24 August 2018
Dear Interested Readers,
Reader Alert!
This week’s letter lives up to the title of “Healthcare Musings.” Perhaps it should be entitled “Political Musings in Search of a Connection to Healthcare.” I have excuses for the “peripatetic” nature of this offering. I have had many different issues on my mind. The health of my elderly father has deteriorated, and this creates new issues for my siblings and me to face. I have recently enjoyed visits from my children and their children, and I am reminded of the uncertainties that face all younger Americans. The revelations and events of the week that I see on the news programs and read about in the newspapers are a continuing reminder that our nation is divided and lacks a leader with any of the traditional leadership values that we once thought were generally accepted minimum requirements for office. Mix these things together and you approach an explanation for what follows.
I am pretty sure that you do not read these letters to discover how I feel about what is happening to me and my family. I am not sure if taken together my family and I are in “the one percent,” but if we are faking it, we are closer to it than many. Short of a truly dystopian future for everyone in the nation or on the planet, cataclysmic accidents, or a devastating medical diagnosis, we are “fine.” I am sure that more than 99% of the people on this planet would be delighted to change places with us. So, what is my concern?
My concern is actually for the other 99%, and in turn for myself, since no one is really secure if anyone is insecure. We live in communities and on a small planet. We are all connected by complexities that we do not understand. As noted in a recent “Talk of the town” piece by George Packer in The New Yorker, we are all connected. Packer looks back over the last ten years since the Lehman Brothers collapse in September 2008 and makes many thoughtful observations. Complexity and connectedness are underlined for me when he writes, “If a defaulted loan in Tampa was used to make bonds owned by investors in Japan, the house infected the global economy.” That image is perhaps more understandable, but expresses the same reality about complex systems that is made by the old observation about how the flight of a butterfly in New Hampshire precipitates a typhoon in the Indian Ocean. Packer’s sad conclusion is that we didn’t learn much from what we suffered in 2008, and we are back for more. He ends the piece with:
This president has made an enemy of facts, Congress no longer passes rational laws, and American democracy is ten years unhealthier.
Perhaps these observations still don’t leave you concerned or motivate you to ask what part of the problem are you, and what might be your best course of action. We all have great defense mechanisms that distract us from what we should be thinking about, planning, and doing. When we retreat to our gated communities, our comfortable suburbs, our vacation homes, and our elite colleges, it is easy to let our concerns slide. We can deal with uncomfortable realities later.
At our friendly neighborhood gatherings garnished with tasty hors d’oeuvres that we wash down with expensive wines, we can fool ourselves into thinking that the primary role of government is to make sure that the stock market keeps rising. As we debate the pros and cons of a new Tesla or talk about what we have been “binge watching” on Hulu, Netflix, or Amazon we relax and put more disturbing concerns aside for a moment. As we seek to elicit envy from members of our small social circle with descriptions of our latest cruise, the accomplishments of our gifted children and grandchildren, or our new fascination with pilates, we may feel temporarily secure and happy, but we are fooling ourselves as we continue under the rule of a fool. We haven’t quite figured out how to evaluate this enigma (the fool) whose greatest accomplishment for the country is the opportunity he offers us to join him in the narcissistic joy of looking into a mirror where we can only see ourselves and can’t see that eventually one of the boats that will sink in the huge wake of our self interest will be our own.
You have been warned. I hope that you will read on and then offer me your thoughts. I am not sure if what follows has correctly analyzed the moment. It is more feeling than thought.
It’s a Journey From Thoughts About Bill Clinton, Brady, Belichick, and DJT to the Future of Healthcare
As Paul Manafort was returning to his cell in Alexandria, Virginia to await his pardon from Donald Trump, and as Michael Cohen strode through a mass of cameras and reporters on his way out of Federal Court in New York after confessing to conspiring with a “candidate for the presidency” to violate election laws and then hide the conspiracy and the crime, I said to myself, “Here we go again.” I was not elated. I was reminded of all the divisiveness and distractions associated with Bill Clinton’s denial that he had not “had sex with that woman” despite the semen stains on Monica Lewinsky’s blue dress, or her other confessions to Linda Tripp. As we remember, much depends upon what the definition of “is” is. Back in 1998 the shoe was on the other foot, or should I say a democratic foot. Twenty years ago I was willing to look the other way from the behavior of a politician whose indiscretions threatened or delayed progress on the issues that concerned me.
I also reminded myself of the Saturday Night Live skit that preceded the 2018 Super Bowl game against the Philadelphia Eagles. In that little piece of theater Tina Fey and company creatively summed up the alternative view of the Patriots that is held by most everybody south and west of a line drawn through Hartford, Connecticut. Bill Belichick and Tom Brady are heroes to sports fans only in New England, and except for scattered expatriate New Englanders around the country, the rest of the country was quite delighted to see them loose a Super Bowl to Philadelphia. Very few people beyond those of us who live in New England suffered as we watched Tom serve his four game sentence for his alleged cheating in “Deflategate.” I know that football fans everywhere but in New England have questioned Belichick’s sportsmanship ever since the Patriots were apprehended in the infamous 2007 “Spygate” controversy for videotaping practice sessions of their biggest rival, the New York Jets.
Through Deflategate and Spygate I was loyal to my team and the position of innocence and the exonerating explanations that I was offered from Foxboro. I was willing to look the other way and offer excuses for errors of judgement and loose values of marital fidelity and disregard for the honor of the presidency offered by “slick Willy. ” I readily accepted the crazy logic offered by Brady and Belichick in defense of their boneheaded attempts to gain an unfair strategic advantage over their opponents. I dismissed their willingness to violate principles of sportsmanship to gain advantage in a kid’s game played by grown men for the pleasure of people who have nothing better to do on fall afternoons. Considering my own ability to look the other way when my heroes behave badly, I would be a colossal hypocrite if I were to be disdainful of the reluctance of my Republican friends to want to do anything to end this moment or admit they made a mistake when they elected this president back in 2016.
I make my confessions to substantiate my offer of sympathy to my Republican and conservative friends who now face this same dilemma of holding a personal idol accountable, or offering excuses for bad behavior while holding out for the unreasonable hope that something will happen that saves the day. The sad reality derived from the outcomes of the Clinton, Brady, and Belichick stories is that the “hold out and deny” strategy seems to work. The Clinton presidency survived his impeachment. We will never know what he might have accomplished for us all if he had not needed to spend so much time defending himself against his own errors of judgement. Brady and Belichick also demonstrate that denying their errors to those who love them is a good strategy. After Spygate and in the midst of Deflategate, they won Super Bowl games in 2014 and 2016. Perhaps, despite it all, they would have won in 2018 except for the “Malcolm Butler affair” which remains an unexplained mystery because information security in Foxboro is much tighter than anything seen in Washington.
Omarosa Manigault Newman documents the modus operandi of DJT, as she sometimes calls the 45th president in her book, Unhinged: An Insider’s Account of the Trump White House (Yes I am reading it). Perhaps DJT is an attempt to give Trump’s ego parity with FDR, JFK, and LBJ. She has known him well since 2003 and has profited substantially from the affiliation. She contends, based on her personal experience, that he has a lifetime experience of succeeding through brash defiance of norms of civil behavior and acceptable business practices. Ms. Manigault Newman points out that he has always worked this way, and for him it is a perfected artform.
As much as I loath what he has done, and could potentially still do to damage us more, I have little interest in seeing anyone, or Congress, attempt to hold him accountable for his daily demonstrations of despicable behavior or for his recently revealed “alleged crimes” (remember the presumption of innocence to which we are all entitled) until much more is known. I am content to wait as Robert Mueller quietly builds his case. He must know that his objectives are to protect us from the possibility of further Russian intervention in our elections, and give us knowledge that we may use to avoid future errors like the series of self inflicted wounds that allowed Trump’s election.
We need evidence that answers all the questions and provides us the motivation to begin the effort to restore some civility to our politics as we attempt to solve the real problems that challenge us all. We need a body of facts that are undeniable by anyone among us and from which there is no escape for all who have put self interest over the best interest of the majority of Americans. Short of definitive answers from Mueller, I would prefer to see an end of this sad chapter that resembles the decision that Richard Nixon made to resign, or have the whole trying experience finished by the election of a more worthy president in 2020. If Jimmy Carter and George H.W. Bush, two presidents who at least did nothing to diminish the high office that they were entrusted to preserve as they defended the Constitution, were denied second terms, why should this man who demonstrates explicit disregard for both tradition and the Constitution be given a second term?
My primary grievances with this president have nothing to do with his lying, his past affairs, his disrespect for women, his mocking of the disabled, or his abuse and neglect of minorities. His bullying nicknames for everyone with whom he disagrees are annoying, but not my primary beef with him. I despise his total disregard for norms, but that is not my main complaint. I understand why he attacks the press because I believe him to be a wannabe authoritarian, and a free press is an obstacle. My guess is that he considers anything that brings attention to “his brand” is ultimately good strategy for him. His tweets, circular language, and bellicose relationships with most of our allies give him lots of attention. He loves to be the center of attention. There is nothing that seems to bring him more joy than bragging about how rich and smart he is before a rally of thousands of his fans wearing their red MAGA hats or chatting with his personal press on Fox and Friends. I couldn’t also care less about seeing the sycophants that surround him as staff held accountable by anything but history or ignominious loss of face. I have no respect for his enablers in Congress, but can wait to see if they suffer punishment for looking the other way through the loss of public confidence as reflected in defeats at the next election.
My problem with the president is his effectiveness, what he has accomplished. He has undermined the future of healthcare through administrative decisions in a way that threatens to erase decades of progress toward the Triple Aim. He has increased the threat to the environment by his policies and his withdrawal from the Paris Climate Accords. He has threatened all of the public programs that provide benefits to the poor and underserved. He has added to the misery of migrants and refugees that seek asylum and opportunity here, just as his grandfather did when he avoided military service in Bavaria by escaping to America. My list goes on and on. It is built on his bad policy decisions and his actions that seem more aligned with a kleptocracy than a democracy. I feel that his tax bill gave away money to the rich and corporations. It wasted money that could have been used to give better health to every American. That action was a national disgrace. There is more, but I have said enough. We have endured much, and are likely to endure more before it is all over. His changes in our international policy will distort our trade and defense relationships for years. His Supreme Court appointments will effect civil rights in America long after I am dead and gone and my grandsons are adults. We lost potential benefit with Clinton’s errors. Perhaps nothing of real value was lost with the errors of Brady and Belichick. There is reason to be cautious about how we proceed with this gifted narcissist.
We have already lost more than many people will admit in less than two years of Trumpism. We will not recover overnight when he is gone. I hope we will be patient and not overly anxious for it to end. The wrong play of the current events could lead to an even longer path to recovery during which time even more disruption to the benefits of the underserved could occur. Trump has taught us to be fearful as individuals at a time when we should find courage and joy in the opportunities to help one another. He has told us that what we should fear those invading or economically taking advantage of us from outside of our national boundaries when in truth our internal issues are the greatest threat to our future.
Back in 2014, before Trump announced his run for the presidency, I read Jeffrey Kluger’s book, The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed – in Your World. Kruger was prescient in his choice of Donald Trump as the poster boy for narcissism that was so intense that it was a personality disorder. What I remember most from my reading of the stories and data that Kruger presented is that “it always ends badly” with a narcissist. They can be very inviting and generate a lot of enthusiasm and transient satisfaction, but in the end it is all about them, never about you, and always messy before it is over. The challenge that we face now is how to let him go without further damage to ourselves and the larger world.
After The Grandchildren Go Home
The header on this week’s letter was taken a few hours before I drove my son, his wife, and my two grandsons aged four and almost one, back to Logan Airport in Boston to begin their journey back to California. I see my grandsons frequently, but because of their parents’ busy work schedules, it is more often in California than in New Hampshire. Part of the idea of living where we do was to have a great place for family to gather and relax. It does happen, not as often as I wish, but it is always a wonderful time, as the “after the party” nature of this picture suggests.
As the time to go to the airport approached my mind was filled with a review of what a great week we had experienced together. When the four year old began to express his sadness about leaving I reminded him that it would be only about a month before we would see him again in California for the celebration of his brother’s first birthday. Then he said, “But we won’t be at the lake!” I knew exactly how he felt. He and I had a great time going around the lake in my ancient motorboat. We caught about a hundred sunfish fishing with worms off the dock. I had never enjoyed our “micro beach” more than when I sat and watched him and his brother play in the sand. They will probably be back for Christmas, and maybe then we will go over to Mount Sunapee where I will watch as his father introduces him to skiing in exactly the place where his father and uncle learned how to ski. Life is all about cycles. The seasons cycle. The generations cycle.
There are two more “summer” weekends before we cycle into fall. Fall is great, but I hope that you have great plans for this weekend.
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
