And Yet He Walked Among Us

        I firmly believe in the concept that those who cannot afford legal representation should be granted competent legal advice via a public defender, courtesy of the cognizant legal authority. I have several dear friends, one a former colleague and several former students who have undertaken this frequently thankless chore. While it is difficult, maybe impossible to find out the percentage of attorneys who actually appear in court, I have seen one citation that estimates 5 to 7% do so. I saw another which alleges that perhaps as little as 2-5% of civil cases ever require courtroom appearance. On the other hand, Public defenders are overloaded and overworked. According to the Bureau of Justice Statistics, the annual caseload assigned to public defenders spanned from 50 to 590 cases. Many, if not most, of these will require at least one court appearance, and may eventuate into a trial situation.    

        I said that to say this: Those who do this work should be among our brightest and best, and believe me, those with whom I am personally familiar are even better than that, but recent events in New York cause me to ponder if we shouldn’t pay these folks better, be appropriately selective,  and elevate their status as representatives of the lowliest. We have, too often, seen appeals granted and even verdicts overturned with incompetent representation cited as a factor, which brings me to what spurred this whole scribble.

        Yesterday, a New York man, Grafton Thomas, drove from his home to a town about 40 miles away with malice in his heart and a machete in his hand. He entered a house where a Hanukkah ceremony was taking place and stabbed five persons,  injuring five participants, one critically, before another attendee struck  him in the head with a small end table, causing him (Thomas) to exit he house and, after attempting and failing to open several doors in a neighboring synagogue, flee the scene in his car. Fortunately, his license plate number was observed and led to his later arrest at his home. He was described by arresting officers as covered in blood and smelling of bleach. A blood covered machete was in his vehicle and multiple guns were found later in a search of his house.

       The article identifies Michael Sussman as lawyer who spoke for the family regarding what he says is a history of mental illness, He also announced he is “taking up” the case, however, in all candor, maybe the family should have called him earlier. Sussman was careful to state that “Thomas has no history of “like” violent acts.” (meaning he never previously attacked anyone with a machete?)  Sussman is not a public defender. 

       In the actual arraignment, a court appointed public defender, Kristine Ciganik, allowed Thomas to plead not guilty to five counts of attempted murder and a burglary charge. She then alleged that he had “no criminal record”, but a law enforcement source said Thomas has three criminal cases from the early 2000s, some of which are sealed plus four other arrests, including charges of menacing and reckless endangerment last summer, possessing an imitation pistol or air rifle in Brooklyn in 2000, possessing a loaded gun in Brooklyn in 2001, and punching a police horse in Midtown Manhattan in 2002, plus other more recent “sealed” charges.

        The attorney is either a liar or incompetent not to have known or admitted to Thomas’ previous record. To repeat, Grafton Thomas has actually been arrested seven times, the majority of them having some element of violence attached, including an assault on a Police horse. He has been a periodic violent offender with alleged mental issues since his teens, and yet? The good news here is that no one has died from his attack; the bad news is that with his history he was allowed to drive and possess handguns (found later in his home).     

Michelle Malkin Off the Rails Again

        The ever whiny, racist, and predictably snotty Michelle Malkin does it again today in her op-ed column which, lamentably, the local rag inevitably runs every time she puts pen to paper. Today her attack was leveled at Jill Biden, and by extension Catholic Charities. One supposes Ms. Malkin is, or was, Catholic at some point, as her parents and, of course, she herself, are Filipino.

         Her criticism, focusing on Dr. Jill Biden, almost assuredly because her husband is a Democratic presidential candidate, derides what she announces are Mrs. Biden’s (And hubby, Joe’s) “true allegiance” - to Mexico. Yeah, she said that. She is saying that the presidential hopeful and his wife are loyal to Mexico and, by implication, not to the United States. This would be laughable, if not for the fact that such outlandish statements are Malkin’s stock in trade.

        All this because Dr. Jill Biden, whose life as an educator has been devoted to at risk children, went to Mexico with a group from Catholic Charities to deliver small Christmas gifts and meals to migrants in Matamoros, by any definition, one of the most dangerous places in Mexico (maybe the world!) for anyone, never mind migrants with no political standing or protection.

       For those who have never been exposed to this harridan’s scribblings, here’s where she typically stands on these issues:

*Any immigrants since she, herself an anchor baby born to a Filipino work-visa couple, are unwelcome.

*Catholic Charities, who is involved in feeding and resettling immigrants is a scam.

*The Pope is equally guilty because he delivered a Christmas homily containing a condemnation of the exploitation taking place in such immigrant camps as “immoral.”

        She then of course repeats her favorite shibboleth – “open borders,” a lie she applies to anyone opposing the current custodial status of immigrants in America. Along the way she repeats the term “immigrant chaos,” which, if it exists, is the result of Trump policy changes which reversed Obama policies which had proven far less expensive, far more humane, and best of all, far more effective.

        She then resorts to a Trumpish tactic, in that she singles out an incident in which a Mexican gang member shot and killed a California policeman in a traffic stop which turned fatal. Malkin then even lambastes the Judge, who bound over the shooter for a competency hearing as "too soft," although the detainee later was fit to stand trial and has been charged with capital murder. 

       Here’s what Trump said at the time: “America’s heart broke the day after Christmas when a young police officer in California was savagely murdered in cold blood by an illegal alien, who just came across the border.” So, what’s wrong with that? Start with the fact that the shooter had been in the US for 7 years, which is hardly “just came across.”  This is Malkin repeating Trump's grandstanding.

        So, what’s the “truth” (if it is determinable) about crimes committed by immigrants? While it is difficult to determine, the non-partisan, but Conservative/Libertarian, CATO Institute has done a significant data gather and it is revelatory. Up front, Texas is the only state which breaks down all crime statistics by immigrant/non-immigrant status, but since its entire long southern border abuts Mexico, it is also most likely the best environment for such studies. I will post a link to the entire article, but here’s a small excerpt: “The Texas research is consistent with the finding that crime along the Mexican border is much lower than in the rest of the country, homicide rates in Mexican states bordering the United States are not correlated with homicide rates here, El Paso’s border fence did not lower crime, Texas criminal conviction rates remain low (but not as low) when recidivism is factored in, and that police clearance rates are not lower in states with many illegal immigrants – which means that they don’t escape conviction by leaving the country after committing crimes.” 

        This is but small sample of what are very involved studies beginning as early as 1911 and continuing today.  One other conclusion from multiple studies in all border states is that crime rates are universally lower in immigrant communities regardless of legal status.

https://www.cato.org/blog/illegal-immigrants-crime-assessing-evidence

       My point here is that by picking one instance where an illegal (and a very bad guy) committed a heinous crime and extrapolating that singular and violent event to the entire group is simply bad statistics and racist bullshit. If I were to use the same tactics, for example, I might announce that Ms. Malkin was, in all likelihood, a hotel chambermaid, since many immigrant Filipinas ply that occupation. One more example of the meaningless nature of this statistic might be to state that since most anti-Semitic hate crimes are committed by white self-professing Christians, we should ban the religion. How odd, that the Trump administration and its sycophants bewail a statistically insignificant number of violent crimes committed by undocumented immigrants but are willing to do nothing about the flood of easily accessible firearms and automatic weapons which are overwhelmingly the implements of these rare events?

         How sad that, while Ms. Malkin bemoans the deaths of two Law Enforcement officers killed by undocumented immigrants, she displays no remorse for the more than 30 immigrants, seven of them children, who have died in ICE custody since the Trump Policy shift. Interestingly enough, these include not only Mexicans or other Central Americans, which are the principal focus of Ms. Malkin’s racist disdain, but Vietnamese, African, Russian, and several Southeast Asians as well.  In spite of this she also supports the idea that volunteer doctors who offer measles shots to detainee children must be deterred.

       This loathsome woman, herself the child of immigrants and what is sometimes derogatorily referred to as an “anchor baby,” should be ashamed…. but she will never be.           

Happy Holidays

Theology: “Religious beliefs and theory when systematically developed.” By????

        There is an anomaly I've noticed more and more recently that simultaneously amuses and bothers me. When I see the haters, the Trumpists and Franklin Grahams, the Uber Patriots, the anti-choice, anti-health care, anti-LGBT rights, in fact pretty much anti-everything persons who abound these days, I find one other salient fact. If you were to ask these persons about their spiritual beliefs, if any, the vast majority would loudly proclaim their muscular, Evangelical Christianity.  In those cases where that is not so, they (Donald Trump, who actually believes he is God) are still sucking up to that demographic in the never-ending quest for votes.

        This confuses me because even the most rock-ribbed Southern Baptists, snake handlers and who knows what else handlers claim that their religion is founded on free will. This should mean, as I understand it, that they believe that every believer should be free to make their own life choices and (I guess) face the judgment music when they die.  If this is true, then why, oh why, oh please tell me why, they are so damned determined that even if they have this "free will" (and they don't, watch a Joel Osteen , Franklin  Graham  or TD Jakes at work and it's obvious they are herding and milking sheep) that free will extends only to them and those with whom they agree. In truth, the Free Will concept itself wasn't some revelatory bolt from the blue, but was simply a theological "nanny, nanny, boo boo" at first by Baptists and Methodists to Presbyterians/Puritans/Calvinists (same bullshit, different name) who espoused Predestination. This seems to revolve around some sort of demented interpretation which goes along these lines: “I have the free will to believe exactly as I wish, and I also have the free will to insist that you believe that way too.  This becomes especially amusing to me when these Bible thumping literalists hijack holidays and enshrine them in some sort of “dogma dome” where we all can be treated to their precise historical and religious significance, as well as the moralistic fables surrounding their origins. This is resonant at this time of year because history is lost in the translation.    

  

      Trust, however, that most Evangelicals are unaware of much theology other than what their local shaman tells them. There's a dirty little secret their leaders don't want their sycophants to know. There is essentially no theology in the Bible. In fact, reflective of this belief, while it is little known, Boston banned all Christmas celebration for part if the 17^th century. I know, I know, “But Mike, the Pilgrims……!” Really? Not so much.

       After the Puritans in England overthrew King Charles I in 1647, among their first items of business after chopping off the (Church of England, but secretly Catholic by then) monarch’s  head was to ban Christmas. Parliament decreed that December 25 should instead be a day of “fasting and humiliation” for Englishmen to account for their sins.

        The (primarily Puritan) Massachusetts Bay colony residents responded in kind. The Puritans of New England passed a series of laws making any observance of Christmas illegal, thus banning Christmas celebrations for part of the 17th century. A Massachusetts law of 1659 punished offenders with a hefty five shilling fine.

        In their strict and fundamentalist interpretation of the Bible, the Puritan elders noted that there was no scriptural basis for commemorating Christmas. The Puritans tried to run a society in which the civil laws would not violate anything that the Bible said, and nowhere in the Bible is there a mention of celebrating the Nativity. The Puritans further noted that scriptures did not mention a season, let alone a single day, that marked the birth of Jesus. Apparently the grinch who stole Christmas was really John Calvin!

        Yet another example of supposed religious piety related to Massachusetts is the Thanksgiving concept. While it has morphed into a generally broad day of reflection and thankfulness (except for losing football teams), there is significant historical uncertainty regarding the origins of the holiday. Perhaps the most accurate description of the “first” thanksgiving, is an account by one pilgrim in a letter which holds that the colonists had not originally invited the Indians, but that in the general 1621 harvest glee of “Hey, we’re still alive,” guns were fired and local (at that time at least “not unfriendly”) Wampanoag  Indians came to see what all the noise was about. Once there, they stayed for the feats and an uneasy, but peaceful, day of food and coexistence ensued. That is the model we choose to tell our children, minus the uneasy truce part.

       Tragically the legislated history of Thanksgiving in New England is much darker.  That celebration in 1621 did not mark a friendly turning point and did not become an annual event. Indians who were convinced to live in “praying towns” were few but were allies of the colony, which had grown, settling in the area of what is now Boston while gradually inching farther west.  By the 1630s, there were more than 20,000 settlers in Mass., the vast majority Puritan and, especially as new lands to the west and in non-Christian Indian lands became bones of contention, relations between the Wampanoag and the settlers deteriorated, leading to the Pequot War. In 1637, in retaliation for the murder of a man settlers believed the Wampanoags had killed, they burned a nearby Indian village, killing as many as 500 men, women, and children. Lost in the fog of war is the fact that this village wasn’t even Wampanoag, but Pequot. 

        Following this massacre, William Bradford, the Governor of Plymouth, wrote that for “the next 100 years, every Thanksgiving Day ordained by a Governor was in honor of the bloody victory, thanking God that the battle had been won.”  In other words, as Wounded Knee would become in 1890, so the slaughter of non-Christian Indians by “praying town Indians,” other tribes who resented the Pequots’ successes, and Christian Colonists’ was celebrated and commemorated as a righteous and even divinely aided victory.

       In the aftermath, a few surviving Pequots were enslaved and shipped to Bermuda or the West Indies or were forced to become household slaves in English households in Connecticut and Massachusetts Bay. Even fewer escaped across Long Island Sound to Long Island. The Colonies essentially declared the Pequots extinct by prohibiting them from using the name any longer. Their real sin? They had controlled the wampum trade with the Dutch. This was resented by British colonists as well as the Mohawk and Narragansett tribes. So, praise God for a success in a commercial war!

        It seems that the free will "clause" is invalid for others, Christian and non-Christian alike, who are fair game for all the petty judgmental pronouncements of a Mike Pence, Mike Huckabee, Bobby Jindal, Dinesh Desouza, Rick Santorum and the rest. Interestingly enough in a sidebar, Pence, DeSouza and Jindal are converts from older, but equally intolerant, religions.  Apparently, the process of conversion requires the ingestion of a gullibility and intolerance pill.

        Leaders in opposing LGBT rights, Women's right to choose (and actually women's rights in general), humane treatment of immigrants, and the litany of things which apparently are not subject to free will seem overwhelmingly to share this strident, whiny, hypersensitive and censorious Christianity, while piously celebrating two holidays whose history is, let’s just say, less than actual.  If Jesus as he is portrayed in the synoptic Gospels were to see what the Apostle Paul and his successors have done to the message, he'd open a can of celestial whoop ass!

Another Bogus Meme

Figures Lie and Liars Figure

The above meme was posted to Facebook by a well-meaning, but woefully under-informed friend. I am no fan of most of Congress, and have been explicit about that numerous times, but we stoop to “their” level when we are complicit in furthering the spread of nonsense such as this meme.  My response follows:

This is absolute drivel. Every figure herein is incorrect. The President gets about $210,000, annually as a pension, which is miserable compared to almost any CEO of a company for either 4 or 8 years. Compared to numerous head football coaches and failed CEOs who get multi-million-dollar buyouts after failing, it isn’t all that much, considering the responsibility entailed in the job. For example, after failing at FSU, fired coach Willie Taggart will receive $17 million. Again I'm referring specifically to the job (The Presidency), not the oafish lout currently holding it.

         As for Congressional pay/retirement:  By law no member of Congress gets (or can get, or has ever gotten) their full salary (which is what this meme shows) for life. In fact, no member of Congress can ever, no matter how long they serve, get more than 80% of their base pay in annual retirement and then only at age 62 (or upon retirement if they have served 25 years). As a point of interest, the average age of a Freshman Congressman is 49, which means that they will only have served 13 years by age 62. 

       Congressional retirement is based on number of years served X 2.5% of their High three. Example: a 5 term Representative will get about $43,000 in retirement at age 62, even if he’s voted out of office at age 45.

         Members of Congress also must contribute full SS and another 8% of salary to their retirement. For example: a three term Senator (18 years) will be paid $78,000 in retirement at age 62. He will, however, have contributed about $250,000 to the system. There are currently 335 former members retired under the current system and they average right at $74,000 annually. Each member, by law, will have paid just under $14,000 annually into their own retirement. Also, there is a five- year vesting period, so a two term Representative gets ZERO retirement and will have paid $56,000 they'll never get back. Similarly, they are all required to buy their own health care coverage, and many use the Civil service Employees group, plan. There is no Congressional “free health care” plan.  

        Furthermore, average US Social Security payout is $17,400 annually, not $12,000. The use of “seniors” is redundant, as all on traditional SS are seniors. Of course, the meme implies that this is their only income, while in fact, for 2/3 of them,  it is just a portion.  

         The actual military pay quoted is even more ridiculous. Let's consider an E-5 (Army Sergeant, lower level.) For the sake of this example, assume he lives in Orlando, has 6 years in service, is a full time National Guard member and is deployed to Afghanistan. (the numbers could be even higher in other localities). 

       His base pay is $36,012 annually. His (or her) Variable Housing Allowance (VHA), (married) is an additional $2475 monthly. This VHA is even higher in other regions, The same E-5 whose family lives in Brooklyn would get an additional $38,808 annually over and above salary!  Combat pay is another (untaxable) $225 per month, family separation allowance is another $225 per month, and basic allowance for subsistence is $370 per month. All in all, the Sergeant makes about $75,000 annually. In other words, double what this ludicrous meme implies.

        This also ignores the fact that if he re-enlists, he could get as much as $72,000 in reenlistment bonus. (it's even more if he's Navy in certain specialties!)

        The service member is also vested in a non-contributory 20-year retirement program. which he can access at, say, age 40 as a 20-year retiree. Assuming he's an E-7 by then (I was an E-9) and retires at exactly 20 years’ service, he'll immediately get over $30,000 annually in just basic retirement, and is eligible for about another $10,000 worth of annual medical insurance benefits. This means the enlisted military retiree, at age 40, can expect to draw just under a million (about $900,000) dollars in retirement before the retired Congressman is even eligible.

        Finally, a low-average achieving military officer (O-4 in 24 years) will out-earn most retired members of Congress starting at, for example, age 45. He'll earn about $70,000 in retirement and medical coverage (not to mention that he will probably get another job and earn even more. This is in no way to be construed as if I'm an admirer of Congress. You all know better, but I am an admirer of truth, which this meme sorely lacks.

        One last piece of real data: Congress has not had a pay raise since 2009. During that period US inflation has reduced their effective purchasing power by 19.9%. That means the quoted $174,000 now has the purchasing power of about $141,000 in 2009 dollars. Meanwhile, military pay has been raised by 17.1% over the same period, and retired pay has, as well. So no, Congress isn't fattening their purses compared to other federal employees. The truth is out there, as Fox Mulder so famously said, it simply isn't anywhere in this meme.

What You Think You Know Isn't Always the Truth

We hear the rhetoric. What are the facts of the matter?

        The measure of any health care system should be first and foremost, in my opinion, how soon can I get care when I need it? Right behind that is “How good is it?” In other words, “In comparable countries, what percentage of adults have quick access to a doctor or a nurse when they need it?”

         Real data (not partisan bloviation and rhetoric) shows that the average number of persons in comparable countries who were able to make same or next day appointments was 57%. Germany (53%), France (56%), The UK (57%).  Australia (67%) and the Netherlands were above that number with the Netherlands at 77%.  Health care consumers surveyed in the UK were 10% more likely to respond positively than those in the US. US was 51%, below the 57% average.  It is noteworthy that all these nations except the US have some sort of mandatory health care provision, private insurance, national health care. or what have you.

  

        Another survey was run to determine what percentage of initial care necessities was an emergency room visit vice a regular doctor visit. Again, results were not surprising, with the US and Canada significantly more likely for an initial care option being an ER. This is not totally unexpected in Canada, which has a very scattered population in a very large area at just around 10 persons per square mile. The USA, while less dense than most European nations, has more than nine times higher population density at 95 per square mile. This is mentioned because the US still has 16% of initial medical care incidents at ERs, while Canada is at 17%. Sweden, which has a relatively low population density (48 per square mile) with much of it rural, still uses ERs 25% less than the US. The UK has less than half the percentage of initial care ER visits as the US.  

        In another survey using the same countries, of which all but the US have some form of national health care provision, the question was asked (actually data was pulled) “What is the frequency of medical, medication and lab errors.” The period surveyed was 2014-2016. The results, considering that we are bombarded with “the greatest medical care in the world” claim by numerous US sources, were depressing. The US led all surveyed nations. The average percent of adults who have experienced these issues for all comparable nations was 12%. Over the same time span it was 19% in the USA (that’s 40% worse!). UK, Germany, Australia, France and The Netherlands were all below that 12% average figure.   

        For whatever reason, from the same survey, the USA rate of suture ruptures (eew)  per 100,000 discharges was twice as high as the next highest nation – Australia. The UK and Switzerland were even lower.

        Finally, I took a look at what is frequently generally put forth by advocates of comprehensive national health plans as their greatest advantage – preemptive and preventive care by general practices before issues become critical. The question was asked (of hospitals, and medical professionals, not patients), “How does the frequency of hospital admissions for preventable diseases vary by comparable nation regardless of healthcare system?” Again, as a personal note, I would propose that the system, whatever it be, which catches possible medical issues first and treats them earliest is the best.  

        Again, the answers were not unexpected but were sobering to say the least. The form of the survey was to analyze four common diseases common to all surveyed nations on the basis of how many admissions were there per 100,000 population ages 15 and older. Results were tabulated by comparing USA numbers (percentages)  of admissions to comparable nations, specifically Australia, Belgium, Austria. The diseases analyzed were Congestive Heart Failure, Asthma, Hypertension (high blood pressure), and Diabetes. Expressed as percentages of hospital admissions for preventable/controllable diseases the numbers are" Congestive Heart Failure: admission percentage -USA 48% higher, Asthma – USA 110% higher (!!), Hypertension – USA 90% higher. Diabetes – USA 35% higher.

        So. what’s the “takeaway” here? Regardless of the mode by which other nations with comparable economies and population types insure all residents are covered by health care, (and it varies more than most Americans realize), the average nation with some sort of universal health plan or system does far better (and for less in most cases) at providing care and services. This is even clearer when looking at the data. Early and/or preventive care (family practice, GPs, etc.) reduces percentages of emergency interventions required.

        A spin-off the above is that preventive measures are almost always far less expensive than ER visits and reduce hospitalizations, in many cases eliminating them with early intervention.  In like manner, quicker access to care allows early intervention. As for “wait” times: opponents of national health care are quick to cite long wait times to see physicians as if it is universally true. It varies by country and population density. The UK National Health system “shoots” for 15 days or less to schedule a non-urgent doctor’s appointment. At present, this year (2019), the NHS is averaging more like 18 days. Remember, this is to see a doctor in a non-emergency situation.

        I know, you’re thinking, “18 days?” Wow, we sure have it better here! Really? Try this on:  The wait to see a doctor is longer in  Boston, where the average wait is 52 days to schedule an appointment with a family physician, dermatologist, cardiologist, orthopedic surgeon or obstetrician/gynecologist.     

       So, the next time you hear someone blast universal health care, step back, recognize their ignorance, correct them if that’s a reasonable option (which it almost surely won’t be) and smile sweetly, knowing that you know better.

All the summaries and interpretations of data in the above are from a Peterson-Kaiser Health System Tracker, the section titled “Commonwealth Fund International Health Policy Survey.”

Head Shakers 12/9/2019

More Things Which Make Me Shake my Head.

        Having heard from any number of Orlando friends of several rather egregious examples of boorish theater behavior at a venue which deserves better, let me begin by mentioning that we rarely, if ever see, that sort of latter-day rudeness here in The Villages. I’m pretty sure that’s because we’re an older crowd, generally, and that, for most of us who attend Broadway style productions, this ain’t our first rodeo! That said, it is interesting that the staffers of the local newspaper, generally an OK paper except for a rightward slant, are far younger than their readership in many instances.

        This is usually of little consequence when it’s high school sports, golf, national news (no local columnists, all AP feeds), regional news or state issues. However, today’s paper featured a theater review which pointed this lack of sophistication(?) out glaringly to me.

        Saturday we (Emily and I) were treated to as good a Broadway musical from a performance standpoint, as we have seen in some time. As one of the first stops on the current “Beautiful” national tour, which will play Orlando next year, we were treated to what I found to be a terrific “book”
adaptation of what could easily have become just another jukebox musical. This is largely because the events and persons portrayed are, or were, (unlike, say, “Mama Mia,” “Rock of Ages,” or “Movin’ Out”) real people, involved in the actual story and portrayed as themselves.

       Having said all this, I noted the review featured a photo (at least 5 X 7) of the superb female lead, Kennedy Caughell, at the grand piano as she begins (and ends) the show. I read the review, which limned the story line in much more detail than necessary and, as I finished, it struck me that nowhere in the review was the star (Ms. Caughell) identified by name. For that matter, none of the principals was identified.  Similarly, not one individual performance (and there were several noteworthy ones) was cited. Oddly, the reviewer did identify legendary producer Don Kirshner as “Donnie” Kirshner.

        I wondered what this young lady (the reviewer, perhaps 25 or 26, and a pleasant young lady with whom we have conversed previously) would have done with “Funny Girl.”  Would she have mentioned the young ingenue who played Fanny Brice? I’m not sayin’ Kennedy Caughell is another Barbra Streisand (yet), but she’s a superb actress who can sing her face off. Too bad you’d never know that from the review.   

        In more typically Floridian news, (and unsurprisingly, South Florida) a Fort Pierce man came home after a brief shopping excursion to find a woman unknown to him wearing a pink shirt and drinking soda from his fridge. When the sheriff arrived, she said she was hungry, so she was looking for pizza ingredients. She acknowledged also using the bathroom and picking up the man’s debit card “on accident.”  She is currently in custody on burglary charges. It must be something in the water.

        In the “Just how long before bankruptcy?” category, plans have been announced for the November 2020 opening of an “Alpine Village” at Dade City, Florida (of course.) For the uninformed, this is actually south of Orlando. There are no Alps, or even moderately large hills in the area. No worries, though, plans include a 60-foot-high, 400-foot-long “snow tubing” hill (yeah, I said snow!) with a “magic carpet” lift to take intrepid tubers (note the rhyme here with “goobers”) to the top. Really?  

        Am I the only one who finds Melania Trump’s anti-bullying rhetoric strangely at odds with her husband’s daily tirades and belittling “tweets?”  Or is it just a thinly veiled plea for help?

        And, finally on sadder note: we are all diminished by the passing of Caroll Edwin Spinney. While the name is relatively unknown to most of us, his creations are part of our collective histories and are well known to all who ever watched Sesame Street or any other Muppet endeavor.

        Caroll Spinney was a puppeteer, cartoonist, author and speaker, but was most famous for playing Big Bird and Oscar the Grouch on Sesame Street from its inception in 1969 until 2018. He, as a principal collaborator with Jim Henson, invented and performed both the large, goofy, 8 foot, 2-inch, tall, canary yellow, Big Bird and the trash can dwelling, curmudgeonly Oscar, for just short of 50 years.  Mr. Spinney, also performed his characters in live concerts around the world and at the White House many times and was featured in films, documentaries and record albums. He died on Sunday at his home in Connecticut. He was 85.

Poor Pharma!

"Speaker Pelosi's drug pricing plan would siphon $1 trillion or more from biopharmaceutical innovators over the next 10 years. CBO's preliminary estimate found this bill ‘would result in lower spending on research and development and thus reduce the introduction of new drugs.’"

— Pharmaceutical Research and Manufacturers of America on Wednesday, November 27th, 2019 in an ad in the “Politico Playbook PM” newsletter.

 The above statement was issued of course, by the drug companies’ lobbying arm and awarded a “Mostly False” rating by PolitiFact, the closest to a neutral observer I’ve found. The PolitiFact article dealt with, to a large extent, the uncertainties related to estimating  the real numbers of potentially undeveloped drugs as well as the $1 trillion estimated ten year cost of doing the most common sense thing imaginable, currently prohibited by Medicare part D plan, which has been flawed from inception.

         What, you ask, is this drug cost panacea? It’s actually elegant in its simplicity. Allow Medicare to bargain drug prices. What? You mean like every other single health care provider in the nation?  Yep. That’s all. Just allow Medicare to compete with every other insurer and negotiate drug pricing. Banning this was a Bush 43 concession to Big Pharma which was lobbying against any Drug plan. I’ve written numerous times on this topic, so in a very brief synopsis: While private insurers and even the VA dicker with drug manufacturers for lower than “sticker” price on drugs, Medicare is prohibited from doing so.

       One quick and relatively current example: Epi-Pen. Mylan Pharmaceuticals jacked the price by about 100% not so long ago. Let’s take a round number price for a 2 pack.  An Epi-pen list price for a two-injector package is about $700 today. If an individual on Medicare with part D drug coverage is prescribed Epi-Pen (a lifesaving remedy for some), between the plan and the copay, Mylan will make $700. If the patient sees a coupon (many of which are issued by Mylan, whose actual cost per injector is well under $15) they cannot use it. Medicare must be paid full price. On the other hand, the veteran’s Administration pays well under $200 per 2 pack. Meanwhile at CVS, with a free coupon (not available to Medicare users!) on the GOOD Rx website, I can get the same Epi-pen 2 pack for $141! Even without a coupon, Mylan also sells a generic epi-pen for a mere $400 per two pack. But wait, as they say, there is another brand, just as effective, Adrenaclick, whose manufacturer makes a generic version which sells at CVS for $110 per 2 pack. Of course, most doctors prescribe Epi-pen and so Medicare pays the full price minus co-pay, which the Medicare “beneficiary” must cover.

        Understand this: In just this one instance for the Epi-pen generic which now combined with its name brand partner, has 80% of the auto injectable epinephrine market, The Government pays well over 100% more than most non-Medicare patients pay!    

How does this relate to total US drug expenditures?  With 15% of Americans on Medicare, Medicare drug spending is grossly disproportional to that population share. Part of this is related to the older population segment in question, but here’s the rest of the story. More than 155 million American industrial workers currently avail themselves of employer provided health care plans. They (in conjunction with their insurers, who strenuously bargain drug costs!) pay 40% of all US Drug spending (2016 data). With about 50 million currently enrolled on Medicare, Medicare paid 39% of that same spending. Understand this: about 44 million Americans, those under Medicare’s bargaining restrictions, paid the same total amount for drugs as 155 million Industrial workers under employer insurance.

        The above is significantly impactful in several other areas as well: Those opposing “Medicare for all” (I prefer National Health Care) cite the current overall cost as a major deterrent, However, they fail to consider the effects of a 50% reduction in drug spending which eliminating part D restriction would accomplish.  In 2016, Medicare drug spending was $128 billion. Reducing that cost by half, would generate, over ten years, $648 billion, or 2/3 of the trillion cited in the Big Pharma sponsored article. That figure is not unrealistic, considering how much lower insurers bargain prices.

        How to save, for the poor pharma industry? Here’s an idea. As of this year, only one other nation, New Zealand, allows prescription drugs to be advertised DTC (Direct to Consumer). US Pharmaceutical companies spend $6 billion annually doing so, even though 79% of senior US medical doctors call it “Not helpful.”   Eliminating this “not useful” advertising would save $60 billion over ten years, which gets us to $700 billion plus. As a point of interest, the two leading single expenditures per drug are Cialis and Viagra.  But the $6 billion DTC dollars is peanuts compared to Pharma’s “treats” to the medical community.

        Overall Big Pharma, between cute drug reps and freebies of all sorts including drug samples, spends another $20 billion annually. This is another $200 billion over ten years. We’re close to the dreaded $1 trillion mark, and haven’t even dealt with what may be the most mendacious of this whole series of Pharma misstatements, which is that, while they are fond of citing R & D expenditures, thy omit the fact that many new drugs  are actually developed by university researchers with NIH grants (yep, our money!)  In many cases the Pharma company buys the patent from the school or the researcher depending on various criteria, and then simply markets it after secondary testing and FDA approval. Gilead’s Harvoni ($84,000 if Medicare pays for it, much less with good private insurance) is a case in point. The developer at Emory University, who worked with an NIH grant was paid $4 million for his efforts by Gilead. We (the citizenry) should “own” that patent. By the way, the generic of Harvoni ($84,000 for twelve pill Hep C cure) sells for $127 for the same cure in India!

       Another Pharma money saver? Stop leading the nation in Congressional lobbying giveaways. It isn’t close for second place either. Or, realize that a 25-30% net profit (they guys at the top make that) at the expense of the rest of us is abusive. It’s almost corporate loansharking. As it currently stands, Big Pharma is fleecing the nation via Medicare drug pricing and a host of lesser but significant evils. Now they’re whining for their right to keep doing it.