Prologue to a Diary of the Second Addams Administration 15.

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            The Agenda: Iran.[1] 

            The Iranian Revolution that overthrew the Shah (1979) spread chaos in the country.  Saddam Hussein, the dictator of neighboring Iraq, sought to exploit the situation by attacking Iran.  The subsequent war[2] (1980-1988) caused all sorts of troubles.  In its aftermath, during the 1990s, the Iranian Republic launched a program to develop nuclear weapons.  The program’s physical component—as opposed to intellectual and technological components–began with the construction of a uranium enrichment plant at Natanz and a heavy-water plant at Arak. 

            In 2002, Iranian dissidents obtained and published secret documents on the nuclear program for all the world to see.  In 2003, Ayatollah Ali Khamenei published a “fatwa” banning the possession or use of nuclear weapons.  No one believed him.[3]  Eventually, in 2006, the United Nations plastered Iran with economic sanctions.  In 2015, the Obama administration, busy with other quagmires in Iraq and Afghanistan, led the negotiation of a deal with Iran.  Iran would limit uranium enrichment to 3.67 percent and send 97 percent of its already-enriched uranium to Russia for safe-keeping.[4]  The agreement would run for 15 years.  It hardly made it out the gate. 

            In 2018, President Donald Trump abandoned the agreement so far as the United States was concerned.  In Trump’s view, the agreement did nothing to address Iran’s non-nuclear aggressive behavior in the region.  Specifically, Iran was arming-up and coordinating allied forces in the region.[5]  Trump seems to have hoped that renewed economic sanctions would force the Iranian regime to cut a new and better deal.  To emphasize his point, in 2020 Trump ordered the killing of General Qassem Soleimani, a leading figure in the Revolutionary Guards. 

Next, in 2021, President Joe Biden[6] tried to revive the agreement, but the Iranians had moved on.  At about the same time that Biden entered the White House, Iran began enriching uranium to 20 percent, and then to 60 percent.  Enrichment to 90 percent creates “weapons grade material.”  All the while, economic sanctions and mismanagement have battered Iran’s domestic economy.[7]  

The last year or so has altered the situation.  First, Israel has inflicted immense damage on Iran’s clients through its wars in Gaza and Lebanon.  Turkey sponsored a rebel offensive in Syria that overthrew Iran’ ally Assad.  When Israel killed a Hamas leader in Tehran, Iran responded with a missile barrage; and, in October 2024; Israel answered with air strikes that wrecked key elements of Iran’s air defense system, among other things.  This leaves Iran open to follow-on strikes against nuclear facilities (and the Iranian leadership cadres) if Tehran doesn’t change its tune. 

Second, Donald Trump’s return to the White House has seemed possible (if not certain) since the beginning of 2024.  Tehran has been intensifying its drive to enrich uranium to 60 percent.  That is, apparently, a hop, skip, and a jump from 90 percent or weapons-grade uranium.[8]  I don’t know how much time that hop, skip, and jump would take.  Expert opinion holds that a basic sort of bomb could be manufactured six months after a sufficient quantity of weapons-grade uranium has been accumulated.  Another year after that and they could have a warhead for a ballistic missile.  One that could easily hit Israel. 

NOTHING in the history of Israel’s military and national security policy suggests that Israel will let Iran get anywhere near that point.  They will not allow Iran to get even one nuclear weapon.  Never mind the ballistic missiles.  “Just put it on a freighter bound for Haifa.”  The time-line for preventive action by Israel (and/or the United States) is very short.  Maybe a year at the outside?  There will be heavy pressure on the prime minister of Israel[9] to act soon. 

The time-line for Iran to decide what course it will choose is very short.  Will the rulers of Iran try to rush ahead and break-out to possession of nuclear weapons?[10]  If they do achieve a nuclear weapon, will they feel compelled to “use it or lose it”?   

Or will the leaders of Iran repent their disdain for Biden’s offer to revive the 2015 agreement?  The country’s alliance network is in shambles and its own defense vulnerabilities have been exposed.  Russia could divert no forces from the Ukraine war to save Assad, so it isn’t likely to do much for Iran.  Would the Iranian leaders—belatedly—seek to engage with the United States?  If so, how stiff-necked would they be about concessions? 

The stakes are high.  In theory, Israel would need the assistance of the United States to attack the key Iranian facilities.  A prime target would be an enrichment facility near the city of Qom.  It is tunneled into a mountain.  So is another site near Isfahan.  The American “Massive Ordnance Penetrator,” dropped by a B-2 bomber would be the only conventional weapon that could destroy the targets.[11]  In reality, Israel has its own nuclear weapons that might do the job.  That’s an awful thing to ponder.[12] 

Finally, there is a loose alliance between Iran, Russia, and China.  How would the Russians and the Chinese respond to either an Israel-America joint attack on Iran or to an Israel-alone attack (albeit with American blessing)? 

Can of worms.  Or, as the French say, “a basket of crabs.” 

[1] “Briefing: A looming nuclear crisis,” The Week, 17 January 2025, p. 11. 

[2] See: Iran–Iraq War – Wikipedia  If you want to explore in depth, see: Williamson Murray and Kevin M. Woods The Iran–Iraq War. A Military and Strategic History (2014).  Murray is deeply knowledgeable and hard-headed.   

[3] Iran is predominantly Shi’ite Muslim.  As a long-persecuted minority within Islam, Shi’ite theologians determined that Shi’ites could dissemble about their real religious beliefs.  Over the centuries, other people have come to believe that Iranian culture has generalized this originally purely religious easement on veracity. 

[4] So, as part of their recent mutual sliming-up to each other, has Russia secretly returned the enriched uranium to Iran?  I haven’t noticed reporting on this question.  My bad.  What does Mossad say? 

[5] Hamas in Gaza, Hezbollah in Lebanon, the Houthis in Yemen, and the Assad regime in Syria. 

[6] More recent developments cause me to wonder if it wasn’t the policy of President-for-Foreign-Policy Antony Blinken.  Who would have been President-for-Domestic-Policy?  Can’t have been Janet Yellen.  We wouldn’t have had the inflation mess.  I understand that this is a nasty remark.  But see “Biden: How to hide a president’s decline” The Week, 17 January 2025, p. 16.  Reports on a WSJ story on “how Biden’s aides and family hid his apparent cognitive decline from almost day one of his presidency.”  On which side of “day one” did the hiding begin? 

[7] Pakistan’s prime minister Zulfikar Ali Bhutto once said that “Even if we have to eat grass, we will make a nuclear bomb.”  You couldn’t force that in a democracy, but neither Pakistan nor Iran are real democracies. 

[8] Obviously, I haven’t tried it myself.  Nor would I try.  Don’t want to get hauled into a black Escalade while I’m walking my dog. 

[9] Probably Benjamin Netanyahu, but it doesn’t matter.  The leaders of the IDF and Mossad seem likely to be on the same page. 

[10] The ever-shrewd Eliot A. Cohen raised this possibility in the Atlantic in December 2024.  For a sample of Cohen’s Atlantic pieces, see: Eliot A. Cohen, The Atlantic 

[11] It has been reported that the Pentagon has briefed President Biden on plans for American attacks on Iranian nuclear resources.  “Briefing: A looming nuclear crisis,” The Week, 17 January 2025, p. 11. 

[12] Many people outside of Israel already are appalled by pictures from Gaza. 

Think about this.

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            “In a conversation with senior staff members on the morning of the scheduled visit [to the Aisne-Marne American Cemetery in 2018, burial place of many American dead from the First World War], Trump said, ‘Why should I go to that cemetery? It’s filled with losers.’ In a separate conversation on the same trip, Trump referred to the more than 1,800 marines who lost their lives at Belleau Wood as ‘suckers’ for getting killed.”[1] 

            Soon thereafter, “one unnamed senior official with the U.S. Department of Defense and one senior U.S. Marine Corps officer confirmed the 2018 cemetery remarks from the above report in interviews with The Associated Press (AP). According to the AP, the official had firsthand knowledge of Trump’s remarks, and the officer had been told about them.”[2] 

            Donald Trump, National Security Adviser John Bolton, and Secretary of State Mike Pompeo all denied that Trump had said these things.  Bolton was not then and has never become a Trump loyalist. 

            In “a separate incident of Trump visiting the grave of [General John] Kelly’s son who was killed in action in Afghanistan, ….. Trump allegedly asked of military personnel who volunteered to join the service, ‘What was in it for them?’” 

            In an October 2023 speech, President Joe Biden referred explicitly to the reported remarks.  Immediately afterward, General John Kelly, who had been serving as Trump’s chief of staff, endorsed the original report. 

            The Snopes evaluation concluded: “In sum, the claim stemmed from a story by The Atlantic, which relied on anonymous, second-hand reports of Trump’s alleged words; there was no independent footage or documented proof to substantiate the in-question comments; and Trump vehemently denies that he once called service members “losers” and “suckers.” While it was certainly possible that he said those things, Snopes was unable to independently verify the claim.”  Nevertheless, those stories were widely reported by media outlets.[3] 

Personally, I believe them.  So, what to make of the following? 

First, the military faces a recruitment “crisis.”[4]

Second, based on November 2024 exit-polls for presidential candidates.[5] 

                                    Trump             Biden/Harris  Percent of the overall vote. 

Veterans                      65%                 34%                 13% 

Non-Veterans              48%                 50%                 87%    

            In the wake of the wars in Afghanistan and Iraq and related anti-Islamist raiding elsewhere, do veterans now think that Trump got it right?  Do they think that they have been betrayed by the country they volunteered to defend?  Did they put Trump in the White House?   

[1] Jeffrey Goldberg, “Trump: Americans Who Died in War Are ‘Losers’ and ‘Suckers’,” The Atlantic, 3 September 2020.  The accusations and denials are examined in Did Trump Call Fallen Soldiers ‘Suckers’ and ‘Losers’? | Snopes.com

[2] Report: Trump disparaged US war dead as ‘losers,’ ‘suckers’ | AP News 

[3] For example, see: Trump disparaged U.S. military casualties as ‘losers,’ ‘suckers,’ report says | PBS News; Did Trump call US war dead “losers” and “suckers”? | Vox. 

[4] The Military Recruiting Outlook Is Grim Indeed. Loss of Public Confidence, Political Attacks and the Economy Are All Taking a Toll. | Military.com makes interesting reading. 

[5] 2024 United States presidential election – Wikipedia 

Prologue to a Diary of the Second Addams Administration 14.

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            On 6 January 2021, a mob of between 2,000 and 4,000 people attacked the Capitol building.  Their goal was to prevent the certification of Joe Biden as President.[1] 

            The numbers are more than a little wonky.  First, how many people attended the Trump rally?  “The House Select Committee that investigated the events of Jan. 6 estimated that Trump’s speech drew 53,000 supporters.”[2]  Second, how many people marched from the rally to the Capitol?  “Federal officials estimate that about ten thousand rioters entered the Capitol grounds,…”  The “grounds proper consist mostly of lawns, walkways, streets, drives, and planting areas” surrounding the actual Capitol building.[3]  Third, how many people actually attacked the police lines and then broke into the Capitol building?  “[T]he Secret Service and FBI have estimated that from 2,000 to 2,500 ultimately entered the building.”[4] 

So, the crowd funneled down from 50,000 at the rally to 10,000 who gathered around the Capitol to 2,500 people who actually entered the Capitol.  It seems unlikely to me that someone would attack the police lines, advance to the outside of the building, and then not enter.  So, did about 2,500 of the 53,000 at the rally take violent action? 

The attack on the Capitol made for a harrowing television spectacle.  Thereafter, Democratic political leaders called Trump a “fascist” and a “genuine threat to democracy.” 

These charges seem not to have resonated with many voters.  Why 6 January 2021 didn’t permanently sink Trump’s political fortunes presents something of a puzzle.  The mainstream news coverage, both in print and on the Devil Box, made the basic things pretty clear.  Despite its bitterly partisan make-up, the January 6 Committee did an excellent job of bringing forward a huge mass of evidence. 

And yet…  A recent YouGov poll reported that 29 percent of respondents “believe the Jan. 6 riot at the Capitol was legitimate political discourse.”  Almost half (46 percent) “describe it as a violent insurrection.”[5]  Unless there is a big overlap between the two groups, then 25 percent of respondents either didn’t know what to think or thought that the events fell somewhere between legitimate political speech and a violent insurrection.  The favored explanation in the WSJ is that subsequent Democratic “lawfare” pushed people to rally around Trump.  The Democratic explanation might be summarized as “They’re a bunch of idiots who shouldn’t have the right to vote.”  Until many of their own voters jumped ship in November 2024.  Another explanation might be that many people have a pretty good idea of who Trump is as a person.  Maybe they went “Got that out of your system, Don?  Feel better now?” 

On 6 January 2025, Congress certified the election of Donald Trump as President of the United States.  Defeated Presidential candidate Vice President Kamala Harris presided gracefully over the ceremony. 

The story would be hard to believe if we hadn’t lived through it.    

[1] “Congress certifies Trump win on Jan. 6 anniversary,” The Week, 17 January 2025, p. 4. 

[2] Jonathan Limehouse, “Trump compare Jan. 6 crowd size to MLK march,” USAToday, 9 August 2024. 

[3] On the Capitol grounds, see: United States Capitol – Wikipedia 

[4] See: January 6 United States Capitol attack – Wikipedia and Alan Feuer, “Capital Attack Prosecutions Have Ensnared Over 1,380 People,” NYT, 16 April 2024. 

[5] “Poll Watch,” The Week, 17 January 2025, p. 17. 

Ruthless.

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            Here’s the rot at the heart of the Republic: American voters of both parties have come to love “free stuff.”[1]  In a Democracy, politicians and political parties see the road to their own success running through giving voters what they want.  For Democrats, it means Tax-Spend-Elect; for Republicans it means Tax Cut-Spend-Elect. 

            As a result, in 2023, federal spending hit $6.75 trillion, with the federal deficit (not debt, just one year’s worth of spending above revenue) hitting $1.8 trillion.[2]  That deficit is 6.4 percent of Gross Domestic Product (GDP).  That isn’t a record.  It has been surpassed before.  However, those other peaks occurred during some kind of emergency: wars, recessions, etc.  Those conditions don’t apply at the moment. 

“Goo-goos” hate this trait.[3]  In the present day, all sorts of experts and commissions offer warnings of coming catastrophe and plans to avoid same.  The trouble is that this is like trying to talk a drunk into giving sobriety a spin.  It isn’t going to happen until they “hit bottom” or have a “moment of clarity.”[4]  What might bring on such a change? 

            Can you cut federal spending by shrinking the federal government?  YES!  And this idea is supported by a majority of Americans.[5]  Can you cut a LOT of federal spending simply by shrinking the number of civil service employees?  NO! 

First, the cost of salaries for all civil servants runs in the area of $200-$250 billion a year.  You will recall (from just above) that this year’s deficit is $1.8 trillion.  So, $200-$250 billion is about one-eighth of the deficit. 

Second, there’s interest on the debt at $882 billion.  An actual default, not just cuts to existing spending, may be coming.  We’re not there yet and we may be able to fend it off. 

Then there’s “discretionary” spending.  This includes the defense budget and everything else.  This comes in at around $2 trillion.  You can cut the defense budget a bunch.  You just have to believe that we are entering an era of peace and tranquility in which no other country will seek to challenge American interests. 

            Third, there’s the elephant in the room: “mandatory” spending on Social Security, Medicare/Medicaid, and related programs.  This amounts to $4.1 trillion, more than double “discretionary” spending.  “So taming mandatory spending means reining in benefits.”  Ouch! 

            It seems impossible for either Congress or the American people in their present state of desiring “free stuff” from the government to address this issue.  Nor will they raise taxes. 

However, there is scope for executive action.  For example, one “Goo-goo” estimate suggests that as much as $1.4 trillion could be saved by reversing Biden administration executive actions.  All we need is a ruthless lame-duck president who doesn’t care about established traditions or Beltway verities or even what he may have promised to get elected. 

[1] This has become a cultural force.  How and why this has happened is worth exploring. 

[2] Greg Ip, “Cutting Deficits Is Easy—Just Unpopular,” WSJ, 27 December 2024. 

[3] See: Goo-goos – Wikipedia 

[4] You might think that the recent unpleasantness with inflation fueled by deficits would have awakened ordinary Americans to this issue.  It doesn’t seem to have done the trick.  Or perhaps the pre-existing interest groups and political habits were just too strong for a not-yet-crystalized change of attitude.   

[5] According to an Ipsos poll, 57 percent of Americans favor downsizing the federal government.  “Poll Watch,” The Week, 6 December 2024, p. 17. 

Interpreting Mangione.

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            Polls in 2024 revealed that more than three-quarters (78 percent) of respondents believed that the United States “is headed in the wrong direction”; and that over half (55 percent) say that our political and economic system needs major changes.[1]  However, only one-fifth (20 percent) as yet think that violence may be required to reform the situation.  That’s still a large share compared to most bygone times. 

            In light of these reports, the reaction to the story of Luigi Mangione is interesting.[2]  Mangione is accused of murdering Brian Thompson, CEO of UnitedHealthcare (UHC).[3]  Mangione immediately became a media sensation and, to some, a folk hero.[4]  Some 124,000 “laughing face” emojis were posted in the Comments section of UHC’s on-line statement about Thompson’s murder.                                              

This idolization of a guy who shot his victim in the back stuck in the craw of lots of decent people.  Matthew Continetti spoke for many when he wrote that the murder tested “America’s ability to distinguish right from wrong” and “far too many Americans have flunked.”[5]  As do we all, Ingrid Jacques found the inhumanity of the response “alarming to witness” and the Washington Post found the response evidence of a “sickness” in society.[6]

What to make of the murder itself?  Seemingly not a “random act of violence.”[7]  The early investigation of the murder produced evidence of careful planning.  The man accused of the killing remains a puzzle.  In the absence of anything beyond police leaks and gleanings from internet searches, people assigned their own preferred meaning. 

Thus the Wall Street Journal wondered if Mangione had adopted “the populist theme of blaming seemingly distant and faceless corporations for social ills.”[8]  Most commonly, commentators immediately assumed that it is related only to problems with health care costs.  Explanations appeared of how health insurers are merely the surface of a much more complicated problem.  What about Oxycontin?  What about Boeing’s planes and space vehicles? 

Or they posit that “congressional gridlock” lies at the root of high health costs.  What if “Government is [just] the entertainment division of the military-industrial complex”?[9]  What if NOT fixing the problems is just what big money donors want…and get?[10]  Regarding another case, the Washington Post argued that tolerating antisocial behavior can lead to vigilantism.”[11]  Is that going too “populist”? 

[1] “The way we were in 2024,” The Week, 27 December-3 January 2024, p. 26. 

[2] “Mangione: Why did he become a folk hero?” The Week, 27 December 2024-3 January 2025, p. 19. 

[3] A loving husband and father, who reportedly made $10.2 million. 

[4] Not the first: The hanging of the abolitionist John Brown, Virginia, 1859; Nick Cave – The Ballad of Jesse James – YouTube and The Highwaymen Chasing scene the Gang 🌟

[5] Matthew Continetti in National Review, quoted in “Mangione: Why did he become a folk hero?” The Week, 27 December 2024-3 January 2025, p. 19. 

[6] In USA Today, quoted in “Health insurance: A CEO’s murder and an explosion of rage,” The Week, 20 December 2024, p. 6. 

[7] Like, say, a mentally disturbed guy with “a record as long as a CVS receipt” (stole that from a “Law and Order” episode) setting fire to a sleeping person on a NYC subway car. 

[8] Quoted in “Suspect in CEO murder raged against ‘parasites’,” The Week, 20 December 2024, p. 5. 

[9] Attributed to Frank Zappa, but who knows. 

[10] For example, Leaked emails show what Clinton told executives in private | PBS News 

[11] “Daniel Penny: A hero or a murderer?” The Week, 27 December-3 January 2025, p. 18. 

The Biden Decline Chronology.

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            In January 2024, President Joe Biden began the new year with a job approval rating in the area of 40 percent.  That is where it had been hanging for some time. 

            In February 2024 Special Counsel Robert Hur argued that his chance of winning a post-presidential case against Biden for “willfully retaining” secret documents would be unlikely to succeed: Biden would present as a “well-meaning elderly man with a poor memory.”  Democrats heaped abuse on Hur as a Republican partisan who strayed from his brief. 

            In March 2024, Donald Trump led Biden in opinion polls by 1-2 percent. 

            In June 2024, Biden gave a disastrous performance in his first scheduled debate with Trump.  The “cognitive decline” on display seemed much worse than what Robert Hur had described.  Democratic support for Biden immediately collapsed. 

            In July 2024, Biden withdrew from the race under massive pressure from leading Democratic politicians orchestrated by former Speaker Nancy Pelosi.  Biden immediately endorsed his failed Vice President Kamala Harris as his replacement.  This short-circuited the possibility of a mini-primary selection process favored by the people who had forced out Biden.[1] 

            In August 2024, Harris chose Minnesota governor Tim Walz as her Vice President candidate.  A bump in opinion polls more than reversed Trump’s 1-2 point lead over Biden to a 2-3 point lead for Harris.  Joy spread everywhere among Democrats. 

            In September 2024, Harris clearly won her debate with Trump.  The Joy Juggernaut gathered speed.  From this point onward, President Biden was really Former President Biden. 

            In October 2024, opinion polls showed that the Harris rebound had ebbed.  Trump and Harris were tied.  This shift occurred in spite of “mis-steps” by the Trump campaign.[2]  As the election drew nigh, the mood in the Harris campaign was described as “nauseously optimistic.” 

            In early November 2024, Trump defeated Harris 49.9 percent to 48.4 percent of the vote. 

            In December 2024, the Former President Biden riff gathered speed.  He embarked on a series of exhausting foreign trips far from the ugly realities at home.  President-Elect Trump was courted by foreign leaders even before he takes office.  Biden pardoned his son Hunter Biden for anything he did or may have done since 2014.[3]  Later, he pardoned almost everyone on the Federal “Death Row.”  This included Kaboni Savage.[4]  Will he pre-emptively pardon Luigi Mangioni for any Federal crimes? 

            In a particularly awful irony, the sitting Vice President, Kamala Harris, will have to preside over the Senate when it certifies the results of the November 2024 presidential election.  Senator Patty Murray (D-Washington) takes over if Harris understandably skips out.    

[1] Before he named Harris as his Vice President, a photographer caught a picture of Biden carrying a note that said of Harris “Do not hold grudges.”  Biden’s notes on display: ‘Do not hold grudges’ against Sen. Kamala Harris  Apparently, he has to be reminded. 

[2] Trump’s speeches became much longer and more wandery-aroundy, and it was noted that people attending them began to leave after a while.  However, Trump did about twice as many campaign events as did Biden and Harris.  It looks like he was becoming exhausted, while his opponents were, frankly, indolent either through age or basic nature. 

[3] I’d a done the same thing.  For my sons, not for Hunter.  But putting Hunter, a recovering drug addict, in prison as punishment for some non-violent crimes wouldn’t do the kid—or society at large–any good.  He’s still got a chance to make a decent life. 

[4] See: Kaboni Savage – Wikipedia 

Prologue to a Diary of the Second Addams Administration 13.

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            The Agenda: Why does health care cost so much? 

One theory is that, traditionally, medicine could not really do much for the sick and injured.  For almost all of human history, science and medicine knew nothing of many things.  Anesthesia and antiseptics for example, or what was a “normal” blood pressure or heart rate.  “Doctors” could be “real” or they could be “quacks” and you couldn’t tell the difference.  Surgeons could lop off arms or legs with a fair chance that the patient would survive.  They could do nothing about deep puncture wounds to the thorax.  They could administer heroic doses of laxatives and they could “bleed” patients to restore the balance of humors in the body.  As for psychiatry, Ben Franklin once helped out his sister by paying for her disturbed son to be chained up in a farmer’s barn to keep him from harm. 

Then, from the mid-19th Century onward, a medical revolution occurred.  It was just as dramatic—and probably more important—than the various political revolutions that have enlivened journalism over the same period.  Invasive surgery became safe and commonplace.  Drugs treated many diseases.  Vaccination warded off a host of terrible killers.  Then, in the second half of the 20th Century, still greater marvels appeared.  However, these ones were vastly more costly than the earlier innovations.  Organ transplants and fertility treatments, for example, are very costly.  Chronic illnesses in a population with an extending life-span is a new development.  In sum, modern medicine is just really expensive.  The best solution is to socialize the costs through government taxation and payments to providers. 

Another theory is that none of this is the real explanation for high health costs.[1]  It isn’t ALL medical costs that are so high.  It is only AMERICAN medical costs that are so high.  On a per capital basis, health care is about twice as expensive as it is in other advanced countries (i.e. Western Europe, Japan).  European doctors with comparable education and skills earn about half of what American doctors earn.  Members of the administrative hierarchy in hospitals and medical networks earn high salaries.  Medical tests, surgeries, and prescription drugs are far more expensive in the United States than they are elsewhere. 

According to this second theory, if you want more affordable medicine, you’re going to have to take it out of the incomes of the health profiteers.  This means everyone from your GP to the pharmaceutical companies.  Trying to compress incomes to cut costs for consumers (patients) will involve battling powerful entrenched interest groups, everyone from the American Medical Association to Big Pharma. 

In all of this, the health insurance industry plays the Bad Guy.  They’re the ones who interact with customers/consumers/patients.  Often they bring bad news.  Some charge is denied, or you still haven’t exhausted your out-of-pocket obligations, or you need to get your doctor to re-authorize some prescription that you’ve been taking—and will be taking—for years.  In truth, health insurers make a profit that is less than half of the average profit for corporation on the S&P 500. 

It is interesting that none of this has come up in discussion of Secretary of Health and Human Services nominee Robert F. Kennedy, Jr.[2]  What could/will Trump force through? 

[1] “The reason health care is so costly,” The Week, 27 December-3 January 2024, p. 14. 

[2] “RFK Jr. softens positions amid Senate scrutiny,” The Week, 27 December-3 January 2024, p. 4. 

Prologue to a Diary of the Second Addams Administration 12.

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The Agenda: The Middle East. 

Syria’s fifty-year-long government-by-massacre suddenly collapsed under a surprise assault by Turkish-sponsored Arabs.[1]  Bashar al-Assad fled (with his millions) to Russia. 

The lead group among the victorious rebels, Hayat Tahrir al-Sham (HTS), began establishing a government.  While people are more or less glad to be shed of Assad, HTS could be problematic.  On the one hand, the group is an off-shoot of al Qaeda; they’re Islamists; and they’ve be labeled as terrorists by Western governments.  On the other hand, HTS and the “Syrian National Army” are Turkish puppets.[2] 

Other countries began adapting to the new situation.  The Russians began cutting their losses by pulling out their men and material.  Israel has every reason to suspect Turkey’s president, Recep Tayyip Erdogan, of harboring anti-Israel sentiments.  He may want to create an Islamist-governed “ally” on Israel’s door-step.  Of late, there has been much celebration of the whole series of blows dealt to Iran’s allies and proxies (Hamas in Gaza, Hezbollah in Lebanon, Assad in Syria).  Erdogan won’t have missed the lesson.  He may use his proxies to exert pressure on Israel.  Israel exploited the opportunity by bombing Syrian bases and arms stockpiles to reduce the weaponry available to the HTS that had toppled Assad (just in case). 

Both Syria and the members of the European Union (EU) began nudging Syrian refugees to go home.  About 3 million Syrian refugees remain in Syria.  Erdogan would like them to go home.  About 1.5 million Syrians fled the civil war that began in 2011 for Europe.  Their arrival contributed greatly to an anti-foreign, anti-liberal reaction in many European countries.  European politics shifted right in an alarming fashion.  Many Europeans are saying “Go.” 

The United States and its European allies began talking to the people who are the de facto rulers of Syria.  They would like the rebels-turned-government to say the right things.  It’s a sticky situation.  It seemed brilliant to overthrow Libya’s Ghaddafi, but the follow-on effects—civil war, gangs, a migrant surge toward Europe—continues to trouble the region.  What if this turns out to be the same basic story? 

            Most immediately, there is the “problem” of the Kurds.  “Kurdistan” sprawls over Turkey, Iraq, Iran, and Syria.  The Kurds have been a dangerous thorn in the side of Turkey for decades.  They form the largest minority population within Turkey and they have long harbored nationalist ambitions.  The successive American wars against Iraq made that problem much worse by creating, then enlarging, a Kurdish proto-state in northern Iraq.  Moreover, the Kurds have been a loyal—and better yet, effective–ally of the United States in the fight against ISIS.  Indeed, the chief check on ISIS has been the Kurds.  In north-eastern Syria, Kurds braced for a likely attack from Turkey or its Syrian proxies.  If Turkey or its minions do attack the Kurds, that isn’t likely to be Turkey’s last move. 

President-elect Donald Trump has said “Syria is not America’s problem.”  He may mean it, more than did predecessors who hoped to “pivot to Asia.”  Is Israel also “not an American problem”?  What about Turkey, nominally a NATO member, but bound on its own course?  Whether he can sustain that resolve to disengage will be an early test. 

[1] “Turkey prepares attack on U.S. allies in Syria,” The Week, 27 December 2024-3 January 2025, p. 5. 

[2] “Syria: From Iranian client to Turkish puppet?” The Week, 27 December 2024-3 January 2025, p. 16. 

Prologue to a Diary of the Second Addams Administration 11.

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            The Agenda: Entitlements.  The financing systems for Social Security and Medicare/Medicaid have been crumbling for some time.  Exhaustion of the funding sources looms.  What to do?  For the Democrats, the standard answer has been “Make the rich pay their ‘fair share,’[1] then spend the money like a drunken sailor.”  For Republicans, the standard answer is “Dump the dependency-fostering bureaucratized systems in favor of sensible market-based solutions; you know, like Boeing and Wells Fargo.” 

            The Republican favorite, “Medicare Advantage” plans, are private health insurance plans that can be chosen by customers as an alternative to regular Medicare.  “Advantage plans” cover hospitalization and surgery, visits to doctor, prescription drugs, and vision, dental and hearing care.  They also limit out-of-pocket spending.[2] 

How do they do this?  They strive to be more efficient and cost-saving than regular Medicare.  For one thing, members are offered a more limited pool of network doctors to consult.  No insisting on the doctor whose manner or reputation you prefer.[3]  For another thing, they require prior authorization by the company for many treatments and services.  Insurance companies often refuse authorization for things that they regard as CYA or treatment-padding.[4]  Beyond these “sensible, market-based solution,” the plans are also accused of “up-coding” procedures.  That is, they turn whatever was done into something higher on the scale, the bill the government for the more costly thing.  Then there is the complaint that they deny services recommended for patients by doctors.  On the one hand, they increase the money paid by the government; on the other hand, they dodge around providing costly procedures. 

Then there is the touchy question of end-of-life spending.  Seventy percent of Americans die from a one or more chronic diseases.  The last few years of life often involve treatments for those chronic diseases.  This makes chronic diseases “the leading drivers of health care costs.”[5]  Almost 950,000 Americans die of heart disease or stroke every year; and more than 600,000 die from cancer.  Shedding end-of-life patients by denying them desired coverage could be good for the bottom line of Advantage Plans by pushing them to shift to Medicare.   

            The new administration may actually try to carry out a sweeping overhaul of entitlements.  They’re going to start with Medicare.  President-Elect Donald Trump has nominated Dr. Mehmet Oz to head the Center for Medicare and Medicaid Services (CMS).  Oz has a track-record of having supported the expansion of “Medicare Advantage” plans.  He also “criticized the drug industry over high prices” during his 2022 Senate campaign.  Will the new administration sustain, and build on, the Biden administrations negotiation of drug prices? 

            Leaving things just the way they are doesn’t seem like a good choice. 

[1] “Fair share” is never defined beyond my beloved sister-in-law’s “More, we’ll tell you when to stop.”  Honest. 

[2] “Dr. Oz: Expanding Medicare’s private option,” The Week, 6 December 2024, p. 33.

[3] This is a big issue for many people, but if you get hurt in a car wreck or have a heart attack, you go to the nearest ER.  Nobody says “I want to see MY doctor and I’ll wait until they’re available—don’t slip on the blood pooling on the floor.”  Why should it be different with an annual visit? 

[4] See, for example, Nicholas Bakalar, “Overtreatment is Common, Doctors Say,” NYT, 6 September 2017; Ryan Levi and Dan Gorenstein, “When routine medical tests trigger a cascade of costly, unnecessary care,” NPR, 14 June 2022, When routine medical tests trigger a cascade of unnecessary care : Shots – Health News : NPR 

[5] Fast Facts: Health and Economic Costs of Chronic Conditions | Chronic Disease | CDC 

Prologue to a Diary of the Second Addams Administration 10.

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The Agenda: deporting the illegals and others. 

Broadly, immigrants vulnerable to President-Elect Donald Trump’s promised “mass deportations” fall into three categories.[1]  First, there are the illegal immigrants, whom Democrats long preferred to call “undocumented immigrants,” as if there had been some kind of bureaucratic snafu.  Second, there are those seeking asylum in the United States on the grounds that they face grave danger in their own home county.[2]  Third, there are those in the United States who have been granted Temporary Protected Status (TPS).[3] 

There are an estimated 11 million illegal immigrants in the United States.  One careful estimate for the period February 2021 through October 2023 suggested that 4.2 million people had found entry into the United States.  Of these, about 2.5-2.6 million had been released into the country, while 1.6 million were estimated to have evaded all contact with the Border Patrol.  A further 2.8 million were expelled immediately back to Mexico.[4] 

Who goes first?  Thomas Homan, Trump’s nominated ICE commissioner, says that illegal immigrants who have committed crimes in the United States in addition to having entered the country illegally, will head the list.  Homan also has said that Texas provides a good model for national policy.  Texas governor Greg Abbott’s “Operation Lone Star” has called out the National Guard and put physical barriers along and in the Rio Grande.  Texas has also sent about 120,000 illegal immigrants to Democrat-led cities in the North. 

For a good while now, some Democrat-led cities have declared themselves “sanctuary” cities where local authorities will not co-operate with ICE.  These same cities often receive federal funding for various programs.  The Trump administration could try to compel co-operation by holding back these funds. 

One question is “Can this policy succeed?”  A second question is “What will it cost?”   The latter question has two sides to it.  On the one hand, there is a monetary expense to the government.  One estimate is that deporting a million people a year would cost $88 billion a year.  On the other hand, the illegals work in great numbers in construction, farming, restaurants, and hospitality.  Who will take those jobs if the illegals are deported?  American teenagers and college kids?  The homeless?  Folks for whom coding “boot camp” didn’t work out?  Another cost will come in fewer houses built, less fruits and vegetables in the grocery stores, slower service in restaurants, and longer turn-around times for hotel rooms.  All of it at a higher price. 

So why do it?  One answer is “Democracy, that’s why.”  According to an Ipsos poll,[5] fifty percent of Americans favor shutting down the U.S.-Mexican border.  Citizens live under the laws of their country.  To see the laws openly flaunted may be infuriating.  To see the spike in demand on various kinds of humanitarian support services in places where the illegal immigrants first arrive may be infuriating.  The pay-off through their eventual contributions to the country may be hard to discern in the current moment.  It’s a tough parlay to make. 

[1] “Immigration: Preparing for the crackdown,” The Week, 13 December 2024, p. 17. 

[2] In 2023, about 750,000 people applied for asylum.  Outmatched: The U.S. Asylum System Faces Record Demands p. 3.  Many of the illegals released from custody are asylum-seekers. 

[3] There were 1.2 million people with TPS in March 2024.  How TPS has expanded under the Biden administration | Pew Research Center 

[4] Lori Robertson, Breaking Down the Immigration Figures – FactCheck.org  27 February 2024.  Old-timers may wonder if the “gotaway” estimates resemble the Vietnam War “body counts” of our youth. 

[5] “Poll Watch,” The Week, 6 December 2024, p. 17.