Healthcare Musings For November 1, 2024

November 1, 2024

Dear Interested Readers,

 

Can You Survive Five More Anxious Days?

 

There are times when it seems that time stands still. The last month has crept along for me. It feels like it has been a decade since Joe Biden’s disastrous debate with Donald Trump at the end of June. Every day seems like a “Groundhog Day” when nothing changes. As a news junkie, each morning I check the New York Times, the Washington Post, the Boston Globe, and my local Valley News looking for some hint that Vice President Harris is developing a clear lead in the polls over Donald Trump. Each morning, I search the media for evidence that overnight Trump has finally said something so outrageous that his most loyal fans see him for who he is and are stomping on their MAGA hats, burning all of their Trump t-shirts, flags, yard signs, desecrated Bibles, and other worthless “merch” that they have bought at exorbitant prices from his website. What I read is that there has been no “statistically significant change” in the projections and that the election outlook remains a dead heat that will be determined by which party does the best job of mobilizing its base and appealing to an incredibly small group of undecided voters in six or seven states. 

 

All of the pundits are speculating. The two most significant speculations that I have read this week are from Nate Silver, the much-respected, self-promoting statistician and pollster, and James Carville, the long-time colorful political operative who, like Silver, is also self-promoting, but has been accurately reading voters for over thirty years. Both men had “Opinion” pieces in the New York Times this week. Silver, the statistician, entitled his piece “Nate Silver: Here’s What My Gut Says About the Election, but Don’t Trust Anyone’s Gut, Even Mine.” Carville’s wisdom was entitled “James Carville: Three Reasons I’m Certain Kamala Harris Will Win.” I hope that you will join me in my anxious state by reading both articles. They are short. 

 

Silver begins by describing the fear I share with many other voters who are asking themselves how they could survive another four years of Trump. Remember that when you see bolding in these notes it is usually my attempt to point out what is important to me. Silver writes:

 

In an election where the seven battleground states are all polling within a percentage point or two, 50-50 is the only responsible forecast. Since the debate between Kamala Harris and Donald Trump, that is more or less exactly where my model has had it.

Yet when I deliver this unsatisfying news, I inevitably get a question: “C’mon, Nate, what’s your gut say?”

So OK, I’ll tell you. My gut says Donald Trump. And my guess is that it is true for many anxious Democrats.

 

When I read those words my heart sank. I wasn’t as bad as if I were told I had a fatal disease, but it was close. I can’t explain why I am so concerned that the outcome may be decided already, and that the next president will be a meaner, more dangerous, and less competent Donald Trump than the one who was impeached twice and should have been removed from office. I still hope that I am wrong, but it seems that what I object to in the man and his rejection of social and political norms turns out to endear him to a growing number of voters in the “swing states.” I should add that I expect Kamala Harris will gain many millions more votes than Trump, but because of the relic of the Electoral College, Trump has a great chance of taking another oath to uphold the Constitution on January 21, 2025, which he will immediately disregard. 

 

Silver spends the rest of the article trying to objectively make a case against his gut. Perhaps, the explanation for why most of the article is about why his gut may be wrong is his memory of how wrong he was in 2016 when he predicted that Hillary Clinton would win by a wide margin. He offers multiple reasons for why he hopes his gut feeling is wrong. I can sort of accept his reassurance that he may be wrong because I can remember how disappointed and surprised I was in 2016. Trump’s victory then was such a trauma that I have an easily triggered form of political PTSD. Silver has been trying to explain his embarrassing flub ever since that very disappointing day. 

 

He ends with a totally ambiguous statement that suggests that the only value in his article is to create a false sense of impending victory for MAGA enthusiasts who might care what his opinion is and a little hope for people like me. His article just failed to help me. I wish that he had kept his “gut feelings” to himself. His last words were a pointless example of a “CYA” proclamation:

 

Don’t be surprised if a relatively decisive win for one of the candidates is in the cards — or if there are bigger shifts from 2020 than most people’s guts might tell them.

 

Carville offers us pure certainty. My gut tells me to be skeptical of anyone’s certainty in religion or politics. He begins with an accurate description of my emotional state by saying:

 

There is a palpable anxiety wailing on the winds of American life right now. More than in any other election in my lifetime, I’ve been consistently asked by people of all stripes and creeds: “Can Kamala Harris win this thing? Are we going to be OK?” This sentiment is heard over and over from sweaty Democratic operatives who all too often love to run to the press with their woes.

While I am not one to take part in the political prediction industry — recently ballooned by mysterious crypto investments gambling on a Donald Trump victory — today I am pulling my stool up to the political poker table to throw my chips all in: America, it will all be OK. Ms. Harris will be elected the next president of the United States. Of this, I am certain. Here are three reasons:

 

Hold that thought. Before I give you the three reasons that are a foundation of Carville’s certainty, let me tell you three brief stories from my life that I keep returning to in my mind as I deal with my growing anxieties in the final week of the 2024 election. First, in 1972 I was convinced that George McGovern would defeat the obviously crooked and defective Richard Nixon. All my friends were voting for McGovern, and he seemed to be very popular in my community. Both facts were true. McGovern did carry Boston by a wide margin and he garnered all fourteen of the Electoral College votes from Massachusetts. Unfortunately, McGovern won in only two places, Massachusetts and Washington, D.C. Nixon got more than 60% of the national vote while McGovern got 55% of the vote in Massachusetts. 

 

The second story has a happy ending since Biden was elected, but it is a reminder of past political “suffering.” In 2020 during the pandemic, my wife and I wanted to visit our grandchildren in California, but we were afraid of getting COVID by flying or by driving and staying in hotels and eating in restaurants. I had never driven across the country, but such a trip which my wife had done with a friend in 1968 was on my “bucket list.” So, we bought a very comfortable RV and headed out in mid-September as the election was gaining momentum. We returned two days before the 2020 election. 

 

As we drove deep into rural New York looking for our first night’s campsite, I began to notice numerous Trump signs and flags in every little town and almost no Biden signs. By choice, we tried to avoid the Interstate highways and all the large cities as much as possible. I wanted to see “flyover” America which soon began to feel like one very large cornfield. When we were forced onto the Interstate highways we found ourselves in a terrifying river of eighteen-wheelers. Some of the trucks were even larger. They had 20 or twenty-two wheels and were pulling large trailers. It seemed that most of them had “Walmart” painted on their trailers.

 

Going out we took a northern route through Yellowstone, and we came back by a Southern Route that took us to the Grand Canyon, New Mexico, Texas, and then Oklahoma where I visited the small towns of my early childhood. On our outbound trip, by the time we had gotten past Troy, New York until we crossed from Nevada into California, I counted Trump and Biden signs. The score every day was about fifty Trump signs for every Biden sign. Coming back in late October and early November, I lost interest in counting signs because “my gut” told me that Trump was going to win. There were even more Trump signs going home by a southern route. The score for the Southern route “felt like” it was a hundred to one.

 

On one particularly scary night in Wyoming south of Jackson Hole and near the Idaho border our RV campsite was adjacent to some ominous-looking dudes who were sitting around a fire under a couple of big Trump flags and drinking beer with their guns standing nearby. I tried to reassure myself and my wife that we were safe, and they were hunters who were out on a weekend lark and just enjoying their First and Second Amendment rights. We were very nervous until we made our getaway the next morning. 

 

What I learned from our cross-country trip is that America is not one place. For much of the trip, it felt like we were in a foreign country. We were seeing MAGA America, and “our America” was on the coasts, and in the cities. Despite the amazing beauty of the land and our common history, it was shattering to witness and feel the sense of estrangement that is the product of our deep political and cultural divisions.  After what I saw and felt, I was amazed that Biden won, but I was not surprised at all by the growing anger that culminated in the January 6th attack on our democracy.

 

The third story is from this last month and presents a reverse experience of the observations in my second story. These days I am getting the majority of my exercise on my bicycle. I have an eleven-mile out-and-back route that takes me around the lake into town, up Main Street, through Colby-Sawyer College, and then back home on the same route by the lake. It is a very scenic ride with enough hills to give me a good workout. A few weeks ago, I started counting Trump and Harris signs, as I had done on the long trip before the 2020 election. The first time I counted, I was reassured that there were eight Harris signs and only three Trump signs. Over the last couple of weeks, things have changed, and on Monday there were 26 Harris signs and only 10 Trump signs. Three of the Trump signs are in one yard, and there are two other “Trump yards” with two signs so three homes accounted for all but three Trump signs.

 

[ I should tell you that the Trump support pictured in today’s letter was not part of my “study.” It is the picture of the garage of a very beautiful home I see less than a half mile into an alternative ride that I take on days when I want to enjoy the gorgeous view of Mount Sunapee and Lake Sunapee from the top of Burpee Hill. The picture is a good reminder that in surveys the result is often all about where you take your sample.]

 

The score or outcome of my “survey” shouldn’t be a surprise.  I live in an affluent community where there are many retired “coastal elites” whom the longtime “locals” often refer to as “Massholes.”  With the Democratic invasion of folks like me, our town has voted for the Democratic candidate for president since at least 2008. I am sure that there are other New Hampshire communities, especially up in the northern part of the state, where the score would be reversed. 

 

My yard sign counting methodology is crude, but I think it may be as valid as the more sophisticated surveys that Nate Silver tries to analyze which just confirm that we are a very equally divided nation. My poor man’s attempt at sampling opinions leads me to put more trust in Carville’s “considered opinion” based on his long experience as a political operative as I look to quiet my election anxieties. I try to calm myself by reasoning that Silver’s “gut response” which is derived from the combination of the polls he monitors and his previous failures doesn’t have much more validity than my bicycle survey. There are just too many ways for small samples to be wrong. 

 

Carville’s first reason that he thinks Harris will win is that Trump has been a “repeat loser” in 2018, 2020, and 2022. Carville doesn’t believe that the realities that explain the continuing MAGA losing streak have changed. He explains:

 

…the Democrats have been performing well in special elections since Trump appointees on the Supreme Court helped take away a basic right of American women. Guess what? Abortion is on the ballot again — for president.

There simply do not seem to be enough voters — even in the battleground states — who turn out at Mr. Trump’s behest anymore when he’s simply preaching to his base.

 

He goes on to imply that Trump has been too lazy to grow his base. He has a committed base of support, but there is also a very committed resistance within the Republican Party. He points to Nikki Haley’s measured success and to Trump’s age:

 

Although Ms. Haley has endorsed Mr. Trump, losing even a fraction of those voters [the 30% of Republicans that voted for Haley in the primaires] leaves Mr. Trump running the final leg of this race with a fundamental fracture of the femur. To add a cherry to the pie, most voters think Mr. Trump is too old to be president, but instead of easing their concerns, he’s spending the final days of the campaign jiving to the Village People and canceling interviews.

 

Carville’s second reason Trump will lose is that “money matters” and Harris “has it in droves.” He writes:

 

All this cash not only effectively offsets the flow of money funneling in for Mr. Trump from some tech billionaires, but it has also given Ms. Harris the resources she needs to persuade swing voters with ads and to organize on the ground. With her field operation moving like a tremendous machine, it seems likely there has never been a greater disparity in voter contact efforts. Mr. Trump can run all the high-profile TV ads he wants painting Ms. Harris as extreme, but what’s less discussed is that she is more than fighting back with ads reminding voters of how Mr. Trump betrayed his oath of office after the 2020 election and ended a woman’s right to choose. She is strapped with the necessary cash to forcefully remind suburban women and voters in the middle that Mr. Trump is, in fact, the extremist candidate.

 

Through his first two points, Carville is reassuring me with well-considered facts. He is not talking about his “gut.” He is basing his case on facts like Trump’s age and his disappointments in his own election in 2020 and in the elections of many of the candidates whom he endorsed in 2022 like Keri Lake in Arizona. Perhaps Carville should have written about the two facts that convince him that Harris will win because his third “fact” is his “gut” feeling. Ugh, he sounds like Nate Silver. Here’s how he says it:

 

It’s just a feeling.

My final reason is 100 percent emotional. We are constantly told that America is too divided, too hopelessly stricken by tribalism, to grasp the stakes. That is plain wrong. If the Cheneys and A.O.C. get that the Constitution and our democracy are on the ballot, every true conservative and every true progressive should get it too. A vast majority of Americans are rational, reasonable people of good will. I refuse to believe that the same country that has time and again overcome its mistakes to bend its future toward justice will make the same mistake twice. America overcame Mr. Trump in 2020. I know that we know we are better than this.

 

I appreciate Carville’s trust in the good intentions of a majority of Americans, but I am surprised that as a seasoned political consultant and a veteran of many elections, Mr. Carville seems to have forgotten that Trump could lose the popular vote by tens of millions of votes which would validate his, Carville’s, trust in the majority of Americans, but because of compromises made in 1787 to get the Constitution accepted by small states, it’s the majority in the Electoral College which elects the president and not the majority in the popular vote. 

 

Carville recovers a sense of some reason as he closes his piece, but he has left me with enough uncertainty that I am still unconvinced that we are not vulnerable to Trump’s reelection and all the grief that would follow in the wake of that awful possibility. Carville leaves us with words that I endorse:

 

Now, I don’t mean for my prediction of a Harris victory to breed complacency. We still have days of vital work to do. I say all this because a movement that marches with hope is 1,000 times as thunderous as a movement that marches with dread.

For the past decade, Mr. Trump has infected American life with a malignant political sickness, one that would have wiped out many other global democracies. On Jan. 6, 2021, our democracy itself nearly succumbed to it. But Mr. Trump has stated clearly that this will be the last time he runs for president. That is exactly why we should be exhilarated by what comes next: Mr. Trump is a loser; he is going to lose again. And it is highly likely that there will be no other who can carry the MAGA mantle in his wake — certainly not his running mate.

 

Click on that last link that leads to an article entitled “J.D. Vance Is Bombing His Audition As Trump Heir Apparent.” If it is true, that would be good news. I appreciate Carville’s attempt to assuage my (our) anxieties. I hope that sometime next week we will know for sure tht he was right, but there is real money betting on a Trump win. One of my neighbors has informed me that our national disease of gambling has invaded presidential politics. There is a cryptocurrency process where you can bet on the election, and in that process, Trump is the leading pick, by a lot. You might have noticed that in my first quote from Carville, there was a reference to this fact. If you didn’t notice, here it is again with the fact bolded.

 

While I am not one to take part in the political prediction industry — recently ballooned by mysterious crypto investments gambling on a Donald Trump victory — today I am pulling my stool up to the political poker table to throw my chips all in: America, it will all be OK. 

 

Having Harris elected will not guarantee a future with better healthcare. It could be that divided government with Republicans continuing to control the House and winning control of the Senate would reduce her ability to do many of the things that she advocates—improve the Social Determinants of Health for disadvantaged populations, lower consumer health care costs, and expand access. There is no uncertainty that if Trump wins, healthcare improvements will stall. Many of the healthcare advances since the passage of the ACA will be vulnerable. While Trump has been making vague references to a “concept of a plan,” Project 2025 boldly calls for the repeal of the ACA. The Speaker of the House, Mike Johnson has visited over twenty states campaigning for the election of Representatives to the next Congress that will vote to end the ACA.

 

Perhaps the scariest healthcare disaster that could follow in the wake of the reelection of Trump was revealed this week as Robert Kennedy, Jr. bragged that Trump promised him that after he was elected, he would appoint him as the Secretary of Health and Human Services with control over Medicare, Medicaid, CDC, FDA, and the NIH. Kennedy said that this was the promise Trump gave him when he endorsed him. In the link above to an article in the New York Times on Wednesday we read:

 

Robert F. Kennedy Jr. told supporters on an online organizing call this week that former President Donald J. Trump had “promised” him “control” of the nation’s public health agencies, should Mr. Trump win the election next week.

The Trump campaign, however, would confirm no such commitments.

“President Trump announced a Trump-Vance transition leadership group to initiate the process of preparing for what comes after the election,” Steven Cheung, a campaign spokesman, said in a statement. “But formal discussions of who will serve in a second Trump Administration is premature.”

Mr. Kennedy, who suspended his presidential campaign in August, said in a text message to The New York Times that a video of the call, which circulated on social media Tuesday, was a recording of an internal discussion with campaign workers discussing get-out-the-vote efforts for Mr. Trump.

“I stand ready to help him rid the public health agencies of their pervasive conflicts and corruption and restore their tradition of gold-standard, evidence-based science,” Mr. Kennedy said in a statement.

 

The Trump campaign is issuing denials, but R.F.K., Jr. Is persistent in his claim to his backers. Further in the article we read more of what he said:

 

“The key that, I think, President Trump has promised me is control of the public health agencies, which are H.H.S. and its subagencies,” Mr. Kennedy said in the clip of the call, meaning the Department of Health and Human Services. He then listed the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and the National Institutes of Health.

He said he would “reorient” the N.I.H. “so that instead of developing drugs” or “serving as an incubator for pharmaceutical products,” the organization would instead “be figuring out what’s causing these autism rates and autoimmune diseases and neurodevelopmental diseases.”

Mr. Kennedy has recently spoken at length about what he calls an exploding childhood chronic disease epidemic rooted in environmental and food toxins. Public health experts have said such claims are likely overblown.

 

R.F.K., Jr. would not be the first person that Trump ever dupped, but the whole incident does give me the shivers. If not R.F.K., Jr., someone will be given the responsibility in the next Trump administration to implement those “concepts of a plan.” 

 

No matter what happens and no matter who wins, our anxieties will not end next Tuesday. Is the worst yet to come no matter who wins? There is no question in my mind that part of the anxiety I am feeling now stems from the aftermath of the 2020 election and Trump’s unwillingness to accept the outcome and participate in a peaceful and accepting transfer of power. Broken trust in the system and the destruction of political norms erode the confidence that we once thought we had in the stability that the Constitution gave to our government. How long it will take to overcome the anxiety that Trump’s self-serving behavior has induced in us may be measured in decades or may never return. Perhaps, as Trump is suggesting, the way out of the uncertainty is a win too big for any question of election interference. I doubt it. Remember, we live in an uncertain VUCA world, defined by volatility, uncertainty, complexity, and ambiguity. I am resigned to more of the same. I am not falling for the claim that Trump is the solution to all our complex problems and fears. I accept that a better strategy is developing the skill to live with anxiety. I just wish it was Tuesday already!

 

Enjoying Halloween During Our Second Indian Summer

 

I won’t bore you with the definition of Indian Summer again. If you need a refresher, re-read the last section of the letter from last Friday. This week has been mostly cold, dark, and dreary. Perhaps a practical operative definition of Indian Summer would be a clear day in the seventies after needing to build a fire to take away the chill. That would describe yesterday which was gorgeous. We don’t get trick-or-treaters coming down our little street that is semirural. Our town does block off Main Street, and the little ghosts, goblins, and Star Wars characters have a great time with the extra safety precautions that seem to be needed in our perilous times. The only problem was that the town elders moved the Halloween celebration to last weekend when the weather was raw. I don’t know if the MAGA crowd has an opinion about Halloween safety, but responsible parents certainly do. 

 

My California daughter-in-law is a great craftsperson. She spins, weaves, knits, and crochets. She works all sorts of wonders with fibers and threads. My son is quite adept with 3D printing, so between the two of them, It should be no surprise that the handmade costumes of my two California grandsons are “theater production” quality. 

 

 

Our daughter-in-law sends us pictures from their lives on a nearly daily basis. Yesterday’s pictures from the parade of costumes at the boys’ elementary school showed me that Halloween is evolving! 

 

 

Modern parents are shy about putting pictures of their children on the Internet, but these are so good that as a proud grandparent, I had to ask, and she said yes! 

 

I hope it was a warm, safe, dry, and bountiful experience for your local goblins. In years past, I remember walking around with my children on cold, wet, and sometimes snowy Halloween evenings. Yesterday, the weather in New London was like a day at the beach. Is a warm day at the end of October yet another benefit of Global Warming–sort of a silver lining to an ominous cloud on our collective future? 

 

I hope that you will have some joy as we move through these last anxious days before the election. I am preparing for what might follow after the votes are cast and the polls close on Tuesday evening. We may be in for days, weeks, or even months of controversy.

 

Please accept my condolences if you are a Yankees fan. Who knows what the score in a more important contest will be this time next week? We turn our clocks back early Sunday morning. I hope that on Tuesday we don’t turn back the hands of time and negate the healthcare progress of the last twenty years toward the Triple Aim!

Be well,

Gene