Saturday, January 21, 2017

Who You Gonna Fear and Loath?


What we have to fear is not Trump the Autocrat, but Trump the Beard.

This conversation that Bob Reich had with a former Republican congressman friend, reproduced below, casts light on where fear and loathing should fall, and it's not on Donald Trump. Yes, this blog has visited his boorishness and other unattractive personal characteristics, as have others TNTC (that's medical-speak for “too numerous to count,” as applied to white cells in a urine specimen that has been spun down and concentrated and looked at under a microscope, and is presumptive evidence of infection. “TNTC” was used, it should be noted, well before email and texting,when medical records were hand-written and succinct.) Yes, he shows signs of wanting to be an authoritarian, but he'll never make it, not in a hundred years. He doesn't have what it takes, and the country's institutions and political culture are too strong for that to happen. And yes to every other shortcoming everyone has noticed. But is he the real threat?

No, the real threat of Trump is as Trump The Beard. Here is Bob's post (I know him a little bit, hence the “Bob” moniker, just showing off....):

I had breakfast recently with a friend who's a former Republican member of Congress. Here's what he said:
Him: Trump is no Republican. He’s just a big fat ego.
Me: Then why didn’t you speak out against him during the campaign?
Him: You kidding? I was surrounded by Trump voters. I’d have been shot.
Me: So what now? What are your former Republican colleagues going to do?
Him (smirking): They’ll play along for a while.
Me: A while?
Him: They’ll get as much as they want – tax cuts galore, deregulation, military buildup, slash all those poverty programs, and then get to work on Social Security and Medicare – and blame him. And he’s such a fool he’ll want to take credit for everything.
Me: And then what?
Him (laughing): They like Pence.
Me: What do you mean?
Him: Pence is their guy. They all think Trump is out of his mind.
Me: So what?
Him: So the moment Trump does something really dumb – steps over the line – violates the law in a big stupid clumsy way … and you know he will ...
Me: They impeach him?
Him: You bet. They pull the trigger.

So, who is to be feared? The new Radical Republican Party, which replaced the old GOP several elections ago, and certainly bears little resemblance to the GOP of decades ago, is a fundamentalist party. There is a lot to argue with about how government currently acts – in that, Trump's disdain has some merit. There is a lot of swamp that could be drained. I won't go on to detail the shortcomings and borderline corruptions (and outright corruption) of government from both sides – read about Fanny Mae and Freddy Mac if you want to get sick to your stomach about Democrats. A lot of reform of government, now that's something tasty to reflect upon.

For all his bluster and ill will toward the many, I bet that the real burr under Donald's butt is the superior class who has captured government, those who hold Donald in low repute even though he has more money than most of them (we assume), and the rank mediocrity of so many governmental officials.

I can't help mentioning once again that the apotheosis of governmental inefficacy was the Obamacare website disaster. And then how Leon Panetta viewed it: “They relied on the bureaucracy for that? For something that important, you have to go around the government!” And that's a Democrat speaking. One had to ask, why wasn't the A Team involved from the beginning?

(That's unfair, too. The VA health care system is head in low repute, but I just read an article in JAMA that shows them to be cutting edge on how they are improving their system – they have the mechanism of improvement down pat. http://jamanetwork.com/journals/jama/article-abstract/2598276.)

But a reform of government by the Radical Republican Party is as chimerical as repeal and replace. The the Radical Republican Party is really the party of increasing privilege and blaming the victims. Trump has the banner in his hand and marches forward, while they use him as they can, then take over and defend the wasteland they have created.

But, personally, I think they are a doomed sect. There's only so much havoc they can wreak. (For “wreck” vs. “wreak,” see: http://blog.oxforddictionaries.com/2016/01/wreak-havoc-wreck-havoc/) And after that, they will scatter to their various infamies.

In health care, if they really wreck the ACA, the next step is, inevitably, single-payer. I love ironies in history! I gravitate to them, my mind seeks them out, they come to me I can't help it. Here's the deal:

The Democrats wanted to establish a health care program that made health care a right for all Americans. They built upon the already-jerry-built structure of Medicare, Medicaid, Children's Health Insurance Program, community heath clinics and Federally Qualified Health Clinics, Rural Health Centers, private health insurance, county clinics and hospitals, federal state and local support, etc. To get enough support for the ACA, they used a Republican structure, originally from the Heritage Foundation, then from RomneyCare in Massachusetts. The Democrats went Republican.

But then, that wasn't good enough for the Republicans! They had to have their say! So they repealed without being able to replace, wreaking havoc in the health care market, causing not only popular distress but institutional distress among hospitals, insurance companies, counties, providers, etc. And then with a new Democratic administration, one not tied to the old ways and with a huge surge of popular revulsion of the Radical Republicans, the people just said: Medicare for All. Thanks to the Republicans. You can't make this stuff up, you can just watch it unfolding.

So, if the Radical Republicans are wolves in a wolf's clothing, let them do what they will, and let them, like the sheep they are, be led over the cliff by a blind one, and may the blind ones at the head of the line be named Paul, Mitch, and Mike. We'll be cheering their precipitous demise.

Budd Shenkin

Sunday, January 15, 2017

Indian Summer



“Make the diagnosis!” – as my medical journals would challenge the reader on page 39 or so. Shouldn't be too hard, for most doctors. First noticed last Friday on the flank of a 75 year old man, about three inches below the left axilla, the patient discovered the lesion by inadvertently touching it when toweling off after a shower, indicating that it was raised enough to be palpable. The pigmentation was variegated within the lesion with a deeply pigmented, almost blue section, and the border was irregular. On very close inspection, there was possibly a small halo of depigmentation, perhaps slightly bluish.

Meanwhile, although the cold and wet weather has come this year in the real weather, in our septuagenarian lives, it seems like Indian summer. “Indian Summer.” Why it's “Indian,” no one seems to know, not even the internet. But everyone agrees on how sweet it is. As a teenager growing up in Philadelphia, I thought that autumn was the best season, sunny and not too hot and not with the Atlantic seaboard humidity of spring and summer. I lived a 15 or 20 minute walk away from my high school, and I remember thinking as I walked across the empty, treed lot at the corner of Montgomery Avenue and North Wynnewood Avenue, that fall would be my favorite season if it weren't for the fact that winter impended, when the cold and winds make you pull your jacket closer around your neck as you walked along the long curve of Montgomery Avenue in the early dark on the way home. That's where the fall weather is headed, but “Not yet!” proclaims Indian Summer. “You got more, man!” And you enjoy it, you take off your jacket, you eat outside, you throw a ball around and take a walk and say how warm and clear it is, and tell each other how lucky you are. You know it will recede, and you hope it stays longer, just a little longer before you have to cover up. That was the way it was in Lower Merion in the 1950's, and that's the way it is for us today in our 70's. Indian Summer is to be relished.

Here in Berkeley it's now January and the weather is cold and rainy, but thankfully not windy, but we are covered up. We know we need the rain, so it's good and welcome and we don't feel oppressed, at least not yet. We've had our health challenges (see http://buddshenkin.blogspot.com/2011/08/welcome-to-neurosurgeryland.html, of course), but when I'm asked how I am, I answer: “Vertical!” Verticality is as sweet as Indian Summer, and you never know when your own personal clouds and wind will come.

Nowadays we know a lot more about our health than we used to know, just as the weather-people on TV and even our smartphones have satellites to consult. It wasn't Mark Twain, but Charles Dudley Warner who said that “Everybody talks about the weather but nobody does anything about it.” That's probably still true of weather. A storm appears up in the Arctic and we follow its course down the coast, and maybe it will weaken and maybe it will continue on down, but we can't do much about it except prepare for the effects. That's where the weather and health differ; in health, we detect and then we act. Maybe there's something we can do about it, sometimes not, but more and more, there's something. Still, sometimes things just come out of the blue and there you are, you're never completely sure what will come and when.

So when I was toweling off and my hand strayed to an area I don't generally look at – you could say I'm not vain so I don't look at myself, or you could say, given my excess mass, that vanity is the motive force for not looking – and I took the picture you see above to Make The Diagnosis, I wondered if an arctic storm had just appeared. I know enough about skin lesion that I wasn' just worried, but alarmed.

Fortunately, four years ago I had been responsible enough to have switched dermatologists from a contemporary to a younger doc. Jason Fung was a new derm in town and had been, humblingly, a schoolmate of my kids at Head Royce School. Good guy, active, extroverted, chatty, efficient, forward looking with a scribe at his side. His survey of my skin had revealed nothing troubling, but he now had the visual record on me. When I called his office with “ a suspicious mole,” they offered me a spot that very afternoon. I couldn't take it because I had to take Ann to the doctor, but as it happened she had a routine appointment at his office four days later so I was lucky enough to get a spot ten minutes after hers. Ann thought my prompt appointment was evidence of special treatment, but I said “suspicious mole” was code for “get me in NOW.” Not only good patient care, but malpractice avoidance dictates some actions in practice. Like, for pediatricians, “he has excruciating testicular pain.” A ball can die if it is twisted on its stalk, and you'd rather not have that, and neither would your insurance carrier.

I told my friend Stu when I saw him at the gym that I was going in to be checked for a suspicious mole and he said, “It's probably nothing.” Which is what Ann had said, although she had said to be sure to get it checked right away. I hesitated to take solace from their opinions because I know wishful when I hear it, and I had seen it close enough to know it was a problem. But you never know. I can be alarmist.

So on Tuesday Ann went to her exam room to have her stitches out and I went into my exam room and took off my shirt, joined by young lady scribe asking the questions on her script. Then Jason burst in asking about Allie and Nick and Brian and Sara and even Peter and … whoa! “That looks funky!” said Jason as he caught sight of the lesion. No more small talk. I was surprised that it had been four years since I had been in for a survey; hadn't felt that long at all. And I don't know when my last physical was and if Jim had looked carefully at my body when I saw him – there's enough to talk about without something you don't know is there. So how long the lesion had been there was unknown, just less than four years, and probably much more recent.

It's at least making a neoplastic transition, he said. It might not have made it to melanoma yet, but it's pending. In less than five minutes it was out and in a prep jar on the way to pathology. I thought that the speed of extraction reflected his efficiency, but neither of us wants that thing in my body one more minute than necessary. It was Tuesday and he would call me Friday on my cellphone. He gave me a roadmap – either local excision in his office, or over to UC for tracing drainage to the nodes and wider excision, no more talk, let's see. Let's not prejudge, he said. But I heard his voice and I knew it was scary. He said that he knows it wasn't there four years ago because he had checked everything before he had come in to the exam room. It wouldn't have been his fault. I do the same thing, look back to what I could have done, etc. Was I culpable, is always my question of myself. Guilt is always alive in the mental workings of the Budd. But how long had it been there? We couldn't tell. Sometimes it takes time, and sometimes they just explode. Path would tell us how deep it went – less than 1 millimeter is the best – whether the excision had gotten it all with a good margin, and how the cells looked, aggressive or not so much. In any case, we'll be seeing each other more in the coming days, said Jason. I like Jason, so I told him I would enjoy seeing him.

I was curiously calm. Fatalistic, or in denial? I know I'm really good at denial. Or, you could say I'm really good at being in the moment. Nah … I deny. Ann didn't understand that it was dangerous until later; I think she was in denial, too, but maybe not. But anyway, I figured, say it's really malignant. What would happen? Scan the whole body for metastases? Where does melanoma go? Brain, for sure. Maybe liver, everything goes to liver. Bone? I dunno; lung goes to bone. I would rather not have brain metastases, with seizures and seizure meds, etc. Rather not. Hard way to go.

But what I thought was, then I would know how I would die, unless something else came up. I've never known how I'll die – my heart's always been pretty good. My mother died of breast cancer. Maybe cancer. Who knows how Indian Summer ends and when? I've always figured, somehow, that I would go to my 80's; maybe that was wrong. I've said for some time now that I had taken care of my major responsibilities. Kids up and out. I've got enough money so that it will be a great help to them. Ann needs me. We're in Indian Summer together, walking together. I thought about my funeral. My book club would come, my poker game, my medical friends, Bob and Adele, my sibs and their kids, Larry and Michael and Marjorie. Stephen. Stu. David and Joanna. SOAPM would send flowers. I had always wondered if any patients would want to come. Maybe some, but how would they hear? Some of them love me, that's what I need to know. As they say, it should be a good time, I'll be sorry to miss it. What would Nick do, my estranged but still loved son who works for the FBI?

My financial affairs – I'm pretty simplified, which is good. If it looks touchy, I'll sell the condos and make it simpler. Everyone should be OK. Need to make final adjustments.

It will be a different life from now on, if the melanoma is a threatening one, knowing more and having the blanks filled out. Shorten the time line. I've been getting into really good shape and made a new lower weight target. Keep that up? What about the French? Continue with that? Do the paper on healthcare I'm working on, or give it up? I had lunch with my friend Richard, with whom I'm working on a project, and I found less enthusiasm if I would have to devote the final days. Would hang back on that. Maybe watch more movies, which I am already doing somewhat. Somehow, less pressure. Not much reason to do anything except enjoy yourself. While waiting for the curtain.

I knew it was a melanoma. Jason said let's not prejudge, but I knew. “Funky lesion” doesn't make it into the diagnosis books, but then, it's taken until this year for Northern California (actually Berkeley-Oakland) “hella” as in “that's hella good!” to make it into Merriam-Webster. And medicine is even more conservative. I never want to be an “interesting case,” and I'd rather not have a “funky lesion.” I was already thinking about immunotherapy, hoping I wasn't going that way. But prepared to do it, too. Making sure that others don't get too upset. At least my parents have died, so they won't get upset. No one's indispensable, and everyone thinks when someone gets sick and dies, at least it wasn't me. Checking the ages in obits. A diagnosis takes the curtain back a bit, knowing from what and closer to knowing when.

What if it was in brain already and very aggressive and I hear, “maybe six months.” What would happen then? Well, it's coming sometime. Get the kids straight,make sure no one gets too upset. Provide for Ann, that will be hardest. Have to work with Sara.

We'll just have to see. I told Jason, yes, we're planning to go to Maui for two weeks starting next Friday, but forget that, we go all the time. The medicine comes first. Maybe I'll have to ….

On Thursday morning Ann had just finished with her yearly physical and we were walkingdown 30th Street past Summit to the car when the phone rang. It wasn't Friday yet, but I saw on the phone that it was Jason. He hemmed and hawed for a minute, and I thought, Oh, shit. But then he got to the point. Yes, melanoma. OK, Jason, not great, but that's not the crucial info. Why was he hesitant. Waiting. But … good news! He should have started out saying “Good news,” but I guess he was still hung up on the “melanoma” part. But, only 0.9 mm deep – hoping to be less than 1 mm, and there it is! Just ducked in under the limit! Excision margins – clear! State of cells – not aggressive yet! So, if you had to have a melanoma, this is the one to have, he said. You bet! He said that he would schedule me for a wider excision by the lady who does them at his office. OK by me! In fact, how about tomorrow, Friday? You bet! 1 PM in Lafayette office? Sure! Get this done.

No need to change any plans – go to Maui, go on cruise, Indian Summer continues! Yessir! Worry dispelled. Looked it up on internet finally, and stage 1a, 97% chance of non-recurrence. I'll take that with gratitude.

So, what people say sometimes after they have been seriously ill and they have refocused on their lives is, I won't say I'm grateful for this, but it did me a lot of good. I'm wondering now, I can't say I'm grateful for this scare, but it was only a scare, but scary enough so that I started traveling in the shady land instead of just imagining it, and I know I'll be there someday, so can I say hey, maybe this was the best of the worlds, that I can change my life for the better and still didn't have to be sick. Can I do that? Or maybe I can just realize that my Indian Summer is going just fine. We'll see what I think.

Carpe diem, man, carpe diem. Do as much good as I can and enjoy every single day, even the cold, rainy ones. I just have to wonder, will this rain ever stop? They say we're mostly out of the drought. Hope so. 

BTW -- here's what it looked like ex post facto.  A lot better out than in....




Budd Shenkin

Wednesday, January 11, 2017

Warriors Redux


Here in the East Bay, home of the Warriors (even though they are not called the Oakland Warriors, and we are worried they will be called the SF Warriors soon instead of remaining Golden State – Oakland gets no respect!) we have been viewing the Warriors a bit quizzically. Last year and the year before, there was no hesitancy. Enthusiasm and possessiveness -- Our Warriors! -- was pervasive. This year, it's more like interest, rooting, hoping – but less possession, maybe. A little less.  They've changed. Change is the way of the world, and capitalism has invaded sports, and not just in naming stadiums but in defining the sport itself, and we understand that “sports is in the entertainment business” and we understand we understand, but that understanding doesn't always penetrate through to feelings.  You never step in the same stream twice, but often you think you're doing it, and other times you know you're not.  This year, we know we're not.

So I'm watching the games, with interest, with cheering and appreciation, but sometimes not to the bitter end. The other night I watched the Memphis game and they were coming apart at the end and KD (Kevin Durant) was playing some hero-ball, which is seldom fun to watch and for which he was loudly called out by Dramond Green afterwards which took some newspaper and coach explaining, and I just went upstairs while they were still ahead thinking they could well lose. Didn't want to see it. Didn't stop me from tuning in to the Miami game two nights later, I'm still interested in how they evolve as a team, but it's not like last year.

I have made a new friend, Benj Demott, from New York, who publishes First of the Month (firstofthemonth.com), whom I met through my good friend Bob Levin. Benj follows basketball, and is now a Warriors fan – good for you, Benj! He said he was preparing an article on the Warriors, so I sent him my feelings. I think men talk about sports the way women talk about boyfriends, btw. Here is what I wrote him, slightly edited:

Here's what I think about the Warriors.  I think that last year was a special year, a magic year, to use two poor, very over-used adjectives.  It was unusual and distinct.  What happened?  First of all, there was the streak -- no, wrong.  First of all, there was the championship of the year before that put a target on their back.  They hadn't had to play San Antonio in the playoffs, and Kyrie and Love were out for Cleveland, and Charles Barkley was on their back, so it was questioned.  Good thing there was no Russian hacking.
And then there was the parade through Oakland.  I was there with my son and granddaughter (the latter only for a while - she was 5).  It was something else.  Klay Thompson said, I didn't know there were this many people.  He said, I mean, they come to the games and they're great, but I didn't know that there were so many people that we mattered to, or something like that.  The parade had a role in ushering in the next year (which, if you're getting confused, was last year, 2015-16, when they lost to Cleveland in game 7 of the finals.) There was something surprising about the championship, and the parade itself was kind of home brewed, and very Oaklandish. Ours.

Then when the new season started -- 2015-16 --everyone was out to get them, so there was no "usual regular season game" for them.  Every game was a semi-playoff style game.  It started with The Streak, and the Warriors took the bit in their mouth and accepted the challenge.  That was unusual.
Then, there was Curry.  Unusual season for anyone, Charles saying no one can keep that up, and the shots kept falling, and his drives were something to see, and the passes.  Stats for threes were "unbelievable," or would have been not long ago.  Now, they are barely believable.  It was a crest.  Everyone on the team wanted him to shoot.  So, that was quite unusual.  There was also Klay's 37 points in a quarter, which I loved in real time.
Then after the unprecedented opening season streak of 24 straight wins there was the season record to go for, so every game counted on that score, too.  Again, Kerr asked them, do we want to go for it?  They said, yeah, we do, and they did and they made it and every game counted and every other game was close, it seemed, and everything broke their way, even the injury to Barnes that let Brandon Rush flourish.  So if you were a fan you couldn't miss a game.  Even though everyone knew this might mean they would peak too early.
And then the goddamn refs.  Charles and even Oscar Robertson said they would know how to stop Curry, rough him up.  That disappointed me about both of them.  I'm nearly ready to throw O off my all-time 5, except I don't believe in making teams according to behavior.  Anyway, that's what the refs let teams get away with.  If you saw Curry without the ball, you saw fouls, you saw rough stuff, and the refs -- who continue to blow so many calls it makes you think "there might be something going on" -- seemed complicit with Charles and O.
Then there was the refs and Dramond.  OK, perhaps immature, but hitting him with all the technicals was really bad, and basically at the end, they cost the Warriors the championship, between Curry not being a full strength which was partly regular wear and tear and partly roughing up, and Dramond out for a game.
And, of course, that team was a real team with some longevity together.  This, being a real team, going crazy on the bench when someone did something good, feeding Klay the ball for 37, laughing and poking each other, warming everyone's heart.  And Kerr had cultivated the second team, Barbosa, Iguadala, Speights, etc.  The year before (2013, I guess), I had gone to a game early on and watched the second team lose a big lead down to where the Warriors were 9 up before he put the regulars back in, maybe against Phoenix.  I thought what I was seeing was Kerr grooming the second team, and by the end of the year they were there.  And then the next year they were even better.
So now, it's different.  There is no streak to work on.  They are a target, but it's not like last year's target, and the team has different guys on it, with Barbosa and Rush and Speights gone from the second team, and Bogut from the first, and Barnes although I don't mind his leaving.  The regular season games seem like regular season games.  The talent is terrific, and there are challenges -- I see too much hero-ball from KD, and they have to say to him, hey, there are other heroes on this team, and we all play together all the time.  So they're good, great even, but in the making of a new team.
I personally think they'll go all the way.  But it will be Warriors #2, not the Warriors as they were, winning again.  It's a new team winning.  They're great, and I still love them.  But this year I'm not nearly so hesitant to book travel and be away for a while.

Budd Shenkin

Tuesday, January 10, 2017

Finding a Strategy, and Why Streep Isn't It


OK, Meryl Streep is a wonderful actress, a very smart and eloquent lady. But I think her Golden Globes statement, while striking and eloquent, was a strategic mistake. And here's why – because it puts style over substance, and not everybody agrees with putting down Trump's style.

Trump is gauche. He's crass. Trump sounds like and often acts like he's from the construction yard, from Queens. Despite his wealth, he seems to act in a way we could see a working class person acting. He's not dumb, but he's not nuanced. He's gruff. He doesn't have the manners one associates with wealth, let's put it that way – the way Romney acted and sounded.

But think of the people who voted for him, the “undereducated.” Many of these people are just repelled by the pretension we see in the classes with money. And I mean, repelled. The Sheryl Sandberg's speak to a certain, privileged class. How to relate to the nanny and keep her away from your husband can be a major concern.

I don't know where the populism comes from in Trump. People are often loyal to their origins. Sports stars “give back” to their home towns -- Damian Lillard comes back to Oakland High and dedicates a gym; Dramond Green goes back to Saginaw . My wife's ex-husband isn't an athlete, but his loyalty to his family origins led him to establish a non-profit that gives computers to poor families in Oakland.
Others are quiet about their loyalty. The Millionaire Next Door kind of person just keeps on living his or her life and piles up the money and then gives it away at the end. Why change a winning game, they figure, I guess. They're happy as they are.
Could Trump's populist attachment be sincere? He himself comes from wealth, but he also comes from Queens, and he has liked to hang out in the construction yards. Maybe, or more probably he just found it in his search for fame and adulation and improvised. Maybe he grew up somehow hearing the Borsht Belt and that's where he got his shtick. Trump is actually faux risen. He acts as though he is giving it back to The Man, as he cheats and bullies his contractors. Then he acts like the avatar of getting back to his roots.

But the fact that he is an imposter isn't the point right now; I just got diverted. The point is, he has carried it off. In his manners and his social defiance and his strong id, he has made many of that oppressed class identify with him. That's the point. He channels resentment, and when Meryl and Hillary and the pathetic Jenn Palmieri try to point out his grossness, the oppressed class responds – up yours! You who have it made, you the ladies who lunch, we're going to listen to you? Crotch grabbing and poor taste is your concern – we're concerned about our jobs and getting paid and our husbands lack of prospects. Don't complain to us about how you might feel disrespected, thank you very much.

This fight over manners is self-defeating. The more the fight is over manners, the more separation of classes there will be, and the more perception of hypocrisy.

Instead, I think one just has to accept the Jacksonian manners. Let the reaction be what it will be. Instead, one has to concentrate on policies. Trump's and Ryan's and Republican policies are atrocious. Don't think people are so dumb they can't see that. It just has to be laid out and explained. And it would be best if it were explained by someone with a working class sound. Bernie Sanders' background isn't working class, but his gruff manner has a sound that resonates to many. It's direct, it's low-pitched, it's intentionally simplifying to make the point. (It's an open question how simple Sanders actually thinks it is – Barney Frank told me he thinks Sanders isn't very smart, but Frank is so partisan....) I'm not suggesting that Bernie be the spokesman, but plainspokenness is essential.

In telling the truth as simply as possible, it can be personified in Trump and the hateful Ryan and then the billionaires who turn out to be hateful. Here's how they are hypocritical and screwing you! Have someone use the word “fucking” and be caught by a “secret open mike.” “Those fucking bastards are screwing the people – how the hell are we going to make that case so that people hear and understand it?”

Find the messenger – and it's not Meryl Streep, and it's not Elizabeth Warren. Warren is eloquent and smart, she even has that humble background, but she's from Harvard and it shows. It needs to be someone like Harold Hughes from Iowa used to be. Or patrician FDR, who knew how to relate, because he really was a man of the people in Warm Springs, Georgia, where he invited everyone into the water with him, to help each other with their polio.

To be simple: Stick to the issues, man. And find a voice of the people. Obama was pretty close; it's too bad he didn't after-sell. Find someone who can, now.

Budd Shenkin

Thursday, January 5, 2017

Color Me Pissed At Hillary & Company


I'm still pissed at Hillary Clinton. It's strange to be pissed at someone for her incompetence, but there it is.

So here's Nicole Wallace on MSNBC with Jenn Palmieri, the Clinton campaign spokesperson, asking her about the campaign. They point back to a speech Hillary gave in June in San Diego, where she was going to talk about foreign policy, and they chose for her to talk about how Trump was unqualified to be President.

“Why didn't that work?” asks Nicole. Palmieri says that it was a bold and gutsy thing to do, that it was true, and that the press chose to cover it with the angle of: she was going to have a major address on foreign policy, but she chose to talk about Trump.

So Nicole says, “So the press was the problem?” They are friends, Nicole and Jenn, and they're doing their jobs, but with some delicacy, because their friends. But this is the issue, right on. Jenn hardly answers because she understands that her excuse has been exposed, so she murmurs no, that's not it, but then complains about press coverage some more.

Gutsy isn't the issue, Jenn. Jenn is older than I thought she would be; I've known about her but haven't seen her. She is tentative, the opposite of the reviled Kellyanne Conway, more delicate, and in the end of course, as Donald would say without a trace of delicacy at all, a loser. She is blaming the press.

I remember that whole episode. That's exactly what I thought at the time, what the press observed. Hillary and her people don't have enough confidence in the candidate, don't have enough confidence for her to present her views, and to make the campaign about issues, and about her, to some extent? OK, the press might not cover issues with enthusiasm, and the amount of time they spent on issues this time through is scandalous. But if your on the Dem's side, and you see Hillary playing ad hominem ball, you can hardly complain. She chose to say, I'm not very attractive, but he's really appalling.

Not to everyone, he wasn't.

And then Jenn says, we'll be fine, Hillary and I. In fact, our lives will be a lot easier and more enjoyable. But we're disappointed because we wanted to do this for the American people.

What an asshole thing to say. Bubble inhabitants. “We'll be fine.” Especially her with a couple of hundred million in her pocket. No fucking shit. “We're doing this for others.” Right. Ambition has nothing to do with it. Right.  Sounds an awful lot like "Living well is the best revenge."  Revenge against whom, exactly?  Those who didn't vote for you, in whose interest it would have been to make you guys President?  Who were too stupid and deluded to see that?  Which is why they are in the state their in and will continue to be because they didn't recognize your excellence?  True enough, guys, true enough, but as the man said, the terrible man ... sad.  So sad.

Jenn could have gone on to say that of the many things that could have tipped the election, the failure of enough African-Americans to vote in Philadelphia and Milwaukee was among them.  And what was the reaction of the chairwoman of the Congressional Black Caucus a week prior to the election, when it became obvious to her that this would be the case?  She said, it's Hillary's fault, because she champion the African-Americans enough, she went with the Hispanics.  Let's see how she likes those cookies, the chairwoman said.  Talk about dysfunction, I think I hear it.  But I divert.

And then Palmieri said that Hillary was one of the least surprised that she lost. She mumbled some things that said, basically, something about what they faced, "the problems." I thought, what is she trying to say with that? Then I saw what she meant, that they knew that Hillary was a lousy campaigner. Mumble mumble. Yeah, especially when she takes her strength – issues, preparation, intelligence – and squanders it in favor of bitching at her opponent. Great decision, you guys. Very gutsy. And you know what the gut produces, at the end.

These people are all friends. Nicole's a Republican and Jenn's a Democrat. Two shows before – yes, we watched a lot of MSNBC tonight – Rachel Maddow welcomed Greta Van Sustaren from Fox over to MSNBC, saying how they were friends and liked to toss down a few together, even though they have worked for competing networks. They're in their own bubble, too. I like them, but they're in the bubble. David Brooks declared that this was his problem, too, and has pledged to get out more. Hey, we're all in our own bubble. Maybe that's the human condition, the blind men and the elephant. I'm getting that metaphor into my blogs as much as Gail Collins got in Mitt Romney's transporting Seamus his Irish setter on the roof of his car. She's got the record. She's so funny.

The last subject for Nicole and Jenn was, why was Hillary going to the inauguration. “I told her she didn't have to go,” said Jenn. But “she's got the responsibility gene, you know.” That's her burden. Pity poor, responsible, Methodist, Niebuhr accolyte, Children's Defense Fund working Hillary. She wouldn't have to go, sure, but Bill has to go, he's a former President, and how would it look if Bill went without Hillary? (He could take his neighbor lady from Chappaqua, the one the Secret Service says they ignore when she come unannounced into the Clinton house, more frequently when Hillary's away, but I guess that wouldn't wash.) Maybe there will be some TV time spent on her as she soldiers though the ordeal as the world grieves for her. Give me a break. At least we won't have to see her striding onto the stage with mouth open and pointing at the crowd.

It's what the awful Kellyanne said; the Clinton campaign seemed totally joyless. An ordeal for everyone, inside or outside. And still an ordeal, if you ask me. She and Bill cleared the field and then she was struck with the yips, couldn't make the easy throw to first, deal with the issues and let others decide on the Trump personality. She questioned Trump's character, providing the opening to be assaulted with her own weakness, her own character. If she had stuck to the issues, she could have asked the media to concentrate on that with some conviction. But to focus on the Trump character and then be offended when her own is questioned – were you born yesterday?

So, go on, complain, soldier on, have yourself a merry little Christmas or two. You screwed everyone, but good, both of you. And probably Robbie Mook, too, the campaign chairman. Can't wait to hear him opining. Go run a campaign for school board. Maybe blame the Russians and Comey when you lose.

Color me so pissed I can't see straight. Can't wait to see pictures of them all lunching in Manhattan like the ladies from Sex and the City. Maybe worrying that Chelsea's cleaning lady isn't doing a good job. Self-pity with a bank account.

Pissed.

Budd Shenkin

Wednesday, January 4, 2017

An Aphorism and a Parable


Aphorisms encapsulate wisdom, even though we know that many of them contradict one another, so it becomes a problem of figuring out when to apply which one. Absence makes the heart grow fonder; out of sight, out of mind. Two heads are better than one; too many cooks spoil the broth. And on into the night.

Which brings us, oddly enough, to Michael Lewis, whom I view as something of a genius for the way he puts together finance, psychology, amazingly transparent prose exposition, and let's not forget that most central concern of modern life – sports and sports management. His latest book, The Undoing Project: A Friendship That Changed Our Minds, is about the joint careers and relationship of Amos Tversky and Danny Kahneman. The parable it brings to my mind is, once again, the Hindu story of the blind men and the elephant. More on this in a minute.

The aphorism I have in mind is the familiar, as I remembered it, “Genius is 5% inspiration and 95% perspiration.” I thought it came from Einstein. But look here, from the “Quote Investigator”: http://quoteinvestigator.com/2012/12/14/genius-ratio/. It turns out that the ratio was 1% or 2% to 99% or 98%, and it was attributed to Edison. But the QI traces it back to a Ms. Kate Sanborn, whom no one has heard of, and who didn't have it phrased just right, and who of course was not a man, so naturally it would be stolen from her. But then it was also attributed to Einstein! His was, “Genius is 1% talent and 99% hard work.” (http://www.goodreads.com/quotes/115696-genius-is-1-talent-and-99-percent-hard-work) Einstein is such a receptacle! One of the quotes I have at the bottom of my emails is this: "Not everything that counts can be counted, and not everything that can be counted counts." This is commonly ascribed to Einstein, but careful investigation (i.e., a quick Google search) reveals that it really came from a William Bruce Cameron. A very smart guy with white curly hair sits there and is happy to be used as a reference for all that is wise! What a life!

But back to substance. The hard work aphorism reminds me also of the inventors of Trivial Pursuit. When it became a phenomenon, an interviewer asked with wonder how the inventors had come up with this amazing invention. The inventors responded that they thought that people came up with ideas like this all the time, but what made them and Trivial Pursuit different was that they pursued it, and put in the hard work to bring it to fruition. Same point.

Lewis, who sometimes works out at the same gym as I do at the Claremont and whom I have seen on the Stairmaster and once out at the pool but have never approached but maybe I will given the right opportunity, talks in his afterward about the discipline he enforces on himself to get the writing done. It's hard work to get his rear end in the chair day after day with a daily goal in mind. Dorothy Parker used to talk about how people envied her writing, but how hard it was to do, although people imagined that she just sat down and had a grand old time. Hemingway had a rigid schedule, up early in the morning, write at the stand up desk, then at 2 in the afternoon (I think that was the time it was) he'd go out fishing and then do his drinking and people thought he was just a hard liver. He was, but his craft was based on very hard work. “Hemingway said: 'Stop when you are going good.'” (http://dariusforoux.com/hemingway-working-habit/)

Churchill was famous for saying he could give a two hour lecture tomorrow, but if it had to be 15 minutes, it would take him a month to prepare. Something like that. At least that's what I thought. More careful investigation (lasting about 10 seconds) yields this, not from Churchill, but from Woodrow Wilson, when asked about speech preparation: “It depends. If I am to speak ten minutes, I need a week for preparation; if fifteen minutes, three days; if half an hour, two days; if an hour, I am ready now.” (http://quoteinvestigator.com/2014/03/01/short-speech/. OK, not Churchill but Woodrow Wilson, still someone famous. But it turns out that if you look at that QI article, more obscure authors actually said it before Wilson did.
Thus is born a new aspiration. I want to be a receptacle! Me, I said it, me!!
Alas, it is not to be. We are who we are, and most of us toil away in obscurity. I've wanted to introduce myself that way, and if and when I introduce myself to Michael Lewis, or to Steve Kerr who also works out sometimes at the Claremont, or even A's manager Bob Melvin who I probably wouldn't even recognize, then I'll say, “Hi, I'm Budd Shenkin, an obscure local pediatrician here in Berkeley.” Can't wait to add in “obscure.” That really makes the case. Maybe they'll pick up a quote from me that can be attributed to them. In your dreams, guy, in your dreams. Like I had always aspired to have written a book that appeared on the remandered table. Oh, ye of modest aspirations!
Anyway, the Michael Lewis book. First of all, the parable of the blind men and the elephant. Although I have wound up doing so much of my work alone, when I have had colleagues, it has been even better. In 1973 I was at Yale for a year and met David Warner, an economist, who was also at Yale for a year. David was massive, 6'6” and about 265 lbs, I'd guess. I was driving a little blue Austin-Healey at the time, and David would bend his frame in two, it seemed, to wedge himself into the passenger seat as we went off to play tennis. As he got in one day, he said, “You know, they ought to give patients their medical records. I'm seeing two doctors, and they can't even get to see each other's notes. I could just take my record with me wherever I went.”
Thus was born, or rather conceived in that little Austin-Healey, an epochal paper published in the New England Journal of Medicine. David was the economist and I was the doctor, but I immediately latched on to the economics theory part of what he said, talking about who should own the information, and what the implications would be for the medical care system if patients were given their records, the production of which they had paid for, so it should belong to them. David stuck with the practical aspect – in other words, we switched roles. Then I ran with it, wrote up an outline, he contributed, as together we put together a basic article which lives on today as the first official presentation of the concept, now made much more practical by electronic medical records. And since we did a really good job of writing it, no one has ever improved on the explication of the theory.
So. Inspiration came from David in about 5 seconds. The extrapolation of the implications of the thought came from both of us, I guess, and the persistence in doing it came from me, probably. I just wouldn't quit doing it, that I remember, and I was a really good writer. And the setting was important, too. Yale as incubator, bringing people together and seeing what would happen. 5% inspiration and 95% perspiration.
For that paper, we talked to each other about the different parts of the elephant we were feeling. It was a collaboration of two minds which couldn't have done it alone. He saw the practical and I saw the theory in the beginning, and then we batted it back and forth and each contributed. And then I went to Washington the next year and he went to the LBJ School of Public Policy in Austin and I don't think we've seen each other since, although we've talked once or twice and almost met up once a couple of years ago, but didn't.
So that's my little bit of inspiration and cooperation for this obscure pediatrician. But small as it is, it allows me to better appreciate the genius collaboration of Tversky and Kahneman over decades – decades! – of inspiration and perspiration in a way that revolutionized the way people looked at decision making. What a wonderful story! Smart, persistent, brave, insightful, and boy did they work hard. Nobel Prize, ladies and gentlemen, and well deserved.
But, on the other hand, there is Trivial Pursuit. And there is something we haven't mentioned, which is the arrogance of others, in this case, the field of economics and the participants therein. When Aaron Wildavsky, a political scientist and arguably a man of genius, established the Graduate School of Public Policy at Berkeley in 1970, his idea was that public policy had to be rescued from the economists, who threatened to take over the field. Wildavsky assembled a team of political science, sociology, organizational theory, and some other disciplines as well (not psychology, unfortunately, since Tversky and Kahneman came later), because he saw that public policy was an elephant and everyone who participated was blind and they needed each other. He was correct, but despite the success of GSPP and the establishment of dozens of schools of public policy in other universities since then, the economists are still insular, and they still threaten to take over public policy with their oracular pronouncements. Give them a hammer and they think everything is a nail, to cite yet another aphorism.
One of the biggest problems with economics, besides their arrogance, was their assumption of rationality. They thought they could quantitate decisions, and on the whole the human mind would follow their prescriptions of how thinking should go. 5% up should be equivalent to 5% down, for instance, although anyone who has any sensibility at all understands what Tversky and Kahneman laboriously proved, that the human mind experiences the pain of loss more sharply than the pleasure of gain. “They shouldn't,” argued the economists, because it should be equal. And they thought that pretty much everything came down to simple figures called utility, which was pretty much like money, and which could be made pretty simple by charts and graphs. Idiots.
I say “any sensibility at all,” because I always felt, this obscure pediatrician in Berkeley, little me, I always saw the holes in the unfeeling armamentarium of economics theory. So when I read in Lewis that conferences between economists and psychologists “didn't go well,” because the economists were rude and arrogant and the psychologists retreated – well, no kidding, Dick Tracy, that was hard to predict. The genius of Tversky and Kahneman wasn't only the insight that they brought to what was really happening in these cases of cognition, the systematic biases that were introduced by humans thinking in heuristics, although that was of course the key cognitive advance. Their genius was finding ways to express it, proving it by experiments, persisting in publishing papers to a disbelieving profession which preferred to go one step at a time down the golden path toward professional advancement by accepting the current norms rather than introducing new thinking. Conformity is the way of the world, after all. Their genius was their bravery and persistence and immunity to the slings and arrows emanating from the established wrong, or at least incomplete, thinkers. Trivial Pursuit of persistence being the key. And ambition, let's not forget that. And belief in the possibility of recognition. And working together – they needed each other.
One of the biggest problems with arrogance, it seems, is that it violates the parable of the blind men and the elephant. Work together, even if it's hard. You have to listen to one another, because others really do have something to teach you. It's hard, because it's hard enough to follow your own thoughts, let alone follow someone else's. Tversky and Kahneman did that with each other, and then they invaded the turf of others and finally got others to incorporate what their perceptions were.
And have the economists learned? Oh, yes, they have learned. Now, they are crowing – see what we have done! We now have Behavioral Economics! We incorporate some of the psychology of people that we have discovered, and now we economists are more powerful than ever! What a hammer we have now! Listen to us! Follow what we say! Economics forever!
Pretty soon some of Tversky's aphorisms will be attributed to some economist. Watch for it. It's coming.



Budd Shenkin

Saturday, December 31, 2016

Trump As Ingenue


Marx was a genius; in fact, he was a super-genius. He had a theory of economics, of sociology, of history, of revolution, and a moral idealistic theory. The whole shmear. So much of what he said 150 years ago is in common usage that, like Shakespeare, sometimes you read what he wrote and think, it's just a lot of old sayings. “Dictatorship of the proletariat”; “the first time as tragedy the second time as farce”, “ownership of the means of production.” In fact, there is so much, you can pick and choose what you use and what you believe, and who's to say whether or not you are a Marxist?

Is Putin a Marxist? Yes, I think he understands much of the world in terms of Marxism. You can't be trained for years on end in Marxism and not come to think in those terms as second nature. When he thinks of “capitalism,” reams and reams of material must bubble up inside him. He must accept much of Marxist thought, probably the labor theory of value and how capital is generated, relations between the classes, the inevitable conflicts that capitalism and imperialism generates in search of markets. All that.

But to understand the world in Marxist terms is not necessarily to accept Marxist ideals. Certainly Russian communism has incorporated nationalism since Stalin's time. Only an ultra-dedicated Marxist can look at Marx's predictions and say they are OK, that we just aren't there yet. He predicted conflicts and wars that wouldn't come, he predicted the rise of the proletariat that wouldn't come, he predicted a classless society that wouldn't come. And lots more. Part of the problem is that no one can predict the future, because it is just unknowable. But another part is what we ourselves bring to our predictions, which in the case of Marx was probably wishful thinking. Wouldn't it be nice if there were to be a heaven on earth? Wouldn't it be nice if everyone were treated fairly (ignoring that “fair” is not an objective terms, but a very subjective one.) Wouldn't that justify the wars and hardship and misery of the world, if there were a heaven at the end of it? And since God is obviously a myth, the heaven will need to be on earth.

Well, good luck with that. After enough time had elapsed to show that Marx was not a reliable guide to the future, but that his analysis of society often did indeed hold up, then the Russians who were supposed to continue to be “Marxists” could pick and choose what elements of belief would be enough for them to be so qualified. What Putin and his ilk have chosen not to believe is the heaven on earth part. He believes the analysis part, just not the idealism part. The masses will always be the masses, Russia will always have a vast peasantry in outlook, even if many of them are no longer down on the farm.

Meanwhile, while the masses are the continuing mass, what's so bad about capitalism? What's wrong with state capitalism? Who says we have to treat the masses to economic prosperity? With our understanding of economics and society, and with the understanding of power that we have achieved in the last 100 years thanks to the ascent of Lenin – what's wrong with our benefitting from it as a class ascendant? What is wrong with being rich and powerful? After all, we can get the traditional Orthodox Church – it was wrong to suppress them – to bless us and be complicit. “Opiate of the masses,” bah! It's good for them to believe, it makes them happy, and why should we stand in the way of that? Add in nationalism and patriotism, a history and expectation of authoritarianism, all of which can substitute for economic health, and you have a winning formula, as long as you have no ideals and no guilty conscience. Go forth and conquer, and if you can't conquer, at least get rich.

In other words, yes, Putin is a Marxist. If you put a check box next to all the elements of Marxism, he would check most of them. He just wouldn't check the idealistic part.

Which brings us to the subject of Donald Trump. What is Donald Trump seen through the Marxist filter? Not a stupid man, but a very narrow man, a classic caricature of a capitalist. Lenin's description of a capitalist fits him well: a man who “will sell us the rope with which we will hang him.” (Another old saying.)

Not a cultured man, not a man of taste, not a man of learning, not a man who understands government, and indeed, not a man who understands and reveres the American theory of democracy. He does not understand the long history of English polity, the rise of parliamentary government, the problems with royalty and aristocracy, the difficulties of finding the enlightened popular will. What he sees is the world of the capitalist. The reference group for Trump is businessmen. His idea of quality was and is to get the best businesspeople (as long as they will be loyal to him) in government, along with some generals. What a high it must be for Trump, the proprietor of a family business, to have the real major leaguers answering to him! The head of ExxonMobil, the guys who have made real money, the real corporatists.

“Where can we do business, and with whom can we do it?” That's Trump's world, which is easy for any student of Marxism-Leninism to understand. Like Putin, Trump doesn't have an ounce of idealism in him. Like Putin, he understands the power of lies, the importance of capturing the attention of the nation without the use of an independent filter of a press, the rapture of immediacy. Tell your story and don't let a counterstory emerge, that's the ticket. Putin likes his shirt off, Trump speaks Queens-ese. Think they can do business together? They think so.

So Vladimir and Donald have a business communality. Beyond that, however, and of course, are their vast differences. What strikes me most is the difference in global sophistication. Putin has been playing this game his whole life. He has seen the Cold War from the inside, he has experienced East Germany, the Stasi, the fall of the Wall, the fall of the Empire, the resurrection from the ashes to the new Empire, the new nationalism. So much, so much.

Trump has had bankruptcies and near bankruptcies, and a migration of his business to one of branding. Globally? He'll be winging it. Where Putin has Marxism, national eclipse and rejuvenation in his back pocket, Trump has … business. Just business. Forget all the personality and character deficiencies. What is his sense of Putin, of Russia, of the world? To Trump, he must see Putin as a businessman ascendant, just like himself. The questions of policy will resolve themselves into, where can we do business, and with whom? He is a realist in the sense that he rejects any concern with the welfare of people anywhere but in the US, and it's questionable how much he is concerned about the US. If he ever thinks about it, which he may not do seriously, he is a trickle down man. He admires Putin because Putin knows how to exercise power, he has succeeded in a crowded field, become very rich, divorced his wife to be with a flight attendant, and doesn't have to bother with public criticism. “What's wrong with that as an ideal?” thinks Donald.

And this is going to be a problem. Donald as ingenue, smiling as he comes on stage, snarling behind the stage and those who would keep him off stage, it's doubtful that he looks into Vladimir's eyes and sees KGB, as he should. If Donald thinks Ukraine is far, far away, and the “stans” not worth thinking about, in fact natural parts of the Russian Empire, Russia will simply regrow like a briar patch. Does that matter to anyone outside the briar patch? Many would say yes, that growth and influence of an inevitably antagonistic force, an autocracy that itself needs to feed off the labor of others, an anti-liberal societal force, a force historically dedicated to aggression under cover of defense – many would say that this is a problem, that you can't just say “shut your door so I can't hear what you're doing.”

Of course, that could be wrong. I'm frequently wrong – just ask my kids. Or just ask me, I'm my own most severe critic. Maybe being a non-interventionist friend will work after all. Maybe live and let live and let's make money together will work. Maybe the ingenue will be wily enough to escape with vital interests intact. Who knows?

But myself, I value the bourgeois virtues of what I see as freedom of thought, freedom of expression, the rule of law, the protection of the weak, the progress of fair competition, the steady increase in equality before the law and equality of opportunity, personal dignity, all those shibboleths. And I don't think that dancing with the big bad wolf is going to do us any good. I just wonder how and where Donald will lose his innocence. It could be bloody.

On the other hand, I take succor in thinking, you never know. You just never know. Hopefully.

Budd Shenkin