April 2, 2020--Cuomo Time

Anyone paying attention knows what Donald Trump did and didn't do to make the COVID-19 pandemic much worse than it would have been if a more competent and compassionate president had been leading the fight to contain it.

We know he sacked most government workers who had expertise about pandemics, claiming they weren't necessary because, grandiosely, he knew all that was needed to take on global epidemics.  

We know that when he could no longer ignore the signs that a pandemic was heading our way he tried to get away with happy talking Americans to distraction, telling then he was on top of things and very soon it would miraculously disappear.

All the while a number of governors, New York's Andrew Cuomo most prominently, were begging for help with supplies, medical equipment, and protective masks and gowns.

To many, Trump was the villain and the governors were adulated, especially Cuomo who has been so visibly on the case that a number of leading Democrats are hoping that a way can be found to nominate him to run against Trump.

I wish that Trump would disappear from the scene later this afternoon. Actually, in half an hour. 

But is it accurate to blame the failed response to the coronavirus to only Trump and his administration?

My view is it's worse than that--there is much more blame to spread around that it even includes governors such as Andrew Cuomo. 

The entire health care system is to blame: presidents, governors, mayors, and especially hospital and health care administrators. Administrators, not the galant staffs.

The federal government, even a competent one, is not exclusively responsible for assuring that hospitals are adequately equipped to take on medical emergencies. 

Do we expect the federal government to be in charge of hospitals' supply of scrubs, face masks, and sterile gloves? Should we expect the central government to make and store enough ventilators to handle everything heath care workers and institutions require to confront an emergency?

There are of course things that the government is best able to do. For example, deploy hospital ships and field hospitals. And perhaps top off emergency supplies when state resources are overwhelmed as they now are.

Isn't it reasonable to expect individual hospitals and state systems to stock at least 50 percent of the supplies and equipment needed to handle a crisis?

Listening to governor Cuomo and his colleagues it sounds as if they see this to be a federal responsibility. That perhaps FEMA should be in charge of it.

This is not the way our health care system is organized. Perhaps it should be. It is not centrally organized and controlled. I suspect Bernie Sanders would make the case that it should be, but to me, when faced with a pandemic, the buck stops a number of places.

July 19, 2017--Trump Fatigue

I try to write five of these a week. One a day Monday through Friday. I've been doing this for 12 years, from August 2005, and have thus far posted 3,158.

For nearly two years more than half my pieces have been about the 2016 election; the emergence of Donald Trump; his election; and, for six months, his presidency. On occasional weeks all five, one way or the other, have been about Trump. Such has been my obsession.

During the weekend, when not posting, I try to come up with two or three subjects to write about for the upcoming week. To get ahead of the relentless pressure to produce five. Sometimes it feels as if I am physically "producing" them.

This is not a complaint. I love doing this. I like the discipline, the motivation to think things through and to approach issues in hopefully fresh ways, and especially hearing from readers who half the time like what I've been writing. The rest of the time, especially the last year and a half when my pieces have been disproportionately about Trump, I've received a lot of criticism that by taking him seriously, by attempting to write about him dispassionately, I'm "normalizing" him, and by so doing have been helping to position him in the mainstream of American presidential history. Not as an incompetent and dangerous pretender.

So, this past weekend, with Republicans in the Senate once more trying to ram viscous changes in healthcare policy through the system while seemingly every day there was another bombshell story about Donald Trump, Jr. eager to hear what "dirt" Russian operatives were pitching to spread around to sabotage Hillary and elect Trump, what with reports of this and infighting in the West Wing and stories about our raging president talking back to the TV, one would think I'd have seven things to write about, not my usual five.

But, if you've read this far, you are catching me writing about not any longer feeling I have things to write about.

If I can make the comparison, Seinfeld-like--writing about not writing.

I did manage to come up with an idea for Monday for a piece about Trump in Paris for Bastille Day and the monarchal ambitions of the new French president. And for Tuesday squeezed out something about John McCain and the now possibly doomed Republican health care plan.

But this lethargy that is the result of feeling overwhelmed, I am thinking, may be the point of Trump's brilliant strategy for governing. (There I go again calling it "brilliant.")

So overload the system that we no longer can remember all the outrageous things he did during the campaign, since entering the White House, and even last week. This cascade of outrageousness elicits so much frustration and anger that our circuits are blown.

I don't know about you, but this is the way I've been feeling.

Chipped away at I am wanting to give up and return to my cocoon and my distractions. I noticed over the past weekend that I was watching a lot of television. Not cable news but tennis and the Yankees-Red Sox series. I even surfed around looking for Seinfeld reruns. Caught the one with Elaine at Yankee Stadium!

Having confessed this, tomorrow I'll be reposting something I wrote in February during five days that I called "A Week Without Trump."

Tomorrow, I hope you will take a look to see how I did.

July 18, 2017--John McCain Would Already Be Dead

He would already be dead from his sub-dural hematoma if it weren't for his platinum senatorial health care plan which assures that he will be treated in the best hospitals and taken care of by the best doctors at virtually no out-of-pocket expense.

He's 80 years old, has a number of serious preconditions, including melanoma, and still suffers from various medical problems that are the result of his being held for six years as a prisoner of war in North Vietnam.

In other circumstances, if he had a job that didn't offer benefits, in the absence of Obamacare, if he needed to buy insurance in the free market Republicans revere, he would be refused coverage by insurance companies thinking only of their bottom lines. It would cost him at least $30,000 a year and he would have a deductible of tens of thousands of dollars.

And, if the bill currently before the Senate were to be approved and then passed in the House and signed by President Trump, he would not be able to secure any heath insurance at all. He would be among the tens of millions who will either lose their coverage or be unable to afford any.

Because of his current medical situation (he's recovering in Phoenix), the GOP Senate leadership is delaying the vote on its version of repeal-and-replace Obamacare legislation since they need McCain's assent to help assure there are enough votes to move it along in the process.

Here's my question--

Why would John McCain even for a minute think about voting for this nasty piece of legislation?

Again, he's 80 years old, is in his last term in the Senate, does not need anything from Majority Leader Mitch McConnell, and has a proud record of being a "maverick."

Some maverick.

In addition, we know he hates Donald Trump. Why would he want to be party to helping Trump have a cheap and mean-spirited political triumph?

Perhaps as he takes a few weeks off to recover from the cranial surgery he had over the weekend he'll think about those less fortunate than he and decide that 20 or so million cut from the health care rolls means that hundreds of thousands will die prematurely.

That's the real bottom line--thousands dying unnecessarily.

One last question--

Where are the plans for a five-million-person march on Washington to oppose the Republicans' dirty dealings? I suppose there isn't one because the people who have traditionally organized massive protests of this kind are in good shape with their employer- and government-sponsored coverage. If it doesn't affect me . . .

Who was it who said, "Let them eat cake"?

March 9, 2017--Health Care Lottery

In an attempt to be responsible, I tried to read through the 123-page American Health Care Act, Trump- or Ryan-Care, promulgated by the Republican House leadership on Tuesday. I needed to do so, I thought, to enter the debate credibly with facts at hand.

I failed at that but did stumble on something morbidly fascinating and all too revealing--after ten pages of gobbledegook (see below) there were six pages of reasonably readable text about what to do with people covered by Medicaid who win state lotteries.

When I mentioned this to Rona, she said my new meds were making me hallucinatory. So I showed her the text and now she believes me, but has been walking around the apartment mumbling to herself.

First, a taste of the gobbledegook, taking it from the top of the text--

TITLE I—ENERGY AND COMMERCE Subtitle A—Patient Access to Public Health Programs
SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND.
(a) IN GENERAL.—Subsection (b) of section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11), as amended by section 5009 of the 21st Century Cures Act, is amended—
(1) in paragraph (2), by adding ‘‘and’’ at the end;
(2) in paragraph (3)— (A) by striking ‘‘each of fiscal years 2018
and 2019’’ and inserting ‘‘fiscal year 2018’’; and
(B) by striking the semicolon at the end and inserting a period; and (3) by striking paragraphs (4) through (8).

Pop quiz to follow. 

Then, after ten pages of this, clearly by placement to highlight its importance, for a full six pages they turn to what to do about state lottery winners who are currently covered by Medicaid.

Here is a bit of the text--

SEC. 114. REDUCING STATE MEDICAID COSTS.
(a) LETTING STATES DISENROLL HIGH DOLLAR LOTTERY WINNERS.—IN GENERAL.—In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2020) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, in- clude such winnings or income (as applicable) as income received—
‘‘(I) in the month in which such winnings or income (as applicable) is received if the amount of such winnings or income is less than $80,000;
‘‘(II) over a period of 2 months if the amount of such winnings or in- come (as applicable) is greater than or equal to $80,000 but less than $90,000;
‘‘(III) over a period of 3 months if the amount of such winnings or in- come (as applicable) is greater than or equal to $90,000 but less than $100,000; and‘‘(IV) over a period of 3 months plus1additional month for each increment of $10,000 of such winnings or income (as applicable) received, not to exceed a period of 120 months (for winnings or income of $1,260,000 or more), if the amount of such winnings or income is greater than or equal to $100,000. 

Of course if someone wins more than $80,000 that should be taken into consideration when determining Medicaid eligibility; but to give it this prominence, to devote so much textual energy to this literally one-in-a-million reality is to reveal the mean-spirited nature of conservatives when it comes to compassion for those who struggle. They reveal here how much they resent any poor person allegedly "getting away with" anything these politicians, themselves imbibing at the public trough, feel they do not deserve.

Take congressman Jason Chaffetz (R-UT) as another example when he spoke about health care for those with little or low incomes. There is an easy way to pay for heath care, he said--the poor should give up their smart phones and by doing so would have enough money to pay for health insurance.

To quote his version of the Golden Rule:

Americans have choices, and they've gotta (sic) make a choice. So maybe rather than getting that new iPhone that they just love and they wanna (sic) go spend hundreds of dollars on that, maybe they should invest in their own health care. They gotta (sic) make those decisions themselves.

Maybe if he knew how much he paid for his health insurance (nothing as a senator) or his smartphone (again, nothing as a $174,000-a year member of Congress) he would realize that if they gave up their beloved iPhones they still gotta get a lot more money from other sources to pay for it. 

Maybe they could give up eating. From the looks of Chaffetz his doing so wouldn't be a bad idea. But as everyone can see he doesn't wanna do that.

Senator Jason Chaffetz

June 29, 2015--Jiggery-Pokery

In his, even for him intemperate rant against the Supreme Court's historic 6-3 decision to uphold the constitutionality of the Affordable Care Act (ACA), associate justice Anton Scalia went further than usual in a descent that went beyond the judicial to the very personal.

More than saying that he fervently disagrees with his colleagues' legal logic, he accused them of participating in a deceitful and dishonest act, even applying the archaic Scottish slur jiggery-pokery to impeach their honor and integrity.

In the old days, which he so reveres, he might have been called out to a duel on the field of honor by one of the other justices. But alas, we will have to endure more of him and more of this because the court, under chief justice Roberts, is going rogue on him.

As the intellectual leader of the court's conservatives, the alleged strict constructionists or texturalists,  for decades dominating the other three to four justices who have placidly gone along with his views of the Constitution (with Kennedy occasionally being a swing vote, agreeing with the four automatic liberals), Scalia now finds himself at times in the minority, especially when the court hands down its most significant decisions, like last week's rulings on Obamacare, same-sex marriage, and the Fair Housing Act. (Do not overlook the importance of the latter.)

Scalia might have been more enraged than ever by Roberts' majority opinion in Burwell (the ACA appeal) where he subtly and without attribution quoted Scalia to himself to support the core of the argument he articulated for the five concurring justices.

It is all about context, as Scalia claimed in cases last year when he employed the same contextual argument--it is all about what the Congress truly intended. In the ACA case, Roberts wrote last week, if one looks at the 900-plus page context of the ACA--as Scalia would have us do in selective instances such as this one for laws he viscerally despises--it is clear that Congress intended the uncovered to be able to obtain affordable health care insurance.

Being quoted this way to justify something he violently opposes clearly got under Scalia's skin and motivated him to deliver his dissent from the bench, a highly unusual occurrence that underscored his fury.

But, again, Scalia's intemperance is less about the Obamacare vote than his sense that the court and American society on key social issues are moving on and he is more and more being left in the retrograde past--multiple meanings intended.

He will learn forcefully now that this is the Roberts' Court, not the Scalia.

December 19, 2014--Best of Behind: A Different Perspective

This is from November 24, 2009, after Barack Obama had been in office for just 10 months. My friend Dick, who contributed this different perspective, got it more right than I. I was already growing restive and he was counseling me to be patient and to look at the unfolding Obama agenda and leadership style in a different way, not as things are traditionally viewed in Washington and New York.

Considering the stunning announcement on Wednesday that Obama is moving to fully normalize relations with Cuba, I thought this was worth a second look--

If you’ve been paying even casual attention to these posts, you could not help but notice that I have been raising questions about President Obama.  

Is he being forceful enough in advancing the agenda he laid out so clearly and hopefully during the campaign? When it comes to health care legislation what does he really want? Is he committed to a single-payer option or is he willing to sign anything Congress sends him so he can claim he was the first president since Lyndon Johnson to reform the system?

What was he up to during his recent trip to Asia? It was good to see he was paying attention to the region after eight years of neglect by the Bush administration, but what did he actually achieve? After so much bowing to the Japanese, what happened in China? He seemed unwilling to make any demands on the leadership there in return for various U.S. concessions. Yes, they are our bankers and we will need them to lend us more money during the coming decade, but how about a word about human rights? How about receiving unfettered access to the Chinese media? He met with a handpicked group of university students who asked him pat questions—an event that was not televised throughout the country—and he wasn’t allowed to hold a press conference. Not impressive it felt to me.

And speaking of Asia, what is going on with regard to Afghanistan? Dick Cheney called it “dithering”; and I, help me, have been thinking that the former vice president may just have gotten this one thing sort of right.  

None of this has been seeming very presidential. Not the change I enthusiastically voted for.

Even my 101-year-old mother—an early and fervent supporter of Obama's—has been getting into the act, raising questions about the effectiveness of his leadership and how out of touch he appears to be with average Americans who are still very much hurting more than a year after his election.

But then there is the perspective of a friend who goes back about as far as I and has had through the years an excellent record of sensing shifts in the country's political culture. Before anyone I knew, for example, he not only recognized Obama’s talents but also foresaw the likelihood that he would be elected. He does not allow himself to be distracted by day-to-day instant analyses of who’s up and who’s down but rather sees things in broader, generational terms.  

So last night over dinner I was eager to get his views of Obama’s first ten months in office.

He felt that things were going rather well. He calmly reminded me about all the extraordinarily difficult problems that Obama inherited. “I know,” he said, “that most people by now are getting tired of hearing him talk about the legacy of ‘the previous eight years.’ But though that understandably might be the emotional and political case—that by now we would like to see more problems solved at home—they are so complex and deeply rooted that it will take much more time to chip away at things much less change them than even one term in office will allow.”

“I agree with that,” I said, “but shouldn’t he be more forceful about what he wants from Congress, our allies, and trading partners?”

“He is a different kind of person, a different kind of leader. He sees what that kind of blustery leadership has achieved—economic precariousness and a disenchantment with America among even our friends. He realizes how difficult and complicated it is to get Congress as it is currently constituted to pass transformative legislation. Or any legislation. Things are so partisan, special interests are so powerful, that to reach any sort of consensus, even among Democrats, is daunting.  

“So, for example, to leave health care legislation to the Congressional leaders, though it is messy and it looks as if he is indifferent, may very well be the one strategy that has a chance to succeed. And getting even a flawed bill passed may not only be as much as can be expected but may actually do some significant good. Just as though Medicare and Medicaid were and are flawed look how much benefit they have provided to the elderly and indigent.” 

“You may be right about this. But what about Afghanistan and the way he appears to be ineffective with, say, China and Japan?”

“I see the same things operating. His is a new and refreshing way. Perhaps just what is needed. We are no longer either the hegemonic military or economic power. At the end of the Cold War many felt that there would be a Pax Americana that would be the result of our unquestioned power and inclusive values, but that view turned out to be very short lived. Faced with terrorism and insurgencies, our vaunted might has turned out to be ineffective and of course our near economic collapse has shown that our form of capitalism is not a viable model for most of the rest of the world. In fact, even our cultural and ideological power has been shown to be compromised and inappropriate for most people and nations.”

“So you are agreeing with me.”

“Perhaps with your diagnosis but not your pessimistic views about Obama. If you hold on for a moment, let me complete my thought—about how the ways in which he has been acting domestically, in this new collaborative mode, is consistent with his view of diplomacy.”

“Go on.”

“I both cases he is displaying patience in the face of seemingly intractable problems. He knows none of these can be quickly or easily solved. Much repair work needs to be done before anything significant can occur. Trust needs to be reestablished. In regard to our role in the larger world, perhaps trust has to be established for the first time in nearly a century as we move into our own version of a post-colonial role.”

“Perhaps.”

“And in order to do so, to begin to achieve this, Obama appears to have decided to spend down some of his national and global political capital. Even at the risk of appearing to be weak and indecisive. Though many here are eager for certainty—for a leader who will tell them what to think and do (take note of Sarah Palin’s current popularity)—Obama is neither inclined to offer this nor does he believe it to be the best way to lead. His is an entirely different approach. He seems to be willing to build trust in others by actually trusting them. Not necessarily naively but with an understanding that they as well as he and we are always motivated largely out of self-interest.

“By doing this he is showing respect, rather than arrogance, because I feel he both respects others—or at least doesn’t underestimate them—and recognizes the roles that everyone needs to play to reach reconciliation and mutually-beneficial consensus.

“Remember, he is not only our first African-American president but is also our first Asian or Pacific president. He was born in Hawaii and spent formative years in Indonesia. So he combines within himself some of the cultural qualities he assimilated from those early years. It is of course dangerous to oversimplify what it means to be at least in part ‘Asian,’ but one thing that characterizes what that might mean is an understanding of the power or being yielding and indirect. And, make no mistake, these are powerful qualities. At least potentially so. And may turn out be in Obama’s case.”

As I suspected, he had given me some new things to think about, including what to order for dessert!

September 8, 2014--Two Cheers for Obamacare

I've been wondering why we've been hearing relatively little recently from Republicans about Obamacare. It had been thought that in the run up to the November midterm elections the GOP would be all over it, savaging it as an assault on both our freedom and the federal budget. It was to be their political trump card. The route to majority control of both houses.

Could it be that there is now relative silence because Obamacare is actually . . . working.

Many millions have signed up, and with the exception of some anecdotal horror stories the vast majority with health care coverage for the first time are happy with it; and, perhaps most surprising, in spite of all the scary stories about how the Affordable Care Act would bust the budget, it has in fact not only been cost effective but has already been contributing to deep cuts in the federal deficit.

Just as Obama said it would.

So then two cheers for Obamacare. It is too soon to offer three because, though the nonpartisan Congressional Budget Office's projections show significant downward trends in overall Medicare costs (the result in part of aspects of the ACA law) and thus dramatic deficit reductions over the decade, we still do not know how many more will sign up, how much subsidy they will require, and the nature of the care these new enrollees will require.

The CBO, adjusting for inflation, recently reported that the average amount spent annually per Medicare recipient declined from $12,000 each in 2011 to $11,200 this year and will be reduced further to $11,000 per Medicare enrollee by 2017. Technically, this is called "negative excess cost growth."

All told, the CBO is projecting that, as a result, over the next ten years the federal deficit will be reduced by $715 billion. Nearly three-quarters of a trillion dollars.

To be fair, this good news is not fully the result of the ACA. This downward trend is also a consequence of "young" Baby Boomers becoming eligible for Medicare for the first time and the apparent, not entirely understood, reduction in costly tests, treatments, and drug use. All good things as our health care system has grown bloated with over-testing and the over-selling of unneeded treatments and medications.

This $714 billion in savings dwarfs all deficit reduction plans being discussed, including Paul Ryan's draconian budget.

Wouldn't it be good if we could stop playing demagogic games with the budget and health care and get on to the real problems we face--how to create more jobs, improve the treatment of veterans, fix our crumbling infrastructure, improve public education, and tackle the inequality crisis.

Why am I not optimistic?

May 12, 2014--Death Panels

Pretty much everything critics have said about the Affordable Care Act, Obamacare, has proven to be unsubstantiated.

First they claimed it would take people's freedom away. Is there any evidence of that?

Then they claimed it was unconstitutional--the mandate part. But the Supreme Court ruled otherwise.

After that critics asserted that few would sign up, especially young people. That too proved to be false. After debugging the Obamacare website, nearly 10 million signed up with more than a third of them young people.

So, the attack that it would cost taxpayers billions also turned out to be untrue. More political scatter shot. The healthier young pay for sicker older people. The non-partisan Congressional Budget Office has repeatedly demonstrated that because of this, Obamacare will not only not cost taxpayers billions but over time will actually save billions. Among other things, because they are insured, fewer people will use much more expensive emergency rooms.

When presented with the fact that nearly 10 million enrolled, Republicans said the numbers supplied by the administration were not to be trusted. But, as we now see, the numbers have held up, in fact, they have continued to creep up as more and more, again, especially young people sign up.

They'll sign up but won't pay for the insurance, we have been hearing. Well, that too turns out to be wrong. Almost 90 percent have already paid their premiums.

Not willing to stop attacking a program that conservatives continue to think is unpopular, they have taken again to saying that it won't work. People will not get good care, premiums will rise, and over time, people will drift away from the program.

In fairness it is too soon to know about this, but it is premature to see Obamacare failing; and, based on Republicans' track record of spin and outright lying, one has no reason to think this current criticism will turn out to be any more valid that all that has preceded it.

What about those death panels that demagogues such as Sarah Palin and Michele Bachmann made careers for themselves by lying about? These too never materialized though a large percentage of the professional paranoid class still talk about them and thereby cynically pray on people's fears.

In fact, according to a recent study of the now universal health care program in Massachusetts, the death rate for those younger than 65 has fallen steadily since 2006 when then-governor Romney advocated it and signed it into law. Specifically, the death rate for those below 65 has fallen by more than three percent.

Since Obamacare is modelled on Romneycare we can expect to see similar results in a few years.

Ironically, the only death panels anyone has to fear are those metaphorical ones that are the result of not having universal health care.

In other words, if you do not have heath care insurance you are significantly more likely to die than those who are covered.

No death panels are needed to cause those deaths.

Thus far we haven't heard a word about this from Sarah or Michele.

Instead, it's now Benghazi 24/7.

January 29, 2014--Uncle Eli's Tongue Factory

While the Obama administration is thinking about publishing a list of individual doctors who are off the charts in the amount they bill Medicare as a way of exposing them to public scrutiny and potential prosecution if there is evidence of over-billing, Health Management Associates in Naples, Florida is already publishing data of its own about doctors affiliated with its South Florida chain of hospitals.

In Naples, according to a report in the New York Times, scorecards are posted for all attending physician to keep track of how many over 65-year-old patients they admit to the hospital each day.

Doctors hitting the target to admit at least half of the Medicare and Medicaid patients who entered via the emergency room are color-coded green; the doctors who were close to that 50 percent target are coded yellow; and those not admitting enough to the hospital are red-lighted.

Since the HMA hospitals, reflecting national changes in the way medicine is practiced, employ more and more doctors rather than just granting them attending status, pressure on these salaried doctors to increase income (and their own bonuses) by admitting more patients who have good insurance is increasing. So much so that at a HMA Naples hospital a Medicaid-elegible child was admitted with a diagnosis of having "fever" when her actual temperature was normal, 98.7; and an 18-year-old with a minor knee laceration was admitted though the wound could easily have been treated in the ER and the patient sent right home.

These are not isolated cases but rather examples of routine business.

These hospitals, like most in the nation, are technically "not-for-profit," but beyond that IRS designation, they are very much in the business of making as much money as possible so as to be able to pay doctors top dollars and hospital administrators seven-figure salaries.

It is thus no wonder that the money-driven healthcare system in the U.S. is by far the most costly in the world and for "average" people far from the best.

With thousands of lobbyists keeping the pressure on politicians not to change anything, very little does change. Big Pharma, the AMA, health care unions, medical equipment companies, hospital associations all join hands in assuring that their bottom lines, not patient care and cost-containment, are paramount. And thus far they have pretty much had their way.

Occasional exposés and law suits as the one being launched against Health Management Associates are rare and only chip away at the problem.

But there is a simple way to keep an eye on quality of service and billing practices.

Years ago, an uncle of mine owned a meat processing plant in the South Bronx. While trying to "find" myself I went to work for him and spent long days unloading truckloads of hams, pork butts, and beef tongues.

The Department of Agriculture required that the meat be inspected and, if it passed, labelled as such--USDA Inspected.

So in Uncle Eli's plant, on site, there were two full-time federal inspectors. They wandered around at will in their long white coats, randomly selecting a rack of curing tongues for careful analysis. They were incorruptible, permitted to work at any single establishment for only a month or two so as to inure them from being approached for bribes. And, in order to contain costs to the government, Uncle Eli was required to reimburse the Department of Agriculture for their salaries and benefits.

It worked rather well and this approach to safety and quality control could easily be extrapolated to all hospitals that are allowed to bill Medicare and Medicaid.

These hospitals, like Paramount Meats, should be required to have a team of on-site inspectors who they would pay for and who would keep an independent eye on services and billings. If, for example, they discovered a red light-green light system designed to defraud taxpayers (which that in fact does), they would have the power to intervene and, if necessary, report abuses to the Medicare-Medicaid Administration which in turn could refer cases to the Department of Justice.

This would lead to a significant decline in medical scams and reduce costs to those of us--really all of us--who through our taxes are paying the cost of abuse and fraud.

Doctors, then, could again be held to the Hippocratic injunction to "do no harm."

October 19, 2013--Ladies of Forest Trace: Immaculate Generation

Approaching 106, there are days when my mother has less vitality. At those times, our conversations are brief as she struggles to take in the oxygen she needs. We talk only about the weather in Florida and New York and what we plan to have for dinner. If she hears we are cooking and eating at home she is happy that we are taking care of ourselves and not "wasting money eating out."

So I was pleased to find her in good form the other day when I made my daily call.

One of the ladies of Forest Trace, she told me, was having trouble with her eyes. "Gussie, poor thing, not only has to walk with a walker but now when she goes down for dinner she can't see where she is going and bumps into everything."

"Maybe she needs an aide," I suggested, "Like yours who would help her find her way and do whatever else she needs help with."

"I tell her that, but she is very proud and doesn't want to admit she needs any help."

"I understand that."

"There's nothing to understand. She's a danger to herself not to mention people in worse shape who she keeps crashing into. If she was driving a car, God forbid, they'd take away her license."

"You're probably right."

"But that's not the worst of it."

"What is?"

"I told you about her condition."

"To tell you the truth I don't remember. There are so many conditions to keep track of."

"Immaculate Generation."

"Immaculate what?"

"Generation. Generation. That's what she has."

"You mean, Macular Degeneration. Her eye problem."

"Whatever."

"What about it? How far advanced is it?"

"Plenty advanced. That's why she's running people over."

"I suppose she's too old to do much about it."

"That to. But her doctor is terrible."

"In what way?"

"He doesn't have time for her."

"He won't make an appointment to see her?"

"Not that. He makes the appointment, but when she goes she's in and out in five minutes."

"If there isn't anything they can do--"

"Still is this a way to treat people who are going blind?"

"I suppose not. What would you have the doctor do."

"You know Gussie's not shy."

"That I know from direct experience," I chuckled, recalling having dinner with her a few times. She has opinions about everything--generally sound ones--and isn't reluctant to share them. At full volume. My mother says she talks so loud because she can't hear and refuses to get hearing aids.

"So she complained to the doctor, telling him he shouldn't be running his office like a factory. Though Gussie knows there is nothing to do for her condition, she wants to feel the doctor knows who she is and cares about her. That he has time to at least talk with her. After the life she lived, she should be entitled to that. A little talking to. A little being paid attention to."

"That is not unreasonable to expect."

"But her doctor tells her he has no choice."

"No choice?"

"That with Medicare cuts he can't afford to stay in practice if he spends more time with patients. 'I couldn't pay my rent or my office staff,' Gussie quotes him, 'if I practiced the way I want. The way I used to.'"

"I've heard that from others," I said. "From doctor friends who are frustrated with the state of health care these days."

"Do you think Obamacares will make things any better?"

"I'm not sure it will for Gussie, but for millions of others, absolutely."

"They're making such a big deal on TV about the computer."

"You mean the Obamacare website?"

"I think so, though I don't know from computer webs."

"No need to worry about that."

"It's the least of my worries. I have plenty of other things to worry about. About why I take so many naps, why I--"

"I take naps too," I cut in before she went down her whole list. "It is not unusual for older people to take naps. And you are nearly 106."

"I never took a nap until I turned 100. I'm wasting my time sleeping the day away. You know what your father used to say about sleeping?"

"Yes, 'There's plenty of time to sleep when you're . . ." I couldn't utter the word to my ancient mother.

"Dead. Dead is what he said. I know what that is. You don't need to sugar coat me. I want to live. I'm fine. But I'm ready for whatever awaits me. That too."

"Anything else about Obamacare?" I was looking to change the subject, "By the way, I love that you call it Obamacares.

"Because he does. Care. And it will turn out to be wonderful. The same kind of people said the same kind of things about Medicare when that came out. How it wouldn't work. How doctors wouldn't take Medicare patients. How people would not be able to keep their doctors. How we wouldn't be able to afford it."

"True. Though I do worry about the cost going forward."

"There's plenty of money for other things like bombs so we shouldn't be so worried."

"Also true," I said.

"But now, ask anyone here what they think about Medicare and they will tell you, 'Don't touch my Medicare.' Even people from that Tea Party who want to get rid of the government. I tell them, 'What do you think the Medicare you love so much is? I'll tell you what--a government program. Socialized medicine.' That one they like. Food stamps, no. Welfare, no. But Medicare because it's for them, and they think it's free, they don't want you to touch."

"I hear the same thing. Don't expect people to be consistent when it comes to their self interest."

"They have what they want and now they want to deny the same thing to others. Like Obamacares."

"I agree with that. Among other things their attacking it feels so selfish."

I could hear her breathing becoming labored. "But you'll see--I won't be here to see it but please God you will be--two years from now everybody will be happy. All of this will be forgotten. Millions more will be healthier. Especially children. And like with Medicare no one will want to change anything. Including the Tea Party. If they are still around. Which I doubt. I see the beginning of the end for them. Which is another good thing."

"Don't overtax yourself," I said, concerned about her breathing.

"I'm not like this every day any more so when I am I want to get things off my mind."

"I'm for that. But I don't want you to overdo it."

"Poor Gussie," she said and hung up.

December 3, 2013--HealthCare.gov

I'm here to tell you that the Obamacare Website isn't working all that well.

How do I know? Because I tried it out Monday afternoon, a day after the new-and-improved version came on line.

A few things--

I already have all the health insurance I need: Medicare Parts A&B, but not Part D, for prescription drugs, because I left the Ford Foundation with a sheath of extra coverage that bridges gaps, reimburses for deductibles,  and pays for all sorts of things that fortunately I have thus far not needed and therefore know nothing about.

So my trying out the site, HealthCare.gov, was in the spirit of reporting. Not just complaining from the sidelines about how Obama and his people screwed it up or ranting about how Republicans, who want to see the whole program crash, should have been happy to see the Website crash rather than blaming Obama for making it hard for people shopping for Obamacare coverage, coverage the GOP doesn't believe in in the first place. Such is our current state of partisan hypocrisy.

With trepidation I entered HealthCare.gov and the homepage popped up in about a second. So far so good I happily thought.

I clicked on an orange circle within which it said--

                                     APPLY NOW
                               For Health Coverage

I was next asked to indicate the state in which I lived. I fibbed, saying Maine since I knew that if I mentioned New York I would be referred to the NY State Website because New York is one of 14 states that created its own health care exchange. Maine, with a Tea Party governor, is not cooperating.

Again in about a second I was prompted to click on "Apply Online," which I proceeded to do. Next, cheerily I was told "Let's Get Started" so I clicked "Get Started" and was promptly asked to "Create a Marketplace Account." This required me to share a few items of personal information--my name, e-mail address, things of that kind.

Fine. I did that. All one-two-three. I smiled, thinking, leave it to those Obama people to finally get things working.

Then the trouble began.

I needed to create a username and a password. Without reading the fine print (there was quite a lot of it) I did my usual thing--in general, not wanting dozens of different usernames and passwords I use the same ones for my bank accounts, charge cards, the cable and electric companies, my newspaper delivery service, my insurance policies, etc.

So I typed in STEVZWRG as my username and STSTST as my password (these are both fictitious in an attempt to protect whatever is left of my privacy). But in an instant (the quickness more evidence of the Website fix), I was informed that both were "Invalid." That I must--

Create a username that's at least 6 characters. It may include uppercase and lowercase letters. Usernames are case-sensitive. It also must include either at least one number or one of these symbols: _ @- /

And for the password, I was told to--

Create a password between 8-20 characters. It must include at least one uppercase letter and one lowercase letter. Passwords are case-sensitive. It also may include symbols, but not these: =? ^ ( )'"/ \ &;. Your password can't contain your user name.

For the username I seemed to get it right--I typed in STEV1zwrg@. But not for the password. I had thought since they seemed to want a lot of characters (between 8 and 20, to make things extra secure, I'll go for the limit--20.

So I entered (or thought I did)--STstStst=?st&;\\ZWRG^ and attempted to repeat it, which was required--STstStst=?st&;\\ZWRG^, thinking again, since I attempted to be careful and extra secure, since I had followed all the rules, I would be fast-tracked to the heart and soul of the Website where I would learn about all my options, the costs, the differences between the platinum, gold, and silver level policies and, ultimately, as the full test of HealthCare.gov, when they looked me up via their interfaced and all-powerful computers and software, they would discover I didn't need any more coverage at all since I had Medicare and the Ford Foundation taking such good care care of me.

But again, before I could complete these naive thoughts, the system flashed in blaring red, "Invalid Password. Invalid Password."

A bit frustrated, since I thought I had taken great pains in inputting and confirming a password, I deleted what I had entered and set about to try again. But because I had forgotten to write down the password I entered, I needed to come up with a new one.

On a notecard, I wrote STZstz&;&;ZWRG^"/Zwrg3 and with considerable care repeated it in the window provided.

Halfway through the confirmation, the Webpage again flashed "Invalid Password. Invalid Password."

Now, quite frustrated, I thought to give it one more try. Since this was just an exercise to see how well the Obamacare Website was working--not my ability to come up with passwords, putting notions of security aside, I opted for the minimum, an 8 character password--STZ"ZERG.

That should work, I confidently thought, but again it, it felt as if I myself, was being declared to be Invalid.

I was instructed to log off and come back latter, better prepared to make the Website work for me.

As you might imagine, I am not looking forward to that. If I do, I'll be sure to get a 10 year-old to help me come up with valid usernames and passwords.

If I do (unlikely), I'll let you know how I do.

In the meantime, I need a drink.

April 29, 2013--The 2400 Diner

"Did you hear the news this morning about Boston?"

We were happily settled in a booth at the 2400 Diner in Fredericksburg, awaiting eggs and grits with some of the best country ham for miles.

"About what? I was busy with e-mail while you were watching."

"That Russian brother who set off a bomb at the Boston Marathon. The one still alive."

"I didn't hear. What happened to him?"

"The report was that he was released from jail and sent to a prison hospital."

"I suppose good for him. Not so good, though, for some of his victims--I think 37--who are still in hospitals undergoing treatment and need extensive rehabilitation."

"That's my point," Rona said, "He's been released and they're still there."

"I just said that." It was early in the morning and until she's had coffee Rona sometimes is not her fully coherent self.

"Sorry. I know. I meant, who's paying his medical bills?" I indicated I wasn't understanding. "Is it Romneycare?" I was still confused about where she was going with this. "As a Massachusetts resident he's required to have medical insurance, right?"

"I suppose so."

"But I bet his insurer isn't liable for his medical bills since he's an accused mass murderer and is in police custody. Which means . . ."

"I get you, that American taxpayers are paying for him."

"Exactly."

"And the sad irony is . . ."

"That many of his victims may have no coverage at all and if they do it's probably capped and they will be bankrupted if they have to pay for prosthetic limbs and months of rehab."

"Exactly. There was a long article about this very thing the other day in the New York Times. How for the thirteen people who lost legs their care will cost a fortune; and, though more than then 10 million dollars have been raised thus far, it will not be enough."

"I assume, right, that some of the hospitals won't charge their full rates or not send victims home prematurely if their insurance is capped?"

"Let's hope so. But, in the meantime, this guy, though he'll never again see the light of day, gets a free ride."

"Yet one more thing wrong with the system. A lot of the injured will now have to depend on public charity to pay their hospital and doctors' bills. Like in Newtown and Aurora"

"As my Aunt Tanna would have said--it's a shonda."

"The real shonda is that to get affordable health care in this country you have to be blown up by terrorists."

Happily our breakfasts arrived.