Policy differences in the Trump cabinet. How to speak about Muslim terrorists.

http://www.foxnews.com/politics/2017/02/25/trumps-national-security-adviser-reportedly-says-label-radical-islamic-terrorism-not-helpful.html

Multiple members of Trump's cabinet have expressed opinions which differ substantially from Trump's. For example Mattis on enhanced interrogation, and Tillerson (and others) on climate change. I could site many other examples. The news media generally has been reporting these conflicts as evidence of disarray bordering on incompetence. Most of us who support Trump see this tolerance of differing points of view as a highly positive quality. It indicates that Trump is choosing advisers based on what he feels are their capabilities and not based on their slavish alignment with his thinking.  (Of course no one thinks alike on all issues so that someone who appears to be doing so would be hiding his true opinions). I suspect that this has been his management style in his business as well, presumably a key to his success. It is also a good thing that differing points of view are allowed to be expressed openly, and not just in private. This stimulates open public discussion which is one of the strong keys to success in a democracy.

It seems to me that this was not a strong suit of the Obama administration, that is that one rarely heard any reports of internal disagreement. This was not to their advantage. For example there were these quiet reports that Hillary (and others) disagreed with the total Iraq pullout, which turned out to be disastrous. Her inability to stray from the party line and make this point during the campaign I think was to her great disadvantage.

My second comment is on the Islamist issue. I can see McMaster's point but I disagree with it. Of course the great majority of American Muslims who accept American values are fine people who are just interested in a good life for themselves and their families. On the other hand, although I have never read the Koran (English spelling) there is this thing they call Sharia law which seems to be fundamentally opposed to western ideas of individual freedom and equality. That these concepts are not just antique symbolism not to be taken literally, as in the Hebrew bible, is indicated by the strict adherence in some Muslim countries such as Saudi Arabia where women are subservient, there is no religious toleration and social deviancy is subject to severe punishment. Apparently this extreme interpretation of the Koran includes capital punishment for those who express derision for Mohammed or for apostates from their religion. There are a great many Muslims in the world and it is my understanding that there is a sizable portion, perhaps even the majority who favor these ideas, even if they do not themselves carry out radical behavior. So with these people there is a clash of civilizations. If they were to simply stay in their own territory and run their civilization as they wish that would be one thing, but some very small, but lethal, proportion are not content with that.

President Obama (and President Bush as well) adopted the policy of minimizing this conflict so as not to offend those Muslims who are content to accept western values and hopefully to recruit them to help in the battle. As it turns out I don't think this has been an effective strategy. In fact the reluctance to forthrightly name our enemy seems to many to have inhibited our response and led to more calamity. Trump's idea, and I and many others agree with it, is to point out that there are 2 kinds of Islam, the modern kind that adheres to the good aspects of Islamic teachings, that correspond to the principles of peace and toleration advocated by other religions, and the abhorrent, fundamentalist kind that teaches a violent intolerance of those who do not accept Mohammed's word as expressed in at least some parts of the Koran.

I think this debate, stimulated by the differing opinions in Trump's cabinet, might hopefully lead to something of a compromise in Trump's polemics. He should state loudly and clearly that our country is freely open to the adherents of all religions as long as they accept western values of freedom, tolerance and equality. (We went through this same debate on a smaller scale 55 years ago with Catholicism when Kennedy was elected.) But at the same time we will adamantly reject those who wish to come here who do not accept our values and wish to change us to their system, sometimes by violence. And he should call on the "good" Muslims to help us in this fight, more openly than they have up to this point, by strongly condemning the radicals and by helping us to identify and remove from our midst, or possibly even to reform, those who do not accept our values.

Where am I going wrong??

The Russians, our election and federal control of health care

The Democrats, and some Republicans who favor the status quo, have been in shock since the election. As a manifestation of this the amount of vitriol directed toward the new President and his many supporters is unprecedented. Also the losers have been intensively pushing the narrative that Russian interference with the election, in collusion with the new administration, is responsible. Of course the Russian government, as well as many others, have been spying and playing dirty tricks on us for years as we have in exchange. This is all public knowledge. Nevertheless until the election the Obama administration for the most part was accommodating to Russia and Putin. They tried the Russian reset. Early on they aborted the planned missile defenses in eastern Europe. Very little was done to prevent the takeover of the Crimea or the overture in the Ukraine. And famously President Obama assured Vladimir that he would be more flexible after the election. But it was the 2016 election result that irked President Obama into expelling Russian diplomats and imposing economic sanctions on some of its citizens.

But if the Russians truly favored Donald Trump and exposed the emails of John Podesta and the DNC to help him, it did not turn the election. The emails verified things that were already assumed to be true, namely that political parties and politicians tell their constituents what they want to hear but say and do the opposite in private. They confirmed the obvious fact that the major news media heavily favor the Democrats and do what they can to help their cause. But it was not the emails of John Podesta or the knowledge that their newspapers favored Mrs. Clinton that induced the good people of northeast Pennsylvania, who have a 3:1 Democrat registration preponderance, to vote to elect Mr. Trump. The election surprise was the culmination of the growing dissatisfaction in much of the citizenry with the direction in which our country has been heading and the blame was placed squarely on the progressively intrusive dysfunctional activities of the federal government.

The federal interference has been involving many areas of our lives, and about these I have my opinions as much as anyone else, but no real expertise. In the medical area I can speak with some authority since I have done a number of types of medical practice in my career and have watched the federal involvement almost since its beginning. Our government has for decades been collecting tax money to finance the medical care of a large mass of citizens who are well able to manage their own affairs and would be much better off doing so. At the same time it has often ignored or given short shrift to many needy persons who have suffered medical misfortune. The limited access, very high deductible solution of Obamacare has proved to be unworkable.

The Medicare program, the ultimate free lunch, incentivizes waste and abuse, spends far more per beneficiary than it takes in, and so despite steadily increasing tax levies over the years has been progressively adding to our national debt. In its desperate attempt to control this situation without major rationing of care, the government has imposed burdensome regulations. The federal government is at this point mandating for private medical practitioners what electronic equipment and software they must buy, what types of personnel they must hire, what specifically they must note in their records, what way they must prescribe their medications, and increasingly what types of tests they must perform and what medical guidelines they must follow in their treatments. Incident to this regulatory activity they are taking from patients what they value most, the time and undivided attention of their doctors.

Other federal programs are equally troublesome. Reimbursements for Medicaid patients are often only a fraction of the cost of their care, but at the same time the program is plagued by even more waste and abuse than Medicare. Recipients are routinely provided with excessively expensive treatments that cannot be afforded by those who are footing the tax bill to pay for them. Also the Veterans Administration program is a well-known bureaucratic nightmare and I have personally experienced it when I practiced for a while as a full time VA doctor.

Those who call for a federal government takeover to correct these problems are seriously misguided. Some quote the experience with such plans in other countries. I have studied these things but have no personal experience to report. However I can say with confidence from my experience that there could not be a worse solution for the political entity that is the United States of America.

Those responsible for federal policy on medical care in the Trump administration understand these problems and have good ideas on what to do about them. Nevertheless we have all gradually adjusted our lives to what we have and therefore it is going to be a very, very touchy task to move things to something more rational without causing at least temporary harm. I'll be watching closely and will continue to comment as things unfold.