[johnu]

Once again I'm disappointed in Lying Mitch the Hypocrite McConnell but not for the usual reasons.

Mitch McConnell Received Donations from Voting Machine Lobbyists Before Blocking Election Security Bills

Sure I'm disappointed that Lying Mitch would sell out the USA and allow the Russians to interfere with our elections, but what's astonishing is how little in bribes political contributions it took to buy him lock, stock, and barrel.

Quote

Sludge found that Brownstein Hyatt Farber Schreck lobbyist David Cohen, who has worked on behalf of Dominion Voting Systems this year, donated $2,000 to McConnell during this time. Brian Wild, who works with Cohen and has also lobbied Dominion, gave McConnell $1,000.

Around the same time, on February 19 and March 4 Emily Kirlin and Jen Olson, who have lobbied on behalf of Election Systems & Software over the last year donated $1,000 to McConnell each.

Quote

McConnell's actions seemed even more out of balance with his party, as the Senate Intelligence Committee⁠—led by Republicans⁠—released a report later on Thursday claiming Russians have targeted voting systems in all 50 states in 2016. Though there was no evidence votes were changed, in Illinois "Russian cyberactors were in a position to delete or change voter data."

How is selling out the country not worth a couple of million dollars in corporate contributions (thank you Citizens United)? We're in serious trouble in this country if you can buy US Senators for just a few thousand dollars

[kenberg]

I will explain where I think Dems have a problem that they need to deal with.

In post number 13192 Y66 cites a NYT article that itself cites some sources on the Cadillac Tax, in particular an article by Sarah Kliff Let's think a bit about this, going back to the claim "If you like the insurance you have, you can keep it." I don't think that there is any real doubt that this promise was part of the advertising for passing the ACA.

Of course there would be a caveat. You can keep it if your employer continues to offer it. Ok, fair enough, so far. But if we take the ACA as a whole, then the statement should have been
:
"If you like the insurance you have, you can keep it, providing that your employer continues to offer it and we are going to be doing everything that we can, including a 40% penalty, to get your employer to stop offering it"

Ok, politicians in general are very good at explaining why words that seem to have a clear meaning of course really, when properly re-interpreted by them, have an entirely different meaning. Here the meaning is that of the person happens to be working for an employer who is so generous ort so dumb. or maybe bound at least for a while by a union contract that s/he will continue to offer this health plan despite the best efforts of everyone in the administration get them to drop it, well the you can keep it. Quoting Ms. Kliff "The whole point of the Cadillac tax was to push employers in the opposite direction, and offer their workers less robust benefit packages."


So here, as I understand it, is where this gets us. These very generous plans push the cost of medical care upward, the Cadillac tax was designed to deal with that, the Cadillac tax is so unpopular there is no chance it will every actually be implemented. All predictable.

The main point: The ordinary person, one who does not spend a lot of time thinking about the long term effect of the ACA, is very aware of being told first that he can keep his plan and then finding that he has to fight like hell to keep it. This does not inspire trust.

I regard myself as an ordinary guy, or close to it. This means that I am not an expert on health care, not an expert on immigration, not an expert on a lot of things, but I can tell when "If you like the insurance you have, you can keep it." is not really a correct description of what is going on.


Here is a shorter version: When I get a bad result at bridge, I start by looking at my own choices to see what I might have done better. The Dems had a very bad result in the last presidential election. I strongly suggest that they try looking at the errors that they made. For one thing, correcting one's own errors is much more likely to be within the power of a person than getting others to act in your interests.

[awm]

 kenberg, on 2019-July-27, 13:33, said:

Here is a shorter version: When I get a bad result at bridge, I start by looking at my own choices to see what I might have done better. The Dems had a very bad result in the last presidential election. I strongly suggest that they try looking at the errors that they made. For one thing, correcting one's own errors is much more likely to be within the power of a [/size]person than getting others to act in your interests.

One has to be careful with the conclusions from the last presidential election. Keep in mind that Hillary Clinton got 3 million more votes than Trump did. This was also an election that saw a great deal of interference by Russian agents, and where the head of the FBI took the unprecedented step of reopening an investigation into the Democratic candidate mere days before the vote. Turnout was relatively low, both candidates were extremely unpopular, and it was decided by less than a hundred thousand votes total in a few states.

Looking at all this (and the trouncing Republicans in the house received in 2018) suggests that "Democrats need a massive change of strategy" is probably an overreaction. Trump has never been above the low 40s in popularity polls and more than 50% of registered voters claim that they will definitely not vote for him. It's hard to imagine what could change before the election that would cause Trump to become much more popular than he has ever been (both his supporters and his opponents are pretty entrenched and events rarely seem to move the number much in either direction).

I don't think this next election will be a low turnout affair, regardless of whether Democrats run on how awful Trump is or what they plan to do to make things better. I'd be more worried that Republicans do something massively illegal to retain power (like cancel the elections, or sending ICE to round up Latino citizens trying to vote and imprison them until the day after the election) than I would be that Democrats will choose the wrong nominee or strategy.

[kenberg]

 awm, on 2019-July-27, 14:57, said:

One has to be careful with the conclusions from the last presidential election. Keep in mind that Hillary Clinton got 3 million more votes than Trump did. This was also an election that saw a great deal of interference by Russian agents, and where the head of the FBI took the unprecedented step of reopening an investigation into the Democratic candidate mere days before the vote. Turnout was relatively low, both candidates were extremely unpopular, and it was decided by less than a hundred thousand votes total in a few states.

Looking at all this (and the trouncing Republicans in the house received in 2018) suggests that "Democrats need a massive change of strategy" is probably an overreaction. Trump has never been above the low 40s in popularity polls and more than 50% of registered voters claim that they will definitely not vote for him. It's hard to imagine what could change before the election that would cause Trump to become much more popular than he has ever been (both his supporters and his opponents are pretty entrenched and events rarely seem to move the number much in either direction).

I don't think this next election will be a low turnout affair, regardless of whether Democrats run on how awful Trump is or what they plan to do to make things better. I'd be more worried that Republicans do something massively illegal to retain power (like cancel the elections, or sending ICE to round up Latino citizens trying to vote and imprison them until the day after the election) than I would be that Democrats will choose the wrong nominee or strategy.

I don't see myself as suggestion a massive change in strategy. Or at least I hope that the things I am suggesting would not seem to the leadership to be a massive change in strategy. I am hoping that the Dems can build trust with a large portion of the electorate, and I suggest that to do that they need to look at some of the reasons that some voters are skeptical.. I like to think that I am suggestion realism. For example, yes Clinton got a good many more votes than Trump did on 2016. That fact should be set against the fact that the path to the presidency will still run through the electoral college in 2020.Whatever one thinks of that fact, it is still a fact.


The penalty on Cadillac Health plans was one example of many I might have listed where I would hope that the Dems would look and say "Oh, yeah, I can see how that might have cost us some votes from people who once would have surely voted Dem". And, just for a moment, let's look at the name "Cadillac Tax". I would be willing to bet that of the people who have such a plan, more of them drive Chevrolets than drive Cadillacs. So what? Well, I think when you write off such people you are writing off quite a few. Also, it's not really a tax, it's a penalty. The purpose of a tax is to raise revenue. But the acknowledged purpose of this charge is to kill off those plans. It's much like a fine for speeding in a school zone. Yes, the money from the fine goes into the coffers, but the purpose is to get people to slow down. It's a success if nobody speeds, even though then there is no revenue, and the "Cadillac Tax" would be judged a success if the plans die out, even thought then there would be no revenue from it. It's a penalty designed to change behavior, not a tax designed to raise revenue. Of course getting cute with words is standard for politicians, and the name is hardly a great issue, but claiming that you can keep a plan that you like while putting in a penalty designed to kill a plan that a person likes is a big deal. Or, as Biden put it, a big ****** deal.

I am suggesting that Dems give some thought as to why Clinton lost, and I am suggesting that if the only reasons that they can think of all come down to it being someone else's fault then I am suggesting that they think a little harder. This should not be seen as a massive change in strategy. I sure hope not.

[johnu]

 kenberg, on 2019-July-27, 18:17, said:

The penalty on Cadillac Health plans was one example of many I might have listed where I would hope that the Dems would look and say "Oh, yeah, I can see how that might have cost us some votes from people who once would have surely voted Dem". And, just for a moment, let's look at the name "Cadillac Tax". I would be willing to bet that of the people who have such a plan, more of them drive Chevrolets than drive Cadillacs. So what? Well, I think when you write off such people you are writing off quite a few. Also, it's not really a tax, it's a penalty. The purpose of a tax is to raise revenue. But the acknowledged purpose of this charge is to kill off those plans. It's much like a fine for speeding in a school zone. Yes, the money from the fine goes into the coffers, but the purpose is to get people to slow down. It's a success if nobody speeds, even though then there is no revenue, and the "Cadillac Tax" would be judged a success if the plans die out, even thought then there would be no revenue from it. It's a penalty designed to change behavior, not a tax designed to raise revenue. Of course getting cute with words is standard for politicians, and the name is hardly a great issue, but claiming that you can keep a plan that you like while putting in a penalty designed to kill a plan that a person likes is a big deal. Or, as Biden put it, a big ****** deal.

In case you didn't notice, Democrats in the House have already voted to repeal this tax.

House votes to repeal Obamacare's ‘Cadillac tax'

Quote

The 367 co-sponsors of the bill by Rep. Joe Courtney (D-Conn.) included members of the progressive wing of the Democratic Party like Reps. Pramila Jayapal (D-Wash.) and Ro Khanna (D-Calif.)—who have championed replacing the employer-based system through Medicare for All—as well as conservative Republicans.

I don't know all the positions of Democratic presidential candidates but assuming the Senate gets around to passing a repeal bill, there won't be much to discuss in 2020.

[johnu]

The buck stops over there .....

Trump blames Obama administration for bad White House air conditioning

Quote

President Trump has blamed predecessor Barack Obama for a litany of issues, from the Iran nuclear deal to the crisis at the border, and on Friday he added the alleged poor state of air conditioning in the White House to that list.

Nothing like manning up and blaming the guy behind the tree instead of taking responsibility for anything

You would think a guy who forced Mexico to pay for a border wall, won a global trade war and made China pay for tariffs, made North Korea and Iran give up nuclear ambitions, and solved the border crisis could have hired some A/C contractors to get the air conditioning working like he wanted. Apparently that's too lofty a plan to implement.

[kenberg]

 johnu, on 2019-July-27, 19:30, said:

In case you didn't notice, Democrats in the House have already voted to repeal this tax.

House votes to repeal Obamacare's 'Cadillac tax'



I don't know all the positions of Democratic presidential candidates but assuming the Senate gets around to passing a repeal bill, there won't be much to discuss in 2020.

Yes, I very much did notice. I think there were 6 no votes, or something of that order of magnitude. I see this as belated realization that the penalty/tax was, at least politically, a very bad idea.

I accept that these high end plans do indeed increase medical costs by encouraging perhaps overly generous use of medical treatment but it's a real problem as to how to address it. In the last ten years I am sure I have used far more medical treatment than I had in all of the previous seventy, and I see myself as still basically healthy. Medicare is good, I have supplemental insurance, I pay a not entirely trivial amount for each of these but nowhere near what is paid out. I doubt it qualifies as a Cadillac plan but it's more than a Chevrolet plan or a Pontiac, maybe a Buick plan or an Oldsmobile plan. Anyway, I like it, but I do see how I might sometimes be getting stuff I could do without. Once I had a rash and the dermatologist was going to prescribe some lotion that would cost around 50 bucks, but then he checked my prescription plan and changed it to something that cost 200. Medicare paid 80% but the doc gave me a coupon for a 40 dollar rebate, So Medicare paid for 160 on the 200, and the rebate took care of the rest. That's nice. For me. Or, here's an item illustrating a problem much in the news: A year or so ago I had a severe tooth problem, the dentist took good care of it on an emergency basis and wanted me back the next Monday. He also wanted to give me a prescription for some opioid for the pain. I refused, he really could not understand this refusal, he got a bit hard sell. Maybe he gets paid off, maybe he is stupid, I now see a different dentist. So there are problems. I think the solution has to involve most all medical plans, even though I don't know exactly how that solution would work.

[Winstonm]

 kenberg, on 2019-July-28, 05:53, said:

Yes, I very much did notice. I think there were 6 no votes, or something of that order of magnitude. I see this as belated realization that the penalty/tax was, at least politically, a very bad idea.

I accept that these high end plans do indeed increase medical costs by encouraging perhaps overly generous use of medical treatment but it's a real problem as to how to address it. In the last ten years I am sure I have used far more medical treatment than I had in all of the previous seventy, and I see myself as still basically healthy. Medicare is good, I have supplemental insurance, I pay a not entirely trivial amount for each of these but nowhere near what is paid out. I doubt it qualifies as a Cadillac plan but it's more than a Chevrolet plan or a Pontiac, maybe a Buick plan or an Oldsmobile plan. Anyway, I like it, but I do see how I might sometimes be getting stuff I could do without. Once I had a rash and the dermatologist was going to prescribe some lotion that would cost around 50 bucks, but then he checked my prescription plan and changed it to something that cost 200. Medicare paid 80% but the doc gave me a coupon for a 40 dollar rebate, So Medicare paid for 160 on the 200, and the rebate took care of the rest. That's nice. For me. Or, here's an item illustrating a problem much in the news: A year or so ago I had a severe tooth problem, the dentist took good care of it on an emergency basis and wanted me back the next Monday. He also wanted to give me a prescription for some opioid for the pain. I refused, he really could not understand this refusal, he got a bit hard sell. Maybe he gets paid off, maybe he is stupid, I now see a different dentist. So there are problems. I think the solution has to involve most all medical plans, even though I don't know exactly how that solution would work.

Here is a significant problem with controlling U.S. healthcare costs and patient outcomes:

Quote

There are two prevalent pay systems for physicians in the US—fee-for-service and volume-based reimbursement, where health care entities, and doctors through them, get paid a fixed amount per person based on a patient’s health and pre-existing conditions. Both are problematic. While fee-for-service incentivizes unnecessary or expensive treatment, volume-based-reimbursement schemes provide the opposite. By ordering fewer services for patients in the latter context, doctors directly and indirectly, make more money per patient.

“Fee-for-service or volume-based reimbursement, which by one estimate determines payments for nearly 90% of US physicians, provides incentives for physicians to order more and different services than those that match patient need,” write Loewenstein and Larkin. They suggest that if doctors were paid salaries, they’d be more inclined to practice medicine that meets patient needs, and could also be happier in the profession, which typically experiences high burnout rates.

One remedy offered would be to pay physicians a salary, which could be the case if all physicians were hired by the government, for example.

I once spoke to an American physician who was licensed a practiced in Canada, and he was quite happy with Canada's care system for just that reason - the physicians were in charge of the care.

[kenberg]

 Winstonm, on 2019-July-28, 08:50, said:

Here is a significant problem with controlling U.S. healthcare costs and patient outcomes:



One remedy offered would be to pay physicians a salary, which could be the case if all physicians were hired by the government, for example.

I once spoke to an American physician who was licensed a practiced in Canada, and he was quite happy with Canada's care system for just that reason - the physicians were in charge of the care.

We are not going to do this. We just aren't, and I doubt anyone thinks that we are. The authors describe it as a simple solution. I suppose that depends on what "simple" means.

[Winstonm]

 kenberg, on 2019-July-28, 19:35, said:

We are not going to do this. We just aren't, and I doubt anyone thinks that we are. The authors describe it as a simple solution. I suppose that depends on what "simple" means.

Yippee-ki-yay isn't much of an argument but it our argument and we love it. So tell me, America, do you feel lucky?

I agree that this won't get done - at least not quickly - but if it is an answer, or the answer, why are we so quick to dismiss it as "impossible" instead of moving toward it or at least talking about it? There is a fine line between pragmatic and stodgy.

[y66]

Guest post from David Leonhardt at NYT:

Quote

In last year’s midterm elections, Democrats won 31 congressional districts that President Trump had carried in 2016 — including in the suburbs of Atlanta, Chicago, Des Moines, Detroit, Oklahoma City, Phoenix, Pittsburgh and Richmond, Va., as well as in more rural parts of Maine, Minnesota, New Mexico and Wisconsin.

How did the Democrats do it? By running a smart, populist campaign that focused above all on pocketbook issues like affordable health care and good jobs. The Democrats who won in these swing districts didn’t talk much about Trump, the Russia scandals, immigration or progressive dreams like single-payer health care. They focused on issues that affect most voters’ daily lives.

Theda Skocpol — the Harvard social scientist who has studied the Tea Party and the anti-Trump resistance, among many other things — has a new op-ed in USA Today that argues that the 2020 Democratic presidential candidates are ignoring the lesson of 2018. By doing so, Skocpol says, they are increasing the chances that Trump will win re-election. As Democrats prepare for their second round of debates this week, I think Skocpol’s message is worth hearing.

“The first 2020 primary debates were a case in point,” she writes. “Thrilling as it was to see female contenders do well, the debates were chaotic and dominated by simplistic questions about topics of little concern to most Americans. The ostensible winners embraced ultra-left issue stands — like calls to abolish private insurance and give free health care to migrants — that would sink them in the general election.”

These stances may help Democrats run up even larger margins in blue states like California and New York. But the presidency isn’t decided by the popular vote. And two of the smartest election analysts — Nate Cohn of The Times and Dave Wasserman of the Cook Political Report — have both written pieces recently that explain how Trump could lose the popular vote by an even wider margin than he did in 2016, and still win re-election.

Skocpol writes: “U.S. politics is not a national contest. Victories in Congress, state politics and the Electoral College all depend on winning majorities or hefty pluralities in heartland states and areas that are not big cities. Hillary Clinton lost in 2016 mainly because she was whomped in non-urban areas where Obama had lost by far smaller margins.”

A final point she makes is that Republicans — like the Koch brothers and their network — are more ruthlessly disciplined about advancing their interests and more focused on winning state and local campaigns. Too many Democrats, by contrast, give in to wishful thinking, imagining that they can control government policy by running campaigns that mostly excite people who live in deep blue areas.

The 2018 midterms showed a clear playbook for Democratic victory. The question is whether the party will follow it.

[y66]

From Jonathan Bernstein at Bloomberg:

Quote

One of the few qualified, well-respected and scandal-free members of President Donald Trump’s administration is on his way out. Dan Coats plans to resign next month as director of national intelligence, apparently to be replaced by a House member who has few obvious qualifications for the job – unless we count strong partisanship and loyalty to Trump.

Trump has been feuding on and off with U.S. intelligence agencies since his presidency began, and we’re told that Representative John Ratcliffe, his proposed replacement for Coats, is going to “clean house,” which presumably means rooting out those more interested in getting the intelligence right than in demonstrating fealty to the president.

Perhaps the Senate will insist on someone with more experience in these matters than Ratcliffe. But it’s a good reminder that Republican senators have flubbed this process from the get-go. They could’ve used their power of confirmation to insist that Trump run a professional White House and executive branch. They’ve largely chosen otherwise.

To be sure, Trump has had an unusually high number of failed nominations. Republican senators have been willing to block some of his poor choices; that’s why Herman Cain and Stephen Moore aren’t on the Federal Reserve Board of Governors and why Judy Shelton, who still hasn’t been formally nominated, may not wind up there either. The Senate is able to block choices when it collectively chooses to, usually by convincing the president to withdraw a nominee before a hearing is held or even before he makes the nomination. But if anything, the process of finding, selecting, and vetting executive-branch nominees seems to be getting worse, considering that it took about seven months and two selections to find a secretary of defense and there’s still no nominee for secretary of homeland security more than three months after the position was vacated.

The underlying problem is that Senate Republicans just haven’t given the president a forceful nudge. The need has been obvious since Trump welcomed Steve Bannon to the White House in a senior position and picked Reince Priebus, who had no governing experience, as chief of staff. Senate Republicans should’ve staged an intervention immediately and threatened to leave other executive-branch picks in limbo until Trump hired someone to run the White House who had a chance to be effective. If not then, they should’ve stepped in when he started the predictable string of failed nominees. Insisting that he run the administration professionally would’ve spared them a lot of trouble in the long run.

It’s true that Trump came in as an outsider, and he had earned some latitude for the individuals he wanted to choose. Yet most of his problems haven’t really come from outsiders. Some of his least successful picks have been Republican members of the House.

At any rate, Republican senators – many of whom were willing to publicly take on Trump when he attacked the intelligence community – should make sure that the new nominee isn’t intent on dismantling things that are actually working.

[kenberg]

 Winstonm, on 2019-July-29, 06:29, said:

Yippee-ki-yay isn't much of an argument but it our argument and we love it. So tell me, America, do you feel lucky?

I agree that this won't get done - at least not quickly - but if it is an answer, or the answer, why are we so quick to dismiss it as "impossible" instead of moving toward it or at least talking about it? There is a fine line between pragmatic and stodgy.

Well, it would be a lot of work! Here is something I don;t know: There are doctors at a hospital who treat patients coming in on an emergency basis. Let's say, as happened a few years back, I am admitted to the emergency room where things are of course hectic, but then I am put into a room where I stay for two or three days. A hospital doc is in charge of what happens to me. Is that doc on a salary? Whatever his form of payment was, I hope to never be under his care again.

But trying to look carefully at all of this would require a lot of time and effort and I it seems so unlikely to happen that I am reluctant to put in the effort. I also probably would not be in favor of it, but as of now I cannot say that with certainty.

[PassedOut]

Doctors at the Mayo Clinic are salaried and I've been very happy with the medical care my family has received there. The whole operation is well-organized, including the timing and accuracy of the appointment schedules.

When my middle son was a freshman in college, he developed painful kidney stones and was determined by a local doctor there to have a problem with one of his parathyroid glands. The doctor recommended immediate surgery -- which he would do -- and pulling our son out of college for the rest of the semester for recovery.

Of course, Constance and I said "Hold your horses until we get back to you." On the phone immediately to Mayo, we learned that immediate surgery was not required and that Mayo had a minimally invasive technique available to remove the defective gland that would require only a couple of days to recover. We scheduled the procedure for his winter break, and everything went like clockwork, as is usual with Mayo. But, even more telling, from my viewpoint, was that the staff there knew that we would be returning to Michigan's Upper Peninsula on the day after the procedure, and that winter driving in the dark could be problematic. To help us out, Mayo offered to have the discharge doctor come in to work an hour early to meet with us so that we could get an early start on our drive. We welcomed that and the doctor did meet with us early and we did get home before the sun went down.

And it's not just us who like Mayo. Mayo generally has a fine reputation, both in the US and internationally. So the idea of doctors receiving (very good) salaries and working in a well-organized setting does not seem a farfetched notion to me. It's the other structures that seem ridiculous.

[kenberg]

 PassedOut, on 2019-July-29, 10:20, said:

Doctors at the Mayo Clinic are salaried and I've been very happy with the medical care my family has received there. The whole operation is well-organized, including the timing and accuracy of the appointment schedules.

When my middle son was a freshman in college, he developed painful kidney stones and was determined by a local doctor there to have a problem with one of his parathyroid glands. The doctor recommended immediate surgery -- which he would do -- and pulling our son out of college for the rest of the semester for recovery.

Of course, Constance and I said "Hold your horses until we get back to you." On the phone immediately to Mayo, we learned that immediate surgery was not required and that Mayo had a minimally invasive technique available to remove the defective gland that would require only a couple of days to recover. We scheduled the procedure for his winter break, and everything went like clockwork, as is usual with Mayo. But, even more telling, from my viewpoint, was that the staff there knew that we would be returning to Michigan's Upper Peninsula on the day after the procedure, and that winter driving in the dark could be problematic. To help us out, Mayo offered to have the discharge doctor come in to work an hour early to meet with us so that we could get an early start on our drive. We welcomed that and the doctor did meet with us early and we did get home before the sun went down.

And it's not just us who like Mayo. Mayo generally has a fine reputation, both in the US and internationally. So the idea of doctors receiving (very good) salaries and working in a well-organized setting does not seem a farfetched notion to me. It's the other structures that seem ridiculous.

Great story, thanks. I have never been to the Mayo but growing up in Minnesota I always understood it to be a great place.

They are salaried? That's interesting. I am guessing that at The NIH this is also true, I think it probably is not the case at Johns Hopkins (two major places near me) but I don't really know in either case.

[Winstonm]

My experience with physicians is that most of them are caring individuals who try very hard to care for patients. At the same time, physicians are human so some of them are arrogant, inept, greedy, shady, crooked, or afflicted by any other human weakness you can name.

I never met one, though, who became a physician in order to buy and sell stocks or run a business; however, because of the nature of the pay for many, they are forced into the role of stockbroker and entrepreneur.

The way doctors are paid makes an enormous difference with those doctors who have the most human faults. The greedy ones over-order tests and procedures if they have primarily Cadillac plan patients. IF their practice is based on Medicaid, their primary interest is in seeing as many patients as they can as fast as they can as volume makes up for the pay difference.

As is normal in the U.S., those who can afford it get the best care while the poorer get less care if not totally taken advantage of - and because of massive and long history of inequality, the price is paid by a disproportionate number of people of color.

[PassedOut]

 kenberg, on 2019-July-29, 11:24, said:

Great story, thanks. I have never been to the Mayo but growing up in Minnesota I always understood it to be a great place.

They are salaried? That's interesting. I am guessing that at The NIH this is also true, I think it probably is not the case at Johns Hopkins (two major places near me) but I don't really know in either case.

Yes, they are salaried, and the whole organization is very well set up to allow the doctors to focus on care rather than extraneous matters. In fact, huge underground walkways connect the hospitals, hotels, and restaurants in downtown Rochester so you could stay there for treatment without ever stepping into the February snow. There is a grand piano in a main intersection of the walkways, often with live music, for example.

Ken Burns produced an excellent documentary in 2018 showing just how the Mayo Clinic began and how it has managed to stay true to its guiding philosophy. Constance and I found it very interesting, especially in light of our own experiences at Mayo.

After you see how good medical care can actually be, it's pretty disappointing to run into the normal situation. Nevertheless, Mayo sets an aspirational standard.

[kenberg]

PassedOut's final line says a lot:
"After you see how good medical care can actually be, it's pretty disappointing to run into the normal situation. Nevertheless, Mayo sets an aspirational standard."


It's inevitable that some doctors will be better, substantially better, than others. But this also goes along with something I said earlier, that when your health is at stake you just cannot afford to passively accept. I have just seen this so many times, and, also as I have said, if you watch what doctors themselves do when they need medical attention, they are very aware that it is necessary to speak up, sometimes pretty forcefully.


There is only so much that can be done about this basic fact of life, in medicine or anywhere.


My general view of people is that, for the most part, they are not crooks or scumbags. This applies to doctors, it applies to truck drivers. But that doesn't mean that they are all wise or all good either. So the structure is important. I seriously doubt that putting all docs on salary is the way to go at this, but my argument would be stronger if I had a good idea of just what we should do.

[y66]

From a report prepared for the House Oversight Committee chaired by Rep. Elijah Cummings (D-MD):

Quote

Overall, the new documents obtained by the Committee reveal that, with regard to Saudi Arabia, the Trump Administration has virtually obliterated the lines normally separating government policymaking from corporate and foreign interests. The documents show the Administration’s willingness to let private parties with close ties to the President wield outsized influence over U.S. policy towards Saudi Arabia. These new documents raise serious questions about whether the White House is willing to place the potential profits of the President’s friends above the national security of the American people and the universal objective of preventing the spread of nuclear weapons.

“You follow drugs, you get drug addicts and drug dealers. But you start to follow the money, and you don’t know where the f**k it’s gonna take you.” -- Lester Freamon, The Wire

Edit: I corrected the source of the follow the money quote per andrei.

[Winstonm]

Quote

Trump is more Andrew Johnson than Andrew Jackson
By Sheldon Clay

I’ve been reading Ron Chernow’s vast biography of Ulysses S. Grant. It’s an epic story of American character and grit. But what really struck me was a subplot I hadn’t expected.
Sandwiched between the accounts of Grant’s hard-nosed Civil War generalship and his election to the office of president are 70 pages describing Grant’s service as peacetime general under President Andrew Johnson. Read that section and you feel like you just picked up this morning’s Washington Post or New York Times. It would serve as good bedtime reading for our current president.

When Donald Trump began his presidency he fancied himself a successor to the rough populism of Andrew Jackson. He even hung a portrait of Old Hickory in the Oval Office. He was off by about thirty years and a couple of consonants. Instead of Andrew Jackson, Trump is mirroring the unhappy trajectory of Andrew Johnson.

The 17th President of the United States came abruptly to office when John Wilkes Booth fired his derringer into Abraham Lincoln’s skull. The job ahead of President Johnson was doubly difficult. He had to fill the shoes of a wise and equanimous predecessor. He had to pick up Lincoln’s unfinished work of healing a country so brutally torn apart.

Instead of approaching his administration with the sensitivity that might suggest, Johnson lurched into governing with a massive chip on his shoulder. He was polarizing and overtly racist, at a time when the urgent question of the day was finding a path to citizenship for 4 million newly freed slaves. His temperament was as erratic as it was intransigent. His defining style was to pick fights with the people he was supposed to be working to bring together.

It’s like Andrew Johnson invented Trumpism 150 years before Trump.

In Chernow’s book the story of the Johnson presidency is told from the perspective of Grant, who believed his duty was to stay out of politics and keep the peace he and his army had fought to win. This is what makes it feel so relevant to the present moment. With each turn of the page you experience yet another level of Grant’s growing dismay at his president’s hard determination to appeal only to a narrow, intolerant base at the expense of the greater nation. The worst elements of the former slave holding aristocracy took their cues from Johnson’s low character and hostility to justice, and unleashed a wave of domestic terrorism across the South. Grant was given little alternative but to break with the president he had intended to serve and put entire states under martial law in his efforts to restore peace.

To make a painful story short, by the time of the midterm elections Johnson had so thoroughly alienated the voting public that the opposing Republican Party won an overwhelming majority in Congress. Johnson became the first president in U.S. history to be impeached, although the articles of impeachment were more a list of technicalities than any clear high crime or misdemeanor. The case was really about a general agreement that Johnson had proven himself woefully unfit for the presidency.
Johnson managed to hang on to his office by a one-vote margin. He faded into a noisome irrelevancy during his last months in office, while Congress governed and the nation counted the days until he could be replaced by Ulysses S. Grant in the next election.

The story is an American tragedy, certainly for Andrew Johnson, but also for the nation as a whole. We can only wonder how things might have turned out if a coarse and pugnacious president had not arrived to wreck the national healing begun by General Grant’s unexpected magnanimity to General Lee at Appomattox Court House. Would we have managed to avoid some of the entrenched racism and bitterly hardened fractures that have plagued the nation ever since?

And yet, there is also hope in this strange passage from America’s story. It was far from a shining moment for the nation’s institutions, but at the least they functioned to contain a presidency veering dangerously out of control. Impeachment was defined as more a political tool than a legal one. The lesson learned is that if it’s needed again, a larger and more illuminating charge might work better than an assemblage of legal technicalities. Breaking the presidential oath to preserve, protect and defend the Constitution comes to mind as an overarching theme.

Think how useful it would be for the current president to read Chernow’s book on Grant, although, at 959 pages long, we’re more likely to see pigs taking wing around the D.C. airspace. Trump would find solace in the fact that Grant fought often with a hostile press, and his political skills were severely underestimated. Trump might even experience a rude epiphany in the story of Andrew Johnson, and reverse some of the habits bringing down his presidency. If they truly want to support their man, perhaps someone from Fox & Friends could summarize the cautionary points for him.