WHO IS AND ISN’T AFRAID OF THE BIG BAD TRUMP?

Whose afraid of the Big Bad Trump? The Big Bad Trump who strides the narrow USA like a colossus. Our Donald, darling of his own MAGA brand, is more teflon than John Gotti, the second last of the great Mob bosses of New York, Donald his good self being the last. Prosecutor Mike Pomerantz, who resigned when a newly appointed District Attorney of Manhattan, Alan Bragg, declined to prosecute Trump for some pretty serious crimes, compared Trump to Gotti. Pomerantz claimed that the only impediment to convicting Trump you would to be able to prove that he was not legally insane.

Trump strikes terror into some and a determination in others to confront his evil. Like other Godfathers, The Don, if opposed takes no prisoners, demands blind loyalty and when he asks for a favor he doesn’t disguise that it is really a threat.  As a former Trump associate mused, “All this comparison is unfair to John Gotti”. 

As the noose that was meant for Mike Pence slowly but surely tightens desperation creeps in. His most powerful allies in his fight for survival are those that fear him the most -  the Speaker of the House, “My Kevin” McCarthy and ambivalent Fox News, a gift that keeps on giving. In addition his challengers for the nomination are a pitiful bunch one way or another. The legal system after decades may precipitate his downfall as it did with Gotti.

SO WHO IS THE NUMERO UNO IN NOT BEING AFRAID OF THE BIG BAD TRUMP?

Thsre is little doubt that “Who is the least afraid of the Big Bad Trump” is Volodymyr Zelensky, Premier of Ukraine. Way back, when Zelensky had only just swapped roles from comedian to President, he persistently and urgently asked Trump for the funds Congress had voted for Ukraine’s fight against Russian aggression. In order to release the money Trump made the novice vulnerable Ukrainian leader an offer which he refused. That decision took unbelievable guts and integrity.  Zelensky had been elected to rid the country of corruption as well as moving it out of Russia’s sphere. Neither were top priorities of Big Bad Trump. Zelensky evenually received his aid but no thanks to the Don. 

There are several prosecutors who are gung ho to end Trump’s reign of terror.

UNAFRAID SPECIAL COUNSEL JACK SMITH WHOSE BOSS MERRICK GARLAND GAVE A CONVINCING IMPRESSION OF BEING AFRAID.

Special Counsel Jack Smith is investigating The Don at breakneck speed to make up for the tardiness of his boss, Attorney General, Merrrick Garland, who is “A Never Indict Trumper”. Trump has fumed, spewed his venom and smeared Jack Smith in his characteristic bullying fashion. When his obnoxious rantings, and in some sense childish outpourings, are analyzed, Prosecutor Pomerantz’s anxiety about a Trump defense arguing that he is “legally insane”, is plausible.

The Don on the occasion of Special Counsel Smith’s appointment.

“Jack Smith (nice, soft name, isn’t it?), is a political hit man, who is totally compromised and shouldn’t be allowed. Our already highly WEAPONIZED & CORRUPT Justice Department and FBI are stuffed with, and listening to, Radical Left MONSTERS, who will cause difficulties for our country the likes of which we have not seen before.”

“The ‘Justice” Department is CORRUPT. Offered Christopher Steele $1,000,000 to lie about me, paid Russian a fortune to ‘get Trump’, told Facebook not to mention the Hunter Biden Laptop before the Election, “it was Russian disinformation, when they KNEW it was not, is Jack Smith going to investigate that?”

As the investigation process proceeded and Smith starting playing catch up on AG Garland’s dereliction of judicial duty,Trump became more and more unhinged.

“Jack Smith(?), is a Trump Hating THUG whose wife is a serial and open Trump Hater, whose friends & other family friends are even worse,” ”Smith is known as “an unfair Savage,” & is best friends with the craziest Trump haters, including Lisa Monaco, who runs “Injustice,”  (Lisa Monaco is Deputy Attorney General).

“Radical Left, (Trump hating!) Special ‘Prosecutor” Jack Smith is leaking to the Fake News Media like a sieve”. He is going absolutely crazy trying to nab the political candidate who is way ahead of his ‘boss’ and won the 2020 Presidential election, except for the fact that it was RIGGED, He’s got a job to do and is working hard to scare & intimidate witnesses, even lawyers who have never seen such antics before”.

So there is little doubt that “The Trump Hating lunatic THUG” Smith is not afraid. His summonses to Chief of Staff Meadows, Vice President Pence. Ivanka and Jared, have to mean he is moving quickly because it is well over two years since January 6 2021 and as the Proud Boys have argued they are standing trial for what Trump told them to do while he runs for President.

Smith’s prosecution is the one our Don has to fear most as it can encompass the whole enchilada. 

WHICH OTHER PROSECUTORS ARE NOT AFRAID?

There are two female African American Attorneys who are on the verge of indicting The Don. 

Ms.Fani Willis, the Fulton County of Georgia Attorney General, is “immanently” about to lay indictments. After a year long investigation before a Special Grand Jury, who heard evidence from seventy - five witnesses and examined physical evidence and documents, unanimously concluded that there was no evidence of “Widespread fraud in the 2020 Presidential Election” which Trump claimed there was when trying to bully the Georgia Secretary of State and Governor to “Find him the votes”. When that failed, false electors were lined up to overturn the result. The Chairperson of the Special Grand Jury has intimated that there are multiple suggested indictments, witnesses who were given immunity and “no surprises”. Her frustration as an apolitical citizen to the non action to date manifested in her interviews to the media

Ms. Laetitia James the New York Attorney General has a civil case against Trump for fraud where she is claiming a minimum of $250 million dollars in fines. The facts of the case have been  established already in other litigation. Trump has already been fined for a frivolous law suit against Ms. James whom he claimed was conducting a political witch hunt against him

The Manhattan Attorney General Alan Bragg, finally, has brought a criminal case to a Grand Jury. It isn’t for the major crimes that Mike Pomerantz had worked up against Trump. It is for an open and shut case where Trump had been named as a co-conspirator for the violation of electoral laws for the payment to shut up Stormy Daniels with whom he had had an affair. Michael Cohen. his former attorney, who carried out Trump’s bidding was jailed for so doing and has been interviewed by Mr. Bragg’s office fifteen times,  presumably to testify against him. 

WHO ISN’T AFRAID IN THE CIVIL COURTS

The litigation that is ready for prime time involves an alleged rape by Trump of a Ms.Jean Carroll. Trump who has outspent and run out the clock on so many other litigants, faces trial in the near future. The pretrial motions have been salacious including whether evidence will be allowed such as the “Access Hollywood” tape where the forty fifth President bragged about his sexual assaults on numerous women, the experience of other complainants alleging sexual assault and Trump’s initial refusal to submit DNA evidence and now his preparedness to do so in order to delay the proceedings further. These cases are screaming to be settled, that is if Ms. Carroll who has been subject to the most unbelievable abuse, is interested.

Other civil cases that have wended their way to near completion are those involving the firing of Peter Strzok the number two man in counter intelligence as well as Lisa Page a lawyer in the Justice Department. The judge has ordered that both Trump and Wray, the current head of the FBI, can be deposed. Again the evidence of malice must be pretty convincing if a President can be deposed for firing officials that ostensibly serve at his pleasure

There are an endless number of other civil litigations that Trump is facing including from his niece Mary Trump who alleges Trump robbed her of her inheritance. The latter is another sordid saga of alleged Trump sociopathic behavior.  

There are a slew of litigants rising out of January 6 riots including from police officers and congressmen. These trials are really just beginning but are very serious and will keep Trump busy till the next decade. They have the potential to bankrupt Trump as the damages can run into billions. 

CHANCELESS GOP PRESIDENTIAL WANNABES WHO AREN’T AFRAID EITHER

There are a few “liberal” Republicans who barely register in the polls that are contemplating running for the “GOP” Presidential nomination. They include “GOP” Governors such as Asa Hutchinson, (Arkansas), Larry Hogan, (Maryland) and Chris Sununu, (New Hampshire). They would have the support of legislators such as Mitt Romney and Adam Kitzinger. More significantly in their court would be Liz Cheney who eviscerated Trump at the January 6 Investigating Committee hearings and is  determined to see Trump not being the Forty Seventh President.

 Mitch McConnell has made it quite clear that Trump was responsible for the January 6 Coup but has done too little too late. if he had had a scintilla of the courage of his convictions he could have provided the necessary votes at Trump’s second impeachment hearing thereby preventing him from ever holding office again. 

Far more interesting are those “GOP”  Presidential wannabes who are afraid.

“GOP” PRESIDENTIAL WANNABES WHO ARE AFRAID OF THE BIG BAD TRUMP

What is fascinating is the fawning, the ducking and the weaving on the subject of The Don by those who are best placed to challenge him.Their bizarre logic is they don’t want to offend Trump’s supporters! By definition the latter are going to support Trump or sabotage any nominee at Trump’s behest should he not be the nominee.

First and foremost among these weirdos is Ron DeSantis who in some polls is giving Trump a run for his money. The Ron pretends he is taking the high road when Trump jabs at him by claiming he is fighting Biden and his “woke” agenda. When push comes to shove the Big Bad Trump will eat the nebbish, “The Ron,” and spit him out in small chunks. So Ron if you want to play with the big boys you will have to create a lane of your own and not pretend that Trump doesn’t exist. Jay H. Ell really can’t see the bearded, gun toting red hatted MAGA crowd screaming for this wuss whose focus is on creating an anti woke College.

Then follows a whole list of those who are so intertwined with Trump that the fact that they are not attacking him makes sense. Included in the bizarre line up is former Vice President, Mike Pence. This in spite of the fact, according to Cassidy Hutchinson, when recalling a conversation between Mark Meadows and Pat Cipollone, in her presence, that Trump maintained that “they were right when they were calling to hang f….ing Mike Pence”. Pence is pathetically equating Trump being "wrong" that he could unconstitutionally overturn the election with the Special Counsel calling upon him to give evidence before a grand jury. It is painful to watch. He may get the Evangelicals over Trump’s dead body but not the MAGA boys.

Also in this category are Mike Pompeo, former Secretary of State who apparently effectively delivered the message to MBS of Saudi Arabia that the latter “Owed Trump” and Nikki Haley who is refreshingly naive and totally and utterly ridiculous in her explanation that she is running to rid America of geriatrics - forgetting that the bulk of the “GOP” Primary voters are white geriatrics. 

Going further down the list are Ted Cruz, Tim Scott, Chris Christie. Greg Abbott, Glen Youngkin and Kristi Noem, (She offered to have his head carved next to Abe Lincoln on Mount Rushmore) all of whom will have to somehow explain their former devotion to The Don, in the context of opposing him now.

Of interest is Brian Kemp of Georgia who refused to “find Trump 11800 votes which was one more than he needed” but still thought that the Big Bad Trump was a jolly good fellow. Should he however run Trump will not let his base forget that he couldn’t do him a simple favor. 

So much for that motley crew. The only one with a realistic chance is DeSantis who will be nobbled by Trump should he somehow win the nomination..

FOX NEWS IS THE MOST SCARED OF THE BIG BAD TRUMP AND PROUD OF IT1

The recent litigation by the Dominion Company against Fox News has been an eye opener to the extent that it reveals how terrified the Fox Establishment is of the Big Bad Trump. This in addition to their hypocrisy in that they promote “The Big Lie” without believing it. Emails between their three nighttime musketeers and the boss Murdoch and his inner circle show that they have the integrity and morals of alley cats.

The fact that the Dominion Company are asking for summary judgement in an area covered by the Freedom of Expression First Amendment speaks volumes to the strength of their case. The courts rarely if ever rule in the Plaintiffs’ favor when it comes to freedom of speech and the bar is unbelievably high in defamation in cases of this nature.  

Dominion are the manufacturers of voting machines, that according to the conspiracy theorists from Trump, to Giuliani to lawyer Sydney Powell that could convert votes from Trump to Biden via a plot hatched by the deceased Hugo Chavez of Venezuela. Fox News purveyed this patent rubbish led by their fabulous three, Tucker Carlson, Sean Hannity and Laura Ingraham. The whole establishment ignored literally hundreds of pleas from Dominion to cease and desist.

While a ton of internal e mails and testimony reveal that no - one at Fox believed all this outlandish fantasy they ran it as they were terrified of losing viewership to a “Mickey Mouse” operation called “NewsMax”. The fabulous three texted one another as did Murdoch and all the other high ups acknowledging that the conspiracy theories were drivel. 

One quote tells it all. After the Fox decision desk called Arizona for Biden thereby hobbling Trump’s “stolen election” mantra, Trump went ballistic to which Carlson’s internal response was breathtaking in duplicity”

“We worked really hard to build what we have. Those fuckers, [at the decision desk], are destroying our credibility…..Trump is good at destroying things… He could easily destroy us if we play things wrong….”

When challenged to respond to Dominion’s allegations, Murdoch stated, “We are proud of 2020 election coverage”

MY KEVIN TEAMS WITH FOX IN  THE LAST DITCH EFFORT OF THE FEARFUL

“My Kevin” who owes his speakership to the Don and who made promises to the loonies under Trump’s control is teaming up with the other terrified entity Fox News as represented by Tucker Carlson. ‘My Kevin” is providing Tucker with every inch of tape of the insurrection, to help him prove that January 6 was something between a minor mob rush and a picnic of Confederates who got a bit unruly at the Capitol. The fact that several of the peace loving protestors have been convicted of seditious conspiracy is irrelevant. 

AT THE END OF THE DAY

As things stand Big Bad Trump will in one way or another prevent any other “GOP” member becoming president. The Republican Establishment were too afraid from the get go to challenge Trump and now they can do nothing to restore the integrity of their party. So rather than fight him they have just joined him. They are all afraid of the Big Bad Trump!

It is inconceivable that teflon Trump won’t be downed by at least one of these major trials against him, but he and Fox are already working on an alternative narrative in order to feed into the lie that January 6 was a 'false flag" operation. 

The Fox machine is over stepping the mark again and don’t seem to mind that they could be responsible for another attempted coup. They are the scaredest of the lot.

US HEALTH CARE IS A PRODUCT - STUPID!

There is a paradox - USA is the world leader in medical research and has the highest standard of treatment of major disease, with kings and prime ministers flying in for care, while it scores lowest in multiple health care parameters, such as infant and maternal mortality, as compared to other high income nations, even though it outspends them astronomically. 

The situation has to have reached crisis levels when The Journal of American Medical Association, (JAMA), leads an online edition with a “Viewpoint - Salve Lucrum, (Hail Profit): The Existential Threat of Greed in US Health Care”, February 5, 2023. The American Medical Association, (AMA), is one of the most influential bodies in dictating the direction that health care takes and has a long history, for better or worse, in shaping health care and medical education in the USA.

On  February 7, President Biden in his State of Union address, while touting what his administration has achieved, encapsulated the health care crisis by rhetorically asking, “Will you have the money to pay your medical bills? Will you have to sell your house”. A day later an Emergency Department Physician in an opinion piece in the Washington Post wrote “Severely Understaffed Hospitals Shouldn’t Be Buying Super Bowl Ads”. The average cost of the latter, without production costs, is between six to seven million dollars. The thrust of his disgust was the juxtaposition of the obscene disregard the business industrial complex of health care has towards those who they rely on to “sell” their “product”, namely the medical profession.

  February had a synchronicity about this subject as an opinion piece in the New York Times  a week later echoed much of what Dr. Berwick Deputy Editor of JAMA had written in his "ViewPoint".  The Times writer indicated that a new generation of physicians were not going to just stand by and allow the profession to be engulfed by profit. 

The Journal of Internal Medicine published in the same February time frame, a research piece that detailed who were on the governing boards of the top twenty ranked hospitals in the US -  fifty - six percent were from the finance or business sector while fifteen percent had clinical training or were from the health sector.

Thus February 2023 heralded  the beginnings of a profession fighting to regain its mission. The activists claim that they are not mere purveyors of the product "Health Care" they are in the noble pursuit of caring and curing patients.

HOW AMERICANS OBTAIN HEALTH CARE COVERAGE

It is important in any discussion on health care finances to know the breakdown of where individuals obtain their coverage as there is no universal health care in America. Briefly about ninety percent of Americans have cover about half of whom are in government programs and the other half in private insurance companies.

Medicare is the government insurance program available for those over sixty - five years of age and has currently sixty million enrollees (It should be noted that half of Medicare recipients have enrolled in Medicare Advantage Plans which are managed by insurance companies, a situation which will be discussed in the body of this blog}; Medicaid covers over seventy million citizens and eligibility is based predominantly on income. {Although Medicaid is funded by the Federal Government it is administered by individual States} The Affordable Care Act, or Obama Care enrollment is seventeen million. The latter contained an important provision that expanded the eligibility for Medicaid and is responsible for the increased enrollment in the latter. 

There are twenty seven million uninsured individuals who are for practical purposes all non elderly. Of the three hundred and forty million covered Americans, one hundred and sixty six million, are with private insurance companies who now have to accept all patients, regardless of pre existing conditions as a result of the Obama Care legislation.

THE AMERICAN MEDICAL ASSOCIATION (AMA)

The AMA is the largest representative body of physicians in America. The AMA has dominated the profession for nearly two hundred years both educationally and legislatively.  It was behind the creation of the landmark Flexner Report in the early twentieth century which laid down the basis of medical education which is still in place to this day. Cynics maintain that the major reason for the AMA enlisting the Carnegie Foundation to pay a twenty - nine year old school teacher to formulate the template for medical education was to eliminate the medical schools, predominantly graduating poorer and black physicians. 

The AMA dictated fee schedules favoring surgical procedures over cognitive skills of doctors and specialization over generalism. This resulted in seventy percent of US MD’s being specialists and only thirty percent  being “primary care” providers, (PCPs). All the PCPs are not true generalists in the international sense because only a third of them are Family Physicians or General Practitioners and thus are able to be first contact doctors to all genders and their children. 

The AMA acting as a trade union on behalf of doctors fought for well over a century against the formation of Government sponsored care even opposing the formation of Medicare in the nineteen sixties conducting a massive costly campaign. When Health Maintenance Organizations were thought to be the panacea of all the health care ills, the AMA challenged the doctors’ rights to advertise their association with those bodies only to lose their dictatorial edict in the Supreme Court. 

It was round about the twenty first century that the AMA finally found religion. In 2007 they launched a campaign to be “The Voice For The Uninsured”. A year later they formally apologized for their earlier exclusion of African American physicians as office bearers and made a concerted effort to rectify that practice. A few years later they backed President Obama’s efforts to overhaul the public health care system including the belief in universal coverage.

In short the AMA have a lot to answer for. They are a wealthy organization with a large lobbying budget so their role in rectifying the current mess is important. Although they no longer have the membership of the majority of the profession they still have over two hundred thousand card carrying members. So this unabashed lead article is far more significant than the coverage it has been given. JAMA is their main academic and policy journal but they have several others thus reaching a large audience. 

“THE EXISTENTIAL THREAT OF GREED IN US HEALTH CARE” - JAMA FEBRUARY 5 2023

All this discussion must take cognizance of the fact that the cost of health care in the US is nearly eighteen percent of GDP, over four trillion dollars a year or one in every six dollars spent. The US GDP percentage is fifty percent higher than those of other high income nations. For example, a country such as France spends less than half the sum in dollars per citizen as compared to the USA. (Thirteen thousand dollars per citizen versus about six thousand). 

The “stratospheric” drug prices, even those that have long been on the market, are highlighted in the editorial. “Eye popping” prices are legion as there is no price regulation legislation. (Biden has modest legislation that begins in 2025). The fact that often the research behind the newest drugs has been executed with government money is not acknowledged or priced in. A constant criticism is that the cost of the self same pharmaceuticals, that are the products of American research, is far higher in the USA than in other countries. The companies basing their pricing on “what the individual markets will bear”.

 The central implication of the JAMA “ViewPoint” is the danger that the business industrial model will come to totally dominate health care. A strategy not yet debated in the public arena is the exploitation of insurance companies of the Medicare Advantage, (MA), Program. Viewers of television should have wondered why they are being overwhelmed by advertisements offering expanded coverage at a very low cost. The MA ;program was brought into being to give Medicare enrollees an opportunity to have managed care by private insurance companies at a low cost. The venture has mushroomed to cover fifty percent of those qualifying for Medicare. The insurance companies have gamed the system to the extent that it will cost the Government six hundred billion more dollars over the next eight years had the beneficiaries remained in the original Medicare program. This surely should answer those who argue that if the private sector were to solely manage health care, costs would be lower!

Hospitals are also in the business of printing money. An example quoted is a charge by one of the most prestigious University Hospitals in the country. They charged seventy three thousand dollars for two infusions of a prostate cancer drug, the price of which in the UK is two hundred and sixty dollars a treatment. 

Non profit institutions are closing hospitals in poorer areas and opening them in more affluent suburbs. There are currently six hundred and twenty one rural hospitals under threat of closure.  Exacerbating this problem are eleven Republican controlled states refusing to accept moneys to increase Medicaid enrollment available under the Obama Affordable Health Care Act. They believe no money is better than that afforded to them by Obama Care. The rural hospitals could be remunerated for many of their patients who cannot afford payment and consequently would be able to remain open.

The JAMA policy piece continues, “Profit may have its place in motivating innovation and quality … but kleptocapitalist behaviors hurt patients, governmental programs,… these behaviors … pose an existential threat to a sustainable, compassionate and equitable health care system…..” 

The "ViewPoint" also alluded to the impact on individuals, “.. 41% of US adults bear medical debts. One in eight individuals owe more than ten thousand dollars… In Massachusetts, forty six percent of adults say they skip care because of costs. As of 2021, 56% of all debt collections in the USA are for medical bills……”.

It should be noted that since the publication of this article the US Consumer Financial Protection Bureau has published a report that found that Americans carrying medical debt has dropped by about eighteen percent bringing the indebted to about twenty percent. The reason they believe is a result of Obama Care which added millions to the insurance rolls both government and private.

The JAMA article ends by outlining plans for action and a plea for those in control to right the ship. The editorial alludes to the demoralizing effect this business industrialization of medicine  has had on health care providers, a situation that was underlined in the Washington Post Opinion Piece. 

EARLIER ATTEMPTS AT HEALTH CARE REFORM

For a very brief period there was a glimmer of hope in the 1990’s with the Hillary Clinton plan for health reform. The President, her husband Bill Clinton, had run on providing a universal health care plan. Central to the plan was to be the role of employers. The plan hit a mountain of opposition led by Republicans, libertarians, big business and the insurance industry. For a host of reasons, including Ms Clinton’s handling of her Task Force and the secrecy of its workings, it went nowhere. The AMA leadership was generally supportive but faced a rebellion from some of its high roller membership. It would not be till Obama’s Affordable Health Care Act of 2010 that there would be any major relief for the "consumer". President Biden has also put into effect further reforms. 

In the 1990’s the First Lady, Hillary Clinton, had recognized that costs would never be controlled nor health care indicators improved unless there was universal access to providers - acknowledging that the major feature that differentiated the US system from other high finance countries was the number of general practitioners/ family physicians. 

THE BUSINESS INDUSTRIAL MODEL TAKES HOLD OF HEALTH CARE FROM THE 1990’S 

Round about the same time that the AMA was finding religion - namely that it needed to come to terms with the fact that it had a social responsibility - the business model of health care was busily taking off. Whereas the major money makers in the latter half of the twentieth century had been the physicians in the surgical specialties such as ophthalmology, orthopedics and cardiac surgery, where some providers were raking in millions a year, the hospital administrators and health care CEOs took over as the major money earners in spades. 

There was consolidation of all aspects of health care - hospitals, health care providers, insurance companies and pharmacies in various combinations. Profit and non profit companies were formed or expanded. For the providers in health care the outcome was irrelevant whether the company was for profit or not. Within a few decades the number of physicians in private practice dropped to twenty - six percent. In 2021 there were a hundred and thirty - five thousand corporate owned medical practices in addition to physicians that the hospitals employed directly. The number of midlevel managers mushroomed as each billing item was categorized and maximized. Twenty - five percent of hospital expenses went to administration which was double that of Canada. 

The health organizations themselves had armies of bureaucrats headed by highly paid CEO’s. The CEO’s of the seven largest  for profit health care companies in 2021 cumulatively earned two hundred and eighty three million dollars. The non profit health organizations CEOs earned multiples more, by comparison to other non profit entities. At least ten such executives earned over seven million dollars a year, headed by the CEO of Kaiser Permanente who garnered eighteen million per annum.

So the health care organizations are in big business and they are selling a product called “health” or more aptly “disease”. The personnel that are “selling” their product are for the most part physicians or nurses who have as their agenda ministering to the ill.  Jay H. Ell personally witnessed a Family Physician being fired because he was not seeing the requisite number of patients per day. Likewise, nurses were being sent home and losing pay because there weren’t enough admitted patients “to justify” them being there. Conversely nurses were having to manage far more patients than previously so as to cut down expenditure. 

Now perhaps the aforementioned articles can be seen in context. 

SO WHY ARE AMERICANS NOT GETTING THEIR BANG FOR ALL THESE BIG BUCKS?

In a comparative study of eleven high income countries the USA was ranked last in four of five parameters. (Commonwealth Fund Organization - “Mirror Mirror 2021: Reflecting Poorly”).

The four measurements were access to care, administrative efficiency, equity and health care outcomes. In a fifth parameter which involved preventive screening USA was ranked second 

The study noted four features that distinguished top performing countries such as Netherlands, Norway and Australia - Universal coverage and removal of cost barriers, investment in primary care systems to ensure high value services are equitably available in all common items to all people, reduction in administrative burdens that divert time, effort and spending from health improvement efforts and investment in social services especially for children and working age adults. (It reads like a synopsis of what ails the American Health Care System).

Added to the USA health care woes is the burnout of physicians, notably those that are in the front line for access to care - first and foremost being the Emergency Physicians,

ACCESS TO CARE

There are three portals of entry for health care - Primary Care Practices, Emergency Rooms and Immediate or Urgent Care facilities.

In the USA access to care is a huge problem, because only thirty percent of the physicians are in “Primary Care”, thirteen percent being generalists. "Mid level" practitioners, nurse practitioners and physician assistants have been added but have made no discernible dent in the problem.

 If you want an old fashioned primary care service where you will have a practitioner respond to you timeously there are so called "concierge" practices, where the patient pays anything up to two thousand per annum just to join.

 As there is not universal health coverage where can the uninsured or poorly paid government insured go? There is only one service that by law that has to accept and evaluate any person who presents for treatment and that is the Emergency Department. At the best of times this service is stressed out by the very nature of the job definition and by being overwhelmed by anyone pitching up. The Covid pandemic resulted in many ER physicians opting out.  Wait times under normal circumstances for any non life threatening presentation can be between four and ten hours. There are six thousand ER departments in the US.

In order to cope with lack of access the number crunchers in the systems created “Immediate Care” or “Urgent Care” clinics for paying or insured “customers”.There are approximately five thousand in the USA. 

Jay H. Ell has practiced in all three of these first contact situations. The ideal non emergent situation is the primary care practice. In the latter context the patient’s history is known, as well as her behavior and if the practitioner is a generalist she may well be managing the whole family. Where there is easy access management can often be time based and the patient can be asked to return if the condition worsens for example. It is much easier to assess the problem in that milieu. 

The Emergency Room is a “specialist” care situation, the problem has to be sorted out there and then. There is disease or there isn’t. It is either urgent even life threatening or it isn’t.  Litigation adds to the stress with nearly every ER physician having had to face litigation. It is far from the ideal situation to manage anyone or everyone who seeks care.

Practicing care in an Urgent Care clinic is extremely difficult because the patient has made the decision that her problem does not require emergent care and or it is not serious. Unless it is a painful throat how on earth does she know? The practitioner who does not know the patient from a bar of soap is working on a primary care model where supposedly she has to see x number of patients per hour. Jay H.Ell found this model which is essential under the  current circumstances, the most taxing, often coming across patients who had to be bundled into an ambulance and referred to the ER.

So much maligned Hillary was right thirty years ago and it is not too late to prioritize medical students going into Primary Care. Jay H. Ell attended a meeting where she  addressed academics and student leaders. When she was challenged that withholding grants for students who wanted to go into specialties was discrimination, allowing only the rich to go into the more lucrative professions, she simply countered that the objective was to serve communities not meet the needs of those going into medicine.

AT THE END OF THE DAY

Biden when asking rhetorically, “Will you have the money to pay your medical bills? Will you have to sell your house?’ , was recalling a situation he personally experienced with his son Beau who had been diagnosed with brain cancer and had no medical coverage. Obama either lent or gave Biden the money.

Just to quote one of the solutions offered in the JAMA article,“Salve Lucrem” (Hail Profit): The Existential Threat of Greed in US Health Care”:   - …Health care professionals in all disciplines need to become noisier about the conflict unchecked greed and the duty to heal. Extortionate drug prices, exploitation of market consolidation, coding games, excessive executive compensation and promulgation of unnecessary care ought not to be met with silence. Silence is assent. One word of caution - there is safety in numbers - individual activists can just be picked off and eliminated.

The AMA are finally on the right side of history. 

The impact of Obama Care is still multiplying. Maybe the politicians of those Republican States who believe no healthcare is superior to Obamacare will start caring when they are left without rural hospitals. 

None of this situation detracts from the remarkable progress the Medical Profession has made in combating disease and the dedication of health care professionals to their patients. Studies that show anger towards the costs of health care invariably indicate that participants are very satisfied with the care executed by “their” doctors. 

While companies are managing health care as a product to be advertised bought and sold like any other in the market place, those that “sell” the product for them are still in the business of caring and curing. 

Finally, just maybe, the “free market” will work the way their apologists maintain and the insurance companies, pharmaceutical companies and hospitals will compete with complete transparency and bring the price of high quality health care down.  

For the meantime US Health Care is Just a Product - Stupid

TYRE NICHOLS - FIVE COPS AND WHO ELSE IS TO BLAME? - “THE BANALITY OF EVIL”

 

On the night of January 7, 2023 nothing was further from the thoughts of five elite police officers in Memphis that nineteen days later they would all be in the cells of Shelby County Jail, having been arraigned on second degree murder and kidnapping charges.The indictment related to what they had thought at the time was nothing remarkable. It was one of many incidents involving “a black male suspect". Once again society would be rocked at the unthinkable incomprehensible obscene brutality ministered by otherwise normal appearing officers of the law. 

The name Tyre Nichols may or may not have immediately rung a bell in the minds of The Five but he was no longer just another, "black male suspect". In death he suddenly had become a persona, a real person, who as a deceased had dramatically changed their lives. This whole episode of a suspect "resisting arrest and sustaining injuries while attempting to escape" had to be a part of the routine of The Five's unthinking job routine. It was just all in their unquestioned job definition until Tyre did them the dirt and went off and died. 

The Five are not alone in their lack of thinking that characterizes everything and everybody in relation to policing and society. However when there is a corpse the whole ball game changes and there is a repetition of the crises that have punctuated policing for the past sixty years. In the interims between corpses  no one gives a second thought to the fact that, in spite of increased resources, fire power and military equipment, the problems being addressed just seem to get worse not better. Periodically there is a death which engenders an outcry which dies down till the next "black male suspect" dies…..

 

ALL IN A REGULAR DAY’S WORK - TILL THERE IS AN INCONVENIENT CORPSE -

Of course with “this incident”, like all the others with a “black male suspect”, there was the matter of filing a report. The elite cops knew the routine drill. They were accustomed to the body cameras and the recording devices. All that those contraptions meant was that they just spat out some inane rationale justifying their violence. They could all corroborate one another. Their story was boringly straight forward or so they thought.

 Nobody knows how many times previously The Five, who were members of the SCORPION UNIT, had reported, “resisting arrest and attempting to escape and sustaining some injuries in the subsequent altercation”. Their UNIT ironically was the mnemonic for “The Street Crimes Operation to Restore Peace in Our Neighborhoods”. Little did their boss Carolyn Davis, think when she established the Unit in 2021, immediately following her appointment as Police Chief of Memphis, that she would be disbanding it so soon in response to the anger of the Nichols family and anger all round. 

Police Chief Davis, who had established similar units in previous assignments, fired The Five following an investigation into the death of Tyre Nichols. Without being too cynical almost anything goes till there is a corpse. Davis had with an air of exasperation, explained, “They have all kinds of de-escalation training. We take them off the streets so they can have a de-escalation moment, have an opportunity to do some retraining…..the officers’ actions that led to Nichols’ death showed there was a problem not just with the training, but with the police culture in Memphis”  

Forgive Jay H. Ell if he is cynical about this all since if there had been no lifeless body would anybody outside of Memphis ever have heard of The Scorpion Unit of Memphis? This is what Memphis Mayor Jim Strickland declared weeks after the launching of the unit, “The SCORPION unit has had five hundred arrests - three hundred and ninety felony arrests. They have seized $103, 000 in cash, two hundred vehicles and two hundred and fifty three weapons". One needs to know what the hell the charges were, what were the outcomes? As Ed Davis, a former Boston police commissioner, commented, “Those numbers should have been a warning sign in and of themselves… where they are pulling in one hundred and eighty people into custody after the unit gets started you’ve got to take a closer look at what they are doing….what those charges are, what probable cause is, what the reason for the stop is….” . The inescapable inference from all of this is that these guys were just a collection of legal vigilantes who reigned violence that finally led to this tragedy. Reverend Sharpton’s allegation that had Tyre Nichol’s been white he would have not been stopped appears to be more than just WOKE rhetoric. 

The more one delves into this the worse it gets. What were  the racial percentages of those stopped by The Five? To bounce back to the Nichol’s travesty, the reason for the stop was ostensibly “reckless driving”, yet there is no evidence for this. The camera situated on a lamppost that blew The Five’s report reflected no images of reckless driving. The further that one applies one’s mind the sicker it gets. There is sixth cop whose only defense is that he cleared off before they butchered Tyre. Then three EMT’s have been fired because they apparently were more concerned with chatting with The Five than meeting the medical needs of the “accused”. The culture is sadly epidemic. 

Before Jay H. Ell continues -  full disclosure  - he worked as an ER Physician where he was in constant contact with the police and EMT’s where the culture was highly attentive to those they took into custody, They were bringing “accused” into the ER on their say so that they were feeling ill or had injuries. 

Jay H. Ell having made this obvious statement that one cannot tar all officers of the law with the same brush, maintains that society cannot rely on whether the culture happens to be positive or not as to whether ”an accused” is going to be beaten up or not. As with Memphis and Minnesota, tor example, the culture was not too hot and the only window into what was going on was when there was a corpse. 

WHO GETS THE BLAME? - THE FIVE? TYRE FOR DYING? THE DOCTORS? MEMPHIS? THE CULTURE OF THE DEPARTMENT AND OR  SOCIETY?

The Five, Memphis, society  and the role of Police Cultures

Who are The Five who have been charged? Are they just The Five who are taking the rap because Tyre did them the dirt and went off and died? The police chief intimated that they were just part of  culture of the Memphis Police Force which has two thousand and eighty one members. Another seven were subsequently disciplined in connection with the alleged murder.

Who could have guessed that Tyre had a weak constitution? How were The Five to know he had Crohn's disease, and at six foot three inches only weighed a hundred and forty three pounds and obviously was not up to being beaten up. How good were the doctors? What did they miss? For G-d’s sake he was a young man, can’t they manage trauma?

Well, The Five  in the dock have names - Demetrius Haley, Desmond Mills, Emmitt Martin, Justin Smith and Tadarrius Bean. They are people. They have to have feelings of some sort or another. They aren’t sociopaths or even malignant narcissists. Are they married and do they have children? Indeed Mill's lawyer argued that Mills was a "respectful father and devastated to be accused in the killing". They all must have mothers and fathers. How are the shocked parents reacting to their sons being the poster children of the polecats of America? 

A more pertinent question is how come all theses bad eggs came to be in the same basket? They all colluded in this alleged heinous crime.? Four of “The Five” have been disciplined for violations in the course of their duty. In two of the disciplinary actions the charge was they failed to report that force was utilized in the arrest. The enquiring body didn’t bother to investigate whether the force was warranted or not?  All that begs the question why these bad eggs were part of an exclusive squad? The Chief who formed the Unit admits that the culture in her department sucks, so anyone she would chosen would have been suspect. Seven more officers have been disciplined over the incident. The culture apparently extended to the EMTs whose job it was to minister to the sick and injured. Who are they? Did everyone who was a bad egg in Memphis enlist either in the police force of their ancillary services? The answer is scary and complex.

Difficult to buck the culture - you just become part of it

It is very difficult to buck the culture around you and defy the prevailing belief system. Hitler could not have effected the scale of genocide that he did if he didn’t receive the buy in from ordinary Germans who bought the lie and its final solution. Daniel Goldhagen’s detailed researched treatise, Hitler’s Willing Executioners - Ordinary Germans and the Holocaust, gives conclusive evidence that the collective consciousness of society unquestionably participated in the most cold blooded genocide in living memory. 

While the cops of Memphis are not comparable to Hitler’s Germany the psychodynamics are the same. This was really the culture of the Memphis police department, its overseeing disciplinary body, and the Mayor who unquestioningly and gleefully exaggerated the scorecard of SCORPIO’S  immediate successes only to condemn The Five when it all hit the fan. He never asked the basic questions as to why, how and who of all those early arrestees In his initial braggadocio. He never gave it a thought. It appeared that Memphis had criminals and crime that they didn’t even imagine. SCORPIO delivered what was expected and more and they weren’t the only show in America as other corpses have revealed. 

Richard Balko defined the morphing of the police into “soldiers” in his seminal work, “Rise of the “Warrior Cop. The Militarization of the American Police ”. Since the sixties the quest to combat drugs, crime, terrorists or whatever has led to the empowerment of the police and loss of Fourth Amendment Right protection against illegal searches arrests and the like. 

Society’s Solutions to their problems

There thus seems to be an underlying desire to rid society of abstract ill defined problems and profiling the group or race who are the alleged perpetrators  In this instance those who are making the streets unsafe are the African Americans. This construct quickly catapults everyday Joes into colluding with the idolatry to stamp out the perpetrators. There is a pattern in this type of scenario.  It can escalate into the unbridled abuse of authority with the power of government behind it.

This phenomenon of unthinking collusion, whether written small or written large has the same etiology. There needs to be a a societal ill perpetrated by an entity who are victimizing society. There needs to be a response by those in power, whether it is the mullahs of Iran via the Morality Police combating sin by arresting and raping the Godless hijabless women or the Nazis claiming that their WWI defeat and subsequent economic depression was because of the Jewish vermin. it is the same old same old…..

The problem is failure to think  - Hannah Arendt and the Banality of Evil, Eichman and the Mystic Chassidim

The Chassidic mystics made the pertinent observation as to the origins of behavior - the way you think of a problem results in the way you feel about it and that consequently dictates the actions taken. So if you think society has a problem such as crime and the criminals are predominantly black you can feel justified in taking any action that will solve the problem. The agents carrying out the deeds feel no guilt or remorse as their action is carrying out societal needs.

Hannah Arendt, who is regarded as one of the greatest philosophers of the twentieth Century reported on Eichman’s trial in Israel in 1961, fifteen years after the Nuremberg trials - the same Nuremberg where Hitler had held his rallies. Those trials saw high ranking Nazis tried, for genocide and crimes against humanity. Those trials took place as an extension of the allied fight against fascism and Nazism. Those charged  sat in the dock in their blood soaked garb and were not regarded as ordinary individuals. They were regarded as monsters

Eichman’s trial took place away from the stench of Auschwitz and Buchenwald in the sanitized environment of an Israeli courtroom. Germany had long repented, paid reparations and had once again become a respected democratic nation. Eichman did not appear at the trial in his Fascist uniform. Gone was the large cap and the collar with its buttons and Nazi insignia which had served as a frame for his angular evil looking sneering face. The 1961 Eichman was stripped of the trappings of his evil persona. He was balding with his head bare. He was a crumpled aging man in a suit, an ordinary citizen who had been kidnapped from his mundane life in the Argentine. It was surreal to watch the prosecution try him for genocide of six million souls, He claimed matter of a factly that he hadn’t killed one jew. It seemed incongruous that someone who appeared to be a mediocre civil servant was being blamed for mankind’s greatest atrocity.

However surreal and ridiculous his trial was, he maintained he was just carrying out orders. Innocuous as the accused appeared he was the organizer and executioner of six million jews. And there he was looking like everyday you and me. Probably he was living the life of a citizen making ends meet, going to work daily at the Mercedes Benz factory in Buenos Aires. He was indistinguishable from those Germans who voluntarily joined in Hitler’s slaughter while going about their day to day living. One had to assume that he had bought the big lie and any action to eradicate the problem was justified. 

Arendt to cope with these paradoxes coined the term the “Banality of Evil”. At its very core it is non thinking mindless, senseless and evil behavior. Arendt concluded that ideologies deaden thought as to what is good and evil. This latter process making society or groups to become easier prey in participating in brutalities. All this is made possible by the massive concentration of bureaucratic and technocratic power in the nations state. 

So ordinary folk who live otherwise ordinary lives join in and become numbed to their own thoughtless  evil. 

The positive legal outcome arising out of the Nuremberg trials was that the defense “just following orders” was no longer accepted in crimes against humanity. 

Once "the black male suspect” was subdued……

Once Nichols was senseless and handcuffed and The Five had thoughtlessly and illegally executed the State’s objective, with their flimsy rarely challenged narrative intact, what did The Five talk about? Did they discuss the Super Bowl, their children or what they were going to do off duty when they had shed their resplendent uniforms which confirmed their status and power? Were they off the next day? Would they do do gardening or shopping while dressed in the civilian garb blending in with all around them? 

Then The Five had company. What passed between them and the EMT’s in the twenty minutes from the latter’s  arrival and Tyre being carted off to the hospital? In all likelihood they had met before. Did they all enquire about each others’ families?  - the trivia of daily life intermingled seamlessly with the trivia of evil. All because nobody did any thinking about what was happening in Memphis. As the ex Boston police commissioner observed the sheer volume of arrests was a red flag in and of itself…… 

Then no one thought and nobody still does that crime is associated with poverty and poor education. Not that that absolves the criminal nor will, even if societal ills somehow are addressed, would crime be eliminated. 

Here we go again

So we are in for another trial. The accused will be in their suits and respectfully stand as the Judge enters. Members of their families may be present because they have to have those who love them. Also fresh from interminable interviews the family of Tyre will attend in the hope that justice will be served and some sort of closure to their unspeakable loss will begin. We have already heard all the pious talk by the leaders of society who unthinkingly assume no responsibility for the tragedy. Finally for the gawking public there was the televised church service with the singing, the sermons and the eulogies. The trial itself as the hours of tape unrolls with its brutality will leave unthinking society confused that such barbarism can take place in cold blood.

So before we educate the next generation to think, what can be done? How about "The George Floyd Justice in Policing Bill"?

The underlying psychodynamics have been identified.- the unthinking powerful bureaucratic state and its unthinking soldiers with the unthinking society’s buy in, BUT can anything legislatively be done now to address the problem.

For those who respect the mass of law enforcement officers who risk their lives daily as they did on January 6  surely they are owed legislation that would separate them from these bad apples.

There is on record The George Floyd Justice in Policing Bill, so named after an earlier grotesque incident where a conscientious thinking young bystander recorded on her cell phone the systematic shameless mindless abuse of force resulting in the death of George Floyd. The Bill increases accountability and establishes best practices. The proposed legislation lowers the criminal standard for guilt to “willful or knowing” that their actions were illegal. It limits the immunity that police have from their actions and allows for them to be sued, Also mechanisms for recording and researching complaints against police are put in place. It also bans lethal actions that are known to occur such as choke and carotid holds and racial profiling.

Needless to say the Bill did not receive a vote in the Senate because ten “GOP” members would not break the filibuster. In fact not even two would vote to just have it passed by a majority vote. The Democrats could have prevailed if Senators Sinema and Manchin believed that this was important enough to pass with a simple majority. In the House one “GOP” member voted for it.

The presence of Tyre's parents as guests of President Biden for the State of the Union address served as a stark reminder of the toll that the unthinking "culture" has on African American parents. Biden's gift of empathy removed any hint of the phoniness that some of the State of the Union guests engender, appearing as mere props

Governor Ron Desantis will tell you why he doesn’t support the Bill - because it is WOKE and makes white people feel guilty even though many of the police offenders are black.

AT THE END OF THE DAY

So you have the ideology, the powerful state, the leaders who mandate the soldiers with unthinking society acquiescing to this banality of evil…. until there is a corpse which precipitates an outcry, but no rethink of how this could happen again and again.

Perhaps there should be rethink about who should be issuing citations for speeding and what the job definition of those policing traffic violations should be. Why on earth should those enforcing the law against those with a non functioning taillight be armed to the teeth? Why if someone is pulled over for not stopping dead at a stop sign, if they are black, have to see to it that their hands are visible and not make any jerky movements? 

A traffic officer's  job definition should just be enforcing the law relating to traffic violations. It should be separated from conventional police activity.

Those in authority must surely wonder why so many who have have broken taillights, allegedly ride recklessly or speed in built up areas seem to resist arrest as well? And the fact that they also happen to be usually not white.

And knowing what we already know it is going to get worse..