Now officially celebrating 31 days, one full month of bronchial inflammation! Everything has cleared up other than the occasional coughing fit which produces reactive airway wheeze and a feeling of impending status asthmaticus which resolves itself in a minute or two. I figure I have about a week to ten days to go until that finally subsides but as long as everything else is holding together, I’ll put up with it. I am most happy about the return of my singing voice which suddenly came back on Sunday evening after having been missing in action for over four weeks. I hadn’t realized how much I had missed it until some bass sonority started rolling out of me when I sang along to the radio. I don’t know just what nasty little virus this was, but I hope my immune system does its job going forward and keeps it from ever returning. It was heinous.
I took this past weekend off from usual pursuits. Instead, Patti Steelman and I road tripped it over to Atlanta on Friday afternoon for an overnight at the W hotel. After checking in and a visit to a not very good vegan restaurant at Ponce City Market (atmosphere 7, food 4) we headed off to the Cobb Energy Center to see Verdi’s Macbetto at the opera. (I’m going to cling to theatrical supersition here and not use the English version of the Scottish Play’s name). Patti is now a regular theater buddy but I doubt I shall ever get her to really appreciate opera. But she does tolerate it. And I gave her some homework so she had some background on Verdi and his approach to the material before we went. I had listened to this one before but had never seen a production so it was nice to tick it off of my life list.. Michael Mayes, Baritone played the title role. Many long years ago he sang the role of Valentin in a production of Faust for which I was in the chorus. He was handsome, supremely talented, affable, and an all around good ol’ boy – which befits someone who hails from Cut n Shoot Texas. Now he sings dramatic heavy roles in all of the great opera houses of the world (De Rocher in Dead Man Walking, Sweeney in Sweeney Todd, Alberich in The RIng Cycle etc.) I made journeys to Atlanta opera to see him in the first two roles. Haven’t had the courage to take on the full Ring Cycle yet. He and Tommy, in particular really got on well. They were both scions of the rural working class and saw the world in the same way. The opera was quite good. Atlanta has come way up in the world over the last few decades and is now a top ten company like Houston, Seattle, San Francisco, and Santa Fe.
On Saturday, Patti and I headed back to I-20 and continued east another three hours or so to Columbia, South Carolina where we met up with one of my favorite partners in crime, Frank Thompson. Patti and Frank had gotten to know each other on social media but had yet to meet in real life so we had a very pleasant long late lunch/early dinner, before we had cocktails (none for Frank before a show – there’s a very long story there involving a performance of Cabaret some years ago) and headed out to the small suburb of Chapin to see Chapin Theater Company’s production of Chicago, in which Frank was continuing his journey through all of the roles originated by Jerry Orbach by essaying Billy Flynn. It was done in a small black box space, making it all very in your face which served the material well and I ended up enjoying it immensely. Or was that the cocktails? More cocktails post show and then to bed to enjoy the time change before getting up for the long drive back.
I pretty much divorced myself from news and politics during my weekend away, but, when returned, I found that 1) measles continues to spread with the government drop shipping budesonide and vitamin A into the affected area rather than vaccinations. 2) tuberculosis is starting to surge in Africa with the collapse of surveillance and treatment programs that were run by USAID. 3) right wing thinkers are pushing the narrative that it is our manifest destiny to invade and occupy Canada. 4) the stock market is in free fall 5) the president is selling cars on the south lawn 6) that the rhetoric is being put in place to dismantle Social Security, Medicare, and Medicaid using a makers and takers dynamic in which only those who are productive and make society go truly deserve government benefits. The takers who depend on government largesse to survive are simply second class citizens whose needs and wants need not be considered. Honestly, I am seeing American society as an oversize Jenga game. The current administration keeps knocking blocks out and eventually the whole thing is going to collapse on all of our heads.
Anyone who can do simple math (and I don’t think this includes most politicians of either party) can understand that the government has been in deficit spending for decades. We can have long arguments about what this actually means but those who try to reduce it to some sort of upscaled kitchen table family budget are way oversimplifying things. If we wish to reduce the deficit spending, there are two choices: increase revenue or reduce expenditures. Increasing revenue (taxes) has been anathema to Republicans since Reagan and they remain slavishly devoted to the idea of supply side economics despite nearly fifty years of failing to do what they constantly promise. The administration is desperate to extend the tax cuts it passed for the wealthy in 2017 during Trump’s previous term. This will skyrocket deficit spending. The only way to offset this is to cut trillions from federal spending.
If you look at federal spending, there are only three areas in which trillions of dollars in savings can be achieved. The Department of Defense, Medicare/Medicaid, and Social Security. Elon and the Muskrats can take a wrecking ball to the entire federal bureaucracy, fire everyone and close every program and office and it will only reduce federal expenditures by about 4%. Everything that’s going on right now is pretty much waste fraud and abuse theater and has nothing to do with any sort of logical plan to save money. Cutting where the real money is is fraught with political difficulty. Elon’s public statements show that he is ready to ride in and pull down the temple but those who actually have to face voters for reelection don’t seem to be quite so sure.
Let’s look at the law of unintended consequences as applied to Medicaid, the most vulnerable of these buckets of money as it is for ‘the poors’ and therefore must be going to the undeserving poor and meet the rather malleable definition of waste fraud and abuse that’s currently being bandied about. As I mentioned in a previous essay, Medicaid is the public funding mechanism by which we provide custodial care (nursing home placement) to those who have become unable to care for themselves due to age, infirmity, or bad luck. Somewhere around half the dollars in the long term care industry originate in the program and it is one of the most expensive line items in the general funds of many states. Why? More older people who are living longer. And for the most part, the Baby Boom hasn’t yet aged into their custodial care years so these expenditures are going to increase mightily over the next couple of decades, and then come back down as the Boom enters its die off in the later 2030s and 2040s.
Let us say we take an axe to Medicaid and that pot of money with which we have been paying to maintain this population shrinks while the population itself is increasing. A number of nursing homes, most of which are corporate owned under venture capital firms, will simply close as unprofitable, causing huge strains on the ones that remain. If the federal government is not providing dollars anymore, what is the state to do? I suppose it can abandon frail elderly people on railroad sidings and downtown parks but that doesn’t look good on the nightly news. It will look for alternate revenue sources. Thirty of the fifty states (Alabama is not one of them) have what are called filial duty laws. These are laws that state that if a parent is aged or infirm, it is the legal obligation of the children to provide for their parents needs and that the state can use the legal system to enforce this duty. This means that the state can seize assets, garnish wages, sell off property of the children to meet the nursing home bills of the parents which are no longer being covered by federal Medicaid dollars. The public hasn’t figured this one out yet but when the state takes your kid’s college fund to pay for your mother’s dementia care, you might have certain visceral reactions to that.
I have no idea how this is all going to work out. There are now calls from both sides of the aisle to leave Medicaid, Medicare and Social Security sacrosanct. Fine. But if they do, those extended tax cuts for the wealthy are going to skyrocket the debt making all of the chaos that’s currently being sown moot. I’m not a politician. I’m not an economist. I’m just a professor of geriatric medicine pointing out that when you make changes in complex systems, there are ripple effects and the more complex the system, the more titanic those effects may end up being.
Here endeth the rant. Gotta write some patient progress notes.
Life, The Universe, and Everything 