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.