Doctor and activist


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Category: USA

US Health System and COVID-19 11/12/20

Here is an article about the US Health system and its response to COVID. Basically it seems that the US government is subsidising COVID treatments so that they are more lucrative than treatment of other diseases, so the private operators are filling their hospitals with COVID patients whether they need to be admitted or not, and non-COVID patients are excluded.

The other thing that is interesting is that there has been a huge growth in administrators since the 1970s. It has to be understood why private health systems are so inefficient. They have to keep individual insurance databases to keep track of premiums and churn as people change funds. When someone is treated they have to account for every band aid, visit, procedure or investigation, bill the patient and pay the practitioner. They have to market their product, compete for staff, and then figure out ways to avoid paying if possible.

Universal systems have everyone eligible, so do not need to worry about who is getting treated. No need to market the system, maintain many different churning databases, compete for doctors, keep accounts for every details of every treatment and bill and pay for them individually.

In terms of better health care there is no problem of adapting to whatever disease needs the most attention as the staff are motivated to do the most effective treatments, and there is no distortion of priorities to maximise profits.

The US health system is the least effective in the developed world in terms of delivering health care. but it is the most effective at its primary object- turning sickness into money.

No one has looked too closely at why the Australian system has been able to respond. Basically our public health system is State-based hospitals, which are still largely public and have doctors who could be re-directed to testing and vaccination. They can also change to do COVID if needed, and treat disease on their merit.

The private hospitals did very well out of the government subsidies here because they were emptied ready for a COVID influx that never came and they just pocketed the cash without much publicity for this from either themselves or the Government.

Australia has continued on its previous course, which is to starve Medicare and help the private system move towards a US system by stealth, and the COVID pandemic has so far not brought this to light. What is left of the public system has done well, helped by the fact that we are an island nation, so had some warning and could act to quarantine ourselves. The government was happy to take advice from the medical professionals because it had made such a mess of not taking advice from the firefighting professionals. But Medicare is still being quietly destroyed and we are moving to a US system of private medicine.

The government saves money on Medicare doing this, even though the system is much less efficient and much less equitable. But the key reason is not the savings on Medicare, it is the money to the Party coffers from the Private Health Industry (PHI), which is now much stronger with the changes John Howard did to the Aged Care system in 1997, which made it effectively a for-profit system, and the NDIS also a for-profit system, subsidised by the taxpayer through the Medicare levee, which was ironically not being used for health. (The discussion of the Aged Care system was in one of my posts last week).

The key thing to understand in the destruction of Medicare is that the rebate to doctors which was set at 85% of the AMA fee, so as to replace private medicine, has risen at half the inflation rate for 35 years and is now 46% of the AMA rate. Doctors are paid half what they were, so specialists mostly will not use it, and GPs who still bulk bill just do shorter visits.

Here is the article on the US response to COVID. Their prevention is also hopeless, as with such a poor welfare system the people cannot afford to stop work, and the story that it was a hoax was also promoted by President Trump. The obsession with ‘individual rights’ sits uneasily with the idea of staying home for the common good, and makes disinformation campaigns easier. People wanted to believe it was a hoax, because they could not afford to stop work anyway.

http://www.informationclearinghouse.info/55999.htm

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Medicine, Reality and the US vote 11/11/20

Doctors tend to assume that everyone knows certain things, particularly because everyone they meet usually does. They also tend to think that everyone knows the order of importance of what they know.

Many years ago as I started to campaign against tobacco, Henry Mayer, the first Professor of Political Economy in Sydney, who had a regular column in the SMH told me that the health people were invisible in the media on the tobacco issue. I said that this was ridiculous, it was the most studied subject in the history of medicine, with over 60,000 papers and growing daily. He pointed to a person called Tollison, who wrote in the non-medical media that was read by the business sector. There were no medical responses there. The mainstream also media had relatively little on tobacco, as tobacco advertising was one of the major sources of revenue.

So the harm of tobacco was known, but ignored, like the fact that you are going to die one day.

It came home to me, when I amputated the leg of a smoker for vascular disease. He had bad lungs and a bad heart. I said, ‘Look mate, if you keep smoking, you will lose the other leg.’

To my amazement he replied, ‘Look, all you doctors go on about smoking, but if it was as bad as you say it is, the government would do something about it’.

He had internalised the government’s non-action as being mute testimony to it not being a problem. Doctors are, after all a subculture that claims to have expertise in a certain area, as do engineers, educators, weather forecasters and many other groups. In tobacco, the Tobacco Industry, the Australian Hotels Association, Clubs and Pubs and the advertisers and sponsorship recipients fought like tigers to stop reasonable public health policy. They are probably still retarding it- there has not been a Quit campaign in Australia for over a decade.

Trump’s denial of the significance of COVID19 must have struck a chord with those who knew that in the absence of decent welfare system a lockdown would send them broke. They needed to believe that they could carry on, and he and his denial were their salvation. A lot of business interests supported them- they would go broke too.

So it was interesting that the health facts became politicised, and wearing a mask was as much a political statement as a medical one. Politics was not, and will not be in future a good basis for personal preventive heath decisions. So controlling the COVID epidemic in the US will be harder than here, where mainly apathy and complacency are in the way.

The figures that only 4% of people in the US changed their view on the dangers of COVID goes some way to explaining why Biden did not have a landslide. For many people, COVID was not an issue, Trump’s rhetoric was plausible if you did not fact-check, and the economy had been going OK prior to the epidemic.

SMH today:

Virus neglect didn’t infect Trump vote

Shaun Ratcliff

📷

Since the first person was diagnosed with COVID-19 in the US, more than 10 million cases have been confirmed and nearly a quarter of a million people with the virus have died.

Watching from afar, in a country where the coronavirus has been significantly less lethal, it is surprising the incumbent president did as well as he did.

While the pandemic probably did cost him votes, surveys we have run over the course of the year showed there are strong partisan effects on attitudes towards COVID-19, with supporters of Donald Trump mostly unconcerned about the risks from the virus, and getting less worried as the year went on.

These surveys were run in May and September. Both surveys consisted of responses from more than 1000 Americans.

In May, approximately 40 per cent of all Americans were very or extremely worried about the possibility they or a family member might catch the virus. Almost the exact same number were only a little or not at all worried. According to our data, this level of concern actually declined slightly between May and September.

This was largely a partisan affair. Respondents who said they were going to vote for Joe Biden retained a similar level of concern during this period, with 48 per cent very or extremely worried in May, and 50 per cent in September.

However, respondents who said they would vote for Trump were not very concerned about COVID-19 in May – about 19 per cent reported they were worried about it in the first survey and just 11 per cent of Trump voters reported this level of concern in the second survey.

The partisan differences, and the declining trend in Republican concern about COVID-19, are largely the product of the extremely polarised media and political environment in the US.

Trump voters are less trusting of information on COVID-19 from medical experts than Biden supporters, and between May and September a quarter of Republican voters became less likely to trust information from these experts.

This difference may, in part, stem from the media through which they obtain information. Those with the lowest levels of trust tended to rely upon more conservative cable and online news like Breitbart and Fox News, for instance, which have played down the risk posed by the pandemic.

Republicans who rely more on these conservative media outlets were more likely to have lower levels of trust in medical experts, even after controlling for demographic differences between Democrats and Republicans. They were also as likely to trust Donald Trump as medical experts for information on the coronavirus.

In this polarised environment, very few voters abandoned Trump between May and September (only about 4 per cent in our data), and hardly any shifted to support Biden.

Trump supporters tended to align their position on the coronavirus with their political allegiance. Relying more on media that downplayed the significance of the coronavirus, and taking cues from Republican leaders, they decided the pandemic was not a significant threat.

Our data indicates Biden was able to win over a small number of voters who supported neither candidate at the start of the year. It was enough to win in the end, but not enough to deliver the predicted landslide.

Shaun Ratcliff is a lecturer in political science at the United States Study Centre, University of Sydney.

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Biden Wins, but is America Trumped? 9/11/20

Biden won the US election, but everyone was surprised how close it was and how well Trump did.

It might be said that had there not be the COVID19 virus and Trumps handling it very badly, he probably would have won. Many have been wringing their hands for years, but whatever lies he tells, however much fact-checking was done, Trump seemed Teflon-coated. The standards have changed. Did we really think politicians had to tell the truth in the past and have them resign if they were caught out? The reality show host told people that economy was doing well, the stock market was up and the COVID would disappear and if he wasn’t consistent with yesterday, that is for fact-check researchers. He is still the same friendly face and reassuring voice for many.

But at a more fundamental level, the middle class in the US have been having a bad time for a long time. Neo-liberal economics favours world trade, China does it cheaper and jobs are offshored. The importers can pay Chinese prices for goods, and charge US prices, so their margins have gone up. In 2008 Obama’s slogan was that ‘Change is Possible’ but he failed to capitalise on Democrat control of the Senate and when the Global Financial Crisis came, he bailed out the banks, not the little people who still lost their homes. In 2016 Bernie Sanders recognised the problem, but the Democrat Establishment were scared of him, suppressed the vote in the Primaries and put in Hilary Clinton. Hilary Clinton, as ex-First Lady and Secretary of State was seen as part of the Establishment, and hence part of the problem.

Trump played this, as well as the voting system that favoured small states with Republican governments who wrote the electoral laws with varying degrees of voter suppression. Trump remained Anti-Establishment man, a populist, who would say anything to be popular. This time again, Sanders spoke of the need for change and used the word ‘Socialist’, a brave thing to do in America. The Democrat Establishment was again scared, and again used some voter suppression and getting the other less successful moderate candidates to withdraw to allow Biden’s late run for the Democrat nomination. So the people who wanted change were dudded again. The Democrats had an Establishment candidate, and the Republicans ran a candidate who pretended to be for the battlers.

The current situation is portrayed as just Trump’s ego stopping Biden getting on with the job, but that does not explain why 70 million people still voted for Trump and are very angry. Poorer Americans have a lot to be upset about. Biden was considered ‘past it’ by both the common people and the Democrat Establishment until the younger candidates were failing against Sanders. Biden was suddenly wheeled in to both save the poor people and get the big end of town’s money.

The Democrats scraped in this time. But this does not make Biden a good candidate. It is by no means certain that Biden has any idea how to fix the problem, or if he would be allowed to fix it if he did. Conservative Democrats put him there, and he is likely to have a Republican majority in the Senate, which neither wants progressive change, nor wants to help Biden at all. So enjoy the fine rhetoric while you can.

Even in defeat Trump will have enough power within the Republican party to destroy the pre-selection chances of any Republican who upsets him, so he may continue strutting around making up realities, with an overall effect like a bull in a china shop. But Trump in a strange sort of way was a beacon of hope, who recognised the discontent and tapped it. Though he did little to improve the situation, he gave hope that the Establishment could be defied and this role may continue.

The crunch time will come soon, when the disillusioned voters realise the situation. Will there be a systematic response, marches or vandalism? Time will tell.

It is accepted that the US voting system is so rigged that there is little chance for any candidate not backed by huge amount of money, and the system is hugely rigged in favour of the small states which favours the Republicans. The question is whether the voting system can be fixed for next time- it is hard to see how. It is stuck in the Constitution. The welfare system, the health system, the education system, the wages system and the competitiveness of American industry all seem very complex, with their solutions in different sectors of the economy. Biden is better than Trump, but that was a very low bar.

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US Election Commentary- Warning- long post, innovative stuff nearer the end 5/11/20

I shudder to comment on the US Elections- it is a crowded field- 15 professional commentators in today’s SMH alone, and that is without the electronic ones.

But I had a few thoughts, firstly about the US Voting system which is very flawed, then about the candidates, and finally about what might happen:

Biden looks likely to win and Trump is dangerously stoking tensions by calling into question the integrity of the whole US electoral system. The US electoral system is probably not corrupt in a limited meaning of the term. The mail ballots are sent in, and should be counted and not be fraudulent. The counting process is well supervised and credible.

But the whole system is hopelessly outmoded and non-democratic.  Here are a few issues:

The candidate who wins the popular votes does not necessarily win the Presidency because of the Electoral Colleges system. 

The Electoral College system gives two votes to every state, but it was set up when the US Constitution was written, so States with few people have far more votes College vote per citizen that populous States.  So Wisconsin has 1 Electoral College vote for every 195,000 voters whereas California has one electoral college  vote for every 670,000 voters, a ratio of nearly 3.5:1.  The small States are mostly Republican and in the centre of the country and there are more of them.

In most States, whoever wins the State gets all the Electoral College votes, so if a lot of  small states are won, this gives the Republicans a big advantage, which is why Bush Jnr and Trump won with a minority of the popular votes. If Trump wins this time, it will again be with a minority of popular votes. 

This problem is hard to fix as it is in the Constitution, and the small states, like Tasmania in Australia will resist this and there are about 30 Tasmanias in the USA.

Voter suppression is another art practised particularly in Republican states. This involves changing the rules so that certain groups are less likely to be able to vote.  If for example, people who have been in gaol are ruled ineligible to vote, it disadvantages black voters.  If the proof of address is needed, poorer people whose voter registration records are less up to date are more likely to be ruled ineligible. If there are few ballot boxes in certain areas and they are hard to get to, etc.  It is almost certain that the actions of Governor Bush in Florida, the Presidential candidate’s brother helped George W Bush by suppressing voters and gave him the Presidency over Al Gore.  You may recall that there was an appeal to the Supreme Court for a recount and this was denied, the Supreme Court members voting in the interest of the Party that appointed them. This is why Trump keeps talking about appealing to the Courts.

There is also ‘first past the post’ voting rather than preferential, which means that any third candidate merely takes votes from the candidate closest to him or her, and this may favour someone with less than a majority.

The gerrymander of the electoral boundaries is another problem in the US. The incumbents set boundaries that wander in strange shapes to take in pockets of voters and allow an incumbent to survive while the adjacent electorates have huge majorities for the other party, and if there was a fair redistribution the seats would all go the other way.

There is no Federal equivalent of the Australian Electoral Commission, which puts out a model for fair electoral boundaries and then hears representations of why they should be changed from this.  Rather, in the US there is a different electoral system in each state, because that was necessary to get the States to form the United States.  It was not that the founding fathers thought that this was the best system- it was simply the best that they could do under the circumstances.  So it will be very difficult to fix.

At a practical level, Trump seems willing to divide the country.  He would probably have won had there not been a COVID epidemic.  There were more jobs and the stockmarket was high. Generally if the economy is doing well, incumbents are re-elected other issues notwithstanding.  Trump was seen to have mismanaged the COVID epidemic, playing it down as tens of thousands died and millions were infected.  How anyone can still think it is a hoax is difficult to understand, (but this article is not about the media).  How much a President can actually do is other question.  Administration at a day to day level is by States, as we have found in Australia in the epidemic, they still have quite a lot of power.  It will be interesting to see how much Biden can do if he wins.  At least he is likely to recognise the seriousness, state it clearly and mobilise resources.

It seems as the votes are counted that Biden will win but partly due to some of the factors above by a lesser margin than was expected.  The longer the count goes on, the more Trump will stir trouble, and there may be riots as his supporters are strengthened in the idea that he was robbed.  It is significant that all the shops are boarded up in the most fashionable streets in Washington DC.  This is not some backwater- these streets are the equivalent of the most expensive areas in Sydney CBD.

The question will be asked, how could Trump do so well after such dishonesty and incompetence.  I will try to get in early on this.  Trump did some good in foreign policy. He probably stopped the US attacking Iran, and did not commit the US in Syria, which allowed Assad and the Russians to win, but it was hard to see a good outcome whatever happened and it may have been another US quagmire.  He has ‘stood up to China’ economically and militarily, made peace overtures to North Korea, persuaded some Arab states to recognise Israel, torn up the NAFTA (North America Free Trade Agreement0 with Canada and Mexico, and taken a far more nationalistic line on trade.  Whether all these are good remains to be seen, but they do constitute policy change that is broadly popular with his constituency.

In his style he has tweeted- a direct communication to the common person.  This is the antithesis of what was done before.  Hilary Clinton was seen as a child of the Establishment, the bankers who had been bailed out in the GFC when a lot of people lost their homes.  Presumably if they had been given the money they would have given it to the banks and they would have survived as well as the banks, but perhaps that was too administratively difficult.  Jobs have gone offshore because labour is cheaper there, which has hollowed out the middle class, particularly in the manufacturing sector.  Though this may have been forgotten by the media it is not forgotten by those affected, who do not trust the Establishment, which is partly why conspiracy theories and populism can flourish.

Just looking at the Campaign hoopla: Trump was exciting and optimistic, Biden looked the Conservative, unexciting with a negative message.  The Establishment had not fixed the problems before, now it was demanding its place at the head again to have another go.  Trump may have been talking fantasy, but it was hopeful fantasy, and reality does not look so bright. It is like a religious cult; if you assess it with your heart, it seems right, if you use your head it does not.  It is as if many people in Western society are choosing pleasant fantasy over unpleasant reality with Trump and Biden personifying the choice. 

I spoke to Joe Laurie of Consortium News during the week before the election.  He had an interesting story about Biden that is probably true.  No one thinks that Biden is a very good candidate. Most of us thought that he was past it, and I asked some weeks ago what the minimum criterion for a President was; to read an autocue?  It seems that the Democrat Establishment were not too impressed by Biden but there was a shortage of a credible moderate candidate.  They were scared of Bernie Sanders. He represented a major change. He admitted to wanting things that had been termed ‘socialist’ like universal health care, bigger taxes and more welfare.  Elisabeth Warren was the next most progressive.  There were a number of moderate candidates, Pete Buttigieg, Amy Lobucher, Tulsi Gabband, and the immensely wealthy Michael Bloomberg.  The Democrat Establishment let them have a run, but Sanders was beating them all.  So somewhat belatedly the Democrat Establishment tapped all the young moderates on the shoulder, told that that they could not win, and asked then to stand aside and let it be Biden v Sanders.  Elizabeth Warren was left there, as she was more likely to take votes from Sanders, and it made it look like a more open race.  The Democrat Establishment then supported Biden as much as possible, including doing some voter suppression in the Primaries in California in areas where Sanders was strong.  Sanders was robbed in 2016, and probably again.  So the Democrat Establishment, which represents much of the business world got an acceptable if not optimal candidate, Biden.

The people who had lost their jobs in the GFC and did not trust Hilary Clinton and were not much more impressed with Biden, who was after all, as much of a creature of the status quo as she was. So if you ignore COVID, and do not care much what else Trump has said, apart from noting that he has upset the Establishment, you get some idea of why his vote has held up so much better than was expected. 

The psephologists say that the polls are wrong, partly because of the complexity of the voting systems, but also because people do not admit that they are voting for Trump.  They tell the pollsters one thing, and vote another.  Perhaps political correctness influences their polling behaviour. 

But if Biden wins, what can he do?  He is very much part of the Establishment, who rejected Sanders’ solutions.  The world market takes jobs to where labour is cheapest, particular if it is well organised, like in China.  An unregulated market is like a Monopoly game. Those with more money set the prices and the rents, and those at the bottom compete with each other as price takers.  So money flows upward; the rich get richer, and the poorer people recognise this.  Governments have to act with wages that share the wealth, welfare that provide services and universal things like parks and roads, health and education.  If governments are not willing to do this, and the welfare is to the top end as it was in the GFC people do not trust the system.  Is Biden the man to fix this?  I doubt it.

Marx looked at history from an economic perspective and said that revolution would come in an advanced capitalist society basically because the wealth would increasingly be concentrated in fewer and fewer people.  He did not glorify revolution (as many have since), he merely said that it would become necessary because the rich would not give up their money without a fight.  The US rioters have been called opportunists and looters, but also the bogeyman of the socialist revolution has been discussed.  All this may seem premature or logistically impossible, but if the economic drivers remain in the same direction, it is certainly a matter of concern.  The Establishment must recognise that the economic system cannot remain as it is.  A Republican Senate with Biden as President does not bode well, particularly if Trump’s swansong is to focus many people’s frustration.

I attach Consortium News’ article on Voter Suppression

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COVID-19 Non-Treatment, American Style Points to the Need to Fix Medicare

10 May 2020 As Australian political parties slowly and steadily dismantle Medicare to move us towards a privatised system American-style, it is worth noting the major feature of the American system. Everyone says it is a hopeless system. It depends what you want it to do. It is the world’s best system at turning sickness […]

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Gun-Toting Protesters Invade Michigan Capitol Building

3 May 2020 Protesters, some armed with automatic weapons invaded the Michigan Capitol (State Parliament) to protest at the State Governor wanting to extend her lock-down powers. It is illegal to carry placards into the legislature, as they might damage the paintwork but open carrying of guns is legal in Michigan. Michigan is the 10th […]

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US Health System is worst to control COVID-19 Epidemic

30 April 2020The US health system which is largely private is poorly set up to handle a pandemic. It is set up to make money, so is not flexible when different equipment and procedures are needed. Added to this 12% of people have no health care insurance, so cannot get healthcare and of those insured, […]

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US Sanctions Will Worsen COVID-19 Effects in Venezuala

US Sanctions will worsen virus effects in South America. The US does not like the Bolivarian Government of Venezuela. The fact that it is called after Simon Bolivar, who achieved independence of many South American countries gives away the orientation of the government, and is a Socialist government, which nationalised the Oil company and has […]

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How the US does Spying

29 March 2020

Some years ago, I had lunch with an acquaintance of mine who was a reasonably successful manager, with a slightly less successful relationship history with men.  She was keen that I meet her latest beau, so we had a small group lunch.

The man in question was a fit-looking American in his early 50s who was keen to talk about himself, so we let him.  He was an ex-US Navy Seal. He would not quite admit that he was down on his luck, but he had a lot of training that the US needed to use, but they would not hire him in the Navy, though he could get ‘contract work’.  He would not be quite specific about this, and he assured us that if the missions went well, no one noticed anything.  That was the ideal outcome.  His life was at risk and he was well paid for each mission, but there was no ongoing commitment or pension if he was injured or had other misadventure.   As the dinner went on he said that he had recently been on a mission in Asia where he had done something and been caught at it.  He was chased by an angry mob up to the first storey of a building.  He was trapped and jumped out a window onto the canvas roof of a fruit truck. He had gone straight through the roof of the truck and landed amongst the fruit, spraining his ankle, but nothing further.  He was very lucky because just as he landed the truck drove away from the angry crowd while he lay low in the fruit.  When he got to the destination not far away, a number of people lined up and formed a human chain to unload the truck and he, being disguised and made up joined the line passing the fruit boxes and got a few coins for his efforts when the unloading finished, before slipping away into the crowd.  All very James Bond stuff.

Asked how he knew who the goodies and baddies were in all this and he said that this was defined in his brief.  In short, he was an agent acting for the US government but they were in a position to disown him if he got into trouble.  He was a pleasant enough fellow, and more interesting than many dinner companions, but I have not seen him again.

So I was interested to read the article below about how ‘an ex-FBI agent had died in Iranian custody’, having ‘disappeared in murky circumstances in March 2007’, ‘during an unauthorised trip for the CIA to gather intelligence on Iran’s nuclear program’.  Iran had ‘kidnapped a foreign citizen and denied him any basic human rights’.   He was ‘a gentleman’ and ‘outstanding’ said President Trump.  Perhaps.  And I like to think of myself as a champion of human rights.  But people do not go on spying missions for personal curiosity and this is a deadly game, ruthlessly played.  The story in the SMH is sourced from Reuters and the Washington Post but does not quite make this clear.

www.smh.com.au/world/north-america/former-fbi-agent-s-family-believes-he-died-in-iran-custody-20200326-p54e4o.html

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Trump’s Win- why? 9/11/16

Here is my theory.  Basically democracy in English speaking countries has been taken over by private entities.  There are only two entities who can win power in the UK, USA and Australia.  They are called political parties.  They are not in the constitution, but because they vote as a bloc, they control the parliament.  Because they are private entities they do what their donors want.  Few citizens want privatisation, but the donors to the parties do- so we get privatisation.  Few want to go to war, but for some reason the parties do, so we go to war.  We want universal health cover- Medicare, but it gets rolled back and we have to buy private health insurance, which suits that lobby.  Unemployment is rising and the government fiddles the figures and no longer takes responsibility for the problem, it just talks about ‘the market’.  What the people think or want does not actually matter.  The parties continually put their interests and power ahead of what the people want.  The rich are getting richer, the poor are getting poorer and the political parties do not seem to care.  They get donations from the rich, and run campaigns to convince the poor to vote for them.

Faced with this situation and two political parties, people are accustomed to voting for the lesser of two evils, or making a protest vote, which is what they did.  Trump was anti ‘the system’, so although he was deeply flawed personally that was enough.  The Democrat Party machine had got rid of Sanders, the leftist challenger to the status quo, so it became status quo Clinton v. Non status quo Trump.  Then the polls got it totally wrong. How come?  Part of the same thing- the whole polling establishment obviously had a large segment of the population missing from their sample, but did not know it- like the government really.  So if some people did not vote for Clinton because they were disgusted and thought it would not matter, they were wrong.

But if the level of disgust in the process of government is enough to turn a US Presidential election, one must also wonder about the effect of the media.  For years, news has been replaced by infotainment.  What is important is replaced by what is titillating or exciting.  News is trivial, what is important is often not covered, particularly things like falling middle class jobs and stagnating wages.  The media is the message.  If you are not in the media, the message is that you do not matter.  But also note the rise of ignorance.   Quiz shows used to ask historic or scientific facts.  Now it is TV trivia.  And ‘shock jocks’ on commercial media are there to shock and to push products.  They do not have to be consistent or informed- just entertaining enough to rate and bring in advertising dollars.  So the non-expert, pontificating and criticising overcomes the expert discussing sensibly- how many of those are on TV?  The shock jock has become more important than the politician.  So why are we surprised when it now happens in real life?  The shock jock beat the politician.  And the pollsters got it wrong again- just like in Brexit.

What will happen with Trump in charge? He will destroy Obamacare, the relatively minor improvements made towards a universal health system, appoint Conservative Supreme Court judges and officials in public policy such as Climate Change, and boost gun ownership.  More significant changes to corporate power will take the approval of Congress and the House, now both Republican-controlled.  Obama was elected on the slogan, ’Change is possible’.  Obstruction by the Republicans ensured it was not.  Now Trump will try, but the same obstructers now have even more power and are not about to let one of their own damage their interests.  So Trump is unlikely to be a force for good unless he has unexpected foreign policy triumphs.

So what is the long-term solution to government ruling for the rich by buying political parties?  Democracy has to be taken back to the people.  The Parliament is controlled by parties and they are private entities and so can be bought by other private interests.  This has ever been the case in systems that evolved in Westminster.  It is Anglo-Saxon arrogance that makes us think that our democracy is best.  Quite simply, it isn’t. Our political power structures, like our corporate structures concentrate power at the top.  Swiss democracy involves power being moved down as low as possible with politicians merely enacting what public referenda decide, and with no opportunity for individual politicians to get long-term power structures assembled for themselves.  It is time we looked at these models and worked for constitutional change based on a real change of philosophies, priorities and power.

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