March 13, 2020

Dear Interested Readers,

 

Revealed: The Folly Of Healthcare For Some In An Uncertain World 

 

I do not know where to start in the expression of my feelings about the rapid evolution of our national experience with the COVID-19 pandemic. Perhaps, you share my confusion and also feel overwhelmed. I am struggling to keep up with factual reports on the progress of the pandemic. I am dizzy from trying to keep up with closings that are altering things that I had planned to do. The cancellations are coming in fast, like the evening that my wife and I had planned next Wednesday in Boston to hear a speech by former UN Ambassador Susan Rice at the Boston Symphony Speakers’ Series. That event has been cancelled along with many others, like the Boston Marathon and opening day of the baseball season. It is shocking to realize that here will be no more college sports events this spring. Will there be graduation ceremonies in May?

 

“March Madness” no longer applies just to the basketball tournament that crowns the Division I NCAA national champ, it applies to a lot of us and perhaps most specifically to the man who claims to be a “very stable genius.” Many of us have been holding our breath hoping that the country might make it through four years of discontent with a minimum of damage. That dream has evaporated in a crescendo of breathtaking events over the past three or four days. As  Paul Krugman wrote in his New York Times column yesterday in a piece entitled “It’s a MAGA Microbe Meltdown: Trump utterly fails to rise to his first real crisis”:

:

For three years Donald Trump led a charmed life. He faced only one major crisis that he didn’t generate himself — Hurricane Maria — and although his botched response contributed to a tragedy that killed thousands of U.S. citizens, the deaths took place off camera, allowing him to deny that anything bad had happened.

Now, however, we face a much bigger crisis with the coronavirus. And Trump’s response has been worse than even his harshest critics could have imagined. He has treated a dire threat as a public relations problem, combining denial with frantic blame-shifting.

His administration has failed to deliver the most basic prerequisite of pandemic response, widespread testing to track the disease’s spread. He has failed to implement recommendations of public health experts, instead imposing pointless travel bans on foreigners when all indications are that the disease is already well established in the United States.

 

Wednesday evening my wife and I decided to go to the annual town meeting. We put CNN on “record” to capture the president’s address to the nation since it was likely to air before we got home. I was not expecting a performance like FDR gave after Pearl Harbor, or even something that approached George Bush’s address to the nation after 9/11, but I was hoping for much more than what caused me to sit in total disbelief as I watched an emotionally bereft individual read a speech from a teleprompter. His monotone, coupled with his expressionless face, was more appropriate to the disclaimer on a drug add than an address to a worried nation. His motive seemed to be to distance himself from any responsibility for the disaster that was possibly going to kill many people, and at the least, throw our economy into turmoil for months to come. “Foreigners” seemed to be the ones who caused our trouble, and “business” was the jist of what his limp words suggested was his core concern. 

 

With perhaps the exception of Fox News, the news feeds yesterday on the “morning after” were uniformly scathing in their review of his presentation. Some suggested that the speech, coupled with his failure to act decisively over the previous month, will go down in history as a prime example of a president’s failure to appropriately manage a moment of crisis. David Frum writes frequently in the Atlantic. He is a respected conservative journalist who was a speechwriter for President George W. Bush. Later he was a fellow at the neo conservative think tank, the American Enterprise Institute. In 2018 he published a scathing analysis of President Trump’s evolving presidency in a best selling book entitled Trumpocracy: The Corruption of the American Republic.  This year he has published Trumpocalypse: Restoring American Democracy. Yesterday, the first article I read was written by Mr. Frum in the Atlantic. He wrote:

 

At every turn, President Trump’s policy regarding coronavirus has unfolded as if guided by one rule: How can I make this crisis worse?

Presidents are not all-powerful, especially not in the case of pandemic disease. There are limits to what they can do, for good or ill. But within those limits, at every juncture, Trump’s actions have ensured the worst possible outcomes. The worst outcome for public health. The worst outcome for the American economy. The worst outcome for American global leadership.

Trump’s Oval Office speech of March 11 was the worst action yet in a string of bad actions.

 

Others, including myself in Tuesday’s post, have noted the president’s lies about “ the millions” of tests that are available. I have been amazed by the way in which his narcissism and his fears for what the truth might do to his reelection has led to his dishonesty with the public and has distorted the responses of his administration to the threat we face. It has been disappointing to see that the fear that he induces in once responsible administrators prevents them from giving him information that any competent executive would deem critical to making the right decisions. Frum presented a withering analysis of the president’s speech. The negative reaction to the speech was objectively manifested by the fact that when the stock market opened trading had to be halted twice because of the dramatic fall in prices that occurred just a little more that 12 hours after the speech. The devastating consequences of Trump’s failures must be obvious to even his most ardent supporters like Senator Lindsey Graham, who now awaits the results of his own test for COVID-19, while it is still difficult for most Americans to be tested.

 

Frum’s points about the deficiencies of the president’s speech are:

 

• He offered no guidance or policy on how to prevent the spread of the disease inside the United States. Should your town cancel its St. Patrick’s Day parade? What about theatrical productions and sporting events? Classes at schools and colleges? Nothing.

 

• He offered no explanation of what went wrong with the U.S. testing system, nor any assurance of when testing would become more widely available. His own previous promises of testing for anyone who needs it have been exploded as false. So what is true? Nothing.

 

• Layoffs are coming, probably on a very large scale, as travel collapses and people hunker down at home. Any word for those about to lose their jobs? Only the vaguest indication that something might be announced sometime soon.

 

• It’s good to hear that there will be no co-pays on the tests nobody seems able to get. What about other health-care coverage? Any word on that? Nothing.

 

Frum was on a rage fueled roll. I will let him speak a little more for me, although I should note that if he had written the piece a few hours later he would have written “The financial markets have plunged into a 1987-style crash, auguring a recession, perhaps a severe one,” rather than calling it a “2008-style crash,” as you can see in his words below. This market meltdown driven by the president’s pitiful performance was the most dramatic downturn in over thirty years.

 

The financial markets have plunged into a 2008-style crash, auguring a recession, perhaps a severe one. The Trump administration has had almost two months to think about this crisis. It has trial-ballooned some ideas. But, of course, fiscal policy would require assent from the House of Representatives. Trump is still pouting at Speaker Nancy Pelosi. So—aside from some preposterously unconvincing happy talk about the economy—again: nothing.

 

Frum pointed out early what others talked about for most of the day. He contends that the moves the president announced, like the travel band from Europe minus England, were bad policy that amplified the economic collapse that was already underway. A speech that was supposed to correct a fall of 1200 points in the Dow precipitated an additional drop of 2,353 points. The toleration of this “very stable genius” by the Republican establishment and the lack of attention to their constitutional responsibilities by every Republican senator, except for Mitt Romney, have created huge problems for every American and may lead to the death of some. Living with a liar has never been a good strategic move for anyone, including Republican politicians, even if he has bought you off with the judicial appointments and tax policy that you think will satisfy your donors. 

 

It is ironic that even as the Republican senators were rationalizing their decisions to overlook his criminal behavior that was magnified by his incompetence as a shakedown artist, his focus on what he thought was best for him prevented him from taking actions back in January that might have mitigated our present situation. It is infuriating to realize that as the impeachment hearings progressed, his administration was suppressing critical facts to appease him, and he was unwilling to accept the guidance from his advisors that a more responsible and less self centered leader would have used to develop an effective strategy based on facts and not political hopes. Actions taken in late January or early February might have better prepared us for what is happening now, and may for all we will ever know saved lives and hundreds of billions of dollars of lost commerce and damage to the personal financial security of ordinary Americans that we are now likely to experience. We now know that he was enraged when a CDC administrator revealed the truth about our risk while he was returning from his trip to India in late February.

 

Frum has more to say that you should read. I added the bolding.

 

This crisis is not of Trump’s making. What he is responsible for is his failure to respond promptly, and then his perverse and counterproductive choice of how to respond when action could be avoided no longer. Trump, in his speech, pleaded for an end to finger-pointing. It’s a strange thing for this president of all presidents to say. No American president, and precious few American politicians, have ever pointed so many fingers or hurled so much abuse as Donald Trump. What he means, of course, is: Don’t hold me to account for the things I did.

But he did do them, and he owns responsibility for those things. He cannot escape it, and he will not escape it.

More people will get sick because of his presidency than if somebody else were in charge. More people will suffer the financial hardship of sickness because of his presidency than if somebody else were in charge. The medical crisis will arrive faster and last longer than if somebody else were in charge. So, too, the economic crisis. More people will lose their jobs than if somebody else were in charge. More businesses will be pushed into bankruptcy than if somebody else were in charge. More savers will lose more savings than if somebody else were in charge. The damage to America’s global leadership will be greater than if somebody else were in charge.

 

Frum’s anger is withering and his prose rises appropriately to the level of a dramatic indictment. Quite frankly we may have been better off in this crisis if another wooden president like Herbert Hoover had been in charge. Hoover failed to effectively manage the aftermath of the fall in the stock market in 1929, but he performed well enough as secretary of commerce under President Coolidge during the devastating floods of 1927 to get elected president. Frum describes the impact of Trump’s narcissism without calling it out:

 

There is always something malign in Trump’s incompetence. He has no care or concern for others; he cannot absorb the trouble and suffering of others as real. He monotones his way through words of love and compassion, but those words plainly have no content or meaning for him. The only thing that is real is his squalid vanity. This virus threatens to pierce that vanity, so he denied it as long as he could. What he refuses to acknowledge cannot be real, can it?

And even now that he has acknowledged the crisis, he still cannot act, because he does not know what to do. His only goal now is to shove blame onto others. Americans have to face the fact that in the grip of this pandemic, the Oval Office is for all practical purposes as empty as the glazed eyes of the man who spoke from that office tonight.

 

We all are beginning to count the cost of COVID-19 to ourselves, even if we are have no physical symptoms.  It is startling to hear that famous people like Tom Hanks and his wife, Rita Wilson are infected. They were lucky enough to get sick in Australia where the prime minister did respond responsibly to the coronavirus threat.  The wife of Canadian Prime Minister Justin Trudeau has the virus. Government officials in Iran, Italy, and Brazil are ill. I learned decades ago that wealth and position are no guarantees of protection from disease even though the poor and disadvantaged always suffer more. In Italy they are now making triage decisions that will allow some people to die. We have already made the same decisions even though we don’t realize it yet because it is likely that our resources, as great as they are, could prove to be just as inadequate as the Italian resources if we had a similar demand. We worry more about the taxes we pay than realizing that the stability of our wealth and health is a function of how well we plan for the unexpected, and the strength of our investment in the well being of our most vulnerable citizens.

 

The president has much work to do. I wonder about the care available to the eleven or twelve million undocumented people in our country. Despite Trump’s contentions, they were never a threat to us when they were moving in the shadows of our society doing the menial tasks we found it economically convenient for them to do. We rarely give them the care they need. With no access to care, will they become hidden vectors for the transmission of disease? We hear early suggestions of ways that we might shore up businesses as they contend with potential losses. Nothing has been decided about how we will support the 40% of Americans who are vulnerable to the loss of the next paycheck. Will we support them through the economic difficulties they will surely encounter over the next few months? 

 

Trump is a problem, but he is mostly a mirror that reveals our darker side. David Brooks wrote a column yesterday that points out that history suggests that in a pandemic we turn against one another to protect ourselves. I have argued that we were doing that long before this pandemic. The embarrassing Democratic debates have been more about what the establishment will support in terms of benefits to the underserved rather than the social safety net that we need to give ourselves and our children to insure a safe future for all of us. As a perverse example of our shortsightedness in reference to our shared planet we are more concerned about the personal inconvenience of not having access to plastic bags at the grocery store than we are to the future health of the ocean which is still a major source of our dietary protein. 

 

I cringe when I hear politicians express more concern about the business of healthcare than the health of the nation. Achieving universal access to healthcare has been a struggle even in the countries that have it, but the other developed countries of the world have finally demonstrated the wisdom to make the compromises necessary to make it a reality. Even though in some countries like the UK, they continue to struggle with how to cover it, they still have it. If you are interested, I would recommend a great article from the New York Times entitled “Strikes And Attack Ads: The Hard Roads to Universal Healthcare” about the struggle for universal coverage in other developed countries written by Quoctrung Bui and Sarah Kliff. My point is that because the other developed countries finally achieved universal access, they are in a better position for this moment than we are. Denying and resisting our collective responsibility to protect the health of the nation ultimately undermines the wealth of the nation. 

 

COVID-19 has now become a personal issue for us all. Much damage has been done, and it will take us some time for life to return to normal even if we never get a cough, and if, by some miracle, we all shake our heads in a couple of weeks and say, “That was an overreaction!” Just as an example, my list of personal and family losses related to the virus over the last week includes: 

 

• We have canceled a river cruise on the Danube for June.

 

• As moderator of my congregation, I am working with others to decide about whether or not to have services since so many who do attend are elderly.

 

• A family wedding in South Carolina at the end of March will not be what we once anticipated with the excitement and joy of the coming together of our far flung clan. Several members of the family have announced that they are afraid to come, and who knows, in the end this joyous event, like so many others, may be cancelled.

 

• My granddaughter in Florida will be out of school for at least a month, and her volleyball season is on hold. Her parents, one a litigator and the other a judge, are uncertain about whether to cancel scheduled events and appearances.

 

• My son who is a social worker, and his wife who is a high school assistant principal in Albuquerque, will be sitting at home for at least a month. The Albuquerque school system is closed. They are unsure about whether they will be paid.

 

• My daughter in law and son in California are expecting school closures for their boys and uncertainties about their jobs.

 

• My son in Brooklyn is telecommuting, and his wife who is in law school is transitioning to an online curriculum.

 

• It is obvious that my wife and I, as “elderly” parents in their mid seventies, are a focus of concern for our children.

 

• The assisted living facility where my father’s widow lives is closed to visitors, and movement within the facility is limited.

 

Multiply those realities across more than 300 million people and it is hard to understand how our leadership has failed to do everything it might have done to prospectively limit the damage, as did the leadership in Australia where Tom Hanks and his wife were lucky enough to be. Doing your best to stay ahead of the virus, as the Prime Minister of Australia tried to do, does not guarantee success in the face of this very dangerous virus, as is demonstrated by the fact that the deputy prime minister of Australia has now joined the ranks of influential people who have tested positive for COVID-19. 

 

I am sure your list of personal challenges and surprises over the last week is equal to, or longer than mine. You should be concerned about yourself, your family, and your community. If you are in practice, you are struggling to meet the needs of those who look to you for care. If you are a healthcare professional you may wonder everyday if the next person who comes to see you will endanger your own health and the health of your family. To be a provider of care at times like this is risky and requires courage. David Brooks said it beautifully in the piece I cited above.

 

 ….In every pandemic there are doctors and nurses who respond with unbelievable heroism and compassion. That’s happening today.

Mike Baker recently had a report in The Times about the EvergreenHealth hospital in Kirkland, Wash., where the staff showing the kind of effective compassion that has been evident in all pandemics down the centuries. “We have not had issues with staff not wanting to come in,” an Evergreen executive said. “We’ve had staff calling and say, ‘If you need me, I’m available.”

Maybe this time we’ll learn from their example. It also wouldn’t be a bad idea to take steps to fight the moral disease that accompanies the physical one.

 

It is understandable that we are fearful, and that there is anger because of the apparent failures of our leadership that may have increased our risks. Perhaps we would not be so angry if we sensed any compassion coming from them. In the last week we have had more collective uncertainty than we have experienced since 9/11. The questions now are how will we manage from this point forward, and what will we learn from this experience?

 

I am impressed by the recent poise and wisdom of Dr. Anthony Fauci. I am hopeful that very soon we will move beyond saying that we are distributing the means of testing, and actually begin to do testing at levels that provide protective information. I do believe that we will eventually understand and control this pandemic. Even if we do nothing at all, pandemics do run their course and fade away like the passing of a storm. I believe that our people will make the personal sacrifices that curtail the spread of the virus. We are all learning the tricks of social distancing and the importance of hand washing. I hope that our medical resources will stand up to the challenge so that we can avoid the necessity of “triage” decisions like the ones being required in Italy. I believe that our local and state leadership are demonstrating good judgement as they cancel events even when there will be large scale disappointment and local economic losses. The virus will pass. We will recover from our economic losses. We will grieve those who do not survive. When it is all over will we change our attitudes about what we owe one another and institute the changes that will protect us from future challenges that are sure to come in time? Will we admit the error of worrying more about taxes than about creating a social infrastructure that improves health and give up the folly of “healthcare for some” in these uncertain times?

 

Town Meeting In Difficult Times

 

The header for this week is a spectacular aerial view of the center of our town with Mount Kearsarge lying to the South, taken at sunrise on a summer day. I lifted the picture from the cover of our town’s  “Annual Report For The Year Ending 2019.” It is another breathtaking photo revealing the beauty of our corner of  the world taken by my neighbor, Peter Bloch.

 

The second week of March is town meeting time in New Hampshire. My town was founded in 1779 and on Wednesday evening we held our 241st town meeting in the gymnasium attached to the elementary school. The high school and junior high were once on the same site, but several years ago they were moved to a site about ten miles away just off exit ten of I 89 when most of the small towns in the Kearsarge region consolidated their secondary schools. That sort of process has occurred all over rural America. Consolidation has meant that our sense of “community” has been expanded. New London is the center of an economic entity that is much larger than the 4,500 people who live within the town’s limits. 

 

We are the center of the regional economic life. We have a college. You can see some of the campus near the upper end of Main Street just past the steeple of the First Baptist Church. We have the only hardware store for miles around. We have one grocery store that is now owned by Hannaford’s but was once owned by a local family. The state liquor store is tucked under the grocery store, and gets a lot of traffic as the only source of “spirits” for miles around. Our “supermarket” and state liquor store are the only ones near I 89 between exit 9 twenty miles to the south, and exits 18,19, and 20, twenty five miles to the north in Lebanon just before the Connecticut River and Vermont. Dartmouth Hitchcock Medical Center is just off exit 18. An employee at DHMC was case #1 of COVID-19 in New Hampshire. Instead of going home as he was instructed, he went to a party and infected another person. 

 

There had been some debate about whether or not to have town meetings, but our town did go forward with its meeting on Wednesday evening. The crowd was thin compared to previous years with only about 150 in attendance. The specter of the coronavirus pandemic was present with us. We discussed and voted on 25 “warrants.” The most contentiously discussed warrant was Article 7 which was the budget for our Health and Welfare Departments. We spent $258,212 in the last budget for ambulance services, the local council on aging, court appointed advocates, administrative functions, and direct grants ($16,000) to citizens in need. The proposed budget for FY 2021 was $267,285. One citizen sought to amend the allocation by increasing it by 50% because of the possibility that COVID-19 might drive increased ambulance needs, stress on VNA service, and needs for emergency financial support for citizens who are disadvantaged by the business downturns associated with the pandemic. That motion initiated a discussion that lasted quite a while as people debated whether we would ever be affected, or how we would respond, if we were. I was one of a small minority who spoke in favor of the motion and voted for it. A week ago the motion would have never been made. Who knows how a vote might go a week from now? It was a demonstration of how hard it is for people to deal with uncertainty, especially when their vote might raise their taxes. 

 

Be well! Practice social distancing, wash your hands frequently, don’t touch your face, cover your cough, stay home if you don’t feel well, follow the advice of our experts, assist your neighbor when there is a need you can meet, demand leadership that is thoughtful, truthful, capable and inclusive, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,  

 

Gene