Our Little Irritations. I think most of us sense them, those petty events that set off little twinges, those inconsequential triggers that blip on our radar and cause us to respond as predictably as Pavlov’s dog (or at least I do) when our bell rings. For me, it’s usually a word, or phrase, that rings my bell.
I’ve thought of this because I’ve been digging into the amazing new evidence that exercise does far more for our health than we knew. Research has demonstrated that our muscles do astonishing things never before imagined. When activated, they secrete peptides and other chemicals that produce healthful changes in our brains, livers, bones, and our muscles themselves. I’ll write about that later, but here I’m focusing on something far less important: my little irritations.
In my reading of muscles I ran across “bicep.” That immediately tinkled my bell, as it has ever since I was a first year medical student. Many people, especially sports writers seem addicted to that word. They huff and puff about injuries to the right bicep, or the left bicep. Apparently they think the ending “s” on biceps denotes a plural, and since they’re writing about only one, they drop the s. Someone should remind them that thousands of singular nouns in the English language end with s (think of stimulus, apparatus, axis). Here are some basics for them: Biceps means that the muscle has two heads, as shown in the diagram below. Also, the muscle on the back of each arm has three heads and hence is called the triceps (which often comes out as tricep). Surprisingly the muscle on the front of our thighs, which has four heads, is more often written correctly as the quadriceps muscle. This issue of course has zero effect on our universe, but it causes little flutters near my diaphragm.
Left Biceps brachii
Another bell ringer:
For years I’ve given family members a Merriam Webster Word of the Day Calendar for Christmas, but I changed brands this year. On January 7 (of all days, my birthday, click here for earlier birthday post), the word a day in the new calendar was fulsome. And the definition? Full, abundant, plenteous. What? Impossible! Speaking of sportswriters, some decades ago a former Kansas City Star writer had used fulsome to mean something roughly equal to the new calendar’s definition. Well, I wrote to set him straight, giving him the definition in my American Heritage Dictionary: New College Edition, copyright 1980. “1. Offensively excessive or insincere. 2. Offensive to the senses; loathsome; disgusting.”
The sportswriter wrote back. He had found the fourth or fifth definition is some dictionary to be consistent with his usage, a definition that obviously had arisen because some people had stumbled upon the word, fulsome, and, not knowing its true meaning, broke down its parts and decided the word had to mean something good. I realize of course that the meaning of words can change over time (click here for examples), sometimes fairly quickly, but fulsome, when used to mean abundant and plenteous, still rings my bell.
Most of us have our little irritations. Do you? Is so, what rings your bell? I, and other readers, would like to know.
Medical topics for 2025. Happy New Year, readers! You may have noticed that I skimmed through the holiday season without writing anything here. Nevertheless, I have been thinking of topics to be considered in 2025. I plan to focus more on medicine, medical costs, and various methods believed to prolong lives, and to healthy living, among other subjects.
Today, I’ll focus on one of the more depressing related topics, namely the sad truth regarding certain healthcare costs. If you’ve read my previous post on absurd prescription drug costs, you know how Congress helped create the sorry tangle of prices we pay for our medicines, not to mention the huge profits made by companies acting as “middlemen” and who distribute our prescription medications (see here for that post).
Our health care costs are also screwed up. Yesterday’s Wall Street Journal published an extensive article on the medical insurance business, specifically Medicare Advantage programs. Its headline: UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare (see here)
Medical topics for 2025 include insurance costs
Here’s some background: The government’s Medicare Advantage system makes use of private insurers to provide health benefits to seniors and disabled people. It works like this, the sicker the patients are, the more money the insurers collect from the government. But how does the government know how sick the patients are? Well, by how many illnesses they are diagnosed as having. In short, the more sicknesses diagnosed by doctors and submitted by insurers, the more money the government pays the insurance company. What could go wrong? Plenty, it seems.
As the WSJ article points out, in the case of UnitedHealth, many of those doctors work directly for UnitedHealth, an industry pioneer in directly employing large numbers of physicians. Its Optum unit now employs about 10,000 physicians, its top executive has said, making it one of the nation’s largest employers of doctors. It contracts with tens of thousands more. No other national insurer has acquired and hired doctors on that scale.
Checklist of potential diagnoses
The company frequently prepared its doctors with a checklist of potential diagnoses before they ever laid eyes on their patients, but only for those patients specifically covered by the Medicare Advantage program. One physician reported its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis, some of which were exceedingly rare. How did this work out?
According to the WSJ article, sickness scores of patients were increased when they moved from traditional Medicare to Medicare Advantage, leading to billions of dollars in extra government payments to insurers. And patients examined by doctors working for UnitedHealth had some of the biggest increases in sickness scores when they made that specific move, according to the Journal’s analysis of Medicare data between 2019 and 2022.
Doctor reviewing patient’s medical history
Sudden increase in sickness scores in Advantage plans
Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. As described in the WSJ article:
Patients who both saw UnitedHealth doctors and were enrolled in UnitedHealth plans had the highest average sickness scores in the Journal’s analysis of claims from 2019 to 2022. Those higher sickness scores triggered about $4.6 billion more in Medicare payments than UnitedHealth would have received if those patients’ scores had been in line with the average for the company’s other Medicare Advantage patients. (My thought: That extra $4.6 billion came from the pockets of us taxpayers.)
UnitedHealth response
A UnitedHealth spokesman said that the company’s practices lead to “more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management.” The company’s approach, he said, helped to avert more serious health problems later, and to achieve Medicare Advantage’s goals of improving quality and reducing costs. The company also said Medicare’s system of paying for diagnoses was developed by the government, not any one insurer, “to help ensure fair and accurate payments.”
The WSJ piece also included this response from a spokeswoman for the Centers for Medicare and Medicaid Services which indicated the agency is studying relationships between Medicare Advantage insurers and medical providers, adding that Medicare Advantage insurers are required to ensure the accuracy of diagnoses they submit, and also that the agency had overhauled the list of diagnoses that trigger extra payments.
Medical topics in 2025: Interviewing patient
More tidbits from WSJ article
When Dr. Naysha Isom started working at a UnitedHealth medical group in the Las Vegas area in 2019, she said, she got two days of training on how to record diagnoses. At the training, a UnitedHealth employee suggested that Isom, who had practiced for more than a decade, should consider diagnoses she had never made before.
Isom said she was told that signs of bruising could be recorded as senile purpura, a condition that generated payments in Medicare Advantage but generally didn’t require treatment. Isom saw no point, since the finding didn’t change patients’ care: “OK, wear some sunscreen. Maybe stop bumping the wall.”
Bonus pay
A December 2023 compensation plan for one UnitedHealth-owned practice offered doctors bonuses of up to $37.50 a year for each of their Medicare Advantage patients if they confirmed or ruled out more than 90% of the suggested diagnoses. That means a doctor seeing 800 Medicare Advantage patients in a year could see a bonus of as much as $30,000 a year.
Like other Medicare Advantage companies, UnitedHealth also contracts with outside doctors in ways that can increase their payments when they diagnose more conditions. That includes arrangements where doctors receive a portion of the Medicare payments insurers get for their patients. . . In some contracts with independent doctors reviewed by the Journal, UnitedHealth linked bonuses to sickness scores and quality ratings derived partly from patient surveys. For patients with sickness scores 20% higher than average and good quality ratings, doctors could get an extra $40 per patient each month, one contract shows. Scores 50% above average and top quality ratings could yield $65 per patient a month. For a doctor with 100 patients covered by the contract, that would amount to a $78,000 annual bonus.
Final thoughts
The article that stimulated this post contains other shocks. Check it out if you’re interested (see here). In the meantime, stay tuned for more medical topics in 2025.
Absurd prescription drug costs! It is hard to believe that prices for a month’s supply of dozens of prescription medicines can differ by thousands of dollars, depending on where you buy them and what insurance plan (if any) you may use. Just last month TheJournal of the American Medical Association published “Strategies to Help Patients Navigate High Prescription Drug Costs (Nov 26, 2024),” an attempt to inform physicians how to help their patients who struggle to afford necessary medications.
Here’s a telling sentence from the JAMA article: “The patchwork of prescription drug affordability strategies outlined in this review illustrates the complex, fragmented, and inefficient prescription drug delivery and reimbursement system in the US.”
In this post I’ll take a brief look at how ridiculous the prescription drug scene has become, and I’ll end by summarizing tips from the above JAMA article, some of which may help you reduce your own absurd prescription drug costs.
A broken system:
Our broken pharmaceutical system is so complex that it would take a thick booklet to fully explain what a botched mess it is. Here I’ll give a few facts to demonstrate how zany our drug prices have become. If you would like to learn more about this tangled system, a good source would be the 46brooklyn website (click 1). This feisty organization seems determined to make drug prices more affordable.
Here are numbers from a recent study of Medicare data, these regarding patients using generic versions of the prostate cancer drug Zytiga. Believe it or not, these specific patients may be charged any of more than 2,200 prices for their drug, depending on where they live, and what drug plan they have. For example, a monthly supply of a generic of the drug in northern Michigan costs about $815, roughly half the cost in suburban Detroit, but it zooms up to $3,356 in a county along Lake Michigan. (See 2for details)
Prices vary widely
Do those differences make sense to you? How can drug prices vary so widely, even in a limited area such as the single state of Michigan? What happened to the principles of supply and demand that normally keep prices closer together? (The effect of supply and demand on prices is one of the basic tenets I learned while studying economics. I majored in that dismal science for my undergraduate degree at the University of Wisconsin.)
Apparently, Washington’s jerry-rigged drug-reimbursement system is the culprit that toppled old Supply and Demand. Both Medicare Part D and commercial insurance plans, which many of us have, employ middlemen (known as pharmacy-benefit managers or PBMs) to negotiate the price ultimately paid for prescription drugs. From there it gets really confusing. Medicare divides coverage into 34 regions around the U.S. and health plans must submit separate bids for each region. This seemingly was the match that ignited the explosion of absurd prescription drug costs.
Even more absurd examples
According to one study, some 61 drugs had monthly prices that diverged by at least $30,000! Yes, you calculated correctly, a difference of $30,000 per month comes to an annual difference of $360,000, right up there between a quarter and a half million dollars a year, not exactly chicken feed, as the old saying goes. The most egregious difference of all was the $223,037 range for nitisinone (brand name Orfadin), a drug used to treat a rare metabolic disorder (Type 1 Tyrosinemia). This inherited disorder is characterized by a deficiency of a critical enzyme, and it requires a restricted diet and lifelong treatment with an extremely expensive drug to survive. How in the world could there be such an unbelievable range in monthly costs of Orfadin? Or for the astonishing range of more than $30,000 per month for many other drugs?
The answer seems to be traced to our federal government and the ridiculous rules it set up to run Medicare Part D. In the past, I’ve blamed Washington for our unacceptable surge in college tuition costs (See here), and for dismantling (while institutionalizing) our medical care, where costs also have become absurd (See here). How can we reduce the flood of inanities coming from our nation’s Capitol? They have to stop. Could we induce our politicians to take a closer look of the Preamble of our Constitution and make them realize that much of their legislation rips up our domestic tranquility and erodes our general welfare. That’s not what our Constitution was set out to do. Here’s a reminder for our lawmakers.
Preamble to US Constitution
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.“
Other opinions on our present situation
“The inconsistent and disconnected way that PBMs arrive at drug prices makes Medicare look less like a trustworthy marketplace intended to yield low, sober prices and more like a casino,” said 46brooklyn Chief Executive Antonio Ciaccia. (2)
“It’s a broken system. It’s really confusing for seniors. It’s really confusing for providers,” said Dared Price, owner of eight pharmacies in the Wichita, Kan., area, and he complains the stores are underpaid. “It’s costing the government way too much.” (2)
Who are these PBMs?
Critics, including 46brooklyn mentioned above, argue that the PBMs are making huge profits as middlemen. the largest PBMs are UnitedHealth Group’s Optum Rx, Cigna’s Express Scripts, and CVS Health’s Caremark. These companies manage about 80% of prescriptions in the U.S. I haven’t studied this group, but I assume they prefer to project a different image than the ones painted by the above quotations. Some PBMs have made efforts to protect their turf. Express Scripts has run a series of full page ads in The Wall Street Journal, attempting to portray a different sort of company. The top half of a number of these full-page ads contained the following, printed in bold type:
WE’RE PHARMACISTS.
WE’RE CLINICIANS.
WE’RE RESEARCHERS.
WE’RE NEGOTIATORS.
WE’RE CAREGIVERS.
THAT’S NOT
A MIDDLEMAN.
THAT’S AN
ADVOCATE.
I think important questions remain. Will an increasing awareness of these absurd prescription drug costs build pressure to dismantle this administrative nightmare? Will supply and demand once again determine the price and distribution of our prescription drugs? Will the newly named D.O.G.E. Commission (Department of Government Efficiency) look into this issue? I certainly hope so. If that happens, I wish Elon Musk and Vivek Ramaswamy and their advisory commission the best of luck.
Money saving tips from JAMA(Information condensed from the November 26, 2024 article). There are some real money savers here.
Co-payment Cards: Manufacturers of brand-name drugs frequently offer co-payment cards to off-set costs of prescription drugs. These cards lower out-of-pocket costs depending on the drug used and the patient’s prescription drug benefits, potentially to $30 per month or less. For example, manufacturer co-payment cards for the anticoagulant Eliquis can lower out-of-pocket costs to $10 per month with a maximum annual benefit of $6,400. But these co-payment cards, which are available from manufacturer websites, CAN BE USED ONLY by patients with private health insurance. (With my Medicare Part D insurance, I pay much more that $10 for my monthly supply of Eliquis.)
Patient Assistance Programs: Some brand-name drug manufacturers offer patient assistance programs to offset the out-of-pocket costs of expensive brand-name drugs for uninsured or under-insured individuals. Patient assistance programs also are offered by independent nonprofit organizations, including private foundations, which are frequently financially supported by brand-name pharmaceutical manufacturers. These programs are typically restricted to patients who meet specific needs-based eligibility criteria, such as a low family income. To be eligible for these programs, patients must submit documentation verifying financial hardship, and prescribers must certify clinical necessity of the prescription drug. Such programs are available across public and private insurance, but options for uninsured patients may be more limited.
Savings at Pharmacy
Pharmacy Coupons:When insurance plans charge substantial out-of-pocket costs, or do not include particular medications on their formularies, some patients may benefit from purchasing the prescription drug directly from pharmacies without insurance. Ordinarily, retail pharmacies charge high prices for cash-paying customers, but several organizations (eg, GoodRx, SingleCare, WellRx, NeedyMeds) offer coupons through which patients can access discounted prices negotiated by pharmacy benefit managers on behalf of insurers. These coupons are available to all patients regardless of insurance status. They can be particularly helpful for uninsured patients and those with high-deductible health plans who take generic medications. (Even though I have Medicare Part D drug insurance, I have used GoodRx and in one case paid almost $100 per month less for a medication than I would have paid as a co-pay on my insurance.) These coupons are typically are available online or through smartphone applications. They also can be useful for drugs that are frequently subject to coverage restrictions, such as generic medications for erectile dysfunction (eg, sildenafil, tadalafil), hair loss (eg, low-dose finasteride), and weight loss (eg, topiramate, phentermine).
Direct-to-Consumer Pharmacies: Thesepharmacies sell a selection of drugs at transparent prices if patients purchase them without insurance. These pharmacies are new entrants in the US prescription drug market, and they provide patients with the option to purchase a range of commonly used generic drugs at prices that may be lower than their insurance-required out-of-pocket costs. Some big-box chain retailers (eg, Walmart, Costco) have direct-to-consumer pharmacy programs with in-person pickup and mail-order options. Other direct-to-consumer pharmacies (eg, Amazon Pharmacy, Health Warehouse) are exclusively online. The Mark Cuban Cost Plus Drug Company primarily sells medications online but also partners with independent grocery store pharmacies for in-person pickup. In 2023, Amazon introduced a pharmacy program (RxPass) that offers unlimited access to several dozen commonly used generics for a $5-per-month subscription; this program is only available to those who subscribe to Amazon Prime.
Two more ways to save on drug costs:
Public Assistance Program: Several federal, state, and local programs help patients afford prescription drugs. The largest such program is Medicaid, which provided prescription drug coverage to more than 75 million individuals in the US as of March 2024. Medicaid drug coverage is generous, with 2013 federal regulations allowing co-payments of up to $4 for preferred drugs and $8 for non-preferred drugs for individuals earning less than 150% of the federal poverty level; these costs are even lower in many states. For patients who qualify, enrolling in Medicaid is one of the most effective ways to affordably access prescription drugs.
International Online Pharmacies: Prices for brand-name drugs in the US are 2 to 3 times higher than prices for the same drugs in other countries, leading some patients in the US to try to import these drugs. While drugs obtained from international pharmacies can be made in the same factories as those prescribed in the US and most high-income countries have regulatory agencies to oversee marketed prescription drugs, patients should be aware that these pharmacies fall outside of the authority of the US Food and Drug Administration (FDA). It is illegal to import a drug that is unapproved in the US, but the FDA permits patients to purchase FDA-approved drugs internationally as long as they are for personal use, for treatment of a serious condition, and the quantity does not exceed a 3-month supply. If patients choose to individually import drugs, they should choose a reputable pharmacy in a country with adequate drug regulation; pharmacies in low- and middle-income countries may be subject to lower quality standards, and rates of counterfeit drugs range from 9% to 41% compared with less than 1% in high-income countries. PharmacyChecker is an independent organization that verifies international online pharmacies and allows patients to compare prices across pharmacies, and possibly avoid the worst of our absurd prescription drug costs.
My Harris-Trump choice drained me. But I finally have determined which candidate I will vote AGAINST. My decision came in a flash, thanks to an unexpected epiphany that focused on factors I had not even considered earlier. An examination of those factors revealed which of these sorry candidates scares me more.
Like many of you, I’ve been obsessed with this election cycle, being worried about the direction of our country, and truly alarmed by what might lay ahead. (I’m still worried and alarmed, but at least I’ve made a decision.)
It has been a long process. Nearly a year ago I reported on this site my misgivings about the 2024 election as Biden and Trump prepared to slug it out (See here for that post). I saw no improvement after Biden was forced out and endorsed Harris. As I’ve followed these two candidates over the past few months, both seemed determined to dig themselves deeper into their self-made trenches.
Donkey versus Elephant Fiasco
Trump worries:
I initially worried less about Trump. The reason was simple. When I compared his term in office with the Biden-Harris term, Trump came out ahead. Biden’s disastrous withdrawal from Afghanistan still rankled me, as did the increase in inflation during his watch. (A CBS article earlier this month reported that groceries cost 26% more than than in January 2020.) And worst of all, Biden’s executive orders that opened the border and allowed millions of illegals to flood across our country (with Harris supposedly in charge of the border). All of these soured me on the present administration.
But Trump is Trump, and he appeared to have the larger shovel, throwing dirt on former associates, the mainstream media, and anyone else he came in contact with. He dug himself deeper and deeper as he ranted on and on. He made stupid comments and illogical allegations. At times he sounded deranged. He lied about practically everything. Not surprisingly, he kept sinking in my ranking.
Harris worries:
Harris too has had problems. After her post-convention bounce, and the resulting few percentage point lead over Trump, she’s bumped along with little momentum. Nonetheless, she gained a bit in my view, mainly I think by remaining well above Trump’s often uncouth level of behavior.
At other times I lowered her grade, partly because of the multiple times she seems to contradict herself. For instance, when asked if she would have done anything differently from Mr. Biden on any issue, she replied, “There is not a thing that comes to mind.” That suggests that she would continue the Biden administration’s policies. But hold on! Her current campaign message focused on “a new way forward.” Is she trying to confuse voters? Or is she confused?
Buying votes:
Both candidates are guilty here, each presumably believing that promising some extra dough for voters (by reducing their taxes, or giving them government handouts), might sway them to punch their ticket. Both Trump and Harris have proposed tax cuts on tips, seemingly to appeal to working-class voters in key states like Nevada, where tipped workers in hospitality and service play a major role in the economy. But Harris may lead the charge here. She has proposed a number of financial incentives to appeal to voters, especially ones focused on housing affordability and family support. She has proposed to provide a $25,000 down payment grant to first-time home buyers. That should get some votes, but at the same time it certainly would increase home prices across the board, just as the government-provided money for student loans and Pell grants ignited the explosion of college tuition (See my take on that here). Harris has also touted a $6,000 tax credit for parents of newborns.
These are just some of the developments I’ve been watching intently over the past several weeks while juggling my view on which of these two mediocre (at best) candidates might cause the most damage if elected. It’s sad to have such negative thoughts, but I see what I see. I’ve never felt so down in all my years of voting. I yearn for the days when I happily voted FOR John F. Kennedy, and later FOR Ronald Reagan.
But yearning does not alter reality. Soon I will need to vote (and you too, if you haven’t already). It may have been that realization that led me to focus sharply on recent events and jam them into the pro-con mish-mash swirling in my head. During this process, suddenly and unexpectedly, I knew how I would vote. My Harris-Trump choice!
My epiphany:
It happened as I zeroed in on both candidates, searching for their pulse if you will. In Greensboro, NC, Trump showed up and yelled at length with his typical hyperbole. “I’m here today with a message of hope for all Americans,” he said. “With your vote this election. I will end inflation. I will stop the invasion of criminals into our country. And I will bring back, as your president, the American dream. We’re going to bring it back. Our country is being crippled and destroyed by Kamala Harris, but it does not have to be this way. It won’t be this way for long, hopefully what we’ve put up with, with the two of them. What we put up with the two of them with your support on November 5th, America will be bigger, better, bolder, richer, safer and stronger than ever before.” He went on, as you might imagine, for nearly two hours. Blah, Blah, Blah.
At about the same time, Harris had a town hall meeting in Michigan that was hosted by Maria Shriver. A woman attending the event asked Shriver, “Are we going to be able to ask a question?” According to the Daily Mail, Shriver replied, “You’re not, unfortunately, we have some pre-determined questions.Hopefully I’ll be able to ask some of the questions that might be in your head,” She added.
What is going on? I thought. Kamala Harris has served in the United States Senate. She has been vice president for nearly four years, and she can only take “pre-determined questions” in a town hall meeting? Why won’t she answer questions? As I factored that into my mish-mash, I related it to Harris’s reluctance to be interviewed by a number of legacy media outlets. Newsweek cited one significant example (See that here), quoting the owner of TIME who said, “Despite multiple requests, TIME has not been granted an interview with Kamala Harris—unlike every other Presidential candidate.
Eureka!
At that instant I saw what I had missed. Donald Trump is in many ways a despicable character, but he has a backbone. He is brash and declares himself in uncertain terms. Kamala Harris, on the other hand has been timorous on the campaign trail, often sounding as if she has a thin spine. I’ve wondered why she behaves that way. Does she shy away from certain interviews, and set up pre-determined questions so that she will avoid saying what she actually believes? Does she fear her honest beliefs will turn off voters? Or is she simply unable to organize and gather her thoughts? These possibilities are the most likely to me. And they worry me.
I prefer someone with a strong backbone in the Oval Office. Although Donald Trump has character flaws galore, he appears to me to be the lesser of two evils as a presidential candidate. For those reasons, I will vote against Kamala Harris by placing an X next to her opponent’s name. I will feel neither joy nor optimism as I vote, and I will continue to worry about our country’s future, but I will know I made a reasoned decision. My Harris-Trump choice!
The personality issue:
Numerous individuals have told me they will not vote for Trump for the simple reason that they could never vote for such an abhorrent individual. I understand that emotion, but it is worth remembering that this election is more than about Trump. This election will greatly influence the future of our country. Shouldn’t that fact be part of a voting decision? After all, 60% of us think our country is heading in the wrong direction.
Here’s a question. Is the Donald Trump of today much different from the one who earlier occupied the Oval Office? I think he is pretty much the same vain, vulgar, insulting, boorish guy he was when president. Yet, despite his character flaws, and despite the battering he took from the mainstream media, and our legal system (over the now-debunked Steele dossier that was funded by Hillary Clinton’s 2016 presidential campaign), he somehow managed to get things done while in office. Another question. Would Trump be effective if elected for a second term? I do not know. He certainly would again be the target of most national media. Nonetheless, I fear him less than I fear Kamala Harris.
Final note:
Okay. This is it. I’m laying off of politics for a while. I intend to be silent on all subjects here until at least after November 5th. Beyond that, unless the unthinkable happens, I will avoid political comment until at least the end of 2024. I plan to clear my head and focus on other topics. Thanks for listening. And stay tuned.
The agonizing Harris – Trump race has created a dilemma for at least half of our country’s voters, I among them. Millions of us find both candidates unfit for the job. To summarize my own view, I rate these two nominees as the least desirable pair to run for the presidency throughout the 70 years I’ve been a registered voter. Each is scarred with worrisome deficiencies.
But this is politics, after all, so each also has swarms of partisan supporters, along with swarms of detractors, both sides being loud and raucous. And both sides screaming that our democracy will end if their opponent wins. Could both sides be right? It’s worth noting that polls consistently have revealed that 60 percent of us believe our country is headed in the wrong direction. (Again, I’m in that majority.)
I’ve written about the agonizing Harris-Trump race before, specifically on Scientific American’s endorsement of one of the candidates. (See that post here.)
Here I will focus on only a sliver of the mass of information available, highlighting the markers of each candidates that worry me. If you nod your head vigorously when I focus on one candidate, and shake it angrily when I focus on the other, you may have confirmed your partisanship.
Donald Trump
To start with the most obvious, Trump clearly is in love with himself. He is loud, boorish, and given to hyperbole regarding his accomplishments. And how he lies! Below is a quote I found on Wikipedia (See here). It summarizes the general consensus well.
Historian Douglas Brinkley stated that U.S. presidents have occasionally “lied or misled the country,” but none were a “serial liar” like Trump. Donnel Stern, writing in Psychoanalytic Dialogues in 2019, declared: “We expect politicians to stretch the truth. But Trump is a whole different animal,” because Trump “lies as a policy”, and “will say anything” to satisfy his supporters or himself.
So, reflecting on Trump’s personality, how effectively would he deal with Congress during his second term. And equally important, how effectively would he deal with foreign leaders? Would he be forceful and effective? Or might he foster increasing tensions and possibly be a factor in igniting World War III?
ChatGPT Summary:
I asked ChatGPT to summarize Trump’s style. Here’s the result:
Donald Trump’s leadership style was defined by an unorthodox approach that rejected traditional political decorum in favor of a populist, combative tone. While his supporters viewed this as a necessary disruption of the political establishment, critics argue that his divisive rhetoric deepened political and social fractures in the country, undermined democratic norms, and left a legacy of polarization. His focus on energizing his base, often through inflammatory language and a rejection of consensus, fundamentally reshaped the nature of political discourse in America.
Reason enough to worry about a possible second term for Donald Trump? The agonizing Harris-Trump race continues.
Kamala Harris
Harris presents herself with less flourish than Trump, and thus by most standards is personally less off-putting than her opponent. Nevertheless, she sets off worries for us undecided voters. Here are two that bother me. She frequently strings together combinations of words devoid of meaning, or at best vague, sometimes referred to as “word salad.” Does she do this intentionally to avoid a direct answer? Or is she unable to clearly analyze certain subjects? I don’t know, but her blabbering bothers me. Here’s an example from when she was asked by CBS’s Bill Whitaker why it seemed like Israeli Prime Minister Benjamin Netanyahu wasn’t listening to the U.S. Her answer? Well, Bill, the work that we have done has resulted in a number of movements in that region by Israel that were very much prompted by, or a result of, many things, including our advocacy for what needs to happen in the region.”
You all clear on the above? By the way, Harris’s above answer was broadcast as a teaser on Face the Nation. Later, when Whitaker’s interview with Harris aired on 60-Minutes, another answer of hers was substituted for the one above. CBS, when editing the interview, changed her answer. The last I heard on this matter, which was yesterday, is that CBS refuses to release the full transcript of that interview.
Reason number two. Harris’s flip-flops. During this campaign, she has shifted from far left toward the middle, as did Obama and Biden before her. Here are three examples: In her brief 2020 presidential run, she said, “There’s no question I’m in favor of banning fracking.” In 2019, she was among a number of Democrats who would not “rule out” expanding the Supreme Court; she saw a crisis of confidence in the Court and said that “everything is on the table” to face that challenge. During her brief, last presidential effort she said in Las Vegas, “We have to have a buy-back program (for AR-15s and similar guns) and I support a mandatory buy-back program.”
ChatGPT Summary:
I asked ChatGPT to summarize her changes on the above issues. Here’s the result:
Kamala Harris’s changing positions on fracking, defunding the police, and expanding the Supreme Court reflect the pressures of balancing progressive and moderate factions within the Democratic Party. These shifts have fueled criticisms from both sides of the political spectrum, with opponents accusing her of political opportunism and lack of consistency. While some see her flexibility as pragmatic, others view it as indicative of a deeper issue with political authenticity.
Reason enough to worry about a possible Harris presidency?
What comes next?:
I’ll tackle more issues soon, and force myself to drill down and decide which of the sorry candidates pictured above I will vote against. The agonizing Harris-Trump race continues. Stay tuned.
DEI is dying in higher education, and in major businesses. To consider higher education first, an extensive article in today’s The New York Times Magazine describes the history of DEI at the University of Michigan. Written by Nicholas Confessore, an investigative reporter for The Times, the article’s title and subhead ably summarize one of its important discoveries.
The University of Michigan Doubled Down on D.E.I. What Went Wrong?
A decade and a quarter of a billion dollars later, students and faculty are more frustrated than ever.
Campus Scene
If you have access to The Times Magazine, I urge you to read the article carefully. It covers Michigan’s experience with DEI thoroughly, and it goes into multiple ramifications of that effort, far more than I will mention here. Below is a segment near the opening of that article.
A decade ago, Michigan’s leaders set in motion an ambitious new D.E.I. plan, aiming “to enact far-reaching foundational change at every level, in every unit.” Striving to touch “every individual on campus,” as the school puts it, Michigan has poured roughly a quarter of a billion dollars into D.E.I. since 2016, according to an internal presentation I obtained. . . . Tens of thousands of undergraduates have completed bias training. Thousands of instructors have been trained in inclusive teaching.
The article also points out that DEI critics deplore that the program is strongly left-wing because it trains professors in “anti-racist pedagogy” and gives handouts on how to identify characteristics of white supremacy. The engineering school even promises a “pervasive education around issues of race, ethnicity, unconscious bias and inclusion.” And that, I ask, is what it takes to be a good engineer?
Michigan’s results? Not good!
Confessore writes, On campus, I met students with a wide range of backgrounds and perspectives. Not one expressed any particular enthusiasm for Michigan’s D.E.I. initiative. Where some found it shallow, others found it stifling. They rolled their eyes at the profusion of course offerings that revolve around identity and oppression, the D.E.I.-themed emails they frequently received but rarely read.
Michigan’s own data suggests that in striving to become more diverse and equitable, the school has also become less inclusive: In a survey released in late 2022, students and faculty members reported a less positive campus climate than at the program’s start and less of a sense of belonging. Students were less likely to interact with people of a different race or religion or with different politics — the exact kind of engagement D.E.I. programs, in theory, are meant to foster.
So, what do you think? Did the University of Michigan spend that $250,000,000 wisely?
DEI is dying in businesses
Businesses also are retreating from DEI. For example, an article earlier this month in The Advocate by Trudy Ring, listed eight major companies that have stopped DEI programs (see here). It is important to note however, that a good number of individuals still favor the concepts of DEI, even if its implementation often bumps into financial problems in business just as it has in higher education.
I think it is fair to say that most businesses that have lowered their DEI efforts, or have abandoned them entirely, have done so for the simple reason that they have been losing customers and thus losing revenue.
If you have been following my blog for a while, you may recall that I’ve written about DEI a couple of times before, explaining why I consider it to be discriminatory and unfair. (See those posts here and here.). So, for me personally, I am pleased that DEI is dying.
Future topic?
On the other hand, and on another subject entirely, I continue to be DIS-pleased by the two major candidates for our highest office. At the moment, I judge neither to possess qualities suitable to be our president. So, as I’ve said here before, my question probably will become frustratingly simple. Whom will I vote against? I am so agitated that I may rouse myself to consider that worrying topic one more time on this site.
Writerken.com is restored. I learned yesterday that some readers logging on to my website were able to land on my home page but could not access any posts from there. I alerted the tech guys at KC Web Specialists, and they soon had things back in order. So, for those of you who missed my last post on Scientific American’s presidential endorsement, it’s now available again (see that here). That post generated considerable interest. And Scientific American’s full article endorsing their candidate can be found here.
As my followers know, I write on a variety of topics here, but this year I’ve focused a bit more on politics and governmental Snafus. Why that focus? Quite simply, because of my concern over the unsettled state of our nation, not to mention the increasing tensions throughout the globe. The world is full of hostilities. Putin invaded Ukraine over two years ago, and that war has now slaughtered over a million people, destroyed cities and villages, and shows no signs of ending. Hamas attacked Israel almost a year ago, and violence in the Middle East is escalating, now spreading into Lebanon, where Hezbollah reigns. Just yesterday, Israel killed longtime Hezbollah leader, Hassan Nasrallah, in an airstrike. China is saber rattling in waters in the Pacific. North Korea’s leader, and his nuclear arsenal, are unstable and dangerous. Iran, where one hears “death to America” shouts, soon will have the bomb.
Bombing of Pearl Harbor, 1941 (This was before the development of atomic and nuclear bombs)
World War III?
Is World War III in our future? That’s a scary thought, but a genuine possibility to consider, especially when one reads the special report of the Commission on the National Defense Strategy, which says The threats the United States faces are the most serious and most challenging the nation has encountered since 1945 . . . The United States last fought a global conflict during World War II, which ended nearly 80 years ago. The nation was last prepared for such a fight during the Cold War, which ended 35 years ago. It is not prepared today (see that detailed, and frightening, report here).
And how is our government responding? Not well, I would suggest. I intend to write my congressmen and women and ask them what they are proposing to remedy the lack of preparation of our country to defend itself should war break out. If you’re interested, perhaps you should do the same.
Our two main presidential candidates
And of course, there is our upcoming November election, a topic I imagine I will write more about now that writerken.com is restored. Here’s an idea, if you truly believe one of these two candidates is actually capable and well-suited to serve as the President of the United States of America, please write to me with your reasons for believing that. I would be happy to put some or all of your opinion on this site. As I’ve said here before, I find neither of these two to have the qualifications, or the character, that we need as our president in these crucial times.
Scientific American‘s presidential endorsement disappointed me. As a person gritting my teeth about the upcoming election, I had hopes of finding some logical and reasonable arguments in this “scientific” article. You’ve probably heard about the endorsement, or maybe you’ve even have read it. It appeared a few days ago, accompanied by the rather proud boast that this was only the second time in its 179-year history that the editors are endorsing a candidate for president (read that endorsement here).
No matter what your political orientation is, I invite you to read to the end of this post. Why? Because I’ll focus on what I believe is the most fearsome danger our country now faces, a vulnerability not even mentioned by the magazine’s endorsement, and one that remains much under-reported by our national media. Nonetheless, it is a genuine peril that is becoming more ominous day by day.
I’ve read Scientific American sporadically in the past, and I actually expected to learn some interesting facts from that publication’s editorial, some insights concerning factors I might otherwise not have considered. (If you’ve followed my blog, you know that I believed our choice between Biden and Trump was dismal (see here for one example). Now, with the substitution of Harris for Biden, my opinion hasn’t changed. In fact, I think it’s possible that these two are the worst presidential candidates ever to run for office during the 179-year history of Scientific American. For this reason, I’ve been in a quandary trying to decide whom to vote against. Yes, you read that right. My goal is simple: to decide which one would do the most damage to our country. If I can figure that out, I’ll put an X in front of the other candidate. I know, that’s terrible, but it’s what I honestly believe.
Our two main presidential candidates
With that in mind, I read the arguments presented by Scientific American with some eagerness, expecting the piece to be relatively logical, possibly with a pro versus con format for each candidate. I was wrong! Both the tone and the arguments themselves disappointed. While reading it, I had the impression that it could have been written by a high school student who had just been fed Democrat talking points; or it could have been composed by an AI bot trained exclusively from leftist sources.
To illustrate, here’s the subheading of the article: Kamala Harris has plans to improve health, boost the economy and mitigate climate change. Donald Trump has threats and a dangerous record. That subhead pretty much previews what follows, which is plenty of opinions, along with scattered facts that are interpreted as positive when related to the Biden-Harris administration, and negative when related to Trump. If you want unbiased information, or in-depth analysis, you will find little of value in that piece.
Climate Change versus the Unnamed Peril
Scientific American of course mentioned climate change (Harris pro, Trump con), a topic that often is described in our media as an existential threat. That is almost laughable when you consider the following. The fearsome worry I referred to earlier is a growing threat to the very survival of our country, and a danger far more terrifying than the possibility that our planet’s temperature could be increased by 2 or 3 degrees some fifty years from now. So, what exactly is this real threat? It is the likelihood that we soon could be embroiled in war, possibly with nuclear weapons (see below), and that we are unprepared. I’ve discussed the relative threats of global warming versus nuclear winter in an earlier post (see here).
The danger of war, and the unpreparedness of our country to engage in one, are not figments of my imagination. This potential recently was carefully analyzed by a select group of eight experts appointed by senior Democrats and Republicans in Congress. This elite and nonpartisan group waded through a huge range of both public and classified information. It then analyzed this massive trove and issued a unanimous report that is absolutely scary to read. That report can be found here, and I highly recommend that you take a look at it. When it came out in July, it should have been front page news in every major newspaper in the country, and the story should have been reported on every national TV news segment on the very day it was released. If that happened, I didn’t see it. I stumbled on it recently. See the teasers below.
Short Excerpts from the Report
A phrase from the Forward of that report: We also address our report to the American public, who have been inadequately informed by government leaders of the threats to U.S. interests—including to people’s everyday lives . . .
The first paragraph of the Summary:The threats the United States faces are the most serious and most challenging the nation has encountered since 1945 and include the potential for near-term major war. The United States last fought a global conflict during World War II, which ended nearly 80 years ago. The nation was last prepared for such a fight during the Cold War, which ended 35 years ago. It is not prepared today.
More to consider
WWI was started by an assassination of Archduke Franz Ferdinand of Austria, although other factors were involved. WWII started abruptly when Hitler invaded Poland, although again there were other factors. Compare those events with what is going on today.
* Russia invaded Ukraine over two years ago, a war that still is causing death and destruction (over a million killed, and countless cities destroyed). That war is being escalated by contributions to Ukraine from the West, and contributions to Russia from the East.
* The Mideast is ablaze as the conflict between Israel and its enemies, Hamas and Hezbollah, intensifies daily. Again, certain other countries are supporting both sides.
And more
* China is flexing its might in the South China Sea: Here’s a recent quote from Time: Experts say that China appears to be baiting a military response from opposing claimants in the South China Sea (or their allies) that would trigger an even more dangerous but legally justifiable use of force on its part, but so far none of the nations involved have militarily engaged with China over the issue.
* Nine countries have nuclear weapons, including Russia and the USA who have nearly 6,000 each (Putin has threatened to use his against Ukraine, and the USA, you’ll remember, used two in WWII). Other countries ready with bombs ready to explode on potential enemies include China, France, United Kingdom, Pakistan, India, Israel, North Korea, and likely soon, Iran. Detonation of a few of those bombs could set in motion a cascade of deaths similar to, or possibly even exceeding, the one that marked the extinction of the dinosaurs.
Early Nuclear Blast
What do you think?
Should our selection of a presidential candidate include a consideration of how that candidate would build up our national defense (which recklessly has been allowed to weaken)? I think the answer can be nothing but an unequivocal YES. So, I still am gritting my teeth over that crucial selection. And that’s why is Scientific American presidential endorsement disappointed me.
A request
If you have friends or relatives who might find this information interesting, I ask you to consider forwarding this post to them. Thank you!
Important differences between Democrats and Republicans were covered in my last post, with focus on the Democrats, and following the theme of Ezra Klein of The New York Times, who claimed that Democrats are united in their belief that the government can, and should, act on behalf of the public.
In contrast, Mr. Klein characterized the Republicans quite differently, The modern Republican Party, by contrast, is built upon a loathing of the government. Many would consider that a gross overstatement, but he did touch on a recognizable theme, especially when one considers certain quotes of perhaps the most popular Republican of the last half century, Ronald Reagan (President from 1981 to 1989). Reagan produced many quotes (see here).Four representative examples follow:
Government is like a baby: An alimentary canal with a big appetite at one end and no responsibility at the other. – 1965
Government’s first duty is to protect the people, not run their lives. – 1981
Government is not the solution to our problem; government is the problem. (First Inaugural Address on January 20, 1981)
The nine most terrifying words in the English language are “I’m from the government, and I’m here to help. – 1986
President Ronald Reagan
Just so there is no misunderstanding, I am in full agreement with Reagan’s concepts, but I believe they also are consistent with what I often reveal in this space, namely that my political base is also compatible with the views of perhaps the most popular Democrat of the last century, John F. Kennedy (President from 1961 to 1963), Ask not what your country can do for you – ask what you can do for your country.
President John F. Kennedy
In my opinion, Mr. Klein of theTimes overstated the Republican view of government. As I see it, most Republicans are politicians, not statesmen, as are their Democrat colleagues, but overall the Republicans have an edge in ineptness.
Some examples: Think of Rep. Marjorie Taylor Greene, and contrast her with Republican members of the House Black Caucus. Think of the frequent changing of Republican leadership of House leadership (as opposed to the long tenure of Democrat Nancy Pelosi). Here’s one that made me smile, an incident described by Rep. Don Bacon of Nebraska. When recently visiting his Nebraska congressional district, he joined a GOP meeting and told the group, “I am a Christian first, an American second, and then a Republican.”
An older gentleman immediately yelled out, “That is why we don’t like you!” Representative Bacon added, rather dryly, “I wondered what bothered him more, the Christian or the American part.”
Enough of that! I’ll cut this short because tonight is THE DEBATE between Kamala Harris and Donald Trump. I dread tuning in, but of course I will. I wrote here earlier a number of times to give my views of the dismal upcoming election with then-candidates Biden and Trump (see here,here, and here). One candidate has changed, but for me the dreariness continues. Surely all voters have evaluated our present contenders and have come to a conclusion. Here’s mine: Kennedy and Reagan they are not!
Important differences between Democrats and Republicans were revealed recently by Ezra Klein in The New York Times (see here). Mr. Klein was laser-focused as he encapsulated the current Democratic party (see below).
Democrats according to Klein
Democrats are united in their belief that the government can, and should, act on behalf of the public. To be on the party’s far left is to believe the government should do much more. To be among its moderates is to believe it should do somewhat more. But all of the people elected as Democrats, from Representative Alexandria Ocasio-Cortez to Senator Joe Manchin, are there for the same reason: to use the power of the government to pursue their vision of the good. The divides are real and often bitter. But there is always room for negotiation because there is a fundamental commonality of purpose.
WHAT DO YOU THINK OF THAT? What grade does Mr. Klein deserve for his summary of the Democrats? I THINK HE EARNED A SOLID A. Next, let’s take a look at his views of the Republican party (see segment below).
Republicans according to Klein
The modern Republican Party, by contrast, is built upon a loathing of the government. Some of its members want to see the government shrunk and hamstrung. This is the old ethos, best described by Grover Norquist, the anti-tax activist who famously said: “I don’t want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub.”
WHAT DO YOU THINK OF THAT? Please give Mr. Klein a grade. He seems to have sharpened his pen here, and even tossed in a bit of exaggeration. Nonetheless, he touched on some truths. I AWARDED HIM WITH A C FOR HIS EFFORT.
Relevance of the above differences
As voters, I would argue, we have an obligation to examine diverging political views and actions, and to determine how they affect us individually, and our nation as well. Since we obviously can’t see into the future, the best we can do is to peek into the past to see how things have gone after government expands, or after it contracts. With this in mind, I’ll take a brief look at the impact of two examples of governmental expansion, specifically laws that were intended to act on the behalf of the public. In a later post, I’ll look at the obverse side of the coin.
Gathered Students
Governmental laws on behalf of college students
The government has acted generously on behalf college students. In 1965, Washington began providing eligible students with Federal Pell grants, which provided funds for expenses needed for students to attend colleges and universities. The establishment of Pell grants basically marked the beginning of a series of governmental laws (summarized here) intended to provide considerable cash as loans and whatnot for financially-strapped college students. How has that worked out?
Over 25 years ago, then Secretary of Education William J. Bennett, argued that, contrary to the intentions of policymakers, increased federal aid actually was making college less affordable (“Our Greedy Colleges,” New York Times, Feb 18, 1987). Bennett argued that the increases in financial aid had enabled colleges and universities to blithely raise their tuitions, confident that Federal loan subsidies would help cushion the increased burden. (For a detailed discussion of this topic, see my earlier post on exorbitant college costs (click here).
Since then, college tuitions and fees have continued to rocket upward to astronomical levels. According to USA Today, in June of this year the student loan debt balance in the U.S. totaled more than $1.77 trillion, having increased by 66% over the past decade. Individual students today not infrequently graduate indebted by hundreds of thousands of dollars, a result probably not intended by the legislators who authorized the funds.
Students’ loss, higher education’s gain
There also have been obvious winners, especially those employed in higher education. Increasingly flush with cash, many colleges and universities have doled out grossly inflated salaries to faculty and administrators. To cite one example from my alma mater, the University of Wisconsin-Madison, the annual salary of Chancellor Donna Shalala in 1988 (a time when tuitions had already doubled from two decades earlier) was $95,000; by 2019, Chancellor Rebecca Blank’s salary was $582,607.
The upward swing persists. In mid-2022, the University of Wisconsin Regents hired Jennifer Mnookin to be the new chancellor at a base salary of $750,000. My quick adjustment for inflation revealed that Chancellor Shalala’s salary in 2022 dollars would be $235,365, thus the inflation-adjusted value of the chancellor’s salary has more than tripled since Donna Shalala presided there. Go Badgers!
The question for us common people to answer, I suggest, is whether we favor what Washington has done for college students, or not. Our answer conceivably could influence which party we affiliate with, and how we vote.
Doctor and patient
Governmental laws on behalf of medical patients
This is a second area in which the government has done much on behalf of citizens. Few, I think, would deny that. One can find a listing of the major “health” laws by clicking here. You probably know, from personal experiences and from reports of family and friends, how that legislation has worked out. Some examples follow.
If you’ve been on this earth for several decades, you’ll remember when your doctor looked at you during an appointment, rather than focusing on a computer screen. You will remember that your physician was in private practice (not a salaried employee), and that telephone calls to your physician were answered promptly by a receptionist or nurse employed by that doctor, and that you could get a medical appointment within days or even hours, not weeks or months as it usually takes today. In those past days, there was no “health care industry,” and a time when a visit to the emergency often cost under $100, not the $1,000s or more for brief visits so typical these days. It was a time when few people even carried health insurance because medical costs were reasonable, and individuals who couldn’t afford to pay their medical bills usually had them written off by doctors and hospitals. That’s the way it was when I graduated from medical school.
It’s worth knowing that more changes in our medical care may be coming. Certain politicians today are eager to pass even more laws on behalf of patients, for example, laws establishing a “single payer” system, and laws eliminating private medical insurance, and much more. Will the potential effects of these proposed changes be beneficial? That seems to be another key question that cannot be answered with certainty. What do you think? Do you favor further changes, or not?
Again, our views on the significant changes in our medical care and its soaring costs may also influence the party we affiliate with, and how we vote.
A broader view and final questions
Clearly, there are important differences between Democrats and Republicans. And the above two examples naturally represent only a fraction of governmental influences on our daily lives, many of them vital, such as those affecting our personal liberties, our public safety, our economy, and the security of our borders. Nonetheless, the examples I cited were enacted “on behalf of the public,” “to pursue their vision of the good” to use Mr. Klein’s phrases (their vision, of course, refers to the vision of “good” according to the Democrats). Having considered all of that, I suppose it is a mysterious mix of these multiple governmental roles that somehow determines our own political views. If so, that raises interesting questions for all of us, which are: can we identify the specific factors that generated our personal political views? Do we know why we call ourselves a Democrat, a Republican, an Independent, a Socialist, or a Communist? Were we influenced by family views, or opinions of friends and colleagues, or our natural kindness for others, or our independence? Or have other factors influenced us? Have we carefully examined our current candidates, or what they promise, or do we automatically lean toward someone who represents the party we identify with? I’ve had a go at all of these questions. Believe me, it was a chore. If you give them a try, have fun!
Alert, next time I’ll continue my exploration of important differences between Democrats and Republicans, focusing on the party that loathes government.
