June 24, 2024
Dear Interested Readers,
The Big Debate
This has been an unusual week. Waiting for a big event has always been hard for me. As a child, it always seemed like my birthday or Christmas would never come. Waiting nine months to meet a new baby seemed like nine years. I didn’t wish it, but two of my sons and two of my grandchildren were premature. All were at least a month early. I hope my impatience was not a factor in their prematurity.
My poor mother told me that I was two weeks late which was a cruel thing for me to do because apparently, it was very hot in a third-floor walk-up apartment in late June and early July in Louisville, Kentucky in 1945. She told me that she looked forward to my arrival and the arrival of the iceman who had to carry the ice up all those stairs.
I work on these letters for a few hours at a time between Tuesday and Thursday. I have usually completed the rough draft by late Thursday and sometimes even on Wednesday. On Friday mornings, I make late additions if new ideas or events occur and search for typos. Almost always my work is completed sometime Friday morning, and then I take a walk or just relax until the letter is released to you and the Internet at 3 PM.
I am always greatly relieved to get an email from myself before 3:05. When that occurs I assume that all is well and that the magic of this era has also made a delivery to you. If I don’t get my own letter, I fear that you haven’t gotten it either, and then I call Russ Morgan, the IT guru who helps me with the mysteries of the Internet. I ask Russ what mistake I might have made and things get fixed. Weird things do happen, two weeks ago I never got my own letter, but I know that others did. Last week, I got it. Go figure. Strange things happen in cyberspace.
My worry this week has been that I would not be able to write while waiting for the debate between President Biden and former President Trump. I wondered how I could write about the healthcare issues in a debate that had not happened yet. I feared that the debate and the reports of the talking heads on TV would not be over until at least eleven. Was I going to stay up late writing, or would I get up early Friday and try to do everything before 3 PM? I was unsuccessful in attempting to forget the idea of writing about the debate. I could not ignore it and choose another subject.
While riding my bike on Tuesday, I had an idea. What if I asked Chat GPT what healthcare questions Biden and Trump should be asked about healthcare during the debate? As I thought about the idea, it seemed like a good idea because it was quite possible that there would be little about healthcare even though we know that our nation’s healthcare is enormously expensive, difficult to access, has complex workforce issues, and produces the worst outcomes of any other advanced economy.
So I typed into Chat GPT: “What healthcare questions should Biden and Trump be asked at their debate on June 27?” The answer, in italics below, appeared almost instantly:
The questions posed to Biden and Trump in a healthcare-focused debate on June 27 could cover a range of critical issues. Here are some potential questions:
- Affordable Care Act (ACA) and Access to Healthcare:
- President Biden, you’ve supported strengthening the Affordable Care Act (ACA). How do you plan to expand access to healthcare further?
- President Trump, you’ve sought to repeal and replace the ACA. What specific reforms do you propose to ensure Americans have affordable healthcare coverage
- COVID-19 Response and Future Pandemic Preparedness:
- Both of you have led the nation through the COVID-19 pandemic. What lessons have you learned, and what policies will you implement to better prepare for future health crises?
- How will you address the disparities in healthcare access and outcomes that were exacerbated by the pandemic?
- Healthcare Costs and Prescription Drug Prices:
- What steps will your administration take to reduce the costs of prescription drugs for Americans?
- How will you tackle the rising costs of healthcare services and insurance premiums?
- Public Option vs. Private Insurance:
- President Biden, your healthcare plan includes a public option. How will this affect the insurance market and healthcare access for Americans?
- President Trump, you’ve advocated for expanding private insurance options. How will your policies ensure affordability and choice for consumers?
- Medicare and Medicaid:
- How do you propose to strengthen Medicare and ensure its sustainability as the population ages?
- Medicaid expansion has been a contentious issue. What are your plans regarding Medicaid eligibility and funding?
- Healthcare for Veterans:
- Both of you have promised to improve healthcare services for veterans. What progress have you made, and what additional measures do you propose to support our veterans?
- Mental Health and Addiction Services:
- How will you address the growing need for mental health services and addiction treatment, particularly in light of the COVID-19 pandemic?
- What policies will you implement to integrate mental health into primary care and ensure parity in coverage between mental health and physical health services?
- Reproductive Health and Women’s Access to Care:
- How will your administration protect and expand access to reproductive healthcare services, including contraception and abortion?
- What measures will you take to address maternal health disparities and improve outcomes for women of color?
- Healthcare Infrastructure and Telemedicine:
- COVID-19 highlighted the importance of telemedicine. How will you expand access to telehealth services, particularly in rural and underserved areas?
- What investments will you make in healthcare infrastructure to improve facilities and technology nationwide?
- Healthcare Innovation and Research Funding:
- How will you promote healthcare innovation and ensure that medical research funding continues to advance treatments and cures for diseases?
These questions cover a broad spectrum of healthcare issues facing the United States today and would provide voters with insights into each candidate’s plans and priorities for the future of healthcare policy.
I was amazed. These answers had appeared in less than five seconds. I was also surprised that Chat GPT did not raise any questions about workforce issues, touch on the healthcare implications of global warming, gun violence, the social determinants of health, or with the exception of a tangential reference to COVID outcomes, speak to the inequalities that plague healthcare in America. Given that Chat GPT is an AI function, it is interesting that Chat GPT didn’t want to ask either candidate about how AI might be utilized to improve the cost, quality, access, and outcomes of the care Americans get from our healthcare systems.
I was pleased that Chat GPT did tangentially touch on healthcare disparities by asking:
- How will you address the disparities in healthcare access and outcomes that were exacerbated by the pandemic?
Reading the questions generated in a flash helped me think more clearly about the questions I might ask of the two elderly gentlemen if I were sitting in Jake Tapper’s chair.
After the Debate
First, the moderators asked no questions about healthcare policy. Medicare, COVID-19, the cost of drugs, the drug epidemic, and the benefits of the ACA did come up in answers to other questions in the debate. All-in-all it was a difficult night for President Biden, and difficult for those of us who wanted a stronger performance. Former President Trump was himself. He was arrogant. He lied. He exaggerated. He failed to accept any responsibility for any of his failures in office. He was ambiguous about whether or not he would accept the results of the election. He also continued to infer that if elected he would use his office to gain revenge. The America he described as failing under Joe Biden was not the America that most of the world recognizes.
The question is whether or not undecided voters will see Trump as a liar, a felon, a risk to democracy, and a threat to the environment, Will undecided voters care that he refused to answer many of the questions he was asked? One of his most developed skills is his ability to “pivot” from answering the question he was asked to one of his favorite issues like illegal immigration, inflation, or the incompetence or criminality of President Biden.
The pundits agree that Biden had a bad night and Trump was Trump. In the first few minutes after the debate, I found two brief quotes from commentators at The Washington Post.
Hannah Knowles wrote:
Trump’s dodges on accepting election results and the Jan. 6, 2021, attack on the Capitol, which he declined to condemn, will remind many voters why they don’t want to vote for him. But Trump also found plenty of ways to hit policy issues where voters generally favor him, such as immigration, and his team appears thrilled with the overall contrast drawn with Biden.
Maeve Reston wrote:
Trump’s performance was full of his usual exaggerations and falsehoods, particularly about crime and immigration. But it’s clear the main thing that many voters are going to remember is the striking contrast between Trump’s energy and vitality and Biden’s struggle to deliver his points in a succinct and understandable way.
There will be another debate. Between now and then there will be calls for Biden to withdraw. I think it is too late for that to happen. I just hope that a majority of Americans will realize that Trump’s previous disregard for truth, his violation of his oath of office, his obvious character flaws, and his lack of policies that can maintain and improve America’s greatness at home and maintain its leadership in the world make him unfit for office.
Biden’s performance was weak, but the real question is his ability to lead an administration that makes good-faith efforts to improve the lives of all Americans while making sure that America tries to use its influence to stabilize and improve a troubled world. Trump was frequently duplicitous and presented no evidence that he had a viable strategy to Make America Great Again. Bragging about his ability to be the “best ever” on a short screening test for mental acuity should not convince any undecided voter that he has the answers to solve America’s problems or maintain democracy in a world that seems to be drifting toward authoritarianism.
We will see. One thing is clear. Healthcare is not a politically significant issue in this election, but healthcare equity, improvements in the social determinants of health, and progress toward the Triple Aim could all be substantially damaged if Trump is elected to a second term.
Strange Sites To Be Seen
I am back on my bicycle. Well, the truth is that I am on my wife’s bike. My bike is “tall.” Getting my leg over the bar and the elevated seat is still beyond my capabilities. My wife’s bike is a “step through” which accommodates my persistent disability.
It is good to be back on the road. There is a lot to see. I am also driving which is a little bit of a trick since I have bilateral foot drop. What a driver normally does with their ankle I have learned to do with my knee. Adding to the transportation problem is that when my wife is using her car I must drive either my truck or one of my two old (1968 and 1973) convertibles which I have prized for more than thirty years. They are strictly for fairweather days in late spring, summer, or fall.
My truck and both old cars are standard shift so it has taken a little practice to figure out how to match my disability to the requirement to use the accelerator plus the clutch and the brake. The key has been the trick of driving with my knee and my acquisition of a variety of foot drop braces from Amazon. These same braces have also allowed me to make great progress with my walking. I set a new personal record this week for two miles with my braces and my new very light carbon fiber crutches.
What I am seeing on the road as we get into the “election season” whether traveling on foot, bike, or by car has surprised me a bit. There are already quite a few political yard signs for me to ponder even though it is still over four months until the election on November 5. If you travel the back roads, which I love to do on my bike rides or in a convertible with the top down on a sunny day, you can see a lot of our state’s history like the covered bridge in today’s header, as well as many political signs and flags.
New Hampshire is a purple state. The Hanover area around Dartmouth votes Democratic as does the southern part of the state around Manchester, Nashua, and along the border with Massachusetts. My town has also voted for the Democratic candidate in 2016 and 2020. I think we also voted for Obama and perhaps even Kerry and Gore. The countryside is Trump country. With the exception of the area around Dartmouth, the state gets more Republican the further north you go. Trump’s signage never goes away. I have seen many of the same Trump yard signs and flags since 2020. Trump flags fly in yards and are nailed to the sides of barns. A frequently observed sign says “F— Biden, and F— You Too if You Voted For Him. For four years I have seen signs that say “Stop The Steal.”
During the pandemic, my wife and I wanted to see our grandsons in California. Flying to California was problematic so for the six weeks before the 2020 election, we drove an RV across the country to California and back. While we were driving across Pennsylvania, Ohio, Indiana, rural Illinois, a little bit of Iowa, Missouri, Nebraska, Wyoming, and Idaho we would frequently get tired of dodging 18-wheelers on the Interstates. It was great to exit the Interstate and take secondary roads so that we could see the country up close.
Off the Interstate, I was amazed and depressed by the plethora of Trump signs. I started counting signs and comparing how many Trump signs I saw versus the number of Biden signs. The sign count was fifty to one Trump over Biden. I was depressed. Biden won the election because he won most of the states along the coasts and carried the cities I avoided. In the “battleground” states of Georgia, Pennsylvania, Michigan, Wisconsin, and Arizona, the Democratic majorities in the cities, partially composed of minority voters, more than canceled the rural enthusiasm for Trump which I observed as we drove through the cornfields and small towns of the midwest.
I am reminded of what I saw in rural America now when I am out and about in the countryside around my little Democratic town that has many retired Democrats from Massachusetts, Connecticut, and New York. The new signs this year have avoided profanity, but do carry some subtle messages. The first one to catch my eye was offensive to me as a regular churchgoer who fears the rise of “Christian Nationalism.”
One of the big campaign arguments of President Biden is that again in this election “Democracy” is on the ballot. George Washington hoped we would not evolve political parties, but we did. In recent times, the countries where there is only one party are controlled by an autocrat. Trump’s demonstrated admiration for autocrats made me shudder when I saw another sign as I was driving through a “quaint” New Hamshire hamlet about ten miles from my home that said, “Obliterate the Two-Party System.”
One of the signs that I have seen on my travels over the back roads near my home left me scratching my head wondering just what the intent was that motivated the homeowner to express an opinion. Was it a message to President Biden? Was this a message to voters suggesting that we just need to accept the fact that both candidates are old? Is it a wishful message directly to President Biden? Is it the expression of a frustrated GenXer who would like to see a race between two younger candidates and hopes that both will meet their maker before November 5? In the media, much is made of Biden’s age. Now after the debate, there will be even more noise about his age. Not as much is made of Trump’s age. Few people seem to calculate that if Trump were to be elected, by the end of his term in 2028 he would displace Biden as our oldest president.
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On my usual bike route into town, there is one house that proudly displays two Biden-Harris signs.
This weekend, I am planning on trying to refurbish our Biden/Harris sign from 2020. There is very little traffic on our road, and few people will see my sign, but I feel obligated to join the “conversation” and will place the sign at the entrance to our drive so that anyone who is lost on our dead-end street will know where we stand.
I salute you if you plan to exercise your First Amendment rights by putting up a yard sign endorsing your favorite candidate. This is going to be a close election. I don’t think it is a stretch to say that both Democracy and the future of healthcare are on the ballot. There is no certainty that Biden will pick up our pace on the journey toward healthcare equity and the Triple Aim, but we will not lose ground if he is elected. I am certain that Trump will try again to dismantle the slow progress we have made over the last quarter century.
Be well,
Gene
