All I Want for Christmas

“All I want for Christmas is a new vaccine…” It has a nice, catchy ring to it, don’t you agree? Though several COVID-19 vaccine successes have been announced, thanks to President Trump’s Operation Warp Speed, it is unlikely any of us will get a shot in the arm until after the New Year. For most, the wait will be months longer.

Sometimes the best presents are the ones we have to wait for. As a child, there was a string of years where my main Christmas gift was late, and I would have an IOU under the tree. Probably the most memorable such present was when I was fourteen years old. I was into photography and wanted an SLR camera, but they were expensive and hard to come by – at least in Midland, Texas. There was no internet shopping in 1975! My father had a friend who was going to Japan (where electronics were cheaper) and he was able to get one shipped to us, but it was not going to arrive by Christmas Day. There’s a reason we use the word ‘ship’ when we talk about package delivery, and the ship with my camera on board took six weeks to cross the Pacific. When that camera finally arrived, I definitely could say it was worth the wait!

Now we all wait on a COVID-19 vaccine.

According to the office of Texas Governor Greg Abbott, Texas is ready. The Department of State Health Services (DSHS) developed a Vaccine Distribution Plan and is working with health care providers to enroll in the DSHS Immunization Program to be eligible to administer these vaccines once available. Over 2,500 providers have already enrolled in the program. The Texas Division of Emergency Management (TDEM) is prepared to assist the swift distribution of COVID-19 vaccines and treatments.

I have followed the COVID-19 vaccine development and approval process for months now. I can tell you I will be 100% confident in any vaccines authorized or approved by the Food and Drug Administration (FDA). FDA Commissioner Stephen Hahn has written, “We are committed to expediting the development of COVID-19 vaccines, but not at the expense of sound science and decision making. We will not jeopardize the public’s trust in our science-based, independent review of these or any vaccines. There’s too much at stake.”

As a healthcare worker, theoretically I’m slated to be in an early cohort to get vaccinated. I haven’t heard any local details yet. The job of deciding “who goes first” falls to the DSHS COVID-19 Expert Vaccine Allocation Panel (EVAP). A Guiding Principles document recommended COVID-19 vaccine allocation be based on the following principles: protecting health care workers; protecting frontline workers; protecting vulnerable populations; and mitigating health inequities. The process is to be data-driven, geographically diverse, and transparent. The DSHS document goes on to describe in greater detail who the First and Second Tier health care workers are in Phase 1A. 

It is difficult to argue against prioritizing healthcare workers, first responders, and even residents of long-term care facilities, who have been devastated by COVID-19. Some have expressed concern about nursing home patients being in the first group because they are elderly and may not tolerate the vaccine as well. However, vaccine trial participants have come from all age groups. And though each vaccine is different, the general consensus is that vaccinating older adults against COVID-19 is safe and effective. I was heartened to read recently that the three living former presidents – Bill Clinton (age 74), George W. Bush (age 74), and Barack Obama (age 59) – have said they would be happy to get vaccinated on camera to show that it is safe and to encourage others to get it. As I called for months ago, I hope President Trump (also age 74) is first in line. We need the unified endorsement of politicians across the political divide to encourage a significant majority of people to get vaccinated.

One particular group that should be vaccinated sooner rather than later is our prison population. Texas inmates and staff tested positive for coronavirus at a 490% higher rate than the state’s general population. Eighty percent of people who died in jails from COVID-19 were not convicted of any crime. Tragically, almost 6% of the prison population at Angelina County’s Duncan Unit, a geriatric prison, has died of COVID-19. That’s one out of every 18 inmates dying in the span of five months. If we are truly concerned about vaccine distribution being equitable and just, our prison populations must not be forgotten or ignored.

As a Texas local public health district, the Angelina County & Cities Health District (ACCHD) under the leadership of Sharon Shaw actively participates in all state and federal COVID-19 vaccine calls. They have a task force represented by hospitals, pharmacies, physician clinics, and long-term care facilities to coordinate local logistics and planning efforts for vaccine delivery. The Coronavirus Call Center at (936) 633-6500 continues to take calls regarding COVID-19 testing, quarantine guidance, and, when available, vaccine information.

Despite the catchy Christmas tune, I long ago stopped wishing for two front teeth. But my Christmas wish for a coronavirus vaccine is about to be granted. I just have to wait a little bit longer. Who knows? It may be the best Christmas present ever!

2020 and Coronavirus Fatigue

I’m tired. I’m tired of 2020 and COVID-19. 2020 has certainly been full of meme-worthy events, but the pandemic has loomed over them all. I vacillate between exasperation and calling people out for not wearing masks, on the one hand, and resignation on the other. Anger? Depression? Mostly, I’m just tired. 

I worry about friends who have had or will catch COVID-19. I grieve for those who have lost friends or relatives to the disease. I wonder if – no, when – I (or a family member) will catch it, and how severe the illness will be. I think we all suffer from a sense of impending doom.

I’m tired of trying to figure out why some people think they have a right to endanger others by not wearing a mask or social distancing. Would they also get drunk and drive? This selfish hubris is bald hypocrisy when practiced by those who conflate Christianity and partisan politics, whose insistence on personal rights and worship of Trump evidently are more important than loving their neighbor. (See there? I am getting angry again.)

And now that Trump has COVID-19, the politicization of mask wearing by some on the right has been countered with a celebratory “I-told-you-so” attitude by some on the left. As one observer said, referring to all the warnings about how cavalier the Trump White House has been about masks and social distancing, “There is no joy in being right.” My private prediction that Trump – if he got out of the hospital fairly quickly – would turn around and say, ‘See? This coronavirus isn’t that bad!’ came true. I do hope and pray he continues to a full recovery. But I am so very tired of the scientific community having to clean up after Trump’s ignorant and dangerous medical beliefs and statements.

Elisabeth Kübler-Ross famously described five stages of grief that terminally ill patients experience when faced with their impending death. These stages – denial, anger, bargaining, depression, and acceptance – have since been used to describe our emotional processing of any loss or tragedy. Or, in the case of 2020, an entire year. Kübler-Ross’s stages do not have to be experienced in the commonly stated order. And those stages, it seems to me, can be seen in our national narrative and psyche as well, not just our individual lives. The United States is reeling from successive, seemingly unrelenting blows (hurricanes, wildfires, protests, murder hornets, the pandemic, etc.), staggering between anger and depression – as I have been personally – or grasping at national denial and bargaining, depending on the day. 

My wife tells me how homesick she is for the life pre-pandemic. I find myself overeating as an escape from the relentless bad news cycle. I can tell I’m not sleeping as well, either. Are you tired as well? How are you handling 2020? We all need to be mindful of how we handle stress and depression. Relying on alcohol, marijuana, or other drugs is not appropriate coping, yet drug and alcohol use are on the rise. Mental health and alcohol and drug abuse organizations – Burke and the Alcohol and Drug Abuse Council of Deep East Texas (ADAC), for example – are here to help. Don’t let yourself spiral out of control. If you are having a mental health emergency, call Burke’s 24-hour crisis line at 1 (800) 392-8343. For ADAC services, call 1 (800) 445-8562 or (936) 634-5753 to schedule an appointment.

Regardless of the sequence or magnitude of the stages of grief, the goal for resolution and healing – individually as well as nationally – must be some movement toward acceptance. In the case of the pandemic, that acceptance ideally should include an acknowledgement of the reality and severity of the illness and the need for at least a basic individual and communal response (hand washing, masks, social distancing), even if we don’t always agree on broader, more complex issues, like how and when the economy or the schools should open up. We must accept that the scientific community is not out to derail the presidency; rather, to save lives.

2020 will come to an end. On December 31 at midnight, we will sing Auld Lang Syne and gratefully close the book on the year. Not so fast with the pandemic. A safe and effective vaccine may still be a ways off. Though we are all tired (and occasionally angry or depressed), we cannot let down our guard as individuals or as a society. Let’s move beyond denial, anger, bargaining and depression and toward acceptance, including acceptance of and care for each other. We have so many strengths as community, and we need each other now more than ever. Together, we can do this. The ancient prophet Isaiah could have written for today: we must renew our strength, to run and not grow weary, to walk and not be faint. And while we are at it, let’s not forget to love our neighbor as ourselves.

Will a Coronavirus Vaccine Be the Answer?

The novel coronavirus has changed our lives. Just about everything we do is affected by mask-wearing and social distancing. The economy has been reeling, although you wouldn’t know it by looking at the stock market. There have been more than 6 million cases in the US and closing in on 200,000 deaths so far. Thankfully, scientific knowledge around coronavirus is expanding at an unprecedented pace. Everyone is looking for a silver bullet against coronavirus. Many hope a vaccine will be that bullet.

Development of a coronavirus vaccine is an urgent priority of the federal government. Since its inception in May, Operation Warp Speed – the collaborative effort between the U.S. Department of Health and Human Services (HHS) and pharmaceutical companies to develop and produce hundreds of millions of doses of coronavirus vaccines – has helped identify well over one hundred vaccine candidates and implement dozens of trials. Nine vaccines are in large scale phase 3 trials. Projections of when a vaccine will be available have ranged from October (per President Trump in the early days of the vaccine development) to the end of 2020 or, more likely, early 2021, according to recent comments by Dr. Anthony Fauci, Director of the National Institutes of Health’s National Institute of Allergy and Infectious Disease. Dr. Fauci seriously doubts we will have to rely on an international vaccine (think Russia or China), having openly criticized the Russian President Vladimir Putin-promoted effort as “bogus”.

Obviously, the sooner we have a vaccine, the better. The Centers for Disease Control and Prevention (CDC) is calling on states to have vaccine distribution sites fully operational by November 1, a gargantuan task. That does not mean a vaccine will be delivered on November 1. We need to temper our expectations of what will happen – and how quickly – once a vaccine becomes available.

The goal of any vaccination campaign is “herd” (community) immunity, where a sufficient proportion of a population is immune to make disease spread from person to person unlikely. In general, 60% or more of a community or population needs to have either had a particular infectious disease or be vaccinated against it in order to provide sufficient community immunity. Sounds easy enough.

According to the Centers for Disease Control and Prevention (CDC), only 45.3% of adults got a flu vaccination for the 2018-2019 season, ranging from a low of 33.9% in Nevada to only 56.3% in Rhode Island. Twenty percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult. On a cautiously optimistic note, there is some speculation that the herd immunity level with the COVID-19 coronavirus might be as low as 43%. That shouldn’t make us think twice about getting vaccinated, however, especially when that vaccine will be effectively free and, if all goes as promised, readily available. The more the merrier, when it comes to people getting vaccinated.

I do worry how long it will take to get 300 million doses of a vaccine delivered and administered in our communities. In the 2009 H1N1 pandemic (caused by a more seasonal flu virus than the novel coronavirus), vaccine doses were first distributed to state and local health departments and then further out to mass clinics, employers, schools, hospitals, pharmacies, and doctor’s offices. Even so, only about a quarter of all Americans got vaccinated before the pandemic played out. The coronavirus vaccination effort will have to be larger and faster, and this pandemic is not expected to fizzle like a flu season does. (We already know that optimistic predictions of a summer lull did not happen.) All that is to say, it may be awhile before we reach herd immunity.

There are other logistical uncertainties as well. Will the vaccine require cold storage? (Probably.) Will a single dose be effective? (Probably not.) How will distribution and dosing be prioritized? (Health care workers? Elderly? Racial disparities?) With so many vaccines in development, “the first” vaccine may not be “the best” vaccine for the long run. I would still take it… and whatever follows as well, if that is what is recommended by the medical experts.

Politics continues to tussle with Science, most recently in the “breakthrough” announced from the White House regarding convalescent plasma as a COVID-19 treatment. FDA Commissioner Stephen Hahn sheepishly had to backtrack misleading comments made about convalescent plasma therapy while defending against Trump’s accusations that the “deep state” at the FDA was making it hard for drug companies to test coronavirus treatments. Thankfully, Politics is funding Science to an incredible extent during this pandemic. I suppose in any dance one partner may step on the other’s toes on occasion. As long as the dance continues, we have hope.

While we wait on a coronavirus vaccine, we should stay current with other vaccinations and definitely get the flu shot this fall. There is some speculation that vaccinations might help “train” or boost our overall immune system. Who knows? And we need to continue to slow the spread of coronavirus by wearing masks (mouth AND nose, please), washing our hands, and social distancing. Remember, this is a community effort.

One final thought. When a coronavirus vaccine does become available – one that is determined to be safe and effective – I would like to see President Trump, Speaker of the House Nancy Pelosi, and other major political and scientific leaders hold a news conference and all get vaccinated together on live television. Lead by bipartisan example! What better way to reassure the public and encourage all of us to follow suit. A vaccine may or may not be a silver bullet, but I am hopeful one (or more) will be a great tool in the fight. 

Coronavirus Information and Misinformation

As a physician, I have been fascinated by the rapid acquisition of knowledge about the novel coronavirus and the deadly disease it causes, COVID-19. True, that knowledge may not be coming as fast as we like. But the pace of vaccine development, for example, is remarkable. But along with knowledge come ignorance, misinformation, and deception.

First, a bit of ignorance. At a rally in Phoenix, in June, President Trump fired up his audience with anti-China rhetoric. In doing so, he displayed his lack of understanding of how COVID-19 got its name. “I said, ‘What’s the 19?’” Trump said. “COVID-19, some people can’t explain what the 19, give me, COVID-19, I said, ‘That’s an odd name.’” Trump apparently thought names like kung flu, Wuhan virus, and Chinese flu were more appropriate.

We can all be forgiven for not knowing something like how COVID-19 got its technical (and not intuitively obvious) name. First, the virus that causes COVID-19 is the novel (meaning new) coronavirus SARS-CoV-2, which stands for severe acute respiratory syndrome coronavirus 2. The first coronavirus caused an outbreak of SARS in the early 2000s. This new coronavirus appeared in 2019; hence, the disease it causes, COVID-19 – CO for corona, VI for virus, D for disease – carries the number 19 for the year it started (2019), not because it is the nineteenth disease (it is not). There’s your – and Trump’s – science lesson for the day.

On to misinformation and deception. Some misinformation is due to inaccurate information. For example, this paper published that while the number of COVID-19 cases has exploded in Texas nursing homes last month, Angelina County is bucking that trend. That turned out to be based on either inaccurate or delayed information, as local physicians are aware of many local nursing home cases. The paper has updated the story as more information has come available. What is certain, however, is that our case count continues to rise.

Lack of information or incomplete information is different from deception. I have written previously about the importance of wearing masks. But mask wearing took another hit recently when our own Congressman Louie Gohmert (TX-01) not only caught coronavirus, he released a video suggesting it was the mask that gave it to him. In his own self-deception, he believes he wears a mask often, but many eyewitnesses (not to mention ever-present news media) suggest otherwise. Gohmert loves history, but history will not be on his side on this one. Deception to support a false narrative is no different than writing history to support a political agenda. Our country has seen too much of that.

When it comes to treatment, President Trump famously has advocated for unproven therapies, from bleach to the anti-malaria hydroxychloroquine. Regarding hydroxychloroquine, the results are in. With strong data that hydroxychloroquine is not effective either as therapy or as postexposure prophylaxis, the Food and Drug Administration (FDA) recently revoked its Emergency Use Authorization, saying it is “unlikely to be effective in treating COVID-19” and that “in light of ongoing serious cardiac adverse events and other serious side effects, the known and potential benefits … no longer outweigh the known and potential risks” for authorized use. Our national coronavirus guru, Dr. Anthony Fauci, minced no words in saying, "The overwhelming prevailing clinical trials that have looked at the efficacy of hydroxychloroquine have indicated that it is not effective in coronavirus disease.” 

This has not stopped President Trump from practically practicing medicine without a license. 

Trump literally is the most famous and influential person in the world. He is not alone in equating personal or anecdotal experience (I did X and Y didn’t happen; therefore, X prevented Y) with rigorous scientific study. My patients do it all the time. However, they do not have an international bully pulpit. His hubris throughout the pandemic in suggesting treatments (like bleach) is jaw-droppingly astounding. (Bleach works on your countertop, right? Why wouldn’t it work inside your body?) Not only is his medical advice suspect at a minimum, it has been dangerous. And just this last week, Trump had his election campaign Twitter account temporarily blocked and a Facebook post deleted when he posted that children are “almost immune from this disease.” When it comes to your health, listen to the doctors.

But don’t listen to quacks, especially those with pseudo-religious and anti-scientific claims. The bleach treatment claim (touted by a family of swindlers who formed a “church” in Florida) falls into that category. But the icing on the cake – so far – has to go to a true charlatan, Dr. Stella Immanuel, a Houston physician of questionable medical training and even more dubious religious authority. She famously believes in alien DNA, demon sperm and that the government is run in part not by humans but by “reptilians” and other aliens. That didn’t stop Donald Trump Jr. declared a video of hers a “must watch,” while President Trump himself retweeted the video.

Unfortunately, attempts to set the record straight regarding coronavirus misinformation by referencing scientific data are considered by far too many to be “fake news” or viewed as a conspiracy theory. Just look at Facebook for examples. I implore you to use this information for how it is intended. Educate yourself on the facts of coronavirus. There is much we don’t yet know, of course. And the vast majority of us – anti-vaxxers excepted – eagerly await a vaccine. In the meantime, please DO wear your mask – over both your mouth AND nose, please! – and DO social distance. DO use hand sanitizer or soap and water often. Together – caring for each other – we can get through this. 

Trump, Faith, and the Church

Our mettle as Americans is being tested. Weary from months of anxiety and self-isolation due to the COVID-19 pandemic, we have emerged into crowd-filled streets to protests against racial injustice while our self-aggrandizing President – ever the expert on any issue – fans the literal flames of violence. The events of June 1, 2020, where the President of the United States tear gassed peaceful protesters so he could have a photo-op – Bible in hand – in front of the historic St. John’s Episcopal Church in Washington, DC, proved once and for all that Christianity is nothing more than a prop to Trump. Frankly, if that is all Christianity is, I want none of it.

But if the tenets of Christianity are true – which I do believe – then Christians must condemn the hypocrisy of a President who continues to attack anyone he doesn’t agree with on one hand – viciously, hatefully – while holding a Bible in the other. The Beatitudes did not include, “Blessed are the politicians who hate.” Loving God and loving our neighbor (white churches: not just our white neighbor), caring for widows and orphans, feeding the poor – these are the acts of the true, living Church.

Granted, Trump is not alone when it comes to caustic rhetoric. Hateful speech can be heard on all sides. But the President of the United States bears the highest responsibility to set the tone, to lead by example, to rise above the fray, especially in times of crisis. But let’s not kid ourselves – a pig loves the mud. The Church has a hard enough time being authentic without the President dragging her into the mud with him.

Four years ago – an eternity? – I wrote a column for the Lufkin News titled, “Let’s Not Get Trumped.” It was April 2016 and Trump had not yet received the Republican nomination. I wrote then, “Trump's campaign speeches are bullying and belittling, full of empty rhetoric and supportive of (indeed, encouraging) violence.” I was appalled at how blindly many evangelical Christian lemmings followed this reality show Pied Piper – one who played “an enticing but fundamentally deadly tune.” It has turned out even worse than I expected. Evangelical Christian pastors who believe they can sidle up to the President to achieve their pseudo-religious, American theocracy, Republican-Party-or-die goals, and not even  look the other way or hold their noses when he tweets, have much to answer for. Apparently, their sycophant-filled congregations aren’t holding them accountable, but a day of ultimate accountability will come (and a terrible day for them it may be).

I fervently pray that my grown daughters and their generation will understand that the faith they were raised with – the faith I cling to – is strong enough to handle these dark and difficult times, the complex issues, the hypocrisy, the hatred, the racism, the injustice in this world, and that they will keep that faith as their own. Of course, faith without works is dead; we have much work to do, many mouths to feed, many wounds to heal.

Christianity – much less democracy – is not validated by tear gassing people protesting injustice so you can get your picture taken holding a Bible in front of a church. True faith would have been displayed by opening the doors of the church and walking inside, arm in arm with protesters in peace and love.

The Anti-Vaccination Movement is Fake – and Dangerous – News

Most vaccine-preventable diseases of childhood are at or near record lows. Vaccines prevent the deaths of about 2.5 million children worldwide every year. Yet some highly contagious diseases like measles and whooping cough still pop up where enough people are unvaccinated.

In the United States, compliance with childhood vaccinations remains quite high overall. At least 90 percent of children are getting the recommended vaccinations on time for many diseases – but not all, and not in all locales. Maintaining a high percentage of children vaccinated is important. Herd immunity occurs when a certain threshold percent of a community (such as a school) is vaccinated, reducing the probability that those who are not immune will come into contact with an infectious individual. For highly infectious diseases like measles, 90 to 95 percent of a community needs to be vaccinated to provide herd immunity. That is why vaccinations are required for our schoolchildren.

According to the Texas Department of State Health Services, students are required to have seven vaccinations in order to attend a public or private elementary or secondary school in Texas: Diphtheria/Tetanus/Pertussis (DTaP/DTP/DT/Td/Tdap), Polio, Measles, Mumps, and Rubella (MMR), Hepatitis B, Varicella (chicken pox), Meningococcal (MCV4), and Hepatitis A. Texas law allows physicians to write medical exemptions if they feel the vaccine(s) would be “medically harmful or injurious to the health and well-being of the child or household member.” All well and good.  Texas law also allows – ill-advisedly – “parents/guardians to choose an exemption from immunization requirements for reasons of conscience, including a religious belief.” The “belief” of the anti-vaccination movement is based on lies and is only “religious” in its cult-like following of a dangerous (and discredited) Pied Piper, Andrew Wakefield.

A 2017 Washington Post article states, “A leading conspiracy theorist is Andrew Wakefield, author of the 1998 study that needlessly triggered the first fears. (The medical journal BMJ, in a 2011 review of the debacle, described the paper as “fatally flawed both scientifically and ethically.”) Wakefield’s Twitter handle identifies him as a doctor, but his medical license has been revoked. The British native now lives in Austin, where he is active in the state and national anti-vaccine movement.”

The political noise made by these charlatan zealots has been difficult for legislators to ignore. This disturbing movement has been gaining traction especially in certain private schools in Texas. In one such school, the Austin Waldorf School, reportedly more than 40 percent of the school’s 158 students are unvaccinated. This is mindboggling ignorance in a “school” where tuition ranges from $11,450 to $17,147 a year.

Baylor College of Medicine professor Peter J. Hotez, MD, PhD, Founding Dean of the National School of Tropical Medicine and Director of the Texas Children's Hospital Center for Vaccine Development is truly on the front lines of the battle being waged by the anti-vaccination movement. The fact that Dr. Hotez is both a world authority on infectious disease and a parent of an autistic child hasn’t stopped the anti-vaccination movement from attacking him. It does, however, make their attacks even more sad; they have no facts to back up their case, so they just get mean (for example, saying he is in denial that vaccination caused his daughter’s autism).

This insidious – and disproven – idea that vaccines are linked to autism continues to rear its ugly, dangerous head, despite what Dr. Hotez calls “rock-solid proof” to the contrary published in peer-review journals like the New England Journal of Medicine, JAMA (the Journal of the American Medical Association), the British Medical Journal, and by organizations like the Institute of Medicine and the American Academy of Pediatrics. The data that originally was claimed to show a link between vaccines and autism was later found to be falsified. In other words, the anti-vaccine crowd is fueled by conspiracy theories and truly fake news. (Though not known with certainty, it is believed genetics and environmental exposure during early pregnancy may play a role in development of autism.)

The problem with conspiracy theories is that facts don’t matter. Those who try to argue based on facts are automatically considered part of the conspiracy. Unfortunately, President Trump was rumored early in his presidency to favor a proponent of this ‘vaccines cause autism’ theory to chair a new commission on vaccines, lending credence to the lies. Thankfully, those commission efforts appear to have stalled.

Some argue against vaccinations on the basis of parental rights. I’m so sorry, but you do not have the “right” to endanger others’ children. It is a time-honored role of government to provide a safe, healthy environment for its citizens. Just look at the public health disaster in Flint, Michigan, where the government abdicated its responsibility.

Texas needs to stop allowing nonmedical “conscientious” exemptions in our schools. Your “right” to ignorantly and dangerously keep your child from receiving vaccinations stops at the schoolhouse door. California made it tougher for parents to opt out of vaccination compliance and vaccination rates increased. Texas should do the same.

In this New Year and upcoming legislative session, may the Texas Legislature resolve to pass legislation limiting nonmedical exemptions. Here’s hoping they can ignore the cacophony of lies and claims of “rights” of those who try to stop them. Those liars endanger all our children, and that is not a right they should have.

What I Would Like to See in Healthcare Reform (Part 1)

I often tell people that if all I had to do was take care of patients, life would be grand. It is the countless hours of dealing with the administrative aspects of healthcare that have practically ruined the practice of medicine for many physicians. You should care; it takes away from our time with you.

TheHill.com, noted that physicians and their staff spent over 15 hours per week complying with quality reporting requirements and that for every hour a physician spends with patients, an additional two hours are consumed completing administrative tasks related to the visit. This meaningless (to physicians, anyway) work has costs in both time and money, leads to burnout, and is increasingly mentioned as the reason for early retirement. I, for one, found myself daydreaming in a committee meeting the other day and I calculated that it was 3361 days until my 65th birthday. That's 9 years, 2 months, and 15 days. No, am not planning to retire early, but sometimes I sure wish I could. Healthcare needs reform.

The average person thought Obamacare WAS healthcare reform. In reality, Obamacare did nothing to actually improve the healthcare system; it simply added more people to the rolls. Don't get me wrong. Having more people insured is not a bad thing. But we need more than just additional enrollees in a broken system.

After Trump was elected, there was an initial, overly optimistic assumption that Obamacare was on its last leg. Recent infighting among policy makers suggests Obamacare may be more like the proverbial cat with nine lives. I only hope true reform is part of whatever "replacement" or "repair" Congress and the President come up with.

In particular, let's hope some of that reform will significantly scale back a bloated, paranoid bureaucracy that sucks hundreds of billions of dollars out of healthcare that could go to those who actually care for patients. And, perhaps, some could go back into the taxpayers' pockets.

Back in 2012, Berkshire Hathaway CEO Warren Buffett called healthcare "the tapeworm of the American economy". To be more accurate, the federal government is healthcare's tapeworm. In an online article in Medical Economics last year, Ryan Gamlin, who studies what drives inefficiency, waste, and harm in U.S. healthcare, found that "as countries spend a larger percentage of their healthcare dollars on administration (as opposed to public health, or providing patient care, for example), things get worse for patients and healthcare providers. High administrative expenditures seem to be associated with negative experiences of providing and receiving healthcare." That is a nice way of saying there's a ton of money wasted going to paper pushers.

Helen Adamopoulos, writing in Becker's Hospital Review in 2014, noted that US hospital administrative costs account for more than 25% of hospital spending, more than double that of Canada, for example, where hospitals receive global, lump-sum budgets. In contrast, US hospitals must bill per patient or DRG (diagnosis-related group), requiring additional clerical and management workers and specialized IT systems. They also have to negotiate payment rates with multiple payers with differing billing procedures and documentation requirements, driving up administrative spending. Not to mention all the personnel, time, and IT required to satisfy CMS’s (the Centers for Medicare & Medicaid Services) monstrous appetite for "quality" and "safety" data, with the ever-present threat of fraud and abuse hanging over every unintentional misstep.

What should be a simple process of billing for services provided is a minefield. And anyone who has ever tried to understand a hospital bill knows it is an impossible task. Aliya Jiwani, writing in BMC Health Services Research, notes that billing and insurance-related (BIR) administrative costs in 2012 were estimated to be $471 billion and that fully 80% of this spending, which provides little to no added value to the healthcare system, could be saved with a simplified financing system. Jiwani predicted that greater use of deductibles under Obamacare will likely further increase administrative costs, stating, "Empirical evidence from similar reform in Massachusetts is not encouraging: exchanges added 4% to health plan costs, and the reform sharply increased administrative staffing compared with other states."

A CNBC report of a Health Affairs study tagged the extra administrative costs of Obamacare at more than a quarter of a trillion dollars, an average of $1,375 per newly insured person, per year, from 2012 through 2022. The Health Affairs blog authors reported, " The overhead cost equals a whopping 22.5 percent of the total estimated $2.76 trillion in all federal government spending for the Affordable Care Act programs during that time."

What do I wish we could be different in our healthcare system? In March, I will discuss some specific changes that would reduce the administrative burden on healthcare providers and, in many ways, return us to a simpler, more direct, and frankly better transaction of healthcare.

Let's Not Get Trumped

I am ashamed. I wrote that phrase recently on a Facebook post of two Finnish friends who are looking across the ocean with a combination of disgust and disbelief at the Trump phenomenon. Consider my vow to avoid public political commentary this year broken.

The first president I ever voted for was Ronald Reagan in 1980. I have voted Republican ever since. But I will not vote for Trump if he is the Republican nominee. Don’t worry… I’m not voting Bernie Sanders, either. The socialist movement in the Democratic Party is just as disaffected and radical as the Trump wing of the Republican Party… and just as dangerous to our American way of life. We are not Finland. But with Sanders, you know what you get. With Trump, all bets are off.

Trump's campaign speeches are bullying and belittling, full of empty rhetoric and supportive of (indeed, encouraging) violence. I don't care how angry you are at the “establishment”; there is no place in American politics for Trump’s inflammatory, derogatory speech. Yes, he has a right to say those things. But shame on each and every American who jumps into the pig sty with him, eggs him on, and actually votes for him! Regrettably, all of us on the sidelines have been stained by Trump’s mud.

To my fellow Christians in particular, Trump – in his campaign rhetoric, at least – displays no evidence of being a Christian, which he claims to be. There, I said it. Forgive me if you think I am being judgmental, but I simply don’t see the fruit. This is not about waffling on various social issues on which well-meaning Christians can and do disagree. Consistently, his public demeanor is far from “Love God”, much less “Love thy neighbor as thyself.” If Trump loved anything as much as himself, we’d all be better off.

I don’t get how so many people – Christians in particular – are following like lemmings in the wake of a reality show Pied Piper – one who plays an enticing (but fundamentally deadly) tune. It is ironic that Jerry Springer, who long ago helped set the nasty reality TV tone that is emblematic of Trump’s campaign, can’t believe we would elect Trump as president.

I get that Trump is tapping into popular themes like immigration and "making America great again" – whatever that means – but the reality TV emperor has no policy clothes. In effect, Trump supporters are saying they want an angry president who doesn't know what he is doing. That is both startling and dangerous. Anger does not lead to sound foreign policy.

Trump's narcissism, lack of a verbal editor and foul speech suggest a personality disorder at a minimum. More worrisome, they expose a disturbing lack of compassion and respect for the innate value of other human beings. Add in a questionable moral compass and I truly fear the international fallout with his impulsive finger on the nuclear trigger. He’s just plain scary.

Ultimately, this column is not really about Trump. It is about me. By what ethic do I live my life and cast my vote? Do I believe that might makes right? Does the end justify the means? God forbid!

What about you?

If the Republican Party implodes (or if the Democrat Party nominates a Socialist), I do not blame the "establishment". I blame voters on both sides of the aisle who can't tell the difference between a slot machine and a voting booth. They just blindly pull the red or blue lever hoping for a jackpot. If only they could see, with that approach we are all going to lose.