Barrett Rainey's Second Thoughts

Say the words “health care” these days and most informed folk will immediately think of the national embarrassment we’ve witnessed from congressional Republicans for the past seven years. Especially the Senate bunch who damned near wrecked the entire system.

But, for seniors, those two words usually first bring to mind our own interactions with the traditional delivery of care that’s morphed into the complicated – and terribly expensive – animal it is today. I’m one.

In the last 20 months, I’ve interacted with 10 physicians and dozens of other medical professionals in three hospitals on both an “in” and “out” patient status. “Up close and personal,” as they say. As a result, I’ve had an education.

If Senate Republicans had managed to pass any of the abortive and secretive “legislation” they devised, it’s damned safe to say the three small hospitals of my recent experience would have disappeared. All are under the same professional ownership and, because of highly creative business practices, exist to serve communities as few as the one we currently live in – population 1,200. They do it well.

Hospitals and clinics survive – first and foremost – because of good business practices and not the care given. If a facility doesn’t “pencil out” business-wise, it won’t exist medical-wise. Plain hard truth.

With Medicaid and Medicare as their most significant sources of income, hospital bean counters have had to be creative. Especially in small communities. Neither government-sponsored program fully reimburses costs of patients who are covered by them. Plus, any hospital that accepts federal funding of any sort – and nearly all do – must serve the uninsured and deal with the uncompensated costs of that care. So, insured and other private pay patients are overcharged to help balance the ledger and keep the doors open. More truth.

Another wrinkle is hiring doctors as staff. Many docs like it because, while most of ‘em will make less money, they won’t have to hire/fire nurses and other professionals, pay office expenses, buy ridiculously priced liability insurance, won’t work nights and weekends, they’ll have support staffs and major equipment readily available and most won’t make hospital visits.

But, to us senior patients especially, that can be a double-edged sword. On one side, hospitals can control costs like salaries and expenses which is good. But, on the other, we’re often just another old 15-minute face who doesn’t get the personal attention or involvement with doctors as we used to “in the good old days.” General practice docs go day-after-day seeing the same types of patients hour after hour with the same types of ailments under a patient load that keeps many from having time for personal interaction or deeper knowledge of patient needs. So care – and the relationship – can seem impersonal and/or sterile

Of the ten physicians seen in my recent medical journey, most had a hard time remembering my name, recalling previous information or test results between visits and had little to no prior knowledge of my appointment needs until grabbing one of the endless charts in the box outside the exam room door as they entered the room.

Adding to the problem, a lot of docs – especially in small facilities – have already retired once and are working part time to keep up their skills while adding to the retirement income. For hospitals, they’re low maintenance and cheaper than full time staff. Keeping costs down. But, part time makes it difficult to schedule consecutive appointments for care resulting in longer periods of treatment or forcing patients to live with the ailment(s) and symptoms longer and – possibly – having to make costly emergency room visits for care between times.

None of this is meant to complain. Institutional medical care has never been better – in my experience. But, as consumers who may – from time to time – have need of serious interaction with the medical community, we all need to understand what’s happening out there.

Small hospitals are no longer as independent. For survival, they’ve been bought and sold – often several times – to assure the doors stay open. Care is often some distance away as facilities have merged or taken on more restrictive “specialty”roles. Some nursing and other support staffs work in more than one location several days a week to keep personnel costs down while trying to provide services to more distant patients. Expensive equipment may be spread among several jointly-owned facilities – miles apart – to avoid duplication but, at the same time, forcing patients to visit more than one hospital for care or drive substantial miles in my case.

And a lot of doctors, who used to more often practice independently or in clinics with ownership, now may be employees with eight-to-five working hours, often seeing patients in more than one location, be unavailable nights and weekends, might never follow their patients admitted to hospitals, while often seeing twice as many patients daily for shorter visits.

You can also add to this changing landscape the increased use of specialists. Again, many are employees or contractors. Seeing more bodies but for much shorter appointments. Some scheduling new patients six to eight months out to manage their practice time and increased patient load in several small communities. Some visiting several locations a week.

Like the Old Grey Mare, health care “ain’t what she used to be.” In rural areas especially. More than ever, business decisions are affecting which will survive. And which won’t. Chain ownerships of hospitals and clinics have altered staffing practices and how major equipment and bulk purchasing decisions are made – and by whom.

Computer systems, while creating huge advances in diagnostics and care, are also depersonalizing many of the traditional interactions between medical professionals and patients.

The availability of care – or the lack of it – is forcing many patients to move from small towns to cities to find the continuing care they need. The number of independent docs and clinics is shrinking. Patients normally seen by physicians are now just as likely to be seen by a physician’s assistant. In some areas, more likely.

For most of us, all this change has been happening with little notice. We seldom think about the structures of medicine or its delivery until we are in need of personal attention. Even then, after diagnosis and treatment, we tend not to look further.

But, all our lives are being quietly reshaped daily by these forces. Fact is, at our house, we’re planning a long distance move shortly. One of the major factors: a 10-story hospital and more than 100 physicians of all stripes right in the subdivision. Recent personal experience has shown these are considerations we need to pay more attention to.

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No, Virginia. This column is NOT about three customers of a Vegas hooker. No! At least I think not. Though I have no idea what the gentlemen above do on their own time.

No, what’s illustrated here is a scene that appears in the hall outside the Senate Majority Leader’s office several times a week. The four meet in Mitch McConnell’s suite, get their stories straight, then proceed out to the marble marsh to enlighten all of us on the important “news” of the day from the Senate Republican caucus. Which lately ain’t been much.

Most often, only the fella in the front wearing glasses is allowed to speak. The others are there as a “show of unity” by that aforementioned GOP clan. Since I’ve heard people ask who they are, I thought it might be useful information to provide some details on the “three Johns.”

First, there’s the baleful looking guy on the far left. I mean, in the picture – not politically. That’s Sen. John Barrasso, M.D. of Wyoming, third ranking Republican. Used to be an orthopedic surgeon in real life. He almost never speaks publically. But he votes. Among his positions: voted for school prayer; sponsored an anti-abortion bill making it a double homicide to kill a pregnant woman; voted against gun buyer background checks; has an “A” rating with the NRA; introduced a bill to stop EPA from limiting background carbon emissions; leading critic of anything thoughtful about climate change; urged pulling this country out of the Paris Climate Agreement; and, since 2012, has received $585,000 from the oil and gas folks.

On the far right – pictorially and politically – is Sen., John Cornyn of Texas, the majority whip. Ted Cruz’s stable mate as it were. Former Sen. Phil Gramm of that fine state quit his term early in 2002 to give Cornyn a leg up in seniority so he could get larger office space. Cute. Problem was, there had been a Senate policy on the books for more than 20 years forbidding that. Sort of gave his fellow senators a graphic example of how little either of them knew about their job.

One of Cornyn’s more “interesting” quotes was about gay marriage: “If your neighbor marries a box turtle, that doesn’t mean it’s right. But you raise your children in a world where that union of a man and a box turtle is on the same legal footing as a man and wife.” Doesn’t that sort of cut right to the heart of the issue?

Cornyn sponsored a bill allowing police to force anyone arrested or even detained to give up samples of DNA for a central crime database. Voted for constitutional amendments outlawing gay marriage and flag burning and voted against the Post 9/11 Veterans Educational Assistance Act of 2008 which would have expanded educational benefits for military serving in Iraq and Afghanistan.

The third “John” is Sen. Thune of South Dakota. Maybe the brightest of the three, third ranking Republican in the Senate, considered a “comer” and has already been urged to run for President. He’s wisely refused so far. More moderate than the rest of the faces in our picture, Thune sponsored legislation to monitor the population of black-tailed prairie dogs. Guess that’s big in South Dakota. He introduced five bills to end the TARP program and has repeatedly tried to get through bills to prohibit the EPA from monitoring carbon dioxide, nitrogen oxide or methane emissions in agricultural areas. Keeps losing. Blame the cows.

Thune has also challenged Facebook for having anti-conservative views. Got nowhere. But the media loved it.

So, there you are. Three Johns and a Mitch. The quartet of senior Republicans on your flat screen TV several times each week with messages of Republican unity and effective leadership. Three former lawyers and an ex-orthopedic surgeon. Now that you know a little about them, I’m sure you’ll feel more comfortable with their regular joint appearances. And that “unity” and “leadership” stuff.

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I’m someone who spends a good deal of time writing. Always have. So, I’m into words because they’re the basis of the craft. Always like to find new ones. A few days ago, I came across a dandy.

KAKISTOCRACY. It’s fun to say. Any idea what it means? Or, like me, is this the first time you’re heard of it?

Well, boys and girls, the old dictionary on the shelf defines it this way: “Kakistocracy – government by the worst persons; a form of government in which the worst persons are in power.”

Next time someone talks to you about America being a “democracy” or a “republic,” you whip out the old Funk & Wagnalls and lay “kakistocracy” on ‘em. ‘Cause the fact is, at the moment, that seems to describe us more accurately.

With any luck at all, it won’t always be that way. If the justice system doesn’t eventually get the current bunch, we’ll have to take ‘em out at the polls. At least that’s the hope at this house.

But there’s an open question. And that’s whether the liar in the Oval Office has taken America’s political fortunes to such a low level that future participants will see his as an acceptable standard. Will role models for future candidates for the presidency continue to be Lincoln, Kennedy, Roosevelt or Eisenhower? Or Trump? Will his blend of lies, arrogance, extreme cronyism and dictatorial behavior be the norm or will the electorate turn to more traditional two-party nominees who’ll try to raise the standards of the presidency?

The answer to that, seems to me, depends on us. Not them. Will we reject this political abnormality and demand – with our votes – a return to civility, a renewed attempt at honesty and a demand for a higher moral code? Will we – with our educated support and with our ballots – select more highly qualified candidates? Maybe not.

The reason for my pessimism is based on poll after poll, survey after survey of citizens in countries around the globe. Polls and surveys measuring what people know about their system of government, their economies and their history.

The nearly unanimous result of all this statistical prying is that we Americans are just about the least knowledgeable about those basic articles of citizenship among all industrial nations. Not just poor knowledge of our governmental structure but real ignorance.

Now, there’s a new corollary showing up. Not only is the American general public more ignorant of our history and governance – we’re also the most dedicated to the falsehoods and myths associated with those categories. Put another way – many who don’t know the basic civics of how this country operates have their own “facts” and are likely to reject real information.

Adding to this lack of knowledge – or belief in mythical facts – is a growing ignorance in the national media of just these same subjects. Examples aren’t hard to come by. NBC reported last week the Governor of Illinois “passed a bill” on some subject. Legislatures “pass bills” not governors. A similar story from New York had the legislature “passing a law.” Legislatures pass bills, not laws. When signed by a governor, bills become law.

Small items to be sure. But wrong. Would you accept “small” errors from your surgeon or a pilot or your banker or your lawyer? “Small errors” left unchecked work their way into our information system and become “facts.” When repeated, more people accept them. People who hear them without knowing the difference become “wrongly” educated. So the error is perpetuated. And accepted.

The value of an educated voter cannot be overstated. But the lasting damage caused by someone ignorant of the political system he/she lives under can be disastrous. Think of all the B.S. we heard in 2016 about wanting an “outsider” for president; someone with “no political experience.” Well, if that was you, you got what you wanted. “How’s that working out for ya? “

The likelihood that significantly more prospective voters will become better informed about our civic and political structure by 2020 – much less by 2018 – is not realistic. About the best we can hope for is there is a reverse education component at work. That disappointment in the 2016 outcome and what it has wrought upon this country has been, in itself, that education.

If not – if more knowledgeable voters stay home – if we repeat the electoral tragedy of the past – we’d all better get more comfortable with that word “kakistocracy.” K-a-k-i-s-t-o-c-r-a-c-y.

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Lots of folks talk these days about the need to “lower the rhetoric,” “speak more kindly,” and generally find ways not to add to the rampant divisiveness in our little country.

That’s just fine. Give it a try. Go ahead. And, while you’re at it, try pushing a peanut up Pike’s Peak with your nose. I’d bet you find more success doing the latter than the former.

The evidence is overwhelming that simply speaking more kindly and turning the other cheek may be fine religious instruction but, the fact is, we’ve long passed the point where such methods can – or will – be effective on a national or world basis.

Politicians can join hands and work for “the common good.” The Birch Society and the ACLU can hold joint garage sales. The KKK and the DAR can co-sponsor a cotillion. All God’s angry children can suddenly become peace-loving Hippies. But – the hate – the anger – the divisions will continue.

The evidence of these dark thoughts is this: the sources of discontent, hatred, anger and division surround us every day, have become part of our way of life and will be with us from now on.

Are the Limbaugh’s, Ingram’s, Jones’s, Dobson’s of the world going to disappear at midnight? Will they give up the lifetime careers that have made them multi-millionaires and brought them fame? I wouldn’t bet on it.

Did Megyn Kelly kill her terrible “in-depth interview” of Alex Jones that was broadcast into our homes? Did NBC pull the plug because that rabid, conspiracy-creating, lying S-O-B might just add to the national hatred from a higher platform? Are you kidding me? Think of the ratings! (Editor’s note: They BOMBED!)

Will the armed members of the U.S. Congress put down their concealed weapons and stop the crazy talk? Will the congressional political ass-kissing of millionaires at the expense of food, shelter and medical care for millions end in a huge Kumbaya of spiritual forgiveness and reconciliation?

Is the Trump crowd suddenly going away – never to be heard from again? Will the Oval Office turn into a place of truth and light? Will lies, continuously flowing from the president’s lips (lower case “p” please, Mister Editor) like water down the Columbia River, turn to truth-telling? Will those in Congress trying to eliminate health care access for 23 million people fall to their knees and plead for forgiveness? Is the NRA going to require background checks and registration of all its members?

These and hundreds of other examples of sources of national mistrust and cancerous anger abound. The most ridiculous voice of those seeking a “kinder, gentler nation” is that of the Trumpster himself. The bomb thrower. The loudest of the loud continuing to spew hate, lies and vitriol all over our landscape. Like a sick joke, he asks the rest of us to lower the volume and speak kindly.

No one in public life today has talked bigger lies, told them more often, called people he doesn’t like more names, challenged more rules of decency, ignored necessary protocols, defamed honest Americans – and a few world leaders – and made a mockery of free speech and common courtesy. Nobody!

Rudeness, crassness, disrespect, greed, name calling, lying, duplicitous behavior, hate speech, racist actions. All part of our everyday lives. Our kids talk it. Movies and TV are full of it. We see and hear it in our workplaces, on our highways and in crowds at any event. It’s worldwide with terrible examples everywhere.

To expect it all to stop – to go away with a few words of positive thought and better behavior – to have the experiences and the extreme feelings disappear in a cloud of more courteous speech – to revert to better, more civil attitudes – is ignoring fact.

In the last 10-20 years, our society has experienced fundamental change. We live in a more crass environment, speak and hear cruder speech, are inundated by anger and violence on a scale we’ve never known. Like it or not, we’ve all changed because of it – either by participating, by ignoring or by simply accommodating it in our personal lives. For more than eight years, the Obama family was subjected to the most horrendous slander, lies, racist behavior and verbal savagery.

To those who want to try – who believe better public behavior and kinder speech will make a better world – have at it. And God bless you. You’re on the side of the angels. You may not live long enough to see real systemic improvement but at least you tried. But you’ll find it doesn’t stop simply because someone – or several someone’s – say “play nice.”

For those of us who believe all that is here to stay, and that real change is not possible, we can continue on our merry way doing little or nothing. Or, make it incumbent upon ourselves to start hammering out new societal rules. We can challenge what we’ll accept in the behavior of those around us and in public life. We can change what we can by accepting the best and acceptable in speech and behavior while excoriating those who befoul our society and our world.

Even if that includes the White House. No, especially if that includes the White House.

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Hate groups. Raucous, loud, foul and dangerous. We’ve got a lot of ‘em out there. They come in all sizes, shapes and twisted minds. Still, I was startled the other day when finding a couple of Christian organizations on the latest lists. Yep. “Christian.” Or so they claim.

There’s a widely accepted definition of a hate group. And that’s any organization having “beliefs or practices that attack or malign an entire class of people, typically for their immutable characteristics.”

There’s no question the Southern Poverty Law Center (SPLC) has earned the international respect it enjoys. For more than 45 years, it’s been a credible source of detailed information on hate groups, their leaders, followers, locations and activities.

Still, it was a bit of a shock to see a couple of so-called “Christian” groups listed among such low-lifes as the KKK, skinheads, “patriot” nutballs, neo-Nazis and the like. But there they were. And, upon reflection, their inclusion – at least to me – seemed justified.

Among those on the dishonor role, Alliance Defending Freedom and Liberty Counsel. More surprising were American Family Association – Don and Tim Wildmon – and Family Research Council headed by slick Tony Perkins. All four are loudly anti-LGBTQ and Muslims among others. Not only intolerant, but at times downright hostile in their public pronouncements. Both groups claim larger memberships than they can prove and say they speak for “millions of God-fearing Americans.”

They talk of branding those they see as “harmful to society” and accuse such movements as being “pedophiles” and “dangers to American families.” They advocate all this “in the name of Jesus” and claim to be living the “Christian way of life.”

Another outfit tracking such things is Guidestar, which calls itself “the world’s largest source of information on nonprofit organizations.” Though primarily interested in how groups handle their funding, who’s listed in the membership and such, Guidestar has added a category to track social – or anti-social – conduct. It was on that list that “Christian” groups first appeared.

Leading the listing of hate groups, of course, is still the KKK. Today’s Klans aren’t nearly as large and organized as they used to be. There’s been a lot of infighting, as there always is on the far right. Battles for leadership and dogma have splintered things so, today, while there are more Klans, some may have only three or four active members.

Those who track these types have found the Pacific Coast Knights in Oregon and California. Washington is the “home” of the White Knights of the KKK of America. Idaho has a “chapter” of Traditionalist Knights of America. It’s believed these groups, together, have no more than a couple dozen members.

Nationwide, authorities count no more than 3,000 KKK members and a few followers. Trying to make the public think they’re more sizeable than they really are, several small Klans will hold marches together, then disperse back under their various rocks. More than half of today’s active Klans were formed or restarted within the last three years. About the time of the beginning of a bitter national political campaign. Hmmm.

The latest effort by the KKK to appear larger than it is has been an attempt to hookup with the neo-Nazi crowd. The Pacific Coast Knights are one such. It’s likely some of the former neo-Nazi group from Hayden Lake, Idaho, are among those folk. Also an old Nazi outfit that has been in Northeast Washington for decades.

Another recent issue compounding noise and hatred from the far right fringe is the emergence of more small offshoots of the white supremacist element. Not surprisingly, SPLC lists the new “Alternative Right” or Alt-Right as part of the mix. They showed up about three years ago. About the time we had a bitter national election campaign starting. Naw, just coincidence.

At the moment, SPLC tracks some 917 hate groups across the country – most in the deep South and lower Midwest. The largest percentage claims some sort of “Christian” affiliation. About ten percent adhere to “Christian Identity,” a longstanding racist and anti-Semitic religious sect.

Still, it seemed startling to see the term “Christian” in the listing of fringe elements and organizations that represent violence and danger to our otherwise mainline society. As a Christian, I found it embarrassing.

But, on some reflection, why not? More important, maybe, what took so long? Perkins, Dobson, Robertson, Falwell (one and two), Baker and the junior Grahams have been mixing their brands of hatred for anything socially different with “Christianity” for decades. Maybe it’s time to recognize their false doctrines for what they are.

Christ’s admonition about “guilt” and “throwing the first stone” was certainly wasted on that bunch.

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