Thursday, May 26, 2016

Mad as Hell

While waiting to receive my Memorial Day email from hypocrite Tim Scott telling me how much he respects veterans (regardless of his votes), I turned on the TV.  It may not surprise you that MSNBC was showing footage of Donald Trump's latest rant.

From TPM

And rant it was.  Along with calling Elizabeth Warren "Pocahontas" and Hillary a "low-life" he went after the quite respectable republican governor of New Mexico Susana Martinez  for no apparent reason.  It may be that simply being another woman in government caused him to make that leap, and he can no longer tell friend from enemy if there are female parts involved.  I can't believe I am saying this, but I am worried about Donald.  He doesn't look good.  And he sounds crazier than ever.  I was once a psychologist, and although I don't often think of people in psychological terms, there are times when nothing else will do.

I will admit that around this time during the presidential campaign season, whatever candidates are left are looking pretty grim.  They all need sleep, and their voices are pretty much shot.  But Donald has added a whole new dimension to being stressed out and exhausted.

His non sequiturs are even less sequital.  Any self-respecting ten-year-old bully could come up with far better insults.  His hair is mussed (!).  The bags under his eyes could carry that stack of papers he was waving around.  And what was that all about anyway?  He seemed to glance at them every now and then as though to wonder what they were, and then just waved them around a bit more.  And then he mocked Hillary for reading with a teleprompter.

As my sweet mother said all those years ago when my father dragged her to see The Exorcist, "Oh, that poor thing."

According to the Mayo Clinic, here are some characteristics of psychotic disorder:

People may experience:
Behavioral: disorganized behavior, aggression, agitation, hostility, hyperactivity, hypervigilance, nonsense word repetition, repetitive movements, restlessness, self-harm, social isolation, lack of restraint, or persistent repetition of words or actions
Cognitive: thought disorder, belief that an ordinary event has special and personal meaning, belief that thoughts aren't one's own, disorientation, memory loss, racing thoughts, slowness in activity and thought, thoughts of suicide, unwanted thoughts, difficulty thinking and understanding, or false belief of superiority
Mood: anger, anxiety, apathy, excitement, feeling detached from self, general discontent, limited range of emotions, loneliness, or nervousness
Psychological: fear, hearing voices, depression, manic episode, paranoia, persecutory delusion, religious delusion, or visual hallucinations
Speech: deficiency of speech, excessive wordiness, incoherent speech, or rapid and frenzied speaking
Also common: confusion, nightmares, or tactile hallucination

At the very least, the man needs some serious sleep.  Instead, he is up all night on Twitter waiting for zingers from Elizabeth Warren.  I imagine him pacing his bedroom in a once-luxurious robe that sorely needs cleaning, muttering to himself about "that Indian."  He was so rattled by her attacks that he has begun to confuse her with Hillary.  And that word salad that has come to signify his speeches of late express ever looser associations, and are no doubt just continued ruminations from sleepless nights.  There are times onstage where he seems to not even realize he is speaking to a group of people.

This has happened before.  A man of passionate if extreme ideas who was given free reign over the airwaves.  A man who caught the fancy of a restless public.  A man who, over time, under pressure from all that scrutiny and adoration, eventually toppled right over the edge.

And won't that  be a suitable ending for the Presidential race of 2016?

Friday, May 20, 2016

ThingsThat Go BOOM

The Ironic Cherry reads...

Command and Control
Eric Schlosser

As we all sit agape listening to Donald Trump mouth off about the crash of EgyptAir and terrorism, I finish reading the incredibly well-researched and heart-pounding book about the development of nuclear arms and its history.  Like I wasn't scared enough, there's Trump riling up his already angry and stupid followers.

Of course, the presumably more intelligent and thoughful number two candidate, Ted Cruz, proposed to "carpet bomb" ISIS and find out whether "sand can glow in the dark."

It appears that it is the thrill of war (and the assumption of winning) that motivates the careless aggression of Trump and his followers.  Similarly, there are all those folks -- family, neighbors and co-workers -- who believe that the right to bear arms anywhere and everywhere equates to life and liberty.

I can't imagine a world without Bruce Willis or Schwartenegger, but that is my escape, not my reality.  These days I wonder at toy guns just as bubble gum cigarettes no longer make sense.  And yet it seems that those who are safest among us, and yes, that typically means white men, are the ones most obsessed with arms.  Guns, missiles, pretty much anything that explodes, the bigger the better.

The history of the nuclear arms race is one fraught with fear, misperception, bad decisions, and outright error.  The conflict has not just been against potential enemies, but military versus civilian control, safety versus potency, even regulation versus ennui, as bored crews cut corners in their scheduled maintenance of weapons that could kill millions.  And of course money, with the installation of safety features being passed over for the development of bigger and newer bombs.  Even as we have recognized the failure inherent in nuclear weapons, we have let them languor, rusty and inadequately guarded, rather than waste resources to protect or safety disable them.

The book tells two parallel and intersecting stories:  that of the history of nuclear weapons, and of the accident that occurred on September 18, 1980, near Damascus, Arkansas, during a routine maintenance procedure on a Titan II missile.  Along the way, Schlosser describes innumerable close calls resulting from dumb human error or negligence or compluter glitches.  Along the way, generals, presidents, and leaders of foreign countries have had to make decisions about what appeared to be nuclear attack.  We have been very, very lucky.

But with luck comes the sense of infallibility.  Those who have recognized the tremendous danger of nuclear arms have continued to meet the resistance of those who believe war is the only way to peace.

As I read this book, the movie Dr. Strangelove kept coming to mind.  The only possible rationale for imagining the success of a nuclear strategy is insanity.

During so many of the accidents and glitches that have been sprinkled over our years in which we -- and our allies and enemies -- have been keepers of this deadly power, we have survived catastrophe because the people in charge were aware of its potential and have kept their heads.  Donald Trump is a narcissistic, stupid and impulsive man.  He should never, ever, be anywhere near a decision that could result in such death and destruction.

Meanwhile, as we wait on the edge of our seats for November, I strongly recommend Command and Control.  Because nuclear weapons are not going away, and too many Americans have no clue about the risks of bombast and ego in this nuclear age.


Tuesday, May 3, 2016

Tim Scott's Tireless Battle Against Cost-Effectiveness

When I get my weekly email from Senator Tim Scott, I groan and debate whether I have the stomach to open it.  The power went out for several hours last night, and I got a bad night's sleep, so let's attribute my weakness to that.

If you can't find "Obama" in one of Scott's weekly emails, it means you haven't opened it.  One of his handlers told him that bringing forth the President's name has the same effect as Mark Sanford's successful run against Nancy Pelosi in 2013.  And Tim Scott does listen to his handlers.

This week the intrepid senator is waging war against the "Part B Drug Payment Model."  In Scott's words,

 Medicare Part B Drug Payment Model
The Obama Administration’s “Part B Drug Payment Model” proposed rule disrupts care for vulnerable patients-such as those with cancer, rheumatoid arthritis, and other serious medical conditions. I, along with a number of my colleagues,have called for the withdrawal of the proposal because it will only hurt Medicare beneficiaries by increasing costs and decreasing the quality of care and patients’ choices.  The Centers for Medicare & Medicaid Services (CMS) did not consult with outside experts or those with real-world experience when coming up with this proposal and in my opinion that is a recipe for disaster. I was joined by my colleagues on the Finance Committee in writing CMS Acting Administrator Slavitt – you can read the letter here.

Are you scared?  Because the CMS (Centers for Medicare & Medicaid Services) has a different take on this proposal than do Scott and his evil republican colleagues.  The purpose of this proposed model is to test the ways in which out-patient administration of drugs by physicians are reimbursed, rewarding the use of the more effective drugs with more favorable rates:

  Today’s proposal is part of the Administration’s broader strategy to encourage better care, smarter spending, and healthier people by paying for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality.

In other words, the purpose of this test is to determine which treatments have more positive outcomes, and to provide financial incentives for physicians' use of those drugs.

Now if you distrust the government the way, say, Tim Scott distrusts the government, you will make the kind of hysterical assumptions that frankly, he is hoping you will make.  If you have a healthy distrust of government, you will wonder why Scott is so vehemently opposed to this proposal.  Here it is in two words:

Corporate Profit

It is the single most fevered purpose of Tea Partiers like Scott to push government out of the way of profit.  This is why we have a system in which the government is not allowed to negotiate better prices for Medicare.  The thought that the government might encourage more effective outcomes means that profit will be taking a back seat to patient care.  And it is this that Scott and fellow greedmongers in the House are fighting.

Scott lies when he claims that CMS did not consult with "outside experts or those with real-world experience."  Unless of course he is referring to the pharmaceutical industry, which does in fact have real-world experience -- in maximizing profit.  I can think of no better way than to study the effectiveness of treatment than to study outcome.  This is an honest-to-gods scientific method, and this is why our anti-science republican House is against it.

Living here in the bastion of anti-science and paranoia, you will no doubt hear someone at some point complain that the government is going to try to take away their Medicare drugs.  Please inform them that the reason Medicare costs are so high is that the pharmaceutical industry has been allowed to control drug costs, and the government has not been allowed to give incentives to doctors for more effective treatments.  You will hear people complain about drug costs out of control, but they will idiotically blame, not just the government, but the evil Obama.  You should explain that this is because republicans like Tim Scott have voted to prevent the government from having any input into drug prices, and so the pharmaceutical industry pushes drugs based on profit rather than outcome.

Scott would like all his frightened, angry, uninformed constituents to support him in his demand that this proposal be withdrawn.  Don't let him get away with it.  Let others know that this is the way to get better health care, by studying what works and encouraging its practice.

It is called quality control, something republicans have thwarted for as long as they have been the party of corporate power.