Last Post of 2020: Making Sense of the 70 Million Trump Voters.

Posted on | December 30, 2020 | 4 Comments

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Mike Magee

On this final day of 2020, I continue to struggle with this 70 million Trump voter issue.

On the surface, it feels like a broad recrimination of the goodness and intelligence of nearly half of American voters – rendering us “unexceptional” at best.

Even if you grant targeted voters against abortion, or for state’s rights, or concerned about budget deficits, this requires that we accept a remarkable reliance on situational ethics: that you could accept evil, degeneracy, selfishness, and cruelty in a clearly unstable leader if you were able to get what you wanted in the bargain.

While there may be elements of truth in that, I think it’s too simple an explanation. There are other contributors.

We are a consumer society (aka greedy).

We are an individualistic society (aka no tradition of solidarity).

We are a gullible society (aka naive enough to embrace fantasies).

We are an entertainment society (aka easily distractible).

We are a young society (aka immature and quick to discard our elders).

We are Americans (aka vulnerable to someone exactly of the size and dimensions and character of Trump).

The good news, as we enter 2021, is – we are other things as well – innovative, creative, energetic, mostly immigrants, hopeful, and loving (sometimes).

This time around, good conquered evil – barely.

Now we must demonstrate that we know how to use the power to move the needle in favor of our better selves.

How do we make America healthy – in body, mind, and spirit?

That is the question for 2021.

Truth and Trust in 2021.

Posted on | December 29, 2020 | 2 Comments

Mike Magee

Exactly three years ago, veteran Health Policy expert, James A. Morone, Ph.D., made an interesting argument for single payer health care in the NEJM. In proposing a sweeping change that would directly address “the American patchwork”, assert “the norms of communal decency”, promote planning and efficiency, and empower “a righteous band of reformers, deeply committed to a cause, pushing against all odds”, he did not sidestep higher taxes on the rich.

Rather he sold into them, presenting high taxes on the rich in return for universal health coverage as “on a short list of available policies designed to push back on inequality.”

His argument boiled down to the fact that a central element of the national crisis we called “Trump” was populist anger grounded in remarkable income inequality. In roughly a half-century, our separation between rich and poor which used to mirror France and Japan, now aligns with Mexico and Brazil.

Three years later, with Covid ravaging us unabated, we’re a mess, and our citizens are pretty fed up. And why shouldn’t they be? Our top 1% controls roughly 40% of all wealth, while the bottom 90% manages a paltry 23%. If you’re a white family in America, you were born lucky. On average, your family is about 10 times as wealthy as your black family counterpart.

Back in December of 2017, Morone reminded us that major policy changes can, and have, flipped on a dime in the past. As he wrote then, “Disruptive populism ended past American gilded ages, and it shows signs of challenging the current one.” With better health delivery, and more equality and social justice, we might also redirect the course of American politics and American politicians.

In the same issue of NEJM,  Henry J. Aaron, Ph.D., explored a different road to reform, raising legitimate concerns about the unintended consequences of disrupting existing insurance holders, and arguing for a more cautious incremental approach including extending availability of Medicare and Medicaid to others, and shoring up ACA exchanges. He wondered then how far and how fast Americans were willing to go?

That same week, New York Times columnist, Thomas Friedman, presciently shared his view. He didn’t pull punches when he accused Trump of intentionally undermining the two critical pillars of American society, truth and trust. And here we are today.

Interestingly, in the careful analysis of these two health policy experts above, both identified an embattled and epic American struggle over how to topple the health care status-quo, a Medical-Industrial Complex controlled and directed by members of the 1%, and a debate that currently hangs on whether we – the citizens – are able to discern fact from fiction.

The key question for health reform and for the future of America: Do we trust a government “of, by, and for the people” to assure that each of its citizens has the right to “life, liberty, and the pursuit of happiness?”

Trump is all but gone -rejected, dejected, marginalized and soon-to-be ignored. It is now on us. If a majority of Americans can move to “yes” on truth and trust, we will find a way to embrace each other equally through health reform. And the quality and durability of that embrace will be determined by these Code Blue principles:

1. Universality: Comprehensive health coverage is a right of citizenship.

2. Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government. 

3. Local Control of Delivery: The actual delivery of services is provided by health professionals and hospitals at the local and state levels.

4. National Health Planning and Coordination is a Priority:  Creating healthy populations is a high priority on the federal and state levels. (Covid disaster – never again!)

5. Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery.

2021 is the year to do right by each other and take care of each other!

Lundberg’s Words: “System-shaking, even convulsing.”

Posted on | December 28, 2020 | Comments Off on Lundberg’s Words: “System-shaking, even convulsing.”

Mike Magee

Last week, Medscape’s editor-at-large, George Lundberg, wrote, “In 2017, I published a Medscape column that asked, “How many books will it take?” listing several titles that were intended to provoke repairs or rebuilds. Still nothing happened. Then came COVID, adding massive insult to injury of our already overpriced, overworked, bloated, inefficient, ineffective megalith American procedure-driven medicine.”

Is it possible, as Lundberg suggests, that America has reached a tipping point on health reform?

Exactly two years ago, in the middle of Trump’s caging of immigrant infants and children, the Washington Post ran the headline, “Our agents did everything they could.” The article captured the performance of Kevin McAleenan, head of the U.S. Customs and Border Protection defending his agencies oversight of the death of a second migrant child in the week after Christmas. His exact  words: “Our agents did everything they could as soon as these children manifested symptoms of illness to save their lives.”

As wicked and depressing as this performance, these were not isolated actions or even outliers. The Covid spotlight has revealed our weaknesses – especially for the most vulnerable. And the knife cuts deep as an indictment of the U.S. Health Care system at large. 

As 2020 draws to an end, Lundberg suggests that we as a nation must finally confront the lie that “we did all that we could.” As yet, we have not. 

Our problems are long standing. When I set out to write the 70 year history of the rise of the Medical-Industrial Complex in America, the glaring absence of fundamental national health planning appeared and reappeared year after year. No one across those many years asked the fundamental question, “How do we make America and all Americans healthy?” 

In his review of my book, Code Blue, Lundberg writes, “…in order to redesign a system to achieve different results, it would be helpful to understand how the system became the way it is.”

In the reading, you can sense that Dr. Lundberg ultimately found what he was looking for, and admires what he labels  “the Herculean task of explaining all this intertwining stuff so that readers can understand how we got here… What Magee does, perhaps better than anyone else in a single location, is name the people, the organizations, the dates, the decisions, the supporters, and the enablers, as well as the victims and the beneficiaries…”

History can go just so far before someone asks, “Where’s the beef?” Dr. Lundberg completes his review by asking, “What to do?”

His answer:  “Magee provides a succinct but detailed list of basic steps to reform the medical industrial complex. Five actions involve medical education, seven involve clinical research, five involve publications, and six regard marketing. Incremental, to be sure, but in aggregate, system-shaking, even convulsing.”

I welcome your reviews of Code Blue in the Comments section HERE.

Wishing You a Hopeful and Safe New Year!

What Do Biden/Harris, Superman and Clean Energy Disruption Have In Common?

Posted on | December 15, 2020 | 4 Comments

Mike Magee

The formal casting of Electoral College votes this week marked the moment that I felt comfortable in removing the Biden/Harris sign from my front lawn. In that moment, with the first Covid vaccines going in and Bill Barr going out, I allowed myself to believe that our new leaders were up to the task of rebuilding our democracy, and making real the ideals of “truth, justice, and the American way.”

That familiar phrase emerged during another epic moment of crisis in our history. It was 1934, in the middle of the Great Depression, when two New York City kids, Jerry Siegel and Joe Shuster, created the comic book super-hero, Superman. America needed a hero then, as we do now – whether they be our nurses and doctors and teachers, or our incoming President and Vice-President.

With the many serious challenges we face at home and around the world, it would be easy to fall into despair and to imagine that our problems are insurmountable. But in truth, there is real progress in the air, and hope for the health of our species and our planet, which has been moving forward under the radar screen.

Nowhere is this more evident (though largely hidden from sight) than in our planet’s positioning to address the health and safety fallout of global warming. This week, we celebrated the fifth anniversary of the Paris Agreement, the climate accord signed by 195 nations, which Trump abruptly dismantled four years ago. But President-elect Biden has signaled that his first order on January 20, 2021, will be to rejoin the agreement when the signatories gather in Glasgow, just a short 1 hour 11 minute ride north of the Trump Turnberry Golf Club.

As Trump patronized his fossil fuel funders, and promised that “we’re going to have clean coal and we’re going to have plenty of it,” the oil and gas industry wrote down the value of its assets $170 billion in the first 6 months of 2020.

Acknowledging as much this past week, a cabal of energy investors, with combined assets of $9 trillion, signaled a shift in their strategy with a pledge to harmonize their investments with net-zero carbon emissions by 2050.

Those investors haven’t suddenly “discovered religion.” No. They’re looking at the numbers.

Clean energy options like solar and wind, combined with the latest battery technology, are now 79% cheaper to produce than US coal production. Investors realize that 90% of the new energy capacity generated worldwide in 2020, as reported by the International Energy Agency, has come from clean energy.

Efficiency, profitability, and technology in clean energy are now aligned. The cost of solar panels has dropped 89% in just the last decade, while wind turbines are close behind with a 59% drop in the same time period. The cost of batteries have declined in tandem by 89% resulting in just a two year horizon before electric vehicles reach cost parity with the venerable fossil fuel guzzling internal-combustion engine.

But what about jobs? The news here is even better. Clean energy is currently generating three times as many jobs as fossil fuels. Solar jobs alone are outpacing overall job growth five-fold.

As Trump was fiddling, American cities and states were quietly adjusting their energy investment strategies. Much of the credit goes to former Vice-President Al Gore, whose leadership in this arena has been tireless and earned him a well-deserved share of the 2007 Nobel Peace Prize.

Al Gore will be highly visible as part of the US delegation in November, 2021, when all signators of the Paris Agreement reconvene in Glasgow, just a 1 hour and 11 minute drive north from the Trump Turnberry Golf Course. But the true celebrity at that historic gathering will be infromation technology.

Gore helped Climate Trace in 2019. As their site describes:

 “In 2019, a group of nonprofits including US-based WattTime and UK-based Carbon Tracker teamed up to apply for Google.org’s AI Impact Challenge with a proposal to monitor all global power plant emissions from space. Google.org not only selected the project for a $1.7 million grant, but also sent a group of seven skilled data engineering and machine learning Fellows to work alongside WattTime and Carbon Tracker for six months to help bring the initiative to fruition.

After the announcement of the Google.org grant, the teams were surprised to immediately hear from over 50 other organizations and scientists around the world offering to help. So they began systematically investigating: Could mixing and matching innovations from various groups improve global emissions monitoring even further? Among the new collaborators was Vice President Gore, who had long suspected that improved global emissions monitoring through satellites and AI held dramatic potential to accelerate climate progress.”

Gore sees the ability to track real-time atmospheric carbon emissions as a “game-changer.” Combined with efficiency, low cost, and jobs, Gore writes, “This precision tracking will replace the erratic, self-reported and often inaccurate data on which past climate agreements were based.”

With Trump defeated, and a Covid vaccine in hand, and planetary health, racial justice, universal health care, and sane immigration policy cued-up backstage, we have the opportunity to imbue this pledge with pride and substance– truth, justice, and the American way.

God Bless BioNTech and Pfizer…and Now Let’s Build a First-In-Class National Health Care System.

Posted on | December 12, 2020 | 3 Comments

Mike Magee

As Americans cover-up against second and third waves of Covid-19, Americans once again place their hopes and prayers on a great scientific discovery to snatch us from the flames. The latest miracle cure, the just approved Pfizer vaccine, is highly efficacious and safe, and should provide emergency relief in the days and months ahead. But a single cure does not a health system make.

When Donald Trump expressed his cluelessness—”nobody knew that health care could be so complicated”—before a meeting of state governors in February 2017, he was exposing a pattern of both arrogance and ignorance that remains on full display.

CODE BLUE: Inside the Medical Industrial Complex was published four months later, and accurately predicted that – stressed by a health crisis like Covid-19 – our fundamentally flawed health system would buckle under the pressure. Nearly 300,000 Americans have died, many of them needlessly.

And yet, today we witness a group of Republican Attorneys General appealing to the Supreme Court to dismantle the ACA and the protections it offers to those with pre-existing conditions including Covid-19.

At the very same time, our President-elect has named a group of leading scientists and experts as transition advisers to help take the Biden-Harris COVID plan and convert it into an action blueprint that starts on Jan. 20, 2021.

The Biden coronavirus task force is led by former Surgeon General Dr. Vivek Murthy and Dr. David Kessler. But what if the Supreme Court dismantles the ACA?

We would be left with a convoluted system of third-party payers, and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it. And Republican loyalists would likely continue to find solace in telling themselves, “Well, we still have the best health care in the world.”

In point of fact, we’re not even close to having the best health care in the world. As legendary Princeton health economist Uwe Reinhardt prophetically remarked two years prior to COVID-19, “At international health care conferences, arguing that a certain proposed policy would drive some country’s system closer to the U.S. model usually is the kiss of death.”

It is at times like these that system weaknesses expose themselves. The inability to swiftly and efficiently test a population for COVID-19, share those results, and rationally plan a swift, coordinated, and effective response is a reflection of the gross inadequacies of our health care system. So is a leaky and disjointed supply system that can’t manage demand for cue tips, let alone ventilators and manpower.

In a review of CODE BLUE last year, John Rother, President and CEO of the National Coalition on Health Care wrote, “Code Blue will make you mad, but it will also make you better informed and better able to understand what we need to do as a country to fix it. I can’t think of a more persuasive book on the need for change.”

The need for change that John forecasted not only included matters of justice, planning, and equitable distribution of health care resources, but also the capacity to respond to a global public health event of the magnitude of COVID-19.

How broken must a system be when our nation can’t keep up with nations like South Korea and Italy in testing for the virus? What does our “patchwork response”, variable across states and communities, lacking any private-public planning and coordination, and absent clarity on pricing, access, eligibility and prioritization, and raft with confusion even on what protections are necessary for health care workers collecting samples, tell us about our need for a fundamental restructuring of our health care system?

God Bless Anthony Fauci, but is our system so fragile that the fate of Americans rests on a single individual having the temerity to speak truth to power in the face of executive incompetence? And how are we to reconcile a Presidential veto on testing kits months ago.

A half-century of systematic underfunding of public health, planning and prevention in deference to entrepreneurial scientists in pursuit of profit and patents over patients and families, ends here – in crisis.

God Bless BioNTech’s scientists, Ugur Sahin and his wife Ozlem Tureci, for their discovery, and their partner, Pfizer, for expertise in marketing and worldwide distribution which will be absolutely critical. With their help, we will survive this “Code Blue” calamity.

But we need to assure through new leadership and deliberate action by the Biden/Harris administration that this will never happen again. Scientific bullets are great, but they are no substitute for a first-in-class national health care system which is long overdue.

The Constitution and Your “Right to Health Care” in America

Posted on | December 8, 2020 | 2 Comments

Mike Magee

I’ve been working on a Spring lecture for President’s College at the University of Hartford titled, “The Constitution and Your ‘Right to Health Care’ in America.” 

My description reads, “This lecture explores the recent political history and legal controversy surrounding attempts to establish universal health coverage in America. “Is health care a right?” viewed within the context of the Bill of Rights and especially the 9^th and 10^th Amendments.”

Self-described libertarian-conservative John R. Graham, a health policy analyst in the Trump administration’s HHS, writing on the topic in 2010 stated that, “As a non-lawyer, my understanding is very simple: The Ninth Amendment states that ‘the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.’ So, if you claim a ‘right to health care,’ there’s nothing in the Constitution that denies your claim. Indeed, libertarians and conservatives should be more willing to concede a ‘right to health care,’ because once it’s defined as a right, the entire weight of the Constitution comes down against federal (and perhaps even state) control.”

This bit of semantics crash-lands with common sense, as it did in my own state in 1965 when the Supreme Court in a 7 to 2 decision (Griswold v. Connecticut) dismantled an 1873 Comstock Law that prohibited married couples from buying and using contraceptives. Writing for the Court, Justice William O. Douglas declared that “specific guarantees in the Bill of Rights have penumbras, formed by emanations from those guarantees that help give them life and substance.” Though marital privacy was not mentioned in the Bill of Rights, legal analysts have suggested that Douglas was asserting that logic dictated that marital privacy “is one of the values served and protected by the First Amendment through its protection of associational rights, and by the Third, the Fourth, and the Fifth Amendments as well.”

Justice Goldberg concurred at the time, writing: “The language and history of the Ninth Amendment reveal that the Framers of the Constitution believed that there are additional fundamental rights, protected from governmental infringement, which exist alongside those fundamental rights specifically mentioned in the first eight constitutional amendments. . . . To hold that a right so basic and fundamental and so deep-rooted in our society as the right of privacy in marriage may be infringed because that right is not guaranteed in so many words by the first eight amendments to the Constitution is to ignore the Ninth Amendment and to give it no effect whatsoever.”

“Common sense” is what Atul Gawande was mining in his classic 2017 New Yorker article when he went back to his hometown of Athens, Ohio, in the Appalachian foothills, to speak with his now grown-up childhood classmates about “rights” and health care. 

Some of his comments drawn from their insights and prejudicies shed light.

“ I had grown up steeped in a set of core Midwestern beliefs: that you can’t get something for nothing, and that you should be reluctant to impose on others and, likewise, to be imposed upon. Here self-reliance is a totemic value.”

“.. A right makes no distinction between the deserving and the undeserving..”

“….‘Frankly, it annoys the crap out of me—they’re nothing but grasshoppers in the system,’ Joe said, recalling the fable about the thriftless grasshopper and the provident ant.”

“… doing all they could to earn a living and pay their taxes—taxes that helped provide free health care for people who did nothing to earn it.”

“Some people see rights as protections provided by government. But others … see rights as protections from government.”

“People don’t think about their water, Tim said, but we can’t live without it. It is not a luxury; it’s a necessity of human existence. An essential function of government, therefore, is to insure that people have clean water. And that’s the way he sees health care. Joe wanted government to step back; Tim wanted government to step up.”

“ The notion of health care as a right struck her as another way of undermining work and responsibility… But Monna, like almost everyone I spoke to, understood perfectly well what Medicare was and was glad to have it…‘We all pay in for that,’ she pointed out, ‘and we all benefit.’… There is genuine reciprocity… To them, Medicare was less about a universal right than about a universal agreement on how much we give and how much we get.”

“… rights are as much about our duties as about our freedoms”

“Trade-offs now have to be considered. And saying that something is a basic right starts to seem the equivalent of saying only, ‘It is very, very important.’”

“…basic rights include physical security, water, shelter, and health care. Meeting these basics is, he maintained, among government’s highest purposes and priorities.”

“‘I think the goal should be security,’ he said of health care. ‘Not just financial security but mental security—knowing that, no matter how bad things get, this shouldn’t be what you worry about.’” 

“As he saw it, government existed to provide basic services like trash pickup, a sewer system, roadways, police and fire protection, schools, and health care… these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down.”

“The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains.”

“During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all…Health care has been the cavernous exception.”

“Maintaining the link between health coverage and jobs is growing increasingly difficult, expensive, and self-defeating.”

“Few want the system we have, but many fear losing what we’ve got.”

“What we agree on, broadly, is that the rules should apply to everyone.”

My Father Would Be 106 Tomorrow: Why I love him.

Posted on | December 3, 2020 | Comments Off on My Father Would Be 106 Tomorrow: Why I love him.

Mike Magee

My father would be 106 tomorrow. Considering what we have endured as a people, as care givers, as human beings over the past four years, what I wrote about him six years ago bears repeating.

____________________________________________________________________

My father was born on December 5, 1914. Today is his 100th Birthday. And although he died on September 15, 1998, and my mother some three years earlier while caring for him, there is rarely a day that goes by that I do not think of them.

What do I love about my father?

First and foremost, he loved my mother, and everything flowed from that. We kids understood that we were an extension of their love.

I loved his physical presence – that he was big and strong, that he embraced us, held us tight.

I liked that he taught me to whistle, which remains a useful skill.

I was proud that he took care of people as a job, and that the people who he took care of loved him so much.

I liked that every Christmas our dining table was full of baked goods that his patients gave him to thank him for his many kindnesses – giving them time, having open office hours day and night, making house calls when they were scared or worried.

I loved that he was honest, that he didn’t cheat or fudge, that he believed your name had to stand for something.

I loved that he was a gentleman and a gentle man.

I liked that he liked to build things, that he owned tools he rarely got to use, and that he’d get upset because we were always messing with his stuff.

I liked that he liked clothes, especially shoes. He liked to look good, and he wore clothes well.

I liked that he always had lots of change in his pockets.

I liked that he knew the owners of the local stores across the street by their first names.

I liked that he was patriotic and courageous. I learned after his death that he earned a Bronze Star on May 9, 1945. We never saw that medal or ever heard him talk about that day, ever.

I like that he was modest. He didn’t brag. He didn’t have to. I liked that.

I liked that he delegated. He and my mother expected us kids (there were 12 of us) to help teach each other skills like bike riding, and catching a ball, and climbing a tree.

I liked that he took risks, and wanted us to take risks as well – even though a few of those risks turned out to be unwise and too costly.

I liked that he wasn’t perfect – it meant we didn’t have to be perfect, but we did have to try, and we did have to be independent.

I liked that he was often watching in the background, a last stop before disaster, and that his intervention was usually at the direction of our mother.

I loved that the two of them were a team – and that we kids were the players.

I liked that he could take a hit, that he would never fall apart, no matter how bad things were, he would get up the next morning. Our father was reliable, consistent, upright, sturdy, alive.

I thought he was handsome. Others thought so too.

I loved that he was a family man.

I liked that he had a spiritual core – not because of his religious belief system, because his values were secure with or without religion. And not for any punitive conceit – hell rarely made it into our family’s consciousness. No, I liked his spiritual core because it signaled respect for a greater good, a directing hand, the capacity to endure, a reason to try to reach for the stars.

I love my father. He was such a good man. I have tried in some ways to be like him.

(…and, in the midst of this pandemic isolation…)

When I think of him, I always remember one evening, arriving home from college, coming through the door, and being greeted by him. He enveloped me in a big hug that night – tight, long – and kissed me on the cheek, and said my name. He was smiling. His eyes were alive and happy. I can smell him. I can feel his presence.

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