August 14, 2020

Dear Interested Readers,

 

The Next 81 Days Of The Campaign For Better Health

 

Yesterday morning I was up early, about 8AM. My Florida family was trying to get away early on their trip back to Miami. I was not enthusiastic about them leaving since going to Florida this week is still like flying into the eye of a hurricane.  They had only been visiting for a little over three weeks, and were quarantined for the first two weeks. I was hoping for more time with my granddaughter who is about to start her senior year of high school. School starts August 24 and like many returning students her upcoming year has been defined by enormous uncertainty. She has just learned that her school is giving all of its students a computer so that they can have online classes. She wanted to return home, and picking up her computer was an argument in favor of going home. Her father, my son, who was not interested in going home, was quick to let her know that he did not consider the computer to be a gift since she already has an excellent computer, and he pays a hefty sum for her tuition at her private school. The idea of a “free computer” was annoying for him. I guess, like many things in our lives these days, it’s a matter of spin.

 

You might wonder why they are returning when school is going to be “online” and since her father and mother are both fully employed online and working here in New Hampshire with the same efficiency that they enjoyed in Miami. I guess, from my granddaughter’s point of view there are four answers: a boyfriend, it’s great to see her friends even at a distance, she is an avid volleyball player and her school’s volleyball team is having outdoor strength and conditioning workouts, and she misses her cats. I relate the story because I know that all across the country individuals and families are trying to decide what to do next as together we face an uncertain fall, and frequently there are conflicting interests even within a family. 

 

This pandemic has created many tensions. Parents can’t work efficiently at home if they are managing the home schooling aspects of on-line learning. I see this tension in the home of my family in Santa Cruz where both parents are working complicated schedules and managing significant projects from home. Their son, my grandson, had a hard time connecting with on-line instruction last spring. What will happen as the stress of isolation returns, and the socialization he enjoyed at a responsibly conducted summer camp is lost? I am sure that many of the readers of these notes have similar struggles in their homes where the stresses of the education of children adds yet another degree of difficulty to the economic survival of the family.

 

I feel deeply for my Albuquerque family since both are employed by the Albuquerque Public Schools where one is an assistant principal at a high school, and the other is a social worker. The Albuquerque schools have many students with personal disabilities, and who are also disadvantaged by the the inequities associated with race and poverty. This fall the system is trying a mixed model of on-line and in person education. Online learning for even part of the week is a real challenge for special needs children from economically and socially disadvantaged families. Since the fifteen years following the 1954 decision, Brown v. Board of Education of Topeka, that segregation in education was unconstitutional, there has not been a more stressful time in the history of American education. A New York Times opinion piece article published today suggests that the large majority of American schools are not ready for even a partial opening of classes for on site learning.

 

We have had family from COVID-19 hotspots living with us since mid March when our Brooklyn family came for a long stay with their two cats. They left last week. The uncertainty that they felt as they returned to Brooklyn was reflected in the chorus of the song my son created for last Monday entitled “Back In Town.”

 

What if I’m not the same

As I was when I left this town?

And all I was made from

Is scattered all around

And out on the sidewalk

I’m hoping for solid ground

It’s a funny thing

‘Cause I don’t know

 

The essay that he wrote to explain the piece articulates feelings that may resonate with many people.

 

To begin with, recording a song is incredibly more difficult in my Brooklyn apartment than it is in a New Hampshire basement. The very moment I hit record on the first guitar take, a car alarm sounded outside my window and continued for four solid minutes. Patience is ever a virtue in New York City.

I cried all the way back from New Hampshire. I haven’t cried behind the wheel like that since the last time I left summer camp. It felt good and right. It was a gift to spend the past five months with my parents, knowing them better, and learning from their generosity, humor, and kindness. It was also our great fortune to be safe from the worst of the crisis so far. It was wonderful to be someplace beautiful and simple.

This place is complicated. I mean that both in terms of the logistics of living, and my feelings about being here. I last felt this way when I first arrived in Brooklyn years ago. Covid has rendered my city alien to me, and I’m a bit bewildered by it. That said, I’ve learned this place before and I can do it again.

 

In truth, the environment to which my son and his wife returned is less volatile than California, New Mexico, and South Florida. That said, and even though New York currently has better COVID statistics, everyone in New York is still living with great uncertainty and probably has some form of PTSD following over 30,000 deaths from their first wave of the pandemic.  Collectively they are  “walking in the dark” because no one can predict for sure what will happen next. As New York opens its schools and economy, they could be bringing on the feared “second wave.” I do believe that New York is moving forward responsibly, and would respond quickly if the data suggested an uptick in pandemic activity.  

 

I rarely have much good to say about the greater New York metropolitan area. My thoughts usually begin and end with a resolve not to sleep there for three consecutive nights if I must go. My aversion to New York dates to 1956 when I made my first visit. My father was terrified of spending money and was convinced that there was a conspiracy of New Yorkers designed to separate him from his cash. His plan to “show us New York” was a well conceived one day tour. We spent the night before our visit in a cheap, or perhaps, economically priced motel in New Jersey near the entrance to the Lincoln Tunnel. Early in the morning we went through the tunnel and emerged in a canyon created by skyscrapers. I was thrilled with the size of it all and was hanging out the window of our station wagon trying to take it all in and to see the tops of the buildings when a crusty veteran of the streets yelled, “Hey Tex, get an eye full, I bet you don’t have anything like this back home!” He was right. 

 

The rest of Dad’s plan was to go to the Empire State Building “to see New York from above.” Next, we took a boat ride around Manhattan on a “Circle Line” cruise to “see New York from the outside in.” The final step in the formula was to go to Coney Island for a few rides to have some fun before rescaping to New Jersey before we had to pay New York rates for supper and lodging. In retrospect, except for the transfer of paranoia about New York from Dad to me, it was a great day and a good introduction to New York. Perhaps it was more than enough New York for me for a lifetime. Although I did enjoy running their marathon several times, and have visited the city on numerous occasions for work and pleasure, I have never violated my three day rule, and I always try to get a hotel room at least 20 stories above the 24 hour hum of the city. 

 

My Brooklyn family was not given a bias against New York like I was. They call it home, and they missed it. My daughter in law is beginning her third year of law school online, but wants to be able to study with classmates while social distancing. My son will continue to suffer through endless Zoom meetings in their apartment near Prospect Park. The truth is everyone is living in a strange new world that no one wanted, and no one saw coming.

 

The main reason I had to get up early on Thursday was so that I could take my granddaughter to the Post Office to pick up a package that she had been tracking, and that DHL had said was delivered to my box at the Post Office late on Wednesday. She also wanted to go to Dunkin’ Donuts. I live about a mile west of the post office, and Dunkin’ Donuts, our only franchised purveyor of fast food, is about a mile further in near the center of town.  I am sure that by now you are wondering, “Where is this going?” I’ll be brief, but it is the pivot point of this letter.

 

The town’s sidewalks begin at the Post Office. As we drove past the post office toward coffee and a breakfast sandwich for her (I brew my own Starbucks, since their closest store is in Hanover), we saw an old man walking on the sidewalk coming toward us. (He looked older than me, and I am 75.)  He was wearing a sandwich board sign that said in big letters, front and back, “ Only 82 more days of Trump.”

 

I had never seen him before because he takes his walk into and out of town long before I am usually out and about. Ironically, my first thought was, “You’re wrong! We won’t know the results for weeks after the election because of all the mail in ballots. Even if Trump loses, he will still be making trouble and defying norms until January 20, 2021. He will probably use the time declaring that the election was a “fake,” and he will likely declare that he really won, and is not leaving office. If not that, expect that he will be busy prospectively pardoning himself and others in preparation for the storm that may follow his ouster.”

 

Later in the day, I was listening to a news report about the selection of Kamala Harris as Joe Biden’s running mate, and she had said essentially the same thing. She said that President Trump would be out in 83 days. I hope that my local free speech advocate with his sandwich board and Senator Harris are right, but I have still not recovered from the trauma of 2016. That’s figuratively and literally true because not only did I, like so many other Americans who never saw it coming, suffer through a nightmare on election night, I also fell and tore my right rotator cuff in mid October 2016 while canvassing door to door for Hillary Clinton. I continue with a small disability and a twinge of pain every now and then that reminds me of both losses.  

 

Friends tell me that the man in the sandwich board has been walking his route since 2016. It’s amazing what one can miss what is going on within a few miles. The old man’s message reminded me that since mid March the healthcare debate has been on hold. The discussion of how to achieve universal coverage has been displaced by a discussion of the pandemic and all the flaws in our society that the pandemic has revealed. 

 

The Democrats won back the House majority in 2018 by focusing on healthcare and the vulnerability to the many losses that would be experienced if Republicans retained control of Congress and the presidency and then made a successful second effort after the election to repeal the ACA and its defense against pre existing conditions. The Democratic presidential debates revealed a difference of opinion among Democrats about how to achieve universal coverage. Bernie Sanders, along with Kamala Harris and Elizabeth Warren favored a “Medicare For All” approach that would eventually abolish employer provided healthcare. Biden and others preferred continuing the path of the ACA with the addition of improvements including a “public option” that had been negotiated out of the original bill a decade ago. That debate dried up the moment it was clear that Biden was the likely nominee, and it has now been replaced by the continuing discussion of the pandemic. Even as we enter the final 80 days running up to the election it is unlikely that we will hear a real healthcare debate between President Trump and Joe Biden about universal access and how to achieve it. 

 

I had one big problem with Bernie Sanders’ “Medicare for All.” He did not seem to be abandoning a fee for service chassis even as he extended and expanded coverage. Sanders emphasized access and quality, but was not very well composed on the third leg of the Triple Aim, sustainable affordability.  I could argue that we have lost the momentum of the ACA with its attention to ACOs and the opportunity for experimentation and innovation offered to CMS through CMMI, the Center for Medicare & Medicaid Innovation, and I would love to hear the return to that way of thinking expressed more directly by Biden and Harris. I would also like to hear them specifically talk about how they will take the ideas from the progressive wing of the party to address the social determinants of health. Unfortunately I doubt that healthcare will return to center stage since the election is likely to focus more on the necessity of removing Trump than the articulation of a positive way forward in healthcare. It will likely be a bullet point under pandemic management, racial inequities, and strategies to restore the economy. It is impossible to imagine “Building Back Better” without addressing healthcare in some forum, but I doubt that the debates, if they happen, will yield much other than a Trump effort to establish healthcare improvements as a covert way of slipping into socialism and worse. 

 

Between the sandwich board man and my own musings, I was feeling pretty down until I read David Brooks’ column, also from Thursday the 13th. It was entitled “This Is Where I Stand: The power of conservative radicalism in an age of upheaval.” I do not hide the fact that I am a mixed bag. On one hand I espouse progressive ideas, and long for the full flower of possibilities they offer, but I also fear the illiberalism of any form of radical thought, be it right or left on the political spectrum. At the end of the day, I come to the middle left on most issues where it is easy to find common ground with an articulate student of our times like Brooks who speaks from the middle right. I love the Friday afternoon jousts on NPR between Brooks and E.J. Dionne of the Washington Post whose liberal columns, ironically, I quote less often than the work of Brooks. It surprises me that I am drawn to a man who learned his trade from William F. Buckley, but it is what it is. Perhaps, I admire and want to model Brooks’ demonstrated ability to listen, think, and change to find common ground with those whose ideas are not his own. 

 

Brooks has written extensively about how Trump has destroyed the Republican Party, and more importantly about how he has damaged, and will continue to damage the presidency. There is no recognized large scale movement that is called Republicans for Biden like the old Reagan Democrats of 1980, other than George Conway’s aggressive Lincoln Project, but if there were “Biden Republicans,” Brooks would be its most articulate spokesperson. Suffice it to say I am a fan of David Brooks, although I don’t see everything from his perspective. Yesterday he offered us a hopeful analysis when he showed how progress in history has been achieve by a combination of energy from the left and the stabilizing, get work accomplished, attitude of the center. He delivers the whole of his thesis in the first 128 words of the article. 

 

Radicals are not my cup of tea, but I’m grateful for them. The radicals who brought us Occupy Wall Street and the Bernie Sanders campaign gave the problem of income inequality a prominence it wouldn’t have had without them.

The founders of the Black Lives Matter organization put racial injustice at the top of the national conversation. The radical populists who ultimately produced Donald Trump showed us how much alienation there is in Middle America.

Radicals are good at opening our eyes to social problems and expanding the realm of what’s sayable.

But if you look at who actually leads change over the course of American history, it’s not the radicals. At a certain point, radicals give way to the more prudent and moderate wings of their coalitions.

 

He then lists some of the eye opening radicals of our history like Samuel Adams, John Brown, and Horace Greeley who were followed by more moderate people like George Washington, James Madison, Alexander Hamilton, Abraham Lincoln, and Teddy Roosevelt who wrote laws and sponsored lasting change. He see the necessity of both radical thought and constructive action.

 

Radicals are not good at producing change because while they are good at shaking up the culture, they don’t have practical strategies to pass legislation when you have to get the support of 50 percent plus one.

They also tend to divide the world into good people and bad people. They think they can bring change if they can destroy enough bad people, and so they devolve into a purist, destructive force that offends potential allies.

…Conservative radicals, like Hamilton, Lincoln and T.R., begin with moderate dispositions. They have a reverence for the collective wisdom of the past. They have an awareness that the veneer of civilization is thin and if you simply start breaking things you get nihilism, not progress. They are acutely aware of the complexity of the world, and how limited our knowledge of it is. They are pragmatists, experimenters, liberals…They understand that when your society is crumbling the only way to restore stability is to address the problems that are breaking it.

 

Later in the article he tells us where we are and what he sees our choices to be.

 

Today, we’re in the middle of another historic transition when dramatic change is necessary if we are to preserve what we love about America. The crises tearing our society are well known: economic inequality, racial injustice, dissolving families and communities, a crisis of legitimacy.

 

Brooks says that he is not alarmed by all that has happened, especially the recent riots:

 

I am not as alarmed. I’m convinced that the forces that brought Joe Biden the nomination are far more powerful than a few extremists in Portland and even the leftist illiberals on campus. I’m hopeful that if given power, Biden, Kamala Harris, Nancy Pelosi and Chuck Schumer will forge a new conservative radicalism.

 

It has been my concern that the deep divides that existed before the pandemic will be heightened during the election in ways that might promote illiberal values, using force to establish change as desired by the radical movement against the objections of either a majority or minority, no matter who wins. Brooks says that he is not worried. 

 

I’m convinced that if Donald Trump is defeated, revolutionary zealotry will fade as debates over practical change and legislation dominate.

During crises like these, each of us has to take a stand, to be clear on which causes we champion and which position we occupy on the political landscape. This is hard, because we’re in a period of flux.

If your views haven’t shifted over the past four tumultuous years, you’re probably not doing much fresh thinking. I find I have moved “left” on race, left on economics and a bit “right” on community, family and social issues.

Mostly I find myself supporting the conservative radicals, leaders who are confident that we can push for big change while defeating the illiberalism of radicals on left and right.

 

Those are words that gave me a lift. I think that if he is right, and the wisdom of change can be turned into law by those in the middle who have some experience and wisdom, we will eventually get back to the hard work of reaching for the Triple Aim in a world where it is recognized that it has been racism and economic inequity that have been thwarting a lot of laudable effort over the last half century. I stand with sandwich board man and David Brooks. I see a faint glimmer of hope now, out about 81 days. 

 

Getting Out For A Ride With Friends

 

Today’s header is a picture that I took yesterday of two of my best buddies: Tom Congoran, the retired CFO of Atrius Health, and Steve Allenby, a semi retired attorney who consults on issues of electric energy who has been my doorway to many satisfying local efforts that ameliorate the generational damages of poverty in our community. I should add that Tom and his wife Mary have also led a charitable non profit in their town for many years that does similar work. This time last year we were climbing mountains together. Things change, and now we are out on “e bikes.” 

 

There are many hundreds of miles of back roads in central New Hampshire that have few cars and trucks on them and run through forests and farms. Some of the farms look like the work of landscape architects, and others have a patina of neglect through which you can imagine what the world looked like 150 years ago. All along these byways are stone walls and huge stacks of wood that are ready for a winter that will begin to arrive soon. Ragweed is the predominant wildflower of the late summer. The yellow blossoms are thick along the sides of the road. I have no allergies, so I can enjoy the view without a sneeze.  

 

My wife purchased an e bike last summer since the hills around us made bike riding beyond the scope of her capabilities. I found that unless we were on a rail trial where the hills had been flattened for the trains of yesteryear, I could not keep up with her. My two friends got their bikes earlier this summer. I tried Tom’s bike a few weeks ago, and realized that I still got a good work out, so I joined the club. Let’s face it, the end of life is a continuous process of compromise between what you once could do and the reality of the moment. 

 

Whatever the reality of your moment this weekend, I hope that you will be out and about reducing the stress of the pandemic with some prudently socially distanced exercise with friends or family. I fear that the end of our collective challenge lies many months into the future. There is a lot of work ahead and we must maintain both a positive perspective and good health to both endure the stress,  and to have the energy to do what needs to be done. If that doesn’t motivate you, then remember that there are only three summer weekends left before fall!

 

Be well! Still stay home if you can. When you are out and about, wear your mask and practice social distancing as best you can unless you are walk, jogging, or riding far from the crowd on a country road.  Don’t try to outguess the virus.Think about the America you want for yourself and others. Demand leadership that is empathetic, thoughtful, truthful, capable, and inclusive.  Look for opportunities to be a good neighbor. Let me hear from you. I would love to know how you are experiencing these very unusual times!

Gene