If you give a mouse a cookie

One of the kids’ favorite children’s book is “If you give a mouse a cookie.” The book takes you on a series of steps after that first cookie offer. In this vein, here are a few meandering thoughts.

If you get your news from extreme talk show venues, then do not be surprised by the strange looks you get when you espouse what you heard or read.

If you get your news from the president, you may want to check additional sources as his veracity is highly dubious.

If you are too rash with getting out of shelter-at-home restrictions, please heed the counsel of Dr. Birx who said on Fox she worries about people bringing home infections to grandma and grandpa, something you will regret the rest of your life.

If you protest with an assault weapon in tow, do not be surprised when your message is discounted. If you walk into a legislative building with a firearm, do not be surprised if you are arrested.

If you say inane things, do not be surprised if people treat you with circumspect. Saying you will eat health care officials if they stand in the way of opening the economy does not improve your argument.

If you drink disinfectant to prevent COVID-19, do not be surprised if you end up in the hospital. Same goes with the Tide pod challenge or shooting your fanny with silicon to look like a Kardashian.

And, if you give a mouse a glass a milk, don’t be surprised if he wants a cookie to go with it.

Help me define the best (or worst in this case) metaphor of the Trump presidency

After the most recent incredulous statement by the US president about ingesting disinfectant as a possible cure for COVID-19, I felt this Marie Antoinette moment might be a metaphor for his presidency. Yet, there are truly many contenders for such a distinction.

Below are twelve top of mind statements or actions that could be considered. Sadly, there are more to choose from. So, readers please let me know your top three, including others I may have overlooked.

1. Ingesting disinfectant – he has to tried to explain this away as sarcasm, but to see Dr. Birx trying to avoid eye contact when he asked her what she thought is telling.

2. Sharpie gate – this is when the president played meterologist and scared the state of Alabama by drawing on the map the hurricane may hit them. This was an unforced error thst aides spent a week trying to diffuse.

3. Firing Comey without telling him – for a person who liked to say “You’re fired” on TV, the president cannot bring himself to fire soneone in person. James Comey found out he was fired via TV news. But, Trump failed to tell his Communication team, so Sean Spicer was hiding in the White House bushes with staff to plan what to say.

4. First travel ban – Trump likes to use the word disaster to define anything he did not do. The first travel ban was so disastrous, it waa pulled after two days. The president failed to vet the change with various stakeholders including the people who would need to conduct the ban. So, people did not know what to do and the lines were long.

5. India/ Pakistan brokering peace deal – this faux pas did not get much air time, but the president announced in front of the Pakistani leader the India prime minister asked him to broker a peace deal between the two countries over the Kashmir conflict. Within the hour, India put out a press release saying no such request was made.

6. Tariffs paid by China – the president has said this at least a dozen times, so it may be a good candidate because of its staying power. Trump likes to say China is paying the tariffs. Economists correct him each time saying US importers pay the tariffs which are passed onto the consumers. So, we pay the tariffs.

7. Extorting Ukraine – after watching a parade of reputable public servants testify under oath at a great risk with such a vindictive president, Trump was impeached over extorting Ukraine for personal gain. He likes to focus on one phone call, but if that call was so “perfect,” why did his staff try to bury it?

8. Siding with Putin over CIA – in Helsinki, standing side by side with a man who is KGB trained on disinformation, Trump sided with Putin over the advice of his intelligence people. Senator John McCain wrote an op-ed piece to blast the president’s words as “traiterous.”

9. Pulling out of Paris Climate Change Accord – the president’s stance on climate change was my worst fear going in. So, he announced pulling out of the Paris accord on June 1, 2017, the day following Exxon shareholders voting for management to tell them what Exxon is doing to address climate change. When we exit, the US will stand alone in the world.

10. Transgender in military – the announcement to ban new transgender people in the military got the press, but the decision process is the metaphor. Per the book “Fear” by two-time Pulitzer Prize winner Bob Woodward, the president announced his decision by two tweets around 10:05 one morning saying the Joint Chiefs of Staff and he had decided to do this. Problem is they had not. The time is important as the Joint Chiefs waited downstairs to meet with the president to go over four options and the pros/ cons of each. The president was told of this and asked when would be a good time to meet. This is a key reason DOD James Mattis abruptly said that a tweet is not an order.

11. Wandering alone at G20 – this was a sad to watch as the president wandered the tables looking for someone to talk with after dinner at a G20 meeting. He finally wandered over to meet with Vladimir Putin alone, a very scary situation with a very informed leader and Trump, who does not study history or issues. Plus, it is a metaphor that he would gravitate to Putin’s table rather than an ally of our country.

12. Bragging on fixing the economy – this is the most relentless of topics and, until the virus hit, was his claim to fame. The problem is he did not fix the economy. Yes, economic growth continued under his watch, but when he was sworn in on January 20, 2017, the US GDP was in its 91st consecutive month of economic growth (that is seven plus years), the stock market had more than doubled under Obama, and unemployment was under 5%. Presidents get too much credit and blame for the economy, but for Trump to say he fixed the economy is untrue – it was not broken He has added both short term tailwinds and long term headwinds.

So, that is a dirty dozen, so to speak. I wanted to limit them twelve, so leaving off Charlottesville, his rallies, his ignoring the early warnings on COVID-19, or just his litany of routine, daily untruthfulness or beating up on the press, etc. proved difficult. Let me know your top three choices. Please feel free to add any others. It is funny, depending on how I want to focus my attention, I could pick a different three – is impact, continuity, or inanity the best measure?

Supreme Court rules against a GOP effort to renege on owed payments to health insurers

On Monday, the US Supreme Court ruled against an effort of several years ago led by Senator Marco Rubio to shortchange health insurers money owed to them for accepting higher risk claimants early on under the Affordable Care Act. In essence, Rubio led GOP Senators to eliminate 89% of the funding under a risk corridor agreement to tie insurers through initial adverse risk (due to pent up demand from folks who were not previously covered).

The following excerpt from an article called “Supreme Court rules government must pay billions to Obamacare insurers,” by Susannah Luthi of Politico, may be of interest.

“The Supreme Court on Monday ruled the federal government owes health insurers massive payments from an Obamacare program shielding them from financial risks after the companies accused Washington of reneging on its funding promises.

The 8-1 decision could open the floodgates for federal cash to the insurance industry. Insurers who accused the government of a ‘bait and switch’ claimed they’re owed $12 billion from the Affordable Care Act program.”

The lone dissenting vote was from Justice Samuel Alito who said the insurers were getting a “windfall.” No, Justice Alito and Senator Rubio, they are getting what was promised in writing.

People could easily dismiss this as a fight that does not concern them. That would be a misjudgment. The Republican Senators led by Rubio screwed Americans to win a political argument in attempt to sabotage the ACA. Why do I say that? As a consequence, these insurers had to raise premiums that impacted unsubsidized folks and caused an increase to the offsetting premium credit under the ACA for the subsidized folks. That subsidy increase in turn increased our budget deficit. It also forced some insurers to exit the ACA with the US government owing them money, which hurt competition.

Sadly, all of the efforts noted above, which the Supreme Court just overturned, are true. That is a reason for the near unanimous vote. I encourage you to Google “Marco Rubio and ACA Risk Corridors” and read as much as you like. What frustrates this retired benefits consultant, manager and actuary is very few people know they got screwed. The following links to this article and one of my many pieces on shoring up the ACA are below.

https://www.politico.com/news/2020/04/27/supreme-court-rules-government-must-pay-billions-to-obamacare-insurers-211184

https://musingsofanoldfart.wordpress.com/2019/07/19/please-stabilize-the-affordable-care-act-now-to-help-americans/

A needed idea or two

When “Saturday Night Live” first aired, they would end the funny news segment with a repeat of the top story for the hearing impaired. Chevy Chase would re-read the top story, while Garrett Morris, would shout out what Chase was reading.

If Republican Senators and leaders cannot get the president to stop doing his press conferences, maybe we need to bring out a Garrett Morris type character who would shout out over the president. The Morris character could shout, please do not accept the words of the president as the truth. What he just said is not only wrong, it is harmful.

Absent that, maybe a correspondent with some gravitas could ask the president if he actually believes what he just said? Maybe, he or she could say, are you joking or being sarcastic, as we are going to report what you just said word for word? Here is your chance to set the record straight.

Another adventuresome reporter could stop the president when he interrupts, saying I asked Dr. Fauci or Dr. Birx that question, not you. Maybe, they could be charitable and say, “Mr. president, with all due respect, I would like to hear the doctor’s opinion.”

What the latest round of remarks that offered a dangerous tactic about ingesting or injecting disinfectant (and UV light) has done, is the inanity was so pronounced and obvious, that even Trump supporters cannot hide from them. They may serve as a historical marker like Marie Antoinette’s “Let them eat cake” remark.

I know the president’s team is trying “erase the remarks” saying he was being sarcastic, but I cannot forget the look of Dr. Birx trying to hide in her chair and not look at the president as he looked at her for validation. Yet, while very memorable, these remarks are not outliers. Too many times, Trump staff has had to waste taxpayer time to make it look like the president’s remarks were not what he meant or supportable by some strange set of facts.

I forwarded my post called “Mr. president, if you cannot add value, please stop talking” to my GOP Senators and Congressman. They know already that the president has and is screwing up. At some point, as things continue, I am going to pose the question to them, are you ready to save our country, our planet and your party and support Joe Biden over your party’s candidate? There are some Republicans already there.

Relaxing shelter-at-home requirements must be done judiciously with health in mind

As Georgia governor Brian Kemp more aggressively lifted restrictions yesterday, joining other states like South Carolina, Oklahoma, etc., a concern that is not getting talked about enough is some of these same states have the worst national health care rankings. More on this below. Per two separate surveys in the past few days, 70% of Americans want the focus to be on health first, before reopening. Americans seem to get where the focus needs to be more so than some leaders.

I understand the desire to reopen more fully, but we must be smart about it. I was pleased to see the North Carolina governor Roy Cooper extend the shelter-at-home requirement for two weeks, but actually announcing a three phased plan to reopen. That is what is needed. It could be postponed if the numbers do not improve, but it is an articulated plan.

This is a state-by-state issue. The relative health of the state is important as it increases the relative risk. The Commonwealth Fund is an organization that measures the relative health of a state based on a number of factors and have been doing so for years. A link below is to the 2019 state rankings. As you think about states that are reopening sooner than others, consider the following:

The worst twelve states (and District of Columbia) for overall healthcare, from worst to twelfth worst, are as follows:
51 – Mississippi
50 – Oklahoma
49 – Texas
48 – Nevada
47 – Arkansas
46 – West Virginia
45 – Louisiana
44 – Florida
43 – Missouri
42 – Georgia
41 – South Carolina
40 – Tennessee
39 – Alabama

The Commonwealth Fund uses a robust number of variables to rank the states and is one of the more comprehensive tools. These states tend to have a higher degree of obesity (BMI greater than or equal to 30), some have a greater degree of child hood obesity, and have a greater degree of people who claim poor health. With the higher degree of obesity comes higher propensity of diabetes, although this data is inconsistently reported. Please click on the link and go through the most recent report.

Obesity and diabetes are critical factors. Data from the COVID-19 reported this week noted diabetics are not faring well when diagnosed. People with breathing difficulties – asthma, COPD, etc. also are at greater risk. It should be noted Florida ranks poorly on childhood asthma. Again, this is an underreported data point in other states.

Another key factor for poor ratings is access to health care providers and insurance. Many of these states did not expand Medicaid. Many of these states have seen more rural hospitals close than others. Many of these states have more food deserts and higher degrees of drug overdoses, alcoholism, and suicides.

I mention all of the above, as the states have varying degrees of preparedness and risk exposure. In fact, many businesses have noted they are ignoring the governor’s orders to reopen their doors. That is also telling.

I get it. I understand the desire to reopen the doors. I also know pandemic diseases spread more readily than other diseases. If we do venture out – please use social distancing and face masks. There are many restaurants who are practicing good procedures to protect the staff and customers through take out and delivery orders. Support their efforts. That is a way to invest in our economy.

And, please listen to the truthtellers, the doctors, nurses and disease scientists. Listen to the folks not patting themselves on the back or making the issue more political. Facts must trump politics. But, we should also be mindful, we are learning more about this virus with increasingly better data. Just because new data sets aside a previous notion, that is not unusual with pandemic risks. AIDs and Ebola revealed this based on their initial discoveries (AIDs was thought to impact only gay men at first, until women and heterosexuals started dying, eg).

These truthtellers understand this is an uphill climb. We must be vigilant and patient. And, judicious and humble.

https://scorecard.commonwealthfund.org/rankings/

Mr. president, if you can’t add value, please stop talking

Yesterday, even the untruthful president went beyond the pale. He actually parroted something he heard somewhere that UV light and disinfectant could be used internally to combat COVID-19. Please read the previous sentence for full effect.

Three comments. First, we should have been concerned when Trump and his VP stood at the podium without doctors. Dr. Deborah Birx was present, but sitting in a chair to the right of the president facing his side. Watch her reaction as he speaks to her for validation – she is not making any eye contact to betray her thoughts.

Second, Lysol put out a statement last night. Please do not ingest or inject our product or any other disinfectant. It is dangerous. A host of doctors noted this is not advice that should be followed.

Third, even Republican Senators and party leaders have asked Trump to leave the speaking on COVID-19 to the experts. He has already forced out one Vaccine expert for disagreeing with him on a treatment the president even now has abandoned. The expert is considering a whistleblower complaint.

Dr. Anthony Fauci and Dr. Birx have often had to correct the president, sometimes in the same conference. Mr. president, this is not one of your rallies where you lie with much greater frequency. These conferences are supposed to be helpful. Yet, John Oliver said it well on his recent comedy/ news show “Last week tonight,”

“The president is belng actively harmful to Americans with his misinformation.” When Lysol has to put out a press release to say don’t use our product internally, it is time for the president to follow his fellow Republicans advice and let others speak on these issues.



If you don’t want to heed their advice, maybe Mark Twain’s may be more directive. Twain said, “It is better to let people think you are a fool, than to speak and remove all doubt.”

Beyond the call – mothers, nurses, midwives and doctors

Our oldest son joined us for dinner on Sunday. He stayed around and watched one of our favorite shows “Call the Midwife.” He certainly got a lesson in births as they had several trying deliveries as the midwives mentored some new doctors. In one instance, the baby’s arm got stuck behind its back and was not coming out very easily, so seeing how the midwife handled it was cool.

We reminded him of the stories of the three births of him and his siblings. His birth was the easiest of the three, with one key note. His mother asked for an epidural too late and proceeded to have him sans pain reliever. So, he was the first of three deliveries without epidurals. His mother obviously has a high pain threshold. A funny story is my wife’s doctor told her the day before it would be another week, until she showed up at my office the next day after her water broke at lunch with a friend.

Our middle child had some challenges, but they were not uncommon to the nurse and doctor. Meconium is a fancy term for the baby’s first bowel movement. It is not uncommon for this to be released before delivery and cause aspiration issues. The nurse detected our son was having breathing issues with each contraction. They whisked my wife’s parents out and brought in a swat team. After delivery, the swat team cleaned out his passages and everything was fine. The doctor told the nurse under his breath “nice catch.”

Our daughter was born in a non-uncommon manner as well. She came out purple. The umbilical cord had wrapped around her neck and was causing breathing difficulties. The doctor went clip, clip with scissors and everything was fine. The doctor said it happens enough not to be rare.

Let me finish with two stories, one before birth and one after. A colleague of mine was in labor with twins and walking around the mall to move things along. In so doing, she was talking with a client on how to resolve a problem with various solutions. When they realized she was in labor, their favorable impression increased even more. That is beyond the call on client service.

The final story is about our neighbors who had triplets after a previous older child was born a few years earlier. The parents said, when one gets sick, they all get sick. They said they did assembly line feeding with the same spoon and three lined up high chairs. When I asked how they were doing, they said “we are numb.”

Kudos to mothers, nurses, midwives and doctors. Childbirth happens everyday, but we still should applaud the miracle it is. Tell me some of your stories.