Accepting the Lifetime Achievement Award from the Law Section of the American Public Health Association

 On October 24th I was honored with the Lifetime Achievement Award from the Law Section of the American Public Health Association.

Here is the nomination statement from Marjorie Jaski, JD, MPH:

Attorney Daniel Swartzman
Nominee for APHA Law Section Lifetime Achievement Award

My nomination of Dr. Daniel Swartzman is derived from my time as his student at the University of Illinois School of Public Health, my continued association with Dr. Swartzman, and witness to his extensive following and influence on some of our brightest leaders today in Public Health as well as his lifelong career in public health law.

Professor Daniel Swartzman became an environmental public interest lawyer in the 1970’s, after graduating from Northwestern Law School and serving as Director of Legal Services for the Chicago Lung Association, working on issues in Illinois and nationally.  Upon receiving his MPH in Environmental Health Sciences in 1978, he also joined the faculty of University of Illinois (UIC) School of Public Health.  

At the School of Public Health, Dr. Swartzman taught some of the earliest classes in the country on public health advocacy and public health ethics, and, today, he is the most awarded teacher in the School’s history in this area.  During his tenure at UIC, he also served as Associate Dean of the School, and his book on cost-benefit analysis and environmental regulations has been widely reviewed and sits in more than 350 libraries around the world.  He has presented widely in conferences, including 20 abstracts at APHA, and in international settings. He started a joint JD/MPH program between UIC and the Chicago-Kent College of Law, and is currently working on a similar program with Loyola’s Health Law program.  His academic work has focused on environmental law, public policy making and social justice.  

Concurrent with Dr. Swartzman’s academic work, he opened his own law practice in 1985 focusing on toxic torts and private brownfield reclamations.  His law firm has been the only Chicago firm that took a cigarette manufacturer to a federal jury verdict, and he has helped close brownfield sites worth hundreds of millions of dollars.  His legal work has been influential in implementing the Clear Air Act Amendments, the work of the National Air Conservation Commission and the National Clear Air Coalition.

Over many years, Dr. Swartzman has helped advise more than two dozen student dissertations and served as advisor to hundreds of MPH students, at least 20 of whom were lawyers or who went on to law school.  In 2017, a group of former students started a campaign raising an endowment of over $100,000 for the “Daniel Swartzman Lecture in Public Health Ethics” at UIC.  He continues his work at Loyola’s new Parkinson School of Health Sciences and Public Health, where he teaches both graduate and undergraduate students.  He advises undergraduate students on becoming lawyers.  He is busy developing teaching case studies focusing on social justice issues which Parkinson hopes to make widely available.

After a highly distinguished career in public health law, that continues to this day, I believe that Daniel Swartzman is an ideal candidate and highly worthy recipient of this award. 

And here are my remarks on accepting the award:

My remarks on receiving the Lifetime Achievement Award
from the APHA Law Section
October 24, 2021

    This is a humbling experience.  I look at the previous recipients of this award, and I think “It is their work that my work is built upon.  These are the shoulders on which my achievement, such as it is, stands.”  With us tonight is the first recipient of this award, Scott Burris, and I am honored to be here with you, Professor Burris.  And I think about a couple of dozen people in our field who deserve this award more than I do.  Of course, I am not going to tell you who those people are, because I don’t want you to change your mind.

    You know, when I graduated from law school, back in 1975, I realized that one can take pride in how well one does their work and in what the work actually is.  But for many lawyers, that second part is not all that easy.  I know so many lawyers who have worked for decades, and have taken pride in how well they lawyer, but not necessarily in what the lawyering accomplished.  But I wanted to be a lawyer for Good things.  And I am sure all of you here tonight know exactly how that feels, because you all want to be lawyers for Good things.  As a public interest lawyer and then as a lawyer for people harmed by toxic chemicals and as a lawyer who helped people clean up polluted land, what we call “brownfields,” I am proud of what I have done.  But there is always that question in the back of your mind, is it enough?  Have I contributed enough?

    Then, a few years later, I became a teacher, teaching public health graduates and undergraduates how to work towards Good things.  Many of you are teachers.  You see your students learning and you can see by the tests scores that they understand the material.  But have you really helped them build careers to achieve what we Jews call “tikkun olam,” repairing the world?  I know that the professors here tonight understand the doubt that I am expressing.

    But four years ago, a large group of my former students worked together to collect more than $100,000 to endow a lectureship on public health ethics in my name at the UIC School of Public Health.  OK, I thought, I probably was doing some Good with those folks.

    And tonight, by being recognized by you, my peers, for my 46 years of practice and teaching and writing, I am being offered an acknowledgment that, yes, maybe what I have been doing was worthwhile, that I really did achieve something.  

    For that statement from you, I am very, very grateful.  Thank you so much for this honor.

No one exists alone; liberty is embedded in community

President Biden is taking concerted action to increase the number of Americans who are vaccinated.  It looks like public opinion favors this move, but he is being criticized by a small but highly vocal minority saying that his actions are unconstitutional and against individual liberty.

It is long established law in the US that the government has the authority to mandate actions, including vaccinations, to achieve public health goals.  This power lies mostly with the states, under the “police power,” the state’s responsibility to protect the “health, safety, welfare and morals” of the community.  This is why the President is only encouraging governors to act, since he does not have the power to force them to do so.  But the federal government does have the power to control the conditions of its own employees, and OSHA has the power to regulate health and safety in the workplace.  These actions will likely be challenged in court, but unless the courts decide to change more than a century of strong, legal public health protections, the President’s actions should be upheld.

But what of that small and noisy minority who insist that this is a violation of their personal liberty?  I think the key is to ask about the context of liberty. We have for a very long time treated liberty as something that is separate from the community. The two are presented as opposing positions, inevitably at odds.  This has become so pronounced over the last forty year that I have taken to calling this a “fetishization” of individual liberty.

I think this view, that liberty is somehow removed from community, is not useful or accurate. Individual liberty does not exist without a community that supports individual members in their individual choices. What keeps us from being a battle-royal of every individual against every other individual is the presence of an overarching community that provides a safe and respected place for individual action.  I believe there is no society of individuals that exists without a healthy community. I said this in a tweet a couple of months ago:

"Freedom is not separate from the needs of the community. It is a right that is protected by, empowered by the community. Individuals enjoying their freedom must respect the community that protects it. A healthy community guarantees freedom, within limits of the community's needs."

Some people say that the individual is the basic unit of analysis within a society. But this makes little sense in arranging the affairs of social animals such as humans.  Who keeps the commons open to individual thought and actions?  I think we were all members of a community before we ever realized that we were individuals. There is no history of individual humans wandering alone in the grasses or forests fending for himself or herself. Our history starts with hearths, kinship, mutual protection and, most of all, caring for “the other.” Going off on one’s own only happens after the community raises you to the point of being ready to try that.  And it is probably waiting behind you when you return, helping you in bad times or sharing in your successes.

We are all inevitably embedded in community, either one present in our lives today or one that operated in the past to support our families and allowed us to get to the point of “striking out on our own.”  If we perpetuate the illusion that all of our successes are due only to our own efforts, we will neglect the communities that are just as responsible as we are for our achievements.  And not being vaccinated and not wearing masks are exactly that neglect.

The ACA is up for grabs; how did we get here?

A bit of history 

The ACA requires that insurers cover anyone, even if they have a pre-existing condition.  That is an expensive requirement for the insurance companies.  After all, you are agreeing to cover someone whom you know will be incurring costs.

In return for this, the ACA requires that everyone has health insurance, the “individual mandate.”  That way, people who are not currently sick or are unlikely to get sick will pay for insurance, and the insurance companies will make money to compensate them for paying out to those with pre-existing conditions.

In order to make sure that people buy the health insurance, the ACA established a penalty for not having insurance, to be collected by the IRS when we do our taxes.

In 2012, the US Supreme Court found that the individual mandate was not constitutionally valid under the Constitution’s “interstate commerce” clause, but that it was valid under the “tax” clause.  Was this a penalty or a tax?  The Obama administration admitted it was a tax, and the Supreme Court said that that was acceptable.  The ACA was constitutional.

However, in 2017, Congress passed a major tax cut law.  And in that law, it set the value of the tax on the individual mandate to zero.  So, it eliminated the penalty for not having health insurance. 

In spite of that, people still signed up for insurance under the ACA.

A Texas judge

But in 2018, a group of state Republican attorneys-general brought suit in a Texas court, in front of a judge known to be conservative, claiming that if the individual mandate tax was eliminated, then that eliminated the constitutionality of the mandate.  And if the individual mandate was unconstitutional, then that meant that the entire ACA was unconstitutional.  The judge threw out the entire ACA.

Is that right?  Does an entire law fall if one part of it falls?  No, not automatically.  There are rules for determining whether an entire law is unconstitutional if a court finds that one part of it is unconstitutional.  Most legal scholars (most of whom, admittedly, are liberals) found that the judge in Texas did not come close to following these rules.  A number of Democratic attorneys-general appealed the judge’s decision.

The Trump Administration’s first response to this ruling was to not get involved.  However, just in the last couple of days, the Administration has changed its position, and recently filed a brief with the Circuit Court of Appeals hearing this case taking the position that the ACA was now completely unconstitutional. 

We liberal scholars still think that the Texas judge’s decision was flawed.  But having the Administration come out in favor of the ruling is a big deal.  And ultimately this is going to go to the US Supreme Court.  In my view, any reasonable decision by SCOTUS would throw out the judge’s faulty decision.  But my view of what is reasonable and what five conservative judges on the Supreme Court think is reasonable do not always coincide.  They may very well throw the whole thing out.

The New York Times coverage

Hence the review by the New York Times this morning:

https://www.nytimes.com/2019/03/26/health/obamacare-trump-health.html

But that is not all.  Back in 2017, Congress decided that it was going to repeal and replace the ACA.  The Republican controlled House, after a lot of back and forth, passed the American Health Care Act, which sort of repealed and sort of replaced the ACA.  The Republican controlled Senate couldn’t find any language they could agree upon.  Late one night, a poorly drafted law was put up for a vote, to at least keep the discussion going.  Whether it would pass came down to one vote, to be cast by Sen. John McCain, who entered the “well” of the Senate chamber and dramatically extended is hand and indicated “thumbs down.”  (In case you were wondering why Trump has been so focused on the now deceased Arizona senator, this is part of that anger.)

The Republican Congress ended up not passing anything.  Why?  Because it is very, very hard for conservatives to come up with the replacement that was promised.  Keep in mind that the ACA is the conservative approach to healthcare reform, published many years ago by the very conservative Heritage Foundation.  And the President and most Republicans in Congress had agreed to keep the ban on refusing insurance to those with pre-existing conditions, a very popular position amongst the electorate, given that more than 100 million Americans have a pre-existing condition.  But if you want to make insurers cover people with pre-existing conditions, you have to make everyone buy health care. . . .  Congress could never figure out a way around this.  And both Congress and Trump had also promised to lower healthcare costs, which no one knows how to do.  (Short of passing a single payer system, which will give the federal government extraordinary bargaining power over the healthcare providers.  This is one of the main reasons why healthcare is much cheaper in the other rich countries around the world.)

Healthcare in the 2020 election

The President has sworn to make this one of the big issues in the 2020 campaign.  He vows that the Republican Party will become “the party of healthcare.”  At the exact same time, the Democrats in the House have submitted legislation to bolster the ACA, increasing the subsidies, and strengthening other parts of the law.  And it is widely viewed that healthcare was one of the big winning issues for Democrats as they took back the House in 2018.  They will likely be delighted to have this debate in 2020.

So, here we are.  The courts shouldn’t throw out the ACA, if they follow established rules, but they well might.  And one house of Congress is making the ACA stronger, while the other house wants to get rid of it. 

And the Times has let us know exactly what is at stake.  Lots of people’s lives and livelihoods.
Quite a moment!

Life in our bubbles

    Two years ago, many of you read my reaction to the election, where I admitted to living in a bubble.  Privileged, upper-middle class, white, urban, male.  And an academic to boot!  But I have been watching, and listening, and thinking about what may be going on outside my bubble for the last two years, and I think I have a pretty good hypothesis of some of that activity.  Here is what I believe.  Am I right?
    There is another bubble outside of mine, with almost no overlap, although there are a few points where they touch.  Inside that bubble there are mostly middle class, mostly white folks who, for many years, are seeing their lives in decline.  What used to be taken for granted, like my kids will be better off than I am, now seems out of reach.  They work hard and play by the rules.  But even though the stock market is booming, and the growth in GDP is healthy, not much of that wealth has made it into their bank accounts or onto their balance sheets.  Many of them have to work two jobs to make ends meet and to send their kids to college.
    And nobody seems to be talking about them and their problems.  The news features a lot about blacks and Latinos and LGBTQ people and their problems.  About immigrants and their problems.  They know that their grandparents were immigrants, too, and are proud of the success their family made in this country, but it is not clear what that means when more and more people in town are black or brown or wearing odd clothes.  The people inside this bubble don’t have anything against others having their problems addressed, but it has been a long time since it was their turn.
    For years and years, the Republican party has been telling the people in this bubble that the GOP was going to make things right for the middle class.  With tax cuts and less government regulation, the economy would boom and we would all be better off.  After a while, though, it has become clear that those policies don’t seem to benefit the middle class.  The rich keep getting richer.  Nothing is trickling down.
    The Democrats, who used to be the party of middle class white people, are reaching out to gays and people of color and immigrants.  They haven’t addressed the economic inequality that the people in this bubble are living.  The Democrats have said that they are worried about being accused of “class warfare,” but then they keep looking out for the underclass, as if the middle class had no problems.
    At some point, they decided, “Enough.  A pox on both your houses.”  Screw the Bushes and the Clintons, both of which have been caught lying to our faces about economics, but also about other important things like war and like moral behavior.  “We want,” they say, “to change this, and change it NOW!”
    Was Trump going to make it worse?  Well, what is worse than being ignored?  Then seeing a steady lowering of your buying power and a decreasing ability to conjure up hope, with nobody paying attention?  So, they voted for him, and he won.  Maybe things will finally get better. 
    From inside my bubble, it seems to me that we have spent two years testing whether they were right.   But things are pretty much the same.  The kids are still going to have to work mighty hard to just break even with their parents.  Republicans still pass tax cuts for the most wealthy and lie to us that this will redound to our benefit, running up a magnificent deficit in the process, a deficit that those kids will have to pay up.  Trump is a pathological liar and a monumental narcissist, with no impulse control and no overall plan for anything, violating the most basic norms of governance and legality.  Of civility.
    And nobody in power is addressing the most pressing problem we face, the reality, not a hoax or a plot, that the climate is changing, that hurricanes will come quicker and harder, that winter will be deeper in some places, and, in others, summer will be unbearable, so hot that planes can’t fly.  This really shouldn’t be talked about in future tense anymore.  Climate change is here, now.  The urgent question is can we stop it from getting much, much worse.  If not, the ecological niche that human-kind evolved in will be closed, or, at best, deeply pinched.  If we live long enough, we may look back on these days as the best in the lives of our children.
    I don’t live within that other bubble.  I think I get it – it was a bad couple of decades for America’s white middle class.  But I just can’t believe that no one within that bubble doesn’t see pretty much the same awfulness that I have seen in the last two years.  If you are one of those people, you have to speak up, to act up, to share your views with your bubble-mates.  We have to learn to act together, or we are all in trouble.  Together.
    Am I wrong?  What don’t I get about the lives in that other bubble?  And why don’t you see the last two years as I do? 

Can the rich and powerful be beaten?

As I write, kids are planning to converge on Washington to demand action on controlling guns.  Will they succeed where other such efforts have not?   It would be tempting to believe that the rich and powerful, in this case, the NRA, are simply too rich and too powerful to fight.  But this would be too cynical, and we would be paralyzed.

Another temptation is to believe that the rich and powerful are easy to defeat, because we have the facts on our side.  This is not cynical enough.  Nothing short of a great social movement is going to overcome the ability of the NRA to spend money on “independent” advertising during campaigns, recently identified as their most successful tactic.

For years, I have been arguing that progress in the toughest fights on public health policy only exists through social movements.  Starting 150 years ago, we had more than a century of successful, progressive social movements, each of which won in spite of seemingly overwhelming opposition by the rich and powerful.

These efforts succeeded because they were social movements – widespread, coordinated and well-led efforts by committed and energized activists who wouldn’t give up:

150 years of Successful Progressive Social Movements
(dates are culminating events; movements take decades to work)

Abolitionism, 1865
Antitrust, 1890
Pure food and drugs, 1906
Conservationism, 1910
Universal suffrage, 1920
Labor low reform, 1935
Social Security, 1935
Child labor laws, 1938
Minimum wage, 1938
Civil rights, 1964
Healthcare for the elderly and the poor, 1965
Women’s rights, 1967
Fair Housing 1968
Environmentalism, 1970
Occupational safety and health, 1972
Superfund clean ups, 1980
Act-up AIDS activism, 1986
Black lives matter, 2013
MeToo, 2018

You can read a bit more about this in “Giving up would be a historical mistake,” at http://danswartzman.blogspot.com/2016/03/giving-up-would-be-historical-mistake.html.

I have been slowly developing a list of things that a social movement needs to be successful.  My current list includes nine things:

1.  Intensity – public health advocacy is all about generating and managing intensity.  A social movement only wins if the issues it addresses and the positions it takes are viewed intensely by its members.  When you see a leader of a social movement take a position that is a bit far out of the mainstream, it is likely an effort to generate and focus intensity.  Example: environmental opposition to the Keystone XL pipeline.

2.  Focus – You have to be able to explain the emphasis of your movement succinctly, and people involved need to be clear what they are fighting for.  This requires focus.  Example: the “Fight for Fifteen.”

3.  Cohesion – The people within the movement need to believe that they belong to something, and their relationship to that “something” and the people within that “something” provides cohesion.  Example: Black lives matter.

4.  Structure – One of the most successful recent movements in the US is the Tea Party.  One of the reasons they were successful is that right-wing big money stepped in and started to organize them.  They have multiple layers of structures.  Does the fact that they are being funded by conservative organizations make them “not” a social movement?  No.  Many social movements rely upon funding from the rich. 

5.  A constant infusion of energy – Physics tells us that any organized system will move from a state of organization to disorganization, without input of extra energy.  Entropy.  So, too, with social movements.  There needs to be some source of a constant infusion of energy, in contributions, in volunteer energy.  Example: the Sanders campaign in 2016, with millions of small donations.

6.  A good narrative – By “good” I don’t mean acceptable to you and me.  I mean that there has to be a narrative that explains why the movement exists, what it is trying to do, and how someone can help by joining.  Example: the Trump campaign in 2016.

7.  A supportive reaction from the media – If you are going to sustain a multi-year effort (and all of the movements mentioned above lasted for decades), it helps to have a supportive reaction from the media.  At first, the Sanders campaign got very little good press.  That continued for quite a while, and even when the media coverage began to shift, much of the mainstream media were still “pooh-poohing” his efforts.  On the other hand, the media played a critical role in the success of the Trump campaign.  Note that they were not substantively supportive, but all of the attention they gave and their lack of an effort to successfully counter his statements were critical to his success.

8.  A bit of luck – It doesn’t hurt to have a bit of luck along the way.  A member of the rich and powerful does something really stupid (think Romney’s talk about the 47% in 2012 or McCain’s picking Sarah Palin in 2008 and the impact of these two decisions on the Obama movement).  A media story breaks that provides an infusion of interest or energy.  World events work to support your narrative.  Everyone needs a bit of luck.

9.  Leadership – There is a view that big, important people are what move history.  That is way too simplistic.  But successful social movements have leaders.  Those leaders are not sufficient to success, but they are necessary for success.  Here is a blog on the importance of this:

“We have forgotten how transformational leadership works,” http://danswartzman.blogspot.com/2015/07/we-have-forgotten-how-transformational.html

So, lets see what happens with the Kids and Guns movement.  They seem to have a good focus, and they seem cohesive.  They are getting great media and have had some initial successes.  Can they maintain their intensity?  Will those great teens with obvious leadership skills be able to step up to the challenge of leading a multi-year effort?  Or will others come along and fill that need?

I am energized by their efforts, and hopeful about the results.

Don’t understand why some conservatives want to repeal Obamacare? Read on.

OK, some of the conservatives who are arguing to repeal the ACA are heartless opportunists.  But all of them?  Probably not.  So, what mindset could possibly justify such an action?

Let’s start here: Do you believe that everyone deserves to own a car?  Not just that they have the right to purchase one if they can, but that they have a right to have a car, and if they can’t afford it, then it is up to us, their community, to provide it.

Keep in mind that if you answer “No, people don’t have a right to car.” then some people, probably a lot of people, will go without one.  And that means they will not be able to get a good job that requires a commute.  They won’t be able to take their children to enriching after school programs.  If they need to go to see a doctor right away, but not in such a hurry that they would call an ambulance, they will have to spend hours on public transportation while they are sick.  They will feel undervalued by a society that glorifies car ownership, and the joy and freedom and convenience that it brings.

Not convinced?  Me neither.  Car ownership isn’t a right.  (It does, however, point to a responsibility on our part for good mass transit.)

When you decide some good or service should not be available “by right,” you are accepting the fact that some people won’t have access to that good or service.  That is what happens in a marketplace.  Some people win and some people lose. 

And that isn’t just a side effect of a market.  That is crucial to the good functioning of a market.  It is the competition to win, to avoid losing, that stimulates the best response from the marketplace, that creates the efficiencies for which markets are praised.  If there are no losers, then the market won’t produce what it promises – efficiency and a promotion of liberty.  (More on this can be found in earlier blog posts on “Vouching for healthcare,” parts 1 through 5.  These were posted in September of 2015 through June of 2016.)

So, now think like a conservative.  You don’t believe that the government has a responsibility to provide health care to everyone.  It is not a right, but a service to be purchased in a marketplace.  This will mean that some people have less healthcare, and some people will have more.  Losers and winners.  Since you are not heartless, you will be in favor of some kind of “safety net” so that the worst off are taken care of to some extent.  But it can’t be an extensive governmental program or you won’t get the benefit of the marketplace.

And it is those benefits that you want very much to achieve.  You want to lower the price of health care, increase the quality of health care, and, overall, create a better match between the true needs of health care consumers and the health care that is available. 

If people compete for health care, this will stimulate health care providers to offer care at a lower price.  It will also encourage providers to offer better care, care that is most appropriate and of higher quality.  By empowering the health care consumer, we get higher quality and more appropriate health care at a lower price.

And some health care providers will get very good at giving high quality care at a reasonable rate.  They will expand their capabilities, thereby employing more people.  And their increased size will bring economies of scale that will benefit their employees, their investors and everyone who purchases care from them.  The benefits of a marketplace trickle down to all of us. 

Unlike manufacturing, where the benefits of bigness were shipped oversees and trickle down in other countries, health care is confined to a locale, so the benefits of the marketplace will accrue to the specific community where the care is given.

Health care costs are rising at two or three times the rate of inflation.  We pay the most (by far!) of any rich country for our health care, without a corresponding increase in the quality of our lives.  In fact, cheaper care in a number of other countries produce better results.  A well-meaning conservative would argue that we could lower health care costs and increase the quality of our health care outcomes by empowering the consumer, by eliminating the government programs for health care and returning it to the marketplace.

The cost to society of these benefits is to accept that some people will not get sufficient care.  But, to use a cliche, the fact that some people will suffer from a lack of health care is not a bug, it is a feature of the marketplace.  It is the price we pay for all of the benefits we reap from returning health care into the marketplace. 

You and I accept the idea that some people’s lives will not be as rich as ours because we don’t give everyone a car.  A conservative believes that we, as a society, would be better off if we accepted some health care disparities in return for lower costs and higher quality.

That is why the central issue of this debate has to be “Is health care a right?”  If so, then the community, through its agent, the government, must assure that everyone gets care.  If not, then we are left to fight over how much disparity we can accept.

I think American public has made clear to Congress that they aren’t willing to have millions of people, real people, our relatives, friends and neighbors, lose their health care in exchange for the illusive promises from “returning care to the marketplace.”  And I think Americans are very, very close to accepting the idea that health care is a right, not a privilege. 

By the way, keep in mind that the ACA, even when fully implemented, was going to leave 30 million people in the US without health insurance.  By passing the ACA, we as a country decided that we could live with one of out ten of us not having care.  How did that happen?  In part, because people didn’t understand that this would be the result, and in part because we didn’t have the public discussion in 2009 about whether health care was a right.

Yes, some of the players in this drama are mean-spirited and heartless.  Shame on them and their supporters.  But some conservatives think they are doing what is best for society as a whole.  They are wrong in two ways.  First, health care doesn’t work well in a marketplace.  And, more importantly, it is a birthright that the community should promise to every child born.  This means that markets are a very bad way of assuring that everyone gets care.  (Evidence – the one big problem with the ACA is the health insurance exchanges or marketplaces.)

Ultimately, if we engage in the debate over whether health care is a right, we are going to have to face the question about where rights come from, which many of my liberal friends don’t want to talk about.  I have proposed to start that uncomfortable conversation at the next annual meeting of the American Public Health Association.  Lets see where that leads.


Addendum as of October, 2017:  My proposal to talk about "where a right to health care comes from" was rejected by my colleagues in the Ethics Section of APHA.  That is the fourth time I have tried to have this conversation at the APHA Annual Meeting, and the fourth time it has been rejected.  I give up.

Two questions: Trump’s supporters? Trump?

Have you ever been so mad that you took a whack at something?  Maybe physically, like pounding the wall or slamming the door?  Or maybe verbally, by saying something vicious to someone?

Me, too.  Not proud of it, but it makes me human.

However, after I calm down, I am able to think about my anger and what I did.  I might decide I was absolutely right to be angry, or I may feel shame for the damage I have done.  Or both.  I may end up apologizing to someone.  But what ever comes next, I have thought about it.

So, I get that Trump’s supporters were angry and frustrated.  Senator Warren, in her ubiquitous appearances on behalf of her new book, points out that from the 1930's to 1980, 70% of the increased wealth of the country went to the bottom 90% of us.  From 1981 to the present, all of the increase in wealth is going to the top tier of the income distribution.  The rest of us have received none of that.

During that latter period, almost all of our politicians have promised to fix the problem.  And then they have done almost nothing, or have made it worse.  They lied, repeatedly and with no apparent shame.

Suffering from this injustice and then being lied to about it made a lot of people mad.  And they wanted to lash out, to strike against the problem and the liars.  So, they voted for Trump, the guy who clearly had not created the problem and who was promising to fix it.  In fact, the only person, they believed, who had a chance to fix it.

I get that.  I have been that angry, that frustrated.  I will restrain from criticizing his supporters for the initial action.  I have spent no time in their bubble, but I think I understand their motivation. 

But it is now time to stop, calm down and reflect.

Instead, 96% of the people who voted for Trump are happy with how he is doing.  Maybe you get a pass for voting for someone with Trump’s obvious faults, but there is no basis for continuing to believe in him.

Therefore, I have to call them to account for their continuing support.

Donald Trump is small-minded, bigoted, ill-read, uneducated, inconsistent, uncontrolled, narcissist.  He has little impulse control and no ability to think strategically.  He is attracted only by people with power or with money or with big breasts.  He doesn’t understand what he doesn’t understand.  His positions are adopted from the last person he talks to or that last cable show he has watched. 

At some point, the people who saw him as a knight riding forth with their banner of righteous indignation must now look at him anew.  Shame on you if you can’t see past your hopes and look at the actual person that we elected.

So, I am done making excuses for his supporters.  They have had 100 days to come to their senses.  That they haven’t is completely unacceptable.

I supposed the second question is somewhat answered by my discussion of the first.  What should I make of Donald Trump?

My visceral reaction has been that he is exactly what he appears to be, an incompetent narcissist, in way over his head.  But I have tried to give him some benefit of some doubt.  Maybe he will start listening to the people around him.  Maybe he will start doing his homework.  Maybe he will start developing strategic and tactical plans to address our national and international concerns.

He, too, got 100 days to show me that I was being too critical, that I should hold out some hope.  That period is now done.  He is what he appears to be:

•    Who knew how complicated health care was?

•    Andrew Jackson, instead of being a vicious genocide, is a model of leadership who wouldn’t have made the same mistakes as did that Lincoln guy.

•    Obama personally ordered surveillance of me.  Sad.

•    We are going to have a beautiful health care bill passed by the Republicans, which will lower costs, provide health care for everyone, and protect those of us with pre-existing conditions.

•    We will build the Wall.

•    We will act against millions of undocumented immigrants, and keep fighting in the courts to exclude more immigration by Muslims.

•    My life before this was hard, but who knew this job would be harder.

•    My inaugural crowds were monumental, bigger than any before.

•    My electoral college victory was historic.

•    My popular vote would have been higher, had it not been for millions of people voting illegally.

•    My tax cut will be the biggest in history.

As of today, I am done.  My little sliver of hope was none too large, but it is now gone.  He is who he appears to be.  And we have to resist him at all costs.

What will that resistance take?  That is my next topic.