different sets of facts that seemingly are at odds with each other, and logically analyze the information into a usable form.  But it’s tough to critically think about something if it’s been pulled off the shelves.

I’ve talked about the whole book banning thing before  When I was younger, I read everything I could get my hands on.  I was reading books written for teenagers when I was in the second grade, and adult books a couple of years later.  Did I make my mother nervous when I read all 872 pages of Norman Mailer’s The Naked and the Dead when I was thirteen?  She never said a word, despite knowing that the word “fug” appeared over a thousand times in the book.  She understood the author’s message was far more important.

In Florida, textbooks must be approved by the State Board of Education, which recently turned down over 50 math books because they supposedly had inappropriate racial content.  What’s race got to do with math?  I don’t know, but if you see Ron DeSantis maybe you can ask him.    

Because of Florida’s large population, their schools purchase a significant number of America’s textbooks. So if you’re a publisher, the last thing you want to do is be shut out of the Florida market. Thus, the “banning” movement has had a chilling effect on what gets published–and therefore what gets taught.

And a chilling effect on the truth.  One history text for Florida children removed any reference to Rosa Park’s race.  Better to sell a watered-down version of history than to sell no books at all.

What did the final version say?  Just that Rosa Parks was a lady who was “tired.”  No mention of her as a civil rights pioneer.

Of course, it doesn’t stop there.  A vaguely worded piece of legislation called the “Parental Rights in Education” bill (its detractors call it the “don’t say gay” bill) restricts gender related discussion, and opens the door for any parent to sue the school district if they think their little Johnny or Suzie has been offended, with the school district (meaning the taxpayers) left to pick up the legal tab.

An advanced placement course in African American Studies was banned by Florida’s all-knowing Board of Education.  The reason? It “lacked educational value and was historically inaccurate,” according to the Board.  Just what about it was inaccurate?  The Board wouldn’t say.

Don’t say gay.  Don’t talk about race.  Don’t use the wrong Math book.  Don’t check out the wrong library book (even if you could). Water down history.  Is it any wonder Florida has a shortage of over 5,000 qualified teachers?  As if being paid salaries that are next to the lowest in the nation weren’t enough, teach the wrong thing and you could well be sued, or even fired.

But if you are a gay school teacher, Florida is quick to point out that your sexual orientation can’t be grounds for dismissal.  You can even have a picture of your gay family in the classroom.  But you’d better not talk about that picture with your students.  That can get you canned.

Make no mistake.  You can’t embrace critical thinking if you exclude any topic you don’t like.  You can’t critically discuss ideas if you keep locking them up.  You can’t arrive at a true picture if you insist that a part of the picture stays shrouded from view.      

Throughout history, there’s been a sure-fire way to shoot down an idea before there’s even a word of discussion.  Create an impossible-to-define term, call it evil, then use it to smear anything you choose.

Woke! Woke-ism! CRT! CRT-ism!  Cultural Marxism!  Undefinable words that can be used as an excuse to ban just about anything you don’t like.  In Florida, Ron DeSantis and company have done a masterful job in this arena.  But be forewarned.  The ultimate victim of these policies won’t just be students.

It will be the Truth.

Because in Florida, each day is starting to look more and more like May 35^th. 

AMERICA IN 2050

“It’s tough to make predictions, especially about the future.” ― Yogi Berra

Although many people may roll their eyes when I say this, the city of Omaha, Nebraska has a lot going for it.  In the midst of the corn, the beef, the College World Series, the Berkshire Hathaway money, and the Union Pacific railroad, it’s also the home of the Free Speech Society.

The group is open to everyone, and seeks to facilitate respectful, open dialogue around the most important issues of the day.  It meets once a month, usually with a speaker who addresses a topic and leaves time for a lively discussion.   The coffee and doughnuts aren’t bad either.

And for June of 2023, the topic for discussion is thought-provoking:  Will we recognize the U.S. in 25 years?

Several questions were suggested by the Society’s leadership: 

• How will America’s ethnic makeup impact future policy?

• What will be America’s standing in the world?

• How might AI impact how we live and work?

• Will the U.S. be fiscally sound?

• What will be the state of national and regional politics?

• What will healthcare look like?

• What will immigration look like?

At the risk of pre-empting any discussion, and for the benefit of anyone who might not be able to attend, let me give my thoughts on each.

First, fair warning: I’ve always been someone who’s lived by the dictum “hope for the best and prepare for the worst.”  So let’s look at how these topics will play out in America, year 2050, from both a best case and worst case scenario.

HOW WILL AMERICA’S ETHNIC MAKE-UP IMPACT FUTURE POLICY?

Best Case:   Through focused programs in financing and employment, the gap in income and net worth between white Americans and non-white Americans has narrowed significantly from its 2023 level.  A focus on advancing educational opportunities in poor neighborhoods has resulted in improved educational performance.  Numerous colleges have Black or Hispanic leadership, and government/private partnerships have enhanced opportunities for trade skills that have significantly improved unemployment.

As predicted, a majority of Americans now identify as Black, Asian, or Hispanic.  More and more corporate leadership roles have been filled by those once considered a “minority,” serving as role models for young people.  Public education has played a vital role in this process, where schools that were predominantly white just thirty years ago now have a majority of non-white enrollees.  A national focus on Civics and history now engages students from all background in participatory citizenship.

Although the playing field with regard to educational and employment opportunities is still far from level, much progress has been made.

Worst Case:  Since the Keep America American (KAA) party broke-off from the Republican party in 2025, national policies have been established to prohibit discussion of issues such as social justice, slavery, and references to Jim Crow and the Civil Rights movement.  Students are taught that any areas of inequality have been the direct result of now-illegal Affirmative Action programs.  This has caused heightened tensions at many schools, especially where teachers have been fired for pointing out that the rising income gap between white and non-white Americans, as well as reduced funding at inner city schools, has led to reduced college acceptances for non-white students.  Teachers are required to teach that racial prejudice no longer exists, equal opportunities are available for everyone, and any difference in income is solely the result of a lack of work ethic.  Yet despite this, society appears to be unraveling more and more along racial lines.

WHAT WILL BE AMERICA’S STANDING IN THE WORLD?

Best case:  Following the 2024 withdrawal of Russian forces from Ukraine, and the subsequent costs of post-war rebuilding, the world has been forced to take a hard look at its future.  America has been a leader in this effort. 

Over the last 25 years, the world has gradually grown to trust the United States once again.  Unlike earlier in the 21^st Century, when America’s foreign policy would swing wildly to the left or right depending on which party was in power, thus leaving the world guessing as to what (if anything) the country really stood for, America’s Republican and Democratic parties have now embraced similar values:  democracy, open trade, free elections, human rights, and respect for law.  Although some American foreign aid is still directed toward military funding, a greater amount is distributed toward the goal of promoting international economic and humanitarian stability, particularly in South and Central America.  This has resulted in, among other things, a reduction in undocumented immigration (see below).

The U.S. has taken a lead in focusing the United Nations on problem solving.  International efforts to address climate change, displaced persons, and free trade have been led by America.  Although a few regressive regimes remain, including Hungary under its 87-year-old dictator Victor Orban, nearly every other country agrees the world is a safer and more stable place, compared to 25 years ago, thanks in no small part to American leadership.

Perhaps most significantly, the conviction 25 years ago of former President Donald Trump for compromising highly classified military intelligence reassured our allies we took the security of the world seriously.

Worst case:  Since the American withdrawal from NATO and the United Nations, the world has become a much more dangerous place.  Following NATO’s devolution, and the subsequent Russian victories in Ukraine, Moldovia, and the Baltic states, the world has struggled to find super-power leadership.  Despite grave reservations, many nations have felt they have no choice but work with China in this regard.

With the KAA party firmly in power, it appears unlikely that the U.S. will re-engage in meaningful efforts to address these issues, other than building up its own military forces.  By now, the country has withdrawn from virtually every international commission/agency, and actively discouraged its citizens from participating, as well.  The recent arrest at Dulles International Airport of three attendees returning from the U.N. Climate Study Conference is deeply concerning.

The rising influence of the RIC coalition (Russia-Iran-China), especially through their heavy-handed conflict resolution process, is particularly worrisome.  Unfortunately, with America’s influence effectively sidelined, there’s little the world can do.  This has been worsening since the round of not-guilty verdicts in the Donald Trump trials 25 years ago, which sent trust in America plummeting throughout the world.

HOW MIGHT ARTIFICIAL INTELLIGENCE (AI) IMPACT HOW WE LIVE AND WORK?

Best case:  Thanks to the work of America’s AI oversight committee, the dire predictions of AI causing human extinction have not been fulfilled.  The committee, a public-private partnership of representatives from business and government, approve research and monitor AI development.  So far, their “first, do no harm” pledge has been honored.  Although AI has shifted some jobs, it has created far more.

It’s difficult to find an aspect of American life that hasn’t been impacted.  Energy, health care, education, transportation—all have been revolutionized through AI.  Our military has maintained its strength by matching research with the rest of the world, enabling our armed forces to be more fully prepared to recognize both cyberattacks and assaults by conventional forces.

Worst case:  As companies use AI to primarily displace workers, seeking short-term profits over long-term growth, unemployment has skyrocketed. The recent riots at the Tesla factory on the old Disneyworld campus in Florida, when Tesla announced a 70% reduction in its workforce, may only be the first such event as industry cuts back further on human employees.

The KAA-sponsored citizen surveillance program has produced an AI controlled network that effectively monitors all activity within our borders, and issues AI-produced arrest warrants if any irregularity occurs.  Despite the claims that thousands of innocent citizens have been detained through overly-aggressive AI algorithms, the KAA insists the net benefit of the program is positive. 

WILL THE U.S. BE FISCALLY SOUND?

Best case:  Much has changed since the President’s landmark “Shape Up or Ship Out” economic speech 20 years ago.  Tax revenues have expanded and spending has been cut, with enough change occurring to earn both cheers and boos from nearly everyone.  But one thing is clear—America now has a balanced budget and is no longer encumbered by debt.

Taxation rates, which had become more and more focused on the middle class since 1980, have been reimposed at 1950s levels.  America entered into the International Corporate Tax agreement, which set a uniform baseline for corporate taxes, thus removing incentives for developed countries to “off-shore” their operations.  Tax havens have been shut down, tax-dodgers have been prosecuted, and for the first time in memory, America actually collects all taxes legally owed by its citizens (something thought impossible back in the 2020’s).

Worldwide trade has been enhanced, and American goods are sold throughout the planet.  Health care costs have declined (see below) and a healthier, more invigorated work force is more productive.  An expanded minimum wage has put more dollars into the hands of workers, where the multiplier effect of those dollars produces far more growth than the previous process of enhancing the wealth of corporate owners, where dollars were used primarily for stock buy-backs, yachts, and vanity space ships (see Musk, Elon).

Worst case: As America’s deficit has spiraled, attempts by government to deal with it have grown more desperate.  The KAA’s ten-year tax rescue plan, which mandates that tax rates must be lowered by 3% every ten years, has not produced the economic growth the KAA insisted would occur.  Instead, unemployment has reached 15%, poverty is at an all-time high, and what little is left of what was once called the “social safety net” has vanished.

Despite eliminating Medicare, Medicaid, and social security, spending continues to outstrip declining revenues.  This has led the KAA to institute further tax cuts, arguing that business will grow, employment will improve, and revenues will thus be enhanced (what was once called “supply side economics”).  Unfortunately, this has not proven to be the case.

Business has been further compromised by the massive tariffs the KAA has imposed on at least 40 countries that the KAA insists have not respected America.  The tariffs, along with the threat to use the U.S. Military against violators, has caused world trade with America to plumet.  This has led to increased prices for many goods here at home, and further increased poverty and economic decline.

To counteract this, the KAA has pledged to decrease taxes once again next year.  But other than the ten American trillionaires, few others expect this to improve America’s debt-ridden situation.

WHAT WILL BE THE STATE OF NATIONAL AND REGIONAL POLITICS?

Best case:  Although it would shock anyone from twenty years ago, American politics have moved from the extreme to a more reasonable center.  Ranked choice voting, open primaries, and a not-infrequent shifting of party loyalties have produced an environment in which over 70% of all bills have passed Congress with bipartisan approval.

The 29^th Amendment, limiting Supreme Court Justices to two 8-year terms, has provided a greater diversity of legal opinion to prop the “third leg” of the American government.  Annual strategic planning sessions between majority and minority congressional leadership has led to unified goal setting and more effective government.

America is once again the model that the world looks to for government that works.

Regionally, pockets of intense political polarization continue to exist, but this is largely limited to the southeast and the west coast.  In Nebraska, for example, a wave of successful petition initiatives overturning more than a dozen Legislative bills apparently got the attention of officeholders.  Real (as opposed to token) public input now plays a much larger role in legislation.

The Redistricting Task Force, set up after the U.S. Supreme Court struck down seven highly partisan attempts at state gerrymandering, now approves Congressional redistricting on the basis of geography and demographics, rather than politics.  At both the state and federal level, this has led to an upsurge in voting, in contrast to 20 years ago, when the only votes that seemed to matter were limited to so-called “swing districts.”

Worst case:  Through a series of Supreme Court decisions upholding the creation of “virtual” districts, the KAA has been able to amass a Congressional supermajority, as well as the presidency for the past 20 years.  All 9 members of the Supreme Court have been appointed by KAA administrations, and KAA dominated states have regularly overturned elections, claiming they were rigged.  This has led to states such as Texas, Florida, and West Virginia getting the bulk of all federal aid programs, with California and New York experiencing significant cut-backs.

Although it is clear that a plurality of Americans do not support KAA policy, the party nonetheless holds power through gerrymandering, successful voter suppression, and an interventionist Supreme Court.  As much out of despair as anything else, voter participation has dropped to barely 20%.  The world, of course, sees all of this clearly, and wonders what has become of this former-democracy called America.

WHAT WILL HEALTH CARE LOOK LIKE?

Best case:  With the passage of the Health Care for All America (HCAA) act, basic coverage has become universal.  Americans are now paying less in health care taxes than they were previously paying in premiums and taxes combined.  Access has improved, and American life expectancy, declining for years earlier in the century, is now rising significantly.

The Act was initially opposed by many, as manifested by the 2-week doctors’ strike in Florida and Texas, but since that time public approval of the program has soared.  A few private companies sell supplemental policies to add benefits to standard programs, but by and large the power of private insurance to dictate health care has declined.  The 600,000 health insurance employees whose positions were eliminated in the conversion to the HCAA quickly found employment in a private sector that boomed when the costs of insurance premiums were removed from their gross revenues.

Business has expanded, the number of uninsured has dropped to near zero, and with access to primary care now available to all, the number of emergent procedures has declined significantly.  Other than a few CEO’s who had previously been paid multi-million-dollar salaries in the private insurance world, everyone agrees the current system is working exceptionally well.

Worst case:  Since the passage of the KAA sponsored “Liberty Vouchers” Act, which eliminated Medicare and Medicaid, the number of uninsured has risen significantly.  Currently, 75 million Americans have no health insurance, and a similar number have bare bones policies that simply aren’t enough to cover essential care.

This was not the legislation’s intent.  However, the voucher subsidies are fixed, and have not kept up with inflation.  Consequently, most elderly Americans claim the vouchers are essentially worthless, since they cover only a fraction of premium costs for available policies, and, they claim even these policies don’t provide the coverage of the old Medicare program.  Nonetheless, the KAA is adamant they won’t turn back to a socialist program like Medicare.

Hospitals in inner city and rural areas continue to close, as available revenues dry up due to uninsured patients.  Doctors continue to preferentially practice in suburban areas, where reimbursement is highest.  Despite KAA assurances that things will improve, American life expectancy continues to plummet.

One area is doing well though—private health insurance.  United Health Care’s 2048 profits exceeded $100 billion, and the NFL now awards the United Health Care trophy to the winning Super Bowl team.

WHAT WILL IMMIGRATION LOOK LIKE?

Best Case:  Although applications for immigration still exceed available vacancies, the applicant number has decreased.  Illegal border crossings have diminished as the U.S. has helped rebuild Central American economies.  America has helped lead the International Refugee Board, which seeks to provide a rational approach to immigration world-wide.  With increasing climate disasters, the number of displaced persons in the world has risen to nearly 200 million. However, using world-wide resources, this population is being resettled in the most effective way possible.

Although initially opposed by many as too expensive, the Central American Partnership Plan, which has modernized Central American police forces and boosted employment, has led to a significant improvement in the standard of living in those respective countries.  Everyone now agrees this was money well spent. Clearly, it has brought about a reduction in those seeking to immigrate from those countries.

As has been the case for over 200 years, immigrants have been assimilated into American society and workforce.  They now contribute more to the social security trust fund than native born Americans, and first-generation immigrants are recognized as among the most patriotic of all Americans.

Worst case:  Since the KAA shut down legal immigration for all non-European immigrants, the number of people seeking to enter the U.S. from the southern border has skyrocketed.  Despite a declining workforce and pleas from American business, the KAA is adamant that immigration must be halted.

What was previously known as “replacement theory” has formed the backbone of American policy.  Though it’s not official, statistics are clear that Black and Hispanic immigrants are more likely to be deported than those from European origin.

The unfortunate incident last month at the southern border when border patrol officers opened fire on border crossers and inadvertently shot 3 Mexican soldiers has led to a deterioration in our relationship with our southern neighbor.  The announcement that Mexico has shut down its own border crossings in reprisal for the shootings, along with the loss of cross-border trade, has been a crushing blow to American industry.  The report that Mexico has signed a priority trade agreement with China in retaliation for our immigration shutdown has rocked the world. 

Where all of this will end is anybody’s guess.

BOTTOM LINE:  Will any of this happen?  Will none of it?  Are these scenarios too dark or too rosy?  Who knows?

Feel free to make your own predictions and then discuss them with others.  Think about ways we can move toward the common good, and avoid the outright disastrous.  Not that any of this will affect me personally.  In 2050, in the unlikely event I’m still around, I’ll be 98.  But how all of this will affect my children, grandchildren, and the world I love is a different story.

And if you think any of these scenarios seems too improbable, remember this:  What were you thinking in 1998?  What were you doing?  What were you envisioning?  Could you have foreseen the changes that have occurred in our country?  The radical Supreme Court decisions?  The normalization of mass shootings?  The rise in authoritarian governments in countries that had previously been democratic?

Probably not.  All the more reason to consider where we are as a nation, where we are headed, and how we must change course.

And all the more reason to talk about it.

Sunday afternoon, the end of another long boring week in America.  Keep on walking.  Nothing to see here.

At least nine people dead in a mass shooting in Texas.  Nothing new.  Last year alone, Texas had 55 of ’em —better than 1 a week. Besides, there’s already that little episode a couple of weeks ago where the guy took an AR to his neighbors.  They’d asked him to please stop firing it since it was making their baby cry.  Only five dead bodies in that one, including a nine-year-old.  Nothing new here.  Just keep on walking.

Oh, yeah, I guess there was also that family up in Oklahoma, the highway shootings in Maine, the ongoing road-rage, the. . .  Well, yeah, you get the idea.  Just 17 mass shootings this past week.  No big deal.  This is America.  Get used to it.

All of this is probably assuring my Swiss relatives that their country is moving in the right direction.  Once (inaccurately) described by the National Rifle Association (NRA) as a nation with guns everywhere, Switzerland has now dropped to nineteenth in the world in gun ownership. 

But maybe the NRA can have a new poster child for gun ownership—Serbia.  It ranks third in gun ownership among countries with at least a million citizens.  And in only 2 days, they’ve had 2 mass shooting.  Who says American values can’t be spread abroad?

Ironically, just today, a letter in the Omaha World Heralddrew attention to the fact that 20% of Nebraskans will experience a mental health condition in any given year.  That’s no different from the rest of the nation—at any given moment, 1 in 5 adults is experiencing significant depression. But should they be carrying guns around?  Of course!  Besides, that just gives us all an excuse whenever someone gets shot.

The NRA is right—people kill people.  And the more drunk, high, depressed, angry, sad, bitter, disappointed, confused, belittled and hopeless people who have guns in their hands?  The more Americans are going to wind up dead.  But that’s OK.  Because we can always T.A.P.-out.

Just abbreviate it like that.   Thoughts and Prayers.  We say it so often these days, we might as well just shorten it.  Thoughts and Prayers.  Thoughts and Prayers.  Thoughts and Prayers.  TAP, TAP, TAP.  TAP, TAP, TAP.  TAP, TAP, TAP.

Nothing new here.  Just TAP-out and walk on by.

But this just gets us started for the week that was.  In other news, the U.S. Congress is engaged in an ever-escalating pissing match over the debt ceiling that has the potential to devastate the economy of the world’s strongest, richest, and most important nation.  Republicans, who care deeply about the deficit (but only when Democrats are in office), seem content to let the country default on it’s debt, turning us into a dead-beat nation.  Never mind that every economic analysis has indicated that unemployment will skyrocket, our economic output will fall, and the country will profoundly suffer.

Do we need to cut our spending and increase our revenues?  Of course.  But any decent business manager can tell you, an organization that manages by crisis isn’t going to last long.

Ditto governments.  Congress needs to dispense with all of the Jr. High drama (OK, it’s Middle School now), raise the debt ceiling so we can function as a nation, then do the hard work of fixing the budget.  It’s way overdue.  In the past, neither Democrats nor Republicans have shown any interest in it.

But the news keeps getting better and better.  Traditionally, the American people have believed that regardless of who controlled Congress and/or the White House, at least the Supreme Court could be an impartial arbitrator of justice.

And despite numerous biased and purely partisan political decisions by the Court this past year, many Americans still believed they could count on the institution for justice.  But any remaining hope for The Court went out the window this week with the mounting evidence that Court decisions were essentially bought and paid for by wealthy conservative donors.  From what we know, Clarence Thomas (https://www.newsweek.com/clarence-thomas-tangled-web-gets-worse-worse-senator-durbin-1798894) and quite possibly John Roberts have been on the receiving end of big dollar influence.

I’ve already commented on Thomas, but Roberts really saddens me.

Most of us have seen a picture of the statue of Lady Justice.  Blindfolded, she holds a sword in one hand and a set of scales in the other.  She is supposed to represent absolute fairness in the Judicial System.  But after this week, Thomas has turned her into an image of a stripper with a wad of dollar bills in her G-string.

Around the country, state legislatures are wrapping up their sessions.  Most of them haven’t bothered to spend time on such mundane issues as health care, mental health services, public education, women’s health, poor nutrition, and inadequate infrastructure.  Instead, it’s been a frenzy of anti-abortion, anti-gay, anti-trans, anti-public education, anti-public health, and anti-public safety legislation.  And in far too many states, there’s also been a far-right Governor salivating to sign them into law.

Of course, all of this just scratches the surface.  At the border, thousands of desperate asylum seekers are waiting for COVID-era Title 42 restrictions to expire.  They’ll be begging for a chance at a better life.

Can we take them all?  Of course not.  That’s why troops have been deployed.  But we can legally take a lot more than we’ve been taking.  Businesses are desperate for employees.  Unemployment is at record lows.  It only makes sense.

But one thing is certain.  Whatever the number of legal immigrants, it will be too many for those who want to use immigration as a political club to bludgeon their opponents, regardless of the human suffering that occurs.  Immigrants are usually poor and powerless.  They make perfect scapegoats for demagogues. 

But on the positive side, unemployment continues to fall, inflation is coming down, and the grass is starting to green-up.

So let’s ignore all of the other stuff.  Just keep on walking and pretend it’s not happening.  Nothing to see here.  Nothing to get upset about.

Ho-hum.  Just another week in America.

“No country which is now developed has done so without providing high quality public education”.—Atishi Singh

“(I envision) A system of general instruction, which shall reach every description of our citizens from the richest to the poorest. . .  If a nation expects to be ignorant & free, in a state of civilisation, it expects what never was & never will be. An educated citizenry is a vital requisite for our survival as a free people.”—Thomas Jefferson

“For Jefferson, there was one step crucial to creating a genuine natural aristocracy. The poor and rich had to have equal access to a good education.”—Fareed Zakaria 

“I can no longer support a party that seeks to measure educational success on the basis of how many children leave public schools.”—Senator James Jeffords of Vermont, on announcing his decision to leave the Republican party in 2001.

I vividly remember the moment I knew I was in deep trouble.  It was the fall of 1970.  I was shuffling out of calculus class where I’d just been slapped in the face with the results of our midterm exams. It not only confirmed that there was a lot of calculus I didn’t know, but that most of the stuff I thought I knew was also wrong.  I was as panicked as an eighteen-year-old could get.

But it was about to get worse.  At that moment, I overhead two classmates who were walking out of the room ahead of me.  “Man,” one of them said.  “Can you believe how easy this class is?”

“I know,” the other replied.  “We haven’t had a thing we didn’t cover in high school.”

I nearly fainted.  Both were from an upper-middle class suburb of Kansas City, and had obviously gone to a school way more affluent than mine.

So maybe I should say a few words about West Platte High School in Weston, Missouri—my hometown.  We had 39 kids in my graduating class.  Math was pretty straight forward.  Algebra your freshman year, geometry sophomore year, Algebra II as a junior, and finally trigonometry when you were a senior.  Nobody thought about calculus.

But because of an overly-optimistic college enrollment process, and the fact that I had decent high school grades, I was thrown into an accelerated calculus class—Math 199 (I was also tossed into a similar advanced Chemistry class where I also struggled, but that’s a different story).   I felt like I was running a race through quicksand while the rest of the class was sprinting away.

In the end, of course, it all worked out.  I made it through Calculus 199, as well as the second semester 200 class.  I found my footing, pulled my grades up, and was able to go to medical school, the one thing I really wanted to accomplish.

How did I do it?  For the same reason I struggled early on—my high school background. 

West Platte was an incredibly safe place.  No one carried guns.  I had teachers who cared about me.  Hard work and perseverance were valued every bit as much as intellectual ability.  The school was basically a “classless” society.  Yes, there were a tiny fraction of kids we considered “rich” and an equal number who lived in poverty.  But for the most part, we were all “salt of the earth” as the quaint expression goes—small farmers, blue collar workers, and shop keepers.  We worked hard, we endured, we stuck it out.  It turned out that was way more important in the long run than whether we left home knowing how to calculate area under a curve.

But today, public schools such as mine are under assault all across the country.  In state after state, teachers are denigrated by politicians, funds are being syphoned off to private schools (many with dubious academic goals), and the financial strength of well-to-do neighborhoods creates growing inequality in what students can hope to experience. 

Bluntly stated, some private schools raise millions of dollars to build fine arts centers, while similar public schools hold fund raisers to pay for textbooks.

Many parents demand the right to micromanage their kids’ education, insisting on what should or shouldn’t be taught.  Don’t say gay, don’t say anything about reproduction, don’t talk about climate change, don’t mention race, don’t even think about evolution—as if education was no different from ordering a Big Mac from a McDonalds Drive-Thru. 

Never mind whether those kids will be able to get a decent job, think for themselves, or compete worldwide.  It’s more important to make sure there are things they’ll never learn.

I’m going to be blunt.  Public education built this country.  Jefferson was right—destroy public education and you will eventually destroy the nation.  But today, that concept has been lost in what can only be described as a blind pursuit of “choice.” 

Parents want to “choose” what their kids learn and don’t learn, where they attend, who their kids see and don’t see, what they can deny and what they can ignore.

In the process, they’re cutting off opportunities for other kids, as well—the same kids their own children will one day work with, and either succeed or fail with. 

I don’t care what your thoughts on “choice” happen to be, you can’t keep your kids inside intellectual and emotional bubble wrap forever.

Unfortunately, this basic message seems to have been lost on many parents.  Instead, they’re demanding that tax payer dollars be diverted away from public schools to private institutions that are often religious, unaccredited, for-profit, or in some cases, all three.  Schools that can refuse children with learning and/or physical disabilities.  Schools that can kick a student out on a whim.  Schools that can pass over kids who have difficulty keeping up.  Schools that can permanently expel students because of their beliefs.

This was the last thing Jefferson, or any of our other founding fathers, wanted.

Take Florida for example. Its Governor Ron DeSantis recently signed into law a bill that could potentially divert billions of dollars away from public schools to private institutions.  What are these schools like?  Almost all are based on either religious ideology, investor profit, or lack accreditation.  How many private Florida schools don’t fit at least one of these categories?  Less than 3%.

When the Civil Rights Act of 1965 was passed the number of private schools (many called themselves “academies”) exploded.  Most were grounded in religious fundamentalism, but their real underlying purpose was clear.  They intended to resegregate white kids from schools that had been integrated.  An added affect was often to incorporate racism, anti-science, and Christian nationalism into the curriculum.  Over the years, their numbers have only grown.

So let’s take a minute to discuss religious schools.  The largest number are run by the Catholic Church and have been around for years.  Some are educationally strong, and some aren’t.  But they don’t play by the same rules as public schools.  They don’t need to meet the same accreditation requirements, or pay their teachers accordingly.  Step out of line, and you could well find yourself on the street.

One of my son’s best friends had a younger brother who was a gifted student.  After college, he took a job as a speech teacher at a Catholic high school in an affluent part of town.  He coached the school’s debate team to multiple state championships. He was admired and recognized by everyone for his teaching excellence.

That is, until the school found out that he was gay and living with another man.  Just like that, he was gone.  Across the country, similar stories abound with regard to both students and teachers whose sexuality, speech, and lives aren’t in line with local Catholic values.

Believe me, I’m not trying to offend Catholic readers.  If you wish your children to experience this sort of education, fine.  But please don’t ask me to pay my tax dollars to support you.

Another family I know inquired of a different private Christian school (this one non-Catholic) about enrolling a troubled son.  The parents felt that the school’s discipline might be helpful to the child’s future.  The school’s Principal, however, reacted as if she’d been insulted.  “We don’t run a reform school here,” she said.  “If students cause problems, we expel them.  If you think this might happen, I suggest you look elsewhere.”

Much has been made about differences in educational outcomes between private and public schools.  Early on, voucher programs that shifted a small number of students from certain poor performing inner city public schools into private schools showed improvements.  This caused many to jump on the voucher bandwagon.

But when such programs were expanded to basically allow all students to use vouchers in private schools, any improvement vanished.  Some students (and private schools) did worse than public schools.  When implemented on a broad scale, the magic of vouchers disappeared.

The only thing that changed was the dollars being drained from public schools—and the students who attended them.

Let’s face it.  “Choice” in a market-driven society favors those most skilled in marketing, window dressing, and profit-taking.  A wide-spread “rob-public-schools-to-pay-for-private-schools” program will lead to a proliferation of heavily marketed, often for-profit schools.  Many will lack accreditation.  Many will promote a rigid ideology over a broad-based education. Many will ban a wide range of books.  Many will promote quack pseudoscience that will poorly equip students for the future.  Many will be implicitly—if not overtly—biased against certain races, religions, and people.  All of them will compete ferociously for student dollars—and some will make out like bandits.

And it will all be paid for by money that should be going to public schools.  In that case, we can replace Jefferson’s dream of universal education with the phrase “buyer beware.”

What about transportation?  Few private schools have buses, etc.  Even if you’re a gifted kid that’s been suddenly handed a voucher, how do you use it if private schools are miles away, and your parents are working, absent, or don’t have a car?

Virtually every parent in America wants their child to get the best education possible.  Many have been led to believe that simply putting the word “private” in front of a school’s name makes it better.  We now know it doesn’t.  Improving education will take more than handing out vouchers and dumping schools into a free-market free-for-all measured by dubious outcomes.  It will require recognition and support of teachers, who along with police officers, are among the most undervalued and underpaid workers in the country.  It will require better training for all educators.

For a second, let’s take a look at one of the most successful educational systems in the world—Finland.  What’s different about it?

For a start, for-profit private schools are banned.  Any remaining private schools must adhere to the same curricula as public schools.  Teachers are held to the same training standards (at least a Master’s degree to start) and the same pay scale as teachers in public schools.

The result?  Fewer than 2% of Finnish kids attend private schools—and as a nation, they have some of the best educational outcomes in the world—a lot better than ours, where over 10% of American kids go to private schools.

What about that kid in Calculus class I described earlier?  What if I’d been offered a voucher when I was starting high school?  Private schools were miles away, and I couldn’t have gone.  And what if I had?  What if I’d somehow wound up in an exclusive Kansas City prep-school full of wealthy kids? Could I have even adjusted to such an environment?  Would I have left with my sanity intact?  Who knows.

Sorry, but I’ll take my small-town public school any day.

Once again, this is not to say there is no role for private education in the future.  But any move in that direction must be carefully targeted and well thought out.  For-profit schools must be excluded.  Both funding and teaching must be balanced.  When you rob Peter to pay Paul, everyone loses. 

The massive shift of funds from public schools to private schools will hurt America’s poorest students and represent just one more tax break for wealthy families.  In Arizona, where a voucher plan was recently put into place, over half of the students who took the vouchers were from upper middle-income families, and already attending private schools.

“Choose” to starve public schools, and you’ll pay a lot more down the road—in “choosing” to build new prisons.

The conservative economist Milton Friedman once said “There is no greater threat to a free society than for corporations to act with any sense of social responsibility other than to make as much money for their shareholders as possible.”  Is this really the vision we want for education?

Make no mistake, Capitalism and the Free Market have worked great in most areas of the economy—selling cheeseburgers, apartment buildings, haircuts, and automobiles.  But in areas such as healthcare, it’s been a disaster.

While the free market has been a boon for health insurance companies and Wall Street-owned medical corporations, it’s given the rest of us out-of-control costs, millions of uninsured, and the worst health care outcomes in the developed world.  How about roads and highways?  America would be crazy to get rid of public highways, let companies build private ones, then hand out vouchers for us to “choose” a road.

Use “choice” to turn education over to the same forces that have perverted our country’s health care, and the results for America’s future students—and for American society—will be worse.  Much worse.

America must choose between the public-school vision of Thomas Jefferson and the market-driven version of “vouchers” and “choice” espoused by Friedman.  The latter has the real possibility of setting our educational outcomes as far back as those in health care.

In an increasingly dangerous world, which “choice” do we really want to make?

COVID AT THREE YEARS—PART TWO:  FAUCI, THE CDC, CHINA, AND THE TWILIGHT ZONE

Last post, I tried to encapsulate some of what we’ve been through these past three years.  Flying by the seat of our pants, we tried to fight a previously unknown virus while desperately struggling to understand it.  All the while, it was rampaging relentlessly across the globe.  We hadn’t been through something like this in forty years.  Not since. . .

So let’s go back in time for a moment.  In the summer of 1981, cases of a previously unknown disease that ruthlessly destroyed the human immune system were being seen in increasing numbers.  Nobody knew what the hell was going on.

That disease, of course, was what became known as Acquired ImmunoDeficiency Syndrome, or “AIDS.”  Its cause?  An RNA retrovirus that was given the name Human Immunodeficiency Virus, or HIV.  Its structure and mechanism of action kept it one step ahead of the body’s immune-recognition system.  Entering the blood stream as a strand of RNA, it first was copied into DNA, then converted back to RNA, then finally into messengerRNA, where it hijacked the body’s cells and did its dirty work.  We’d never seen anything like it.

Scientists at the Center for Disease Control (CDC) and the National Institute for Allergy and Infectious Disease (NIAID) worked non-stop to understand and combat it.  This meant identifying the viral structure, determining how it spread, gaining some understanding of where it came from, putting in place safeguards to try to control its spread, and coming up with effective treatments.

It was an overwhelming task that landed squarely on the shoulders of one person.  A man who worked tirelessly to combat the disease.  A man who took enormous flak from both conservatives (“you’re pro-gay!  You’re promoting promiscuity!”) and liberal-leaning AIDS activists (“why aren’t you doing more?  You must be anti-gay!”)

In truth, this no-nonsense physician-scientist was neither.  Instead, he was a tireless worker who led an effort that eventually wrestled the virus to the ground.

His name was Dr. Anthony Fauci.  Fortunately, a Republican administration gave him the tools, the respect, and the leeway he needed to go after the disease.

Forty years later, another Republican administration would take a far different approach.

No, COVID is not AIDS and SARS-CoV-2 is not HIV.  The latter is spread only through blood and/or sexual contact, and is far deadlier.  The former is spread through respiratory droplets and aerosols (this makes it much more difficult to avoid) and produces everything from minor symptoms resembling “the cold” to an explosive “cytokine storm” that carpet bombs every major organ system in the body.

Regardless, both can kill you.  As of today, just under 7 million have died from COVID worldwide.

So how did Tony Fauci go from hero to villain, suddenly blamed for anything and everything that went on during the pandemic, and ultimately cast as the person who somehow started the whole thing?  Let’s go back to some basic questions from my favorite antagonist and perpetual thorn in my side, Larry Scheissekopf.

Larry (Year 2000)  “This is one big hoax! Fauci’s making this up.  Why’s he trying to make this into something it isn’t?  Standing six feet apart, wearing a mask, staying home, talking about a vaccine!  What a bunch of crap!  There’s nothing to this!  He’s just trying to undermine our President Trump who knows this doesn’t amount to anything!”

Answer:  No Larry, in truth it was Trump who undermined our efforts to fight the virus.  When HIV came along, Reagan didn’t know squat about it, just like Trump didn’t know squat about COVID.  The big difference was, Reagan was willing to admit it.  Trump wasn’t.

This meant that for Trump, the ultimate showman, COVID was nothing more than another show.  “It’s just a hoax!  Nothing more than a few cases!  It’ll be over by Easter and we’ll all be back in church!” (Donald Trump in a church?  I’d be worried the ceiling would cave in).

Instead, as much out of desperation as anything else once the body count started rising, Trump pivoted to fictional cures, like “powerful lights,” “strong disinfectants,” and who could forget “we have this wonderful drug.  Chloroquine.  Some people put ‘hydroxy’ in front of it—hydroxychloroquine.  Powerful drug.  Very powerful drug.  It’s been around a long time, so we know it doesn’t kill anybody.”  (Actually, it can).

If Trump had listened to those who actually understood the disease and just kept his mouth shut (like Reagan, who supported Fauci and the CDC), we’d all be a lot better off today.  But listen and keep his mouth shut? Those are two things Trump just can’t seem to do.

Larry (Year 2003)  “This is all Fauci’s fault!  He created this virus!  And I never said it was a hoax!” (Actually, Larry, you did).  “It came from a Chinese laboratory that Fauci funded!  He did this!  It was some kind of thing called ‘Gain of Function!’ Fauci did it!”

Answer:  Let’s go over this again, Larry.  We don’t know where this virus came from, and we’re likely never going to know. 

When President Biden requested that all government agencies submit their conclusions regarding the source of the virus (something Trump certainly never did), two agencies indicated that they felt it was the result of a lab leak, but could only say this with a low level of confidence.  Other evidence pointed to the Wuhan “wet market” (a sort of open-air stockyard/sales barn for every exotic animal you can think of—readers with a rural background will immediately get my analogy), where bats and racoon dogs were the suspected culprits.

The jury’s still out.  But for a moment, let’s assume that it did come from a lab at the Wuhan Institute of Virology (WIV).  What would Fauci have to do with that?

The conspiracy theory goes something like this.  A foundation called the Ecco alliance , which seeks to find treatments for emerging viruses around the world, was provided a $3.7 million grant by the NIAID to assist with virus research at the WIV.  Nothing unusual here.  The Alliance conducts worldwide research, and gets funding from a variety of sources throughout the world.

But because this particular funding went from the NIAID, to the Ecco Alliance, to the Wuhan lab for viral research, and because the virus was first noted in a Wuhan hospital, this was somehow all Fauci’s fault.  The research at WIV, the conspiracy buffs insisted, somehow took a run-of-the-mill coronavirus, and made it into a Frankenstein virus!  And none of this would have happened if it hadn’t been for Fauci!

In truth, there’s no evidence that any “gain of function” activity occurred at the lab.  And even if it did, it’s doubtful that the $3.7 million from the EccoAlliance would have made any difference one way or the other.  I’ve visited several Chinese research facilities—they’re big, well-staffed, and frankly should scare the hell out of all of us.  Last year, China spent over $500 billion of their own money on research.  If they really wanted to do gain-of-function research, they sure didn’t need anything from us.

Of course, none of this has kept America’s favorite ex-Ophthalmologist/current-conspiracy buff, Senator Rand Paul, from pushing his theory that Fauci personally financed some sort of Frankenvirus.  But then again, Rand was also the guy who claimed that since he’d had a minor case of COVID, he didn’t need to wear a mask or get vaccinated because he’d be immune forever. As I’ve already said , he should be glad he’s already a doctor, because if he were in medical school today and said something this incredibly stupid, he’d get his butt flunked out in a heartbeat.

So you don’t like Rand Paul.  I get that!  But why would anyone in a government agency be saying that the virus came from a lab, if it wasn’t true?

Answer:  Well Larry, we simply don’t know.  And maybe that’s for the best.  I want our security services to do their jobs and do them well.  Some of their sources need to be classified.  But those agencies also aren’t perfect, and sometimes get things wrong.  Very wrong.  Exhibit A?  Saddam’s weapons of mass destruction that never existed.  The important thing is that the insights of all agencies need to be pooled and considered when trying to uncover the virus’s origins.  And right now, those agencies are all over the place in their assessments.

But not one of them has pointed at Dr. Fauci as somehow being behind any of this.

“But Fauci lies all of the time!  He told us we didn’t need masks, then said we did!  He told us a vaccine would protect us, but then said we needed all kinds of boosters!  He said it would be over once we had a vaccine, then told us something different!  I’m telling you, the man’s a liar!  So is everyone else with the CDC and NIAID!  I’ll never trust them!”

Answer:  Larry, let’s get something straight.  This virus did not come with an instruction manual!  From the outset, it spread rapidly, killed unpredictably, and mutated like mad.  And all the while, the Trump administration downplayed it, denied it, scapegoated it, and once the body count was undeniable, promoted phony cures that were straight out of the Twilight Zone.

Dr. Fauci, in contrast, told the truth.  Larry, I’d challenge you to find a single instance in which Dr. Fauci made any kind of statement about the status of the pandemic, where he did not also use a phrase like “based on the best evidence we have now, and knowing that evidence may change,” or “based on the information we have available at this time,” or something of that nature.  Fifty bucks says you can’t.

Trump’s pronouncements, on the other hand, were completely devoid of such qualification.

Science follows the evidence, and sometimes evidence takes us up blind alleys.  We have to turn back and regroup.  This happened with HIV.  It happened with Ebola.  And it certainly happened with COVID.  The big difference was that COVID affected way more people.

Larry, for nearly thirty years I gave a talk to incoming medical students, a bunch of bright-eyed, bushytailed doctors-to-be.  One of the things I warned them about was this:  “If you’re going to be a physician, you must accept the fact that medicine changes.  We uncover new information.  That means that some of the things you’ll stay up all night studying in medical school and accept as true, will one day be proven to be absolutely, totally, completely wrong.  That means you will have to back up and relearn that information, and reapply it to the way you treat patients.  And if you can’t do this, ladies and gentlemen, you have no business becoming physicians.”

The truth is, Larry, Dr. Fauci and the CDC were forced by the President to fight this virus with one hand tied behind their back.  They had to fight two wars—one against the COVID virus itself, and another against the misinformation virus spread by the Trump administration and their allies.  Based on the decline in death rates, we may be close to winning the first war.

The second war, I’m afraid, may never end, given the number of Monday morning quarterbacks who insist on criticizing our response.

“So you’re telling me Fauci is some kind of hero?”

Answer:  That’s exactly what I’m telling you.  He steered us through the pandemic as well as anyone could.  He told the truth even when it wasn’t popular.  And he didn’t let politics stop him.  There aren’t many who would do that.

And remember, he’d been through all of this before.  Throughout the HIV epidemic, there were plenty of conspiracy buffs claiming that HIV had been manufactured in some secret facility in Africa, or Pennsylvania, or Russia, or God knows where.  Fauci had to just take those insults and keep going.  Of course, it was much easier back then, before the internet and its massive spread of viral lies.

“So what happens now?”

Answer:  Your guess is as good as mine, Larry.  But with newer and deadlier viruses bursting onto the scene as fast as we can keep up with them, it’s going to be very interesting.  Will we have learned anything from COVID that will save lives in the future?  I see reasons to be both optimistic and pessimistic.

But if the past fifty years are any indication, we’re soon going to find out.  So hang on to your powerful lights, strong disinfectants, hydroxychloroquine, ivermectin, colloidal silver gargles, garlic, crucifixes, and whatever else you still think gives you magic powers.  The next time around may get really ugly.

Further reading/listening:  Try The Great Nations of Europe by Randy Newman.  Pay close attention to the last verse. . .

Lyrics:

Randy Newman – The Great Nations of Europe Lyrics | Genius Lyrics

Music:

The Great Nations of Europe – YouTube

COVID AT THREE YEARS:  SEPERATING FACT FROM FANTASY

Three years ago this month, I was on an Amtrak passenger train pulling out of Vancouver, Canada, headed toward Seattle, Washington.   The eight cars had more train crew than riders.  We didn’t know it then, but it would be the last train out of Canada for the next 2 and a half years.

The COVID-19 pandemic was just beginning to body-slam the world.

Today, 16 million deaths later (over 1.1 million in America alone), the world is in a much different place.  What have we learned about the disease, and what have we failed to learn?  Maybe more importantly, what have we learned about ourselves?

From the outset, COVID was politicized, dismissed, scapegoated, subjected to blatant science-denial, and used as an excuse for Americans to despise and threaten one another.  Any other time in our nation’s history, COVID would have been a reason for Americans to put differences aside and come together as a nation to fight this threat.

Instead, twenty years into the supposedly enlightened and advanced twenty first century, it ripped us apart.  It made us weaker, dumber, more inwardly focused, and frankly more vulnerable to our enemies than at any time in years.  Our response—or lack of one—led to the highest COVID mortality rate in the developed world.  If we’re looking for someone to blame, forget about government, China, public health, or the medical profession.

Instead, we need to take a long, hard look in the mirror.

Someday, volumes will be written about the pandemic.  But for now, let’s focus on where we stand today, and try to separate truth from fiction.  Let’s start with some basic questions and answers.

“Three years?  Lockdowns, masks, vaccines, cancellations?  When is this thing finally going to be over?”

Answer:  Probably never.  Everyone who thought that we should just “let nature take its course” and quickly achieve “herd immunity” was wrong.  Everyone who thought just getting vaccinated would be enough to make you immune forever was wrong.  We were all wrong.  It turns out this virus mutates like crazy.  It’s now endemic, like influenza (although a lot deadlier).  The best we can hope for is an annual vaccination, like the influenza shot, that will boost immunity year-to-year and save lives. 

“But vaccines don’t work!  I know people who got all kinds of shots and still caught the virus!”

Answer:  There’s nothing magic about vaccines.  They simply boost the body’s immune response to enable it to produce antibodies more quickly when the virus does strike.  The same is true with an actual infection—if you survive, you will have some degree of immunity from the infection, too.  But that immunity will wane.  From what we’ve seen so far, those who have both had the vaccine and been infected have the highest level of antibodies.  But even they may get it again.

From a personal standpoint, I’ve been vaccinated, boosted, and received the bi-valent booster.  I still came down with COVID.  I had a fever for less than 24 hours, was knocked on my butt for a couple of days, but otherwise that was it.  A friend said “so the vaccine didn’t keep you from getting it?”  No, I responded, it didn’t keep me from getting it.  It just kept me out of the cemetery.

“So some people get the vaccine and still die, right.”

Answer:  Yes.  Like I said, vaccines aren’t magic.  But the protection is significant.  At the present time, over 300 Americans are dying each day from COVID.  The death rate is four times higher in those who haven’t been vaccinated.

“But the vaccine is killing people!  You hear that everywhere!”

Answer:  No, not everywhere.  Just from unreliable news sources.  But it’s an example of the kind of misinformation that’s still out there.  Here are the facts:  Some patients, usually younger males, have developed a temporary inflammation of the heart muscle called myocarditis.  The risk is far less than the risk of getting myocarditis from the disease itself.  Have any patients died from the vaccine?  Throughout the world, with over 13 billion doses of the vaccine administered, a total of 4 deaths are thought to possibly be linked to vaccine-related myocarditis.  That’s in contrast to a documented 6.7 million deaths (some think it’s closer to twice that many) from the disease itself. 

You’re more likely to get hit by an asteroid than die from a vaccine complication.  COVID itself, obviously, is a different story.

“OK, but this whole thing is still a joke.  It’s really no worse than the flu!”

Answer:  Yes, it is.  Depending on the year, between 10,000 and 50,000 Americans die from influenza.  Last year, 270,000 died from COVID.  It’s not “just the flu.”

“Fine, but what about masks?  The government has no right to tell me to wear a mask.  That’s communism!”

Answer:  No, it’s not communism.  It’s no different than speed-limits or laws that say you can’t walk around town naked.  But I’ve already written about that here , haven’t I?  And along with it, an explanation as to why masks weren’t initially recommended (only social distancing) but later were found to be worthwhile.  That’s the great thing about links.  You don’t have to write it again.  Just click and go back and read it.

“But they don’t work.  They did this big study over in England that proved masks were worthless!”

Answer:  What you’re talking about was an analysis done by the Cochrane Library.  It wasn’t a study, and it really didn’t prove much of anything.  It tried to evaluate evidence of how physical interventions (masks, handwashing, nose drops, even the colloidal silver that charlatans like Alex Jones sell) affect the transmission of respiratory viruses in general.

What Cochrane does is analyze what are called “controlled trials.”  That is, studies that look at what happens when half of a group does one thing (like take a blue pill) and the other half does something else (like take a green pill).  That’s easy to do when you can watch people actually take a pill.

But what about masks?  You can’t follow people around all day.  So any comparison is pretty suspect from the git go.  Plus of the 85 or so studies where the researchers tried to control the groups, only two had anything to do with COVID and masks.  And both showed results that leaned toward benefit from masking.

The rest of the studies looked at viral transmission in general—influenza, the “cold,” etc.  The bottom line was that none of the studies were really controlled well enough to tell much of anything.  But none of them said masks “didn’t work.”

But we have plenty of other evidence that they do indeed work.  Numerous studies have shown reduced transmissions when masks are worn.  Others showed that where masking was abruptly dropped, COVID cases increased.  Just like vaccines, masks aren’t magic.  All they do is form a barrier between someone’s lungs and the outside world, and can only reduce the particles going in or out. 

But if you really don’t think a barrier is that important, let me ask you this:  the next time I’m standing next to you, and have to cough, do you want me to cover my mouth, or can I just cough straight in your face?  After all, if you don’t think a mask works, then just covering my mouth with my hand or a crook in my elbow isn’t going to do anything either, right?   So it shouldn’t be a problem if I sneeze right in your face?

“Smart-Ass!  That’s different!”

Answer:  No, actually it’s not.

“But don’t change the subject.  I heard that Controlled-Studies are the gold-standard in Medicine.  So you’re telling me you don’t really have any controlled studies that prove masks work?

Answer:  No, we really don’t.  We just have plenty of other evidence, but controlled trials are going to be difficult to reliably perform. 

But imagine this—you’re in a car wreck, you wind up with your arm ripped off, and you’re lying in a ditch bleeding to death.  I just happen to see you, slam on my brakes, jump out of my car, and try to put a tourniquet on your arm to stop the bleeding.

But before I do, are you going to look up at me and say, “Wait a minute, Doc!  Do you have any controlled trials that prove tourniquets work?” 

Because if you ask me that, I’ll have to admit, “No, we’ve never done a controlled trial.  We’ve never taken a hundred people, chopped their arms off, put a tourniquet on half of them and no tourniquet on the other half, and proved that tourniquets work.  But we have a lot of other evidence that shows they do.”

If I said that, would you let me use the tourniquet, or would you tell me that since there weren’t any controlled trials, I should just get lost?

“You really are a smart-ass, aren’t you?  But how about Fauci, China, the CDC, and all the other science crap I don’t trust?  How about that?

Answer:  You’re right about the smart-ass part, but that’s beside the point.  I’ll have plenty to say about those other things later, but we’re out of space.  See you next time.

AMERICA IS KILLING ITSELF.  DOES ANYONE CARE?

A shorter version of this article first appeared as an op-ed piece in the Omaha World-Herald on March 7, 2023.

Americans understand the threats we face in an unsettled world.  A war in Ukraine, a worldwide refugee crisis, a crazed dictator in Russia, and a surging economic and military giant in China.  Across the globe, democracy seems in full retreat.   

But a far greater danger looms here at home. 

It’s us.  With every passing year, America keeps killing itself.

No, I’m not just talking about suicide.  For a host of reasons, American death rates are soaring.

Let’s look at some basic numbers.  By 2015, an average American could expect to live nearly 80 years.  We’ve been going downhill ever since.  This past year, life expectancy dipped to barely 76.  For native American males, the figure was a shocking 61.5 years.

What’s going on?  Certainly, COVID took its toll.  To date, over 1.1 million Americans have died from the pandemic, giving us one of the highest COVID death rates among western nations.

But there’s more to the story.  Suicides are increasing here in the states at a time when they are falling in the rest of the world.  Since 2000, U.S. suicides have jumped by 33%, and currently take over 45,000 lives each year.

Opioid overdoses are killing another 100,000 Americans.  Alcohol takes an additional 95,000.

Automobile accident fatalities increased over 10% in the past year.  With nearly 46,000 deaths, we lead the developed world in both fatality rate and absolute numbers.  Anyone paying attention on our highways knows that Americans are driving faster, angrier, and more aggressively than ever.

Obesity and poor diets also take their toll.  Over 42% of Americans are obese.  Diabetes rates are skyrocketing—along with massive costs.  Yet options for prevention and treatment are limited.  In many areas, fast food is more available than fresh groceries, and in some instances, cheaper.

Are you working two jobs and exhausted?  No grocery stores within miles, you don’t have a car, and buses are late more often than on time? That burger may be your only option.

Vaccination rates for both children and adults are plummeting, owing in no small part to a rabid anti-vaccine campaign that was well underway even before COVID.  This will mean increased deaths from diseases once considered preventable.  What happens when the next pandemic hits?  It won’t be pretty.

The role of firearms in a country that swamps the rest of the world in gun ownership must be acknowledged.  Whether measured in murders, accidents, mass shootings or suicides, guns are killing over 45,000 Americans annually.  Conservatives are quick to note high homicide rates in Democratically controlled large cities, while liberals point to statewide murder rates that are highest in solidly Republican states.  Both are correct.

Liberals maintain that bringing American gun laws more in line with the rest of the world would save lives, while conservatives counter that better mental health policy is the key.  We need both.

Unfortunately, most American politicians would rather argue about these issues than actually do anything.  The result?  They refuse to put their money where their mouth is.  Florida, for example, was one of the first states to codify “stand your ground” laws.  Since then, their firearms mortality has increased by over 32%.  Could better mental health have prevented this?  Who knows?  Florida spends just $36 per capita on mental health services, the lowest in the nation.

Let’s be clear.  Throughout the country, mental health is underfunded, undervalued, and needs far greater support.  But mental health alone won’t fix our increasing death rates.

And don’t get me started on health insurance.  According to a Harvard University study, as well as estimates by the American Public Health Association, up to 45,000 Americans die each year because of a lack of health insurance.  Research by Public Citizen indicates that as many as 33% of COVID deaths in the U.S. were tied to a lack of insurence.

Tackling any of these issues individually would be difficult enough, but in an environment in which people distrust—or even hate—science, their government, and even their own neighbors, solutions will be even harder to find.

Despite all its wealth and prosperity, America seems intent on killing itself.  Our enemies, of course, are watching all of this with glee.

We all own this.  Independent of our political passions, can we rationally discuss the root causes of our spiraling death rate and come up with realistic solutions?  Or will we continue to make excuses while America’s mortality grows?  

Christmas, 2022

In the aftermath of one of the coldest and most brutal weather events in recent history, Christmas is still arriving.  People will dig out, presents will appear, and hopefully a little warmth will return.

It hasn’t been an easy year.  Inflation, war, hunger, hatred, and a seemingly endless cycle of infectious disease.  It’s been tough.

Plenty of things will be coming at us in the year ahead.  Immigration questions, an uncertain economy, wars, and rising inequality, all occurring on an increasingly crippled planet.  For the record, I’ll have plenty to say about all of them in the months ahead.

In the meantime, a couple of readers have asked if Jesus will make another blog appearance, like he did last year in the https://afamilydoctorlooksattheworld.com/christmas-2021/ post.  So at the risk of offending anyone, here’s another letter as I imagine Jesus would likely submit.

Hello everyone.  Jesus here.  Has it actually been a whole year? 

I’m not sure I have much new to offer.  If you’re looking for some sort of additional wisdom or insight, you’re going to be disappointed.  Everything important I had to say came out two thousand years ago, and most of it you’ve either forgotten or just don’t want to listen to. 

But it still pains me to see what you’ve been doing to each other down there.  People are freezing in Ukraine, at least those who haven’t been killed in the streets.  Children are shooting each other all across America. Food is vanishing in Africa.  Cholera and anarchy are thriving in Haiti. And no one seems to notice or care.

Yes, I realize there may not be much you can do about this as individuals.  But at least you could be better to one another.

I guess that’s why I really get miffed when you use my name to justify something that’s just the opposite of what I taught.  Don’t get me started on how many religious conflicts are being fought right now. 

Eighty years ago, the Nazis went into battle with the words “God With Us” emblazoned on their belt buckles. And now, religious leaders all over the world still try to use religion to justify their little wars.  Sometimes, even the same religion in the same war. 

The Ukrainian and Russian Orthodox Churches each support different sides in the killing.  According to some Russian priests, soldiers dying in the war will have their sins absolved, as long as they’re fighting for Russia.  Not that long ago, Irish Catholics and Protestants were saying basically the same thing.

Don’t ask me where you come up with this stuff.

Much as I try to understand you people, I can’t.  Some of you self-proclaimed Christians carried crosses to the U.S. Capitol while police were being beaten.  Some prayed one minute and shouted “hang Mike Pence!” the next.

And it sure doesn’t seem like much has changed.  Just the other day I saw a bumper sticker that read “Jesus is my Lord and Trump is my President.”

Really?  Do you have any idea how insulting that sounds?  Back in Exodus, the Law says “Thou shalt not take the name of the Lord thy God in vain.”  If I wasn’t such a nice guy, that character would be driving his car straight into the Sun right now.

I could go on and on, but I won’t.  The truth is, I still have faith in you people.  There are times when I see enormous acts of kindness.  I’ve seen some of you sacrifice incredibly to help those in need.  I’ve seen tears turn to smiles with just a few words.

I just don’t understand why you don’t do it more often.  The opportunity won’t come around again.

No matter your religion, you people do have a thing for holidays, don’t you?  Christmas in a few days, just as Hanukkah wraps up. Kwanza next.  Muslims will begin the Ramadan fast in March.  Hindus will celebrate Diwali in November.

Each will underscore faith, generosity, and sharing.  I just wish they all would last a little longer.

So maybe that’s my thought for this year.  Take care of each other.  Take care of the Earth.  I don’t care how much crap Elon Musk tries to sell you, you won’t be able to bail out of the Earth and live on Mars. Take care of the place you have right now, for your children’s sake.

Maybe this letter will be an annual event if Frey keeps writing his Blog.  Who knows? 

But one thing is certain.  The acts of kindness you show to one another will last much longer than any of you will as individuals.  And those things will define your legacy to a much greater degree than who you voted for or which church you wandered in and out of.

Something to think about.

See you down the road.

Jesus

MEDICARE ADVANTAGE—WHOSE ADVANTAGE IS IT?

“. . .my experience was that it was fine unless you get sick, in which case they severely limit your options, including getting a second opinion.  I quit as soon as I could.  Do not get this plan unless you know you’ll never need any kind of serious medical care.”—Eva, a former Medicare Advantage patient, expressing her frustration with the program.

At long last, election season is over.  The shouting, screeching, wild claims and outright B.S. of non-stop political commercials are gone—at least for a short while.

But if you’re somehow missing all of that, I have great news.  You can still turn on your TV and hear a litany of monotonous, mind-numbing exaggerations.  You can still go to your mailbox and find it stuffed full of slick marketing materials.

Of course I’m talking about Medicare Advantage.  Just call our toll-free number.

As a physician and an Old Guy myself (I mean really old—I’m nearly 71, for God’s sake!) I have a real concern about the future of Medicare.  It’s been around since 1965.  Congress passed it so older Americans wouldn’t have to choose between forgoing health care and getting crippled physically, or receiving health care and getting crippled financially.

Like most legislation, it was far from perfect.  But it’s still been a godsend for millions of older Americans.  There’s a whole chapter about Medicare in my book, if you’re interested.  For now, let’s just look at a portion of Medicare.  The part you constantly see on T.V.

The part that’s threatening to bankrupt the entire Medicare program.

From the outset, private insurance companies have made money off Medicare.  Private carriers have served as “intermediaries.”  That is, they got paid to process the claims submitted to Medicare.

They made plenty of money doing this.  It just wasn’t as much as they wanted.

So the insurance industry had to find another way to get at all of those Medicare bucks.  In 1997—after intense lobbying—the industry convinced Congress to pass a plan that allowed older Americans to enroll in private programs, rather than Traditional Medicare.  Instead of paying for an enrollee’s medical expenses directly, Medicare would instead turn over a fixed sum of money to a private insurer to “manage” the patient’s care.  They called it Medicare Advantage.

From the outset, any rational person could have seen this was going to be an expensive boondoggle, but we’re not talking about rational people here.  We’re talking about Congress.  Traditional Medicare had run an overhead (even with the claims processing being outsourced) of around 2-3%.  Private insurers exceeded 10%.  Even by third grade arithmetic standards, the numbers didn’t add up.

And they still don’t.  Today, Traditional Medicare runs a 2% overhead.  Advantage plans combined overhead and profit checks in at over 12%.  That difference represents taxpayer dollars that don’t pay for health care.  Instead, they’re eaten up by TV ads, marketing, and corporate bottom lines.

But money buys influence, and the insurance industry has plenty of both.  And since its passage, Advantage plans have been marketed non-stop.  They’ve become a gold mine for private insurers, but a multi-billion dollar drain on the Medicare Trust Fund. 

But how can Advantage plans offer all of those “extras” like gym memberships, etc. and still be so profitable?  Through the twin processes of “upcoding” and “care management” (which really means denying referrals and refusing to pay for treatment).  Both are endemic in the Advantage world.

Upcoding works like this.  The money the Medicare Trust Fund pays an insurer is based on the diagnoses listed for an individual patient.  The more diagnoses, the greater the payment, whether the patient actually receives any care for those diagnoses or not. Through aggressive data mining, seniors are suddenly assigned diagnoses they’ve never heard of, never been treated for, and likely never will.  But it adds big bucks to the insurer.

How widespread is this?  According to the Office of the Inspector General, 4 of the 5 largest Advantage insurers are guilty of overbilling.  Three have been charged with outright fraud.

Multiple whistleblower complaints have uncovered a scale of fraud that’s unprecedented.  In addition to the quote at the beginning of this post, further evidence reveals seniors have been lied to about what the plan covers, whether their doctor is included, and what treatments are available.  That’s right—I said outright lies.

But they’ll be so convincing when you call that toll free number.

Estimates of how much all of this costs Medicare run upwards to $25 billion per year—money that would otherwise actually pay for care in Traditional Medicare.

But upcoding is only part of the story.  Because Advantage plans are basically managed care products (unlike Traditional Medicare), patients are only allowed to receive care through a specific insurance-designated network—and pay through the nose if they go out of network.  Claiming you didn’t know the providers were out of network won’t help.  You’ll still pay.

Think staying “in network” sounds simple?  Think again.  Some hospitals might be in network, but most of the doctors aren’t.  Sometimes the laboratory testing will be in network, but not the radiologists reading the X-Rays.  For those expenses, you’ll have to cough up the money yourself.  And you probably won’t find out until you get the bill.

And even if you stay within the network, testing, treatments, referrals, and even some admissions must first be approved by the insurer, resulting in long delays in care and often outright denials.  A recent audit found that 18% of those denials were for treatments that Medicare was supposed to cover.   And in each instance, the care was ordered by the patient’s physician.  It was the Advantage insurer who denied it.

One of the added financial drains from Advantage insurers is the fact that each year older Americans can sign up for a different plan.  That’s where the TV adds, mailings, and repeated badgering phone calls come in.  It’s high stakes marketing that gets thrown at Seniors year in and year out.  And it’s extraordinarily expensive.

“Ditch your traditional Medicare for our Advantage plan!”  “No, ditch their Advantage plan for our Advantage plan!”  “But ours gives you these benefits!”  “But we give you these benefits?”

Often these products are sold on a commission basis, where the incentive for sales reps to shade the truth to older Americans, or simply outright lie, is enormous.  And every phone call, every advertisement, every come-on, is paid from one source.  Your tax dollars.  And not a penny of it goes to pay for health care.

But don’t some of those Advantage programs say they’ll also pay for dental care?  And vision?  And home meals?  And rides to the doctor?  And trips to Mars on Elon Musk’s spaceship?

Some do, some don’t.  And nobody pays for all of it (listen closely when that commercial says “they told me I might qualify for. . .)”

But shouldn’t I want dental coverage?  Of course.  What Medicare Advantage plans do is take some of the thousands of extra dollars they receive from the Trust Fund and buy a policy that is available to everyone for $10-25 a month.  Then they pocket the rest. 

Forget the fact that I’m a doctor.  I’m also a patient.  And as a patient, I really don’t give a damn about the bells and whistles in an insurance plan.  I’m interested in something else.

Can I see any doctor I want, or just someone in my network (who may not be in the network tomorrow)?  Can I get the tests my doctor orders, or do I have to wait until the insurance company approves them?  Can I get admitted for treatment, or have to wait for the company’s OK?  How much will I ultimately be stuck paying in copays and deductibles after I’ve paid the premium—regardless of how low the premium seems at first (remember, there’s no free lunch)?

According to an investigation by the Kaiser Family Foundation, insurers are now reaping twice the profit from Advantage plans as from their non-Medicare products. 

This was never the intention of the Medicare program.  And if it continues, Medicare’s future is in serious jeopardy.  Through clever (and expensive) marketing, nearly half of all Medicare recipients have signed up for Advantage plans.  They’re wildly popular.

That doesn’t change the fact that these plans are bleeding the Trust Fund dry.

And to be honest, I’m also concerned about something other than just my own health care.  I want Medicare to be there for my children and grandchildren. 

According to news sources, some in Congress are demanding cuts in Medicare and an increase in eligibility age, claiming both are necessary to sustain the program. 

Fine.  But I hope those Senators and Representatives also realize that there are far greater savings in the $25 billion currently being lost through Advantage overpayments.  If Congress has the courage to act, these dollars could quickly be recouped by moving the program back to the far more efficient Traditional Medicare, where overbilling would cease and care placed back in the hands of health care providers.

That would go a long way toward stabilizing the Medicare program.  It could even pay for those dental benefits for all Medicare recipients.

If that were to happen, it would be a true advantage for all Americans.