Pirro & Patel comments about Shooting of Two National Guard Members

 The shooting of two National Guard members was horrific.

FBI Director Kash Patel appropriately said “We must come together as a nation”, but he and Jeanine Pirro, United States Attorney for the District of Columbia shamelessly politicized their discussion of the event. (https://www.youtube.com/watch?v=SmVT3F2_bA0; text below).

While praising the brave ”sacrifices that so many are making around the world and around this country to secure our freedoms”  “for people they don’t even know”, they cowardly licked President Trump’s boots.  (To be clear, the blue-highlighted comments don’t bother me.)

While admitting that that Afghans who entered the country under the Operation Allies Welcome “had a relationship in Afghanistan with partner forces” and stating that they needed to review “his immigration history and the vetting process itself”, they nonetheless repeatedly lied in the strongest terms claiming the Biden administration failed “to vet in any way, shape or form, this individual and countless others”.

Earlier, Democratic administrations falsely assured us that they could vet immigrants to assure our safety.  That was clearly untrue because:

1.        You can’t perfectly vet people.

2.        People can become radicalized after arriving here.  Rahmanullah Lakanwal entered the USA on September 8, 2021. He might have become radicalized in the past 4 years, 2.5 months.  Patel and Pirro admit they don’t know yet state “This is what happens in this country when people are allowed in who are not properly vetted.”

3.        The biggest threat of violence from immigrants may come from their children.  They are stressed by parents “from the old country” and wanting to assimilate into their new country.  They don’t feel as though they belong.  For example, the 2013 Boston Marathon attack was done by children of immigrants.

More than 85000 Afghans entered the USA through Operations Allies Wlcome but for a variety of reasons approximately 195,000 Afghan immigrants were in the USA in 2022.               

According to a 2021 Cato Institute study, “native-born Americans were about 11.6 times as likely to be incarcerated as Afghan immigrants.“  In 2022, Air Force general Glen D. VenHerck said his research indicated “law enforcement violations [of Afghan immigrants] that are on par, and in most cases, significantly lower than the rates that we're seeing in similar-sized populations across the United States". 

There is risk in allowing immigrants to our country.  However, immigrants contribute a great deal to our country and living up to our principles involves risk.  Some of the people who express concern about immigrant risk are comfortable with the risk of guns.  Both risks are related to freedom.

Pirro said “This was not just an attack. It was a direct challenge to law and order in our nation's capital.”  I wonder what she would say about the January 6^th riot.

Transcript

Jeanine Pirro, United States Attorney for the District of Columbia

My name is Jeanine Pirro.  I am the United States Attorney for the District of Columbia, and I am joined here by several individuals who represent agencies who have been working around the clock since this horrific event happened.

To my left, we have the director of the FBI.  We have General Leland “Bill” Blanchard of the National Guard.  Mayor Bowser is here as well.  We have Frank Sana of the DEA, Chris Heck of DHS, executive assistant chief Jeffrey Carroll of the MPD, Darren Cox of the Washington FBI field office, and a special agent in charge Samuel Ward of the ATF in uh Washington.

Now, I want to provide you with an update on the tragic shooting that occurred on two brave members of the West Virginia National Guard as they served in Washington DC. Unfortunately, today, as most families join together to give thanks for the blessings that have been bestowed upon them, two families are shattered and destroyed and torn apart as a result of the actions of one man.

First and foremost, our hearts go out to the victims and their families. These are dedicated service members who were performing their duties in service to our nation, and they are currently in critical condition. They have undergone surgery. We pray for their well-being as they continue to be cared for in the best possible way.

We have been in constant contact with their families and have provided them with every resource needed during this difficult time. The two National Guardsmen that we're talking about are Sarah Beckstrom, who is 20 years old, and Andrew Wolfe, who is 24 years old. They were uniform members of the West Virginia National Guard, and they were in DC to keep DC safe.

Pursuant to President Trump's executive order to make DC safe and beautiful, they answered the call. They took the charge. They volunteered. They put their lives on the line for people they don't even know. And that unfortunately is becoming a reality more and more for the members of law enforcement.

Yesterday on Thanksgiving Eve at approximately 2:15 near 17th and I streets in the northwest section of the district near the Farragut West Metro Station, two uniform guardsmen were ambushed in a brazen and targeted attack. A lone gunman opened fire without provocation, ambush style, armed with a 357 Smith and Wesson revolver.

One guardsman is struck, goes down, and then the shooter leans over and strikes the guardsman again. Another guardsman is struck several times.  Fellow guardsmen who were there responded immediately, engaging the suspect, neutralizing the threat, and subduing him at the scene.

He was transported to a local hospital where he remains, as we speak, under heavy guard.

Thanks to the swift and coordinated response of the National Guard and the Metropolitan Police Department, no additional victims were harmed, and the scene was secured within minutes.

The suspect has been identified as Rahmanullah Lakanwal, a 29-year-old Afghan who entered the United States under Biden's Operation Allies Welcome, a program following the disastrous withdrawal from Afghanistan.

He resided in Bellingham, Washington with his wife and, we believe, five children.  We're working very closely with our federal partners, especially DHS and the FBI, to review his immigration history and the vetting process itself.

What we know about him is that he drove his vehicle across country from the state of Washington with the intended target of coming to our nation's capital.

As we stand here today, the charges that are appropriate right now are three counts of assault with intent to kill while armed, a violation of DC code 22-41, and DC code 4022-4502.  He will also be charged with possession of a firearm during a crime of violence.

He faces 15 years under the assault with the intent to kill. We intend to continue monitoring what the charges will be depending upon uh the well-being of the guardsmen. We are praying that they survive and that the highest charge will not have to be murder in the first degree. But make no mistake, if they do not, that will certainly be the charge, murder in the first degree.

The Department of Justice under Attorney General Pam Bondi is committed to a thorough and an impartial investigation where we will hold this perpetrator accountable under the full weight of the law.

Now, Sarah and Andrew volunteered. They came here to protect the people of the district pursuant to a crime emergency that President Trump rightly declared in this city and in other cities across the country.

Our nation's capital should not and must not be a place where evil comes to commit violence. Whatever their cause or motive may be, we should not have to live in fear in the nation's capital, especially by one who came here from a foreign country through a process that was so absurd that he came through and released into this country, as many were, knowing virtually nothing about his vetting.

This is what happens in this country when people are allowed in who are not properly vetted.

These guardsmen and all who are here to protect the district are the line that separates a civilized society from a barbaric one. They are the ones who stand for law and order.

This was not just an attack. It was a direct challenge to law and order in our nation's capital. And they the individual will be made fully accountable. And though it seems that we have been here before under President Trump, make no mistake and the attorney general, we will not allow this to be normalized. It will be confronted, condemned, and prosecuted to the full extent of the law.

Now, my message to the individual who committed these acts is you picked the wrong target, the wrong city, and the wrong country. And you will be sorry for the violence and the evil that you perpetrated in our nation's capital.

And now I call upon the director of the FBI, Kash Patel.

Kash Patel, Director of the FBI:

Thanks, Judge. I'll begin my remarks and my end my remarks the same way with prayer for our fallen soldiers, prayer for our law enforcement community, prayer for our National Guardsmen and women. Prayer for our brave prosecutors at the Department of Justice and the offices of the DC United States Attorney.

We must come together as a nation, especially on this Thanksgiving Day, and remember the sacrifices that so many are making around the world and around this country to secure our freedoms under President Trump's brilliant leadership and administration.

I'll provide an update on the on the case as follows. It is an ongoing investigation of terrorism. Make no mistake about it. We the FBI is leading out on this federal assault on a federal law enforcement officer investigation on many fronts.

We immediately with our law enforcement partners and the Metropolitan Police Department and the inter agency secured the scene, seized the weapon, sent in our evidence response team immediately to collect evidence and started doing block-by-block canvases. We are looking for and interviewing witnesses.

The firearm and other materials have been sent to our Quantico laboratory already yesterday for immediate analysis. That work is ongoing, partnering with the DC United States Attorney's Office.

We have also executed multiple search warrants around the country to include the subject's last known residence, which is in the state of Washington. The search warrant was executed on that house last night or early this morning and it is an ongoing process. All the individuals found in the house have been interviewed and some interviews remain ongoing. We will not stop until we interview anyone and everyone associated with the subject, the house and every piece of his life.

There was also subject interviews relations conducted in San Diego pursuant to our ongoing investigation.

So, as the judge noted, this is a coast to coast investigation being led right here in Washington DC. And this subject definitely did pick the wrong country.  And we will rise together as a nation to show the world what we do here. And we are thankful that we have the attorney general's brave leadership and President Trump's brave leadership and priorities to safeguard our communities.

I also spoke to director of the CIA John Radcliffe last night and Secretary of War Pete Hegseth. There is confirmation now that the subject had a relationship in Afghanistan with partner forces. We are fully investigating that aspect of his background as well to include any known associates that are either overseas or here in the United States of America.

That is what a broad-based international terrorism investigation looks like. We will provide continuous details to the American public while at the same time not jeopardizing the ongoing prosecution to ultimately hold this perpetrator accountable in our courts of law. We will provide as much transparency as possible.

But as you can see, the breadth and scope of this investigation will continue. We will continue to hit the streets and hit every town and every house and talk to every witness. The men and women of the FBI and the Metropolitan Police Department and the inter agency to include the Department of Homeland Security, DEA and ATF are working tirelessly on this Thanksgiving day. And I know just by talking to the leaders behind me that instead of going on and being with their families, everyone rogered up and showed up to work today and none of them want to go home. That's the resolve that we have together as a team to bring to you justice for this heinous act of terrorism here in our nation's capital.

And as the judge said, we will ensure that our law enforcement partners are out there in full force to make sure the world can enjoy our nation's capital. We will not let this heinous act of violence prevent people from visiting our beautiful nation's capital. And we will also continue to highlight any evidence that we can publicly.

And as the judge said, this individual is in this country for one reason and one reason alone. Because of the disastrous withdrawal from the Biden administration and the failure to vet anyway in any way, shape or form, this individual and countless others. And this administration has taken the rightful step to stop any further allowance of people with this similar background into the country. And we're thankful for that. And as I said, this investigation remains ongoing. And I think I'll turn it over to General Blanchard to the National Guard now.

Thank you.

General Blanchard:

Thank you, director.  All across America this morning, families are waking up.  They'll spend the day with their children, their brothers, sisters, husbands, wives, friends from across the community.  There will be the smell of turkey, all the fixings. They'll watch parades, football games. They'll pray together.  They'll talk about what they're grateful for.

This morning, there are two families that will not have that opportunity.  Andy and Sarah's families. They're spending the day reflecting on the past.  And in the days coming, they'll reflect on and think about what could have been, what might be.

Because regardless of the outcome, we know that their lives, their family's lives are all changed forever because one person decided to do this horrific and evil thing.

And all across America, we are also reminded that there are many law enforcement agents, first responders, soldiers, service members all around the world who at best will come home, eat some cold turkey, open up Tupperware, eat what's left over because they spent the day defending the American ideals, getting out there and getting after on every American citizen's behalf.

I will say that the District of Columbia National Guard, this task force is more committed this morning to the president's directive to make DC safe and beautiful.

Our resolve will be tested. It is being tested. But make no mistake, each and every one of these soldiers and airmen will meet and exceed the expectation that we have for them. They are in fact America's best. I'm proud of each and every one of them.

I pray for each and every one of them today and in particular for these two young service members who are willing to go above and beyond and pay whatever price our nation asked of them. I ask every American today to keep them in their thoughts and prayers as you go about your day. Thank you.

Mayor Bowser

Thank you, Judge. I'm Muriel Bowser. I'm the mayor of Washington, DC, and I want to associate myself with the remarks from the DC National Guard.

I want to be very clear what the judge and everyone has reported here.

Somebody drove across the country, came to Washington DC to attack America and that person will be prosecuted to the fullest extent of the law.

These young people should be at home in West Virginia with their families.

I also want to say that the both Sarah and Andrew I believe were sworn in less than 24 hours before they were shot on the street in Washington.

Any questions?

You know, as the director has indicated, this is a fluid investigation. People are working around the clock. It's too soon to say what the motive is. But there are definitely areas that we're looking into, but not ready to say.

 

Q: Can you characterize a little bit about how taken down?

A: He got shot by another by another guardsman.

A: And you mentioned earlier that he had the shooter had initially not just initially shot one of the guards that leaned over as they shot him again.

Q: How many how many shots?  the specific number.

A: Look, he had a 357 Smith and Wesson revolver. So, I believe that's a six shooter. So, you know that kind of tells us how many shots he had.

The Biden administration was a failed.  I don't even want to talk about whether they should have been there. We ought to kiss the ground and thank God that the president said it's time to bring in more law enforcement to make sure that a city that had the fourth highest homicide rate in the country was that violence was quelled. I'm not even going to go there.

You miss all the signs when you do absolutely zero vetting. And that's exactly what happened in this case when the prior administration made the decision to allow thousands of people into this country without doing a single piece of background checking or vetting.  That's how you miss every single sign.

And Secretary Christy Noom has put out details specifically related to your other questions. So I'll let that speak for themselves.

Yes, I believe Christine put that out and that's a DHS matter and I'll refer it to them.

Could you elaborate on the investigation?

So, what happened was thanks to the quick investigation by the inter agency and the FBI, we were able to track down his last known residence, working with our United States attorney's offices here and at the Department of Justice and prosecutors across the country, we were able to serve search warrants literally overnight and through the night and we were able to hit the house in Washington State.

During that process, we seized numerous electronic devices to include cell phones, laptops, iPads, and other material that is being analyzed as we speak. pursuant to that investigation and any known associates of the subject and of that house is how we ended up in San Diego where interviews were conducted and are going to be continue to be conducted and we will go anywhere in the country or the world where the evidence leads us.

Q: Are there relationships in San Diego?

A: All of that is an ongoing investigation.

Q: Can anyone give an update as far as Sarah and Andrew who were injured? You said critical condition. Can you give anything beyond that? Are they expected to make it?

A: Touch and go.

Q: Can you tell us a little more about how we're doing?  Spelling of their names, please.

A: Sarah Beckstrom and Andrew Wolfe.

Now, with respect to their medical condition, as I said, they're receiving the finest medical care. their families are with them now. They are critical. I think you understand the meaning of that. It's not clear, you know, how this is going to end up. But let me be perfectly clear about how it will end up in this office. If one of them is to pass and god forbid that happens, this is a murder one. Period. End of the story. We are praying on a day like today when families come together in America and they hold hands around the Thanksgiving table. I beg you, I beseech you to play to pray for these two young people that they survive.

Okay, I think that's it.

A "never Trumper" blames the Democrats for the government shutdown

Originally written 18Oct25; updated 30Oct25.

I have documentation of being a “never Trumper” since at least 1988, but I blame Democrats for the government shutdown.  

Democrats could have refused to fund the government because the Trump administration is acting unconstitutionally, undermining separation of powers.  Democrats could have demanded that Adelita Grijalva be seated in the House (which Republicans are blocking to avoid release of the Epstein files), that President Trump get Congressional approval for military action in the Caribbean, etc.  

Instead, Democrats shut down the government because they don’t like a law that was legally passed.  That’s a terrible reason to shut down the government.  If you disagree about a law that passed, you close the government???  Consider the national and international ramifications.  If it is appropriate to shut down the government because you don't like a law that passed, our government could be shut down permanently. 

Amazingly, Democrats aren't objecting to something the Republicans did.  They are objecting to the APRA of 2021 which is a law drafted, promoted and passed by Democrats in the Biden administration!  Democrats don’t like that they said increased subsidies were temporarily necessary and could expire at the end of 2025.  Because they don't like what they did, they shut down the government.

Democrats insult the public’s intelligence by saying “Republicans control the government, so the shutdown is their fault”.  Obviously, if the Republicans had complete control, the government would not have been shut down.  The Democrats have rejected at least 13 clean continuing resolutions.

Democrats say the Republicans should compromise with them.  I agree in compromise in most cases, but I don't think the Republicans should accommodate the Democrats because it would encourage both parties to engage in more government-closing shenanigans.  (Furthermore, what compromise offer have you heard from the Democrats?  They insist that they get what they want or they'll keep the government shut down.)

Some Democrats say this issue is worth shutting down the government because higher health care costs will cause people to die.  What about the people who can afford higher prices?  Maybe Democrats could actually offer a compromise instead of  stonewalling.

Of course, if the possibility that "someone could die" is your criterion, will Democrats refuse to open the government until there is universal health care?  Is gun control also necessary?  Should Republicans close down the government because our military lack of preparation will cause people to die?  You can argue that "people will die" because of a whole lot of disagreements.

The shutdown is not only wrong, it is stupid because it gives the administration opportunities to shut down projects most precious to Democrats.  It would be terrible if the Republicans end the filibuster because of the Democratic shutdown of government.

Chuck Schumer consistently strongly criticized such government shutdowns until the leftist support for Mamdani in NYC increased his fear of losing the Democratic nomination for his seat to Alexandria Ocasio-Cortez, prioritizing personal ambition over the good for the country.

Reducing the cost of health care

A college classmate asked me for ideas about reducing the cost of health care.  Here's my response:

Thank you for asking me to suggest ways to reduce the cost of health care.  I certainly do NOT pretend to be an expert in this complicated topic.  Although I’m an actuary, I didn’t work on acute health care.  I studied the issue significantly in 2009 to help our country decide how to proceed.  Unfortunately, I learned that my politicians were not interested in my expertise.

To answer, I reviewed numerous sources, including an article of mine published in 2009.  I apologize that this is so lengthy, but there is no “magic bullet”.  Many changes could collectively have a significant impact.  I invite readers to add ideas and to promote some of these ideas if you like them.

In 2009, I described the advantages and disadvantages of three alternative philosophies.  The “Equality Philosophy” espouses the same health care for everybody.  The “Rising Tide Philosophy” espouses a safety net, allowing people to purchase more health care.  The “Libertarian Philosophy” espouses no threshold.  My article included 26 principles that should guide any of those philosophies.

Since 2009, our health care system has had many modifications.  I’ve given them little thought because I had no influence and felt I could have more impact by investing my time otherwise.  Nonetheless, I suspect you’ll conclude that at least some of my points are relevant.

I number paragraphs to help people focus a comment or question.  Several topics could appear in various sections below and the sections are not necessarily in priority order.  The sections are:

1.      Goals

2.      Pharmaceutical costs

3.      Tort Reform

4.      Price transparency and “skin in the game”

5.      Healthier food

6.      Regulatory Issues

7.      Environment

8.      End-of-life care

9.      Long-Term Care

10.   Other Medicaid issues

11.   Health Care fraud

12.   Mental health

13.   Overreliance on pharmaceuticals, psychologists and technology

14.   Drug policy

15.   Mental health

16.   Integrated health insurance

17.   Veterans’ care

18.   Education

19.   Foreign aid

20.   Gun control

                                             

1.      Our goals are unrealistic to some degree. 

a.      We citizens want everything without having to pay, so politicians make crazy promises.  With an aging population and a desire to tame or cure myriad diseases and with viruses replicating and changing, the cost of health care seemingly must rise. 

b.      We make invalid comparisons to foreign health care systems, ignoring our greater obesity, more sedentary behavior, more convenient and prompt health care for those who can afford it, much greater investment in end-of-life care, much more expensive tort system, etc.

c.      We seem unable to quantify the value of increased productivity as an economic offset.  Increased quality of life is a return on the investment, albeit not necessarily an economic return.

2.      Pharmaceutical costs.  It is important not to kill “the Golden Goose”.  If we stymie research, we won’t even know what we’re missing. 

a.      I believe pharmaceutical manufacturers priced drugs so USA sales would cover R&D costs.  When other countries put arbitrary limits on price, manufacturers could accommodate those governments if the price was more than their marginal cost of production.

President Trump issued an executive order to establish a “most favored nation” pricing policy.  That is, the USA would pay the lowest price at which that drug is offered to a group of developed countries.  By limiting the comparison to a group of developed countries, the executive order avoided the pitfall of stymieing donations of drugs to needy countries.  The MFN approach may help manufacturers negotiate more strongly with European countries, resulting in a price increase there and decrease in the USA.

(CNN asked a Democrat about this.  The lady said she was glad to see President Trump adopting one of President Biden’s programs.  The CNN host failed to comment.  President Biden claimed he was allowing the government to “negotiate” with pharmaceutical companies, but his program involved the government setting a price.  The manufacturer could contest the price, but the government had total control on the final price, and if the manufacturer was not willing to sell at that price, it would be fined!)

b.      Prescription Benefit Managers are middlemen in filling prescriptions.  The theory is that, as large buyers, they can negotiate discounts from manufacturers and pass those discounts on to clients.  However, some of their practices may need to be outlawed.  For example, I understand that they created intermediaries (under common ownership) which retain some of the discounts, leaving the PBM with less “discount” to pass on to the client.

c.      Private industry can help: Mark Cuban’s CostPlus Drugs and other disrupters (GoodRx) help drive down the cost of pharmaceuticals.  CostCo is driving down the cost of hearing aids.

d.      The Rx Advocates educates people about available manufacturer drug discount programs.

e.      GLPs are an interesting case.  They are causing health costs to soar but may eventually reduce health costs significantly.  In 2009, I commented “obesity costs us $117 billion/year in health care costs, not counting the additional costs of workplace absenteeism, etc.”

3.      Tort reform would save money by reducing the number of lawsuits, reducing aggregate settlements, lowering medical liability insurance premiums, and especially by reducing defensive medicine. 

a.      One study indicates 2.6% potential reduction in costs, but it might be higher. 

b.      An example of fraudulent tort suits: “He Fought the Tort Bar -- and Won”, published in the WSJ, May 4, 2009.

c.      Punitive damages assessed against health providers should be used to offset the cost of health care rather than to enrich plaintiffs. 

d.      Plaintiffs should be responsible for the cost of a lawsuit they lose, if the judge or jury determines that the lawsuit was frivolous.

e.      My example of defensive medicine: Having demonstrated a minor heart arrhythmia, I wore an external heart monitor for a while.  The results were favorable, but my doctors ordered a 45-minute exercise EKG stress test, which I passed with flying colors.  My cardiac electrophysiologist educated me about my very infrequent arrhythmias, assuring me repeatedly that I was fine and needed no more attention.  When I asked a couple of simple questions as to which chambers had misfired, he excused himself to talk with a senior doctor.  When he returned, I suddenly needed surgery to try induce arrhythmia.  If they were successful, they would implant a pacemaker.  If not, they would implant a heart monitor.  I demurred, saying it didn’t seem necessary based on what he had told me, but he stuck to his new story.  I then consulted my other cardiologist; she suggested it was a good idea.  I’ve had the heart monitor nearly 3 years; it has never gone off. 

4.      Price transparency and “skin in the game”:

a.      Price transparency helps but if health consumers don’t have “skin in the game”, they have little incentive to control cost by shopping around, negotiating a discount, or finding alternate solutions.  

b.      I’m a fan of Health Savings Accounts with high deductibles for people who can afford them.

c.      Skin in the game/incentives would make people more likely to adopt lifestyle changes such as exercise, reduced substance abuse, and better diet and to preventive health options.

d.      Originally, the Affordable Care Act had an artificially low ratio of insurance premium cost for smokers vs. non-smokers.  That ratio was subsequently raised so may be high enough now, but it is worth reviewing that ratio and other potential factors to reflect in pricing.

e.      Transparency includes admitting the huge size of our “off-ledger” liabilities.  Only some of those liabilities are related to health care, but our health care is likely to suffer greatly when our economy collapses due to its debt burden.  If we believe in “preventive care”, we should address our huge on-ledger and off-ledger debt now.

5.      Healthier food: We should encourage consumption of healthier food.  Here are some ways to do so:

a.      SNAP cannot be used to purchase alcohol, tobacco, or foods that are hot at the time of sale.  During his last term as Mayor of New York City, Michael Bloomberg sought permission to exclude sugary drinks from food stamp purchases, but the USDA denied his request.  Recently, the Trump administration approved such limits in AR, ID and UT.  This could be helpful.  Bloomberg also tried to outlaw 32-oz servings of such drinks, arguing that people could get two 16-oz servings and/or refills.  Such ideas would probably improve health.

b.      I recently hosted an event for The Land Institute and American Farmland Trust.  Several other food-related non-profits attended, some of which are noted below.

                                          i.     The Land Institute creates deeply-rooted perennial grain crops to replace our current annual crops, with tremendous potential to sequester carbon, retain topsoil, decrease fossil fuel usage, and reduce or eliminate chemical inputs and toxic run-offs, thereby helping to stabilize climate, stop aquifer depletion, and regenerate diverse ecosystems, including pollinator populations.  See the root comparison below and learn more about their work in this 3-minute video or from KCUR.  This can also make food healthier and eventually less expensive.    

                                         ii.     I started supporting American Farmland Trust 40 years ago when they started helping farmers put easements on their property forbidding development for 99 years.  As a result, their property taxes were based on farm value rather than the development value of encroaching suburbs.  AFT works on an array of issues that improve the quality, and reduce the cost, of food while protecting the environment.

c.      The Giving Grove sponsors local fruit/nut orchards/bushes in areas of food insecurity.  I thought it was a great idea, but not sustainable.  However, I supported the Giving Grove, and they proved me wrong, now having expanded to 20 cities across the country!

d.      Tiered aquaponics allows high levels of production of healthy food with minimal inputs on vacant inner-city plots.  I supported Nile Valley Aquaponics in KC but I think it is out of business.  This idea is a HOME RUN, in my opinion! Do any of you know someone who would run with this idea?

e.      We have lots of ponds in housing developments.  I’ve tried to find a non-profit which would seed ponds with fish, then harvest them.  One non-profit was interested but wanted me to do all the work creating the project.  I have too many things on my plate.  Do any of you know a non-profit interested in this idea?

f.       We also have a lot of Canada geese that get thinned.  I’d like to support a non-profit which would thin the flocks and provide the geese to the nutritionally-challenged.  Some people criticize this idea because they say goose is not a healthy meal.  WebMD disagrees.  Furthermore, I think it is a moot point if people are going hungry.

g.      We should use “ugly” harvested fruit and also food wastes.   Urban Produce Push rescues fresh, nutrient-dense produce and delivers it directly to food pantries and people in food-insecure communities.  Panera’s Day-End Dough-Nation program is another great model.  Find and support such programs in your neighborhood.

h.      Food deserts are a huge problem.  Stores can’ t afford to stay open, partly because of theft and destruction.  We should be able to address those problems.

i.       RFK, Jr. banned the use of red dye #3.  I’m not knowledgeable about this issue.  I believe environmental issues (including diet) contribute to some health issues such as ADHD, autism, cancers, and dementia.  On the other hand, I’m skeptical of studies criticizing various compounds because enormous consumption would cause a problem.

6.      Regulatory issues may be sprinkled throughout this paper.  Some that don’t fit elsewhere:

a.      RFK, Jr.’s attacks on vaccines and fluoridation seem ill-advised.

b.      “Any willing provider” laws undermine plan administrators’ ability to negotiate lower costs.  While plans must have an adequate footprint of services, AWP is going too far.

c.      The FDA safety process has a fine line to toe, between safety and obstruction.  People with incurable diseases should be allowed to test new, unproven techniques.

d.      Immigration policy is important because immigrants provide supply that lowers the cost of health care.

e.      Many people are unaware that Independent Review panels can resolve some disputes between insurers and claimants for acute health claims and long-term care health claims.  I’m not sure this point belongs in this paper, but readers might be interested.

f.       It is my impression that nurses go into nursing to help patients but end up being unable to spend much time with patients.  We need to enable health care professionals to do their job without undue stress.

g.      I don’t know how much progress we’ve made toward compensating for quality of care vs. quantity of care.

7.      Environment: Improving the environment will also improve health.  Some of the above-mentioned food projects address this issue, but obviously there are a lot more environmental issues that can impact health.  I don’t think we fully understand the environmental impacts on health.  Climate is relevant to health, so climate change is clearly relevant.

8.      End-of-Life care: There is disagreement as to how extreme USA costs are for end-of-life care, but it is expensive.  Here are some sources: Patterns of Healthcare Spending in the Last Year of Life - PMC;    End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported | Health Affairs; End of Life Care Cost: The Financial Side of End of Life Care.  The second source says “End-of-life care accounts for approximately 30 percent of national Medicare spending and, as such, continues to have the attention of healthcare policymakers, payers, and providers.^1,2 While decedents represent only a small fraction of all Medicare beneficiaries, Medicare spends on average $40 to $50 thousand per decedent in the last year of life compared to only $7 thousand per year for survivors.^1,3,4“

Risking being very politically incorrect and perhaps strategically unwise to mention this in the context of reduced health care costs, I am a strong supporter of Compassion & Choices, the main advocate of Medical Aid in Dying, which I consider to be a civil rights issue.  An unintended consequence is health care savings.

9.      Long-Term Care (LTC) costs:

a.      Medicaid is intended to pay medical costs for those who can’t afford to pay for their care.  If you receive Medicaid LTC in a facility, we protect your house, so you can return home if you recover.  When you die, we recover what we paid for your care from your assets so we can afford to provide services to others.  However, we do not collect against your house if your spouse, minor child or blind or disabled child still lives in it, nor if a child who was your caregiver for two years lives in the house or a sibling who was your caregiver for a year lives in the house.  That’s all fine, but beyond that, we ignore $730,000 of home value (2025 value; it is indexed.  In some states $1,097,000).  For two decades, I’ve written papers explaining why the $730,000 protection should be removed.  Democrats should love this reform because it protects Medicaid for the needy.  Republicans should love it because it upholds personal responsibility.  We’d save the government a lot of money and processing costs; quality of care would improve because providers would be paid private-pay rates rather than the discounted fees paid by Medicaid; state and Federal governments would earn more tax revenue from the increased income of care providers and from insurers and insurance brokers selling LTC insurance; and the types of care provided under Medicaid could be expanded.

b.      See Posit Science under mental health.

10.   Other Medicaid costs

a.      President Obama expanded Medicare promising that the federal government would pay 90% of the cost, clearly a problematic design.  I live in a state that hasn’t expanded Medicaid.  The #1 argument we hear for expanding Medicaid is that it is “free money”.  Obviously, it is not free as it should be funded by taxes we pay to the federal government.  Worse, the federal government doesn’t have the money.  Regardless of a person’s position on expansion, we should admit that it increases our destructive debt burden.  (Productivity offsets should be considered.)

b.      States assess “provider taxes”.  Providers (hospitals) profit from being taxed!  The state spends that tax on health care, triggering a federal match of 100% to 900% depending on the state and whether the money is spent on normal Medicaid or Medicaid expansion.  That money funnels back to the providers.  In 1991, when George H.W. Bush signed bipartisan legislation to limit this scheme, even  Nancy Pelosi and Chuck Schumer voted for it.  Currently, a 6% or lower provider tax is automatically presumed to be fine; above that is subject to review.  The “Big, Beautiful Bill” reduces the 6% “safe harbor” to 5.5% and down to 3.5% in 2032.

11.   There is a lot of health care fraud by providers, patients and insurers. 

a.      For example, in my LTC insurance work, I run into people who have a long history of disability but want insurers to accept them as healthy risks for LTC insurance.  They explain that they really weren’t disabled all that time; their doctors were cooperating to help them maintain undeserved benefits. 

b.      Of course, there are disagreements as to how much fraud there is and, in some cases, it may cost more to catch the fraud than to ignore it.  However, that is a slippery slope, because ignoring fraud encourages fraud. 

c.      Insurers get criticized a lot, but, in my experience as an insurance executive, I was pressured by the insurer’s attorneys to pay inappropriate claims because payment was less expensive than the cost of litigation.  This is a ”tragedy of the commons”.   If each case is settled to avoid litigation, we encourage fraud. 

d.      Minor, but personal example: I locked my keys in my company car and did not want to bother my wife to bring my spare key.  An attendant at our parking garage offered to jimmy the passenger door to unlock the car.  I accepted, but the passenger car door could no longer be unlocked from the inside.  I asked the entity managing our company cars whether I had to go to a dealer or might find another mechanic who could fix the door less expensively.  The repeated response was that I should simply file a claim!  Despite my strong pushback, they continued to insist that I file a claim.  I reported them to our management.  They denied their behavior, so I hope I altered their behavior prospectively.

e.      Another example: I never got a bill from a dentist to cover my co-pay.  After repeated efforts, I learned that he was overbilling so that I wouldn’t have to pay my co-pay.  I never saw that dentist again.

f.       In general, I think we have slipped in raising our children to be virtuous.  For example, announcers compliment “cheating” in sports as being a “smart” play.  We need an inspirational leader to encourage us all to make sacrifices for the common good.

12.  Mental Health

a.      I’ve maintained for many decades that the pace of change in our society is so fast that even bright people have trouble keeping up with it.  Thus, there are increasing mental health problems.  I think most people suffer mental health illness during their lives.

b.      A friend of mine suggests the following direct-to-consumer behavioral health offerings

                                          i.     Benepower | TriggerHub

                                         ii.     Helping Humans - YourCoach Health

c.      I’ve been following Posit Science for over 20 years.  Their amazing brain fitness programs delay dementia, improve balance and hearing, widen useful field of vision (peripheral vision), improve mood, etc.  We should promote usage.  It is available as an extremely inexpensive employee benefit which I’m trying to promote (so far unsuccessfully).

d.      Digital health: Screen Sanity, an organization founded and run by my daughter, is a leader in addressing the mental health problems related to use of electronics.  Their services are also available as a very inexpensive employee benefit.

e.      Post-partum blues can be reduced significantly by educating prospective parents about the “fourth trimester”.  If first-time parents understood that their new-born would not be able to reward their attention for three months, those parents would be healthier after delivery.  Happiest Baby, which developed that concept, also has other ideas, including a medically-certified bassinet that keeps babies asleep through swaddling, playing music, and rocking, so parents enjoy better sleep and health.  I also promote Happiest Baby as an inexpensive employee benefit.

f.       A great way to improve mood and health is to help others.  We could try to inspire couch potatoes by scrolling messages under TV screens leading them to find ways they can help.

g.      When I was younger, I didn’t respect psychologists and psychiatrists, thinking people should simply apply self-discipline.  I have learned to have much more respect for such professionals, and I also think mental health care has improved a lot. 

My son did a lot better on a particular medication for his ADHD.  My daughter went through a mental health problem in high school when, in short order, my mother died, and a fellow student died in a car crash.  I was oblivious to the problem, but her friends and Young Life helped her pull out of it.

I think we have to be more attentive to others’ needs.

h.      At risk of inflaming some readers, I think we contribute to mental health issues and other health costs by grooming children to become transgender.  Puberty is a difficult stage in life in which most of us question our ability to be successful.  Persuading children that their uncertainty is because they aren’t really their gender seems unwise.  We twist language in many ways, in this case by saying gender is “assigned” at birth and treatment to change gender is “gender-affirming” care.  It seems obvious that it is “gender-disaffirming” care.

13.  Overreliance on pharmaceuticals, psychologists and technology. 

a.      Despite my above comments about mental health, I still think we have a cultural attitude that we want doctors, psychologists and medications to fix things for us.

b.      We also want convenience.  If we were willing to travel farther or to wait longer to access technology, we would not have so much technology and frequent upgrades every hospital.  Does the value of convenience offset the cost?  (My wife and I benefit greatly in this regard.  The health care we have within 5 minutes is incredible, but I could sacrifice that for the common good.)

c.      However, I believe electronic medical records will save cost (and improve health) in the long run and help analyze optimal treatment.

14.   Drug Policy: I don’t know the answer, but George Shultz and Paul Volcker wrote an article (WSJ, June 11, 2011) in which they suggested: “One possibility is to decriminalize the individual use of drugs while maintaining laws against supplying them, thus allowing law-enforcement efforts to focus on the drug peddlers. Some of the money that is saved can be spent on treatment centers, which drug users are more likely to seek out if doing so does not expose them to the risk of arrest.”

15.   Telehealth is a very promising way to reduce the cost of healthcare.  Telehealth regulation is a challenging area.  Some suggestions are listed in the Mental Health section.

16.  Integrated health insurance.  Acute health insurers would have more incentive to reduce long-term health risks if their policies covered long-term care.

17.   We under-spend on Veterans’ Care.  We should take better care of our soldiers, including cosmetic surgery.   

18.   Education:

a.      I’m not familiar with the health teaching in our schools.  It is my impression that we are doing a lot better than in the past, but maybe we can do better.

b.      Our public education system is failing us, relegating too many citizens to lives of poverty which include greater health challenges.  I’ve written about a lot of things we can do to improve education, among them public school choice and public charter schools.  (I don’t support total school choice, but the entrenched public school monopoly risks pushing a lot of people to favor school choice.  One way or another, we can’t continue locking people into under-performing inner-city schools!)  You can read about my ideas on education here: A Thausand Ideas: My Beliefs about Education.

19.   Foreign Aid: Some foreign aid contributes to our health by reducing the risk of pandemics and imported infections and by keeping peace.  (I consider micro-loans to be our best foreign policy.)

20.   Gun Control:  I would be remiss not to mention this topic.  I support some types of gun control but am haunted by the experience of the Dutch.  In the 1930s, Queen Wilhelmina convinced them that gun registry would make them safer.  When the Nazis rolled in, they found the list and went door-to-door demanding that specific weapons be surrendered.  As a result, the Dutch resistance had no guns.  (Source: “Was God on Vacation?”, an amazing autobiography by Jack van der Geest).