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Category: Social Commentary

Physician, Heal Thyself!

Physician, Heal Thyself!

No, this isn’t about drugs or addiction or ODing, or any of those things. It is about frustration, though. Frustration with the medical profession. Frustration in trying to create sense where sense seems not to exist. Frustration that can lead to scenes such as in the image. Fall down on the floor, tear out your hair, rend your garments sort of frustration.

To be perfectly clear, this posting is based on a personal incident – drama is more like it – playing out now with certain elements of the medical profession. To protect both the innocent and the guilty, I’m not going to name any names. Now. But if I continue to be stymied, that decision might change. Watch this space.

If you’ve read my piece on The Biggest Shell Game in the World, which you should before reading on here, you know how I feel about the so-called “healthcare system” we have in this country. You’ll also see I elaborated on some specific actions that might help ease the growth in the cost of healthcare. That posting focuses on the macro dynamic of the system. This posting focuses on the micro dynamic, the one on the doctor level.

It’s no longer a laughing matter – it never was a joke – to say that much of the medical profession is still anchored, not just in the last century, but maybe even the one before it.

When I lived in Montana some dozen years ago, my physician – an author of the reputed Helena Heart Study, so no slouch – presented himself as advanced because he took his notes on a laptop. Why that should have been considered advanced when small computers had been in fairly wide business use for a quarter century already is a good question to ask, if you’re inclined to ask questions. Now, all the doctors I go to use laptops for their notetaking and recordkeeping. Of course, it is, at last count, 2017.

The one thing my Montana doctor did that really stood out was to communicate by email. Quick, easy, asynchronous. Email. One would think this also would be pretty standard now. That’s what I thought. I mean, I run a global business and communicate with clients all over the world at close to 100% by email. So picture my surprise to be out of Montana and in a southeastern state that also shall remain nameless (besides, I often reverse the “d” and the “i” in the name, which is embarrassing) and to find that email does not play a role in typical doctor-patient communication.

Does one even have to wonder why calling a doctor’s office often leads to more frustration, lengthy stays on hold listening to dreadful “hold” music and self-serving promotions, being asked, finally when you get past the official hold, “Can you hold, please?” (Okay, at that I’m tempted to fire back, what are my options here?)

Again, how can almost any organization in 2017 function without email? It’s not only a fast and easy means of communication, but it also can be used as a system of sending health information to patients and even, if one is allowed a bit of crassness, as a marketing device. But, no, this seems to be beyond the understanding of most doctors.

Then there are those doctors’ portals. Potentially great idea, completely mutilated, misused, and just plain not used, in execution and practice. First, they’re all clunky in that clunky way that special-purpose software (like used in lawyer and, yes, doctor offices) always is. I don’t know, maybe it’s me, but I’ve had a litany of problems with the portals of several doctors and healthcare groups. Sometimes I’d have to enter a new password each time I signed in. Sometimes things I’d want to see, like reports, are there. Sometimes not. One portal doesn’t even tell me my next appointment, which would seem pretty basic. I’ve yet to be able to get a prescription refill put through based on a request posted on a portal site. And, perhaps the biggest issue I’ve encountered, often doctors’ front offices don’t mind the sites, so sending a message to the office through the portal is like throwing a quarter down a deep well. “Pathetic” is too kind a word.

Okay, despite all that, that’s not my biggest problem nor the most immediate. Oh, no. I have a far bigger gripe, which we’ll get to now. The one that concerns the Health Insurance Portabliity and Accountabillity Act – HIPAA – and how doctors not only seem not to know much about its requirements but, worse, seem to think it exists to protect them and not the patient. Which is wrong.

I had one doctor earnestly tell me that there is a $50,000 fine attached to a single HIPAA violation. Well, he was part right. Fines can range from $100 to $50,000, or $1.5 million maximum per year for ongoing violations. What puzzled me then, and which irks me now, is that the implication was that the doctor had to protect himself against violations and resultant hefty fines. The point that was completely missed, even inverted, is that denying a patient access to his or her records in whatever way the patient deems suitable seems like a more sure route to a violation than just providing what it is the patient requests, in the form or via the means requested by the patient.

Now that doctor’s office will fax me things like test results. Some will even (horror!) email them. And then there are others, like another one of my doctors, who refuses to provide records or results in any form other than by mail, or picking it up in person. Never mind the inconvenience of the latter choice, I would defy anyone to show me how snail mail is any less prone to pilferage or misdelivery than a fax or email. I even maintain an encrypted email account for highly sensitive information. But all that is irrelevant. The Department of Health and Human Services (HHS), which oversees application of HIPAA, is clear on the subject: A provider should email, fax, or accommodate alternative delivery means as requested by the patient. Look it up. It’s right there, explicitly spelled out by HHS, in the department’s HIPAA FAQs.

That’s really the key issue: Patients have a right to see and receive their own records and results, and HIPAA exists to protect them, not the doctor or other provider. So if a patient wants his or her bloody records emailed or faxed to them, HHS says the provider should accommodate that request. But you’d never know that from the patchwork of restrictions, most of which make little to no sense anyway, that one encounters when requesting one’s records.

Of course, all this assumes that a patient has signed a statement authorizing release of information to the patient and whatever third-party designees, if any, that the patient might include in the release. Now here is a suggestion – a strong one: Why not include a check-off box with a line where the patient authorizes positively (by checking the box) transmittal of records via email or fax? Easy-peasy, and takes care of any misunderstanding. And while you’re at it, how about another line with a check-off box authorizing the same thing for any third-party designees? Two lines, and you can sleep better at night knowing the patient has asked for this and HHS says you should give it to them. And it’s in writing, no less.

All this leads to the source of my current distemperous mood toward doctors and things medical. It’s been four weeks – not hours, not days, not business days, but weeks – that I have been requesting the results of an MRI from a certain specialist. I requested that the doctor or his nurse-practitioner call me before I left on an extended trip so I could at least have a sense of what the MRI revealed. I was told, well, he probably won’t call you. He likes to do things in person.

Well, I like to do things in person, too, when that works. But in this case, it wasn’t even possible to get an appointment in less than a month or more. And I was clear that I was leaving the state and needed the information before I went.

Ha. Fat chance. Four weeks have gone by, I’ve lost count of the number of times I’ve called this doctor’s office, had my primary care physician’s office call him, even the insurance company called the office when I filed a grievance with them over this. And still I can’t get either the doctor or the nurse-practitioner (which would be fine) to speak with me and discuss the test results, much less actually get those results. Now if ever there is a HIPAA violation, it would seem this is it. It will take a formal complaint to HHS, but that is imminent. I now even have my attorney on the case.

The doctor might have his procedures, but there are two parties to the transaction, the other being the patient, and in this case this patient has different procedures. And HIPAA is on his side.

It’s bad enough having to deal with doctors and tests and health issues without having to be put under further stress and duress by providers and offices that just throw more roadblocks and obstacles in the patient’s path.

All this seems very 19th Century to me. Doctors hold themselves up as miniature deities and patients are just supposed to accept whatever inconveniences, incompetence, or affronts that the doctor and doctor’s minions subject them to. And there are others besides those discussed here. Let’s just save my rant on the prescription system for some other time, ‘kay?

If you’ve encountered any of these issues in dealing with doctors, I invite you to tell everyone about it in the comments. And if you have a different and more positive story to tell, by all means post that, too, in the comments. And if you question the premises on which this piece is based, well, fire away with that, too.

Meanwhile, I’m going to fax this piece off to a few doctors I know (I have to fax them since I don’t have their email addresses) and maybe shake a few trees. Or else things will just go on as they always do. And watch this space if I decide it’s necessary to start naming names.

Physician, heal thyself!

The Hurricane Next Time

The Hurricane Next Time

Another week, another hurricane. There was Harvey. And then Irma. Jose is heading north. Maria has worked its devastation. Hurricane Season being what it is, the storms line up across the Atlantic and the Pacific. Whatever the next time is, there will be a next time. And another hurricane.

I’m back aboard my boat after evacuating to Destin in the Florida Panhandle to get out of the way of Irma. Part of my excuse for the delay in posting to this blog. Irma, it turned out, was accommodating and jogged northeast just before it hit the Tampa Bay area. Good news for me and my neighbors. Bad news, very bad news, for people in the interior of the state and further to the northeast. Storms create winners, and losers. Mostly losers.

Ask the people of Houston and elsewhere in Southeast Texas. Ask the people of the Florida Keys, or Southwest Florida, and lots of other places in the state. Ask the people of Barbuda and St. Thomas, of Sint Maarten and Saint-Martin and Puerto Rico. And before them, ask the people of the Philippines, of Mississippi and Louisiana, of Mexico and Honduras and South Carolina and New Jersey and even New Hampshire and numerous other places.

Hurricanes aren’t picky and they don’t discriminate. They’re equal opportunity destroyers and, given enough time, they spread their devastation around. Of course, the planet would have worse problems were it not for the big storms that redistribute the earth’s heat energy, but try telling that to someone who can’t get out of their house without a boat, or no longer has a house at all, or who has no water, food, or electricity. Or lost a loved one. It’s a tough sell.

I’ve been around hurricanes almost my whole life, in their projected path several times but, if you ignore passing through two of them during one sea transit of the North Atlantic as a kid, I’ve never been in the middle of one. I guess that’s my hurricane karma. But I’ve seen the aftermath of them, spent weeks that turned into months that turned into years living with the after effects of Katrina, and I’ve had a chance to observe both close-up and at a distance the preparations for their arrival and dealing with what they leave behind.

It’s those two elements – advance preparations and dealing with hurricane aftermaths – that I want to focus on here. Some of what I have to say is based on observation of those two things in several storms, and some is based on a plan I developed while living with the protracted recovery from Katrina.

Based on the events of recent weeks, at least in the U.S., I think some lessons have been learned. Some are partly learned. But we still have a continuing learning curve to go up and more work to be done.

The debacle that was the overland evacuation in Texas from the approach of Hurricane Rita in 2005 taught us some things about evacuations. Rita, the Atlantic’s fourth most intense hurricane ever recorded, the most intense storm ever seen in the Gulf of Mexico, and coming just three week’s after Hurricane Katrina’s onslaught, prompted fears the storm would devastate the Texas Coast. This led to an uncoordinated series of evacuations that poured between 2.5 million and 3.7 million people onto the state’s highways, leading to total gridlock. While the concept of contraflow, to reverse all inbound lanes on the Interstates to outbound, was already known, the order to implement it came too late and it took more than eight hours to make the change-over. Of the seven people in the U.S. who died directly as a result of Rita, only one was in Texas. But an estimated 113 people died in the botched Texas evacuation, including 23 nursing home residents who were killed when the charter bus they were on caught fire on the Interstate.

In advance of Hurricane Harvey this year, Houston Mayor Sylvester Turner decided not to issue any evacuation order for the city. Not mandatory, not voluntary. Turner, looking back at Rita, reasoned that you can’t put 6.5 million people on the highways without creating mayhem. But virtually the entire city wound up inundated, with many left homeless, or stranded in flood-damaged houses from record rainfall. Some were electrocuted when, for reasons that are not apparent, the power was not cut off as a precaution as is normally done. It seemed the city was far from prepared for the storm to come.

As for evacuations, the answer, of course, is not to evacuate an entire city the size of Houston, the nation’s fourth largest, but to evacuate the most vulnerable areas. To provide local shelters. To move some people in buses and not everyone in private vehicles. And to do the necessary to avoid ancillary deaths, to the extent possible. It wasn’t a mystery that Houston was going to be pummeled with massive rainfall. The path and potential of the storm was known, as was Houston’s topography and propensity to flood. And yet, there was no evacuation order.

Contrast that response with the response of Florida Gov. Rick Scott and state, county, and local officials in Florida. With Irma on its way and a high likelihood it would hit the state in some place or other, Scott went on what was almost a personal campaign to get people to evacuate the most vulnerable areas, and made it as easy as possible for them to do so. Tolls were removed from the state’s toll roads – they are about to be reinstated at this writing – hotels were ordered to accept pets, the Florida National Guard was partially mobilized, and state troopers were used to escort fuel trucks.

The first priority was evacuating the Florida Keys, which are tethered at the bottom of the state by 90 miles of the Overseas Highway, the sole land access to the Keys. Other areas deemed most vulnerable, the low areas of Southeast and Southwest Florida, were the next priority. And then other vulnerable areas came after that. Scott’s campaign launched a week before Irma’s arrival, and kept up throughout the storm and in its aftermath, and continues even well after the storm. Florida’s evacuation was not perfect – there were serious fuel outages, long delays at times on the state’s Interstates and other highways, and Irma’s vagaries wound up unexpectedly sparing some areas while hitting others, hard – but overall it went pretty well, given the enormous number of people affected.

Not everyone followed the evac. orders, and authorities said they would not arrest anyone for not complying. While a major reason for an evacuation is so first responders don’t have to risk their lives searching for stragglers in trouble, authorities also said that after a certain point no one should count on a rescue. Whatever the factors involved – in part, at least, the euphoria and excessive confidence that pervades many Keys residents – those who stayed behind in the islands came to find out the devastation a Category 4 hurricane can bring. It’s not yet known what the death toll is in the state as teams go through the destroyed housing of the Keys looking for survivors and casualties.

Of the points where preparations for the storm failed, perhaps the most telling and disturbing was the lack of back-up plans, power, and action by some nursing homes, both in Texas and Florida. The incident that has gotten the most attention was a nursing home in Hollywood, Fla., where so far 12 elderly residents have died. With a hospital just across the street, it’s hard not to assign negligence to the managers and owners of this facility. The state has opened an investigation and alleged criminal negligence, but meanwhile the horse – 12 of them so far – has left the proverbial barn and can’t be brought back.

A spokesperson for the nursing home association said that nursing homes are not required to have generators, only a back-up power supply. Whatever the hell that means. From my perspective, based on what happened in these and other storms and the personal experience of my own mother when she was alive, there is entirely too little oversight of nursing homes and assisted-living facilities. This paucity of oversight applies in other times, too, not just when there are storms. But certainly things need to be beefed-up to deal with natural disasters. Every nursing home and assisted-living facility should be required to have an emergency action plan (EAP), which should be reviewed by regulators, and also to conduct drills practicing the EAP, to the extent practical. There also has to be more attention paid to those “back-up power supplies” and sufficient generation capability should be required to not just keep the lights on, but also run the air conditioning in hot areas and heat in cold ones.

As I mentioned, I lived on the Mississippi Gulf Coast through most of the recovery from Katrina. The very slow pace of recovery in both Mississippi and Louisiana was a source of frequent frustration to me, but it was a true bane to those who had to suffer through it. In some cases, people have never recovered. Burdened with too much bureaucracy and red tape and some truly bone-headed decisions, FEMA proved to be largely inefficient and, for many, ineffective in its response. In the end, someone calculated that for all the money spent on FEMA and other agency responses, the government could have built a new house and put two new cars in the driveway for each affected family. That is a scandal of the first order.

What I have seen, and experience has borne out, is that a multi-pronged approach is needed to respond to any natural disaster of this magnitude. In the plan I previously developed, this approach would be more forward looking than backward looking. At the head of the effort would be a disaster council combining federal government agencies, non-profit relief organizations, faith-based groups (which often provide a major portion of recovery efforts), and the profit sector. All these groups have a stake, and a contribution to make, both in preparing for natural disasters and in recovery. And this applies not just to hurricanes, but to other natural disasters, such as tornadoes, earthquakes, and major fires.

Similar councils should be established at the state level in the most affected states, with coordination between the state and national councils. And under my plan, Congress and state governments should consider establishing a disaster fund into which both public and private funds would be deposited in advance of disasters, not leaving things to allocations after the fact, which often come too late to deal with the worst immediate effects of a major storm or other disaster. This approach makes the response both prospective – looking ahead to future disasters – and retrospective – looking back in the aftermath of those that have already occurred. The cost will be there in any event, but by having funds already allocated they can be assigned quicker and will offer the most and most efficient benefit to those affected.

We tend to avoid thinking about what might happen tomorrow, even less about paying for it. But just as our learning curve in preparation and recovery has continued to go up with each major storm, I see this as a logical next step in our approach to dealing with hurricanes and other natural disasters, which are not just going to go away.

There Goes, Here Comes, the Sun

There Goes, Here Comes, the Sun

It isn’t news to anyone that a full eclipse of the sun traversed the United States on Monday. You’d have to be ensconced in a lunar base on the dark side of the moon to have missed that. But if you got to experience the eclipse, especially in a place where totality occurred, you probably know how special this event was. And maybe you noticed how it was special in ways beyond the purely celestial.

I traveled from West Central Florida to the coast of South Carolina for the big event. This was the second full eclipse I’ve experienced, the first one being in March of 1970, at Cape Charles, Virginia. After that experience, I wasn’t going to miss a chance to be present for another one, especially one this close.

Without going into all the minute details, I wanted to stay flexible in terms of my precise destination since the weather was looking pretty iffy. As the morning of the eclipse went on, clouds were moving in from off the ocean and conditions were heading south almost by the minute. Viewing conditions along the coast were predicted to be fair to poor and, in the midst of all that, the Charleston weather radar went down, so I was pretty much on my own.The moon eats the sun

Charleston, which was on the southern edge of the zone of totality, was overcast as I passed through it, as was North Charleston, across the harbor. Following my inclination that conditions would be better on the coast north of the city, I continued up US 17, and that’s when I came across some signs pointing to a side road that led to the Cape Romain National Wildlife Refuge. Making a snap decision, I turned right there and followed that road until it ended at the refuge. Cars were parked up and down both sides of the road, so I found a place, parked, and walked in to the picnic area and boat launch site at the road’s end. Cape Romain was actually the place, virtually on the center line of the zone of totality, I had thought to view the eclipse when I first started planning this expedition.

A long concrete pier stretched out across the marsh and clumps of people were out on the pier, interspersed with some open areas. I found one of those open spots and set myself up. It was about an hour until totality.

When I arrived there were big blue breaks in the clouds, allowing the sun to shine through, but as time went on more and more clouds moved in from off the ocean. At times the clouds obscured the sun, but when they did, one could see the disk of the moon encroaching on the face of the sun. With one layer of clouds, it was too bright to see the image. With three layers, the sun was too obscured. But with two layers, it was perfect, and the moon could be seen eating the sun – as primitive peoples believed – without benefit of eclipse glasses.

Birds overheadWith about a half-hour to go, a family of four set up next to where I was. It turned out they had come from Denmark, just to see the eclipse. As more and more people arrived, and looking up and down the pier, I was thinking how many people, not just on that pier but from coast-to-coast, had come to share in this event. I was hoping we’d get a clear view, not just for myself but for others, like that family, who had never experienced a total solar eclipse before.

Minutes before the moment of totality, more clouds passed in front of the sun. Inland and to the south things were totally socked in, with lightning strikes to the west. A bank of clouds was moving in off the ocean, but a big band of blue stood between where we were and it. The wind was blowing the lower clouds quickly, and then the wind blew them past, and there was the sun, framed by two high, thin, motionless clouds, and that was when the eclipse entered totality. And our view was unobstructed for the entire duration of the eclipse, as short as it was at about two minutes and 40 seconds. Speak about making the right decision and lucking out.

If you haven’t experienced a total eclipse, you don’t know what that moment of totality Totalityis like. Even 99.99% totality is not the same as 100%. It is when the sun is completely obscured by the moon, when the sun’s corona can be seen flaring out from behind the moon, when day turns almost to night, and when earthbound creatures express their confusion by going wild, that makes a total eclipse the awesome event that it is. Even knowing that an eclipse is happening and that it’s a natural phenomenon that has a beginning and an end, it can be a disconcerting experience. It is no wonder that people over the ages spun such myths and felt such fear around eclipses.

I have to say that the first eclipse I experienced seemed more awesome, and I think it had mostly to do with the environment. At Cape Charles, I was right on tidewater, and there were flocks of birds, and it seemed the tides reversed and the birds went crazy at the moment of the eclipse. At Cape Romain, it was marshes, and the few birds that there were had passed overhead minutes before the eclipse and flew on. But as a sheer celestial event, this eclipse was as awe-inspiring as any. This eclipse, any eclipse, reminds that we’re on an object somewhere out in space, spinning around a star, out in the vastness of the universe.

Plane flying close to the sunAt that moment of totality, I think most people experiencing it for those couple of minutes might have forgotten the differences, the views, the beliefs, the expectations that separate Major cloudsus. For those couple of minutes we weren’t liberals or conservatives, Americans or Danes, dog lovers or cat lovers or none of the above. We were just humans, curious, eager, awe-inspired humans, beneath the shadow of the moon as it crossed the face of the sun. It’s too much to expect that the feeling would last much beyond the eclipse and the return of the sun from behind the moon, but it was nice while it lasted.

After the eclipse was over, it took more than four hours to get to the Interstate, with the flood of people returning to wherever they came from – the plurality of cars on my route had Florida license tags – and from there things got easier. By the next morning the eclipse seemed already to have receded into the past, a curiosity for strangers to ask about in passing.

The marsh near totalityBoth on the way to South Carolina and on the way back, things seemed to be more homogenized than they had been in years past. Chain restaurants and fast-food joints, more than ever, supplanted a lot of the local down-home places that formerly one could find with ease across the South. I finally found the kind of down-home place I had been searching for, Grannie’s Country Cookin’, on US 301 in Starke, Florida, and it was worth the wait. The Jurassic-sized slab of meatloaf and the giant flaky biscuit and the grits and mashed potatoes and gravy were what I’d expect at a place called Grannie’s, and not some pseudo chain Grannie’s. But the average age of the patrons was somewhere north of 60, so I had to wonder how long it will be until the entire country is homogenized, fast-foodified, Amazoned, Uberized, Facebookifed, plasticized, devicified, electronicuted. What will the roads, and the country, look like for the next solar eclipse to come here in seven years, in 2024?

It’s a disconcerting thought, and the roadsides, and our world, will be darker for it. And not because the sun is in eclipse.

All photos by the author.

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Pointing Immigration in the Right Direction

Pointing Immigration in the Right Direction

My service as a U.S. consular officer in the late 1980s and early1990s quickly debased me of any previous open-borders ideas I might have had prior to that time. While serving as vice consul for the geographically largest consular district in the world, covering most of the South Pacific and part of the North Pacific, I came to realize how poorly our immigration system served the country. Our two-officer office – me and the consul, my immediate boss – processed some 21,000 non-immigrant visas (NIVs) and about 6,000 immigrant visas (IVs) annually. I personally handled about two-thirds of the NIV applications and about a third of the IV applications. To say that some of those IV interviews verged on the scary would be an understatement, and made me wonder about the quality of people we were admitting for permanent residence in the U.S.

What occurred to me then was that the U.S. badly needed to implement a points-based immigration system similar to what already was long in place in Canada as well as in Australia and New Zealand, and has since even been adapted by the UK. Not that it would supplant this country’s family-based immigration system, but rather would supplement it, while revising the family-based system of preferences. While other countries were getting the cream of the crop of immigrants, we were limited basically to what came over the transom with our chain-migration policies, and that was not always beneficial to the U.S.

During my tenure as vice-consul in Fiji, yet another seemingly hair-brained idea was introduced, the so-called Diversity Visa Program (DVP), better known as the visa lottery program. A brain child of Congress, it allowed people from many countries deemed to be “under-represented” among U.S. immigrants to compete in a lottery to obtain the right to apply for permanent residence status. Besides debasing the whole concept of U.S. residency, this scheme essentially opened up a new category of immigrant visas to anyone who could fill out a postcard or pay someone to do it for them, as if we didn’t already have enough immigrants coming to the U.S., many with no discernible skills.

Over the intervening quarter century I have seen limited progress in immigration reform, combined with some steps in the wrong direction, acerbated by an ill-informed and prejudiced public and media debate over immigration. With this past week’s introduction of the so-called RAISE Act (RAISE – not Reyes – standing for Reforming American Immigration for Strong Employment), I am for the first time in more than 25 years seeing reforms introduced that actually seem to make some sense. And of course the naysayers immediately came out in force, spouting the same sorts of nonsense that have kept our immigration system stuck under a law that dates back some 65 years, the Immigration and Nationality Act of 1952, as amended and modified by some less overriding intervening laws.

To begin to understand the forces arrayed against any real reform of our outmoded and ineffectual immigration policy, one needs to understand two truisms about what the major political parties hope to gain from immigration: The Democrats want cheap votes, and the Republicans want cheap labor. These two impulses are the biggest factors keeping things pretty much where they are, if not pushing them further in the wrong direction. And it is these same factors that are the biggest enemies of the American people at large and which help keep our economy in a low-growth mode in which real wages remain stagnant while the costs of the welfare state continue to grow.

It’s also important to understand that the U.S. is not a laggard when it comes to immigration. While it may no longer be strictly true that we admit more legal immigrants than all other countries in the world combined, it is true that we admit, by far, the largest number of legal immigrants each year – more than a million people – and that number does exceed the total number of immigrants admitted by all the other largest immigrant-welcoming countries of the world combined. At present, close to 45 million immigrants (both legal and illegal) live in the U.S. There are some 85 million people, or about 27 percent of the total population, who are immigrants or the U.S.-born children of immigrants.

There are a lot of myths and stereotypes about immigration and these help perpetuate our current system. One of those myths is that immigrants strengthen the economy and do better than native-born Americans. While this was once true, it has not been true in more than a quarter century, and since then, in general terms, immigrants tend to fare worse than the overall population. This fact is buttressed by the numbers that show that immigrants to the U.S. are far more likely to wind up in poverty than the native-born population. Here are some disturbing figures from the Center for Immigration Studies:

Despite similar rates of work, because a larger share of adult immigrants arrive with little education, immigrants are significantly more likely to work low-wage jobs, live in poverty, lack health insurance, use welfare, and have lower rates of home ownership.

  • In 2014, 21 percent of immigrants and their U.S.-born children (under 18) lived in poverty, compared to 13 percent of natives and their children. Immigrants and their children account for about one-fourth of all persons in poverty.
  • Almost one in three children (under age 18) in poverty have immigrant fathers.
  • In 2014, 18 percent of immigrants and their U.S.-born children (under 18) lacked health insurance, compared to 9 percent of natives and their children.
  • In 2014, 42 percent of immigrant-headed households used at least one welfare program (primarily food assistance and Medicaid), compared to 27 percent for natives. Both figures represent an undercount. If adjusted for undercount based on other Census Bureau data, the rate would be 57 percent for immigrants and 34 percent for natives.
  • In 2014, 12 percent of immigrant households were overcrowded, using a common definition of such households. This compares to 2 percent of native households.
  • Of immigrant households, 51 percent are owner-occupied, compared to 65 percent of native households.
  • The lower socio-economic status of immigrants is not due to their being mostly recent arrivals. The average immigrant in 2014 had lived in the United States for almost 21 years.”

While laws are in place that are supposed to limit immigrants’ access to welfare and other public assistance programs – the idea being that newcomers to the country are supposed to be able to support themselves, or have sponsors that will support them until they can support themselves – so many exceptions are made, so many jurisdictions overlook the rules, and so many benefits are obtained through the U.S.-citizen children of immigrants, that immigrants tend to use social welfare programs at rates in excess of the native population. The two charts that follow (also from the Center for Immigration Studies) clearly demonstrate the numbers. The first one compares legal immigrants with the native population while the second one compares illegal immigrants, who do even worse and aren’t even supposed to be here, with the native population.

Welfare Use Legal Immigrants

Welfare Use Illegal Immigrants

Another key element that is widely misunderstood, further evidenced by some of the silly things said in the days since the RAISE Act was unveiled, is the system of preferences under which our current immigration system operates. This system imposes strict numerical caps on different categories of immigrants from various countries, and creates serious distortions that those only peripherally familiar with the rules don’t understand. For instance, while there is no cap for the spouses or unmarried minor children or the parents of U.S. citizens, 21 years old and older, there are limits for just about every other category of immigrant.

The chart below shows the current (August 2017) preference limits for the various preference categories. It shows the dates when petitions would have had to be filed for intending immigrants in those categories, or preferences, to file their applications this month to be approved for immigrant visas. Depending on the country, these dates can vary significantly.

Preference Chart August 2017

For instance, for the first preference, the unmarried son or daughter, 21 years or older, of a U.S. citizen (native-born or, more commonly, naturalized), their petition would have had to be filed prior to 2011 in most countries of the world to file their applications for visas beginning this month. But if they are a citizen of the Philippines, the petition would have had to have been filed in 2007, or in 1996 if they are a citizen of Mexico. In other words, perhaps the beneficiaries were 22 or 25 or 27 when the petition was initially filed, but now they are anywhere from 10 to 21 years older. And these time periods don’t include processing times, which can be a year or more, once the application is filed.

If the applicant subsequently marries after the petition is filed, they drop to the F3 category and the preference dates of it.

For a second preference applicant in the F2A category – the spouse or unmarried minor child of lawful permanent residents (LPRs) – the wait has been a little more than a year worldwide. Not too bad. But for the unmarried son or daughter of an LPR who was over 21 when the petition was filed, the wait jumps to six years for most countries, 10 years for citizens of the Philippines, and 21 years for citizens of Mexico. If that unmarried minor child subsequently marries, they’re completely out of luck since there is no category for married children of LPRs.

As the chart shows, things get worse as one goes down the preference categories, until reaching F4, the preference category for brothers and sisters of U.S. citizens, when the wait can be as long as 22 years. Now that is a lot better than when I was a consular officer, when the wait for some countries was as long as 120 and 150 years, but it’s still a very long time. In practical terms, what these very long wait times do is encourage people in those categories to come on visitor visas to the U.S. and then overstay their visas, hoping to find some other mode to become legal.

In fact, more than half of those qualifying for immigrant status are already in the U.S. in some sort of temporary or illegal status, changing status when their preference comes up or simply remaining illegally if their preference never comes up, which distorts the entire system and enables those who are willing to jump the queue and break our laws to gain an advantage.

Seeing the effect these very long wait times have on people, it has been my contention since my consular days that the brother/sister category should be eliminated altogether. And that is one of the things the RAISE Act sensibly does, along with dispensing with the DVP, which never should have been introduced in the first place. I’d further argue, to cut out much of the incentive for overstaying, that changing status in the U.S. also should be strictly limited to those categories of immigrants for which no preference limits exist.

What is very difficult, if not impossible, under our current system of chain migration is to migrate independently to the U.S. – something that once was allowed and frequently done. There are many highly qualified potential migrants who would love to immigrate here, but who are blocked by our system of family preferences. So what happens with many of these people? They wind up migrating to another country, and our loss is Canada’s or Australia’s or New Zealand’s gain. The same applies to graduates of U.S. colleges and universities who study under student visas and then are forced to go back home after graduation. We’ve educated these people, and then don’t reap the benefit of that education, passing it on somewhere else. Again, these are exactly the kinds of people we should be seeking through our immigration system, and who will gain points under the RAISE Act.

One of the dumbest arguments I heard this week came from U.S. Sen. Lindsay Graham of South Carolina. He said that the RAISE Act would destroy his state’s economy by blocking lower-level employees who work in hotel and agricultural jobs. First of all, if those are the only kinds of jobs available in the Palmetto State, South Carolina has more serious problems than the RAISE Act would cause. Of course, that’s not true, and there are more jobs in South Carolina and across the land that can use more highly skilled people to fill them. Additionally, there already are programs, such as the H-2A temporary agricultural worker visa, to address the demand for agricultural workers, not to mention a ready supply of illegal workers that Republicans like Sen. Graham seem all-to-eager to tolerate. Sen. Graham’s assertion actually reinforces the argument that our current immigration system funnels people into lower-level positions and helps depress wages across the board while forcing lower-skilled U.S. workers to compete with immigrants, legal and otherwise, for scarce jobs. It also fits neatly into the theory that Republicans support cheap labor.

Meanwhile, we’ve heard a chorus of objections from the Democrats, reinforcing the theory that nothing suits them better than easy, low-level immigration from which they hope to harvest cheap votes. Perhaps encapsulating some of the lame arguments on the left side of the house are that the RAISE Act invalidates the poem on the Statue of Liberty welcoming the world’s huddled masses – never a tenet of U.S. immigration policy or law – or that immigration would be limited to Anglophone countries, such as the UK or Australia, since knowledge of English would be one of the requirements for independent migration. As White House Senior Policy Adviser Stephen Miller ably pointed out, there are many English-speaking people around the world in just about every country, and all would be meet the language preference. Additionally, knowledge of English has long been a requisite for naturalization, and at one time in our more distant history was even a requirement to immigrate here.

In the past few days I’ve also heard some media people saying, well, they wouldn’t be here if the changes proposed in the RAISE Act were in place when their grandparents migrated here, and I fail to see the logic of this. First, they are here. Second, while they might be here, someone else, perhaps equally worthy, was excluded. And third, what might have been good for the country 100-some years ago isn’t necessarily good for the country today. Ironically, some of the people making the argument that we should keep our current system are the first ones to argue that the country is a different country today than it was in the past and it needs to change to keep up with the times.

The other argument that is raised is that the actual numbers of immigrants admitted would be cut from the current million-plus to about two-thirds that number, or roughly back to mid-1980s levels. This might be more in keeping with the ability of the country to absorb new immigrants, but in any case this number seems reasonable and can be adjusted over time. It is argued that the high level of immigration has kept the U.S. relatively competitive with European countries and other nations, but what is missing from that argument are the details that it is both younger immigrants and more highly skilled immigrants who can contribute to economic growth, rather than draw down on it. We need to regenerate a period when immigrants do better than the general population, as in the past, than worse than the general population, and the RAISE Act is a step in that direction.

Like any piece of proposed legislation, there should be debate and discussion, and probably some tweaks made, to the RAISE Act, which is sponsored by Sen. Tom Cotton of Arkansas and Sen. David Perdue of Georgia. But what I fear will happen will be bipartisan support to kill the proposed reforms, never letting the bill out of committee, in keeping with the divergent desires of the two parties that I stated above: The Dems will want to keep their cheap votes and the Republicans will want to keep their cheap labor, and the rest of us, and the country, will continue to suffer as a result.

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Why I Don’t Care About the Russia Thing

Why I Don’t Care About the Russia Thing

Let me say it right up front: I don’t give a ruble (which is not very much) about the Russia thing. There, you’ve got the main point, right in the lead. Now let me explain why I don’t care about it.

First, let me say that I’m convinced that corruption has become so deep-seated in our political process that it’s become as American as apple pie and F-150 pickups. Same with incompetence. That’s as American as our so-called public education system and our inability to solve such problems as urban blight and poverty. It’s not that I’m happy with these things, since I’m not. But they are realities, just as the compass orientations of sunrises and sunsets and the phases of the moon are. It makes no more sense to rail against these overriding problems than it does to argue for new coordinates for the sun or a different schedule for the moon.

That might sound like a cop-out to you, and fair enough. In a way, it is. But that’s just touching the surface of things. It’s just setting the stage for the other things I have to say, the things I have to say about why I don’t care about the Russia thing. Did I tell you I don’t care about it? It’s true. I don’t.

I hope I don’t have to explain the Russia thing. Turn to almost any radio, TV, or print news or commentary, and you’ll hear or read probably more than you want to hear or read about the Russia thing. It’s almost impossible to ignore it, as much as you might want to. And depending on the slant of the medium to which you have turned, it’s either the worst thing since (pick one) Watergate/the Vietnam War/the Civil War/the beginning of recorded history, or it’s overblown and (in the words of former Obama-era Special Advisor for Green Jobs Van Jones) “a big nothing-burger” ( to be fair to Jones, if that’s called for, he later clarified his statement to mean that nothing will come of the Russia thing, not that it wasn’t significant, in his view).

Russian Rubles
Photo FreeImages.com/2happy

So now here’s where I come down on this. It’s not that I don’t think corruption and incompetence are inconsequential – lord knows we’ve been saddled with both for most of this new millennium, which has gotten us where we now find ourselves – but just that I think things need to be put into perspective. And there has to be some sort of fair apportionment of blame and punishment, if there is to be any at all. And at the moment, I don’t think there is any likelihood of either, whether perspective, or fair apportionment of blame and punishment.

As I’ve said in previous postings, it shouldn’t come as news to anyone that the Russians, and before them the Soviets, have been meddling, or at least trying to, in U.S. affairs for decades and decades. The earnestness with which it’s declared that there was Russian attempts to influence our elections is equivalent to Captain Renault, in Casablanca, declaring that he was “ . . . shocked – shocked – to find that gambling is going on here!” Oh, come on. Grow up, will you? At least Renault knew he was play- acting, which is more than can be said about our hysterical mainstream media and the Democratic side of the aisle.

There also is zero evidence that even one vote was changed or influenced by whatever Russia might have done, or not done. But there is tons of evidence that the internal corruption of the Democratic Party (not based in Moscow, last time I checked) had enormous influence on the outcome of delegate selection despite the results of many state primary elections in which Bernie Sanders came out the winner, or close behind, versus Hillary Clinton. Now one can reasonably argue that there is little chance Sanders could have bested a Trump, or almost anyone else the Republicans put up, but that isn’t the point. The point is the influence that Democratic National Committee corruption and incompetence had on the selection of H. Clinton as the Democratic candidate, or at least on the margin of delegates voting for her.

One can argue endlessly over whether it was the Kremlin that hacked and then released the tens of thousands of DNC emails – 44,053 emails and 12,761 attachments in the first tranche alone, released in July 2016 by Wikileaks – or an intermediary, or an independent third party. Wikileaks head Julian Assange, once a darling of the left, insists it wasn’t the Russian government, but he won’t divulge who the actual source was. Regardless, it was the substance of the emails leaked, more than who did the leaking, that, if anything, had an impact on how American voters viewed Hillary Clinton and the Dems. When I was a Foreign Service Officer and had a close call to make, the equation I’d put into play is how, whatever the decision was, it would look on the front page of the Washington Post. This apparently was not an equation that ever occurred to the top people of the DNC, like Debbie Wasserman Schultz, Donna Brazile, John Podesta, or many other top operatives within the DNC and the Clinton campaign. So instead of admitting to what they did, it’s easier to point the finger at the Russians and say it’s all their fault and, by some sort of illogical extension, Donald Trump’s fault, that things turned out as they did.

But things go beyond this, to one of my key issues about why I don’t care about the Russia thing. And that is the lack of impartial imposition of either justice or injustice, depending on how you see it. For her entire time as Secretary of State, Hillary Clinton used a private email server to conduct official State Department business, a clear violation of law and regulation covering handling of classified material, as well as any official government communication. Again, drawing on my experience having been in positions of trust handling highly classified materials, and familiarity with the documents I had to sign acknowledging my acceptance of the stringent requirements for handling such sensitive materials, I have never for a moment doubted that, had I done what Hillary Clinton did, I would have been put in prison. Which is where she should be. But instead, the political powers that be shielded Clinton from prosecution, with none other than FBI Director James Comey inventing a whole new legal concept, called “intent,” to exonerate her from prosecution while at the same time confirming she had broken the law. Pretty good line of reasoning, and one I bet a lot of criminals wish they could call on in their own defenses.

Regardless, what Hillary did almost certainly harmed national security far more, and provided more help and succor to the dreaded Russians, than anything Trump might have done.

But wait, it goes beyond that. Comey, in public testimony, admitted he had demurred to then-Attorney General Loretta Lynch’s suggestion that he refer to the Clinton investigation as “a matter” rather than as an investigation, and that isn’t called “collusion” on the part of Lynch and even Comey himself. But when President Trump asked Comey to conclude his investigation of Russian involvement in his campaign, after Comey on at least three occasions confirmed to Trump he was not the subject of the investigation, that is categorized as “collusion” and “obstruction of justice.”

Vintage Russian Car
Photo FreeImages.com/Ivaylo Georgiev

Going still further, now we have this meeting last June involving Donald Trump, Jr., and the Russian attorney Natalia Veselnitskaya. Here is where things get unbelievably smelly, and there are growing indications, if not actual evidence, that this meeting, and the entire supposed scandal, were actually engineering by Democratic operatives in an effort to frame the President and his son. One can reasonably argue that Trump Jr. should not have taken on this meeting, but it is now known that Fusion GPS, a group that initially worked with anti-Trump Republican candidates before turning to assisting the Clinton camp, set up the meeting with Veselnitskaya. This same group was responsible for release of a whole rack of salacious, and false, accusations concerning Trump Sr., including the now discredited report that he had engaged Russian prostitutes in a golden shower incident in a Moscow hotel.

If that is not enough, we see Veselnikskaya posting statements supporting anti-Trump demonstrations in Chicago on her Facebook page, but even that isn’t the punch line. The real punch line is when we see that Veselnikskaya was permitted into the U.S., after her visa application was denied, on what is called humanitarian parole, granted by, once more, former-AG Loretta Lynch. She additionally remained in the U.S. even after her parole expired in January 2016. Again, drawing on my consular and diplomatic experience, granting of humanitarian parole is an extraordinary measure, usually reserved for children and others seeking family unification, for emergency medical treatment, or for urgent refugee protection, outside normal visa guidelines. I have never heard of it being granted in a case like this, and the political implications are too hard to ignore.

Now Fusion GPS head Glenn Simpson says he will plead the Fifth if forced to testify before Congress. Republican Chuck Grassley and Democrat Diane Feinstein have both said they want Simpson subpoenaed to testify before the Senate Judiciary Committee. Just to pose the question, if Fusion GPS is blameless in all this, why would Simpson need to hide behind the Fifth Amendment to avoid answering the committee’s questions?

Russian Street Kids
Photo FreeImages.com/Chris Greene

It’s now known that Obama knew of Russian efforts at meddling in the electoral process going back as far as July. But he failed to take any action until after Trump’s election when he imposed sanctions on the Russians, in December. Why would the President ignore what has now become such a big issue? There can be only one plausible explanation, which is that he never expected Trump to win and he didn’t want to muddy the political waters with his knowledge. But once Trump was elected, then the knowledge became the basis for attempting to embarrass the President-elect and to bolster the Democratic campaign to question his legitimacy.

One other key issue has gotten short shrift, and that is the extent of leaks coming from within the intelligence community and elsewhere in the government, Many of these leakers are actually committing felonies, releasing classified information to the media, and even Comey himself copped to being a leaker during his Senate testimony in June. But to date no one has been charged or prosecuted for these offenses.

Finally, we get to the media (how could we not?) Ever since the results of November 8 came in, it’s been “all Trump, all the time” for the mainstream media. Normally I wouldn’t object to the media trying to get to the heart of things – after all, I used to be a journalist, too – but where have most if the media been through the onslaught of scandals that cascaded out almost non-stop during the Obama years? Ask most Americans, and I would wager few have even heard of, much less could describe, the Fast-and-Furious scandal, the IRS scandal, or (though a few more might) the VA scandal. Most would not be able to tell you what happened at Benghazi, Libya, on September 11, 2012, or why the Obama Administration (including Hillary Clinton and then-U.N. Ambassador Susan Rice, and the President himself) chose to tell the American people a lie about the cause of those events for weeks and weeks afterwards. And it has never been made clear, in most U.S. media, why or how Hillary Clinton broke federal law and put U.S. security in jeopardy by her careless, callous, and illegal use of a private email server during her tenure as Secretary of State. And I could go on beyond these most notable scandals – there are many others most Americans have never even heard about — but the point is made.

Now we’re inundated with this Russia thing, and we’re to believe that not only were laws broken and our election stolen, but that treason and high crimes and misdemeanors were committed by the President and members of his close team. To which I say, first, bullcrap, and second, so? Even if these accusations are true, for which there is no evidence, why the unfair prosecution (whether in the media or the judicial system) of Trump when so many egregious offenses committed by Clinton, Lynch, Comey, Rice, and others, including Barrack Obama, go virtually unmentioned?

Meanwhile, real issues facing the country, ranging from healthcare to tax reform, from what to do about ISIS to what to do about Afghanistan, and on and on and on, get shuffled away under this tidal wave of the Russia thing and the one-sided coverage of “all Trump, all the time.”

Like I said earlier, if justice, or lack thereof, is to apply to one party, then let it apply to all parties. Until it does, and there is no sign that it will, then, no, I don’t care about the Russia thing.

This piece also appears on Medium. Follow me there, and here, and if you like the post please comment and share it.