December 30, 2016

Can We "Privatize" the VA Without Jeopardizing National Security?

Serious questions. Appreciate your thoughts. Seems to me that if veterans---especially those with PTSD or other mental or physical problems that occurred as a result of military action-----have their care outsourced to private docs, a lot of sensitive military secrets suddenly will be recorded on less than secure electronic medical records. The insurers who administer the so called "private" VA will also demand access to records. Those insurers will also be vulnerable to hacks.

What if patients tell their non VA docs about secret missions? What if non VA docs learn about secret weapons? All of that information would then be available to the same Russians who hacked the election. Is this the real reason Trump has been so hot to "privatize" the VA? He will not be president long---and Russia will no longer have access to his security briefings. But if the VA is disbanded and the work outsourced to the private medical community, Russia could have an entirely new database to mine for secret information about our national security.

VA mental health records could also be exploited by domestic right wing terrorists who want to recruit. They could use what they learn to target veterans, taking advantage of their illness. Or by threatening to blackmail them. "We'll tell everyone what you did in the war of you don't do what we say."

December 25, 2016

Will Putin's Other BFF, Russian Mafia Kingpin Semion Mogilevich Come Off The FBI's 10 Most Wanted?

It bears asking. The real power of the United States president is that he can pardon criminals and tell the DOJ to lay off VIPs like Russian mob boss ( and Putin BFF) Semion Mogilevich. As long as Mogilevich stays on the FBI's 10 Most Wanted, he has to stay in hiding in Russia or other countries that do not extradite to the US.

Here is some info on Mogilovich. This man has his hands in everything especially Russian energy. He could well be the power behind Putin's throne (those who know Putin from his KGB days describe him as "not too bright.&quot

http://www.businessinsider.com/semion-mogilevich-2014-11

There are deep ties between the KGB and the Russian Mob that go way back to the days when Russian criminals were sent to the U.S. both to get them out of Russia's hair and to act as agents.

http://articles.latimes.com/1988-02-16/news/mn-42975_1_russian-mafia

Saying that the leader of another country hand selected Trump is much better, politically speaking, than saying that the leader of the Russian Mob hand selected Trump. How do we know that Putin is not doing Mogilovich's bidding? How do we know that when Trump vowed to fight even if he lost it was not because some mobster told him "You win and pardon me and all my boys....or else."? Did you see the deer in the headlights look in Trump's face for just a moment when they told him on live television that he had won? He did not look like a man whose dearest wish that been granted. He looked scared.

I will be interested to watch what happens to Russian prisoners in U.S. custody and those who are currently under indictment or being investigated. And speaking of investigation, why is Trump so eager to get the details of criminal investigations before he is even sworn in to office? Is he afraid that the Obama DOJ will indict some VIP Russian mobsters before he has a chance to protect them?

More on Russia's Public Enemy Number One (from Listverse):

Extremely intelligent. Ruthless. Degree in economics. This sounds like the kind of guy who could pull off a successful hack of a U.S. election.

December 18, 2016

De-constructing Trump: Extremely Wordy Thread of No Interest to Anyone

I mean it. Shoo! Move along! You do not want to read this.

Ok, now that we are alone, here's what I have been thinking about today. First, some context.

A friend suggests that the GOP will be unable to dump Trump because they fear angering his core constituency of sociopath self styled "outlaws" who prefer "truthiness" to facts or reason and who worship him precisely because he commits crimes and fraud in order to enrich himself and his family. You know, hillbillies. Biker wannabes. People who steal their elderly cancer stricken mother's pain medication because she is too old and demented to enjoy it. People who wish they had not flunked high school chemistry, because they would love to get into the business of making and selling meth, not just using it. People who cheat on their taxes. People who slip in Krogers as a living. People who commit insurance fraud. People who buy a dress, wear it to the prom and then return it for a full refund. People who feel no guilt about these and other criminal actions, because society "owes" them. People who do not understand that they belong to a "society." People who may not even understand what the word "society" means.

Add to this Trump supporters' propensity to commit acts of violence and terrorism in his name proudly, boldly--almost as if they are auditioning for roles as mob goons in his organized crime administration----and you have a rabble that few politicians would want to rouse. These dudes and dudettes are toting guns, forchrissakes! There is no telling who or what they will try to shoot. So, the Republican Congress will try to anoint him the new Ronald Reagan instead, except as an outlaw cowboy this time. Think Henry Fonda in "Once Upon a Time in the West."

However, this is not the real Trump. This is a story of Trump as Bandit of the People. Robin Hood. Pretty Boy Floyd. And a story can be dissected and twisted and used to ones own political ends.

Do the members of the press have what it takes to defeat President Public Enemy Number One? We know they want to. He called them out on the carpet and now they hate his guts. But will they understand that there is a right way to separate a popular mob boss from his followers and a wrong way?

I am putting my money on ABC. Disney/the Mouse showed exceptional narrative brilliance in 2006 when they helped Democrats win control of Congress, first through the GOP-Propaganda piece that was really a stealth Democratic Propaganda piece----"The Path to 9-11" and then when they outed Congressman Foley.

Since George Stephanopolous was in the room when Trump shit all over the press, I expect the Mouse to take a keen interest in his administration. And heaven help anyone who gets on the wrong side of the Mouse. All the GOP did was threaten to pass a la carte cable and look what Disney did to them.

I think we will see a media dogpile on Trump, but I am counting upon ABC to come up with the winning strategy. What's the point of having all those writers and creative people at Disney if you do not know how to manipulate the narrative--and win hearts and minds while doing so?

December 18, 2016

Working While Poor and In Pain in the United States

First off, let me make one thing clear. This diary is about the United States and other so called first world countries. If you are poor and in pain and living in a third world country, your pain will not be treated. Period. Because international drug policy says that morphine (which is dirt cheap) is much too dangerous to put into the hands of health care workers in poor countries. They will divert it to the black market (we are told). And so their patients dying of cancer get acetaminophen and a pat on the hand and a “Maybe if you were good in this life you will be reincarnated into a new life in a more prosperous country and you won’t have to suffer this way next time.”

Ok, enough about our neighbor’s problems. Let’s talk about our own problems. What’s that you say? You are not poor? You are not in chronic pain? And none of your friends or family are poor or in chronic pain? That’s what we call denial. Or willful blindness. Because the woman waiting on your table at Waffle House has two eroded knees. She can barely hobble out of bed each morning, but she spends all day on her feet for tips and minimum wage. She pours your coffee with a smile, even as her hydrocodone wears off. She won’t take another pill until she gets home. It is going to be a long day. The doctors want her to get knee replacements, but she does not have insurance. And if she gets insurance, she won’t be able to afford to take off work for the surgery, because she does not have disability insurance. The hydrocodone allows her to go to work each day so she can pay the rent and buy gas and groceries and take care of her kids.

She knows her doctor secretly thinks of her as a drug addict. She has seen the pharmacist roll his eyes when she comes in for her monthly refill of hydrocodone. She does not list her pain medication when she sees other doctors for fear of what they will think. Because pain is shameful and people who get treated for pain---unless they are children (innocent) or cancer sufferers (unfortunate)---are weak and selfish and should be ashamed of themselves.

Your Waffle House waitress is not alone. The woman working the cash register at Walmart has carpal tunnel syndrome. If she slows down while checking you out, you fume. You tap your foot. She is going as fast as she can---she can’t afford treatment for her carpal tunnel syndrome so she relies on pain medication to get through the day---but your time is valuable. If she can’t keep up, Walmart should fire her and hire someone younger and healthier---

An aside. The recession of 2008-2010 was a godsend to industry which adopted a first hired first fired policy. A fair number of 40 and 50 something middle managers with some seniority and a good salary and benefits with health problem found themselves downsized and reduced to waiting tables, flipping burgers and checking groceries. Jobs that were much more physically demanding than the jobs they lost, jobs with no benefits. That’s how I met them. I was doing family practice at a county clinic at the time. I met a lot of people who had always had good jobs and good benefits until the recession. For the first time in their lives, they had to hold their noses and seek publicly funded health care. And among their many medical problems, chronic pain was often near the top as a barrier to returning to the high paid with benefits work force.

But enough with the up close and personal. What about the public health? What about our right to live in a country where there is no drug addiction problem adding to crime and the rising cost of uncompensated health care? What about our right to make sure that no pill pushers sell our babies prescription drugs without a prescription?

The medical director of a large, county funded clinic for the uninsured stated publicly that “Poor people should not have their pain treated with opiates. They will be tempted to sell their medication.” That doctor was not being cruel. She was looking out for the public health. She was determined to stop the flow of drugs at its source---the waitress who works at Waffle House. The cashier who works at Walmart. The former realtor who kept putting off her knee replacement surgery when she had good insurance because she did not want to miss work but who started slowing down because of the pain so she got downsized and now that she is out of work and has time to get her knee replaced has no insurance, so all she can afford is pain medication. I’ll bet you didn’t know that woman is a (potential) drug pusher. Public enemy number one.

Good news! The GOP is looking out for your kids. One Republican is floating a plan to have Medicaid stop paying for opiates. Cut off the supply, that will dry up the demand. Several states have already capped the amount of pain medication that Medicaid covers. That should help with the awful problem of the working poor selling their pain medications. If we eliminate the ACA, a lot of people will lose their Medicaid benefits, making it even harder for them to obtain pain medication—and if they can’t get medication for their pain, they won’t be tempted to sell it. If we dismantle the Veterans Administration which treats a lot of chronic pain—being blown up by a land mine can have lasting, painful effects---that will further reduce the supply.

Poor people were not put on this earth to enjoy themselves. They were put on this earth by God to remind us that the wages of sin---and being born female or Black or Latino or joining the military and being sent off to fight in a foreign war---are suffering and poverty and pain. They were put on this earth to change the sheets in our luxury hotels and trim the lawns at our golf courses and clean dishes in our four star restaurants. And they will do all this while their knees, backs, hands are killing them, because their suffering is their atonement for the sin of not being born among the Elect. God loves the Trumps of the world and He hates the poor and every time a rich person crushes a poor person under his foot, God gets a great big grin across His bearded white face. Amen. So sayeth Calvin.

Yes, that was sarcasm. Now, some honest emotion. Be careful. What follows is true and may make you cry or at least want to punch something.

Put yourself in someone else’s shoes. A hard worker who, for no fault of her own, was standing in the wrong place when a truck at her job went into reverse instead of forward. She got crushed. Her neck was broken. Through some miracle, she was able to regain the use of her arms and legs, but from that moment on this 20 something lived in chronic pain. Her neck injury also made her blood pressure unstable. That plus her pain would drive her blood pressure up dangerously high.

One day, while in the emergency room for one of her hypertensive crises, she overheard the emergency room physician refer to her as an N-word junky. She left. She called her family doctor. In tears, she described what had happened.

The American health care system, the so called best system in the world failed that woman. It shot her in the heart. It made it impossible for her to ever trust a doctor again. Because that emergency room doctor was not looking out for her good. He was looking out for the public good.

There is no easy solution for the problem of opiate addiction in this country. But there is an easy solution to the problem is stigmatizing people who have real pain for seeking relief from their pain. You wouldn’t deny a poor asthmatic an inhaler because she might sell it. Why deny your Waffle House waitress treatment for her pain?

December 17, 2016

Mourning in America 2: The Abyss

I have been in denial. I think a lot of us have been in denial. The loss was too great. The change too abrupt. It was too much to process. We denied. We raged. We bargained.

“The recount will come up with a different number.”

“The president will invalidate the election”

“The electors will do the right thing---“

If doing the right thing were still on the table, we would not be where we are now. We are a long way past “doing the right thing.”

The last time I remember feeling this sad and angry and helpless was during the Reagan administration, when Ronnie refused to fund AIDs research, because he claimed the disease was God’s righteous punishment of gays. Lots of friends died…

Today, while looking at the infamous photo of an American dentist gloating over the corpse of Cecil the Lion, I found grief. It’s been somewhere close by ever since the election. Just behind my left shoulder, always just out of sight. I have tried to keep myself busy. Think positive thoughts. Make plans. Don’t mourn, organize. We’ve overcome worse than this----

And then, while scrolling through an online paper, I saw Cecil and the hunter. The pain was sudden, sharp and visceral. My eyes stung with unshed tears. This, I thought, is why we are where we are. Because there are people like this hunter who smile for the camera and boast about killing innocence and beauty and freedom and pride. They grind all that is good in the world under their boot-heel.

I am crying for Cecil and our democracy. I am crying for nature and for the future. Some part of me is even crying for the hunter and Trump----because what kind of horrors must a human being endure to make him boast of being a monster? But most of all, I am crying because I must.

Too long a sacrifice Can make a stone of the heart.
O when may it suffice?
That is Heaven's part, our part
To murmur name upon name,
As a mother names her child
When sleep at last has come On limbs that had run wild.

Yeats, Easter 1916

There is no beauty in what Trump has done. Only loss and sorrow. And so, to paraphrase

We “Are changed, changed utterly: A terrible sorrow is born.”

December 16, 2016

Put Trump and China In a Cage Match and Who Wins?

No, I am not speculating. The match is on. Trump threw the first punch when he called Taiwan. China responded with a show of military strength over the South China.

Who decided to pit Trump against China? It was Putin’s idea. Putin needs to continue selling Russian oil to its biggest customer, China. If China becomes energy self-sufficient, Russia goes broke—again. The way it was at the collapse of the USSR, when the Soviet leaders were tossed out of office. If Russia goes broke, Putin will be tossed out of office---and he likes being Czar for Life. So Putin came up with a plan. Get the U.S. and China in a cage and make them fight. Make the South China Sea so hot that China cannot drill for oil. Set the Sea on fire and watch it burn.

That show of military force was a bad move, and it could have ended badly for China, giving the U.S. an excuse to increase its provocative military presence in the South China Sea. But then someone in China decided to stop flailing around wildly and use strategy instead.

http://fortune.com/2016/12/14/why-gm-ford-might-get-slapped-with-a-fine-from-china/

Shares of U.S. automakers General Motors and Ford Motor Co. skidded on Wednesday after a Chinese official warned the government could slap a penalty on an unnamed U.S. automaker for monopolistic behavior.

The warning from a senior Chinese state planning official, conveyed through the official China Daily newspaper on Wednesday, came days after U.S. President-elect Donald Trump questioned the longstanding U.S. policy of acknowledging that Taiwan is part of “one China.”

Trump’s rhetorical challenges to long-established policy toward China have rattled U.S. corporations. Relying on stable U.S.-China relations for more than 40 years, the companies have ramped up sales in China and developed complex supply chains that feed Chinese-made parts to their U.S. operations.

Touche, China! How will Trump respond? The auto industry that he promised to save is now threatened because he is acting like a dick in order to prop up the price of oil. Russian oil. Is that good business? No. Is that good politics? No. Can China hit him---and the United States---again and again right where it hurts? You bet.

So, who wins if you put China and Trump in a cage match? Putin. Who loses? Anyone who works for a U.S. firm that does business with China.


https://www.theguardian.com/world/2016/nov/14/china-threatens-to-cut-sales-of-iphones-and-us-cars-if-naive-trump-pursues-trade-war

“If Trump wrecks Sino-US trade, a number of US industries will be impaired. Finally the new president will be condemned for his recklessness, ignorance and incompetence,” the newspaper said in an editorial.

The Global Times claimed any new tariffs would trigger immediate “countermeasures” and “tit-for-tat approach” from Beijing.

“A batch of Boeing orders will be replaced by Airbus. US auto and iPhone sales in China will suffer a setback, and US soybean and maize imports will be halted. China can also limit the number of Chinese students studying in the US.”

http://markets.businessinsider.com/currencies/news/A-China-economist-told-us-how-China-could-hurt-the-US-in-a-trade-war-1001576652

The Trump administration could launch trade actions against China's steel sector under the WTO or otherwise, to try to put pressure on China to negotiate trade restraints, but the outcome of any such negotiations would be highly uncertain as Beijing has many options for possible retaliation. For example, China can replace Boeing jets with Airbus and US soybeans with those from South America. A trade war will also jeopardize progress with the US-China Bilateral Investment Treaty, which is currently under negotiation.

http://www.nytimes.com/2016/12/12/world/asia/if-donald-trump-pushes-on-taiwan-how-china-could-push-back.html

Chinese analysts say China has plenty of leverage to retaliate against Mr. Trump. One prominent target is Boeing, whose Seattle plant Xi Jinping, China’s president, visited in September 2015.

In 2016, Boeing is expected to complete plane deliveries to China worth $11 billion, mostly 737s that have become the workhorse of China’s rapidly expanding airlines. The Global Times warned that it would be easy for China to switch orders to Boeing’s European competitor, Airbus.

“On economic issues, China has more and more leverage,” said Wu Xinbo, the director of the Center for American Studies at Fudan University. “If we feel he is still pushing the Taiwan issue, we will take action. If he wants to keep it up on Taiwan, it will only backfire.”

American trade officials worry that China could intensify its discrimination against American technology firms by using the country’s antimonopoly laws. Last year, the Chinese government slapped a $975 million fine on Qualcomm, a San Diego-based chip maker, for what it said were licensing infractions.

December 15, 2016

Poor STILL Can't Afford Outpatient Pneumonia Meds---Thanks to Generic Price Fixing

Maybe someone out there listens. Back in 2014, I wrote about how my patients could no longer afford outpatient pneumonia treatment, because the most effective generic drug (at that time) indicated for pneumonia treatment, doxycycline had gone from being a $4 drug to a $50 plus dollar drug.

http://www.dailykos.com/story/2014/03/09/1283383/-The-Poor-Can-No-Longer-Afford-Pneumonia-Treatment-in-the-U-S

How does an old dirt cheap generic suddenly increase its price ten times? The manufacturer claimed to have a monopoly on the precursor ingredient, meaning that it could keep any other generic company from making or selling the drug. Ugly, but I guess it’s legal.

However, twenty state attorney generals are now saying that it was not that simple.

http://www.nytimes.com/2016/12/15/business/generic-drug-price-lawsuit-teva-mylan.html

The world was shocked when they realized how expensive Epi-pens are. The manufacturer claimed the steep price was justified, because it was cheaper than an emergency room visit--- stupid logic if you consider that when you use an Epi-pen you then have to go to the ER for follow up treatment. And, of course none of us will forget the sense of sticker shock we experienced when a greedy exec raised the price of Daraprim from $13 to $750---because he could.


Or thought he could. The generic drug industry is probably angry as hell at him for blowing the lid off their ongoing scam. They probably thought no one would notice that doxycycline only increased its price ten times. But if you are a doctor treating people without insurance or jobs, you notice when they come back to you still coughing to complain “Doc, I couldn’t afford that antibiotic. You said it was a generic. But the drug store wanted fifty bucks for it!”

State attorney generals, can you please add generic Suprax to your list? That medication is older than the hills and my cash paying patients are still being charged $200 for it. Like doxycycline, it is more or less unique (only third generation oral cephalosporin on the market) and treats things that no other generic antibiotic treat---like resistant kidney infections---but that is no excuse for it being priced like a patent medication.

December 12, 2016

Russia Needs Higher Oil Prices. Putin Will Blackmail Trump For Higher OilPrices. It's That Simple

We saw it with W. Do I have to spell it out? Wars for oil---with lost American lives and spiraling national debt. Koch Brothers paid to stockpile crude. Alternative energy investments the sole prerogative of China which will be our new lord and master in a couple of decades when the crude runs out, our air and water trashed, our savings used up just buying fuel to keep us war and get us to work .

Anyone who can see the evidence of what Putin has done and who is not afraid---Because he is WHIT and MALE and CHRISTIAN and HATES GAYS---deserves what is coming.

The rest of us I feel sorry for.

It would be cheaper and easier just to gather together a trillion dollars, give it to Trump as a payoff. Fewer lives would be lost. Byut no, the greedy oil industry likes to pretend it makes its money.

http://www.businessinsider.com/russia-oil-and-gas-dependence-chart-2014-7

https://www.bloomberg.com/news/articles/2016-01-26/how-cheap-oil-is-squeezing-russia-s-economy

http://www.cnbc.com/2016/06/17/russia-too-dependent-on-oil-and-its-hitting-the-ruble-says-ex-russian-fin-min.html

December 12, 2016

Manufacturing Sector, Transportation, HOusing and Retail---Soaring Oil Prices Will Hurt You, Too

No, Trump is NOT good for the economy. He will not help business owners. Trump, like W. has been installed with a mandate to raise the price of oil for his master, Putin's whose country's economy is almost completely dependent upon oil.

Remember what happened under. W., GE? Remember whatr happened to the airlines? Remember what happened to the cost of transporting merchandise to stores? Remember how much money consumers had left over to spend after they paid $4 a gallon for gas? Well, say hello to $5-6 a gallon gas. Putin will love you for it.

December 12, 2016

Pentagon! Defend Your Country! Unless YOU WANT to Fight Putin's Wars for Oil.

What is Trump's mandate from Putin, the man who hacked the election for him, the man who almost certainly has enough blackmail info on Trump and the GOP to make them his personal poodle slaves?

Russia's economy--like that of Texas---is dependent upon oil. Putin is just barely hanging onto power. If Russia's economic situation worsens, he could get tossed out. On the other hand, if Putin openly has Trump and the GOP in his pocket, if he can brag to his people "I can make Trump do anything!" and then has Trump go to war with one or two large oil producing nations---and Iran will almost certainly be one of them---without Russia having to lift a finger, sacrifice one of its own soldiers' lives or bear any international heat or budget deficit breaking expense, Putin will be the hero of Russia for all time.

Why has Putin been so open about what he has done for trump? Why is he leaving his finger prints all over everything, including the SOS pick--a personal friend of Putin? Because he hopes to win hearts and minds at home.

If, while convincing Russian that he is THE MAN, he breaks the heart of widows who lose their military spouses in the next war for oil or military personnel who lose their minds or lives, he could care less. If the US is sent in order die in suicide missions whose only purpose is to disrupt Iranian oil fields---so what? If we get entrenched in other land war, Putin will bear none of the economic or political cost--and he will reap all the reward.

The Pentagon is supposed to defend this country. We are under attack.

Oh, and btw, if you have not read "War Is A Racket" there is a link below.
https://www.ratical.org/ratville/CAH/warisaracket.html

PS, why the hell would Trump poke China with a stick over Taiwan? Answer, South China Sea Oil. If Putin persuades the US to launch war on two fronts, Iran and in the South China Sea, Russia will be sitting pretty all the way to the bank.