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Tuesday, June 30, 2020
The Cobra Asked Tim O;Brien, A Biographer Of The *ILK (*Impeached But Not Removed) Lyin' King, What The *ILK Would Do If He Faced Humiliating Rejection In The Last Days Of The 2020 Campaign & O'Brien Predicted The *ILK Would Descend Further Into The Triple As — "Abuse, Alienation, & Authoritarianism" — But O'Brien Omitted The 4th A: "A$$holery"
The NY Fishwrap's Cobra (Maureen Dowd) bites The *ILK (*Impeached But Not Removed) Lyin' King several times in this Op-Ed essay. Her venom is strong because it is infused with TRUTH, something that The *ILK avoids at all costs. We are living in the worst hard time in this blogger's memory as he repeats daily, "I never thought that I would see anything like this is my lifetime." As the old Chinese curse put it, we are living in interesting times. If this is a (fair & balanced) account of life in a plague year, so be it.
PS; The source of this blog's noms de stylo serpent reference to the three women on the NY Fishwrap's Op-Ed staff began with this 2001 essay by The Cobra (Maureen Dowd) who's been joined by her distaff colleagues: The Krait (Gail Collins), and — most recently — The Viper (Michelle Goldberg). [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x NY Fishwrap]
Trump, Not So Statuesque
By The Cobra (Maureen Dowd)
TagCrowd Cloud provides a visual summary of the following piece of writing
For a long time, Republicans have brandished the same old narrative to try to scare their way into the White House.
Their candidates were presented as the patriarchs, protecting the house from invaders with dark skin.
With Nixon, it was the Southern Strategy, raising alarms about the dismantling of Jim Crow laws.
With Reagan, it was launching his 1980 campaign on fairgrounds near where the Klan murdered three civil rights activists.
With Bush senior, it was Willie Horton coming to stab you and rape your girlfriend.
With W. and Cheney, it was Qaeda terrorists coming back to kill us.
With Donald Trump, it was Mexican rapists and the Obama birther lie.
For re-election, Trump is sifting through the embers of the Civil War, promising to protect America from “troublemakers” and “agitators” and “anarchists” rioting, looting and pulling down statues that they find racially offensive. “They said, ‘We want to get Jesus,’” Trump ominously told Sean Hannity Thursday night.
For re-election, Trump is sifting through the embers of the Civil War, promising to protect America from “troublemakers” and “agitators” and “anarchists” rioting, looting and pulling down statues that they find racially offensive. “They said, ‘We want to get Jesus,’” Trump ominously told Sean Hannity Thursday [7/25/2020] night.
But Trump is badly out of step with the national psyche. The actual narrative gripping America is, at long last, about white men in uniforms targeting black and brown people.
In the last election, Trump milked white aggrievement to catapult himself into the White House. But even Republicans today recognize that we have to grapple with systemic racism and force some changes in police conduct — except for our president, who hailed stop-and-frisk in the Hannity interview.
The other scary narrative is about our “protean” enemy, as Tony Fauci calls COVID-19, which Trump pretends has disappeared, with lethal consequences. With no plan, he is reduced to more race-baiting, calling the virus “the China plague” and the “Kung Flu.” Nasty nicknames don’t work on diseases.
The pathogen is roaring back in the South and the West in places that buoyed Trump in 2016. Texas, Florida and Arizona are turning into COVID Calamity Land after many residents emulated their president and scorned masks and social distancing as a Commie hoax.
Is Trump’s perverse Southern Strategy to send the older men and women who are a large part of his base to the ICU?
The president showed off his sociopathic flair by demanding the repeal of Obamacare — just because he can’t stand that it was done by Barack Obama. Millions losing their jobs and insurance during a plague and he wants to eliminate their alternative? Willful maliciousness.
And this at the same time he has been ensuring more infections by lowballing the virus, resisting more testing because the numbers would not be flattering to him, sidelining Dr. Fauci and setting a terrible example.
The Dow fell 700 points on the news that Texas and Florida are ordering a COVID-driven last call, closing their bars again, and the virus is revivifying in 30 states.
In 2016, the mood was against the status quo, represented by Hillary Clinton. But now the mood is against chaos, cruelty, deception and incompetence, represented by Trump. In light of our tempestuous, vertiginous times, Joe Biden’s status quo seems comforting.
It is a stunning twist in history that the former vice president was pushed aside in 2016 by the first black president and put back in the game this year by pragmatic black voters.
Bill Clinton was needy; he played a game with voters called “How much do you love me?” Do you love me enough to forgive me for this embarrassing personal transgression, or that one?
But Trump has taken that solipsism to the stratosphere, asking rallygoers in Tulsa to choose him over their health, possibly their lives, recklessly turning a medical necessity into a tribal signifier. I wasn’t surprised that so many seats there were empty, but that so many were filled.
In a rare moment of self-awareness, Trump whinged to Hannity about Biden: “The man can’t speak and he’s going to be your president ’cause some people don’t love me, maybe.”
It’s not only the virus that Trump is willfully blind about. A Times story that broke Friday evening was extremely disturbing about Trump’s love of Vladimir Putin. American intelligence briefed the president about a Russian military intelligence unit secretly offering bounties to Taliban-linked insurgents for killing coalition troops in Afghanistan, including Americans. Yet Trump has still been lobbying for Putin to rejoin the G7.
Trump had a chance, with twin existential crises, to be better after his abominable performance in his first three years. But then, we’ve known all along that he is not interested in science, racial harmony or leading the basest elements of his base out of Dixie and into the 21st century. Yes, the kid from Queens enjoys his newfound status as a son of the Confederacy.
A Wall Street Journal editorial Thursday warned that he could be defeated because he has no message beyond personal grievances and “four more years of himself.”
But Trump has always been about Trump. And the presidency was always going to distill him to his Trumpiest essence.
I asked Tim O’Brien, the Trump biographer, what to expect as the man obsessed with winning faces humiliating rejection.
“He will descend further into abuse, alienation and authoritarianism,” O’Brien said. “That’s what he’s stewing on most of the time, the triple A’s.”
Good times. ###
[Maureen Dowd received the Pulitzer Prize for commentary in 1999, with the Pulitzer committee particularly citing her columns on the impeachment of Bill Clinton after his affair with Monica Lewinsky. Dowd joined The New York Times as a reporter in 1983, after writing for Time magazine and the now-defunct Washington Star. At The Times, Dowd was nominated for a 1992 Pulitzer Prize for national reporting, then became a columnist for the paper's editorial page in 1995. Dowd's first book was a collection of columns entitled Bushworld: Enter at Your Own Risk (2004). Most recently Dowd has written The Year of Voting Dangerously: The Derangement of American Politics (2017). See all of Dowd's books here. She received a BA (English) from Catholic University (DC).]
In an e-mail yesterday that delivered today's TMW 'toon, Tom Tomorrow (Dan Perkins) also wrote:
Well, we made it through another week in the Stupidverse. Statues, masks, and a raging pandemic much of America has decided to ignore as infection rates soar. NYC managed to get the numbers down with a three month lockdown and pretty widespread mask-wearing, but now that it’s summer and we’re in Phase Two, restaurants are placing tables out on the sidewalk and, in some cases, the street, but what I’ve seen is… not reassuring. Tables too close together, crowds of people standing around waiting for a table, etc. I am not immune to the craving for some sense of normalcy and am making my own small attempts to open up my life a little bit, but sitting around in a closely-packed crowd of conversing diners for maybe an hour or two is not going to be on my list of things to do, even if it is outside, which is apparently a magical totem against infection. (The recent protests, happily, do not appear to have spiked the numbers, but in addition to being outside, almost everyone was masked, which is obviously not possible for people dining out.)
Whoever suggested building a tent-like structure to discourage the cat from jumping on top of the fish tank had the right idea, by the way, but failed to account for my cat’s determination. He stood on the chair next to the tank, eyeballed the whole thing very carefully, and jumped up anyway, somehow finding the barest perch for himself. At any rate, it makes it a less pleasant place for him to hang out when I leave the apartment.
It has been a long few weeks in the world. I have dim memories of a time when summer was somehow synonymous with relaxation, but it may just be something that I dreamed.
Stay well, stay safe, and please wear your face masks.
Dan/Tom
Tom Tomorrow (Dan Perkins) succinctly listed the sources of our msierable week: "Statues, masks, and a raging pandemic." However, his list of sorrows did not include the pandemic of police brutality across the nation and the pandemic of presidential maladministration at home and abroad. Those additions make the list of sorrows more complete. If this is (fair & balanced) sorrow for the United States of America, so be it. [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x TMW]
More Life In The Stupidverse — Round & Round & Round It Goes...
By Tom Tomorrow (Dan Perkins)
[Dan Perkins is an editorial cartoonist better known by the pen name "Tom Tomorrow." His weekly comic strip, "This Modern World," which comments on current events from a strong liberal perspective, appears regularly in approximately 150 papers across the US, as well as on Daily Kos. The strip debuted in 1990 in the SF Weekly. Perkins received the Robert F. Kennedy Award for Excellence in Journalism in both 1998 and 2002. When he is not working on projects related to his comic strip, Perkins writes a daily political blog, also entitled "This Modern World," which he began in December 2001. More recently, Dan Perkins, pen name Tom Tomorrow, was named the winner of the 2013 Herblock Prize for editorial cartooning. Even more recently, Dan Perkins was a runner-up for the 2015 Pulitzer Prize for Editorial Cartooning.]
In this blogger's humble opinion, Sarah Cooper is the best comedian doing The *ILK (*Impeached But Not Removed) Lyin' King with one telling difference, she doesn't mimic the idiot's voice. That's right, forget Stephen Colbert, Alec Baldwin, and Anthony Atamanuik who attempt to mimic The *ILK's speaking voice. Sarah Cooper does comic bits by acting out The ILK while lip-syncing The *ILK's own voice from White House Press Conference audio. Her brief videos on "How to President" or "How to Bible" or "How to Medical" in the fashion of YouTube tutorials on how-to-do-this-or-that are produced in her own apartment as Cooper acts out the words she is lip-syncing. The titles of the videos are as funny as the videos themselves. The title for this post might have started with "Roll Over, Will Rogers," but Sarah Cooper is sui generis among political comics today. If this is (fair & balanced) authentic American humor, so be it. [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x NY Fishwrap 'Zine]
Sarah Cooper Doesn’t Mimic Trump — She Exposes Him.
By ZZ Packer
TagCrowd Cloud provides a visual summary of the following piece of writing
When Sarah Cooper lip-syncs Donald Trump’s news conferences, there’s no lectern or presidential seal. There’s no Mike Pence, face calibrated to Placid Gratitude as he gazes beatifically into the middle distance, and no Dr. Anthony Fauci, looking as though he’d give anything to be transported someplace better, like maybe Edvard Munch’s “The Scream.” No, in Cooper’s version there’s just Cooper, posting videos online, usually from her own apartment, miming along to the president’s characteristic rasp — part pontificating doorman, part tepid Marlon Brando impersonation, grasping from one excuse to another, one enemy to another, one wrecking ball to another.
Cooper is a black Jamaican immigrant, an erstwhile Google designer, a writer and a comedian. She looks nothing like Trump and suffers no pains to make herself physically Trumpian. He’s white, she’s black; he’s orange, she’s tan; she’s easily half his Taftian size. What she portrays is not his persona but his affect: the glib overconfidence, the lip curl of dismissiveness, the slow nods of fake understanding. She uses jump cuts and darting eyes to capture the rate at which Trump leaps from one topic to another — midsentence, midthought, sometimes midsyllable. In “How to Very Positively,” her expressions chase her train of thought as we hear Trump, asked about his coronavirus test, stumbling over his own allergic reaction to admitting anything “negative”: “I tested very positively in a, in another sense, so, this morning, yeah — I tested positively toward negative, right? So, no, I tested, ah, perfectly this morning — meaning, I tested negative.”
Or there’s “How to the Black People,” featuring Trump’s response to the death of George Floyd: a rush to reassure the 8 percent of African-American voters who helped elect him that his base loves their race. “MAGA is ‘Make America Great Again,’” he says — and “by the way, they love African-American people.” The president is unable to resist using the vocal equivalent of jazz hands when saying the words “African-American,” and Cooper captures this minstrelizing perfectly, zigzagging her way through Trump’s phrasing as if it were a sax solo. Then it’s back to hollow reassurances: “They love black people. MAGA. Loves. The black people.”
Trump impersonators usually try to capture his goofiness (Alec Baldwin), his air-headed frivolity (Stephen Colbert) or his smarmy lasciviousness (Anthony Atamanuik). They fall into the trap of having to imitate the very qualities that make the president appealing to some people, exaggerating them until his base sees only the mockery, not what’s being mocked. But Cooper doesn’t seem interested in embodying or mimicking Trump. She’s all about exposing him, in the most literal sense — and exposing, along with him, all the props, bluster and stagecraft he has cultivated for years. What would it be like, her videos ask, if you could take away everything else — all the trappings of authority, the partisan resentments, the sorcery of the performance — and leave only what Trump is literally saying? This, more often than not, is what she foregrounds. When the president asks aloud whether “injection inside or almost a cleaning” with disinfectants might help treat Covid-19, she grabs a bottle of Mrs. Meyer’s and pretends to spritz her eyes. When he touts hydroxychloroquine by saying, “I want the people of this nation to feel good,” she slips pills from an inside jacket pocket like a 1970s drug pusher.
There is an “I don’t see color” crowd that might say Cooper’s ethnicity and gender aren’t part of why these videos have become hugely popular online. But most surely recognize that when Trump’s words come from a different mouth, we approach a sort of reckoning. A black woman — no matter her obvious intelligence, her hip affect or cool apartment — could never get away with talking like this. She channels the entitlement of someone accustomed to bluffing their way out of speeding tickets, blustering through corporate presentations, excuse-mongering a way out of kids’ birthdays and partners’ anniversaries — the guy at the end of the bar whose expert opinion always begins with ignoring the experts.
Trump was “able to become the most powerful man in the world on posture alone,” Cooper told Lawrence O’Donnell during a TV appearance last month. But her videos “take away the podium and the people behind him nodding and the suit and the ‘I’m so rich’ and just have the words there with my facial expression — so people can actually see how he literally has no clue what he’s talking about.”
Here we arrive at the part that’s less funny. If Trump won the presidency on posture alone, and has occupied it without magically becoming more “presidential,” then what are we left with but posturing? When the Coronavirus appeared, the president repeatedly said it would simply go away. When its threat grew, he held a rally and dismissed criticism of his response as the Democrats’ “new hoax.” When it became a crisis, he held news conferences that managed to look like a Coronavirus-task-force version of “America’s Got Talent.” (But of course this is not a show; it is people’s lives.) Then came the killing of George Floyd, which sparked protests nationwide and an overdue conversation on systemic racism. Yet the president proved incapable of replacing his strongman fantasies with any call for unity, reconciliation or reform. “Once the looting starts, the shooting starts,” he tweeted, borrowing an old segregationist rhyme. “You have to dominate the streets,” he warned governors, chastising them for being “weak” — even as he himself was briefly sequestered in the White House’s underground bunker.
Cooper plays a paranoid Trump in “How to Bunker,” hiding behind walls as Trump says, “I was there for a tiny — little short period of time, and it was much more for an inspection.” She fondles a shower curtain the way Trump often caresses the flag, but it’s when she peeks from behind it that you may be reminded of “The Wizard of Oz” — the moment when Dorothy’s dog, Toto, pulls back a curtain, revealing that there is no wizard, only a showman working the machinery behind the booming voice and orange flames.
This is what all of Cooper’s videos portray: a one-man show in which the man is mired in an image of his own making. Most leaders — even the showmen, cynics and opportunists — would have recognized the seismic events of the past months as an opportunity to remind citizens of their special place in history. A hustler must still put in the work of hustling, and even tyrants require a dash of vision and imagination. Trump seems unencumbered by either. Cooper’s version of him is so suffused in every variety of American privilege that he doesn’t have to show us anything. ###
[Zuwena (ZZ) Packer is Chicago-born, but graduated from Seneca HS in Louisville, KY. She received a BA (English) from Yale University, and MA (English) from the Johns Hopkins Univerfsity (MD), and an MFA (writing) from the Iowa Writer's Wokshop at the University of Iowa. She also was a Stegner Fellow (1999-1991) at Stanford University (CA). Paker received another honor when she was awarded a Guggenheim Fellowship in 2005. In 2013, she was awarded a Dobie Paisano Fellowship by the University of Texas at Austin. Packer also has written an acclaimed short story collection, Drinking Coffee Elsewhere (2003).]
Princeton history professor Sean Wilentz is an acclaimed member of those who write and teach history from the mid 20th century to our present day. He offers some powerful words about US historical monuments. However, that said, Wilentz equivocates on the removal of those Confederates who attempted to defeat the United States of America (1861-1865) as well as those figures who were, and are, symbols of white supremacy and racial animus. This wobbly conclusion does not bring clarity to the struggle against divisiveness in the US of 2020. If this is (fair & balanced) disappointment with a failure of historical judgment,, so be it. [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x WSJ]
Monuments To A Complicated Past
By Sean Wilentz
TagCrowd Cloud provides a visual summary of the following piece of writing
On the evening of July 9, 1776, after a public reading of the newly adopted Declaration of Independence, some 40 Americans gathered at Bowling Green in lower Manhattan, lashed ropes to a statue of an imperious King George III on horseback and pulled it to the ground, where it shattered. The patriots melted down the shards and made them into musket balls to fight the American Revolution.
The building of Confederate statues and monuments began as a counterrevolution in historical memory with deep political significance. Starting in the 1890s, hundreds of monuments appeared across the South in honor of the defeated Confederacy. Ostensibly designed to glorify the “Lost Cause” of secession, the monuments’ actual purpose was to celebrate the violent overthrow of Reconstruction and the re-subjugation of the formerly enslaved and their progeny into the economic peonage and racial caste system of Jim Crow. For more than a century, those fraudulent, oppressive monuments stood undisturbed, until the removal of statues of Robert E. Lee in New Orleans and Charlottesville, VA, in 2017 touched off a major controversy. Since the killing of George Floyd in Minneapolis, that controversy has exploded into an escalating crisis of national self-understanding.
At one extreme stands President Trump, who has proclaimed himself a champion of the disgraced Confederate symbols and lashed out at all who would remove them as unhinged leftists out to “desecrate our monuments, our beautiful monuments.” To Mr. Trump, who has weaponized the Lost Cause mystique for his own purposes, an attack on Confederate symbols is no different from an attack on America itself. His ignorant rendering of history exalts the defenders of slavery who fired on the Stars and Stripes to instigate the country’s bloodiest war. He equates their treason with American valor.
At the other extreme are scattered bands of nihilists, anarchists and simply uninformed protesters who have defaced or destroyed monuments dedicated to Americans, from revolutionaries like George Washington and Thomas Jefferson to antislavery leaders like Abraham Lincoln and Ulysses S. Grant—and even, in one incident, the radical abolitionist poet John Greenleaf Whittier.
No less than Mr. Trump, these desperadoes equate the southern “Slave Power” that fomented secession with the rest of the nation. They, however, see the American republic at its core as a racist empire of violence and greed, and consider its professions of equality and democracy nothing but mendacious covers for white supremacy. In this long debunked understanding, recently refurbished as radical truth-telling, knocking down King George’s statue in 1776 was really just a blow to protect slavery; and in the Civil War, one set of racists defeated another before the two sides made up and joined hands to dominate the world.
Between the extremes, a majority of Americans now rejects Mr. Trump’s embrace of the Confederacy and sympathizes with removing monuments to slavery and racism. Given history’s complexities and contradictions, though, where should we draw the line?
In the starkest contradiction, Thomas Jefferson, the revolutionary who pronounced the American democratic ideal as the self-evident truth “that all men are created equal,’’ also bought, sold and exploited human beings his entire adult life. On one occasion, he wrote racist speculations about the inferiority of Africans at the same time that he denounced enslaving blacks as an indefensible offense to the Almighty. Should Jefferson’s image therefore be spray painted and trashed, as it was last week in Portland, OR, as an embodiment of racist evil, little different from Jefferson Davis or Robert E. Lee? Or should the spirit of democratic equality that his image proclaims be taken seriously, as Martin Luther King did when he quoted the Declaration of Independence at length at the March on Washington in 1963?
Intentions as well as history help to clarify these matters of memory. There can be no doubt that statues of Davis, Lee, John C. Calhoun and others are tributes to slavery, secession and racial domination. They were built for precisely those reasons. They have no other possible meaning, apart from transparent euphemisms about states’ rights and federal tyranny.
But the same is not true of the Jefferson Memorial in Washington, DC, with its paeans to universal enlightenment, equality and religious freedom. It is not true of the Lincoln Memorial, a living monument that for decades has been a touchstone for the nation’s freedom struggles.
Ulysses S. Grant, for his part, was raised in an abolitionist family; when he received a slave from his slaveholding father-in-law, Grant immediately released him from bondage. Those who know little about Grant hold this against him. Instead, we should honor him for crushing the Confederacy and then, as president, breaking up the Ku Klux Klan, advancing the 15th Amendment and signing the Civil Rights Act of 1875—the first of its kind and the forerunner of the landmark Civil Rights Act of 1964.
Andrew Jackson is heavily and accurately criticized for his Indian removal policies, although historians still dispute how much those policies arose from tragedy, intention or previous federal policies. But no monument to Jackson celebrates the Trail of Tears or the fact that he owned slaves. He is honored for two lasting accomplishments. As a general, he repelled a massive British invasion at New Orleans in 1815; and as president, he secured the Union by standing up to Calhoun and his militant proslavery supporters, the forerunners of the secessionist slavocracy, during the Nullification Crisis in 1832-33. Somewhere, Calhoun’s shade, embittered by the decision to remove his monument in Charleston, SC, is smiling grimly at the attacks on his greatest antagonist.
Unless we can learn from history the difference between persons who preach and practice evil and those who at best imperfectly extricate themselves from evil yet achieve great good, we might as well cease building monuments to anyone or anything, and cease teaching history except as dogma. Unless we can outgrow the conception of history as a simplistic battle between darkness and light—unless we can seek understanding of what those in the past struggled with, as we hope posterity will afford to us—we will be the captives of arrogant self-delusions and false innocence.
The past offers lessons about how to handle great shifts in perception as well as power. Although the destruction of political symbols goes back a long way in our history, the current attacks on Confederate monuments have a specific origin in events that occurred during the Civil War. Those incidents involved the destruction of the emblems and structures of the slaveholders’ regime and their replacement by new symbols honoring the Americans who fought against racial oppression.
One powerful example occurred in May 1861. Following Virginia’s decision to join the Confederacy, Union troops seized the Arlington plantation and mansion owned by Robert E. Lee, whose wife had inherited it as a member of the Custis family, related by marriage to George Washington. The site was of military importance, offering an unobstructed view of Washington across the Potomac.
General Montgomery Meigs, the Union’s quartermaster general, considered Lee an abject traitor and was determined that neither he nor his family would ever inhabit the place again. On May 13, 1864, a year and a half after President Lincoln issued the Emancipation Proclamation, he and Meigs inspected the Union military encampment at Lee’s mansion. Meigs won Lincoln’s approval for using the plantation as a burial ground for Union soldiers and for constructing a Freedman’s Village on the grounds, complete with frame houses, schools and churches, where some 1,500 former slaves soon settled and farmed the land.
Thus was born Arlington National Cemetery, hallowed American ground expropriated from the leading general of the slaveholders’ rebellion. Meigs commissioned the creation of monuments and statues there, the first ones to memorialize those who sacrificed their lives for what Lincoln called ”government of the people, by the people and for the people.” In this way, he erased the soiled legacy of its previous Confederate owner.
The revolution in historical memory that we are experiencing today will remain incomplete unless we can build something new upon what has been undone. We might start by creating new monuments to the hundreds of men, women and children who devoted and often sacrificed their lives to the cause of racial equality. This ought to be done with deliberation and accountability, with public and private support, at the local as well as the national level, but it ought to be undertaken as soon as possible. In a century or two, some of these heroes may appear less than perfect, even highly imperfect, for reasons that we cannot foresee. But they deserve to be honored now and will deserve to be honored then. ###
[R.(obert) Sean Wilentz is the George Henry Davis 1886 professor of American History at Princeton University., where he has taught since 1979. He received a BA (history) from Columbia University (NYC) and received another (also history) from Oxford University )UK) as a Kellett Fellow. Wilentz then received a PhD (history) from Yale University (CT). In addition, he won the Frederick Jackson Turner Award (OAH, 1985), the Annual Book Award (Society for the History of the Early American Republic, 1985), and the Albert J. Beveridge Award (AHA, 1984) for his first book: Chants Democratic: New York City & the Rise of the American Working Class: 1788-1850 (1984). His most recent book is No Property in Man: Slavery and Antislavery at the Nation’s Founding (The Nathan I. Huggins Lectures) (2018). See other Wilentz books here.]
Roll Over, Typhoid Mary — You Probably Caused The Deaths Of 53 People Of Typhoid Fever In The Early 20th Century, But That's Nothing Compared To COVID-19 Don Whose Maladministration In The First Half Of 2020 Has Caused More Than 120,000 Deaths & Counting And He's Not Done Yet
COVID-19 Don wants to stop testing for the viral infection that is ravaging the United States of America and many other nations of the world. Could it be that the death count will be greater than his worth as shown in his still-secret tax returns. COVID-19 is more efficient than The *ILK (*Ipeached But Not Removed) Lyin' King AKA COVID-19 Don. If this is a (fair & balanced) version of macabre comedy, so be it.
PS; The source of this blog's noms de stylo serpent reference to the three women on the NY Fishwrap's Op-Ed staff began with this 2001 essay by The Cobra (Maureen Dowd) who's been joined by her distaff colleagues: The Krait (Gail Collins), and — most recently — The Viper (Michelle Goldberg). [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x NY Fishwrap]
Trump Speaks! And Speaks. And Speaks …
By The Krait (Gail Collins)
TagCrowd Cloud provides a visual summary of the following piece of writing
“You could say 10 speeches. One little word, they’ll say: ‘He’s lost it,’” the president complained during a speech in Phoenix this week.
That would presumably be an inaccurate little word. Or something very weird, like his claim at a famously underattended event in Tulsa that he’d ordered a slowdown in Coronavirus testing to make it seem as if the infection rate was smaller.
Desperate presidential spinners said that was just a joke. “I don’t kid,” Trump retorted.
Tulsa was, according to the president, the beginning of his re-election campaign. He’s actually shot off the starting gun several times before. But it does feel as if we’re in a new phase. Those big rallies are Trump’s very favorite part of being the leader of the most powerful nation on the globe. He’s been locked down for months now, confined mainly to gatherings in which other people occasionally get to talk.
He needs his screaming fans, even if this is a terrible idea, healthwise. Six members of Trump’s advance team got sick while doing the planning, and now at least two other staffers tested positive. [Add dozens of Secret Service agents and staffers in Tulsa to possible victims in quarantine.]
You’re not going to get this guy to stay home. He needs to compliment himself in front of thousands of people. Lacing into the Democratic “elite,” Trump assured his audience that he is more elite than anybody. “I look better than them. Much more handsome. Got better hair than they do. I got nicer properties. I got nicer houses. I got nicer apartments. I got nicer everything.”
And, for sure, a bigger ego. After he finished raging to his staff about the tiers of empty seats in Tulsa, the president announced the night had been a historical smash hit: “No. 1 show in Fox history for a Saturday night.”
Yeah, Fox News announced “a whopping 7.7 million total viewers” had tuned in to listen to Trump speak. Pretty impressive, particularly if you ignore the fact that most of the nation has been locked up at home in a world without sports broadcasting, having already rewatched every episode of “Star Trek” and “Friends.”
Still, many of us will remember Tulsa as That Rally Where Two-Thirds Of The Seats Were Empty. His next appearance, in Arizona, was much more Trump’s cup of tea: a megachurch packed with cheering fans who generally ignored all the official pleas for masking.
Most of the audience was young. Having lured them into endangering their health for his ego, Trump entertained them with tales of his heroic efforts to drain the political swamp. “I never knew it was so deep — it’s deep and thick and a lot of bad characters,” he confided.
Well, there aren’t many swamp critters more appalling than Roger Stone, the political fixer who spent part of the 2016 presidential campaign trying to get information for the Trump forces about Hillary Clinton’s emails.
Stone was convicted of lying to Congress and attempting to intimidate a witness — in part by threatening to kidnap the guy’s therapy dog.
As swamp residents go, Stone would maybe be the equivalent of a 5-foot-11-inch mosquito. But on Wednesday a federal prosecutor told Congress that he and his associates had been told they could be fired if they didn’t go easy when it came to sentencing. On account of how, you know, Stone was the president’s pal.
Even if they’re a little dodgy on the facts side, the rallies are at least a good way to keep Trump distracted. In Tulsa, he was fretting about the ongoing demonstrations in Seattle. He asked a congressman who was traveling with him on the plane whether he ought to “just go in” and do something to stop the protesters.
The reply was: “No, sir, let it simmer for a little while.” Darned good advice, although if he’d gone the other way, maybe the congressman could have added, “And be sure to bring a Bible.”
One other thing about that story — it’s an example of how Trump likes to lace his rallies with anecdotes in which people call him “sir.” There were 11 “sirs” in the Tulsa speech alone.
Daniel Dale, a CNN reporter who’s been following this tic for a long time, theorized that “sir” was a hint that whatever anecdote Trump was telling was actually fictional. But it’s also pretty clear that the president just loves stories in which people are addressing him as if he were, say, a general.
Trump’s been spending a lot of time trying to beat down that image of him at West Point this month, leaving the stage with an old-guy totter down the ramp. The fake news, he insisted, cut off all the film that showed him running — running! — for the last 10 feet. “I looked very handsome,” he observed to the crowd.
Later, Trump asked Melania what the reaction to his West Point speech was. She assured him that the media wasn’t saying much about his address but “they mention the fact that you may have Parkinson’s disease.”
He referred to Melania as “my wife,” which is, I guess, nicer than “the old ball and chain.” Interesting, though, that she didn’t feel compelled to deliver any good news. Maybe when you have to live with an ego that large, you try to chip away every little chance you get.
And she didn’t call him “sir.” ###
[Gail Collins joined the New York Times in 1995 as a member of the editorial board and later as an op-ed columnist. In 2001 she became the first woman ever appointed editor of the Times editorial page.Her most recent book isNo Stopping Us Now: The Adventures of Older Women in American History (2019), See other books by Gail Collins here. She received a BA (journalism) from Marquette University (WI) and an MA (government) from the University of Massachusetts at Amherst.]
After a lengthy hiatus, Joan (Joanie No Baloney) Walsh returns with a takedown of the worst Attorney General since 1789 when Edmund Randolph of Virginia was appointed by George Washington. William Barr is serving as Attorney General for the second time; his earlier appointment came from President George H.W. Bush. And he doesn't smell better with age. Like his current appointing POTUS, The *I (*Impeached But Not Removed) Lyin' King, Barr is rotten to the core. If this essay is a powerful list of particulars for a future impeachment before Barr leaves office, so be it. [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x The Nation]
Bill Barr Gets Shredded: A Threat To "Our Rule Of Law And To Public Trust In It"
By Joan Walsh
TagCrowd Cloud provides a visual summary of the following piece of writing
On the same day that a Trump-appointed judge backed Attorney General William Barr and instructed trial judge Emmet Sullivan to drop the case against former national security adviser Michael Flynn on charges to which he pleaded guilty, Assistant US Attorney Aaron Zelinsky outlined the corruption of Barr’s Justice Department in similarly meddling in the case of Trump buddy Roger Stone.
Testifying before the House Judiciary Committee, former Stone prosecutor Zelinsky essentially repeated what he said in a bombshell statement yesterday: He was pressured to “cut Roger Stone a break” because “he was the president’s friend.”
What I heard–repeatedly–was that Roger Stone was being treated differently from any other defendant because of his relationship to the President. I was told that the Acting U.S. Attorney for the District of Columbia, Timothy Shea, was receiving heavy pressure from the highest levels of the Department of Justice to cut Stone a break, and that the U.S. Attorney’s sentencing instructions to us were based on political considerations. I was also told that the acting U.S. Attorney was giving Stone such unprecedentedly favorable treatment because he was “afraid of the President.” [Former US Attorney (MD) Aaron Zelinsky, June 24, 2020]
Zelinsky says the prosecution faced pressure to leave some of Stone’s misdeeds out of the sentencing recommendation, but resisted. When Shea first tried to reduce the recommendation that Stone be sentenced to seven to nine years, Zelinsky threatened to leave the prosecution team, and Shea relented. But when the sentence recommendation was announced, Trump tweeted his dismay, and Barr stepped in to reduce it himself. That’s when Zelinsky left the prosecution; he is still an assistant US Attorney for the District of Maryland.
Appearing with Zelinsky was a career Justice Department lawyer who went to the inspector general because of what he perceived as Barr’s corrupt meddling in antitrust cases. John Elias, who has worked for presidents of both political parties, reported possible “abuse of authority, a gross waste of funds, and gross mismanagement,” with Barr particularly targeting the cannabis industry, as well as car companies trying to meet California’s rigorous emissions standards. Cannabis company cases normally make up 2 percent of Justice Department cases, Elias testified; under Barr, that number rose to 30 percent.
Donald Ayer, former deputy attorney general under George H.W. Bush, was there to back up the two whistle-blowers: “I was privileged to serve in the Department of Justice under two Republican and one Democratic president, and I am here because I believe that William Barr poses the greatest threat in my lifetime to our rule of law and to public trust in it.” He said Trump’s attorney general worked on behalf of “an authoritarian president.”
On behalf of House Republicans, former George W. Bush attorney general Michael Mukasey defended Barr’s intervention, since Judge Amy Sullivan ultimately sentenced Stone to 40 months, which was within the window Barr recommended. Thus, he argued, Barr’s intervention made no difference; effectively “no harm, no foul.”
Anyone who watched the impeachment hearings suffered some PTSD sitting through this one. Republicans performed their trademark stupid pet tricks, insisting Zelinsky was politically motivated and relying on hearsay while barely acknowledging Elias’s charges. Early on, Texas Representative Louie Gohmert almost got ejected for banging on the table like an angry toddler. Ohio Representative Jim Jordan mockingly compared Zelinsky to the anonymous whistle-blower who triggered impeachment, insisting he had no firsthand knowledge of Shea’s reasoning. “All of the people I mentioned were in fact in conversation with Acting US Attorney Shea,” the assistant US Attorney replied calmly.
Representative Mike Johnson even mocked Zelinsky for testifying remotely, even after he said he had a newborn at home and the pediatrician cautioned against visiting Congress in person because of the coronavirus pandemic. Speaking of the pandemic, Arizona Representative Andy Biggs brought back the insane Fox News–fomented Obama-era “scandals” involving the New Black Panther Party and the Fast and Furious program, as the Coronavirus ravages his home state. It even devolved into a culture war over masks; Jordan refused to wear one, breaking House rules, and said “the only masking we should be discussing” was the so-called “unmasking” of Michael Flynn by the Obama administration.
Bush administration veteran Ayer denounced the “Obamagate nonsense” the GOP minority was “spewing.”
Democratic Representative Cedric Richmond had the best retort to those insisting the hearing was only about embarrassing Trump: “Let’s just be clear. If we wanted to embarrass the president, we would sit back and do nothing, and just let him continue to embarrass himself and say that you should drink bleach.”
Maryland Representative Jamie Raskin committed to tracking down the “liars and felons and frauds” assisted by Barr on behalf of Trump—an important promise given that many leading Democrats are wary of trying to impeach Barr, though he deserves it, so close to an election. Raskin is the type of legislator I trust to honor that commitment, and I hope he has a lot of company. Even if Joe Biden wins in November, Barr and Trump and other administration wrongdoers need to face consequences for their behavior over these four long, lawless years. ###
[Joan Walsh is The Nation’s National Affairs Correspondent and an MSNBC political analyst. Prior to joining The Nation in 2015, Walsh was the editor-in-chief at Salon. She is the author of What’s the Matter With White People: Finding Our Way in the Next America (2012). See her other book here. Walsh received a BA (history) from the University of Wisconsin at Madison.]
Today's essay by The New Yorker's John Seabrook took this blogger back to unpleasant experiences with a cardiologist and urologist the blogger's problematic heart and bladder, respectively. Both attempted to use tele-medicine software that involved linking up with the blogger's PC and taking control of the PC's camera. Nothing but technical glitches: no video with audio or the negative rejection by the blogger's cyber security and defense software that guards the blogger's computer. THe experience was a waste of time for both the patient and the care-provider. In the end, the blogger ended up with unneeded prescription refills that probably was taken as proof of service provided to the health care system bean counters. If this is a (fair & balanced) account of the new normal that replaces a visit to a doctor's office, so be it. [x YouTube]
"The Liar Tweets Tonight" (Parody of "The Lion Sleeps Tonight")
By Roy Zimmerman and The ReZisters, featuring Sandy Riccardi
[x The New Yorker]
The Promise And The Peril Of Virtual Health Care
By John Seabrook
TagCrowd Cloud provides a visual summary of the blog post below
The call came in to the emergency department at Alice Peck Day Memorial Hospital, a twenty-five-bed facility in Lebanon, New Hampshire, around 2 PM on a weekday in mid-March. Patient X had arrived by car, and, by the time he reached the hospital, the pain in his legs was so severe that he couldn’t move.
Jesse Webber, a paramedic, donned full personal protective equipment (PPE) before going outside with a wheelchair. Since the onset of the pandemic, almost all sick people who entered the hospital’s ER were considered, whatever their symptoms, to be PUIs—persons under investigation for COVID-19.
The patient, a heavyset man in middle age, was lucid when Webber wheeled him into the emergency department’s negative-pressure room; a seven-by-eleven-foot windowless space fitted with a noisy exhaust fan that removes contaminated air. Once the man was inside, his mental state deteriorated rapidly. A team made up of Nancy Ferguson, a doctor, and two critical-care nurses, Kacie Boyle and Laura Williams, in full PPE, joined Webber and Patient X in the cramped room.
The patient was having difficulty breathing. “Very quickly, his respiratory rate dropped,” Webber later told me. He was “crumping,” as nurses say—not crashing, but failing fast. “His body essentially stopped breathing in front of us,” Webber said.
Ferguson ordered a rapid-sequence intubation, a procedure for swiftly connecting a patient to a ventilator. Ventilating a patient is a complex task that involves not just putting a breathing tube into the trachea but also inserting intravenous lines to deliver sedatives, so that the patient doesn’t fight the tube—known in hospitals as “bucking the vent.”
“As soon as I heard the doctor say that, I reached behind me and hit the emergency-telehealth button,” Webber recalled. Within seconds, the team at Alice Peck Day was connected, through a secure audiovisual link, to the tele-emergency hub at Dartmouth-Hitchcock Medical Center, an academic training institution with more than five thousand employees, affiliated with Dartmouth College’s Geisel School of Medicine. Sadie Smith, a nurse, and Victoria Martin, a doctor, were in the middle of twelve-hour shifts, sitting side by side at one of the hub’s four-screen workstations. The workstations are hardwired into the emergency department at Alice Peck Day, and also into those of ten other community hospitals across the region; the most distant is a hundred and eighty miles away.
Smith’s face popped up on the screen in the Alice Peck Day negative-pressure room. Smith is one of the most experienced tele-emergency nurses on the Dartmouth-Hitchcock staff, and she has an air of unflappable competence that would inspire calm in any crisis.
“How can we help?” she asked
Smith and Martin had control of a high-resolution camera mounted on the wall of the negative-pressure room. They could zoom in on Patient X, watch his cardiac monitor, and talk to the doctor, nurses, and paramedic on the scene. Electronic-record-sharing allowed them to “chart on” the patient—to have real-time access to his vitals and his medications, just as though they were there. But, unlike the staff attending to him, who were working elbow to elbow in the negative-pressure room, straining to speak over the noise of the exhaust fan, the tele-hub team was unharried and safe from possible COVID-19 exposure. The hub personnel could check records and arrange for transport to the medical center, on the other side of town, without the nurses having to leave the room, thereby avoiding the hospital’s PPE-doffing procedure—a two-person, twenty-eight-step job—and the need to put on new PPE on their return.
In the hub, Smith noticed that the hydration fluid the patient was receiving wasn’t compatible with the sedative that he was on; the Alice Peck Day nurses switched fluids. The doctors decided to insert a second IV line, using the intraosseous method, which infuses medicine directly into the patient’s bone marrow. Smith told me later that “really large patients are difficult, because it’s really hard to find IV access. So I suggested going through the humeral head”—the top of the arm bone. “I’m standing there, with my camera view, going, ‘Bring his arm over, lay it across his belly, then feel here, and right in the middle is where you want to go.’ ”
“Sadie kind of guided us in,” Webber said.
Finally, they got Patient X intubated, and “it turned out his expired CO2 was really quite high,” Smith told me. As the nurses used the ventilator to blow pressurized oxygen into his lungs, his CO2 level started to trend down. The crisis had passed.
Telemedicine and telehealth involve a myriad of remote-health-care technologies and services collectively known as “virtual care.” For years, virtual care played a minor role in the United States’ $3.6-trillion health-care industry; now, with the COVID-19 pandemic, millions of people are discovering its benefits and its shortcomings for the first time. If virtual care is the future of health care, is it a future that we want?
In a narrow sense, the word “telemedicine” can mean the type of hardwired hospital-to-clinic setup that allows workers in a large hub hospital to assist in complex emergency procedures in distant spokes. This approach is descended from nasa’s pioneering research, in the nineteen-sixties and seventies, into satellite communications and methods of monitoring astronauts’ well-being in space. One of the first telemedicine projects in a terrestrial setting, which operated between 1973 and 1977, offered remote health care on the Papago—now the Tohono O’odham—reservation in southern Arizona while also testing the technology for use in spaceflight. In the early eighties, NASA began developing a tele-ICU for astronauts on Space Station Freedom. Telemedicine in the Dartmouth-Hitchcock Health system, a network of hospitals and clinics across New Hampshire and Vermont which serves 1.9 million people, is the twenty-first-century embodiment of the fifty-year-old prototype.
Telehealth also comprises virtual interactions between individual doctors and patients, in which the participants rely on an audiovisual hookup instead of an in-person visit. You have a bad sore throat but don’t want to wait to see a doctor—or you are among the thirty per cent of millennials who don’t have one. You could go to the ER or to a brick-and-mortar urgent-care center. Or you could download the telehealth app you saw advertised on MSNBC. Before long, you are connected to a physician, who, using your phone to look down your throat and relying on your description of the swollen glands in your neck, can prescribe antibiotics and other noncontrolled substances. You’ve saved yourself a trip to the clinic, and you haven’t made other people sick or caught something else yourself.
Online visits can be enhanced by Internet-connected devices that collect patient data at home and then send it to a doctor. These include fitness trackers, blood-pressure cuffs, pulse oximeters, and gadgets like Kinsa’s smart thermometer and TytoCare’s self-examination kit, which link up with a phone and make it possible to perform at least part of an annual wellness check on yourself.
Telehealth providers typically offer virtual urgent care for non-emergencies. And patients suffering from chronic conditions, such as diabetes and colitis, can conduct routine follow-ups online. Proponents of telehealth have long argued that fifty to seventy per cent of visits to the doctor’s office could be replaced by remote monitoring and checkups. But, until the pandemic, most Americans weren’t interested.
Dartmouth and its affiliated think tank, the Dartmouth Institute for Health Policy and Clinical Practice, have been on the vanguard of health-care reform for decades. Twenty-four years ago, they began publishing the Dartmouth Atlas of Health Care, an annual survey of medical spending and patient outcomes in communities across the United States which was credited as an important influence on the 2010 Affordable Care Act. In 1999, Dartmouth-Hitchcock opened the Center for Shared Decision Making, with the aim of giving patients the tools to engage in their own health-care decisions. The Connected Care center, which was launched in 2012 and today includes the tele-emergency and tele-ICU hubs, was an extension of its founders’ belief in patient empowerment and data-based medicine.
Among Dartmouth-Hitchcock’s patient base are members of a number of medically underserved communities, as defined by the Department of Health and Human Services: poor, elderly, and special-needs populations who lack easy access to primary-care physicians and medical specialists. Patients who routinely drive two hours to visit a cardiologist or a gastroenterologist can “see the doctor” through a secure smartphone app. Dartmouth-Hitchcock offers a diverse menu of services for distant patients, including tele-psychiatry, tele-neurology, and tele-urgent care.
But even in rural northern New England telemedicine has been a hard sell. “We have been struggling in some areas, to be perfectly honest,” Mary Oseid, the medical center’s senior vice-president for connected care, told me. Many rural clinics and community hospitals in small American towns fear that their already meagre medical staffing, and the revenues generated from procedures that can be performed on-site, will be further hollowed out by remote medicine. And often the patients who need care the most—the old and the poor—don’t have smartphones or broadband connectivity, or can’t afford extra minutes on their wireless plans, placing one of telehealth’s greatest promises, of allowing old people to “age in place,” out of reach. Before the pandemic, outpatient telehealth across the entire Dartmouth-Hitchcock Health network averaged only thirty visits a week.
This is representative of virtual care throughout the country. Telehealth totalled just 0.1 per cent of all medical claims filed in 2018, according to fair Health, a nonprofit that analyzes data on insurance claims. The National Business Group on Health, which publishes an annual survey of employee health benefits offered by large firms, found that in 2016 seventy per cent of companies included telehealth as part of their plans, but only three per cent of their workers used it. Some employees weren’t aware that the service existed; others didn’t trust an anonymous doctor. According to a 2019 survey conducted by J.D. Power, forty-nine per cent of patients believed the quality of virtual care to be inferior to that of an old-fashioned in-person doctor’s visit.
Reimbursement has been another issue. Until recently, Medicare covered telehealth only in rural areas, and required patients to conduct visits in a clinical setting. And, in spite of the time-and-money-saving advantages of telehealth, a lot of people clearly want to be in the physical presence of their physician, undergoing the familiar rituals of a checkup—the doctor’s scrubbed hands emerging from the crisp cuffs of a white lab jacket—that no screen can yet provide.
Doctors haven’t been sold on telehealth, either. In a 2019 survey conducted by the American Medical Association, only one in three specialists expressed full confidence that virtual care would benefit their practice, and only two in five primary-care doctors did. In addition to the diagnostic and therapeutic limitations of seeing patients on a screen, there are economic considerations, too: virtual doctors’ visits can actually take longer than in-person ones, owing in part to the widely varying ability of patients to operate the necessary technology. Local regulations present another barrier. Last December, a team of legal analysts determined that only ten states required private insurers to reimburse virtual visits at the same rate and with the same freedom from restrictions as in-person visits. Tele-doctors could spend more time with fewer patients for less money. What’s the appeal in that?
Then “lo and behold, a pandemic, right?” Oseid said. On Friday, February 28th, a Dartmouth-Hitchcock employee, recently back from a trip to Italy, reported flulike symptoms to medical staff at the hospital. He was told to self-isolate, but instead went to a party, hosted by Dartmouth’s Tuck School of Business, at the Engine Room, a music venue in nearby White River Junction. Three days later, he tested positive for COVID-19—the first known case in New Hampshire. By the following Tuesday, a second Dartmouth-Hitchcock employee had tested positive. The story made national headlines. Thirty beds were allocated for the treatment of COVID-19 in the Dartmouth-Hitchcock Medical Center.
On an average day before the pandemic, Dartmouth-Hitchcock and its outpatient clinics scheduled forty-five hundred ambulatory visits and almost a hundred elective surgeries. The economic foundation of the medical center—like that of health-care facilities everywhere—rests on in-person visits and procedures. “Let’s be clear,” Mary Dale Peterson, the president of the American Society of Anesthesiologists, told Politico in March, “elective surgeries are the lifeblood of many hospitals, if not all hospitals.”
By mid-March, Dartmouth-Hitchcock had all but shut down its ambulatory business and reduced its elective surgeries to only the most essential ones, in order to conserve supplies of PPE, and to protect both doctors and patients from COVID-19. By April 1st, the Dartmouth-Hitchcock Health system was managing two thousand outpatient telehealth visits a week. “Now everyone wants to do telehealth,” Oseid said. Still, Joanne Conroy, the CEO of Dartmouth-Hitchcock, told me, “the chief financial officer and I exchange e-mails all the time at night.” The two discuss how they’ll make up for the shortfall in the hospital’s budget.
As the country went into lockdown, its health care went virtual. In-person primary care, which is responsible for nearly fifty per cent of medical visits, effectively ended. Some elective surgeries, like hip replacements, were postponed; patients who needed such procedures as a kidney-stone removal or a heart-valve replacement got sicker.
The regulations governing telehealth changed. On March 6th, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which, in part, cleared the way for fifty million seniors to use their Medicare benefits for telemedicine, including physical therapy and psychotherapy, without the former restrictions. Medicare claims for telemedicine jumped from ten thousand a week in March to well over a million a week in April. The government also temporarily waived privacy rules set by the Health Insurance Portability and Accountability Act (HIPPA), allowing doctors and patients to connect over FaceTime and Zoom. With White House encouragement, state governments suspended rules that limit doctors’ practices to the states they are licensed in; similar injunctions against writing prescriptions for out-of-state patients were also lifted.
These are boom times for businesses that offer telehealth infrastructure to hospitals and to health-care providers and make direct-to-consumer telehealth apps. In the states that were hit first by the pandemic, telehealth companies became “forward triage” centers, allowing doctors to prescreen patients who exhibited COVID-like symptoms, in the hope of preventing all but the sickest from going to an emergency department. Teladoc, the largest such company in the U.S., saw a hundred-per-cent increase in virtual doctor’s visits from the first week of March to the first week of April. Its CEO, Jason Gorevic, told me that within that approximate time span the company doubled its roster of doctors from three thousand to six thousand. It includes internists, dermatologists, dieticians, pediatricians, and psychiatrists, all of whom are turning to telehealth to keep their practices afloat. The platform now handles twenty thousand visits a day.
Both Teladoc and Amwell, a major competitor, also offer online doctor’s appointments, starting at about eighty dollars, to people without insurance. Other companies sell yearly memberships that offer access to a particular virtual specialist, rather than billing per visit. Among the advantages of virtual health care is that patients can talk to a doctor outside office hours—by secure chat, for example. You can request a doctor you’ve had before, or you can take the first one who’s available. The ability to text your physician or therapist whenever you need enables “less structured interactions,” Gorevic said—a convenience for patients, if not always for doctors.
Prior to the pandemic, virtual doctors had to be licensed in the state that the patient called from. Mia Finkelston, an Amwell family doctor I spoke with who works from a basement office in her home, in Leonardtown, near Chesapeake Bay, is licensed in twenty-nine states. She used to work in a practice nearby, but she “just got tired of the commute,” she said. Lindsay Henderson, an Amwell psychotherapist, told me that she switched to telehealth in 2016, after the birth of her second child; it allowed her to continue seeing patients without having to be away from her kids all day.
For many years, I have lived part time in rural Vermont, and I have a long and painful relationship with Dartmouth-Hitchcock’s ER. Most recently, my wife and my daughter drove me to the ER with a deep wound in my shin, the result of my aspirational belief in the health benefits of chopping firewood. (I now have a gas-powered log splitter.)
On a snowy day in early April, I visited the hospital’s Connected Care center remotely. Mary Oseid FaceTimed with me while standing in the center, which is divided by a glassed-in corridor, with the tele-emergency room on one side and the tele-ICU on the other. Through the glass, I could see Sadie Smith at work in the tele-emergency hub, with Kevin Curtis, an ER doctor and the center’s medical director, next to her at a four-screen workstation. They were in the final stages of treating a patient who had suffered a cardiac arrest and been taken to one of their connected regional hospitals. Local staff had hit the emergency-telehealth button when the ambulance was on the way, and Smith and Curtis had been waiting in the hub when the patient arrived at the hospital, in Claremont, New Hampshire.
Both Oseid and Curtis have master’s degrees in health-care-delivery science from Dartmouth College. In their view, Dartmouth-Hitchcock’s advanced telemedicine infrastructure is an example of “reverse innovation”—technologies devised in the developing world that are later adopted by wealthier nations—a concept that was popularized by the Tuck School management theorists Vijay Govindarajan and Chris Trimble. In a US setting, Oseid told me, “we think of our work as something we’ve developed in a rural market that can go to an urban market and be just as successful.”
Oseid turned around so that I could see into the tele-ICU, where Robert Westlake, a critical-care physician, was monitoring patients. The tele-ICU is connected remotely to eighty-five ICU beds—sixty in the main hospital, where the hub is situated, and twenty-five in the regional hospitals.
Oseid told me, “We have created a system where a patient who is potentially COVID-19-positive can be seen by a provider without going into the room. That’s a huge benefit for us. We save PPE, and we save exposing the health-care worker to COVID.”
The tele-ICU uses a software platform designed for Dartmouth-Hitchcock by Philips, the Dutch technology company. It runs predictive algorithms powered by artificial intelligence to monitor patients’ prognoses. The system constantly updates each patient’s “acuity score,” a grade that reflects remotely gathered patient data—such as blood pressure, oxygen level, heart rhythm, and pulse—to evaluate the risk of a sudden deterioration. When Westlake, in hospital scrubs, came out into the corridor, he told me that, because of data analytics, “we here in the tele-hub often know what’s going on with the patients before the people who are ten feet away from them do.” One recent analysis suggested a correlation between equipping an ICU room with telemedicine technology and a reduction in patient mortality.
The Dartmouth-Hitchcock hub closely reflects the founding idea of telemedicine. It’s space medicine, brought to a rural setting on Earth. According to some estimates, an ICU can consume a quarter of a hospital’s budget. And COVID-19 patients are likely to remain in intensive care for longer than the average stay, of four days. Studies have shown that telemedicine can reduce the expense of intensive care, but the cost of equipping and running a single hardwired ICU. room can be as high as a hundred thousand dollars a year—prohibitive for many smaller hospitals.
At Dartmouth-Hitchcock, Oseid told me, there are also tele-ICU carts, which cost about twelve thousand dollars each. The carts carry audiovisual equipment and can connect directly to the tele-ICU. software from any hospital room. Another critical-care doctor I met at the hub observed, nodding at one of the carts, “We can just look at the patient and ask, ‘How are you doing, sir? How is your breathing?’ ”
In theory, portable units of this kind could be used to deliver care at home. But that would also undercut the prevailing business model at many hospitals, which is to get as many “heads in beds” as possible.
Corey Siegel, a Dartmouth-Hitchcock doctor who is one of the top specialists in inflammatory-bowel diseases in the country, was an early adopter of telehealth. Many of his patients, such as Jessica Caron, a young mother of two from Manchester, New Hampshire, who has Crohn’s disease, were driving an hour or more to see him at his office, in Lebanon, often with kids in tow. Siegel started to offer virtual visits in 2015. “It was a big win for me,” Caron told me. “It doesn’t replace the brick-and-mortar visit, but it complements it.” Using the telehealth option, “Corey and I can get together and talk about what makes sense, and when we need to see each other in person.”
When Caron heard about COVID-19, she panicked. “Managing chronic illness never really stops,” she said. “I thought, Oh, gosh, I’m on immunosuppressant medication, is that going to be a problem for me?” Telehealth offered Caron a way to keep in touch with Siegel and manage her condition until she felt safe enough to visit the office again.
“I won’t say anything good has come out of COVID-19,” Siegel told me, in April. “But we’ve done almost seven hundred telemedicine visits since it hit. Already, my colleagues are saying, ‘This is great, let’s do this after the pandemic ends.’ We might have learned in a very scary way that this is a great way to deliver care to patients.”
But it’s one thing to offer tele-care to a patient you know; it’s another to try to distinguish a bowel disease from indigestion during a virtual first visit. A tele-doctor who misdiagnoses a stomach ache that turns out to be stomach cancer has the same liability that a traditional doctor does. For that reason, virtual doctors are supposed to tell patients whose symptoms suggest a more complicated underlying condition to make an in-person visit to an office, for lab tests and a hands-on physical exam.
Internists I spoke with in New York City were quick to point out the diagnostic limitations of telemedicine. “You can’t have a belly exam” via a screen, my New York doctor, Martin Beitler, said. He was doing virtual visits from home as a necessity, but he wasn’t a fan. He says that telehealth, at its worst, promotes a kind of “knee-jerk, ‘give them antibiotics for every cold that they get’ attitude. That’s the kind of medicine you are going to get if you switch to all telehealth.”
Thomas Nash, an internist whose practice is on the Upper East Side, said, “Is it doable? Of course it’s doable. I’m doing it now.” But, he added, “I worry that it’s going to delay a good exam, and get in the way of deeper interactions between people and their doctors.” David Avram, a dermatologist in Brooklyn, told me that telemedicine works well for checking moles, because you can look at a mole with a smartphone. But he’s postponing full-body exams until he can return to the office.
In recent years, a wave of app-driven direct-to-consumer telehealth startups have appeared, offering to be Marcus Welby, e-MD, for millennials—a virtual doctor who makes tele-house-calls. The idea of having a doctor who makes the equivalent of old-fashioned home visits came up in several of my conversations with people at telehealth companies. Roy Schoenberg, a co-CEO of Amwell, likened the Amwell experience to a visit from Hiram Baker, the fictional physician in “Little House on the Prairie.” In this idyllic view, virtual care is a way of returning the doctor-patient relationship to the pre-insurance days.
Zachariah Reitano is a twenty-nine-year-old co-founder of Ro, a telehealth company that allows consumers to request medications for erectile dysfunction and other sexual-health-related issues, in addition to those for allergies and weight loss, and get them delivered to their door. His father was a doctor. “When I think about what we are trying to build at Ro, I am really trying to re-create my dad in software,” Reitano told me. “The man has saved my life, truly, and he has saved every person in my family. When you have a doctor in the home, when he can solve a problem for you, he’d solve it right then and there.”
Our health-care system is user-unfriendly and wasteful. The average patient has to wait twenty-nine days to get a physician’s appointment, and in most cases you don’t know what the visit and the lab work will cost until you receive a bill. If you need a prescription, you have to make a separate trip to the pharmacy.
Reitano, noting that the annual deductible in employee insurance plans can be more than two thousand dollars, said, “That’s insane. When you turn patients into more traditional consumers, they get to determine what they find valuable. They Google. They compare. They demand price transparency, metrics on the quality and efficacy of care, and the consumer-driven experience they get from Amazon, Apple, or Nike.” He added, “Look at Lasik, cosmetic surgery, breast augmentation. The technology dramatically improves, prices come down, and the patient experience becomes better.”
But what’s to stop Amazon itself from offering health care to its hundred million Prime members? Amazon Care, a pilot program for Amazon employees and their families, was rolled out, in February, as a telehealth supplement to workers’ existing insurance plans. Facebook, Apple, Microsoft, and Alphabet, Google’s parent company, have also made big investments in the health-care field in recent years. Many of the health-care changes spurred by the coronavirus outbreak are in Big Tech’s wheelhouse. At the same time, the economic losses caused by fewer in-person visits are likely to force smaller hospitals into bankruptcy, a trend that began before the pandemic. By one estimate, as many as sixty thousand physicians in family medicine may lose their practices because of the Coronavirus crisis.
It’s one thing to make an appointment with a virtual (but real) doctor at Amwell; it’s another thing to list your symptoms on an Amazon or a Google portal and get a diagnosis from an AI. So far, tech companies have focussed on developing diagnostic tools and sourcing supplies for medical workers during the pandemic. But how long are they likely to let the disaster go to waste?
On Good Friday, I had a Hiram Baker-like virtual house call in my home with Matthew Mackwood, a family doctor with a master’s in public health who is one of the physicians on Dartmouth-Hitchcock’s staff. There was a lump on my foot, and I worried that I might have stepped on a piece of glass, or that a critter had burrowed under my skin. Googling “chigger” only fed my cyberchondria.
Treatment at home offers certain advantages beyond those of keeping quarantine. Benjamin Fogel, a pediatrician at Penn State Children’s Hospital, in Hershey, Pennsylvania, told me about some of his patients. “They are in their room with the door closed, and they feel like it’s private, more than they feel like it’s private in a doctor’s office,” he said. “These kids are sitting at their desks or on their beds. I can tell they are more at ease.”
I’d had some experience with telehealth since the lockdown. My wife and I were having a weekly Zoom session with our therapist. To get some privacy from our kids, we had to sit in the back of our pickup truck, parked close enough to the house to get the Wi-Fi signal. (There’s no cellular service where we live, which is not uncommon in certain parts of Vermont.)
In person, doctors often spend the first ten minutes of an appointment studying records on their computer while you sit across from them, looking at their framed degrees and family photos. But during a virtual visit the doctor meets you face to face, and her gaze mostly stays on you (or on your records on her screen—it can be hard to tell the difference). For fans of telehealth, this is one of its most appealing features. “You’re looking at the physician, and the physician is looking at you,” Schoenberg, the Amwell co-CEO told me. “This is a very intimate encounter. And, once you get exposed to it, at some point you’re going to say, ‘If this is available to me, why should I revert to the laborious, dangerous, hard effort of going into the practice?’ ”
Thomas Nash, in Manhattan, was skeptical. “Eyeball to eyeball is not a normal human interaction, right? A normal human interaction—you shift your body a little, you look to the left for a second, you gather your thoughts, you take a pause, which you really can’t do in this compressed screen-to-screen interaction.”
When my appointment with Dr. Mackwood rolled around, my daughter had the iPad I was planning to use, my son was in a bandwidth-hogging Zoom class, and the cat was howling for food, so I grabbed my phone and retreated to the bathroom.
Mackwood began, “Let me ask you a few questions, and then I’ll take a look at your foot. You said it hurts with pressure. What does that pain feel like? Sharp? Burning? How would you describe it?”
“It’s not a sharp pain,” I responded. “It’s more of a burning, generalized pain. I have my index finger on it. The circumference of it is about the size of a dime, though not as round. It doesn’t feel like there’s a splinter or a piece of glass in there.”
“Any numbness or tingling associated with that? Weakness in the foot or toes? Any drainage?”
“No, but it does have kind of a little dimple right in the middle of it. It’s possible that it’s a little critter that’s burrowed in there. Maybe a chigger?”
“Very uncommon in these parts.”
Using my phone, I showed the doctor my foot. I had to pretzel myself around to give him a good view.
Mackwood diagnosed my lump as an ordinary plantar wart. In normal times, he said, I would be able to come into the clinic, where, over a few visits, he would use liquid nitrogen to freeze it.
“There’s also the duct-tape method,” Mackwood added. You stick a small piece of duct tape to the wart, leave it on for a week, rub the softened wart with a pumice stone, and repeat, for four to six weeks.
I’m waiting for the clinic to reopen.
About a month after Patient X arrived at Alice Peck Day, I had a Zoom call with the team who had assisted him. Kacie Boyle emphatically stressed the benefit of having Sadie Smith there. “Jesse and I had no time to chart on this patient, so Sadie was writing down every medication that was given, every vital sign, reminding us to cycle blood pressures as needed,” Boyle said. “She was just there as an extra set of eyes, and when sometimes we didn’t feel we had enough hands.”
Laura Williams, the other nurse on the scene, said that, in spite of the high-tech nature of their teamwork with Smith and Martin in the hub, telemedicine is “a human connection for me. It can be isolating when you’re in one of those rooms with all your gear on. When I see Sadie pop up on the screen, I feel like she’s right there for me. It’s a reminder we’re all in this together.”
My daughter had made a colorful poster with a drawing of a masked health-care worker and lots of blue sky and rainbows. She asked me to hold it up in front of my laptop’s camera, during my call with the team, to say tele-thanks to everyone who had saved Patient X’s life. But Boyle and Williams were on audio only and couldn’t see the poster, so I did my best to describe it. ###
[John Seabrook has been a contributor to The New Yorker since 1989 and became a staff writer in 1993. Seabrook explores the intersection between creativity and commerce in the fields of technology, design, and music. He has published four books, including, most recently, The Song Machine: Inside the Hit Factory (2015). See John Seabrook's other books here. He received an AB summa cum laude (English) from Princeton University (NJ) and an AM (English) from Worcester College, Oxford University (UK).]
