The Daily Parker

The US and the UK share a common language, a common legal tradition, and a common scourge of right-leaning political parties trying to destroy anything that the government does better than private industry. Despite over a century of evidence that many public services are natural monopolies, and therefore will provide poor quality at inflated prices whenever personal profits get involved, the electorates of both countries keep believing the lie that "industry does it better."

That's why 13 years of Conservative rule has hollowed out the UK's National Health Service (NHS), and why 25 years of Republican obstructionism has allowed corporate mergers to gut US health care.

First the NHS. As journalist Sam Freedman recently explained, NHS administration plus the Tories cutting funding to the NHS repeatedly have left the UK almost as badly off as the US in health-care outcomes:

It is well known within health policy circles that the NHS is severely undermanaged compared to other systems. The UK spends less than half the OECD average on management and administration, which is why I bang my head against the nearest wall whenever I see a newspaper splash bemoaning fat cat managers, or yet another politician promising to get more resources to the “frontline”. It is, of course, the case that if frontline staff are not properly supported they end up becoming expensive admin staff themselves (see also policing). Meanwhile the number of managers per NHS employee has fallen by over 25% since 2010 due to deliberate policy decisions from the centre of government, particularly Andrew Lansley’s disastrous “reforms”.

Meanwhile the central bureaucracy has grown to manage all this complexity. There are fewer managers but more managers managing the managers. .... The lack of clarity as to what they are supposed to be achieving is concerning, and we’ve already seen the Secretary of State slash their funding, which can hardly help.

Overall though we are drifting further into crisis due to a stubborn refusal to accept the obvious. Doctors need to be paid more. There needs to be significantly greater capital investment – in beds, equipment and IT. We need more managers, with greater autonomy. Yes this all costs money but at the moment we are wasting enormous sums on a low productivity system.

Meanwhile, the ever-more-desperate search for higher returns has led private equity to invest heavily in US health care providers, even though (a) they know nothing about health care and (b) it elevates profit-seeking behavior to actual rent-seeking, not to mention driving doctors and nurses out of practice:

E.R. doctors have found themselves at the forefront of these trends as more and more hospitals have outsourced the staffing in emergency departments in order to cut costs. A 2013 study by Robert McNamara, the chairman of the emergency-medicine department at Temple University in Philadelphia, found that 62 percent of emergency physicians in the United States could be fired without due process. Nearly 20 percent of the 389 E.R. doctors surveyed said they had been threatened for raising quality-of-care concerns, and pressured to make decisions based on financial considerations that could be detrimental to the people in their care, like being pushed to discharge Medicare and Medicaid patients or being encouraged to order more testing than necessary. In another study, more than 70 percent of emergency physicians agreed that the corporatization of their field has had a negative or strongly negative impact on the quality of care and on their own job satisfaction.

Concerns about the corporate takeover of America’s medical system are hardly new. More than half a century ago, the writers Barbara and John Ehrenreich assailed the power of pharmaceutical companies and other large corporations in what they termed the “medical-industrial complex,” which, as the phrase suggests, was anything but a charitable enterprise. In the decades that followed, the official bodies of the medical profession seemed untroubled by this. To the contrary, the American Medical Association consistently opposed efforts to broaden access to health care after World War II, undertaking aggressive lobbying campaigns against proposals for a single-payer public system, which it saw as a threat to physicians’ autonomy.

Throughout the medical system, the insistence on revenue and profits has accelerated. This can be seen in the shuttering of pediatric units at many hospitals and regional medical centers, in part because treating children is less lucrative than treating adults, who order more elective surgeries and are less likely to be on Medicaid. It can be seen in emergency rooms that were understaffed because of budgetary constraints long before the pandemic began. And it can be seen in the push by multibillion-dollar companies like CVS and Walmart to buy or invest in primary-care practices, a rapidly consolidating field attractive to investors because many of the patients who seek such care are enrolled in the Medicare Advantage program, which pays out $400 billion to insurers annually. Over the past decade, meanwhile, private-equity investment in the health care industry has surged, a wave of acquisitions that has swept up physician practices, hospitals, outpatient clinics, home health agencies. McNamara estimates that the staffing in 30 percent of all emergency rooms is now overseen by private-equity-owned firms. Once in charge, these companies “start squeezing the doctors to see more patients per hour, cutting staff,” he says.

As demonstrated repeatedly in public services as diverse as transport and drinking water, taking the profit (or rent-seeking) motivation out of the equation leads to better outcomes for everyone—except the private monopolists. But that's what governments are for.

Former UK Prime Minister and professional circus clown Alexander Boris de Pfeffel Johnson (Cons.—Uxbridge and South Ruislip) resigned his seat in Parliament this week ahead of a damning all-parties report recommending he be suspended for 90 days:

The death certificate for Boris Johnson’s career in politics read June 12th. A government statement appeared that evening appointing Alexander Boris de Pfeffel Johnson as “Steward and Bailiff of the Three Hundreds of Chiltern”, the title MPs accept, according to Britain’s absurd constitution, in order to resign. He went because an inquiry into whether Mr Johnson deliberately misled Parliament found that he had. Not only that, he’d also impugned the investigating committee and joined a campaign of abuse and intimidation against it. Mr Johnson faced suspension as an MP for a remarkable 90 days. Given forewarning of the report, the former prime minister quit.

Conservatives are losing everywhere. But support is falling fastest in the northern constituencies the party was so proud of winning. Across the country Labour enjoys a 14-point poll lead. In “Red Wall” constituencies, this rises to 23 points, according to one pollster.

Andrew Sullivan, who attended Oxford with Johnson, wishes the US Republican Party would treat their former leader the same way:

And now we have Donald Trump and Boris Johnson. This past week saw two official reports into the abuse of their respective offices, and their lavish lying about it. The Smith indictment alleges that Trump knew full well that the documents he took from the White House and stored haphazardly at Mar-a-Lago and Bedminster were highly classified and not his own. But rather than hand everything back, Trump ignored the best legal advice, lied to his own lawyers, ordered an underling to move boxes to conceal them from the FBI, and threw out his usual barrage of excuses, distractions and falsehoods.

In an eerily similar fashion, the British parliamentary committee set up to investigate whether Boris Johnson lied to the House of Commons about his breaking of social distancing rules during Covid, published its final report this week. It’s as authoritative as the Trump indictment — first-hand witnesses, photos, sworn testimony, due process. And it too focuses on a very basic fact: just as Trump knew he was not authorized to keep top secret documents, so Johnson knew that crowded office-parties were quite clearly banned across the UK. But this awareness of the rules did not stop either man from flagrantly breaking them — and then complaining of a “witch-hunt” when called to account.

And it would be “utterly incredible” — unless you had a pulse and two ears at the time, because the ban on workplace parties was incandescently clear to the entire country. When the Queen had to sit alone at the funeral of her husband, it was obviously not ok for the prime minister to have “bring your own booze” parties at Number 10.

And as with Trump and his bizarre behavior with “his boxes,” it’s very hard to see some profound, malign motive here in pursuit of something important. It’s just mindless egotism, married with an infinite capacity for deceit.

[T]here is almost nothing in the narrative of these men’s late careers that isn’t exactly replicated in every previous episode of their lives. A mature democracy will throw up these characters every now and again, and use them. But a healthy one will also test them, and cast them out if they threaten the integrity of the system as a whole. The Brits and Tories have done that, in the end, with Boris — and it speaks well of the remaining integrity of their democracy.

The GOP needs to do the same with Trump. And soon.

Oh, completely unrelated, of course: today is the 165th anniversary of Abraham Lincoln's address to the Illinois Republican Convention in Springfield, Ill., also known as the "house divided" speech. It's worth a re-read.

I had a lot going on this morning, so I'm only now snarfing down a Chipotle bowl. Also, I'm going to have to read these things tomorrow:

• Over 100 candidates, including a dog, will stand for election in Toronto's mayoral election on the 26th.
• Writing for Mother Jones, Ali Breland thinks the content-creator rebellion at Reddit won't stop what Corey Doctorow calls "the enshittification" of online platforms.
• Similarly, private-equity debt has killed yet another good company making good products, Insta-Pot.
• After what insiders call a deliberate campaign by New York mayor Eric Adams to strip her of power, New York City's police commissioner Keechant Sewell abruptly resigned Monday.
• Despite yesterday's rain around Chicago, the drought in Illinois has gotten worse.
• Save the firefiles!
• Tinley Park, Ill., has launched a brewery trolley that technically puts 2 new breweries on the Brews & Choos list. (I had plans to return to Banging Gavel later this summer anyway, as they're about to open the Vogt House to the public.)
• The list of people excited about the NASCAR race in downtown Chicago keeps getting shorter.

Finally, today is the 35th anniversary of the best baseball movie of all time, Bull Durham. If I had time I'd watch it tonight.

Coach US Senator Tommy Tuberville (R-AL), whose election to the Senate in 2020 coincided with the elections of Representatives Marjorie Taylor-Greene (R-GA) and Lauren Boebert (R-CO), has given those two a good race to the bottom of the IQ charts since all three took office. But I have to give him the "dumbest person in Congress" honors just on the basis of his current program of holding up all general officer promotions in the Senate.

Tuberville, who has never served in the military, explained his reasoning in April: "Experts have known for more than a decade that the military is top heavy. We do not suffer from a lack of generals," Tuberville said. "When my dad served in World War II, we had one general for every 6,000 troops. Think about that: one for every 6,000. Now, we have one general for every 1,400 enlisted service members."

In just a few weeks, Tuberville's obstinance will leave us without officers in the following positions:

• Army Chief of Staff
• Chief of Naval Operations
• Commandant of the Marine Corps
• and up to 650 other admirals and generals this year alone.

That's 3/5 of the Joint Chiefs of Staff, not including the Chair, who plans to retire soon. Also we will have several areas of the world where our allies or adversaries have 3- or 4-star officers that will have to interface with 2- or 3-star Americans, which is an astounding loss of face for us and an insult to them.

This also holds up promotions to lower-ranking service members, as O7 and higher officers must sign off on awards and assignments to the senior officer corps. This affects readiness as those officers can't plan to move their families to their new duty stations, and can't collect the pay they've earned for their promotions, until they formally "put on" their new ranks.

I'm also aware of service members overseas who can't visit their families because there isn't an admiral or general to sign off on them visiting certain countries (like the Philippines) or, in some cases, taking any leave at all. This is already having deleterious effects on morale and retention, in some of the most dangerous places in the world, like Korea.

Why is Tuberville doing this? Abortion, of course. And because he has no idea how the military actually works, or why we need proportionately more high-ranking officers than we did when we had 12 million men and women in the military. (Today we have about 1/4 that number.)

Just to get a handful of promotions through, including the Joint Chiefs of Staff, Democratic senators may have to hold roll-call votes on the Senate floor, which takes a lot of time. As of last week, Tuberville is blocking 221 promotions, and that number will continue to get larger as generals and admirals retire. So even with roll-calls on each nominee, there simply isn't enough time to get them all through.

When you elect clowns, you get a circus.

Dr Aaron Carroll of Indiana University studied five other rich-country health systems to figure out what we need in the US:

We are one of the few developed countries that does not have universal coverage. We spend an extraordinary amount on health care, far more than anyone else. And our broad outcomes are middling at best.

When we do pay attention to this issue, our debates are profoundly unproductive. Discussions of reform here in the United States seem to focus on two options: Either we maintain the status quo of what we consider a “private” system, or we move toward a single-payer system like Canada’s.

It’s outrageous that the health care system hasn’t been a significant issue in the 2024 presidential race so far.

Even if we did have that national conversation, I fear we’d be arguing about the wrong things. We have spent the last several decades fighting about health insurance coverage.

No other country I’ve visited has these debates the way we do. Insurance is really just about moving money around. It’s the least important part of the health care system.

Universal coverage matters. What doesn’t is how you provide that coverage, whether it’s a fully socialized National Health Service, modified single-payer schemes, regulated nonprofit insurance or private health savings accounts. All of the countries I visited have some sort of mechanism that provides everyone coverage in an easily explained and uniform way. That allows them to focus on other, more important aspects of health care.

It's almost as if entrenched special interests, like the insurance industry, want us to keep debating insurance rather than health care outcomes. And we seem to fall for it every election.

We lost three people last week whose deaths have made the world ever so slightly better on balance. Religious swindler Pat Robertson went first on Wednesday. Then Saturday, Ted Kaczynski, also known as the "Unabomber" for his terror campaign against university professors in the 1990s, killed himself in his jail cell:

Kaczynski was found unresponsive in his cell around 12:30 a.m. ET and transported to a local hospital where he was pronounced dead, according to the Federal Bureau of Prisons.

Kaczynski was previously in a maximum security facility in Colorado but was moved to a federal medical center in Butner, North Carolina, in December 2021 due to poor health.

Kaczynski, who went nearly 20 years without being captured until his arrest in 1996, was considered America's most prolific bomber.

Between 1978 and 1995, Kaczynski placed or mailed 16 bombs that killed three people and injured two dozen others, according to authorities.

Finally, yesterday the world lost Silvio Berlusconi, the corrupt former prime minister of Italy whose entry into politics to stymie the many legal cases against him  may have inspired the XPOTUS to do the same:

Liberal politicians, and the prosecutors he demonized as their judicial wing, watched in dismay as he used appeals and statutes of limitations to avoid punishment despite being convicted of false accounting, bribing judges and illegal political party financing.

His governments spent an inordinate amount of time on laws that seemed tailor-made to protect him from decades of corruption trials, a goal that some of his closest advisers acknowledged was why he had entered politics in the first place.

One law overturned a court ruling that would have required Mr. Berlusconi to give up one of his TV networks; others downgraded the crime of false accounting and reduced the statute of limitations by half, effectively cutting short several trials involving his businesses. He enjoyed parliamentary immunity, but in 2003 his government went further, passing a law granting him immunity from prosecution while he remained in office — in effect suspending his corruption trials.

By the time he finally resigned in 2011, amid a fractured conservative coalition and general national malaise, a good deal of damage seemed to have been done. Many analysts held him responsible for harming Italy’s reputation and financial health and considered his time in power a lost decade that the country had struggled to recover from.

On a totally different topic, while I traveled last week I read Death of the Great Man by psychiatrist Peter Kramer, a book journalist James Fallows recommended back in April.

OK, maybe not a totally different topic. You should read the book, though.

Police Scotland has arrested Nicola Sturgeon, who resigned as first minister of Scotland two months ago, as part of their investigation into allegations the SNP misspent £600,000 of donated money:

Her husband, Peter Murrell, the former chief executive of the SNP, was arrested at their home in Uddingston near Glasgow on 5 April, and interviewed under caution for nearly 12 hours before being released without charge.

The police searched their home and back garden, and also searched the SNP’s headquarters under warrant, taking out boxes of documents and computers.

Colin Beattie MSP, then the party’s treasurer, was arrested and questioned as part of the same inquiry on 18 April and also released later without charge, pending further investigation.

The BBC has a timeline of the investigation.

I've just read the indictment against the XPOTUS and his "body man" Walt Nauta. Wow. As a FBI agent in The West Wing once remarked, "In 13 years with the Bureau I've discovered that there's no amount of money, manpower or knowledge than can equal the person you're looking for being stupid." And wow, was the XPOTUS stupid.

I'm not a practicing lawyer but I can read an indictment. If the US Attorneys can prove any of these facts—and I have no doubt they will—he's going to get convicted of a felony. Oddly, under our Constitution, he can still run for a second term if that happens, though he won't be able to vote for himself in Florida. But as Josh Marshall points out, the larger issues just distract from the utterly banal issues:

I wanted to share one thought.

That is the sheer ordinariness of the whole story. That may seem like a odd thing to say: ex-President facing multiple federal felony indictments for the first time ever, the bizarre details of this antic clown’s Florida Villa-cum-Hotel stuffed with banker’s boxes of classified documents, the bathroom chandelier, the power glitz jammed together with gaudy dime store aesthetic. But we grant Trump too much by lavishing, wearying too much in the purported weightiness of the moment. It’s very normal. Yes, powerful people get away with a lot. But if you commit crimes repeatedly and brazenly you’re very likely to get charged with one or more crimes, particularly if you’re in the public spotlight.

We hear endlessly how everyone not thoroughly in Trump’s thrall wants to ‘move on’ from the man. The first and most important part of that is shaking free of the reality distortion field that surrounds the man, as much for his foes as his followers. He’s hit with charges with evidence of his guilt that is clear and overwhelming and he jumps to the front to declare no one ever thought this could happen or be possible. He didn’t do it … but of course he was perfectly entitled to do it, even though he chose not to. Remember, he could have but chose not to. Got it? He attacks, defames. People get caught up in the frenzy of his seeming invulnerability and transgressive nature, the entertainment and the confusion. They’re wondering what he’ll do next. They’re baffled and suddenly the obvious ceases to be obvious.

Don’t be baffled. You may be thinking somehow there’s no way he’ll actually get convicted of anything. You’re wrong. He probably will. Maybe not. That happens too. That’s normal. It’s all normal.

I lived in New York in the late '80s and late '90s, and we always thought that the XPOTUS would never survive first contact with law enforcement. It took a while, but eventually his narcissism, unaccountability, and yes, his tiny little hands mind would eventually lead us here.

One more thing. John Scalzi called out all the remaining XPOTUS supporters to "get off the train," but hit on the reason they won't: "no one who is still on the Trump train at this point in 2023 is there for logical or rational reasons, you’re probably...stuck too far down in the grift to ever admit you’re the chump." But wow, the national security implications of this indictment alone should have every rational person in the country running from this guy.

Televangelist and horrible person Pat Robertson has died, after a long career grifting true believers for billions:

Rev. Robertson, the son of a long-serving U.S. congressman and senator from Virginia, was among the first evangelists to take religion out of the realm of private belief and into the secular arena of politics. In large part through his influence, the Christian right became a potent force in American politics and culture.

Although he bristled at the term televangelist, Rev. Robertson was one of the most popular and influential religious figures of his time. For decades, he was the host of “The 700 Club,” a casual talk show that combined hard-right politics, faith healing and lifestyle news. Broadcast in dozens of languages and in more than 200 countries, the show made Rev. Robertson the world’s most-watched TV preacher.

In addition to his TV programs, Rev. Robertson made public appearances and produced dozens of books and videos as he built a business empire that brought in more than $300 million a year at its height.

“In the not-too-distant past, the charismatic and Pentecostal wing of American Protestantism saw political engagement as a ‘worldly’ and sinful activity,” the late Michael Cromartie, who was vice president of Washington’s Ethics and Public Policy Center and a longtime watcher of the evangelical movement, said in a 2011 interview with The Post. “Pat Robertson, perhaps more than anyone in the charismatic wing of conservative Protestantism, was pivotal in creating this paradigm shift.”

In Inferno, Dante described nine circles of Hell, each with its specific punishments for specific kinds of sin. I haven't read the whole poem, so it's not immediately clear to me whether Robertson would head down to the 8th Circle (fraudsters), possibly in the 6th Bolgia (hypocrites) or maybe he'd get off lightly in the 4th Circle (greed). 

In my imagination, he'll spend the next several thousand years apologizing to everyone he's hurt, either directly (for example, through stealing money under the guise of religion) or indirectly (for example, all the gay people his followers harmed at his urging).

As long as credulous people walk the earth, grifters like Robertson will be there to fleece them. But it's good when someone of his stature descends to his just reward.

Just a few stories I came across at lunchtime:

• In an act that looks a lot like the USSR's scorched-earth retreat in 1941, Ukraine accuses Russia of blowing up the Kakhovka Dam on the Dnieper River, which could have distressing follow-on effects over the next few months.
• A former Chicago cop faces multiple counts of perjury and forgery after, among other things, claiming his girlfriend stole his car to get out of 44 separate speeding tickets.
• James Fallows explains what probably happened to the Citation jet that crashed in rural Virginia over the weekend after two F-16s scrambled to intercept it over Washington.
• Molly White explains the SEC's case against Binance.

And finally, giant-sized coconut crabs may have stashed away the remains of lost pilot Emelia Earhart, and scientists think they know where.