Wednesday, June 27, 2018

2018 Midterm Elections - What To Do?

All elections are important because, as they say, “elections have consequences.” They all do, but it's hard to overstate the importance of the 2018 and 2020. As my brother Bob said yesterday, if the Dems win in 2018 and 2020, we can dismiss Trumpism as an aberration – an important and scary aberration, but an aberration, although with lasting consequences that might take a very long time to fix. If the Dems don't win, however, it's time to think about emigration. He exaggerates, but the sense is right. The ascent of Trump and Trumpian barbarism around the country is the most serious challenge to our way of life in our lifetime. As Bob said, I knew these people were around, but I didn't know there were so many of them. And I would add, and that so many of them are so vile.

In the last instance all politics might be local, but sometimes the national issues and national mood are such that the local elections are run in a national force field. This is clearly such a year.

What is to be done? If the national Democratic Party is to have relevance – if it is to be a continuing viable force – it had better work to make that national force field favorable for Democratic candidates. How can they do that? How about making some good ads? Some direct, unhedged, sincere ads that tell it like it is, that are not so studied to catch this group and that group that they drift into the forgettable mist of identity politics. Some good candidates are already doing that on their own, as with last night's victor in Queens-Bronx, Alexandria Ocasio-Cortez. Time for the national Dems to see if they can emulate their juniors.

So, here's what I'd do. Starting, say, next week, I would have a series of subjects with two or three minute ads for each subject. I would take them on week by week, cumulative, building the case, objective in presentation but pressing and even outraged in tone, and perhaps growing more outraged as each week passes. Forget this group and that – just make the case.

Ad campaign #1 – Taxes. It is a hallmark of us as a nation that we should look out for one another, and be both compassionate and fair. We want to reward those who are successful and not be jealous of their success, but also to provide a strong safety net for the less favored in society, and to provide a chance for every single person who is willing to work hard, to rise. The Republicans don't agree. Don't look at what they say, look at what they've done. Their favor-the-wealthy Tax Deal of 2017 gives $1.5 Trillion in benefits to big businesses and the wealthy. They say it helps everyone. It doesn't. Donald Trump's kids get $100 million extra from this deal. (add a couple of other wealthy recipients here). And you in the 90% of our population? You didn't get much, if anything.

This Tax Atrocity blew up the budget. The Republicans now want to get that money back from the middle class by lowering Social Security payments, making Medicare more expensive, and eliminating health insurance for 20 million people.

If you vote for a Republican, this is what you are voting for. Don't let them sweet talk you to think anything different. Republicans are for the superrich, first, last, and always. They'll tell you otherwise, but they say a lot of things.

Democrats will end this stupid unfairness. Make America Fair Again. Make us proud to be Americans again. Vote Democratic.

Ad campaign #2 – Health care. Before the Democrats passed what's known as Obamacare, millions of people went uncovered. If you had a preexisting condition, you often couldn't get health insurance. An illness often led to bankruptcy. Obamacare wasn't perfect, but it enabled 40 million Americans to obtain insurance coverage even if they had a medical condition. The coverage was sometimes too expensive and had terrible deductibles, but the cost was just coming under control and it was improving, when the Trump Administration and the Republicans in Congress decided to kill it. They couldn't get all of the votes they needed in Congress, so they have done it on the sly, cutting here and cutting there, when you weren't looking, and now 20 million people who had coverage have lost it, and millions more won't have it in the future because the Republicans are against covering people who have something or other, even if it's unlikely to cause trouble. This is scandalous. If you can't afford to pay for health care yourselves, the Republicans figure you should go without it. Thanks, Republicans.

Make America Healthy Again. Make us proud to be Americans again. Vote Democratic.

Ad campaign #3 – Foreign affairs and trade. The Greatest Generation who won World War II bequeathed us a rule-based world, led by the West and by America. We have been united in fighting for a strong world of democratic governments who respect human rights and try to get along among ourselves, and to provide a beacon of good life and good government to the world.

Trump has upended that world. He has offended all our friends, and likes best to hang out with dictators. He loves Putin, he loves the Duterte, he loves Erdogan – find an autocrat and chances are he'll be a good friend of Trump. He even tried to deal with North Korea, where the great dealmaker got bamboozled by a 30 year old dictator who uses assassination as a primary tool. Trump boasts that they get along very well. But our friends in Europe and Canada, who have our traditional Western values of fairness and freedom? Trump insults them.

Trump also lays stupid import taxes on the goods of our friends. The result? We pay higher prices for those goods and other countries retaliate so our businesses and our jobs suffer. Trump is pretty stupid when it comes to trade, and we are the ones who suffer as a result.

Make America Friends With Our Friends Again. Make us proud to be Americans again. Vote Democratic

Ad campaign #4 – Environment. In the bad old days, smog polluted our cities, our waterways were polluted and unhealthy, one river even caught fire. Since the creation of the EPA, we have gained cleaner water and air for everyone. Trump and the Republicans think our water is too clean and our air too unpolluted. We need more fossil fuels spewing smoke, they say. They say, Let's Make America Dirty Again.

Make America Clean Again. Make us proud to be Americans again. Vote Democratic.

OK – you get the drift. Start calling a spade a spade. Make the charges stick. Own the agenda. Other subjects? Human rights and immigration. Women's control of their own bodies. State sponsored child abuse at the border.

And then, in the last few weeks before the election, hit his lying.

Make America Honest Again. Make us proud to be Americans again. Vote Democratic.

Then self enrichment and corruption, Zinke and Pruitt and Ivanka's trademarks in China.

Make America Honest Again. Make us proud to be Americans again. Vote Democratic.

And finally, the practice of Democracy. Who's country is it?

The Democratic Party gerontocracy needs to learn from the younger generation to be aggressive in making its points. Let the Right react; so be it. If the Dems don't state the case specifically and forcefully, who will? And without a direct statement of what's wrong and what would be better, of whose country is this anyway, how can you get a mandate?

Budd Shenkin

Monday, June 25, 2018

State Sponsored Child Abuse - my view

We have an active listserve within the American Academy of Pediatrics, the fabled SOAPM listserve (Section on Administration and Practice Management.)  Here, as elsewhere in the country, there has been much discussion on our current problems at the border, which probably should be labelled Adventures In State Sponsored Child Abuse.  Here's what I wrote:

On this topic of immigration and refugees, it is not surprising that we should see controversy here on the listserve.  I agree that many issues are intermixed.  I reflected on what was said, and I divided myself into parts.

As a citizen (and, I guess, as a Jew who knows Nazi and Communist history) I feel pretty much the way Sonia does; no need to go through that in detail.  I would prefer to be welcoming to refugees fleeing failed states in Central America, which unlike European and African refugee states, is on our doorstep, is in our neck of the woods.  If they want to become Americans, I would set up ways for them to become Americans and adopt American culture, while bringing their own culture here to enrich us, but to learn and use English, for example.  Most would welcome as a gift classes, support, and jobs.  If they don't want to become Americans, they can be provided with support with the intention of their returning to the homeland when safe.  This is basic humanitarianism.  I would say that the US could support the return to lawfulness in the home countries, but our militarized foreign policy (see, for instance, Ronan Farrow, War on Peace: and our history in Latin America gives scant hope that we could be effective with that.

Other citizens may feel differently on this issue and still be within the bounds of reason.  Much of it probably has to do with the size of their amygdalas, their surroundings, their personal history, and many other factors.

As a pediatrician, however, I think I know child abuse when I see it, and I think I know abuse of families.  If tearing children from parents is not child abuse, if preventing ongoing connection among family members, if producing and tolerating ongoing anguish is not abuse, what is?  As a pediatrician, and as a member of the AAP, I am outraged at ongoing immorality that to my mind constitutes crimes against humanity (I guess I just veered back to politics with that.)  As a pediatrician and a member of the AAP, I fully support what officials and individual pediatricians have done to point out that clean beds and toys don't constitute sufficient care, and that individual psychological health is much more important than meeting objective bureaucratic government standards.  As a member of the AAP and as a pediatrician, I feel so terribly strongly about this issue that I will join any march I can, hold signs when I can, and I would hope that the AAP would have contingents in every march, emphasizing that holding children hostage and separating them from their parents is child abuse, a crime against humanity, and even (I would say) state sponsored terrorism (it's hard to keep politics out of this.) I will do whatever else I can also -- we all have different things to contribute.

Finally, as a student of history and political science, I can only deplore what Trump and this administration are doing to the country.  A recent book is good: How Democracies Die (  In this fine work of political science, tucked away in a stray paragraph, the authors observe that there are very few instances in world history where a dominant ethnic group has easily given up that dominance.  In the US, we can see that since the Civil Rights movement, the Southern Strategy, Willie Horton, and now the anti-immigrant anti-Muslim anti-non-European foreigner movement, the Republican party has gone to great lengths to suppress the vote of others and otherwise to at least postpone the change in the country from white to multi-ethnic dominance.  It's hard for me to see this crisis through any other lens.

I am doing my best to be objective, and this is about as dispassionate as I can get.  Seeing children cry and be torn apart just breaks my heart, and I am furious with those who institute and perpetuate the conscious policies intended to bring anguish, basically for their own selfish ends.

Budd Shenkin

Budd Shenkin <>

8:53 AM (1 minute ago)

Tuesday, June 19, 2018

Crimes of Monster Trump: The Horror of Taking Children from Parents

Trump is literally a monster.  He conforms to this definition: "a person of unnatural or extreme ugliness, deformity, wickedness, or cruelty."  This fits him like a sock.  It also fits those around him: Stephen Miller, John Kelly, Kirstjen Nielsen, and others TNTC, as we in medicine say when looking at leukocytes in infected urine (too numerous to count.)

To my mind, the transgressions are so severe that we might need an American Nuremberg Trial, get those people in the docket, get their enablers there, too -- Tucker Carlson, how'd you like that? -- all the monster followers.  ICE agents need to be treated like the Brown Shirts; they can resign or they can follow their immoral orders.

Yes, this is "not normal."  Some abnormality can be tolerated, can be good, but a monster's abnormality needs to be excised.  There must be some accounting.  The midterm elections and how the Democrats choose to approach nationalizing this election, the skill they can bring to getting the Bill Kristol's and Jennifer Rubin's and Max Boot's - Republicans with a conscience - into their camp for this election, that will tell the tale.  If there is not a wholesale rebuke of Trump, there will be blood on the streets.

There is nothing so heinous as torturing a child.  Torturing children is now official state policy, as declared by another prospective docket resident, the elfin racist Jeff Sessions.  Here is a letter from a doctor who has seen some of these children torn away from their parents.

"Dr Kivela,
I live in Denver, CO. I'm approximately 2340km from the Mexican Border, but I grew up in Texas, and I speak Spanish fluently. Despite my distance, I have recently taken care of 3 toddlers, between ages 1-2, who were seized from their parents at the Border. All of the information I have on them, I obtained from their foster parents. While I have no way to independently verify what I was told, I also have no reasson to doubt the information that I was given.
All of the children I took care of were brought to the emergency department by their foster parents (foster mothers in all of these cases). As we discussed today, I suspect that you will find many of these such cases because foster parents are legally required to seek medical care for those in their charge prior to administering any kind of treatment. They are also required to get documentation of these visits, and in many cases, the children are brought to the ED for evaluation because of lack of a pediatrician.
The children I saw had similar stories. Two were from Guatemala. One was from Honduras, Two were boys; one was a girl. All had mild childhood illnesses: gastroenteritis and dehydration, upper respiratory infections, rashes, etc. Their foster parents, none of whom spoke Spanish, knew nothing about their medical histories, their allergies, or their immunization statuses. They knew only two things: 1) the children's parents (both mother and father in 2 cases; father in 1 case) were being detained by ICE and 2) they had no idea how long the child would be staying with them or if they would be in contact with the parents. These are children, who by the definition of our government, are in the safest, most stable possible situations. They are living with experienced, caring foster families, their illnesses were relatively minor, and they were receiving medical care.
While their bodies appeared relatively healthy, their behavior was so far from that of a "normal" toddler so as to be striking to both myself, as a pediatric emergency medicine physician, and to their foster parents. Children this age are rambunctious. They climb on everything, they put things in their mouth that they're not supposed to, they begin to explore the world away from their parents, they begin to seek and to find the limits of their world. These children, in all cases, clung so tightly, and so completely, to their foster mothers, both in the ED and at home, that they were literally unable to be put down. They didn't explore the world, they were terrified that their world would be broken for a second time. Their trauma, and the direct effect it was having on their development, was obvious. One foster mother told me that she couldn't figure out how to bathe the little girl properly. Since she would scream every time she tried to leave her or put her down, she couldn't safely get her into the bathtub. She knew the child would be calmer if she could get into the tub with her, but as a foster parent, she wasn't allowed to do so. Another told me, tearfully, "I'm just trying not to ruin his life. He screams every day for his pappa, and I don't even know where his pappa is."
In all cases, these were experienced foster families. They understood and had dealt with traumatized children in the past. This was not new territory for them. What they hadn't dealt with was the complete lack of a timeline or plan for reconciliation. They had no information on hearing dates/times for the parents; they had no contact information for the parents; they had no idea if/when visitation or contact would be allowed, and they didn't have access to a case worker who could obtain this information. These children, those lucky ones who "made it" into caring foster homes, were floating, unanchored to their past or their future. As a PEM physician, I was utterly useless, a bandaid for a gaping wound.
Tara Neubrand, MD
Pediatric Emergency Medicine"

When is "too much" too much for the American people?  If this isn't too much, what the hell is?

Budd Shenkin

Monday, June 18, 2018

How Democracies Die, Racism, and How The NBA Gives Us Hope

Even with all that's going on, I'm still startled that on our pediatrics SOAPM listserve, immigrants and children of immigrants are fearful, even though they are here legally, but they are still afraid that they will be rounded up. I understand the nervousness of immigrants, but I'd say, if you're legal, you're safe, no if's and's or buts.  It's not Nazi Germany and it won't be.  It's certainly a more than nasty episode, but still, their nervousness is an index of how serious our Trump insurgency problem is.

I read an excellent book, How Democracies Die:  The authors detail the death of democracies in some other countries, like Peru, and the steps taken by the dictators in achieving non-democratic power, which are exactly the steps that Trump is trying to take.  They point out how norms are so important, because not everything can be detailed in law, and how important it is that contenders in the political fray respect the legitimacy of opponents, rather than viewing them as enemies of the state. They summarize their guidelines in the words “forbearance” – don't do something just because it is not legally forbidden, but rather respect tradition and reasonableness of the way things have been done – and “respect.” Political opponents are not the enemies of the state. These are very good and important observations.

But what particularly caught my attention was a just a sentence or two. What they said in a very short space was this: as a rule, no ethnic group voluntarily gives up power. Just a small sentence or two, just a small observation in a longer book, but to me, glowing and pulsating like a thumb jammed in a car door.

Of course, I thought, of course. Of course. I have been wrestling with this myself. I have realized the severe lifelong deficiency of my understanding of the pervasiveness and devastation of racism. While in fact there it was staring me in the face: what has led America to continue to be glued together, to respect the norms of democracy and to respect others as opponents and not enemies? To a certain extent, as America was predominantly white, what both parties could agree on was that Blacks should remain oppressed. Even in Roosevelt's America, when the President had the the task of delivering a decent life to the working class, he had to give obeisance to southern senators, as in exempting agricultural workers – Blacks in the South – from labor laws. In very stark terms, part of the basic deal that kept American democracy together was an agreement to let racism thrive.

And of course, as an American, I've been part of that. Case in point: when I was 19 years old I wrote a paper for my freshman English class that I thought was wonderful (and still do.) The title was Mr. Basketball, or Why I Hate Bob Cousy. It was a seminal paper in that, amazingly, now, over 50 years later, my friends and I are still discussing and arguing over its premise, which is that Bob Cousy was severely overrated. This is important for basketball fans! There is an amazing amount of assumptions and detail and statistics and history for us to chew on, and spit out on occasion.

Maybe I was right; I actually think I was, but it's debatable. But some years ago I reflected on my exploration of why Cousy was so overestimated. I thought then that Cousy, a rather short guard for the National Basketball Association's Boston Celtics, was glorified precisely because he was short, and fans could identify with him, David against Goliath. I think he himself made that very point. I thought that the fans' identification with him clouded their appreciation of the real excellence of bigger and better and more effective and less showboaty players. But here's what I realized as I reflected: at the time, in 1960, it never crossed my mind to think the important thought that Cousy was white, and that the league was just then becoming increasingly Black. Talk about opportunities for identification. Whiteness might trump shortness.

In other words, while I was a nice Jewish liberal boy who would go on to become a doctor, in 1960, I was oblivious to racism except in its most obvious forms. Since then, even though I have done good things and thought good things and certainly done my bit for racial justice personally, I have had my eyes opened gradually and progressively to the depth and severity and lethality of racism in America. It was only recently that I realized that even my Black physician friends have experienced being pulled over by police, and followed around stores by security, for the obvious reason. I had no idea.

I could have been more racially conscious at the time I wrote my great paper, since it was written in the midst of the civil rights movement's beginning, and predated civil rights legislation by just a couple of years. But it predated by eight years Nixon's adoption of the Southern Strategy, by 12 years Nixon's use of Donald Segretti's dirty electoral tricks, and it predated by 28 years the Willie Horton ads that propelled George Bush to the 41st Presidency. Political and social movements take time, and so does social understanding.

And now we are engaged in another civil political war that will test whether this nation, or any nation so conceived and so dedicated to democracy, can long endure. Ethnic groups do not easily give up dominance. When faced with a choice between ethnic dominance and democracy, what does one choose? From this point of view it is not surprising that a dominant group would turn to voter suppression (time honored in the South), to electoral tricks such as gerrymandering, to the infusion of large amounts of money to capture cleverly local and state governments just below the radar. It is not surprising that the Other will be demonized, that possession of weapons will be lionized, that mutual respect and norms and expectations and decency will be jettisoned by agents of the historically dominant faction. It just makes sense. Hypocrisies will be revealed. The contradictions of the ideology of democracy and the actuality of its enactment will become evident.

So, scales have been lifted. But I have to say, as outrageous as the Trump Administration the ICE brown shirts and the would-be thug friends of the President are, as scary as this can be to those most vulnerable, as best as I can see, we are not present at the destruction; rather, we are present at the inflection. Democracy will not die here. At heart, we are indeed a decent nation. Many have lost their way. Christians are having their faith tested – do their sympathies lie with the murdered church people of Charleston who forgive their racist murderer, or the bigotry of Franklin Graham? In the end, I'll put my money on decency.

Could it happen here? I guess it could. But it won't. There's too much to live for, there's too much good in the people, there's too much good history and there's too much good memory in being proud of who we are. There's too much music and sports and literature and food and drink and fun and love and racial mixture, and acceptance. It's all here. There's too much basketball, and football and the South and the prejudiced and those out of the mainstream will just have to catch up. We are not dying as a nation, we just have a fever.

In the end, we will go the way of the NBA, which learned to accept not only African Americans, but to glory in them, to bring in foreigners Black, white, and Asian, from all corners, women as coaches, and to glory in them, too. It is a glorious history, and I'm sure it will not stop here. It just can't.

As goes the NBA, so goes the nation.

Budd Shenkin