The Obamacare Nobody Knows – Part 2

By David Adamson

Guarantee: If you click on a few of the links below, you’ll know more about Obamacare than 90 percent of Americans. If you read just one of the books at the end, you’ll know more than 99 percent, including most representatives in Congress.

When compared to Barack Obama, John Kennedy took the easy road when he chose to put a man on the moon as his legacy project. Reforming U.S. healthcare is infinitely more complicated.

David Adamson worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness. Learn more about David…

Healthcare reform was a priority on Barack Obama’s agenda long before he was president. At the Democratic National Convention in 2004, he delivered an electrifying speech in which he first championed “the audacity of hope,” and warned against the false belief “the health care crisis will solve itself if we just ignore it.”

Arriving in the White House four years later, Obama had a responsibility to address soaring healthcare costs because the federal government’s share for Medicaid, Medicare, VA, and federal employee insurance accounts for more than 50 percent of total dollars paid to the system. Like we citizens, the federal government cannot afford it.

Because the federal government is the largest consumer of healthcare in the U.S., it has enormous negotiating clout. So, under the guidance of leading clinicians, insurance actuaries, healthcare policy wonks, hospital system CEOs, and other experts, Obama used his power to redirect the U.S. healthcare system.

What do you think? Take the short poll at the end of this blog.

As explained in Part I of this series, the Medicaid expansions and private insurance programs which opened healthcare access to over 20 million Americans is only part of the Affordable Care Act, which most Americans simply call Obamacare. In fact, the ACA includes 10 sections, and only two of the them pertain to expanded access. The other eight sections are designed to lower the cost by improving the quality of care for all Americans. No matter where or how you obtain healthcare in the U.S., it is now shaped by the ACA, and will be for a long time to come.

The ACA is structured to attain the Institute of Healthcare Improvement’s ambitious and worthy “Triple Aim”: 1) to improve the quality of care and patient satisfaction, 2) to improve the health of populations, and 3) to reduce the per capita cost of healthcare.

Here’s a glimpse into how Obama aligned U.S. healthcare with the Triple Aim in those eight hidden-in-plain-sight sections of the ACA. You might notice some of these when you visit your doctor:

Health Information Technology (HIT)

Nothing symbolizes the accountability expected with Obamacare more than the computer your provider has in the exam room with you (and may make you feel like your provider is paying more attention to it than you as s/he pecks away at the keys).

Dependent on information technology: The use of electronic health records adopted through Obamacare helps to speed up and increase accuracy of diagnosis and treatment.

President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. It provided $19 billion in funds to providers serving Medicare or Medicaid patients, which is the vast majority of medical practices whether government funded or private, to adopt electronic health records. The technology push was made in anticipation of the ACA to enable the reporting of performance data that would be required from all providers and insurers.

In the exam room, EHRs help your provider do mundane tasks more quickly, like order labs, write online prescriptions to your pharmacy, or double-check if you are up-to-date on immunizations. Some EHRs even suggest a diagnosis for certain symptoms and recommend a treatment.

But another main function is to generate data to verify you are receiving high-quality care. This data shows up in various places such as the Healthcare Effectiveness and Data Information Set (HEDIS).

Prevention

Experts concur that the best way to reduce the cost of care is not to need it—by preventing a disease from developing in the first place, or intervening as early as possible when one develops.

Thus Obamacare requires insurers to provide preventive screening services, such as mammograms, colonoscopies, pap smears, and immunizations, for free or at low cost. These screenings are based on clinical evidence evaluated by the U.S. Preventative Services Task Force.

You might also get screened for depression and substance abuse because about one out of four visits to a primary care office have a mental health component. Obamacare recognizes mental health as a bona fide healthcare issue.

Prevention efforts extend to community health programs promoting smoking cessation, weight reduction, better eating, exercise, stress reduction, childhood immunizations, and fall prevention in the elderly. Obamacare also aims to improve what are known as the social determinants of health—non clinical factors that can make it impossible to live a healthy life.

Obamacare rewards your healthcare network for keeping you well, as opposed to just treating you when you’re sick. One way is through Pay for Performance (called P4P in healthcare circles). Another is through Accountable Care Organizations, a model to de-fragment care delivery through collaboration between primary care providers, specialists, and hospitals. (These integrated approaches did not originate with Obamacare, but have been tried and tested in health maintenance/managed care organizations since the 1970’s to the present. Think Kaiser Permanente.)

Quality of Care

Experts agree that high quality primary care reduces the need for costly emergency room visits and hospital admissions, therefore Obamacare includes financial incentives and punishments for quality of care.

Obamacare has been the subject of protests since it was proposed and then adopted in 2010. Protests, though, have been less vigorous than current ones against the various proposed versions of Trumpcare, which would result in increased premiums and millions of Americans without insurance.

Your provider’s organization might be a National Center for Quality Assurance (NCQA) Patient-Centered Medical Home , which has very stringent performance requirements, and uses a team approach to your primary care, as well as coordinates your care with specialists and hospitals.

If you have a chronic disease, your provider is following evidence-based clinical guidelines like these from the American Academy for Family Physicians. These guidelines are based on extensive research into what treatments have proven to be most effective. Adherence to clinical guidelines, documented in the EHR, gives you the best odds to get better or stabilize the disease.

You might be surveyed to obtain your feedback on your experience with your provider as patient satisfaction is factored into the final score your provider/plan receives, and the amount of their reimbursement.

Obamacare has already improved the health of millions of Americans and their communities, despite unrelenting efforts to sabotage it.

Obamacare has targeted preventative and quality of care.

Whatever happens to the ACA in today’s cynical, ignorant and corrupt political environment, Vice-President Biden spoke the truth when he whispered these words into Obama’s ear (and a live microphone) the day the ACA was signed into law: “This is a big fucking deal!”

It still is a big deal, a very big one. This is the last audacious hope we have to make the profit-driven U.S. healthcare system work for all of us.

P.S. If you want to delve deeper into healthcare, read these. All are written by medical doctors in accessible language. (If you have limited time or interest, get the first one.)

 

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The Obamacare Nobody Knows – Part 1

By David Adamson

(This is the first of a series.)

I was a foot soldier in the crusade to pass Obamacare.

David Adamson worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness. Learn more about David…

Initially, it wasn’t by choice. I was the executive of a federally qualified community health center (FQHC) with outpatient clinics in rural mountain towns in Colorado. FQHCs, the linchpin of the national healthcare safety net, would play a frontline role in its implementation. Part of my job was to learn what was going to happen, when, and why.

I read books and articles, attended conferences and workshops, joined conference calls, and talked to high and low government officials. Most importantly, I read all 906 pages of House Resolution 3590, the Patient Protection and Affordable Care Act (ACA), which became known as Obamacare. Hidden within the legalese was the thinking of our best clinical and health economics and finance experts translated into policy.

Among the healthcare communities with whom I worked, word got out that I knew a little about the ACA, so I was invited to summarize it to county commissions, hospital boards, and public health departments who didn’t yet. I’d show graphs like this:

 

Then I would explain that our healthcare system had become a financial black hole, sucking in every free dollar, and closing in on 18% of GDP (it’s now 20%). Insurance premiums and deductibles were soaring out of control, as they had pre-Obamacare (and still are — in 2016 it was $25,826 for a family of four). They were squeezing out wage increases and other purchases, like vacations and college. Private sector American companies complained the cost of employee health insurance was making them uncompetitive in global markets. And uncompensated care delivered to the uninsured flooding emergency rooms was hurting hospitals. I’d finally present how the ACA would change this.

My time in the ACA crusade was an eye-opening adventure. Had I been more astute, I would have seen the anti-Obama, ultra-conservative onslaught coming that now plagues our body politic, starting with this troubling scene at a pro-Obamacare rally in Grand Junction, Colo., on Aug. 1, 2009.

Troubling scene: Protest at a pro-Obamacare rally in 2009 in Grand Junction, Colo. Photo by David Adamson.

Or two years later when I was requesting the support of a Republican county commissioner who dressed like a Wild Bill Hickok, right down to boots, duster, shoulder-length hair and handlebar mustache. We were planning a new clinic, to be partly supported by federal funds, in a town that was overrun by uninsured natural gas fracking workers with their attendant health problems, e.g., respiratory ailments, VD, alcoholism, and meth. He took me in his computer to show the National Debt Clock (it’s really cool), and, with sincerity, said that as a patriotic American concerned about our future, he would not support any project using federal funds because that would increase the debt. He added warmly that he supported what we were going to do (and did).

These days when Republicans threaten to repeal Obamacare, it’s obvious that they don’t know what Obamacare actually is. They didn’t when it was passed in 2010, and they don’t now.

Same protest at a pro-Obamacare rally in 2009 in Grand Junction, Colo. Photo by David Adamson.

President Obama could have enjoyed a long tenure in the White House without ever getting tangled with healthcare. As the hapless Republicans are about to discover, healthcare is dangerous for politicians. Corporate healthcare is not heavily populated with leaders whose values are inspired by Mother Teresa. If you threaten their profits, they will try to stop you. Obamacare has been profitable! (Remember insurers sponsored the ads that first branded Hillary Clinton as a cold-blooded, elitist bureaucrat when she tried to help Bill reform healthcare in the early 1990s, and the poisonous label stuck with her right up to her defeat in 2016.)

However, President Obama, a faithful Christian, believed that all people should have access to healthcare. Suffering, disability, and death may be part of the human condition, but access to modern medicine can often eliminate, reduce or postpone them. In his view, it was flat-out immoral that almost 50 million Americans were blocked from it. The Bible commands believers to heal the sick.

Also, one of the most visionary presidents ever, President Obama realized that the healthcare system itself poses a long-term threat to the US economy. He needed to act. It would be dicey; he would be like the kid in the boat with a hungry tiger in “The Life of Pi,” only he would have to finesse multiple tigers — insurance, pharmaceuticals, hospitals, nursing homes, provider associations, equipment suppliers, laboratories.

This already dangerous task was made worse by the ignorance, hostility, and, let’s be honest, racism of Republicans in Congress.

On Feb. 25, 2010, I stayed home from work with a wicked head cold and happened to flip on C-Span, which was live broadcasting the Health Care Summit, hosted by the President, for the leaders of both parties to exchange views about the bill.

Aware he was on national television, Eric Cantor, then Minority Whip, walked into the room with a hang-dog look on his face, carrying a foot-high stack of loose paper that he plopped down on a table with a dramatic sigh.

President Obama patiently watched this, then observed, “The truth of the matter is—is that health care’s very complicated. And we can try to pretend that it’s not, but it is.” At every opportunity, Republicans had been exaggerating the gross volume of the healthcare bill to frighten the public that it was packed with god-awful provisions such as death panels and socialized medicine. (Read the transcript here. President Obama knew his stuff.).

Senate Minority (now Majority) Leader Mitch McConnell, then and now the personification of active aggression towards President Obama, was in the room that day, sulking like always. But to his credit, he was listening because just last week, after releasing the Republican’s 147 page tax cut for the rich posing as a healthcare plan, he conceded that healthcare is “a big complicated subject.” Republicans have no plan of their own to improve healthcare.

Many of us, me included, would have preferred a single payer system like those in the rest of the industrialized world. However, President Obama was a pragmatist. He inherited an economy in the worst recession since the Great Depression. Support was shaky because of turncoat, deficit hawk Blue Dog Democrats. A single payer system was not a politically realistic option.

Facing reality, President Obama smartly neutralized the fears of the healthcare establishment, especially the insurance companies, by ensuring they would not lose money. He combined taxes on the rich, as well as several more obscure ones, and deficit spending to create access quickly. As a result, Obamacare has provided healthcare access to over 20 million Americans. That’s an amazing achievement.

Today no contorted Republican free market math can accomplish the same for less. Under any imaginable scenario, no matter how you fund access for the poor and people with pre-existing conditions, it will never be profitable and will have to be subsidized forever.

Obamacare was never just an insurance program. That’s why it was 906 pages long. It is the framework for a long-term transformation of our healthcare system to make it better and less costly.

It has already irreversibly changed the delivery of health care. You can see it when you go to your primary care doctor or into the hospital, if you know what to look for. In the long run, all of us, including Republicans, will be healthier because of it.

The Russians Are Coming

By David Adamson

My wife and I felt it was the right thing to do to expose our children to other cultures early in their lives, in the spirit of Thomas Paine’s humanist declaration: “My country is the world, all mankind are my brethren, and to do good is my religion.”

David Adamson is a writer living in Fort Collins, Colo. Learn more about him…

Along with traditional American collections of cute animal stories like Mother Goose with happy endings, we included a few translations from other countries which were more realistic. One was a book of old Russian folk tales that was so brutally realistic we donated it to a book sale. But I always remembered the story about a devious fox and a dim-witted wolf in which the former tells the latter he can catch fish by sticking his tail though a hole in the ice on a frozen lake.

To Americans coming of age in the Cold War (1945—1991), Russia has always been coming. We were conditioned in schools and churches to loathe communism. One of the first TV shows we watched was “I Led Three Lives,” about an advertising executive who’s really an FBI agent spying on the Russian-controlled U.S. Communist Party. The commies were evil, denying the existence of God and teaching subversives how to convert vacuum cleaners to bomb launchers.

My family moved to Mannheim, Germany, in the mid-50s as part of a huge post-war U.S. military presence. Purportedly an army of occupation to snuff any resurgence of Nazism, actually we were there to stop any further Russian expansion into Europe. A few times a year we’d be awakened by alert sirens; then my father would don his fatigues and .45 automatic and disappear. We’d watch the long procession of tanks from the 510th Heavy Tank Command roar away, ripping up the cobblestones, to the anticipated battle front along the borders of East Germany or Czechoslovakia.

Nuclear war and kids hiding under tables

Back stateside in the early 60s, the Russians were still coming. Stationed at the North American Air Defense Command (NORAD) in Colorado, my father worked on an anti-missile missile project to intercept Russian intercontinental ballistic missiles. In high school, during the Cuban missile crisis in 1962, we practiced crowding into the crypt-like basement of a Catholic church. The room was lined with containers of water and C-rations where we’d wait out the nuclear exchange in case those antimissiles failed.

I was reminded again the Russians were still coming in the 80s as I stood in a cavernous building at Lawrence Livermore National Laboratory that housed the Nova Laser. It was built during President Reagan’s Strategic Defense Initiative to provide a shield against incoming Russian “independently targetable reentry vehicles” (MIRVs) with multiple warheads.

By then I knew a little more about Russia and the Union of Socialist Soviet Russian Republics (USSR). In college, I learned to admire the great Russian writers from Tolstoy to Solzhenitsyn, who could only be understood by studying the historic conditions during which they wrote.

Russia’s history like bloody folktales

Russia’s history was as brutal and bloody as their folktales: close to a million killed by Ghengis Khan, millions by Napoleon, millions by Stalin, millions by Hitler. For centuries, Russian was invaded from every direction. As a result, Russia grew hostile to outsiders and systematically and forcibly annexed bordering countries to deter invaders. Inadvertently, they also created a vast expanse of ungovernable expanse of diverse cultures, speaking over 100 languages, which could only be controlled by force. Their isolationist stance spawned a national character that was not really European, but not really Asian either.

With the fall of the Berlin Wall in 1991 and the collapse of the USSR, there was absolute glee among the Western democratic super-powers, especially the U.S. We signed some limited nuclear disarmament treaties. We invited the Russians to join the elite G-7 in 1997, to create a G-8, with the expectations that Russia would enthusiastically embrace all things Western—shopping malls, free elections, gay rights, individualism, and rock and roll.

It didn’t work out that way. In 2014, Russia was kicked out, and the club of elites shrunk back to the G-7. Now Russia and the West are back to the future. What happened?

In short: Vladimir Putin, the reincarnation of the Russia’s past, ready to avenge.

Unlike Western Europe, Russia did not participate in the two critical passages that gave rise to democracy and capitalism. Russia skipped both the Renaissance and Protestant Reformation, watershed events in which the ideas of individual rights and liberty took root in Europe.

During the Renaissance, the barbarian tribes, which later merged to become modern Russia, were busy fighting the Mongols, and they never had any exposure to the democratic principles that Europe adopted from ancient Greece. As to the Reformation, it didn’t gain traction because the powerful Russian Orthodox Church was not rotten to the core like the Roman Catholic Church, guilty of selling indulgences and other shortcuts to heaven.

(Russia did embrace the scientific method from the Enlightenment. This enabled them to put the first satellite and human in space, and develop atomic weapons, using little more than slide rules.)

Putin: Make Russia Great Again

Russia has always been hostile to the ruthless destruction of traditions, order, and community bonds that accompany multiculturalism, capitalism, and globalization. They flat don’t buy our way of life. They never did. Russians are not Europeans.

Upon the collapse of the USSR, the first elected president was Boris Yeltsin, a drunk and loud-mouthed buffoon whose “anti-establishment” rise to power was similar in many ways to that of Donald Trump. The privatization of the Russian economy engineered by Yeltsin, and encouraged by the West, was a disaster. There was chaos, near total economic collapse, and the open plunder of the country’s wealth by oligarchs.

As if part of a sinister master plan, Putin, a career KGB officer, learned about geopolitics while a spy in Germany. He showed up on the political stage and became Yeltsin’s understudy. While a witness to the embarrassing debacle, he mastered the ins and outs of Russian politics, including killing opposition. When Yeltsin was forced from office, he appointed Putin president.

A fervid Russian nationalist, Putin despises the West. He was insulted by the USA’s and Europe’s triumphalism during the Reagan years and after. Once in power, he immediately embarked on a project to restore Russian greatness. To aid him in this cause, he formed a surprisingly strong bond with the Russian Orthodox Church, with whom he shares a hatred for homosexuality, to communicate and affirm his message—Make Russia Great Again.

The Russians are coming because the Cold War never ended, as should be obvious to Americans, especially those transfixed by minor threats like ISIS and terrorism, and under the leadership of a president who is a clueless imbecile when it comes to history and geopolitics.

How the folktale ends

Just look at what Russia is up to:

Naive Americans may believe the pop culture images of us trumping the backward Russians at every turn. Think of all those jingoistic Tom Clancy novels, or Clint Eastwood cleverly stealing a top secret Russian jet in “Firefox,” or a bunch of American high school kids repelling a Russian invasion in “Red Dawn.” Were geopolitics like the movies! Especially those happy endings where we always win.

Based on history, sometimes it’s more like a Russian folktale.

In case you wonder how the fox and the wolf story ended, the fox’s advice was a devious trick to punish the wolf for ruining the fox’s life. The wolf’s tail froze in the ice, trapping him.  The fox told the town peasants, and they attacked with their farm implements and killed him.

Trump versus Putin. Guess who’s the fox?

The Lost SEAL

By David Adamson

Expect no Hollywood reprise of Zero Dark Thirty following the death of Chief Petty Officer William “Ryan” Owens, a 36-year-old Navy SEAL killed in action in Yemen on Jan. 29, 2017. President Trump’s explanation for what happened: “They lost Ryan.” The raid on a terrorist compound did not go according to plan. There were civilian casualties, some children, and the target escaped.

Days afterward, President Trump experienced the awful symbolic duty of being Commander-in-Chief as he stood with gravitas on the tarmac at Dover Air Force Base, watching a military detail remove Ryan’s flag-draped coffin from the cavernous fuselage of a C-17 transport. No doubt this was on his mind when he recently spoke to a joint session of Congress and promised, “We will never forget Ryan!” and everyone present rose from their seats in bipartisan cheering.

For once, Trump spoke at least a half truth. He may never forget Ryan, as he should not because he approved the raid. But sadly, except for his family, old high school buddies, community members, and fellow SEALs, the vast majority of around 319 million Americans will forget Ryan.

SEAL William “Ryan” Owens was the recipient of two Bronze Star Medals, the Global War on Terrorism Service Medal, and nine other distinguished medals. He was killed January 29 during a raid in Yemen, the first American combatant to die during the term of the current president.

Since the Vietnam era, the military has become hermetically sealed. Dinnertime frontline war footage of our wounded and dead, served up by the three major networks, eroded popular support for the war. Ever since, our military has restricted access to combat by selectively “embedding” journalists and exerting tight controls on what can be filmed, photographed, or reported.

Today less than one percent of Americans serve in our all-volunteer force. Many Americans don’t know any Middle East veterans, much less about their lives as soldiers overseas. Consequently, they also don’t understand why this military generation has the highest rates of suicide, divorce, drug abuse, spousal abuse, unemployment, and homelessness of any in our long history of wars.

To minimize U.S. casualties many combat actions are undertaken by elite, small special operations units like Navy SEALs. The demanding and dangerous nature of their work depends on secrecy and the element of surprise. Few journalists could physically endure SEAL missions as it’s not unusual to be dropped by helicopter miles from a target, trek to it carrying 100 pounds of arms and equipment, engage in combat, then trek back for extraction, sometimes hauling the dead and wounded.

After the bin Laden mission, SEALs were as revered as Jedi

A couple years ago, I had the opportunity to spend time with some retired SEALs whose careers spanned Vietnam to the War on Terror. After the SEALs’ successful mission to eliminate Osama bin Laden, they were revered as Jedi’s. I was curious to find out what these elite soldiers are actually like.

The one I was most curious about was the youngest of them, a retired commander in his early forties. He had just been out of the service for a few weeks when I met him, ending 20 years of service, most of the last 10 in the Middle East. Call him Jim, not his real name (SEALs have a tradition of keeping a low profile; American Sniper-type tell-alls are rare).

Jim was a graduate of the U.S. Naval Academy with an advanced degree in international affairs. He was quiet, modest, of average height, wore a trimmed beard, and was fit looking. You would never pick him out if he were standing in a line to purchase movie tickets with his lovely wife and kids.

Jim wasn’t much for small talk, but we were able to connect when he heard I had moved from Colorado. He said that early in his career he had trained for a mission in Bosnia up in the Collegiate Range west of Buena Vista, Colo. He smiled remembering when the chopper dropped him and a group of other San Diego-based SEALS into waist-deep powdered snow on an unknown ridge.

Most civilians are clueless

Over the few months I spent weekly time with him, I always had questions. He would answer patiently, but I sensed Jim thought most civilians, including me, were clueless and lacked interest in or knowledge of the Middle East or the lives of soldiers serving there.

The older SEALs were curious, too. Sometimes I’d hear scraps of cryptic conversation as he and his shipmates (that’s what they called each other) talked about missions, those that went “kinetic” (their word for violent) like one where they breached a door and were met by an armed “bad guy,” so for some reason the lead SEAL rammed the barrel of his rifle into the man’s eye socket, instead of shooting him. Or the time an Army medic accompanying the SEALs got caught out in the open when an RPG exploded and Jim had to pull him behind a wall, the look on the medic’s face when he regained consciousness, bleeding from his ears and nose, and realized he was alive, but deaf. These snippets were always short, matter of fact, with no trace of braggadocio.

I asked Jim how he learned to function amidst the violence and chaos. He said you don’t ever get used to it, but suggested I read Lt. Col. Grossman’s On Combat and On Killing, as he did during his training.

I asked if he believed the U.S. still needs to be there—the public is tiring of wars. His answer was terse: if we don’t get them there, they’ll come after us here as they did on 9/11. I expected a more elaborate geopolitical analysis, but that was the gist of it.

How does this end?

I asked how does this end? He said you will never understand the greater Middle East until you know the difference between a Shia and a Sunni and the nations dominated by each. The violence will not end any time soon, and will get worse and spread. Turns out, he was prophetic.

How is your knowledge about Islam? Take the quiz at the end of this article.

What do you think—can members of Congress, who vote on the defense budget, identify the location of the countries in the Middle East? For that matter, can you? Click here to test your knowledge.

Jim was looking for work. Fishing or paddle boarding, even going to the local shooting range, didn’t offer much of a thrill to a frogman. He had applied for various corporate jobs, but got no interviews. He tried with the state police, but was turned down. One of the older SEALs asked him why.  Jim surmised that during the interview they asked about any problem areas he perceived with the police and public. He said police departments had become too militarized, especially the tactical squads with armored personnel carriers and carrying very-high-powered assault weapons.

I suggested with his degree and experience he should teach at the local community college. But he said no chance, I’m not politically correct—I don’t like Muslims. He said he’s a Christian, but that’s how he felt after what he witnessed.

I never saw him again after that summer ended. I heard from one of his shipmates that eventually he got a job with the local police department. However, that didn’t last long. Something was missing just handing out tickets and arresting drunks.

Jim ended up going to work for a private contractor providing security to state department facilities in the Middle East. He’s overseas half the year. The work is dangerous (remember Benghazi), but the pay is much better than being a cop (or, for that matter, a SEAL).

Now whenever I hear of attacks on U.S. facilities in Iraq, I pause and think of Jim.

Results disastrous in terms of lives and money

I also thought of Jim when President Trump proposed a $50-billion increase in defense spending. We already spend more on defense than all the other great military powers in the world combined. We’ve always had a militaristic and interventionist streak, but it went ballistic after 9/11. The result has been disastrous in terms of lives (our soldiers, bad guys, and orders of magnitude more innocent civilians) and money.

If you really appreciate the courage, dedication, and sacrifice of our soldiers—as I do—you also need to be very skeptical of anyone who advocates solving international problems with force.

The writer of this article, David Adamson, has worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness.

We need to confront the reality that Americans live now in a perpetual fog of war created by their political leaders, the chickenhawks in both parties, striking macho poses in front of the TV cameras. They are actually consumed with fear, and thus vulnerable to the relentless pressure of military-industrial complex lobbyists, apocalyptic religious zealots, and fair knee-jerk patriots.

To do so doesn’t mean we don’t appreciate our soldiers, simply we demand to know the why, what, when, how and where of our defense policies before deploying them to godawful places where Americans are hated.

Ryan Owens joined more than 6,000 other U.S. soldiers killed in the Middle East since 9/11. Due to insidious mission creep, our fatality reports now include losses in Yemen and Syria. I’d wager the majority of people in Congress—who vote on the defense budget—would not be able to identify either country on a map of the Middle East if the countries were not labeled. Neither could their constituents, I suspect.

The financial support for our growing defense misadventures resides with Congress, the very people who rose to cheer Ryan’s shaken widow, a mother of four children. Appropriately, the cheering lasted over two minutes, a record for such tributes. However, there was something hollow and superficial about it, like it was a convenient, carefully staged photo-op.

Prior to voting on more defense spending, a more fitting tribute, and reality check, would be for every member of Congress to drive from the Capitol Building over the Potomac to Arlington National Cemetery. It’s only about 15 minutes away.

Amidst the endless rows of white marble tombstones, they’ll arrive at Grave 11483 in Section 60. There they’ll find Ryan.

 

Test your knowledge: 

One Nation, Under God, Avoiding Bigly Crazy

By David Adamson

When I floated the idea of writing for this blog to my wife, she agreed it was a good idea. In her words, “It might be better than talking to the TV.” Normally, I don’t talk to televisions, but after Trump’s victory, I grew so agitated I cursed or babbled at the sight or sound of him.

I take some solace that I am not alone. Each day fellow Trump-crazed Americans express a non-stop howl of negative reactions—angst, anger, shock, desperation, paranoia, depression, fear, panic, insomnia, disorientation, alienation, resignation, despair and distraction. They forward, share, tweet, email every Trump scandal, gaffe, ugly photo, insulting cartoon, and inane remark.

David Adamson worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness

David Adamson worked in high technology and health care. He’s the author of Walking the High Tech High Wire and The Wellness Club. He’s written hundreds of blogs on politics and fitness

However, beyond a certain point, much of this is unproductive, frenzied singing to the choir. We all know by now that Trump has dwarfed genitalia and why Melania looks so unhappy.

Repugnant politicians: During my decades of adulthood, there have been plenty of repugnant politicians, but there’s something different about Trump—the bombast, self-aggrandizement, bullying, belittling, incoherence, dishonesty, misogyny, faux-Christianity, hyperbole, racism, impulsiveness, self-contradictions, xenophobia and sexual predation. His dangerous alt-reality in which America’s allies are enemies and our enemies are allies, media invents the news, facts are fantasy, America needs rescue, science concocts global warming, a border wall will save us from bad dudes if it’s built bigly high, bigly high, believe me, believe me…Trump is crazy.

Trump is crazy.

The word “crazy” is used here in a clinical sense, not as a pejorative. He clearly has a severe personality disorder. Recently, a group of mental health professionals co-signed a formal letter to the NY Times expressing their concerns about his mental stability. A Duke psychologist went so far as to diagnose Trump as suffering from “malignant” narcissistic personality disorder (diagnostic code 301.81 in Diagnostic Statistical Manual-VI, if you care to Google it).

Don’t forget to take the short poll at the end of this post.

Others go crazy, too: I wondered as much. Hearing their expert opinions reminded me of the late R.D. Laing, a ground-breaking British psychiatrist, who made a couple of prescient, unsettling observations from his work with schizophrenics that are pertinent to helping us stall the destructive plans of the Trump/Republican regime:

#1 – If one family member goes crazy, other family members will go crazy, too. Worse, as the family members become crazy they make the already crazy person even crazier.

#2 – A person becomes crazy not just because of brain abnormalities, but also because serious dysfunction already exists in the family that precedes triggers it. There is a huge social component to losing touch with reality.

So what does this dead psychiatrist have to do with Trump and the U.S. early in his presidency?

Regarding #1, understand that the more we disparage and embarrass him, whether in satirical SNL skits or scientific Pew Research polls showing his unpopularity, he’ll get crazier. He’s shown no indication he’s able to modify his behavior; therefore we can expect more and more maniacal night tweets, conspiracy theories, and random outbursts and insults.

If we immerse ourselves in his craziness…We’ll remain stressed, spellbound and powerless.

Daily assaults: If we immerse ourselves in his craziness by spending all day sharing, reacting and refuting his latest crazy behavior, whether in social media, work or the coffee shop, we’ll squander valuable time and emotional resources. His daily assaults on political normalcy will logo_fina_150pixelsdivert us into ineffective, ridiculing, bitching and complaining. We’ll remain stressed, spellbound and powerless.

Regarding #2, Trump is a symptom, not the disease. His presence in the White House is the result of dysfunctions in our economic and political system that will take focused, creative efforts to fix:

  • An electorate more polarized than any historic period since the Civil War.
  • Gerrymandered congressional districts and an obsolete electoral college that tilts federal elections towards the Republican Party before a single vote is even cast.
  • A Democratic Party that lacks vision, is bureaucratic, and falls back on outmoded New Deal/Great Society approaches to solving the novel challenges of a diverse and rapidly changing population in urban and rural areas.
  • Extreme income inequality that is sustained by soulless corporations and the 1 percent who own and control them, along with our two major political parties.

These are why Trump and a minority of Americans were able to hijack the U.S. government. At some point, Trump may be impeached, but not because he’s crazy. Many prominent leaders were mentally ill (read the book A First-Rate Madness by Nassir Ghaemi, M.D.) Trump and his inner circle of zany ideologues and congressional enablers can only be excised through the mundane, grunt work of politics and elections. That’s where we need to expend our passions for revenge and justice.

Dr. Allen Frances, the psychiatrist who chaired the task force that identified narcissistic personality disorder for the DSM, wrote that the diagnosis does not apply to Trump because he does not exhibit enough “distress and impairment.” In fact, Frances concluded:

“His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.”

What we can do:

Therefore, it’s time to limit our fixation with Trump’s antics, minimize his time in our psyches. Let’s substitute some of our hours squandered obsessing about him with small, simple daily actions.

You’ll find an arsenal of grassroots action ideas at Rogan’s List. Another really innovative organization is The Sisters Project, which bypasses the ineffectual and expensive Democratic Party apparatus in Washington D.C., and funnels resources directly into supporting candidates and developing voting constituencies in the places Trump and other alt-reality candidates usually win.

And don’t worry–you’ll still have plenty time to stick pins of anger and moral outrage in the pudgy voodoo doll with the blonde hair out in cyberspace.

 

More ideas on how to deal with Trump stress: First step to resistance: A peaceable daily routine by Bear Jack Gebhardt.