31 August 2018

Dear Interested Readers,

Whataboutism, Pivoting, Economic Injustice, and Healthcare

Lately I have been asking people in my circle of acquaintances what they think about “whataboutism.” I have gotten many blank stares which indicates to me that some people are not familiar with the term.  If you’re not familiar with “whataboutism,” Wikipedia is always a good resource. I liked the disparaging description given by Philip Bump in the Washington Post about a year ago in an article about how President Trump defended his pardon of former Arizona sheriff Joe Arpaio.

Whataboutism is a cheap rhetorical tactic that relies on drawing false or sketchy comparisons between two things which may not actually be all that comparable. Our Dan Zak notes that the tactic is not a new invention, favored in the past by the Irish Republican Army and, yes, by Russian President Vladimir Putin.

The article that Bump references by Dan Zak is also worth your attention if “whataboutism” represents a new word in your vocabulary. As Zak points out, someone using “whataboutism” as a defense is often trying to establish a moral equivalence between what he or she has done and some other previous event. He notes that when Vladimir Putin was criticised for the annexation of Crimea, he responded by asking a “whatabout” question in reference to the annexation of Texas by the United States back in 1845. President Trump is the indoor champ of “whataboutism.” Sometimes the “whatabout” becomes theater as it was during the 2016 presidential campaign when he brought many of the women with whom Bill Clinton had a questionable history to the presidential debate with Hillary Clinton that was held soon after the “Access Hollywood Tapes” were released.

You have probably unknowingly used a “whatabout” defense at sometime. I know that I have.  There is another maneuver, the “pivot,” that is almost as good but should be used in slightly different circumstances. You can hear “pivots” in abundance if you listen to any of the Sunday morning political programs. The “pivot” is a favorite tactic of political types when they want to avoid an uncomfortable question. I have heard it said that the objective of politicians is to match the answers or information that they want to give to any question that they might be asked. They might as well say, “Go ahead and ask me anything you want. My answer to any question you ask will make the point that is important to me.”

Omarosa Manigault Newman’s “tell all” book, Unhinged: An Insider’s Account Of The Trump White House is all about her long history with the president and her experiences with both the Trump campaign and her year in the Trump White House. She describes at length what it was like to work as a member of the Trump communications team. Much of her book may seem to be self serving and may be unreliable, but one “fun fact” that she delivers is the president’s conscious use of “whatabouts.” His favorite “whatabout” targets are events from the Clinton and Obama presidencies. She reports that every morning at 7:30  the communications team meets and they meet many times throughout the day as necessary to do damage control from the overnight and early morning tweets of the president as well as all the counter tweets and unusual statements that randomly occur throughout the day. They review all the issues expected to come up as questions from the press. After cataloging their list of issues, they develop responses that will be used with the press that they then check out with White House attorneys and other authorities and sometimes the president. That’s not nefarious, it’s just good PR process. But as potential recipients of such engineered communication I would advise us to be skeptical and use a form of “caveat emptor.” What the “seller” of information wants us to consume as the customers of information is worth considering carefully. You may be well advised to apply that principle to what I write as well!

How do these communication strategies play out in the real world? Typically some administration spokesperson, like Kellyanne Conway, is asked a direct question by someone like Chuck Todd or Jake Tapper which you know will never be answered. Rather than saying, “No comment,” the answer that comes back is a “pivot.” What you get is the answer to another question, or a statement about something that may be related, but not what the questioner was seeking. Sometimes what you get is totally absurd. That’s how we got “alternative facts.”

It’s an informative tale. Chuck Todd, of NBC’s “Meet The Press” interviewed Kellyanne Conway a few days after the inauguration and a day or so after Sean Spicer had deliberately lied to the press by confirming the president’s assertion that his crowd at the inaugural ceremony was larger than the crowd at Barack Obama’s inauguration. Todd tried again and again to get Conway to say that Spicer had told a falsehood. She refused. If you watch the video, you can see and hear Ms. Conway use pivots and “whatabouts” and begin talking about events in the Oval Office on the previous day when the president was falsely accused of having a bust of Dr. Martin Luther King, Jr. removed from the Oval Office. As Todd insists that she is not answering his question, and as he points out that the error about the bust was quickly corrected with a fact, she comes back with her famous pronouncement of the validity of “alternative facts.” What is interesting is that after inventing “alternative facts,” she pivots to a totally new subject, healthcare, and answers his questions with a question. She asks Todd if he thinks that it is a fact that millions of people have lost their health plans and their doctors under President Obama. Her pivots and whatabouts continue on and on as she goes through a series of questions about healthcare, poverty, and failed public education policy under Obama. It is a brilliant amalgam of verbal gymnastics, and a tapestry of “pivots” and “whatabouts.” Conway’s delivery should have been considered worthy of an Emmy. Todd is a pro and holds his own with her. It was good theater even as it demonstrated a pretty sad reality.

So, why do I bring up “whatabouts,” pivots,” and “alternative facts” in a blog about healthcare strategy? I have several objectives. First, I have found that in conversations with friends, family, and even other professionals in healthcare I hear “whatabouts.” Many of those responses represent biases that have been essentially “programed” by listening to years of the “whatabouts” and “pivots” that have become a significant part of our political dialog. Just tell ten different people that you are interested in seeing Congress move healthcare finance to a “single payer” model. There will be some who immediately do a “whatabout” and begin describing what they have heard as the horrors of the NHS in the UK. A few more will keep their “whatabout” in North America and  come back with “Whatabout the lines of those waiting for care in Canada?” They may say “What about all those Canadians who come to the US to get care that they can’t get in Canada?” I counter their “whatabouts” with “whatabout” our infant mortality rate, the high cost of our care, and the low life expectancy of Americans compared with most other developed countries. Try to have a conversation about economic injustice or the social determinants of health and you are likely to hear “whatabout” welfare queens and shiftless drug users.

“Whatabouts” work because they can be loosely connected to the truth. “Whatabouts” are often “numerator observations” that are divorced from denominators and from realistic comparisons to other populations. “ ‘Whatabout’ illegal immigrants who commit crimes?,” is effective because there are some who do, although the percentage of illegal immigrants that commit violent crimes is minuscule compared to the entire undocumented population, or even as great as the percentage of legal residents who are violent criminals.

The second reason to get into examining the words that come at us in an attempt to win our votes is that we face a very critical election in two months. The party primaries are just about over and it is likely that the president’s base will never abandon him or those who believe in his message. It is also true that those who identify as Democrats or as Bernie Sanders inspired Democratic Socialists are ready to vote for their candidates no matter what happens. The outcome of this critical election will be a function of two things: who gets the most undecided and “independent” voters and the turnout, particularly the turnout of the under 35 voters and those of all races who have been the victims of economic injustice and social disparities. Anyone who needs any form of public assistance for housing, education, child care, good nutrition, job training, healthcare, or is concerned about the care of a poor and feeble elderly relative has an interest in this election. Healthcare is one of the biggest issues for 2018. The two candidates for Governor in Florida who won their party primaries this week set the example of what we can expect.

The Miami Herald published a very informative article after the election that was picked up in my local paper. The article nicely describes the two candidates in what is already a historically important contest:

On the right: U.S. Rep. Ron DeSantis, a 39-year-old conservative, Harvard-educated Iraq War veteran who rode presidential tweets and FOX News interviews to a resounding primary win over Agricultural Commissioner Adam Putnam.

And on the left: Andrew Gillum, a 39-year-old liberal who with the help of progressive political organizations surged in the last weeks of his campaign to upset a better-funded field.

DeSantis is a congressman from Palm Beach and Gillum is the African American mayor of Tallahassee. The article continues:

The surprise matchup figures to be a pure test of partisan strength between a member of the ultra-conservative Freedom Caucus and a Democrat who scored his party’s nomination with the help of Democratic-Socialist Sen. Bernie Sanders. Voters will choose between a candidate in DeSantis who wants to build Trump’s border wall and believes “people should have a right to pursue the healthcare that they want,” and one in Gillum who wants to abolish Immigration and Customs Enforcement and create a Medicare-for-All system.

When I read DeSantis statement that “people should have a right to pursue the healthcare that they want.” My jaw dropped and I wanted to shout. “Whatabout” the millions of poor and underserved who do not have the means to “pursue the healthcare that they want?” I am also sure that time and again Gillum will face “whatabout” questions related to single payer healthcare, or if you prefer, “Medicare-for-All.”  I think the same polarized views will be seen across the country in the 2018 election and will be back around again in 2020.

A third reason for bringing “whatabout” and “pivoting” to your attention is to make the case that you prepare to respond to retorts like “ ‘Whatabout’ the stock market and the economy?” Likewise, expect to hear “ ‘Whatabout’ North Korea?” My response to those and other “whatabout” statements is to try to respond with facts even though I know that “facts” have been greatly discounted in the world of “whataboutism.” The stock market is great for me at the moment. Our investments are doing very well, thank you, but almost half of Americans have no market assets and no one really knows why this market has been on the rise for so long, long before Trump became president. More importantly “whatabout” when it falls, as it will surely do in time. In terms of “Whatabout North Korea?” it is too early to know what will really happen in Korea, but it is not too early to assess that America has abandoned its leadership role in world affairs and that will surely become a liability.

I have no problem with policies that over the long run will protect America from foreign threats or improve the economic status of all Americans. The question is are we really making progress toward objectives that will benefit us all? Is the price we are paying in terms of the debt associated with the tax bill ever going to deliver the outcome we want?

It is hard to imagine achieving anything other than concierge care for the wealthy if we adopt Congressman DeSantis’ concept of how healthcare should function. The question is really how to effectively engage voters in a discussion about mitigating economic inequality, promoting opportunity for all Americans, and guaranteeing everyone access to the care they need to help build a stronger, fairer America. “Whatabout” that!

As I write about “whataboutism” it occurs to me that a good retort would be “whatifism.” “Whatif” we could have a dialogue that established goals for America that we all shared. “Whatif” we resurrected JFK’s admonition to “Ask not what your country can do for you, but what you can do for your country.”? “Whatif” we endeavored to discover whether trying to ameliorate economic inequality and achieve the Triple Aim might be a better strategy for a greater America than reducing the taxes of wealthy individuals and corporations over the next decade by over a trillion dollars and hoping that economic growth and cutting entitlement programs might eventually balance the budget and produce a better America. There are a lot of positive “whatifs” that could cancel the negativity of the ubiquitous attempts at deception associated with “whataboutism.” “Whatifism” would seek to establish a national culture of continuous improvement. If that happened we would have no attraction to “alternative facts” and we could move from “pivoting” away from difficult questions to “elevating” our conversations to answering the difficult questions of our times.

Yes, I am a dreamer, but I do live with the hope that eventually we will move toward living in harmony with one another and our small planet. It will not happen suddenly. If it happens, it will be a very slow process of continuous improvement. If we can’t live in the hope and expectation of a better day, we are dooming ourselves and our children to a future that is dominated by fear, despair, and collective loss. “Whatabout” that?

Beginning the Long Goodbye to Summer

I have always had mixed feelings about the Labor Day weekend. It is sort of like the backdoor of summer. Sure, there will be some very nice days over the next two months that may feel like summer, but those long summer evenings are fading fast. Sunset is moving rapidly toward the late afternoon and before many more weeks pass I will be watching the evening news on TV again at an hour when I would rather be viewing nature from my kayak.

Credits for the beautiful summertime picture in today’s header go once again to my neighbor Peter Bloch. I appreciate his generosity. The picture is a great shot of the “East Basin” of Little Lake Sunapee and shows the waterfront at Twin Lake Village which has been in operation as a family oriented retreat since the late nineteenth century. I live at the far end of the “West Basin.” An esker leftover from the glacier that carved our current terrain some 12,000 years ago forms a peninsula that divides the lake into two parts that are almost equal in size which is the origin of one some of the alternative names for the lake, Twin Lakes and Spectacle Pond. I have lifted the still picture from Peter’s drone video entitled Four Seasons on Little Lake Sunapee which I have shared with you before. If your have never seen it and have six minutes to relax and get a quick exposure to the beauty I am fortunate enough to experience year round, click on the link and enjoy.

It has been unusually hot and humid in the Northeast this week. We have brought out the fans to help us endure weather that seems more like early July in South Florida than a usual late August in New England. I am not fooled by the aberration in the temperature. School has already started in many places and the yellow buses will be all over my town’s roads on Tuesday. College football is in full swing this weekend. The pros are wrapping up their preseason, and will be ready to start the long march to the Super Bowl in February next weekend.

All seasons are as much a state of mind as realities on the calendar. I just always feel gypped by the way the fall state of mind always clips three weeks off of summer. I love all the seasons in New Hampshire, but summer is my favorite. I wish there was some way to take three weeks off of winter and give it to summer.

One reason that I bemoan the loss of summer is that my wife and I don’t have long to exercise our new outdoor passion. I have always enjoyed bicycling, but the hilly terrain of New Hampshire has been an impossibility for her. We recently made the leap and she is enjoying an electric assist bicycle. Now it’s me who is struggling to keep up with her and we will ride on into a fall that I hope will last way into December. This weekend we are traveling to Falmouth to enjoy a reunion with old friends and hope to get in some good rides on the bikeway to Woods Hole and other back roads and byways of the quieter end of the Cape.

I hope that whatever your plans and wherever you are, this weekend you will have an experience with those you love that you will be able to savor long after the lake is frozen and the roads are to slippery for a safe ride.

Be well, take good care of yourself, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,

Gene

Dr. Gene Lindsy, MD.