“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 2020)  “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 2023)  “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.

TURNING BACK THE CLOCK AN HOUR—OR A CENTURY?

As should be painfully obvious by now, it’s election time.  With a total of 16.7 billion dollars spent on advertising, it’s pretty hard to escape the biased campaigning coming from all sides.

By now, I hope that all of you have voted.  Most states have provisions for early voting, or vote by mail, and we need to be exercising this right.  Nothing in the constitution says that in order to vote you are required to stand in line for an hour in the rain, while someone wearing a camouflaged mask, body armor, and carrying an assault rifle glares at you.

No, it’s your voice that’s important.  And how you express it—either in person or by early ballot—should be no one’s damn business but yours.

So it you’ve voted, all of what I’m about to say may be old news.  But because it relates to the future of our nation, it’s still important.

If you are voting Republican, you’re more likely to cite inflation and crime as your primary concerns.  You believe inflation is out of control, and it’s because of Joe Biden’s policies.  You believe Democrats are “soft” on crime, and that crime rates are out of control—especially in states run by Democrats.

If you’re voting Democratic, you’re more likely to be concerned about efforts to criminalize anything to do with abortion, and the risk to health care and our national infrastructure.

But regardless of how you vote, I hope you’re just as deeply concerned about the rising tide of hatred, suspicion, and disunity that threatens our very existence.  As I mentioned in my first post An Open Letter to the People of the United States, these things are a far greater threat to our national existence than any foreign power.

So let’s take a hard look at some of these pressing issues.  It won’t be pretty, and some of you may disagree.  That’s OK, as long as we are thinking and talking about these things, rather than shooting at one another.

 Health Care—I won’t belabor the point.  Republicans say we have the best health care system in the world.  Any honest doctor will tell you we don’t.  Our safety net is fraying, people are going without care, and even people with insurance may face bankruptcy from medical bills.  This isn’t a snowball going downhill, it’s an avalanche that will eventually crush us. 

You don’t have to read my book.  Just check this post by Dr. Josh Freeman from the University of Kansas at his Medicine and Social Justice site for more details.  Premiums are up, people are dying and insurance companies are making out like bandits . 

The Republican approach is that the “free market” will somehow fix this.  It hasn’t.  And it won’t.

Medicare and Social Security—Both of these programs are paying out money faster than they are bringing it in. That’s not sustainable.

Democrats have proposed securing additional funding from other sources (nobody pays into social security on the basis of their stock market profits, for example) to fully fund these programs.

Republicans have proposed cutting benefits and raising the age to qualifying for benefits.  That won’t hurt high rollers, but it’s going to impact people who’ve struggled their whole lives.  The rationale that eligibility age should go up because people are living longer needs to be reassessed, too.  Life expectancy in America isn’t increasing, it’s decreasing.  One more bit of evidence that America is backsliding.

Which of these two approaches is best?  Your vote will decide.

Inflation—As the impact of the COVID pandemic slammed the world’s economy, and Russia’s invasion of Ukraine sent food prices soaring, inflation has taken its toll.  Most recently in the U.S., it has hit 8.2%.  Gas prices are down substantially from their peak, but other prices continue to rise.

Republicans contend this is all Joe Biden’s fault.  Their reasoning is that COVID relief programs were too generous, leading to “too much money” floating around, which has in turn led to an inflationary spiral.

Sorry, but this doesn’t hold water.  Many other countries that didn’t have programs nearly as generous as ours are seeing even higher inflation.  Britain recently hit 10.1%.  The entire Euro zone averages 10.7%.  And be glad you don’t live in Turkey, which checks in at a cool 80% inflation rate.

As a reminder, Joe Biden isn’t president of any of those nations.  Even the ones with higher inflation.

The real question isn’t so much what our economy is like compared to two years ago.  It’s where would we be if the Republicans were in charge?  Somehow miraculously better?  The same?  Or possibly even worse than European countries?  That’s what no one seems to want to consider.

Crime—In the past year, the overall crime rate has increased, although violent crime is down.  Republicans have always made hay by saying Democrats are “soft” on crime.  But most crimes are state-to-state issues.  So where are the most violent crimes occurring?

Basically, in Republican controlled states.  The seven states with the highest murder rates are all solidly Republican, with Mississippi leading the way.  My old home state of Missouri comes in fourth, which shouldn’t be surprising.  Among all major American cities, St. Louis’s murder rate is the highest, with Kansas City consistently in the top ten.

It’s hard to make a valid argument that Democrats in Washington are responsible for crimes that should be at the forefront of Republican-led state legislature’s agendas. And according to some analysis, the most rapid post-pandemic rises in crime have occurred in rural areas, rather than cities.

Without a doubt, there are things we can do to better address crime.  Police officers need better training and certainly better pay for the risks they must take.  Prisons need more focus on rehabilitation and not just a “lock-em-up and let ‘em out when they’ve served their time” approach.  Violent criminals should be the focus, rather than minor violations.

In Maricopa County, Arizona, Sheriff Joe Arpaio was the poster-child for “get tough” policies.  He made prisoners sleep in tents in the desert, wear pink underwear, and eat lousy food.  His thinking was if you make incarceration tough enough, no one will break the law again.

It didn’t work.  His prisoners committed just as many crimes when they got out as did prisoners who hadn’t received the “special” treatment.

Take your pick.  A focus on improved training, compensation, and rehabilitation, or a focus on just building more prisons and locking more people up until they’re released to go back to criminality?  Your vote will decide.

Women’s Health? or Abortion!Abortion!Abortion! (Select one, depending on your view)—This pretty much sums up the two official positions of the political parties.  I’ve already talked about abortion here.  But it’s important to keep in mind that many of the same voices that scream about abortion being murder also want to restrict access to birth control, cut funding for women’s health, hold women to a different standard than men (think that big orange-haired guy who brags about his sexual conquests), and slash benefits to pregnant women and children.

I don’t think I have to paint a picture about which Party takes which of these positions.

Climate—The earth is warming significantly, glaciers are melting, weather is being disrupted, “thousand year” floods and hurricanes are now happening every few years instead, and lives are being destroyed.  Mosquitos resistant to insecticides are rapidly spreading through Africa and bringing with them soaring malaria rates.  These critters could well wind up in the U.S., too.

Sorry, but building a wall won’t keep any of them out.

According to Democrats, we’ve kicked the can down the road too long and need to address the threat.  According to Republicans, the economic costs are too great, and besides, it’s not real anyway.

Who’s right?  You’ll decide that with your vote.  But remember, it’s only your children’s and grandchildren’s future that hangs in the balance.

Science—I’m going to be blunt.  I’ve got pretty strong feelings about this.  I’ve devoted my life to science.  My inspirations were my high school science teachers, L.D. Young and T.J. Beach.

Science and scientific research helped us win the Cold War, raise our standard of living, and basically change the world.  It has the potential to transform our energy requirements, protect our environment, and improve our health.  But we have to follow the evidence instead of what we want to “believe.”  Millions of lives have been saved by vaccines.  Millions more have been lost because of lies told about vaccines.

One party wants to fund scientific research, give scientists the latitude to explore their fields, and allow scientific education to permeate our schools.

The other party wants to cut funding, demand that scientists not research fields that conflict with conservative political “beliefs,” and severely restrict what scientific facts can be taught in our schools.

Once again, I don’t think I have to tell you which party is which.

There are plenty more issues that divide the two parties, but I think this will do for now.  In general, mid-term elections are no big deal, and the turn-out isn’t great.  But this year the stakes are much higher.

There are no elections on the face of the earth that the world follows more closely than those in the United States.  On Tuesday, the world will again be watching.  What direction will America take, and how will it impact billions of others on the planet?  The world watches and waits.

Early Sunday morning, Daylight Savings Time goes away.  We’ll set things back an hour.

Fine.  But on Tuesday, will we set things back a hundred years?

WHAT DOES IT TAKE TO MAKE A LIVING WAGE?

Recently, I was asked by Nebraska Appleseed to write an opinion piece regarding a proposal to raise the Nebraska minimum wage.  I immediately contacted my old friend John Kretzschmar, the Founding Director of the William Brennan Institute for Labor Studies at the University of Nebraska.  He’s spent a career dealing with the status of American workers and is far more knowledgeable than me. Together, we put together an article that appeared in the Omaha World-Herald.  There’s a link to the actual article below.

In the meantime, there’s plenty about the minimum wage that simply couldn’t be included in the paper because of space limitations.  So here’s some additional information.

First, the national minimum wage has been in place ever since the Federal Government instituted it in 1938 at a whopping 25 cents an hour.  And ever since, its detractors have been trying to convince us that it’s all some sort of communist plot.

Their thinking goes something like this. If employers have to pay their workers a little more, they’ll either have to fire some of them or not hire anyone else.  In other words, you can’t raise wages and maintain profits.

It sounds plausible, but in each of the instances the minimum wage has been increased, no one has demonstrated any sort of consistent adverse effect on employment, incomes, or other major economic factors.

Every economic change, whether public or private, has winners and losers (just ask anyone who used to work at Sears, K-Mart, or Toys-R-Us).  Short term, some jobs transition.  The long-term consequences are usually different.  And no one has been able to clearly demonstrate that increasing the minimum wage, or for that matter, even having a minimum wage in the first place, has had a negative effect on the economy.

But isn’t raising wages substantially something that’s bad for business?  Is it even possible for a business to increase wages and increase profits at the same time?

History says yes.  Enter the picture, Henry Ford.

In 1914, Ford shocked the world when the company announced that it was doubling the salary of its workers.  That’s right, doubling—as in a 100% raise. 

In Ford’s words “It is our belief that social justice begins at home. We want those who have helped us to produce this great institution and are helping to maintain it to share our prosperity. We want them to have present profits and future prospects. … Believing as we do, that a division of our earnings between capital and labor is unequal, we have sought a plan of relief suitable for our business.”

The Wall Street Journal, along with several other newspapers, went nuts.  Ford had “committed economic blunders, if not crimes,” the Journal’s editorial page screamed.  The conventional wisdom was that Ford would be bankrupt within a year.

Instead, the opposite happened.  Turnover at Ford factories fell sharply, reducing training costs.  Ford workers poured more money into the local economy.  And many of them bought cars themselves—Fords.

Within two years, Ford doubled its profits.

Let’s get one thing straight, though.  The bit about Ford doing this from a concept of “social justice” is a load of crap.  If you look up “nice guy” in the dictionary, Henry Ford’s picture won’t be there.

He was a bigoted, anti-Semitic racist.  He even purchased his own newspaper, The Dearborn Independent, to spread his racist views. He hated the prospect of his workers organizing, and hired Harry Bennett, once described as “America’s most reviled corporate thug” to ambush, beat, and sometimes kill workers who got out of line. 

So what was the real reason Henry Ford massively raised wages in 1914?  Simple.  He knew it would be good for Ford. 

Ford’s decision proved the fallacy of the “Gee, if we have to raise wages we’ll automatically lose money” thinking. 

Economics is a complex field, full of human variables.  It’s not a hard-science, and every honest economist knows this. 

A scientist can predict what will happen when two particles collide.  But when humans with their own biases collide?  That’s much less predictable.  It’s what makes psychology, sociology, and economics more subjective, and in many ways, much more difficult.

And in all my reading, I’ve yet to find convincing evidence that paying a living wage ends up being an economic negative in the long term.

As a nation, that’s where our focus really needs to be.  On the future, and not just next quarter’s report to corporate shareholders.

So enough background.  Here’s the article. 

Nobody Loses When Everyone Makes a Living Wage

Donald R. Frey and John Kretzschmar

Dr. Frey is Professor Emeritus of Family Medicine at the Creighton University and Mr. Kretzschmar was the Founding Director of the William Brennan Institute for Labor Studies at the University of Nebraska-Omaha. The views expressed here are theirs personally, and not necessarily those of their respective institutions.

With the upcoming midterm election, Initiative 433 will also appear on the ballot. Its passage would incrementally raise the minimum wage in Nebraska from its current $9 dollars an hour (an amount unchanged since 2016), to an eventual $15.

Nebraskans are fond of describing our state as “The Good Life.” But let’s be honest. No one can live The Good Life on $360 dollars a week. We’re not talking about extravagance. For Nebraskans, a good life means honest, hard work that at least allows us to put food on the table, a roof over our heads, educate our children, and provide for decent healthcare.

According to an analysis by the Massachusetts Institute of Technology, such a living wage for a typical Nebraska family is $30,847 annually. Do the math. That’s $14.80 an hour.

Initiative 433 would benefit thousands of working Nebraskans, but its effect would be especially important for women and young parents. Child poverty would immediately decline.

Families living paycheck to paycheck would finally get a little breathing room. A set of bald tires might finally be replaced. A broken washing machine is repaired. And there’s one more important benefit. The pride and dignity that one feels in providing a decent life for their family. How do you put a price tag on that?

Unfortunately, every time the subject of raising the minimum wage comes up anywhere in America, the same old excuses keep getting rolled out. Unemployment is going to rise. Workers will get laid off. Businesses will go belly up.

We’ve been hearing all of this for decades. Nebraska has raised its minimum wage seven times in the past forty years. Nationally, it’s been raised at least 22 times since 1938. And with each increase, none of the predicted disasters followed. Not once was an increase in the minimum wage shown to cause an economic downturn. Not once was it demonstrated to cause a rise in unemployment. In fact, recent economic developments in Nebraska have shown just the opposite.

Once the current minimum wage of $9.00 an hour was implemented, Nebraska’s low unemployment decreased even further. New business start-ups increased by 4%. The total number of Nebraska businesses grew by 2.7%.

Everyone won. Nobody lost.  In a consumer driven economy where consumer spending accounts for about 70 percent of GDP, the BEST friend of Main Street merchants is a well-compensated workforce.

The American economy is one of the most robust, vibrant markets in the world. But if you were to actually believe the arguments of the minimum wage detractors, you must assume that our economy is strong only because we can suppress wages to the point that workers must ask for handouts in order to survive. You must believe that only if significant numbers of Americans are paid less than a living wage can businesses survive.

This is wrong. Our businesses are stronger than this. And our nation—and our state of Nebraska—is better than this.

Changes in the minimum wage in surrounding states have shown similar economic positives. Raising the minimum wage doesn’t just improve people’s lives. It contributes to a vibrant and growing economy that ultimately pays dividends for us all.

We urge the voters of Nebraska to support Initiative 433. It’s the right thing to do for all of us.  Because nobody loses when we all make a living wage.

Midlands Voices — Initiative 433 Pro: Nobody loses when everyone makes a living wage (omaha.com)

READ BEFORE BANNING

Recently I was talking to someone about education.  Before long, he was lecturing me on critical race theory, sex education, Marxism (apparently, it isn’t enough to just smear something as “communist” these days) and something called a “woke” curriculum, which he couldn’t actually define.  Then he launched into libraries.

Parents should have control over what their kids read, he said.  And if that means banning certain books from libraries, so be it.  

I was a little taken aback.  “Like what books?”

He rattled off a half dozen, only two of which I’d actually heard of. 

“Have you read any of them?”  I asked.

Now it was his turn to look shocked.  “Of course not!” he said.  “Why should I?  Everybody knows they’re bad for kids.”

“Well, maybe you should,” I replied.  “That way, find out for yourself.”

By now he was turning red and starting to stammer.  Then I asked him a far more important question.

“So Bill (his name’s not really Bill), what was the last book you read?”

His stammering stopped, and he just stared at me.  “Come on Bill,” I said.  “You can remember all those Facebook and Twitter posts.  But how about your last book?” 

He turned and stormed away.  The reason was pretty obvious.  Bill couldn’t remember his last book.

Maybe I take all of this differently than most people.  I grew up in a family where the act of reading was considered almost sacred.  My Father was the first in his family to graduate from high school.  I was the second.

My Mother was fortunate enough to complete college. Both she and my father were emphatic that reading was the most important single factor in determining where you ended up in life.  Yes, they recommended plenty of books, but their message to me was much more basic.

Read every damn book you can get your hands on. 

No matter the author, no matter the subject.  Read.  And keep reading.  Then talk about it.

They trusted that if I read enough diverse opinions by enough diverse authors, I could sort out the contradictions on my own.  The local library was my source of knowledge (thank you, Miss Marie Ohlhausen).  The idea that any book would be “banned” there was simply out of the question.

The last thing my parents cared about was preventing me from reading.

My, how times have changed.

Recently, armed protesters demanded that an Idaho library remove over 300 books from its shelves.  Turns out, none were even in the library.

Florida banned over 50 math books because they were somehow connected to critical race theory.  What’s race got to do with math?  Beats me.  Ask Ron DiSantis. 

Closer to my home in Nebraska, a story about a York County farm family was selected by The Nebraska Center for the Book, an affiliate of the Library of Congress, for its “One Book Nebraska” award. 

The award was never presented.

Why?  Nebraska Governor Pete Ricketts refused to issue the necessary proclamation.  According to the Governor, the book’s author, Ted Genoways, had been critical of President Trump and was an “activist.”

Activist?  There goes any award to Carl Sandburg, Sinclair Lewis, John Steinbeck, or for that matter, anyone describing the teachings of Jesus Christ.

And what did the Governor have to say about the book itself, “This Blessed Earth: A Year in the Life of an American Family Farm?” Nothing.  He never read it.

Sadly, this has been going on for centuries.  A lot of it doesn’t make much sense.  George Orwell’s classic “1984” was banned in the Soviet Union because it was deemed anti-communist.  Some libraries in Texas and Florida have taken it off the shelves because they viewed it as pro-communist.  Some books have been banned in certain areas for being anti-black, and in others for being anti-white.

Book banners of all political persuasions frequently lift a single passage out of a text, ignore the book as a whole, and demand the book be removed.  I’ve read a book many times that vividly describes rape, torture, incest, and murder.  It’s called the Bible.  Should we ban it?

Sorry, but reading a book by Karl Marx won’t turn you into a communist.  Reading a book by Ayn Rand won’t turn you into a fascist.  Reading about a gay kid won’t make your kid gay.  Reading the Bible won’t make you a Christian.

What books will do is make you think.  The rest is up to you.

And if our world has a shortage of anything these days, it’s critical thinking.  Instead of removing books, we should be encouraging one another to read and write more.

Recently, the Grand Island (Nebraska) Northwest High School journalism class published an article in their school paper The Viking Saga.  The piece titled History of Pride was sandwiched between articles on the school’s FBLA program success and the local skeet-shooting club.  Unfortunately, an LGBTQ article was too much for local authorities. 

Not only did they shut down the school paper, they cancelled the entire journalism program.  So much for critical thinking.

But this is exactly the sort of thing book banners do. 

So here’s a suggestion.  The next time you might be inclined to ban a book, try reading it first.  Then make up your own mind. 

It might just surprise you. 

ARGUING ABOUT THE DEATH PENALTY:  HOW TO TALK YOURSELF HOARSE, PISS OFF YOUR FRIENDS, AND ACCOMPLISH NOTHING

Some of the most knock-down-drag-out arguments I’ve ever heard have had to do with the death penalty.  People get pretty worked up.

And to bolster their arguments, folks start pulling out all sorts of ostensibly sacred texts and writings.

“The Bible says Thou Shalt not Kill!”  “No, that really means Thou Shalt not Murder!”  “The Bible says An Eye for an Eye!”  “But it also says Love your enemies!”  “Well, Jesus said if you had anger in your heart, it was the same as murder—should we execute every angry person?”

On and on it goes, and no one convinces anyone of anything.

If we’re honest, though, the issue of the death penalty breaks down around three basic questions.  The first question has long been answered.  The second question—the one everyone wants to get worked up about—will never be answered.

But it’s the third question that’s by far the most important.  And it’s the one everyone wants to run away from and avoid.

We’ll get to those in a minute.  First, maybe we should recap how we got here.

Humans have been imposing penalties for breaking laws ever since they started inventing laws.  And one such penalty was death.   

One of the oldest set of laws is the Code of Hammurabi, written over 3,000 years ago.  It listed death as the penalty for over twenty violations.  Interestingly, murder didn’t make the list.

This continued for centuries.  Over time, it got to be even more hardcore.  In colonial Virginia, you could be executed for stealing grapes or trading with the local Indians. 

But by the late twentieth century, capital punishment in America had pretty much been confined to First Degree Murder.  Most developed countries had done away with it, but for better or worse, the U.S. has persisted to this very day.

So what are the three big questions about capital punishment, and why do they matter?

Question number one is whether the death penalty is a deterrent.  That is, if I’m about to murder someone, do I suddenly stop and say “Oh my God, I might get the death penalty, so I’m not going do it!”

This has never made much sense.  People resorting to murder generally don’t think this way.  Plus, there are plenty of real-word examples of how this doesn’t work. 

I live in Nebraska, barely a stone’s throw from Iowa.  In many cases, a criminal has abducted someone in Iowa (where there’s no death penalty) and murdered them in Nebraska (where there is).  Obviously, the death penalty didn’t make much difference.

So toss out the deterrence argument.  The second question is the one everyone loves to go round and round about.

Is the death penalty moral?  It’s a philosophical and ethical question, and I’m sure as hell no philosopher or ethicist.  And neither are most other people.

You can rant, rave, and shout about this all you want.  Jump up and down, scream, and wave your arms if you’d like.  The only thing you’ll do is make yourself hoarse, and you won’t change anyone’s mind.  The question of the death penalty’s morality can never be answered in any universal way.  People will simply believe whatever they want to believe.

Which brings us to the third question, the one no one wants to talk about.  It’s neither philosophical nor ethical.  Instead, it’s a blunt, in-your-face proposition.

How many innocent people are you willing to kill in order to execute the guilty ones?  Yes, you read that right.

Be careful how you answer it.  Because if you say “none,” you’ve just expressed your opposition to the death penalty.

Why?  Because the death penalty is imposed by the criminal justice system.  And our system of justice is administered by human beings, not by gods (OK, we have some Supreme Court Justices who think they’re God, but that’s a separate issue).

And if seventy years on this planet has taught me anything, it’s that human beings screw up.  Big time.

In the criminal justice system, this means that sometimes guilty people will go free (think O.J. Simpson) and sometimes innocent people get convicted.  And if you’re convicted of murder, you could well wind-up dead.

I’ve testified in court numerous times, and I suppose I’m about as familiar with the system as anyone who’s not directly involved in either law or law enforcement.  I’ve even been a defendant a couple of times in medical malpractice suits.  True, my life wasn’t on the line—just a bunch of money that an insurance company might have to pay.  But I still took the whole thing very personally.

Which brings us to the ultimate wildcard in the whole justice system.  The jury.

If you’re on trial, the first day in court will likely be involved with selecting a jury.  And each side—the prosecution and the defense—will do everything they can to get a “favorable” jury.

That is, a jury that might be inclined to be either for or against you.

Are you black?  How many of the selected jurors are actually racist?  Are you gay?  How many of the jurors are closet homophobes?  How will that impact their thinking?

Remember, if it’s murder you’re accused of, it’s only your life that’s on the line.

The fact is, there are no totally “impartial” juries.  They all have their own lives.  They all have their own prejudices. 

They’re all just humans.  And they’re all being asked to render judgement.

I remember my first malpractice trial.  Jury selection was in full swing and we had a lunchtime recess.  Immediately, all of the lawyers started calling everyone they knew who might have insights into prospective jurors.

“Fred?  Sam Davis.  We have a trial downtown and Mike Thompson is a prospective juror.” (All names are made up, by the way).  It looks like he works for you.  Here’s what the case is about.  How do you think he’d be inclined to look at a matter like this?”

For an hour this went on, call after call.  The other Doctors and I looked at each other, baffled.  One of the attorneys noticed this, then said bluntly, “You may not realize it, but this may be the most important thing that happens in this trial.”

Jury selection.  Choosing a presumedly impartial group of people to hear the facts.  And who was chosen might be the most important thing in the trial?

I felt like a football player who’d just learned that the most important thing that would happen in the game wasn’t how well he played, but who won the coin toss.  It wasn’t exactly reassuring. 

None of this is meant to demean the jury system.  Juries are made up of sincere human beings.  But they’re still human beings, nonetheless.  And they’ll still make mistakes.

Add to all of this the impact of the nature of the murder.  The more heinous the killing, the more the public wants the perpetrator off the streets.  The more law enforcement wants the crime to be solved.  The more the prosecutor wants a big win.

Being a prosecuting attorney is often the launch pad for a political career.  Solve a big case and put the “XYZ Killer” away?  The next step up might be State Attorney General.

Then United States Senator.  Then maybe President.

Plenty of smart, ambitious people harbor these hopes.  And there’s nothing wrong with that.  But couple such ambition with a mentally challenged defendant, being tried on largely circumstantial evidence, and being represented by an overworked, stressed public defender, and mistakes will happen.

Add to all of this the pressure that law enforcement feels.  From the moment the crime is discovered, they’re under the gun to solve it.  Often, they’ll have hunches about who the murderer might be.  They’ll apprehend him or her, and subject them to questioning.  Their goal?  Get them to confess.

This is supposed to involve the officers writing down what the suspect says, then getting him to sign a confession.  But not always.  If the officers feel strongly that the suspect is guilty in their eyes, they’ll have a confession ready to go.  They’ll pressure the suspect to sign it.  Even if it takes hours.

Just north of my hometown is the city of St. Joseph, Missouri.  In 1978, a four-year-old child was found sexually assaulted and brutally murdered in the river bluffs just outside of town.  Immediately, suspicion fell on a 25-year-old mentally impaired, bisexual man who had a local reputation as a Peeping Tom.  In 1970’s Missouri, that was enough to get you labelled a creep.

He was brought in, questioned, and signed a confession.  Just before his trial, he recanted his confession, and said it was coerced. 

Yeah, right.

He was found guilty, sentenced to life (this was during a time when the death penalty was suspended), and promptly carted off to the State Penitentiary in Jefferson City.  Everyone breathed a sigh of relief.

Four years later, an identical murder occurred.  The police were stunned.  This wasn’t a copycat.  There were details about the first murder that had never been made public, and were now a part of this murder, too.

The wrong man had been convicted.  The real killer was still on the loose.

I won’t go into detail, but thanks to some determined detective work, the real killer was found.  He’d been a person of interest early in the first murder investigation, but went off the radar as soon as the first suspect was apprehended.

Now feeling himself cornered, the actual murderer confessed to both killings.  And to at least 16 others around the country.  There may have been more.

How many of those murders occurred during the four years when he should have been in prison, if the wrong man hadn’t been convicted?  Who knows.

In Michigan, a similar case occurred.  A young woman was horribly raped and murdered.  The police were convinced they’d arrested the murderer.  After hours of questioning, he signed a confession.  Later, at his trial, he claimed he was tricked into signing a paper he was told wasn’t a confession.

Yeah, right.

When the judge sentenced him, he said, “Young man, you have committed the vilest crime I’ve ever seen in all my years on the bench.  My only regret is that the state allows me only to sentence you to life without parole, and I cannot sentence you to death, which is what you deserve.”

A few years later, the real killer was identified.  Several officers admitted they’d indeed misled the original suspect into signing a false confession.

And the judge who made the comment at sentencing?  Not surprisingly, he’s now a staunch opponent of the death penalty.

Dozens of people—some would say hundreds—have been sentenced to death row, only to be released when the real killer was found.  Fine.  Justice was done.

But this brings up a much more troubling question.  How many innocent people have actually been executed?

Who knows?  It’s not something the legal system likes to talk about.

So I’ll just give you one possible example.  In 1991, Cameron Willingham’s home caught on fire.  Running outside to find his children, Willingham realized they were still inside.  The house was ablaze.  Neighbors and rescuers held him back as he screamed and tried to get inside the flames.

He had lost his three children.  Then he was arrested.

A state Arson Investigator testified that the fire was intentionally set and fueled by an accelerant.  In addition, prosecutors claimed that Willingham had set the fire to cover up abuse of his children.  The whole crying and screaming to save his children thing had been a ruse.

Willingham maintained his innocence.  He’d never abused his children, he said.  And he had no idea how the fire started.

Yeah, right.

The jury didn’t buy it.  Willingham was convicted and sentenced to death.  After his final appeal was rejected (by the politically-ambitious Texas Governor Rick Perry), he was executed.

Soon thereafter, the truth began to come out.  The Arson Investigator who testified the fire had been set was found to be incompetent.  An independent investigation revealed there was no evidence the fire had been set, and bad wiring was the more likely issue.  As a result, other cases where the Investigator had testified were thrown out, too.

But of course, it was too late for Cameron Willingham.  In addition, it was learned that the prosecutor in the case deliberately withheld evidence that could have led to an acquittal.  The prosecutor was eventually disbarred from practicing law after another murder conviction where he had misled the court was overturned.

But again, it came too late for Cameron Willingham.

I could go on and on, case after case.  I hope I’ve made my point.  If someone is wrongly convicted, and years later found to be innocent, you can always apologize, shake her hand, and let her out of prison.

But if she’s been executed, it won’t do much good to dig her up out of the ground.

Maybe some people do deserve to die for the horrible things they’ve done.  I won’t argue that point.  As a physician, I’ve dealt with the aftermath of some of those horrible things.  But we all need to come to terms with that third question I raised earlier, the question seemingly no one wants to look in the eye and confront.

How many innocent people are we willing to kill in order to kill the guilty ones?  Because until we have the moral courage to confront that question, I’m not sure we have any business carrying out the death penalty.