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Wednesday, July 20, 2016

The Trump campaign health care policy position


Well, as of July 19th, he's no longer "the presumptive nominee," he's now the official GOP candidate.

Count me among the millions of people continually aghast at the prospect of the vulgar, belligerent, policy-detail-dementia'd, make-shit-up-on-the-fly, unabashed war crimes proponent Donald J. Trump as U.S. President in 2017. Nonetheless, he could very well win the election, given Hillary Clinton's ineradicably high "trustworthiness" negatives.

Can we tell what he might actually try to do in the health care space were he to win the White House?

Probably not. But, here's what's on his campaign website.
We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans...

Congress must act. Our elected representatives in the House and Senate must:
  1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
     
  2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
     
  3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
     
  4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
     
  5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
     
  6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
     
  7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
That's pretty much it. A "Seven Point Plan" at this stage. Oh, and, of course, this:

Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.
We'll take these up point-by-point shortly (nothing in the foregoing about InfoTech, we can note). But first...


Also, for now, see "Donald Trump’s Health Care Ideas Bewilder Republican Experts."

And, from Politico a few months back:
“It’s kind of warmed-over Republican mush,” said Tom Scully, who was a top health official in George W. Bush’s administration. “I just don’t think there’s a whole lot to shoot at.”
“I’m not sure health care issues matter much to the Trump candidacy,” added Doug McAuliffe, a GOP consultant who worked on Chris Christie’s super PAC before the New Jersey governor dropped out of the race. “The Trump candidacy is based on his vainglorious message. When it comes to issues, he ranges from uninformed to helter skelter.”
Critics say there’s no way to predict where Trump might come out on these issues if he secures the party’s nomination for president. His evolution — from professed admiration of Scotland and Canada’s single-payer health systems to denunciations of health insurers’ profits — suggests a willingness to tout different, in some cases even contradictory positions, based on political expediency.
I'll eventually get around to the health policy proffers of both the Clinton and Libertarian campaigns as well.

Tangentially, see my prior post "145 Tech Leaders on the 2016 election."

UPDATE

The Libertarian candidates (Johnson-Weld) have nothing directly on health care as of today. From their website "Issues" page.


The Hillary Clinton "Issues" page is fairly overflowing with topical detail across a breadth of policy areas. "Health Care" specifically is here.

ERRATUM

A young writer reached out to me this morning, offering to comp me his new book in return for a review. He'd seen a comment I'd left on Amazon concerning another book on the topic.


I opted to just buy it and add it to my never-ending reading pile. Looks interesting. Stay tuned.
This book will help anyone who is interested in learning more about death, coping with a loss, approaching death, or explaining death to a child. It is an exploratory journey that includes multiple viewpoints, including Steve Jobs’s embrace of his death, Ray Kurzweil’s striving for immortality, and Joseph Campbell’s view of death as the “ornament of life.” The book looks at death from the perspectives of atheists, Christians, and Tibetan Buddhists, among many others. Interestingly, it considers the often unexplored aspects such as the curious relationship between death and ayahuasca. It is a guidebook, offering insights and comfort on a topic that many find frightening or macabre...
Maybe it's again a good time to contemplate death.
“I genuinely believe that if Trump wins and gets the nuclear codes there is an excellent possibility it will lead to the end of civilization.”
LOL. The guy who ghostwrote "The Art of the Deal." See "DONALD TRUMP’S GHOSTWRITER TELLS ALL."

GOP CONVENTION UPDATE

Speaking of "death."


Okeee Dokeee, then. Never mind any due process quibbles and the precise, narrow Constitutional and statutory definitions of "Treason."

UPDATE
RNC: And Now for a Different Take on Obamacare ACA
Refor
m, not repeal, urged by former HHS Secretary


by Shannon Firth
Washington Correspondent, MedPage Today

CLEVELAND -- Could a Republican administration repeal Obamacare? That was the topic up for discussion at a briefing Tuesday, held outside the Republican National Convention.


"I do not believe ... that my political party is going to be able to put together a complete repeal, and I don't think it should," said Tommy Thompson, JD, a fellow of the Council on Foreign Relations, who served as Secretary of Health and Human Services under President George W. Bush, and four terms as governor of Wisconsin...
Maybe they'll want to shoot him as well.

ANOTHER ERRATUM


I just learned from my sister that my niece April and her brainiac husband Jeff Nyquist, PhD, co-founders of NeuroTrainer, are taking the Silicon Valley startup VC plunge at the end of this month. Way cool. I first mentioned this project back during WinterTech: "#WinterTech 2016: Venture Capital in #HealthIT."

More on my beloved April here.

The NeuroTrainer Facebook page is here.
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New at THCB: "Is the Public Option an Option?" apropos, see my 2009 post "Public Optional."

FRIDAY NOTE:
2016 PRESIDENTIAL RACE HEALTH POLICY UPDATE

The principal elevator speech on national health policy in two words (irrespective of party)? "Payment Reform." The finest clinical infrastructure in the world is of no use if people can't access it when in need because of crushing costs.

The 2016 partisan span runs from "Single Payer" (which I took a first run at in 1994) to (the mythical) "Free Market" (via which -- all together now -- to "Repeal and Replace ObamaCare").

This just in from Health Affairs:

Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.

What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.

Covered California, that state’s marketplace, just announced premium increases averaging 13.2 percent. But even if premiums increase by the 10 or 15 percent overall that some are predicting for 2017, they will still be far lower than premiums otherwise would have been in the absence of the law. Moreover, this analysis does not include the effects of premium and cost-sharing subsidies that serve to make ACA marketplace plans more affordable for many people...
Of course, the GOP side is not gonna buy any of this. It's an enduring article of faith for them that if we simply permit the (mythical) "free market" to work its wonders, MRIs will soon cost only $29.99 at Jiffy-Scan in the strip mall, and the CABG px will be a mere $149.99 at the Walmart walk-in AcuteCardioCare Clinic near you.

ERRATUM

OK, this is funny. H/T to one of my FB pals.

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More to come...

Sunday, July 17, 2016

The future of science

This blog has long delved primarily into issues in information technology in the health care delivery space (the legacy of my recent REC tenure in the federal Meaningful Use initiative). But I recurrently range far afield into significant overlapping (and frequently n-dimensionally mutually confounding) related issues such as economics (including public funding and private capital markets), "socioeconomics/demographics" (e.g. the "upstream")," organizational culture, workflow/process QI, leadership, law/policy/intellectual property, and clinical pedagogy, as well as scientific methodology  per se.


Good article up at Vox.com:
The 7 biggest problems facing science, according to 270 scientists
  1. Academia has a huge money problem
  2. Too many studies are poorly designed
  3. Replicating results is crucial — and rare
  4. Peer review is broken
  5. Too much science is locked behind paywalls
  6. Science is poorly communicated
  7. Life as a young academic is incredibly stressful


But,
SCIENCE IS NOT DOOMED
To that end, here are some broad suggestions:

One: Science has to acknowledge and address its money problem. Science is enormously valuable and deserves ample funding. But the way incentives are set up can distort research.

Right now, small studies with bold results that can be quickly turned around and published in journals are disproportionately rewarded. By contrast, there are fewer incentives to conduct research that tackles important questions with robustly designed studies over long periods of time. Solving this won’t be easy, but it is at the root of many of the issues discussed above.

Two: Science needs to celebrate and reward failure. Accepting that we can learn more from dead ends in research and studies that failed would alleviate the "publish or perish" cycle. It would make scientists more confident in designing robust tests and not just convenient ones, in sharing their data and explaining their failed tests to peers, and in using those null results to form the basis of a career (instead of chasing those all-too-rare breakthroughs).

Three: Science has to be more transparent. Scientists need to publish the methods and findings more fully, and share their raw data in ways that are easily accessible and digestible for those who may want to reanalyze or replicate their findings...
apropos, two current reads I will soon be reporting on, triangulating with numerous earlier reads.

Link
Link

See, e.g., some prior posts of mine,
to cite just a few. See also the intriguing essay "Four Futures."


UPDATE

Interesting quote from Dr. Hadler:
“Disease” is no longer an elusive monster in the swamp of ignorance; “disease” is prey. It can be defined, parsed, deduced, and sometimes defeated.

Little of this pertains to “health.” Health does not objectify itself. Nor is it simply the absence of disease. Health has temporal and geographic dimensions. Health is inseparable from the context in which it is experienced. Health has a narrative laced with peculiar, often idiosyncratic idioms.  Furthermore, there is a crucial difference between the health of a person and the health of the people.

Science has limitations when it comes to studying health. For one, the studying becomes a component of the experience of health... 
See my post on Dr. Hadler's new book in Fixing U.S. health care by "monetizing altruism"?
____________

More to come...

Thursday, July 14, 2016

145 Tech Leaders on the 2016 election

What do these 145 tech leaders have in common?
  1. Marvin Ammori, General Counsel, Hyperloop One
  2. Adrian Aoun, Founder/CEO, Forward
  3. Greg Badros, Founder, Prepared Mind Innovations; Former Engineering VP, Facebook
  4. Clayton Banks, Co-Founder, Silicon Harlem
  5. Phin Barnes, Partner, First Round Capital
  6. Niti Bashambu, Chief Analytics Officer, IAC Applications
  7. John Battelle, Founder/CEO, NewCo, Inc.
  8. Ayah Bdeir, Founder/CEO, Little Bits
  9. Piraye Beim, Founder/CEO, Celmatix
  10. Marc Bodnick, Co-Founder, Elevation Partners
  11. John Borthwick, Founder/CEO, Betaworks
  12. Matt Brezina, Co-Founder, Sincerely and Xobni
  13. Stacy Brown-Philpot, CEO, TaskRabbit
  14. Brad Burnham, Managing Partner, Union Square Ventures
  15. Stewart Butterfield, Co-Founder/CEO, Slack
  16. Troy Carter, Founder/CEO, Atom Factory
  17. Sukhinder Singh Cassidy, Founder/CEO, Joyus
  18. Vint Cerf, Internet Pioneer
  19. Amy Chang, Founder/CEO, Accompany
  20. Aneesh Chopra, President, NavHealth; Former US CTO
  21. Patrick Chung, General Partner, Xfund
  22. Tod Cohen, General Counsel, StubHub
  23. Stephen DeBerry, Founder/Managing Partner, Bronze Investments
  24. Peter Diamandis, Entrepreneur; Author, Abundance and BOLD
  25. Barry Diller, Chairman, Expedia and IAC
  26. Esther Dyson, Executive Founder, Way to Wellville; Investor
  27. Amy Errett, Founder/CEO, Madison Reed
  28. Caterina Fake, Founder/CEO, Findery; Co-Founder, Flickr
  29. Christopher Farmer, Founder/CEO, SignalFire
  30. Brad Feld, Managing Director, Foundry Group; Co-Founder, Techstars
  31. Josh Felser, Co-Founder, Freestyle Capital & ClimateX
  32. Hajj Flemings, Founder/CEO, Brand Camp University
  33. Natalie Foster, Co-Founder, Peers
  34. David Grain, Founder/Managing Partner, Grain Management, LLC
  35. Brad Hargreaves, Founder/CEO, Common
  36. Donna Harris, Co-Founder/Co-CEO, 1776
  37. Scott Heiferman, Co-Founder/CEO, Meetup
  38. David Hornik, General Partner, August Capital
  39. Terry Howerton, CEO, TechNexus
  40. Reed Hundt, Former Chair, FCC
  41. Minnie Ingersoll, COO, Shift Technologies
  42. Sami Inkinen, Founder/CEO, Virta Health; Co-Founder, Trulia
  43. Craig Isakow, Head of Revenue, Shift Technologies
  44. Rev. Jesse L. Jackson Sr., President and Founder, Rainbow PUSH Coalition
  45. Irwin Jacobs, Founding Chairman/CEO Emeritus, Qualcomm Inc
  46. Paul Jacobs, Executive Chairman, Qualcomm Inc
  47. Leila Janah, Founder/CEO, Sama & Laxmi
  48. Sujay Jaswa, Former CFO, Dropbox; Founder, Witt Capital Partners
  49. Mark Josephson, CEO, Bitly
  50. Sep Kamvar, Professor, MIT
  51. David Karp, Founder/CEO, Tumblr
  52. Jed Katz, Managing Director, Javelin Venture Partners
  53. Kim Keenan, President/CEO, Multicultural Media, Telecom & Internet Council
  54. Ben Keighran, Entrepreneur; Former Design Lead, Apple
  55. William Kennard, Former Chair, FCC
  56. Vinod Khosla, Founder, Khosla Ventures; Co-Founder, SUN Microsystems
  57. Ron Klain, Executive Vice President, Revolution LLC
  58. Walter Kortschak, Former Managing Partner and Senior Advisor, Summit Partners
  59. Jared Kopf, Founder AdRoll, HomeRun, Worldly
  60. Joseph Kopser, Co-Founder, Ridescout
  61. Karen Kornbluh, Former US Ambassador, OECD
  62. Othman Laraki, Co-Founder/President, Color Genomics
  63. Miles Lasater, Serial Entrepreneur
  64. Jeff Lawson, CEO, Twilio
  65. Aileen Lee, Founder/Managing Partner, Cowboy Ventures
  66. Bobby Lent, Managing Partner, Hillsven Capital
  67. Aaron Levie, Co-Founder/CEO, Box
  68. John Lilly, Partner, Greylock Partners
  69. Bruce Lincoln, Co-Founder, Silicon Harlem
  70. Ruth Livier, President, Livier Productions, Inc.
  71. Mark Lloyd, Professor of Communication, University of Southern California - Annenberg School
  72. Luther Lowe, VP of Public Policy, Yelp
  73. Nancy Lublin, Founder/CEO, Crisis Text Line
  74. Kanyi Maqubela, Partner, Collaborative Fund
  75. Jonathan Matus, Founder/CEO, Zendrive
  76. Josh McFarland, Vice President of Product, Twitter
  77. Andrew McLaughlin, Head of New Business, Medium; Venture Partner, betaworks
  78. Shishir Mehrotra, Entrepreneur & former VP of Product & Engineering, YouTube
  79. Apoorva Mehta, Founder/CEO, Instacart
  80. Doug Merritt, CEO, Splunk
  81. Dinesh Moorjani, Founder/CEO, Hatch Labs; Co-Founder, Tinder
  82. Brit Morin, Founder/CEO, Brit + Co
  83. Dave Morin, Entrepreneur; Partner, Slow Ventures
  84. Dustin Moskovitz, Co-Founder, Asana; Co-Founder, Facebook
  85. Amanda Moskowitz, Founder/CEO, Stacklist
  86. Alex Nogales, President/CEO, National Hispanic Media Coalition
  87. Alexis Ohanian, Co-Founder, Reddit
  88. Mike Olson, Founder/Chairman/CSO, Cloudera
  89. Pierre Omidyar, Founder, eBay
  90. Felix W. Ortiz III, Founder/Chairman/CEO, Viridis; Board Member of The NYC Technology Development Corporation
  91. Jen Pahlka, Founder/Executive Director, Code for America
  92. Barney Pell, Founder Powerset, MoonExpress, Locomobi; Founding Trustee, Singularity University
  93. Mark Pincus, Executive Chairman and Founder, Zynga
  94. Shervin Pishevar, Co-Founder/Managing Director, Sherpa Capital and Co-Founder/Executive Chairman of Hyperloop O
  95. Brandon Pollack, Director of Global Affairs, 1776
  96. Amy Rao, Founder/CEO, Integrated Archive Systems, Inc.
  97. Eric Ries, Entrepreneur & Author, The Lean Startup
  98. Justin Rosenstein, Co-Founder, Asana
  99. Alec Ross, Author, The Industries of the Future
  100. Javier Saade, Venture Capitalist; Former Associate Administrator, SBA
  101. Chris Sacca, Founder/Chairman, Lowercase Capital
  102. Dave Samuel, Co-Founder, Freestyle Capital
  103. Julie Samuels, Executive Director, Tech:NYC
  104. Reshma Saujani, Founder, Girls Who Code
  105. Chris Schroeder, Venture Investor; Author, Startup Rising
  106. Jake Schwartz, Co-Founder/CEO, General Assembly
  107. Robert Scoble, Entrepreneur in Residence and Futurist, Upload VR
  108. Kim Malone Scott, CEO, Candor, Inc; Former Director, Google
  109. Tina Sharkey, Partner, Sherpa Foundry & Sherpa Capital
  110. Clara Shih, Co-Founder/CEO, Hearsay Social
  111. Shivani Siroya, Founder/CEO, InVenture
  112. Steve Smith, Executive Director, Public Policy Institute, Government Relations & Telecommunications Project, Rainbow P
  113. Jonathan Spalter, Chair, Mobile Future
  114. DeShuna Spencer, CEO, kweliTV
  115. Katie Stanton, CMO, Color Genomics; Former VP of Global Media, Twitter
  116. Jenny Stefanotti, Co-Founder, OneProject; Board of Directors, Ushahidi
  117. Debby Sterling, Founder/CEO, Goldiblox
  118. Seth Sternberg, Co-Founder/CEO, Honor
  119. Margaret Stewart, Vice President of Product Design, Facebook
  120. Jeremy Stoppelman, CEO, Yelp
  121. Michael Stoppelman, SVP, Engineering, Yelp
  122. Baratunde Thurston, Former supervising producer, The Daily Show with Trevor Noah; Co-Founder, Cultivated Wit
  123. Stephanie Tilenius, Founder/CEO, Vida Health; Board of Directors, Seagate Technology
  124. Richard D. Titus, Entrepreneur; SVP, Samsung
  125. Anne Toth, VP of Policy & Compliance, Slack
  126. Bill Trenchard, Partner, First Round Capital
  127. April Underwood, VP of Product, Slack
  128. Max Ventilla, Founder/CEO, AltSchool
  129. Tabreez Verjee, Co-Founder/Partner Uprising; Board Director Kiva.org
  130. Jimmy Wales, Founder of Wikipedia
  131. Hunter Walk, Partner, Homebrew VC; Former Director of Product Management, Google
  132. Tristan Walker, Founder/CEO, Walker & Company Brands, Inc.; Founder/Chairman, Code 2040
  133. Ari Wallach, CEO, Synthesis Corp.
  134. Padmasree Warrior, CEO, NextEV USA; Former CTSO, Cisco
  135. Laura Weidman Powers, Co-Founder/CEO, Code2040
  136. Kevin Weil, Head of Product, Instagram
  137. Phil Weiser, Hatfield Professor of Law, University of Colorado and Executive Director of the Silicon Flatirons Center
  138. Daniel J. Weitzner, Principal Research Scientist, Computer Science and Artificial Intelligence Lab, Massachusetts Institut
  139. Emily White, Entrepreneur; Former COO, Snapchat
  140. Ev Williams, Founder/CEO, Medium; Co-Founder Twitter, Blogger
  141. Monique Woodward, Venture Partner, 500 Startups
  142. Steve Wozniak, Co-Founder, Apple
  143. Tim Wu, Professor of Law, Columbia University
  144. Andrew Yang, Founder/CEO, Venture for America
  145. Arielle Zuckerberg, Partner, Kleiner Perkins Caufield & Byers
"We are inventors, entrepreneurs, engineers, investors, researchers, and business leaders working in the technology sector. We are proud that American innovation is the envy of the world, a source of widely-shared prosperity, and a hallmark of our global leadership.

We believe in an inclusive country that fosters opportunity, creativity and a level playing field. Donald Trump does not. He campaigns on anger, bigotry, fear of new ideas and new people, and a fundamental belief that America is weak and in decline.  We have listened to Donald Trump over the past year and we have concluded: Trump would be a disaster for innovation.  His vision stands against the open exchange of ideas, free movement of people, and productive engagement with the outside world that is critical to our economy—and that provide the foundation for innovation and growth..."


Well, uhhh... make that 144 tech leaders and the Reverend Jesse Jackson? What's up with that?

Link: An Open Letter From Technology Sector Leaders On Donald Trump’s Candidacy For President

My views on Donald Trump are no secret. Click here. And here.

UPDATE
Silicon Valley's Hyper-Partisan Future
A major venture capitalist will speak in support of Trump, as dozens more decry him.


Most years, the power players of Silicon Valley regard their counterparts in Washington, D.C., with some mix of detached affection and amused pity—the way an EDM-inclined son might feel about his father’s love of The Eagles. (Sure, they might have mattered once, but that harmony’s never gonna sound as sweet again.) More than one venture capitalist has told me that when he visits Capitol Hill, he mostly wants to make sure Congress isn’t about to screw up his work, which is, it’s left unsaid, more important. Software is, after all, eating the world.

So it has been odd this week to see some of the highest-profile leaders of the technology industry speak clearly and publicly about political issues—and American partisan politics, in particular.

First, the venture capitalist Peter Thiel announced he will speak at the Republican National Convention next week in Cleveland. Thiel made his fortune by co-founding Paypal and investing early in Facebook; since then he has run venture funds with varying levels of success and created anti-college fellowships. He remains on Facebook’s board of directors...
I reported on Thiel's book "Zero to One" back in October 2014. It's a bit difficult to square what I wrote back then with this latest news.
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UPDATE

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More to come...

Monday, July 11, 2016

"Guns Don't Kill People"

OK, bullets fired from them by people do. Is that better?

I was in Las Vegas to attend a memorial service last Thursday for the recently deceased father of two of my closest friends, Jerry and Lenny Lopez of the Santa Fe Band. After the service and reception I checked into my hotel and flipped CNN on while changing clothes as I prepared go eat at Lindo Michoacan, my favorite Vegas Mexican restaurant. Live aerial coverage of the downtown #BlackLivesMatter-related protest resulting from the week's prior police shootings in Baton Rouge and Minneapolis was underway.

All of a sudden, people started scattering in panic in all directions. "Shots fired! Active shooters firing from an elevated position...!"

Aghast, I sat on the bed, riveted at the breaking news of our latest unfolding mass firearms tragedy. I quit changing and just slipped under the covers and eventually crashed, emotionally exhausted by this latest grotesque incident. #NeverAgain


Right.

Was Dallas simply yet another unavoidable instance of "Force Majeur"?
...Are we simply left, then, with dueling antagonistic, frequently epithet-overloaded speculative arguments, many of them based on the weakest (and most cherry-picked) of empirical evidence, buttressed and amplified by the most fevered illogic? Some of them that hark to a time of a frontier nation comprised of less than 1% of today's U.S. population, a new nation still smoldering from the flames of war on its soil, a nation where the relative "balance of power" expressed via citizen vs government armaments was orders of magnitude smaller compared to that of today?

Are we left to simply argue that the ONLY thing preventing our self-government from devolving into despotism is our putatively prophylactic "Right to Bear Arms"?
Also, beyond fatuous notions of manly, preening "Revolution 2.0," recall the contentious "Docs vs. Glocks" thing? See, e.g., "The Absurd Logic Behind Florida’s Docs vs. Glocks Law." See also
Is gun violence actually a public health issue?
Gun violence is killing 30,000 Americans a year. Why not treat it like smoking? Or heart disease?

For over two decades, there has been a virtual freeze on gun violence research in the United States. In 1996, Congress passed a bill preventing the use of federal funds for studies that advocate gun control, which was widely interpreted as preventing all research into firearm violence. Though U.S. President Barack Obama reversed the order in 2013, Congress continues to block dedicated funding. And this data deficit is posing a significant complication for those hoping to find a solution for America’s gun-death epidemic...
I know people in the health care community who will forcefully, angrily scoff at the very notion of epidemiological firearms research and any further firearms control legislation.
I'll be clear. I would "Repeal and Replace" the antiquated, subsequently incoherent case law-validated 2nd Amendment. I've gotten repeated Keyboard Commando "death threats" just for stating that. Try to imagine my abject terror.
EHR Social History tabs must not extend to the recording of firearms possession and use, notwithstanding the potential risk factors (the extent of which we simply cannot know given the lack of any research data).

"The only thing that stops a bad guy with a gun is a good guy with a gun."

Yeah, sure. During the recent Roseburg, Oregon Community College shooting there was a student on campus, a military veteran with a concealed carry permit. He was packing, but told reporters he didn't act because he thought police might suspect him as a "bad guy." Similarly, the Dallas PD Chief just finished a press conference during which he reiterated that during a exigent shooting circumstances the police will not have the luxury of time to deliberate on "good guys vs bad guys."
Dallas Police Chief Debunks Conservative Media's "Good Guy With A Gun" Myth
Chief David Brown: In Open Carry States "We Don't Know Who The Good Guy Is Versus Who The Bad Guy Is If Everybody Starts Shooting"


"We are trying as best as we can as a law enforcement community to make it work so the citizens can express their Second Amendment rights. But it's increasingly challenging when people have AR-15s slung over and shootings occur in a crowd and they begin running, and we don't know -- or we don't know if they're the shooter or not, or they begin, it's been the presumption that a good guy with a gun is the best way to resolve some of these things. Well, we don't know who the good guy is versus who the bad guy is if everybody starts shooting, and we've expressed that concern as well."
Some aggregate tangential summary Guns-Don't-Kill-People outcomes data here: "[A] list of the 30 deadliest single day mass shootings in U.S. history from 1949 to the present."

Lots more to think about. Some of this, in particular related to the latest controversial police shootings, gets a bit personal for me. My daughter Danielle is mixed race, adopted at birth. My grandson Keenan is now 22 and has just graduated from St. Olaf College in Minnesota. Potentially "scary-looking" hefty minority ex-football lineman, if encountered at night on a dark street or during a traffic stop.


UPDATE
Dallas Chief to Lawmakers: Do Your Job on Gun Control 

During a Monday morning press conference, Dallas police chief David Brown said he believes legislators aren't doing enough about guns in the United States. "There is a greater role in policy-making, and folks just need to do their job," Brown said. "There are too many things we all agree on on both sides of the aisle that we haven't gotten done. We just need to get it done. Quit asking cops to chime in and do it for you." He added, "We've got a full plate. The policy-making, the laws being passed, that's their job. We need to do it to be safer in this country. The issues have been long discussed. We are not getting to a place where we do anything. That's the frustration for police officers. We all know what needs to be done that we agree on, just to say we did something."
He'll continue to get death threats as well. Count on it.

"The antiquated, subsequently incoherent case law-validated 2nd Amendment"
"A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."
OK, just try asserting your unfettered Constitutional right to own a fully automatic military assault rifle, an RPG, Abrams tank, Blackhawk helicopter, or Sidewinder Missile-equipped UAV (a drone). Notwithstanding that SCOTUS case law has by now dispensed with the opening "well-regulated Militia" clause, infringement on ownership, possession, and use of certain types of weapons is in fact by now well-established -- dispositively so.

Moreover, taking up arms against the government -- romantically referred to by some gun nuts and pandering politicians as "Second Amendment Remedies" -- is the very Constitutional and statutory definition of "Treason."

Neither the houses I have owned, nor our innumerable cars, nor my large inventory of fine guitars have Constitutional "right" protection. No one from government has ever come to confiscate them (and neither have my lenders, given my history of on-time payments as due). But, it's conflatingly axiomatic among 2nd Amendment extremists that any regulation of firearms is the precursor to inevitable blanket prohibition and dictatorial confiscation.

Delusional.

That "gun enthusiasts" bristle at real or imagined "inconveniences" posed by regulation (in addition to other bogeyman apparitional threats) is not of the slightest relative interest to me.

Having to go to the DMV episodically is a pain my my ass as well.

THE "INHERENTLY DANGEROUS INSTRUMENTALITY"

That's a tort phrase, one used successfully against the tobacco industry. Basically, the assertion is that there is no safe use of the product. Used as directed it destroys.

Firearms don't  rise to precisely that level of analogy (and I've been slammed for even mentioning it), but there's no denying that the entire point of their use is to propel high-speed projectiles that damage or destroy the objects they hit, be they paper or clay targets, beer cans or bottles, or the bodies of living beings.

That's close enough for me to want them to be rationally regulated in an increasingly densely populated world. Bullets are "inherently dangerous" to the things they strike -- whether intended targets or not.

"What an AR-15 Can Do to the Human Body"
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More to come...

Monday, July 4, 2016

4th of July, 2016, the summer of our myriad festering discontents


If you're paying any attention, you know that acrid, increasing unhappiness abounds at every turn. First, a couple of recent posts emanating from the Health IT blogosphere:
The Physician’s Case For Trump
Anish Koka, MD

Brexit has been hailed as a turning point in the history of Western Democracy by a collection of liberal and conservative elites that decry the vote of a disenchanted and ignorant populace.  The greatest threat to democracy in the modern age turn out to be the very same people that make up the democracy.  We are told these are the same forces that propel Donald Trump forward.  It is a convenient narrative that extinguishes any real debate on policy.  If you support Brexit or Donald Trump you are an uninformed, xenophobic bigot.  Yet here I am – an Indian immigrant, a physician, and a lifelong democrat to boot, who sees no other choice than Trump this election cycle.

I must confess that I have no emotional connection with Mr. Trump – his public demeanor, braggadocio, and above all, the coarseness of his manner when he engages opponents are not what are familiar or soothing to eye or ear.  Yet, as a physician who has struggled through the last eight years of policies and regulations that have made my ability to take care of patients more and more difficult, Mr. Trump has taken on the form of an orange-tinged life preserver...
Then there's Margalit Gur-Arie, who I respect greatly in general, and whom I've cited here many times (relatedly, see also here).
Confession of a Liberal
TRIGGER WARNING: Long read, Trump


I am a woman and I am an immigrant to this country. I am Jewish by birth and atheist by faith. I am fairly well educated, borderline socialist and straight Democratic ticket voter. I have no use for guns, I despise hunting, and I believe the death penalty is state sponsored murder. I think abortions are perfectly fine and I think everybody should be free to choose how they use their own body for their own happiness and joy. I have no respect for authority, strength, power or large wads of cash. Come to think of it, I have no respect for anything or anyone in particular.

On November eighth, barring any natural disasters, Iwill be voting for Donald Trump and according to my liberal bible, I will be doing so for all the wrong reasons...
I've read and re-read their posts, along the the many comments, and I remain flummoxed and disconcerted. But, that's just me. I just don't like the guy.

With respect to health care and Health IT specifically, you need not look far to read volumes of discontent.
How to End MACRA, Meaningful Use and ONC Certified EHRs Programs/Mandates
Hayward Zwerling, MD

While the Federal Government’s promotion of EHRs via the HITECH act has been successful at increasing the prevalence of EHRs, their continued advocacy of Certified EHRs, Meaningful Use (MU) mandates and MACRA seriously impedes innovation in health information technology realms. For this reason, I think it is time for our Federal politicians to alter provisions of the HITECH ACT so as to end all legal mandates resulting in Certified EHRs, MU and MACRA...

...I have submitted the below resolution to the Massachusetts Medical Society which, if passed by the next House of Delegates (HOD) meeting, will make it the official policy of the MMS to use it’s [sic] political influence to end these Federal mandates... 
My comment below his post.
“…use it’s [sic] political influence…”

Which is likely nil. But, President Trump® will make everything Terrific. Patience.

All snark aside, notwithstanding that I worked in the MU program at one of the RECs, I routinely bit the hand that fed me: ClinicMonkey.blogspot.com.

The EHR Cert program is a joke.
Yeah. We have our chronic frustrations and irritations. And, this year, we seem to be in increasing thrall to a political nihilist sentiment, worldwide.

As we ignite colorful celebratory explosives in effusive commemoration of the 240th anniversary of our Declaration of Independence, I cannot get other imagery out of my mind. e.g., Syria today.

We live in an age of disintegration. Nowhere is this more evident than in the Greater Middle East and Africa. Across the vast swath of territory between Pakistan and Nigeria, there are at least seven ongoing wars — in Afghanistan, Iraq, Syria, Yemen, Libya, Somalia, and South Sudan. These conflicts are extraordinarily destructive. They are tearing apart the countries in which they are taking place in ways that make it doubtful they will ever recover. Cities like Aleppo in Syria, Ramadi in Iraq, Taiz in Yemen, and Benghazi in Libya have been partly or entirely reduced to ruins. There are also at least three other serious insurgencies: in southeast Turkey, where Kurdish guerrillas are fighting the Turkish army, in Egypt’s Sinai Peninsula where a little-reported but ferocious guerrilla conflict is underway, and in northeast Nigeria and neighboring countries where Boko Haram continues to launch murderous attacks.

All of these have a number of things in common: they are endless and seem never to produce definitive winners or losers. (Afghanistan has effectively been at war since 1979, Somalia since 1991.) They involve the destruction or dismemberment of unified nations, their de facto partition amid mass population movements and upheavals — well publicized in the case of Syria and Iraq, less so in places like South Sudan where more than 2.4 million people have been displaced in recent years...


Everywhere nation states are enfeebled or collapsing, as authoritarian leaders battle for survival in the face of mounting external and internal pressures. This is hardly the way the region was expected to develop. Countries that had escaped from colonial rule in the second half of the twentieth century were supposed to become more, not less, unified as time passed.... - Patrick Cockburn
Below: as I made my news rounds today.


And the Hits Just Keep on Comin'...
Trust in Government Is Collapsing Around the World
The trend helps explain Trump and Brexit. What’s next?


...Richard Edelman, the head of the communications marketing firm Edelman, sees something more significant in the change: proof of a new “world of self-reference” that, once you notice it, helps explain everything from Donald Trump’s appeal to Britain’s vote to exit the European Union. Elites used to possess outsized influence and authority, Edelman notes, but now they only have a monopoly on authority. Influence largely rests with the broader population. People trust their peers much more than they trust their political leaders or news organizations...
Interesting "Trust in Government" chart therein:

I was born in 1946 after my Dad came home from WWII in Europe, minus a leg, so this chart covers most of my lifetime. In our house the 4th of July was not about 3-day-weekends, cookouts, and Dollar Daze Sales. It was about reflective patriotic reverence for our nation of self-governance  -- won and recurrently defended at such unspeakably high prices. I continue to find ignorant, flip, dilettante calls to sedition the object of my utmost scorn.

If the data comprising the foregoing graphic are to be taken at roughly face value, ~80% of respondents are cynical about governance. A distressing trend. The U.S. population has doubled across my lifetime thus far. Are we becoming "ungovernable"?

apropos, demagogic flamethrowers like Mr. Trump rarely pass on an opportunity to crassly diss "expertise" across the board. Yeah, we know, Donald; experts are always wrong about everything (except you of course).
Why the World Is Rebelling Against ‘Experts’
An unconventional, sometimes incoherent, resistance arises to the elites who keep explaining why changes that hurt the middle class are actually for its own good.


The Great Rebellion is on and where it leads nobody knows.

Its expressions range from Brexit to the Trump phenomena and includes neo-nationalist and unconventional insurgent movement around the world. It shares no single leader, party or ideology. Its very incoherence, combined with the blindness of its elite opposition, has made it hard for the established parties across what’s left of the democratic world to contain it.


What holds the rebels together is a single idea: the rejection of the neo-liberal crony capitalist order that has arisen since the fall of the Soviet Union. For two decades, this new ruling class could boast of great successes: rising living standards, limited warfare, rapid technological change and an optimism about the future spread of liberal democracy. Now, that’s all fading or failing.


Living standards are stagnating, vicious wars raging, poverty-stricken migrants pouring across borders and class chasms growing. Amidst this, the crony capitalists and their bureaucratic allies have only grown more arrogant and demanding. But the failures of those who occupy what Lenin called “the commanding heights” are obvious to most of the citizens on whose behalf they claim to speak and act.

The Great Rebellion draws on five disparate and sometimes contradictory causes that find common ground in frustration with the steady bureaucratic erosion of democratic self-governance: class resentment, racial concerns, geographic disparities, nationalism, cultural identity. Each of these strains appeals to different constituencies, but together they are creating a political Molotov cocktail...
Brings to mind my latest read.

[U]ltimately, it is our self-conscious awareness and ability to shape the world around us that is the most distinctive aspect of our species. 

A concern shared by many is that we seem to have lost our way with regard to this particular ability in recent years. So, while we can now sequence a human baby’s genome in twenty hours or image its brain patterns as it learns to speak, at the same time other children are dying for lack of clean water or being blown up by smart missiles in some distant war. Meanwhile, despite our vast technological capacities our governments and political leaders seem incapable of doing anything to tackle the most urgent issue of our times— the warming of the planet. So perhaps it’s not surprising that some people feel more threatened than empowered by the growing prospect of scientists soon being able to decode the genomes of every individual on the planet. Personally, I am excited by this prospect, but it will need to be coupled with a real and democratic debate about the ways we intend to use this information. As such, my conclusion to this book is the hope that it has stimulated a desire to know more about the workings of the genome and how it affects our lives, but also that it has reaffirmed the importance of what truly distinguishes our species— that is, our potential to not only shape the world, but to do so for the good of every human being on the planet and all the other organisms (who are, after all, our biological cousins) with whom we share this miraculous blue biosphere within the cosmos.

Parrington, John (2015-05-28). The Deeper Genome: Why there is more to the human genome than meets the eye (p. 207). Oxford University Press. Kindle Edition.
"...our potential to not only shape the world, but to do so for the good of every human being on the planet and all the other organisms..."
Dunno. Sometimes I get the feeling that we are drifting slowly the other way.

Have a safe holiday.
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CODA

"What Trump offers is an easy escape from the pain. To every complex problem, he promises a simple solution. He can bring jobs back simply by punishing offshoring companies into submission. As he told a New Hampshire crowd—folks all too familiar with the opioid scourge—he can cure the addiction epidemic by building a Mexican wall and keeping the cartels out. He will spare the United States from humiliation and military defeat with indiscriminate bombing. It doesn’t matter that no credible military leader has endorsed his plan. He never offers details for how these plans will work, because he can’t. Trump’s promises are the needle in America’s collective vein..." - "Opioid of the Masses"
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More to come...