Would a Wall be Too Expensive

In response to the last post the question of the cost and efficacy of a border wall has come up and I want to address that. 

Protection of our national borders is a truly fundamental legitimate function of our federal government, an activity which could not reasonably be left to the individual states. It is far more legitimate for example than federal involvement in the education of our children or our medical care which should be primarily state, local and of course individual matters. So for border protection the federal government should provide the funds to carry out the job and tax us accordingly. To be sure we are provided with a border patrol and other measures, but it is obvious that our federal representatives and officials for decades have failed miserably to properly carry out this fundamental business. Mr. Trump, despite his personal idiosyncrasies and lack of political experience, was elected to some considerable extent because he spoke up about the fact that the emperor has no clothes. He called out the Washington politicians for their obvious failure in this important area and proposed his own solution and this resonated with a large portion of our citizenry. These comfortable politicians, from both parties, mostly dislike Mr. Trump but have no one to blame for the disruption to their lives that he's causing but themselves. 

So Mr. Trump, as he should, is now forcing the matter. In fact he had to force the members of congress from his own party to address it. So if the time has come to truly face the issue, and I and many others are hoping that the President can hold fast in his demand, the question remains of how to carry out the task. Since we must do it, it should be done in the most efficient, effective and economical way possible. The federal government does not have a good track record in this regard. 

Mr. Trump has proposed a physical barrier which on the surface at least seems sensible. Although the cost would be substantial it would be a one time expense and the amount pales in comparison with the amounts collected and spent by the federal government on its other projects. Under his leadership it's likely to be done properly. Whatever your opinion of Mr. Trump otherwise it must be admitted that he has great expertise in constructing high quality products, brought in on time and under budget. As far as its effectiveness is concerned such barriers are working in other countries, and it's hard to see where it wouldn't help to greatly reinforce the efforts of the border patrol. 

The Democrat leaders resist the concept of a physical barrier. In that they have previously acceded to one, it seems clear that a large part of their opposition is reluctance to give the President a victory. But lets take them at their word that their real concern is about cost and effectiveness and that technology and increased personnel could do the job better. Where are the concrete studies and plans that indicate what specific technology is needed, how it would be deployed, how effective it is predicted to be and what it would cost? And if more border personnel are needed what would be the ongoing cost of that? 

Here's the point! The Washington politicians from both parties have let this problem fester and grow for decades and have done nothing but make promises. It could be that, thanks to the efforts of Mr. Trump, the time has come for them to actually do what they're elected to do. No more Lucy pulling the football out from Charlie Brown as was done during the Reagan administration. Mr. Trump has put his idea on the table and is anxious to get moving on it. If the Democrats in congress feel they have something better other than vague ideas, the time is short but they must get it out there. Let them get busy and pass a law specifying exactly the actions that are to be taken to prevent illegal entry over the southern border, and if it is believable it's likely they'll get public support. Otherwise we're tired of false promises. Personally I don't think they're sincere and that they actually favor the status quo. Until I see something better I say bring on the wall. 

The Battle of the Wall

Well, the great battle of the wall is on. Instead of posting someone else's article, as usual I'm going to say what I think about it.

The fundamental problem is that we have a long southern border past which annually tens of thousands of people come illegally, whose identity, destination and purpose we do not know. Everybody know this, so why point it out. It's because the politicians seem not to appreciate the problem. They say they do, in that for example there are numerous videos on the internet depicting them in the past decrying the negative effects of illegal immigration. It is hard not to doubt their sincerity in that this is a situation that has gone on for many decades without resolution.

Without getting into the arguments pro and con about the illegal entrants per se, as well as the other routes of illegal entry into the country, I think one of the major problems with simply ignoring our porous southern border is that it is a fundamental barrier to our developing a rational immigration policy. This failure of our government is detrimental both to our own citizens and the immigrants themselves.

Mrs.. Pelosi and Senator Schumer both claim to desire border security but are dead set against a wall. I just listened to a talk by Mr. Schumer who claimed the President is simply catering to his far right wing base. This is of course nonsense. Mr. Trump's promise to at long last address this problem by building a wall was a major element of his winning the election. Millions of ordinary citizens sensed that, unlike the usual political claptrap, Mr.Trump would fulfill his promise. Despite his other accomplishments, failure in this area would be a major blow to his support. In fact, if the truth be known, I believe a substantial majority of our citizens understand the negative implications of an uncontrolled southern border, would like the problem addressed, and except for the fact that Mr. Trump wants it, most Democrats would not oppose a physical barrier at least on the vulnerable parts of our border.

So the Democrat leaders are in favor of border security but against a wall. Mrs. Pelosi says it would be immoral. Others say it's too expensive or would be ineffective. These arguments don't stand the test of common sense. But taking them at their word that they really believe what they're saying my response is, what's your plan? Let's hear it. Nebulous talk of high tech sensors, drones, and increased personnel sounds doesn't cut it. Let's have a specific concrete proposal. That's what our elected congress is supposed to do. And if you can't pass a law that specific, then pass a law instructing and giving funds to the President to use whatever means other than a wall he deems necessary to stop people from crossing the southern border illegally. Short of that sort of action it's just the same old political baloney.

You see it's not really a wall that the millions of ordinary Americans are interested in, it's stopping once and for all illegal entry over our southern border. Mr. Trump proposed a wall as an efficacious means to this end and that seems sensible. If there is some equally efficient way that really and truly does the job that's fine with me, but it seems that the President is saying that the time for the political song and dance is over. Sounds good to me.

Solution to the Immigration Problem.

Addressing the illegal immigration problem seems to be pretty straightforward to me. Here's what I think it would involve:

 

1. Prevent people of unknown identity or purpose from sneaking into the country. This should be done in the most efficient and cost effective way. It seems to me that a physical barrier, such as is working well in Israel, is in that category rather than staffing the whole border with razor wire, guard stations and robots, but, hey, whatever works. I would put this as the key item, without which anything else you do falls apart.
2. Have a good guest worker program with regulations that would protect the interests of present American citizens as well as the workers themselves. Any employers found skirting the system would be subject to a very substantial penalty fine.
3. Intensify our visa reporting system. Visa holders should be accounted for. Anyone given a visa would be obliged to report his or her whereabouts periodically and those continuing to stay beyond its limits would be sent home with severe restrictions on any consideration of return. In the digital age there is no excuse for our present laxity.
4. Have a complete review of the criteria for legal entry to the country outside of the guest worker program. We need to have decisions on who and how many immigrants are desirable. I think generosity would be advantageous but there are limits. We already take in a million legal immigrants a year who now make up 1/10 of our population. Except in unusual circumstances it makes no sense to take in those who would immediately be dependent on our public support systems or would simply undercut the welfare of our present citizens. It goes without saying that our regulations regarding political and religious asylum need revision. Asylum is being used as a substitute for economically motivated immigration and everyone knows it.
5. The hard part after this is deciding on the status of those here illegally. Allowing individuals simply to remain here in a limbo status seems to be an absurdity, neither good for the country or for the individuals involved; although I suppose that if all the above criteria were carried out those here illegally would eventually leave or die out, eliminating the issue. The "dreamer" group would be an easy one, but then for the others there should be a mechanism for declaring oneself after rules on how one's case would be handled are clearly spelled out. I think that if illegal entry were actually stopped the American people would prove very generous in this regard, to the chagrin of those who have patiently been waiting in line.
6. For those who claim the solution is to help the Latin American countries become more stable and prosperous I absolutely concur. Just tell us how to do it.

 

I welcome any discussion on these ideas, preferably not that I am stupid, or hard hearted or don't have the right "values". As logical as it seems to me, I'm afraid our dysfunctional congress is going to prefer the kabuki dance over whether we should authorize $5 billion for the wall or shut down the government.

 

 

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Government Follies

 

Interesting story in the paper this morning about some spinoffs from the Mueller investigation. Mueller hasn't come up with anything against Trump as far as we know but now they're finding, in addition to Paul Manafort, a bunch of other Washington insiders, from both parties, making big money from secret lobbying deals with various foreign countries.

 

No surprise folks. The place is a money and power magnet, not really a good place in which to put our confidence. It's why our founders were so skittish about the idea of a strong central government, devising a balance of powers, three separate and equal branches, each with designated oversight over the other two. They balanced the States off against the feds, giving each one two senators and setting up the electoral college. And then they topped it off with the Bill of Rights, just to make double sure they got the point of who was boss. They tried their best but, with all that money and influence funneling in to DC it's not at all a sure thing that their strategy worked. It's a constant battle requiring an informed and educated citizenry. Given the present state of our media and education establishment it's hard not to be pessimistic.

 

But, hey, the feds aren't alone. On another page there was another article about New York State considering the funding of badly needed NYC subway repairs by legalizing and taxing pot. It seems inevitable since New Jersey has done it. No doubt some day soon we'll be hearing radio adds to smoke a little dope to keep New Yorkers riding. Sort of like the adds to help the old folks by playing the lottery, otherwise previously known as the numbers racket. No wonder you don't hear much about the mafia anymore.

 

In another part of the article one transportation expert opined that another benefit of legalizing pot would be that it would help keep people more relaxed when the subway was late.

 

Who needs the funny papers?

 

 

 

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Medicare for All

Among the agenda items of the new Socialist wing of the Democrat party is the concept of Medicare for All. Why not! As a standard Medicare beneficiary I can attest to how pleasant it is. At the time of any medical service I present my cards and it's all taken care of. So if it's this easy just extend it to everyone and our health care problems are solved. Seems pretty simple. 

Before we jump into it though there are a few little details that we should think about. 

Medicare Part A, which pays for hospital and home health, is in the red and the trust fund is expected to run out somewhere around 2026. Part B, which pays for the rest, won't go broke because, even though the recipients pay some in premiums, they only cover 25% of the cost and the general tax fund pays for all the rest. The cost is steadily increasing and continues day by day to add to the deficit. The really interesting statistic is that the unfunded liability, that is the amount that is anticipated to be needed for all present citizens when they reach eligibility but would not be funded by the present tax structure is something in the range of $50 trillion. Whoa!

More than that though, Medicare is structured something like a Ponzi scheme. The money that's paid for my medical services comes not from a fund I've saved up, but from taxes paid by present day young 'uns, thank you very much. That's one big problem because every year there are more and more of us, and less and less of them. When you think about it when everyone is on Medicare, who will be the poor suckers paying the bill? I guess all of us, but hey, if it's running us into debt now when the young majority is paying for the old minority, where are we going with that.  

No problema say the Socialistas. We save money on efficiencies and decreased administrative costs. OhKay?? How economical and efficient is the Medicare we've already got. Well for starters it's going broke and continually adding to the debt. This despite the fact that the percent of our incomes we pay to fund it have been gradually increased to anywhere from 10 to 15 times what they were when the program was started. Doesn't seem that economical to me, about what you'd expect from a government run program. What can we say about administrative costs which a single payer system is supposed to reduce. Well when Medicare started, doctors and other service providers just sent in their bills and they were paid. Now the payment systems are so complicated that doctors actually, quite literally, often take courses to learn how to do the coding that must be sent in to get paid. Why's that? Well what do you suppose happens when you're selling a service where you get guaranteed payment whatever you charge. You guessed it! So now the prices are set and documentation is required in detail that would warm the heart of any tax accountant. If you ever wondered why your doctor was typing on his computer so intently instead of listening to you this is what it's about. He's not just catching up on his emails. 

Now think about what I'm describing, folks. In the old days, when I was a young fella, you went into the doctor's office and he was it, or maybe there was a nurse or a secretary hanging around. But all the people around to check your Medicare number and do the billing and coding and reporting and the scribes and all the IT people, why they're all part of the administrative savings. 

Before Medicare poor people were treated gratis by a lot of doctors. I remember that when my mom called him to see me, my pediatrician, Dr Curtin, would always stop by to see the kids of the poor family across the street. When old folks needed the hospital but couldn't pay they went to Scranton State where they were treated by interns supervised by local doctors who went in to make rounds. Lyndon Johnson wanted to change that, and rightly so it appears, since the poor old folks opted for private care in droves. But ol' Lyndon said he wanted things the same for everybody so he arranged to put the government in change of the medical care of everyone over 65 whether they needed it or not. That worked fine for a little while because then there was plenty of money floating around for the politicians to play with. And for us beneficiaries it's still a pretty good deal. Not many restrictions and very heavily subsidized by the rest of the taxpayers and the national debt. The fit's going to hit the shan someday but, Hey, that's the future, and today's today. Personally I think 'ol Lyndon made a big boo-boo. Yes, help those who are unfortunate and can't arrange to take care of themselves, but leave the rest of us alone. 

Medicare for All? Boy does that sound good. But it can't be done without major destruction to our medical care system. I know, I know - they do it in Europe and Australia, etc so there must be some flaw in my reasoning. Our government really can run our medical care economically and with minimal bureaucracy. That's a subject for another day. All I can say is for the seniors who like Medicare the way it is - watch out!

Thoughts on the Caravan

 

 

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The people in "the caravan" are prima facie not asylum seekers although it appears that this is what they propose to claim if they reach our border. If they were fleeing political or social or religious persecution in Guatemala they have now escaped it by reaching Mexico. They are instead headed to the U.S. seeking jobs and available social services, the same as were obtained by those who preceded them. Some few mixed in are coming for more nefarious reasons. They are unskilled but are young and strong, and who does not admire their predecessor's dogged willingness to do hard physical labor. It is just what many of our forebears did, but in a legal fashion.

 

Their intention is to flaunt our sovereignty en masse since for decades this is what has been done on a more individual basis. Our country's immigration policy has been a sorry joke, fairly difficult for those who are inclined to obey the rules, non-existent for those who are contemptuous of them.

 

The timing of this event is fortuitous, some say purposely, coming just before the primaries. The Dems see it as a political opportunity, placing the onus for addressing the incident squarely on the President, even though it is the culmination of decades of mismanagement, hypocrisy and procrastination by previous administrations and especially a dysfunctional congress. They believe Mr. Trump is placed between the Scylla of preventing entry to a large but unarmed band by physical means and the Charybdis of recanting on one of his fundamental issues. He is an expert in getting around tight situations and it will be interesting to see what he comes up with.

 

Here's the issue, and the stakes are high. If this ploy is successful and the caravanners are dispersed throughout our country to do as they will it's essentially the end of any pretense of an immigration policy. They will be hired by the bottom feeders, attend our public schools, use our ER's and their children will blend into the next generation. Money will go back to the mother country and some of them will go back home to enjoy the fruits of their labors. The signal will go out even more strongly to those left behind that the sky's the limit, the boundaries are down.

 

The Dems and Libs are not raising a peep. It's time to make them say what they think. Do they want to go back to 18^th and 19^th century America with unrestricted immigration, but this time with government sponsored social services and Sanctuary Cities? If not what's their proposal for the caravan? This time it can't be "catch and release", because as we've seen, that's the same as doing nothing. Come on you guys, let's hear it!

The Judiciary Committee Hearing. Dr Ford vs Judge Kavanaugh.

I joined the millions of Americans who were riveted by the hearings yesterday.

 

Dr. Ford's testimony was emotional and seemed heartfelt. As it went on, especially in the face of the creampuff interrogation by Ms Mitchell and the interval sympathetic encouragement by the Democrat Senators, the feeling grew in me that Judge Kavanaugh's nomination might be sunk.

 

Then came Judge Kavanaugh, filled with righteous indignation and emotion over what was being done to him, who strenuously and unequivocally, under oath, completely denied all allegations made against him. My impression was that either he was absolutely truthful or a world class liar, on a par with Bill Clinton (couldn't help that one).

 

What is the observer to decide to resolve this stalemate? Well here's what I think.

 

Dr Ford was entirely believable, in that she seemed to believe what she said. But there are some major flaws in her case.

 

She recalled vividly all the details of her traumatic event, including walking past the others to leave the house. I can't fault her for not knowing where she was. She says the party was impromptu. But she doesn't know who took her there or more importantly how she managed to get home since she must have gotten there by car. Such vagaries of memory seem very strange.

 

She was able to name four of her companions at the party, including her close girl friend with whom she says she went to the party. All of these have given written statements under oath that they have no recollection of the event, including her close friend who Dr. Ford says accompanied her and who later apologized to her about having to truthfully undermine her accusation. The Democrats complain that these persons should be questioned in person, but when you read their statements they are all unequivocal. Dr. Ford herself could give no reasonable explanation.

 

It was brought out clearly in the hearing that her statement that she was unable to give testimony in private to the Judiciary committee due to fear of flying was clearly a falsehood. She appeared embarrassed by this. She also seemed not to know that the Committee had offered to interview her in California. It gives the impression that at this point of the situation she had become under the control of her handlers.

 

Judge Kavanaugh's testimony has to be taken somewhat at face value. However he was able to give some corroboration in the form of a calendar which he kept in great detail about his activities. But there is another useful way to judge. By this time numerous of his close high school friends have spoken on national media to testify about his character during the time in question and universally support him. His subsequent conduct since, particularly his behavior toward women, has also been validated by numerous friends, co-workers, students and his public record. The accusations against him are completely inconsistent with this reputation and don't jibe with the normal human experience of consistency of an individual's character.

 

I think those who come out worst in all of this are the Democrat Senators, particularly Senator Feinstein. It seems obvious that when Dr Ford's complaint came to their attention, that they determined to use the situation to their advantage as a political weapon. Probably the most telling fact is that Senator Feinstein had a lengthy private interview with Judge Kavanaugh and made no inquiry about the accusation even though she and her staff had already arranged legal counsel for Dr Ford. It seems clear that the Democrats, despite their call for further investigation at this late date, have no serious interest in fact finding, or as Senator Lindsey pointed out, they would have done it long ago. In fact they actively worked at avoiding fact finding by preventing Dr. Ford from testifying to the Committee in private after the accusations came to light. It seems impossible to avoid the conclusion that Dr Ford was exposed and used as a political tactic.

 

 

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Medicare For All Can't Be Done

As a 15 year Medicare beneficiary I can testify to its appeal. With standard Medicare and a supplemental plan one shows his card and by and large that's it. From then on you get high tech care with no direct cost, extremely wide availability of providers and very timely services. The out of pocket costs for the coverage are heavily subsidized and therefore affordable. I don't think any other national plan I have heard of matches it, and I have friends in various countries around the world whom I have quizzed about their circumstances. Once a month I get documentation from CMS showing me the services I have received, the usually grossly exorbitant prices I was charged and  the markedly lower payments that Medicare has approved, assuring me that I have been protected from the storm. Beneficiaries accept the present level of services as they stand and have little appreciation for the waste and inefficiency built into the system. 

What politician of either party worth his salt wouldn't salivate at the thought of providing this benefit to all his constituents. The reason we don't have Medicare 4 All today is that it can't be done. If it could be we would have had it long ago. But the politicians have a big problem. The Medicare system we have now, with all its gross ignoring of the basic laws of economics, is hurtling toward fiscal destruction. The CMS bureaucrats are flopping around like fish in a net trying to discover some new method of service delivery, risk shifting or management technique which would allow them to realize their vision of central control nirvana. 

There is no possible way that Medicare as presently delivered to the seniors can be extended to everyone and they know it. Any attempt would involve unacceptable increases in taxation, as well as major cuts in the availability and quality of providers and services. This would especially be the case if the thing was done wholesale as its proponents advocate so that people could still recall what they formerly had. 

So I think there is time. And as the foundation of our present overall system continues to crumble I think the best idea is to continue widespread efforts to provide working alternative examples of medical care without third party interference, and to vigorously promote and extend the opportunity for individual saving for future medical expenses through HSA's. I greatly fault the Republican legislature for falling down on this end while they had the opportunity. 

The Argument over President Trump

The election of Donald Trump was a shock, both to his enemies and supporters, in the main because we had been led to believe by the major media and pollsters that Hillary's victory was a foregone conclusion. Immediately after the election, efforts began to reverse the result by recounts, attempts to change the votes of the electoral college and calls for impeachment. Failing that, collusion with "The Russians" became the new battle cry, somewhat ironic in that President Obama was overheard whispering to Vladimir that he would be more flexible after his election and generally placated Russia in multiple policy decisions.

 

Those of us who voted for Trump did not do so because of his moral virtue. We had tried this with Mitt Romney, a squeaky clean goody-goody whom the Democrats and media turned into a haughty aristocrat who mistreated animals and held women in disdain. We wanted Trump because he promised in his many campaign policy pronouncements to end the decades long slide of our federal government into a self-serving oligarchy with the concurrence of both political parties. The ideas and opinions of the east and west coast metropolitan areas were dominant and the concerns of the rest of us deplorables were being held in contempt.

 

In less than 2 years the President has more than fulfilled the expectations of his supporters on many levels. This is partly due to his governing style. He has been skillfully able to use tools that were unavailable to his predecessors, social media and other means, to communicate directly with the public, over the heads of an overtly hostile major media cabal. But his enemies are powerful, wily and relentless.

 

Evidence a special prosecutor investigation, purportedly for the purpose of identifying Russian interference in the 2016 election and now gone far afield to the point where it is unmasked as an effort whose obvious aim is to bring down the President. There seems to be little interest in the strong evidence that leading members of our own government's intelligence community themselves consorted to interfere in the election, exonerating Mrs. Clinton and seeking to undermine the Trump campaign.

 

What's going on now is very reminiscent of the attempt of the Republicans in the 90's to bring down Bill Clinton. That impeachment did not work out well, and Clinton was reelected handily. However Trump's sins pale in comparison with Clinton's. Although not the stated issue of his impeachment Clinton was credibly accused of rape and unwanted genital exposure to an unsuspecting campaign worker, things that landed Harvey Weinstein in prison, as well as using his dominant position to take advantage of a 21 year old intern in the oval office itself. Trump's purported dalliances occurred years ago and involved fully adult and consenting women. He took measures to avoid scandal by monetary inducement whereas Hillary resorted to an all out campaign to threaten, smear and destroy the reputations of the women who were Bill's accusers. Failing to uncover Russia collusion the special council has put incredible pressure on some of the President's aides, obviously more directed at catching up Trump than the accused themselves. Now it's said that his past business dealings are being scrutinized. These have been well documented in many biographies but it's impossible that anyone's activities involving years of complex financial and political maneuvering could avoid something controversial.  

 

Trump's enemies, liberals and many establishment Republicans, despise him in particular because he has been so successful in advancing his policies, and broadcast their animosity at every opportunity. His supporters, on the other hand,  tend to hold back, not being consumed by politics and to some extent disliking the invective they receive if they speak out. That's how I have felt about it personally. I don't like the bitter hostile responses, generally avoid them and when they inevitably arise try to handle them lightheartedly. However I'd like to make one serious point. I voted for Mr Trump wholeheartedly. I did not vote for him because of his moral qualities, although generally I don't find them more offensive than many of his predecessors, just more open, and I think most of the charges against him of ignorance and personal prejudice are obviously false on their face. I didn't vote for him because of his flamboyant style, although I feel that much of it is necessary in today's politics, and I find his forthrightness and openness to be a refreshing change in our politics. I, and millions of others like me,  voted for him because I viewed the situation in our country on many levels to have gone seriously astray, especially in our federal government. He campaigned on an platform of doing something about my concerns and so far he has performed much to my satisfaction and I want him to continue. I understand that many others don't agree with that opinion and wish to change course again. That's their right. But Mr. Trump won the election, fair and square, because those like me voted for him. The accusations that outside interference played a role have so far not amounted to much and in fact much has been revealed about possible election tampering by members of our own government that are seriously concerning. Other elections are coming soon and Trump's opponents should focus on trying to achieve their desires through that mechanism and forget once and for all about trying to remove the President from office by other means. In trying to get around the American system they are forgetting that the rest of us are watching, 

 

Medicare, the American Central Payer System.

There is no need to speculate about what American "central payer" would be like since we already have the bona fide model, Medicare, up and running and refined with the government's best efforts for 50+ years. Just as in the other advanced countries, it's so pleasant to simply present your card and all is taken care of. Who can argue that the same should not be extended to everyone. But there are some problems lurking in this scenario. 

Money will be saved say the proponents. And yet the details of Medicare's financial woes are well known but summarized best by the trustee's estimate that the unfunded liability, viz. the amount promised to present day citizens which is not covered by the present taxing structure, is in the range of $50 trillion. Consider that the benefits to today's elderly recipients are being paid for by present day workers. What will be the result of the Medicare for All system that is being called for so blithely wherein the present day funders would as well become the beneficiaries and we would all be paying for each other. Incalculable! So much for the vaunted cost benefits. 

What about the administrative efficiencies. Since there is no fear of business failure, Medicare is not constrained by the problematic actuarial details faced by private insurance. But a major administrative cost of Medicare is in the form of mandated regulatory compliance. Studies abound detailing the massive waste of time and resources devoted to such effort which has only increased over the years. Are we to believe that this will be lessoned by extending the system?

But the most problematic results of our Medicare system are the severe consequences implied in any centrally controlled system that have been detailed by the liberal economists.

 

Prices in the Medicare world have lost their signaling function. Medical providers do not compete to offer the most efficient economical services, but instead attend to maximizing income through fitting their services to the regulations. Medical records now have documentation for compliance as their primary function. Doctors have limited idea of the cost consequences of their decisions and decide based on other considerations. Their patient consumers act likewise and accept anything that is offered that is not too inconvenient or unpleasant. There is no such thing as shopping for the lowest price. 

Prices are fixed by central committees and are often grossly unrelated to reality. Providers rush to perform overpriced services and ignore underpriced ones. Our medical offices actively resist modern methods of communication with patients since only face to face encounters are paid for. How many millions of hours are wasted as a consequence while committees all over the country go through the farce of debating whether telemedicine should be permitted. 

Drug and device manufacturers focus on efficacy and devote limited R&D attention to innovations in manufacturing so that, unlike the computer industry, new medical products are always more complex and more expensive. Like the rest of the system they are focused on what arrangements they can make with the third party payers. And so we have the spectacle of multiple drugs with the same mode of action from different manufacturers that are heavily advertised but with no discernable open price competition. 

As doctors rush in droves to employment with large medical conglomerates which are tapped into government funding how many articles are written decrying the plight of primary care, the pressure to see more patients in less time, the burgeoning number of medical administrators. Who knows what primary care should be? A free market would sort the problem out far better than any expert committee. 

The U.S. is not Canada or England or France. It is a behemoth of a free wheeling, highly demanding, legalistic and contentious public catered to by a very unwieldy, often self-serving political and bureaucratic class. As a model of central payer the anti-competitive, wasteful, inefficient, fiscally unsound Medicare system is the best we can do. To extend it to all would be a disaster and then where do we go. 

Trump, the Democrats and the Illegals

The President acceded to the media storm as well as probably to the
feelings of himself and his immediate family and has now ordered that
the children of aliens caught sneaking over the border may remain in
the detention centers with their parents. The new policy does have
problems in that it conflicts with a previous judicial decision
precluding children remaining in such detention for more than 20 days.
This decision from the liberal 9th circuit appeals court resulted from
a case brought forward by advocates for the illegals so it's unlikely
they will be satisfied by the President's decision. It appears that
what these militants want is a return to the previous policy of "catch
and release" in which those crossing the border without permission
were simply given an appointment for a future court appearance and
released into the country. Very few such persons ever returned for
their hearing, which isn't surprising considering that they felt
comfortable flaunting U.S. law in the first place.

The administration's zero tolerance policy requires treating entry
into the country outside the legal entry points as the illegal act
that it is, in keeping with our immigration laws, as well as those of
most other countries in the world. The cases of those legitimately
seeking asylum from political oppression or violent unrest must be
addressed but it appears that only a small minority fit into that
category and even in such cases asylum seekers are obliged to apply at
a legal entry point. Those caught illegally crossing the border will
now be detained until their cases can be adjudicated, and unless they
are legitimate asylum seekers will be returned to their country of
origin.

The new procedures are costly and time consuming but are in keeping
with the law and make more sense than what went on before. "Catch and
release" has resulted in an influx of massive numbers of unskilled,
non-English speaking individuals into our population whose whereabouts
and means of support are largely unknown. There has been a recent
estimate of 50,000 per month being caught at the border and presumably
many more escape detection. And of course, aside from the recent
furor, the great majority of minors sneaking in are unaccompanied.
Such individuals live in the shadows, often working at low paying jobs
without benefits, with for example their medical care relegated to
emergency rooms or the free clinic where I volunteer weekly (so that I
know something of what I speak).

What the demonstrating "immigration advocates" seem to really want is
unfettered entry into the country. They do not distinguish between
legal and illegal immigration. They seem to feel that the U.S. should
not have the right to determine its own immigration policies. They
hold up signs saying such things as "Humans are not illegal". Under
cover, this view appears to be shared by some in the business
community who benefit from uncomplaining cheap labor. Another major
factor in this situation are the governments in the countries of the
migrants who welcome the money flowing back to their homes as well as
the social problem release valve and therefore seem to encourage the
migration. Mexico, despite its own strict immigration policies, seems
to have no problem permitting a large flux of migrants through its
territory en route to the U.S.

The immigration position of the Democrats is obscure. It appears that
at present they are mostly trying to placate the left wing of their
party since there are widely available past videos showing both Bill
and Hillary, President Obama, Leader Shumer and Speaker Pelosi all
decrying the evils of illegal immigration. They presently are
primarily advocating a rejection of whatever the President wants,
regardless of the fact that the policies he is advancing were primary
reasons why he was elected. But what is it they do want? They reject
the building of a wall, saying that it's too expensive and won't be
effective but their attitude suggests that their real fear is that it
will be effective. They call for "comprehensive immigration reform".
But what does that actually mean? Certainly our present immigration
laws are outdated and should be revised. And the issue of how to
handle the millions of illegal immigrants already well entrenched in
our country is a serious one. But it seems incomprehensible that they
actually favor continuing the situation of easy access across our
southern border of large numbers of unknown individuals, not to
mention drugs and other nefarious things? We know what President Trump
wants. They should state clearly what they want so that in the coming
mid-term elections we will have a basis to choose.

Thoughts on the Big Summit. Trump vs Kim

Successful deals are not successful because of complicated paperwork (a la the Iran Deal). When I was in practice I made lots of deals with other colleagues, including several years of sharing office space with 3 others, and never did anything but a handshake. On the other hand I signed a complicated contract with a big medical company, which I won't name, and got screwed. Deals work when both sides get something they want that they would otherwise not have, not because of complicated diplomacy.

What's in it for Kim. Well it appears that throughout the last 3 administrations the Norks kept working and now have Nucs and ICBM's, and a year ago were showing off their prowess. Their problem, however, is that Trump loudly made it known that if Kim dared to push his red button that it would be the last thing he ever did. (I love it that Trump does his negotiating in public). Kim isn't a religious fanatic like the Mullahs so I don't think that result was too appealing to him, but he could still sell his technology and make a few bucks. But "how you gonna keep him down on the farm after he's seen Paree", or even better S. Korea and Singapore. (How about the background scenes of Singapore on TV.) Trump pushed the real estate value pretty hard and how do you ignore that. I'll bet Kim liked it and has a few visions of sugarplums dancing around in his head.

So what do we get. Well the elimination of an unscrupulous regime with Nucs is a no brainer. But a prosperous N. Korea, less dependent on China for its every breath and morsel of food would also not be a bad outcome. We would like that as well as S. Korea, Japan and the other players in the region, but what about China. It's said they like having a local puppet to screw us up, but I don't know how much of a prize it is with a desperate population and crazy scientists playing around with Nucs right next door. I don't know much about Nucs but they've got to be tricky in the wrong hands. Also I think we have more leverage over China than we give ourselves credit for. Who else is going to buy all the stuff on Amazon.

I think Trump just might pull it off. It's all very public so we'll know soon enough whether Kim is just joshing around. I don't think Trump is in it for a Nobel Prize and that he'll walk away in a New York minute if there's any horseplay on Kim's part. I read his "Art of the Deal" and just finished Conrad Black's biography. The guy is a master strategic thinker and dealmaker and after a year he knows the job better and now has a great foreign policy team. Anyone who still thinks he's a moron and a fool should reconsider.

The "Caravan", Asylum Seekers and The Wall

Here's something that really puzzles me about the "caravan" of refugees from Central America. They worked their way all through Mexico and are now clustered at the border fence just outside Tijuana. Apparently there's an international convention that we signed in 1980 that obligates countries to give asylum to people fleeing violence and oppression for various specified circumstances. According to the New York Times in the U.S. there's been a giant surge in such claimants in recent years, overwhelming the court system that's supposed to decide whether their claim is legitimate. So people are caught and released until their court date never to be seen again.

But here's what puzzles me. Isn't Mexico a country that's subject to the same convention? In fact it's a pretty big country with a moderately successful economy. So if these refugees from Central America have reached Mexico why aren't they seeking asylum there? You'd think it would be better for fleeing refugees to take their refuge in an environment that shares their language and culture.

It makes you kind of wonder, doesn't it, if these refugees are less trying to get away from somewhere and more just trying to get into somewhere. In other words if you and your family are in such danger that you're forced to leave the shelter of your home, isn't the idea just that you want to get to a place where you've escaped the danger, such as the country just across your border. Getting to the absolute best place, where you get the most benefits, shouldn't really be the issue. Not to mention waving the Salvadorean flag. What's that all about?

I read a couple of articles in the New York Times about the situation. The reporters detail the plight of the refugees, the passionate statements of those organizations advocating for them, the complexity of the legalities they face in the U.S. courts and the intransigence of the Trump administration, but nowhere is it mentioned why asylum isn't being sought in Mexico rather than the U.S.

But the photos in the articles raised my interest about another subject. They show fencing along the border which wouldn't stop a really determined trespasser but is enough to cause all the "caravan" people to collect on the Tihuana side. I looked it up and it turns out that there's actually fencing along 635 miles of the southern border, although much of it isn't very effective. Where it has been effective, along 46 miles of the 60 mile border of southern San Diego County, apparently there was a drastic drop in nighttime sneak-ins along that part of the border after it was put up. The photos also show that for some reason even that fence is covered with wire mesh along the Mexican side, making it fairly easily scalable by a young healthy guy. Trump's prototypes appear to be much less inviting.

The 635 miles of border fence has been there for decades, mostly in the area not bounded by the Rio Grande River. So the opponents of Trump's wall don't really seem so much to mind a barrier as long as it isn't effective in preventing sneaking into the country. But isn't one of the big arguments of the wall opponents that it would be a waste of money because it wouldn't be effective? That seems to be a contradiction but somehow that part doesn't puzzle me.

The Attack on Assad and the TV News Media Response

President Trump, with his military advisers, and with the participation of France and England, carried through with his warning to President Assad that his use of poison gas would have serious consequences. A year ago a similar attack destroyed much of Assad's delivery capacity. This time it was the chemical weapon manufacturing and storage facilities. Apparently the attack was carried out with great precision and without involving civilian casualties or involving Russian assets which would have complicated the matter. 

President Trump was specific about his threat and followed through with it in an astute manner. This was in contradistinction to President Obama who issued the same warning to Assad but did not follow through. He and his surrogates explained at the time that the reason for this omission was that he had obtained the agreement of the Russians that they would see to it to remove chemical weapons from Assad's arsenal. Events have proven that President Obama's compliance with and trust in the Russians was misplaced. Unfortunately he allowed the Russians to become deeply embedded in the region. 

I have for some time now stopped paying much attention to TV news shows, including those on Fox News, finding them to be excessively focused on boring Washington political infighting. I tuned in this weekend to find out the details of this attack because of its potential importance. On the Jesse Watters show on Saturday, the night after the attack, I watched a Democrat commentator complain that while he had no disagreement with the attack, that President Trump was inconsistent because he had expressed his intent to get American forces out of Syria. This was a pretty far reach to be critical but not unexpected. It didn't tell me much. 

On Sunday morning I tuned into Fox News Sunday which I had always considered to be "straight news" as opposed to the obvious repetitive anti-Trump bias on the other networks. There I saw Chris Wallace repeatedly press the question as to why Trump responded to chemical weapons and not to Assad's use of conventional weapons. I watched as Jonah Goldberg, a long time conservative "never-Trumper" smugly accused Trump of responding mostly to things he saw on TV. 

The world was so revolted by the pervasive use of poison gas in WW1 that such weapons have been considered beyond the pale ever since. Every person with normal sensibilities understands the consequences of letting that cat out of the bag. Thus the negative reaction of both Presidents Obama and Trump to Assad's use of poison gas. On the other hand the Syrian civil war is a morass, with the anti-Assad forces being a very mixed bag. Trump's desire to extricate American troops from that situation as soon as is feasible is probably shared by the large majority of Americans. Chris Wallace's apparent misunderstanding of this basic distinction suggests to me that he is being provocative for the sake of provocation. Goldberg's misplaced attitude of superiority seemed ridiculous.

None of these people had to face the real decision about the event, the importance of it relative to overall national policy, what should be our response, how and with whom it should be carried out, what might be the collateral consequences of our actions, how would our friends and adversaries respond, how should it be announced to the world. To my mind the thing was carried out expertly all around. Good for Trump. Back to the waste basket for the TV news yappers. 

Guns and Sick Kids.

I am not a gun enthusiast. I never owned one and never fired one except while I was in the compulsory ROTC program in college. Even when I was in the Army, in the Medical Corps, I never used a gun. When we lived for years in an isolated wooded section of East Mountain where it sometimes felt a little scary it never occurred to me to get one for protection. It's not that I'm anti-gun; just not a gun person.

So I don't really have any skin in the game in the present gun argument after the school shooting. I know all the pro and con arguments and I don't want to get into that no-win situation. It just strikes me as sad that the immediate reaction is the usual angry debate over gun control which seems to take all the attention.

There are lots of ideas focused on the gun aspect of the problem floating around, and some of them even sound practical enough to get carried out this time, especially by some of the individual states, as opposed to the usual heated argument and do nothing result. We hear about raising the legal age to buy a rifle, banning "assault" weapons, limiting the number of bullets in gun magazines, arming some specially trained teachers, putting in metal detectors at school entrances.

I don't know. If this sick kid wanted to carry out destruction it seems to me he could have gotten a gun somewhere, or used a bomb, or a truck, or even waited a couple of years till he was 21. How much difference would it really make in the big picture if he killed 5 or 6 people instead of 17. And how pathetic is it that we would have to have armed teachers and metal detectors in the hundreds of thousands of schools around the country because of these rare incidents.

I was thinking about that the other day when we were flying from Florida and waiting in the long line to be inspected before going to our gate. I was around in the times when we just walked right in and so I guess this ritual that we've all gotten used to as being normal still jars me a bit. Think of all the waste of time and money being expended on millions of flights every day just because of lunatic fanatics.

Not much we can do about that I guess. But it seems to me the sick 19 year old in Florida is a different story, and while we're busy arguing about guns we're missing a big picture. Lots of people knew this young person was sick/violent and reported it but nothing was done about it except to expel him from school.

There are a lot of violent adults around but I'll bet most of them developed these traits when they were young. Pretty much everybody in our country goes through one school system or another when we're young. I'm sure it's not all that easy, but while we're arguing about guns, shouldn't we be paying at least as much attention to the idea of identifying sick kids and working with them. Parental loss seems to have been a major problem with this kid. Too bad there wasn't a guidance program supplying a surrogate adviser.

I had the good fortune to go to the old Scranton Prep. The physical facility at the time was bare bones and the tuition was very affordable for most families. Most of our teachers were Jesuits in training, not a heck of a lot older than we were. They took us on hikes and played football with us. We had to wear coats and ties and the teachers called us Mister. There was a lot of acting up as you would expect with teenage boys, but with only a couple of hundred students in the whole school it was pretty personal, unlike modern schools with thousands. So character building was part of the curriculum, not officially, but in actual practice. And those who had problems didn't get lost in the shuffle.

This treatise is getting too long as usual so I'll wind up. My point is that if all we do is make a few extra gun laws, or make every school child in the country go through metal detectors, and at the same time ignore problem kids we're fooling ourselves.

Trump's State of the Union

Trump's SOTU speech has been well received by the public who watched it. In the CNN poll public opinion turned out to be about the same as the reactions to Obama's and Bush's first try, about 3/4 favorable. Trump has a way different style from Obama but in his own way is an effective orator. His many years of being in the spotlight make him comfortable and confident in front of the cameras. His detractors will certainly disagree but his mannerisms bespoke a sincere personal belief in the words he spoke. He made extremely effective use of a large cast of sympathetic persons exemplifying the points he was making. 

It was booked ahead of time as being conciliatory but turned out to be a fairly full throated endorsement of conservative principles. The deal he offered on immigration was just that - a deal, and not a strategy of attempting to become friends with his opponents a la President Obama. The Democrats are opposing it and they showed their attitude in their behavior last night. It seems to me however that it's going to be difficult for them to hold the line and convince the so called Dreamers to turn down such generous terms. It would be a far better situation for them than the temporary reprieve they had under the Obama executive order which could be easily reversed and did not lead to full citizenship. 

It was largely an American pep talk, reminding me of the Reagan days. His supporters will love it overall, even those who don't like the idea of citizenship for the Dreamers. I think it will largely improve the Trump image with the apolitical independent group who will be swayed by appeals to economic improvement and patriotism. 

I disliked Obama and had a visceral negative reaction when I watched him speak despite a grudging admiration for his oratorical ability. However the Democrats, with a few exceptions,  have an almost pathological detestation of Mr. Trump and they showed it last night. I don't think that their inflexibly dour facial expressions will help them in public opinion except among their like-minded supporters. Minority leader Pelosi especially should have gotten some preliminary acting advice. To my mind she was almost for the first time showing her true age, perilously close to my own.

I found the image of the Congressional Black Caucus especially puzzling. The President's touting of the low black unemployment rate appeared to anger them. It is understood that they have a different opinion about the cause of the statistic but, knowing ahead of time that it was coming, they should have had a different response prepared. What really bothered me though is that in the Congress of the United States, a country that's supposed to be celebrating its diversity, especially among the Democrats, we have all the members of one race clustered as a bloc together, and all wearing symbolic African garb. These men and women are not Africans. In fact, despite all the despicable treatment their forebears received, they have more ancestral ties to this country than most others, and would do better I think to proudly display that reality. Isn't a special section for black people something those that preceded them fought so proudly to end? Just asking. 

Much of the Immigration Solution is Common Sense

The squabble over immigration policy is mystifying. Most of the basic principles seem like such common sense. 

The Democrats want something done about the DACA kids. Trump rescinded Obama's previous edict which allowed them to stay but allowed a 6 month grace period.  In essence he handed the decision to the legislature which was the constitutionally correct thing to do. This decision belongs to the legislature and not the executive. These individuals have been here most of their lives and are Americanized. So it makes sense to work out an arrangement to make them legal.

At the same time measures must be taken to end illegal immigration, really and truly. How can you disagree with that? Who can give a rational argument for allowing the free movement of individuals into our country whose identity, whereabouts and reasons for coming are unknown. There are some libertarians who believe in unrestricted migration but even if we concede that argument, which I think is craziness,  we still should know who's coming, where they are going and what brings them here.

I listened to a discussion of drug overdose deaths today. There were something like 65K in 2016 alone, more than the number of names on the Vietnam War Memorial. The overwhelming majority were not due to doctor's prescriptions but were from fentanyl and heroin brought into the country over the southern border.

So unless there is an argument which justifies allowing anyone who wishes to come over the southern border to do so unobstructed, and bring any contraband they'd like with them, then it seems pretty common sense that there should be an effective physical barrier to reinforce the thin line of the immigration officials, at least in those areas where there is no significant natural barrier. That would seem to me to be money well spent. 

And who can give an argument to justify allowing those with time restricted visas to ignore the restrictions and simply stay as long as they wish or for employers to hire those who they know are in the country illegally. If you have a visa and your time runs out either go back home or apply to have your time extended. If you have a business that could not exist with American workers then work to get a legal exemption. Allowing such obvious flaunting of the law makes no sense and it should be stopped. The laws should be enforced.

I am pro-immigrant. My father and all my grandparents were immigrants. I know all their stories well. They came, through legal channels, to seek a better life. They faced and overcame adversity. I saw personally what immigrants can contribute to our society. But what sense does it make to select immigrants based on a lottery, or solely based on what country they come from or what family members they happen to have here. We should want newcomers who admire the American ethos, who can contribute and who can make their own way regardless of their origin. So that should be our immigration policy, not some diversity quota or chain migration policy. 

These are all common sense things, not ideology. I am offended by those who try to confuse the issue by claiming that those who once and for all want to end illegal immigration are xenophobes and racists. Let the burden of explanation instead be on them to explain just why it is that they favor illegal immigration if that indeed is their opinion. 

Yes, beyond the DACA people we have the major issue of what to do with the millions of individuals who have come here illegally, have settled in and have done no wrong other than take advantage of many years of lax enforcement of the immigration law. That's a sticky problem. But let's first handle the issues that seem to the ordinary citizen like myself to be common sense. Come on congress - will you please for a change do your job. 

Government Controlled Medical Practice in the U.S.

The very first paragraph of the Medicare law states the following:

"Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, ... or to exercise any supervision or control over the administration or operation of any (medical) institution, agency, or person."

How pathetic a joke this statement has become. To be sure the Medicare bureaucrats and their academic health care planner allies do not actually enter the doctor's office to select the antibiotic, although I have no doubt they would like to if they could figure out a way to do it. But supervise and control doctors, hospitals and other medical entities they do in exquisite detail. Their invasion includes things like telling doctors what items to ask the patient, what body parts to examine, what categories of tests and treatments are preferred, and how and by what means these things must be written into medical records. They work their will by control of payments. Do it their way or you don't get paid.

They get the money to make the payments from us, from our payroll taxes and our income taxes. That's been a problem through the years because what they spend on us is always a lot more than what they collect from us even though the actual percentage of our paycheck that they take has multiplied many times over since the program began. Nowadays they put a lot of it on the tab, the national debt which is now 106% of GDP, up from 62% 10 years ago.

Ever worsening government interference bugged the hell out of me while I was in practice. I recently had occasion to meet some of my old colleagues and it's only gotten worse. They all tell the same sad story of the tremendous time and resources wasted on bureaucratic nonsense that does not add an iota of benefit to actual patient care. Well, you might think, that's the doctor's problem and none of my concern. Unfortunately that's far from true. All the billers and coders and IT personnel, etc, add greatly to the cost of medical care and bring no health benefit. And all the time wasted by your doctor in dealing with this nonsense translates to less time he or she can spend with you.

In the past few years CMS, the agency that runs Medicare and Medicaid, has come up with even more complicated regulations that went into full effect in 2017. A recent internal study announced that these new rules appear to be of no value in reducing cost or improving medical care. No study was needed. Any practicing doctor could have provided this information. The most depressing fact is that the ever increasing cost and complexity of government regulation is driving doctors rapidly our of private practice and into salaried positions with large medical conglomerates. It's the same with independent hospitals. That's not good folks - that is, not if you like being treated as an individual and not as a commodity.

Government has a legitimate function in making sure that acceptable health care is available to those who for one reason or another can't provide if for themselves. But for the rest of us government should bug off; it does nothing but screw things up.