My Idea of Jesus's Birth. The Stable and the Manger.

Here's an aspect to the Jesus birth story that I thought was interesting.

According to biblical scholars Jesus was indeed born in Bethlehem and that Mary and Joseph were there visiting. But rather than an inn, where observant Jews would not stay, they were likely housed in a private home, presumably with friends or relatives. But were they unceremoniously sent out to the barnyard? That's how we tend to interpret it in modern times, but actually the situation seems to be that since the house was crowded, probably from other visitors, they were put up in the lower level where some of the household animals were kept. To us it seems strange, but to a society which was 90% agrarian, and in which farm animals were very valuable, keeping them in the house was ordinary and routine.

It's not so strange to me either, and here's why. The house pictured on my home page is very special to me because it is the ages old stone house on a plot of farmland where my father told me he was born in Palazzo, a little town in the plain below the breathtakingly beautiful city of Assisi. He was brought to Scranton by his father in 1906 at age 18 months, and finally went back for a visit in the 1970's to see his cousin who was still living there. He visited the old house which was then occupied by a tenant farmer who evidently was still using oxen to plow the fields since he showed me pictures of the animals, sure enough on the ground floor, what the Italians call pianterreno. The family lived on the upstairs level. My dad told me there was no heat in the house, the climate being something like Northern California, but the animals gave off a lot of heat which rose upward in the cooler months.

I finally got to visit the house in the early 1990's. At that point it was unoccupied since it had been damaged in an earthquake, and I didn't try going upstairs but I did open the door, which was a little off kilter, to look around the pianterreno. It was empty, stone plastered walls, and sure enough, along one wall, the feeding trough, or if you'd like, the manger. So, in a pinch, to people of that time, being put up in a room downstairs, near the animals, wouldn't seem so strange.

So this place, now completely boarded up, which still chokes me up to visit, gives me a bit of an idea of what the scene might have been like in the countryside around Bethlehem, 2 millennia ago, when the one we celebrate today was born.

 

 

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The Great Impeachment Show

I hate to give any attention at all to the impeachment fiasco, but I can't help myself. The actual articles of impeachment that the Democrats have come up with are so contrived and inconsequential as to reveal the true nature of what is going on, namely that they are driven to distraction and so desperate that they will grasp at any straw to make themselves feel better. That fact that their efforts are certain to fail in the senate has not deterred them. It's likely that another motivation is that they have felt that they will blemish the President enough to make him fail in the pending election, particularly since none of the Democrat candidates that are presently offering themselves seem likely to do it. The public response to their efforts so far seems to be having the opposite effect.

 

Mr. Trump's personal qualities grate on their nerves, as to be sure they do on some of the Republicans, most especially the small group of never-Trumper "conservatives" who find themselves being replaced as the philosophical spokespersons of the party. But his real crime is his success, not only in being chosen over a very substantial group of establishment Republican candidates and then, against all predictions and assumptions, over Mrs. Clinton, but in also his ability to articulate and carry through his policies.

 

The whole affair is obvious fakery. From the moment of his inauguration there were calls for impeachment, and since then a variety of justifications have been put forth to remove him before fulfilling his first term. Appeals to the 25^th amendment, the emoluments clause, the 2-year Russia investigation have all failed. In 2016, however, the new Democrat controlled House seized its opportunity and have relentlessly investigated, seemingly to the exclusion of all other activities, to come up with something that would fill the bill. The result is totally unconvincing to anyone who is not hopelessly biased and likely would not pass muster even if the Senate was not Republican controlled. I suspect that the ultimate political result will be for the Democrats the same thing the Republicans suffered after their failed impeachment of Bill Clinton over lying to a grand jury about his sexual peccadillos.

 

Ms. Pelosi has cautioned her followers not to gloat or appear jubilant. Accordingly, the Dems are wearing long faces, black clothing and announcing that they feel sober and solemn, another indication of subterfuge since they are no doubt gleeful and high fiving in private. In this I agree with them that there is a sadness to the occasion. The body of the elected representatives of the people of this great republic, whose duty is to debate and legislate over matters that concern us, has become a circus show. We can only hope that eventually they will be chastened enough from their actions that the show will not now be repeated in each successive administration.

 

 

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New Diabetes Medications

Medication recommendations are changing rapidly. The usual strategy for beginning treatment of mild to moderate type 2 diabetes has been an initial trial of diet and exercise. These things remain of great importance but present-day thinking is that, unless they are completely successful, they should not be carried on very long before starting medications. Appropriate medications to get control of the diabetic condition as soon as possible appears most effective in the long run in producing good results long term and preventing diabetic complications.

 

Metformin is still the commonly accepted starting point for almost everybody. It is effective, low cost and has little serious toxicity. I like it because it directly addresses what appears to be the primary problem in type 2 diabetes, insulin resistance.

 

However, unless metformin, with diet and activity measures, is perfectly effective after 3 months or so, it's becoming standard recommended practice that one should consider adding one of the two new groups of diabetes medications, the GLP1 agents or the SGLT2 inhibitors (explanations of both of these coming). This is because both, when added on, not only reduce blood glucose but have also been found to produce significant reductions in major diabetes complications. As usual with new medications they are expensive and of course have their own side effects in some who use them.

 

GLP1 agents – We've discussed these previously. GLP1 is a hormone normally produced in the intestine that works when eating to decrease blood glucose and also to control the appetite. It is usually deficient in those with type 2 diabetes and seems to be an integral part of the diabetic problem. Multiple medications have now been developed which replace this action. Most patients, particularly those who are overweight, have significant improvement in blood glucose and lose some weight. But these medications have an additional important benefit in that several studies have now shown that they also reduce the risk of heart and vascular problems, a big issue with diabetes.

Those presently being sold are Victoza, Bydureon, Trulicity, Adlyxin and Ozempic, the last one seeming to be a little more effective than the others. All are given by injection once weekly except for Victoza which is injected daily. Most people tolerate them well but an occasional side effect is nausea.

A new development in this group is that within the last couple of months the FDA has approved an oral form of Ozempic (generic name – semaglutide), which seems to be just as effective as the injected form. It is taken daily and will be marketed under the name of Rybelsus. So those who want to avoid injections will have this alternative and I suspect it will be the way most will want to go.

 

SGLT2 inhibitors – These medications block the uptake of glucose by the kidney and cause a large output of glucose in the urine, in turn causing a lowering of glucose in the blood and some weight loss, and usually some lowering of the blood pressure. Due to the increased urine glucose there is some increase in urine output but usually not too bothersome, although the dose of other diuretic medications may have to be reduced. Also, because of the increased urine sugar, there is a problem in many women of vaginal yeast infections.

Those presently on the market are Invokana, Jardiance, and Farxiga. These are all taken orally and all of of them are also marketed in combination with metformin under different names.

The big news here is that these medications now have also been shown to significantly reduce heart problems as well as kidney complications. Most of the heart benefit has been shown to be primarily a reduction in the development of congestive heart failure (CHF), at present an increasing problem in the U.S. In fact, the improvement in CHF has now been shown to also be a benefit in non-diabetics, so that these are now being considered as an important new CHF treatment by cardiologists.

The finding that they also reduce the development and progression of kidney damage in diabetics has been a big pleasant surprise, and this benefit, along with the heart benefit is causing many experts to strongly recommend their use, particularly in those with some element of kidney involvement.

 

 

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The Trump Zelensky phone call and Mr. Schiff's impeachment hearing

The Dems hate Mr. Trump and from the moment of his election have called for his removal from office by the impeachment rather than the election process. And to this end they've continued to fish around for a suitable reason. It's sort of like the Alice in Wonderland scene in which the King of Hearts calls for the verdict first and then the evidence.

 

The most recent eruption was brought about by a "courageous" whistleblower, who however is not courageous enough to identify himself or submit to questioning, talking about Mr. Trump's traitorous behavior in a congratulatory phone call to Ukraine's newly elected president. Since then other Trump opponents have come forth who are familiar with the conversation and have reported similar impressions. However, their revelations are no longer necessary since the entire transcript of the call was declassified by Mr. Trump and is readily available to those who are interested to read for themselves.

 

It's hard to avoid the constant commentary about the significance of the phone call, but I'm almost ashamed to say that I never actually read the transcript until today. I'd recommend you do it and judge for yourself whether it's contents should call for impeachment. I don't. To me it's not even a close call. Here it is if you're interested. It takes less than 5 minutes to read:

 

https://drive.google.com/file/d/1uyWKAGgHIqDEORgjOyo0uq7JOXzhxOQf/preview

 

On the contrary, it seems to me that Mr. Schiff should lose his office for the "parody" hoax of the phone call, just after the transcript had been released, that he read in his committee hearing. I happened to be listening to the hearing at the time and with most others was fooled into thinking he was reading the actual text until part way through it became obvious that it was a bizarre fantasy which sounded like a script from one of his movie producer friends. Judge for yourself:

 

Schiff, Sept. 26: It reads like a classic organized crime shakedown. Shorn of its rambling character and in not so many words, this is the essence of what the president communicates. We've been very good to your country, very good. No other country has done as much as we have. But you know what? I don't see much reciprocity here. I hear what you want. I have a favor I want from you though. And I'm going to say this only seven times so you better listen good. I want you to make up dirt on my political opponent, understand. Lots of it. On this and on that. I'm going to put you in touch with people, not just any people, I am going to put you in touch with the attorney general of the United States, my Attorney General Bill Barr. He's got the whole weight of the American law enforcement behind him. And I'm going to put you in touch with Rudy. You're going to love him. Trust me. You know what I'm asking. And so I'm only going to say this a few more times. In a few more ways. And by the way, don't call me again. I'll call you when you've done what I asked.

 

 

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The Syrian Pullout

It's hard to know what to make of the troop pullout in Syria. I discount automatically the uproar of the Democrats and the liberal media who reflexively oppose Mr. Trump whatever he does. After all, these are the people who fairly consistently oppose military action and restrict military funding as much as possible, and who supported President Obama's abrupt pullout of 10,000 troops from Iraq.

 

But the response from moderates and many prominent Trump supporters has also been negative. They predict that the U.S. will lose influence in the region, that ISIS may reconstitute, and that abandoning our help for our Kurdish allies against the Turks will not only cause them grief but will also serve as a sign of undependability to our other allies around the world.

 

But not all Republicans and conservatives oppose the move, and of course Mr. Trump has been forthcoming in his own defense of his decision. The action should be no surprise. Non-intervention in remote conflicts which have no direct impact on the U.S. was a major campaign promise and, in contrast to most other politicians, he has been relentless in his attention to fulfilling his promises. And in fact, for most ordinary citizens, avoiding such military action seems to be a worthy goal and how to go about it is the crux of the problem.

 

The resistance by some advisers to avoiding involvement in timeless Middle East conflicts has perplexed Mr. Trump. In fact for instance, the intention to pull out from Syria seems to have been the breaking point for General Mattis. Nevertheless, there seems to be a tendency for small conflicts to escalate uncontrollably. Korea started as a police action. Vietnam started with a small contingent of military advisors. Both started with the purpose of aiding small beleaguered countries and with only the most peripheral threat to our own interests. Both turned into major bloodbaths under Democrat administrations, generally the opponents of military ventures. Once in place there seems to be a tendency keep our military without end wherever they are involved. Here we still are in Germany and Japan 70 years after the end of WWII. So is that just a general reluctance to change from the status quo or is there truly unacceptable risk in leaving.

 

The Democrat's characterization of Mr. Trump as a fool is absurd. He is a disrupter which was a major reason that he was elected. He has obviously thought through the consequences of his actions relative to his goals, with the help of a great deal of intelligence to which we are not privy. I have listened to his arguments. The Kurds and the Turks have been at each other's throats for centuries. The Kurds have been our allies in the fight against ISIS, largely in their own interest as well. Are we thereby obligated to take on the task of supporting one component of this never-ending conflict? The Kurds are tribal and have often been at war with each other. Some of the Kurd groups actually have been using terrorism techniques in Turkey. On the other hand, the Turks, despite being a NATO member, must be restrained from their own terrorism and killing of civilians and economic and diplomatic constraints against them are being put in place. Turkey and Syria are in constant conflict over their border and the Kurds are now turning to Mr. Assad for protection which the President sees as a good thing.

 

So is the President making the same deadly mistake that President Obama did in abruptly leaving Iraq, or on the other hand is he trying to avoid the similarly deadly mistakes of President Bush in his involvement in Iraq. Clearly Trump and Obama are worlds apart. In stark contrast to Mr. Obama, Mr. Trump has made it his mission, also a campaign promise, of rebuilding the military so that it can be used effectively where appropriate. The primary reason for our involvement in the Syrian civil war to begin with was to pursue and disband the remnants of ISIS which has been accomplished, and Mr. Trump has stated his intention to watch them carefully from a short distance to intervene if they seem to be reconstituting.

 

For the outside observer with limited knowledge the situation is confusing but still of vital interest to all of us so we should be paying attention. For now, I'm trusting to the President's judgement. As he so often says, we'll see what happens.

 

 

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The Tariff War, China and Mr. Trump

Our China problem has been developing for decades. President Nixon opened relations with the communist government in 1972, to a large extent as a counterbalance to the Soviet Union. Thereafter it was the common wisdom that, as their contact with the free world increased, they would eventually fall into line with the behavior of the rest of the developed nations. Indeed, this seemed to be coming true in the 1980's when Deng Xiaoping liberalized their economy, opening it up to the outside world. Nevertheless, their leadership has remained steadfastly Communist and, instead of accommodating, is ominously determined to become the world's prime super-power. To this end they are steadily expanding their military and have established a strong presence in the developing countries of Africa, Latin America and Asia. The main engine of this activity has been their dramatically expanding economy, fueled by an almost limitless number of formerly impoverished peasants turned into new diligent factory workers but in addition more traditional Communist tactics of stealing secrets and prohibiting outside competition.

Previous U.S. administrations, from Nixon on down, have largely ignored this developing situation but Mr. Trump campaigned on the idea that it is critical to our country's welfare to at last confront China's expansionism and in his can-do manner he is attempting to carry out his promise. The major weapon he is using is the strength of the U.S. consumer economy, which has in the past been providing the largest portion of the increasing Chinese wealth.

I am not an economist, but I have read a lot of the works of the traditional liberal economists and strongly accept the great importance of the traditional liberal idea of the free market and free trade, as does I believe Mr. Trump. However even Adam Smith, the great founder of the modern economic ideas of the Enlightenment period, who pointed out the bad economic effects of trade interference by the English government of his time, admitted that tariffs are sometimes necessary for public protection in times of potential conflict. So, for now, I have bought into Mr. Trump's use of tariffs as a weapon and, as he frequently comments, will wait and see what happens. Because of the large imbalance of trade between our countries, largely the result of their restrictive policies, it seems that the tariffs should have a great deal more impact on them than us. Indeed, this seems to be playing out in a declining Chinese economy and their recent tactic of currency devaluation, which maintains the competitive price of their exports but at the same time reduces the buying power of their own citizens. Furthermore, China has, in the many emerging economies of the world, competitors for the U.S. market which have started to replace it as a source of low-priced consumer goods.

Nevertheless, some fear that China's unitary, authoritarian government, which allows for more long-term planning, must inevitably be the winner. But herein I believe lies our greatest and most potent weapon, that of individual freedom. China has for millennia been, and continues to be, an authoritarian country. Their government has allowed a measure of economic freedom, with good results, but it remains oppressive, both in the political area and even in its economic structure. Major businesses continue to be subject to Party observers and regulators. There are secret police, control of the news media and internet, as well as suppression of religion, minority groups and political dissent. Our country was founded on the principles of individual rights and a government that exists and operates by the consent of the people rather than the other way around. It is the resulting vitality and innovativeness of our citizens that has produced our economic success, and not the control and planning of a central authority.

The ongoing unrest in Hong Kong is an interesting test of the Chinese Communist party. How will they handle the demands of the Hong Kong people to maintain their political sovereignty? If too lenient, there is risk, as happened with the Soviet Union, of incentivizing other dissidents. If too severe, they will demonstrate to the rest of the world, and especially to the developing countries with which they have made inroads, what they are really made of.

 

 

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Harris, Biden and School Busing

In the recent Democrat primary debates Senator Kamila Harris chastised Senator Biden over his anti-school busing stance back in the 70's and has thereby gained significant ground in the polling. Ms. Harris gave an emotional speech, pretty clearly pre-arranged, about how much being bused to an alternative school changed her life. Ms. Harris is the daughter of a Jamaican father and an Indian mother, both well paid academic scientists, and grew up in an upper middle-class family in Berkeley, California, probably the most "progressive" city in the country. It seems unlikely that in her childhood she ever suffered significant racial animosity. Mr. Biden's response was that in the past he was agreeable to the concept of busing, but not when it was imposed by federal court order, probably an untrue statement when you look at the record, but the best he could do. The subject of court ordered school busing is interesting to me because it is one of the foundations of my conversion from a youthful liberal to a mature conservative.

School busing started in San Francisco right when my son was entering first grade. When all the buses came on the first day there were only a handful of kids, most families having found other alternatives. I resolutely convinced a reluctant Emily to let him go, that it was all for the good, and that "there was nothing to fear but fear itself". So off he went every day to Hunter's Point, a predominantly black area, without incident. In fact, down the line he was put in a "gifted" program which was shifted from one school to another and so wound up being bused to 3 different schools.

As it turned out we made the difficult decision to return home to Scranton after 14 years in California. Making the decision involved a temporary stay in Scranton, and on returning to San Francisco, we enrolled my 2 kids for a couple of years in a Catholic school a few blocks from our house. My liberal eyes were opened! Now they walked to school. And when they came home, they played around with schoolmates who lived nearby. We got involved with neighbors for fund raising events for the school. What busing did was to rob my kids of the blessing that I had experienced of growing up going to a neighborhood school. Racism had nothing to do with it. There was no way to live in San Francisco, even back in the 1970's, without mixing with people of other cultures. The Catholic school enrollment was largely Hispanic, and my son's best friends were Pancho and Miguel, who lived down the street.

This was one of many experiences that taught me that society was the way it was for many complex reasons and that simplistic ideas for change, introduced abruptly without thinking through the consequences, often did more harm than good. Liberals have a tendency toward what Thomas Sowell calls one stage thinking. They perceive a problem and agitate to apply a direct solution without more than a superficial analysis of cause and effect. If you do not agree with what seems to them to be obvious it is either that you are ignorant or have some nefarious motive. I understand that way of thinking well, having indulged in it when I knew no better. Most who reason that way are I think well intentioned, but some are merely opportunists, taking advantage of their more sincere comrades for personal benefit. I can't read anyone's mind, so I'll leave it to you to decide in which category Senators Harris and Biden belong.

 

 

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The Media, Trump and Independence Day

I had to chuckle when I read the reports on Independence Day celebrations in this morning's Times. The coverage of the national celebration in Washington, arranged for the first time in decades by Mr. Trump, was from an Associated Press article. The President gave a patriotic speech with no political references, celebrating our heroes of space exploration, civil rights, and so on, with a significant tribute to our military. Each branch was singled out, recounting their history and various heroic achievements, and was accompanied by patriotic renditions by the Army band and chorus along with military displays, primarily warplane flyovers.

 

This seemed to me when I listened to large parts of the President's speech that it was pretty standard Independence Day fare expressed by our nation's leader. But where Mr. Trump is concerned the press is the press. I would judge the article to have been about 75% negative. After the first paragraph it described the confusion of the staff and the concern over possible poor turnout. In fact, there was a large enthusiastic crowd but the article's implication was that a significant portion of it was manufactured, and that many of the attendees were there simply because of curiosity or custom. About half the article was devoted to the inevitable protestors and their activities with interviews recounting their complaints. The report I heard was that there were a tiny handful but you sure couldn't tell that from what was reported.

 

Compare that with the following article about the local annual Mayor's Independence Day celebration which was given substantial space and 2 photos. The attendance was meager, and the celebration was all military. It was organized by a retired military officer, the keynote speaker was the Commander of the local VFW, there were representatives from veterans of various wars and a traditional American flag was blessed and then raised. In the article there was nary a disparaging word.

 

So, in Mr. Trump's case the celebration was primarily for personal aggrandizement, was received with a lukewarm contrived response, and was excessively militaristic. The local celebration was a big deal, despite its attendance by 50 people, and appropriately honored our military heroes and flag.

 

So, the major media congratulate themselves for "speaking truth to power" and can't understand the skepticism of us folks in flyover country. We get the picture folks. 

 

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The Census and Citizenship, Legal and Illegal

 

 

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I don't get the problem with asking about citizenship in the census. The question was asked to everyone in every census until 1950 and then thereafter in the "long form" which was given to every 6th person until 2000. The question was stopped under President Obama.

I have checked the census forms for my grandfather in 1930 and 1940 and his answer to the citizenship question was in the negative. No problem with that. Many people are in the country legitimately who are not citizens. The Dems who are dead set against the question fear that it will inhibit people who are here illegally from responding to the question. I'm not sure why that would be since there would be no inquiry into legal status, just citizenship. They would just answer like my grandfather.

But the whole controversy brings up the issue of whether we should be counting people who are here illegally in the census in the first place. The census count is used to determine each state's number of congressional representatives whose most important task is to determine where federal funds should go and how we should be taxed to pay for them. And if states which encourage illegals and have large numbers of them have more influence in congress than those who don't I see an obvious problem with that.

Furthermore the numbers of each state's electors in the Electoral College is based primarily on the number of it's congressional representatives. This in turn means that people here illegally are essentially voting in our elections for President and Vice President.

Bottom line is that I do think it's important that we make an actual determination of the proportion of our population who are citizens. But much more critical to me is knowing the actual numbers and general whereabouts of people who are here illegally since, if they are counted, they can have a significant impact on the decisions made in our House of Representatives and Presidential election. How we could ever accomplish that task is hard to say since some are fighting tooth and nail even to prevent asking the citizenship question.

 

Our Conflicted Immigration System

I  just returned from a 2 week trip to Italy and Switzerland. It was a great trip but it's nice to be home again.

 

At the airport in Geneva we left from the part of the terminal dedicated to international flights. At the baggage check in counter we were asked to show our passports, and again at the check in line, once more at a passport control area and finally when boarding the plane. In the U.S. we arrived at a part of the terminal dedicated to international flights, and here the process involved first scanning our passport photos against a facial recognition camera, then going through another gate where our passports were inspected and questions were asked about our trip, and finally through customs where our passports were checked again.

 

Contrast this with the bizarre irony of our immigration system in general. We are all aware that millions of individuals are in our country who have no legal right to be here. Thousands are regularly sneaking in unobstructed. The new strategy of claiming asylum is an obvious ruse. Those fleeing their homes in Central America because of intolerable violence or political persecution have escaped their dilemma once they have crossed the border into Mexico. There is no need to come an additional 1000 miles to the U.S. Yet, as is common knowledge, they are being encouraged, given transportation and coached what to say on arrival. Clearly they are being attracted for socioeconomic reasons, which is understandable, but not legal. We are told that many more individuals who have entered the U.S. with visas are simply ignoring the restrictions. Employers are hiring illegals with impunity.

 

In the past, prominent officials, including liberals such as President Obama, Joe Biden, and both Bill and Hillary Clinton, have publicly commented on the bad effects of illegal immigration and have promised to address the issue. And yet today many in their party, with little resistance from a great many Republicans, seem to be actively encouraging it. Illegals who have committed crimes are being sheltered from immigration authorities. Legal challenges abound against holding individuals at the border or even to inquire about citizenship status in the census. Political correctness demands that we refer to them as undocumented instead of illegal. Efforts by Mr. Trump to fulfill his campaign promises on this matter are being denounced as being heartless or racist.

 

So I ask you, what exactly is the point of all the folderol we went through on coming back to the U.S. from Europe.  

 

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Trump's Offer to the Sanctuary Cities

Mr. Trump has now demonstrated why he is regarded as having great skill in deal making. Our country is in a period of deep political division and no subject is proof of this more than the illegal immigration issue. Many of us, probably a substantial majority, feel that unsupervised and unrestricted immigration is a major problem which we wish our political representatives to resolve. However a great many others feel just the opposite and have done everything possible to retard and obstruct any such resolution. These latter proponents argue that immigrants are a blessing, both economic and social, and consider the resulting diversity to be a great virtue. They make little distinction between legal and illegal immigration, considering those who skirt the established process as being simply undocumented. In addition they welcome those who come claiming asylum and resist the solution of encouraging asylum in Mexico where there is similarity of language and culture, free from the racial animosity which is claimed to be rampant in the United States.

 

This political battle has led to the present stalemate in which our country's usual immigration procedures are being overwhelmed. Efforts to reinforce our control over immigration are being resisted and great numbers of asylum seekers and others coming illegally are entering into the population at large. Many communities view this phenomenon as a negative, complaining of the rapid cultural disruption, including illegal activities, as well as a financial strain on their resources. Others, however, including our largest state, see it differently, offering compassion and sanctuary from federal authorities.

 

So now we have a grand political compromise being considered by the President. In his proposal asylum seekers, both those coming through the points of entry as well as those caught entering illegally, can go to those areas where they are received positively and, one would presume, there would at the same time be freed up resources for the immigration authorities to retard their filtering back into other areas where they are considered problematical. The initial response from many Democrat politicians and liberal media sources has been critical of the idea, accusing Mr. Trump of using the problem for political purposes. However with such statements they risk being considered as insincere and hypocritical.

 

We often hear it said that the individual states and communities are laboratories where new ideas can be tried out, which if successful can be imitated by the rest. Communities which declare themselves to be sanctuaries, and who consider such influxes to be on balance beneficial should welcome the President's offer. In doing so they can serve as examples to the rest of us about how to work out the social and economic implications. Additionally they could free up their new residents from the constant anxiety of living in secret and could even allow voting in local elections. It seems to me that our bitter ideologic conflicts are to this point largely theoretical. As someone with something of a scientific background, there seems no better way to come to a consensus than such a practical experiment.

 

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The TAVR Procedure and Other Medical Advances

During my 50 years of medical practice I've witnessed some pretty dramatic changes. As examples I can still recall the amazement I felt the first time I saw the results of coronary angiograms before and after angioplasty showing blockages eliminated. Likewise when I first viewed a 3 dimensional echocardiogram showing the ventricles contracting and the valves moving inside the heart. These things have advanced greatly and are now commonplace, matter of fact techniques but were breathtaking events at the time.

 

Even so for a new report I just saw from the ongoing annual American College of Cardiology meeting regarding the TAVR procedure, the technique of replacing a constricted aortic valve, the main one leading from the heart, by a device passed by a catheter from the groin instead of by a major surgical procedure. The procedure, initially restricted to those who were too frail to undergo surgery, has been  advancing in its use over a few short years. New studies reported in the meeting indicate that it is working as well or better than the surgical approach in low risk patients as well. There are some lingering questions about how long the replaced valves will function. However there is no doubt that treatment of this lethal condition, which was a death sentence at the start of my career, is being transformed before our eyes to one which will be easily treated, perhaps without even a hospital stay.

 

I've seen many other similar medical miracles in other areas, but this one caught my eye and I couldn't resist mentioning it. What a privilege it has been to be a participant in applying these advances as they've come along to patients. But mostly I have to give tribute and profess the greatest admiration to the pioneers and innovators who are inspired to seek new ways and go through the very difficult process of developing their dreams for the benefit of the rest of us.

 

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Lilly and the Price of Insulin

I just saw a New York Times article reporting that Lilly company has decided that they would be selling an authorized generic version of their rapid acting insulin, Humalog, for $135 a vial. The actual brand name version, for those paying out of pocket, is around $330 at your local pharmacy. You can print out a discount coupon from GoodRx that lets you pay $177. A vial might last the average diabetic about a month.

 

Humalog came out in the mid 1990's. The price has ramped up exponentially in the past few years. Pretty obviously they can actually produce this insulin at a far lower price. There are 2 other major companies producing very similar rapid acting insulin brands, but they all sell in the same price range. Why isn't competition working? Well I think mostly it's the same reason that medical costs generally are too high – that most of us pay for medical items indirectly and so at the point of sale the cost to the customer is only a small amount of copay. In medical care, prices are not set by the market, but instead by negotiations with third party payers, insurance companies and government. As in any negotiation the initial seller's price is set high to be  negotiated downward. Those who don't pay through third parties are left holding the bag.

 

The market works differently. Prices, except for very high ticket items like cars and houses, are not negotiated but are fixed and consumers choose from competing options. All other things being equal they flock to the lowest price, forcing prices down and in this case leaving the high priced seller holding the bag.

 

But payment for medical care is changing. Although more of us are insured, there's a great increase in high deductible insurance. I think it's this factor, and the public pressure resulting from it, that is forcing Lilly to relent. One thing worth noting in all of this is that older types of insulin, regular and NPH are still available at a price of about $28 a vial. These are less convenient but perfectly effective, so that there is no reason whatsoever for anyone to get sick or die for lack of insulin. Nevertheless, when I was still in practice, seeing a lot of diabetics taking insulin, almost everybody was paying through third parties and very few took advantage of these cheaper varieties. On the other hand in the free clinic where I volunteer, where no one has insurance, they're the only insulins we prescribe.

 

Just to put everything in perspective I want to point out that Dr Banting, who received the Nobel prize for working out the initial extraction and production of effective insulin in the early 1920's, was totally swamped by requests for his product from all over the world by desperate sufferers. He worked out an arrangement with the newly organized Eli Lilly company, which in the space of about 2 years, with the use of effective production techniques, was making enough to supply everybody.

 

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Of Men and Monkeys

Here's something that puzzles me.

If monkeys evolved into men, how come we still have monkeys.

I asked Mr. Google about it, and I find that there is lots of debate about the question. The usual response seems to be that men did not evolve from monkeys but instead both men and monkeys evolved from a common ancestor.

OK then if that's how it works, how come there were just two branches and not a whole bunch of intermediate creatures.(Maybe we do have them - they're called liberals!)

Couldn't resist kidding my liberal friends, but the question is serious even if it seems dumb to any real biologists.

 

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Should the President Accept the Bipartisan Compromise?

I think the President should accept the new compromise bipartisan bill. Yes, the amount allotted for the wall is a ridiculously paltry sum, but nevertheless it is an important admission that a barrier is a reasonable measure in the fight for border security. The Democrats up to this point have resisted a wall on principle, terming it alternatively ineffective, too costly and immoral. They have caved I believe to political pressure. Although they must placate their leftist base who desire open borders, their polling has revealed the major problem that a large majority of the public are concerned with the present uncontrolled immigration situation, want better border security and think a barrier is a sensible tool to use.

 

The compromise bill is a foot in the door. The Democrats will no longer be able to claim that they oppose a wall on principle, but only that they are agreeable to a wall of inadequate length, a fairly absurd unconvincing position. When the prototype wall section is built and it is seen to be effective public pressure will build further for extension where it is needed.

 

 

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The Trump Border Crisis Address and the Democrat Response

The problem of a porous southern border which our politicians have done nothing about has been festering for decades. President Trump has now brought the issue to a head and has started a real national debate. In actuality Mr. Trump is just a vehicle for bringing this situation to the forefront. The peculiar circumstances of his election was the result of large masses of U.S. citizens being disgusted with our dysfunctional federal government. The real instigators of all this fuss are the people who voted for him, the people who are increasingly concerned about the enlarging numbers of illegal immigrants among us along with drug traffic and the influx of some truly bad actors, the people that finally want some action about this fundamental federal government function.

Mr. Schumer and speaker Pelosi argue that a barrier would be ineffective, which defies common sense. Border walls have been shown to work dramatically in Israel and Hungary, and for that matter in our own country where they exist. Their idea that the present request for $5 billion is too expensive is laughable, considering the way billions are thrown around by their colleagues, not to mention the national expenses that would be reduced by truly controlling the border. Mrs. Pelosi argues that a border wall is immoral which is silliness. If that were true we should tear down the effective border walls we already have, such as in San Diego and El Paso. For that matter why would all our other efforts to prevent unauthorized entry such as the Border Patrol not then be considered immoral.

They argue that the President should sign their budget bill, and allow the federal government to fully function and then they will seriously address border security. How dumb do they think he is? The veto power is the one serious tool that the President has been given by the constitution to serve as a check on the congress. The obvious truth is that the main reason for the opposition of the Democrat leaders to principles they vigorously espoused in the recent past is to avoid giving Mr. Trump a political victory. I suppose that's understandable, but in doing this they are also thwarting the strong will and desire of those who put him in office. In truth I believe that a large majority of our people see the need to control our southern border, and indeed fix our broken immigration system generally, and are ready to have something serious done about the matter. Mr. Trump has put his plan on the table and it seems like a reasonable start. The Democrats offer us – opposition!

 

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The Cost of Government, and Especially the Federal Government

 

Since I now have the time, I've been using a software program which tracks and broadly categorizes all my personal income and expenses and it's enlightening.

 

One thing that's notable is that the largest expense category of all is taxes. And that doesn't even account for added on taxes like sales and gasoline tax. Breaking that down further I found that federal taxes amounted to more than twice the amount of all other types of taxes combined together.

 

Now despite what it may seem I'm not an anti-government anarchist. Government is essential in human society for protection, settling of differences and as Jefferson put it, for the pursuit of happiness. And for these United States a federal government that's strong enough to carry out its essential functions is important. Our founders determined that point after observing the results of the weak federal government embodied in the original Articles of Confederation. The U.S. Constitution which they devised was truly a work of practical genius, world-changing really. They established the principle that governmental authority is derived from the consent of the citizens and they laid out a simple framework in which this principal could be expressed in practice. They came up with a system dividing up specific functions, balancing each with specific powers over the other, and accommodating regional differences.

 

There are essential services that belong at the federal level and these are timelessly spelled out in general in the Federalist Papers. That must have been a remarkable time when there was a real national debate on whether to accept the new constitution. The Feds are needed to protect the general integrity of the country from outside forces, to interact with foreign powers, to settle differences between the States, to establish a common currency, and importantly as a general protector of individual rights. On the other hand the principle was established that governing should be done as close to home as possible, where we can get our hands on it if need be, and where its services pertain specifically to the community. I like especially the 10^th amendment to the Bill of Rights which states that "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

 

So back to taxes. We certainly have to provide the funds for all this necessary government functioning. But I ask myself, should it be the largest expense category? Well then I look at what I'm getting in return. It's significant – roads, schools, garbage pickup, the courts and so on. But then it strikes me that most of that stuff is all fairly local, paid for by local and state taxes, plus the added on sales and gas tax. To be sure there are some important federal services that are not so evident, like the military and the ambassadors. But are these enough to justify federal taxes that are more than twice all the other taxes combined.

 

Then I look at the statistic about half of all the richest counties in the U.S. being with an hours drive from Washington and the $20 trillion dollar national debt, and it makes me wonder what's going on here. No real answers but it's worth thinking about.

 

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The Bizarre World of Hospital Charges

I'm involved in a minor financial battle with a hospital where I stayed overnight back in July. Being what's called technically an "observation" admission, my Medicare covered everything but "self administrable" medications. Why the distinction is anybody's guess. These are meds you normally take at home, but in the hospital they're provided for you and you're never given the option to bring them from home, and I don't even know if hospital policy allows it.

 

In any case, while I was in the hospital a nice lady from the business office came by and briefly mentioned the charge along with other details. I was feeling fine and everything was hunky-dory.

 

Three months later I got my bill for $200 for the one day supply of my meds. I take a few, and one expensive one, but nothing even close to that price. So I wrote back that I thought the charge was unreasonable and requested an adjustment. I recently got back an itemized bill listing the individual meds and the charges and sure enough they were all anywhere from 5 to more than 20 times  their out of pocket cost from the pharmacy, that is, not the discounted cost that the hospital would pay.  I won't go into the details, but for example 1 baby aspirin for $5.50.

 

So it brings up the whole subject of medical prices which is a great mystery, since no one pays for anything directly. We get letters from Medicare monthly in 20 different languages explaining the unexplainable, what the charges are, what Medicare approves, and what we may be responsible for, which is of course the only thing we're interested in. But that leaves out the secondary coverage which adds to the mystery.

 

At least now I have the actual charges detailed, after the fact of course which is a bizarre aspect of the whole transaction. I mean how many restaurants do you go into without prices listed on the menu and you find out when the bill comes. If you're in the rare one with no prices, you shouldn't be unless you are a multi-millionaire or a Washington politician.

 

So I wrote them back, thanked them for their service, which was good by the way, but still contended that the $5.50 baby aspirin, etc. was pretty absurd and I still want an adjustment. After all, I could just as well have brought in my pills from home and taken them with no problem.

 

Hospitals are a particularly byzantine component of the high cost of medical care. The ins and outs of the finances of these "non-profit" institutions is a great mystery, even for someone who worked in them for many years. It's true that they must write off a lot of services that they're obliged to do because they get federal financing. So they shift the cost to other payers, and that's where things get really complicated. But the bottom line is that they're a big player in the medical care cost picture. These "non-profit" institutions pay their CEO's big salaries, are presently in the process of buying up doctor practices wholesale, and are a bright spot in our somewhat shoddy infrastructure picture in that they seem to have the dough to build shiny new high tech buildings all over the place.

 

If you think handing over medical payments to the government would solve the problem, think again. One big reason for the present comfortable status of such mega health care institutions is that they're hand in glove with the federal government.

 

So it's going to be interesting to see how my little battle works out. The service was done, the hospital was out of town, so I could just blow it off, but I like to pay my bills. I just don't like getting caught up in this shell game. Emily says I should just pay the bill, but I'm too stubborn for that. Medical consumers should fight back, but it's hard to do when everything is a secret until you get the bill.

 

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