Everyone will agree that people should be treated equally, regardless of their circumstances. Hence each of these color-blind policy dictates and requirements is to be applied across the board, no exceptions.

 

*In order to help save the planet, all people shall either own an electric vehicle or use public transportation. Approximately 80% of Green and 20% of Gold are able to buy a vehicle.

 

*In the belief that owning a house is correlated with a more stable society and that reducing the debt load is conducive to maintaining that ownership, all buyers must put down 10% cash when they purchase a house. About 70% of Green and 10% of Gold are able to buy a house.

 

*Clothing stores at the nation’s malls have instituted a policy of random searches in order to combat shoplifting. Some 50% of those searched are Green and 50% are Gold.

 

*All school systems within a given state shall receive the same per-pupil funding allotment. Allowable non-school spending for educational add-ons: private lessons, trips, summer camps, etc. shall be capped at 25% of the school allotment. 50% of Green and 10% of Gold are able to use some or all of this benefit.

 

*In order to most economically deploy local police department personnel in combatting street drug traffic, they will focus entirely on urban areas; 15% of Green and 75% of Gold will be affected.

 

*Mental health is an issue of growing concern, with well-known personalities going public with their situations. Studies have indicated that interaction with a psychologist of their own ethnicity is favorable for a patient. Green connects on 95% and Gold on 5%.

 

*The state police have cracked down on speeders on interstate highways: the issuance of tickets has been 50% Green and 50% Gold.

 

*Creating the most cost-effective route for the urban portion of an interstate highway requires the relocation of some people. Around 15% of Green and 50% of Gold are affected by the route.

 

At what point is it reasonable for Gold to think the deck is stacked against them, perhaps even reflecting a bit of antagonism by Green toward Gold? Can a technically impartial policy or requirement be in fact a convenient, legally enforceable way for Green to keep Gold subservient?

 

P.S. Why are the 50%-50% outcomes above unfair?

 

 

 

 

 

Most people I know are either good communicators or at least have an understandable pattern in their response to an inquiry. Occasionally, an exemplary individual lapses into a mode of non-communication.

In trying to figure out the reason for this non-communication, below I have listed a baker’s dozen of possibilities in alphabetical order:

Embarrassment

Family problem

Friend situation

Health issue

 

Homework comes first

In jail

Making a Complete Change in one’s life and deferring communication until all the details are in place

 

No Internet available

Out of the Country

Phone and laptop both out of service

 

Saving Good News for another time

Self-description as being a disappointment to others

Taking a break to work and save money for the next phase of life

 

Question: which of these reasons make it impossible for person X to respond to an inquiry from person Y with a two sentence informative communication?

 

On Wall Street, I was a partner in a relatively small, but highly regarded, money management and institutional research firm. In December of 2022, the founder and managing partner passed away at the age of 96. My last lunch with him was shortly before the onset of the pandemic. We ate in his office; he was mentally sharp while struggling a bit physically. We had kept in touch over the thirty years since I left the firm to initiate my education foundation endeavors.

Back in the day, as we would pore over all the facets of a company and its top executives, it became evident that there was a personality and process profile worth noting. I put together the following succinct list. It should be apparent as to our preference.

Long studies                       Short memos

Fluff                                       Facts

Egotistical                            Self-deprecating

Spender                               Innovative capital expenditures

Average Health                  Physically fit

 

Spread out                          Concentrated

Gourmet                              Simple eater

Speechmaker                     Questioner

Long Answers                    Short

Imprecise                             Articulate

 

Conceptual                         Concrete

Earnings                               Cash Flow

Methodical                         Energetic

Serious                                 Engaging

Staff                                       Individual

 

Overhead Money             Product and marketing money

Calculus                                Simple math

Growth                                 Wealth creation

Manager                              Owner

Philosophical                      Numerical

 

Fuzzy Pay                             Big incentives

Small Talkers                       Business talk

Political                                 Direct

Flashy                                    Conservative

Reward                                 Risk

 

Even with the advent of social media and the centrality of TechnoWorld, the list above seems useful. As Warren (you know his last name) says, investing is not like baseball where three strikes and you are out. With investing, you can wait, sometimes for a lengthy period, until you find the people and company with whom you want to be associated as a long-term shareholder.

 

 

For more than a quarter-century, I have assisted young people on their higher education journey. Around 85% have been Hispanic. It quite naturally follows that the subject of immigration is not foreign to me, quite the contrary. At times (many years back), I have written essays on the subject, often underlining the demographic changes which make increased immigration critical to economic growth in the United States.

More recently, I have kept a running compilation of immigration-related facts and thoughts, gleaned primarily from my daily in-print newspaper fix: the “New York Times” and the “Wall Street Journal.”

It was helpful to me to then create a somewhat logical, heavily edited grouping of this type of information. Note that in the material below, it would be stunning if there were not some confusing inputs, even outright contradictions – they go with any discussion of immigration.

Before moving ahead, these are a few baseline background thoughts relevant to immigration.

Did past USA policies in certain countries south of our border screw up governments, distort economies, and cause the death of innocent people? Yes. In recent years, are there similar policies which have produced similar results? None of which I am aware. Are these countries unable to foster stable governance and job-creating economies not saddled with the fear of criminal activity? Good question. Are we to assume that the resident population of these countries is permanently incapable of positive change? If so, no point continuing with this piece of writing. If not, then the assumption is that aiding these countries directly is not a forever proposition, even if it is a multiyear commitment.

In the meantime, as the saying goes, people will beg, borrow, or steal in order to get to the USA and its implicit promise of jobs, relative safety, and the freedom to call the President bad names without fearing reprisal.

Fully realizing that all immigration issues overlap with the approximate structure of spaghetti, nonetheless below I have grouped my immigration notes under these headings:

The Border: General, Asylum

Domestic: Data and Demographics

Politics/Economics: Politics, Economics, Legal

International: Canada, Other Countries

 

The Border: General

 

*At least for the moment, the number of border crossers has dropped significantly, reflecting tougher policies instituted by both Mexico (for example, people who are apprehended being transported far from the border) and the USA (five-year ban on repeated illegal crossers) plus improvements to the latter’s appointment scheduling app: CPB One (Customs and Border Protection, which is within Homeland Security; Border Patrol is part of CPB, which was created after 9/11 with an anti-terrorist mission.) Communication by lawyers to clients is said to be chaotic, despite the improvements.

 

*Near Eagle Pass, the state of Texas is creating a long floating barrier of orange buoys to discourage border crossing swimmers; it is now the subject of a lawsuit. Other Texas measures under Operation Lone Star, including the use of razor wire, have come under substantial attack; use of Texas state troopers and National Guardsmen has fueled irritation, as have reports of undue aggressiveness, including the killing of a tribal member in Arizona. Texas’ response is basically that it is attempting to bring order to a federal issue, international borders and immigration enforcement, when there is no evidence the federal government is committed to doing so. Minorities directly affected by the border situation have themselves supported Texas’ actions; some elsewhere have questioned whether the benefits are worth the cost of approximately $2.5 billion per year.

 

*Border crossing has become a business, no longer featuring random coyotes; Mexican drug cartels are heavily involved in certain areas. The cost of a coyote exceeds $10,000. A record number are dying at the border, especially in places with treacherous water.

 

*The Supreme Court has supported the Biden policy of prioritizing deportations: those deemed threats and those who crossed illegally get full attention. Those who have been in the USA for many years and done nothing wrong get a pass. The backlog of all cases is about two million. To address this with clarity and justice requires significant additional staff and money.

 

*In the year ended September 30, 2022, there were 2.3 million border encounters compared with 405,000 in pandemic 2020. About 70% of border crossers are single males. A reported 75% of unaccompanied minors are from Venezuela, Ecuador, and Haiti. Overall, 250,000 migrant children have come alone to the USA in the past two years, here to work and send money back.

 

*Entrepreneurs at the border are selling infrared rifle scopes, spyware, materials for fence sensors. Border states and individuals are becoming enforcers of their own interpretation of immigration laws. Non-profit organizations are at the border for more humane purposes. QAnon representatives are functioning at the border as well, purportedly to help kids in need.

 

*The average wait in an ICE detention center is 37 days. Detention capacity is 20,000. Pending cases are up sevenfold in the past decade (Transactional Records Access Clearinghouse at Syracuse University). There is a 150-day waiting period before eligibility to work. Both immigrant advocates and prospective employers (at present anyway) would like eligibility to happen quicker, even if it was only for a stipulated period of time, e.g. two years.

 

*The movie ”Sound of Freedom” has grossed over $150 million at the box office; filmed in 2018, it is based on the true story of an American Homeland Security Agent who investigated pedophiles. Its producer and director are Mexican, as were most of the movie’s investors.

 

The Border: Asylum

 

*The CBP One app is designed to facilitate would-be crossers signing up to get themselves in the immigration data system. There are 1,000+ appointments available daily; 40,000 monthly. The person has 23 hours to register and confirmation of the booking is within 23 hours.

 

*More than 170,000 people received appointments in the first half of 2023, 38,000 in June alone.

 

*A federal appeals court judge has given the Biden asylum process at least a temporary green light, shortly after a federal judge had nixed it.

*Asylum judges (who are located in the Justice Department) look at the asylum application and read State Department reports on their home country. Fleeing solely for economic reasons does not make a person eligible for asylum. Some 80% of new arrivals have received decisions within a year; only one-third had lawyers. Migrants have a right to a lawyer, but the government is not obligated to pay them.  There are 70 immigration courts, with an average of 10 judges each. The average time to close a case has been four years. When families cross illegally – unsure whether this is rendered irrelevant with the newer procedures — the head of household is obliged to wear an ankle monitor; the goal is a 30-day decision on whether they can stay or are to be deported.

 

*Regional processing centers have been opened in Colombia and Guatemala. Their objective is to do an initial screening of prospective asylum seekers, including referrals to relevant federal programs. The overall goal of recent changes is to cut the asylum process time to six months. Said cases are 40% of the two million immigration case backlog.

 

*Private citizens can offer logistical and financial responsibility for refugees; a “Welcome Group” must have at least five people and raise at least $2,275 per refugee. Reportedly, more than one million have signed up to be sponsors of migrants from Cuba, Haiti, Venezuela, and Nicaragua.

 

Domestic: Data and Demographics

 

*In 2022, there were 7.3 million visas issued for all categories of people, meaning the breadth and depth of administrative challenges is quite large.

 

*Some 900,000 immigrants became citizens in 2022, the third highest ever and the most in 15 years. About 20% of American households communicate in a second language; in order, these are the leading languages: Spanish, Chinese, Tagalog, Vietnamese, Arabic. It is projected that by 2060, there will be 110 million Spanish speakers in the USA, a number twice the entire population of Colombia.

 

*Around 10% of black individuals in the USA were born elsewhere; including children, they represent 21% of the total black population. On average, they are more educated, with higher incomes and fewer living in poverty. Racial issues are basically the same as those impacting native born blacks.

 

*One-fifth of immigrants come with less than a high school education. Half of immigrants can speak English. Asians represent 37% of recent immigrants; Hispanics, 28%. In 2001, those numbers were 22% and 53% respectively.

 

*Contrary to what might be thought, in recent years, the undocumented count in the USA has stayed flat at approximately 10 million, compared with a peak of 12 million in 2008. New Jersey is one of the six states which represent 59% of undocumented individuals; it has an estimated 475,000 undocumented individuals. Two-thirds of undocumented adults have been in the state for more than a decade. They can now obtain professional credentials, e.g. teacher or nurse.

 

*New York City is home to a half-million undocumented individuals, plus more than 50,000 new migrants (and 50,000 homeless as well). It has about 200 shelters. Immigrants are half the workforce and own half of the businesses in the city. New York has also lost 500,000 legal residents since 2020. Under a consent decree signed by the city, it is obliged to offer housing to all who request it. Reportedly, a NYC resident would have to be making $280,000 pre-tax to afford what a migrant family is receiving.

 

*During the Biden administration, one million migrants have been admitted, including 300,000 who are wearing tracking devices. Some 1.7 million have been turned away. One-quarter of nonelderly legal immigrants have no health insurance, compared with 8% of all Americans.

 

*The USA has a shortage of academic talent; it has one high scoring young person compared with two who score low. Germany has equal numbers in the two categories; Scandinavia has three times as many in the high scoring category and Japan, five times as many. About 70% of American college graduates in Electrical Engineering and Computer/Information Services are foreign nationals.

 

*Without immigration, the working-age population (25-64) will decline in this country.

 

Politics/Economics: Politics

 

*In 1986, President Reagan gave amnesty to 2.7 million undocumented individuals. The memory of this action is implanted in the minds of those who believe people crossing the border on betting on some type of amnesty program, whatever the specific terminology.

 

*President Obama deported 3.0 million people, of whom 1.7 million had no criminal record; Trump’s numbers, counterintuitively, were actually less.

 

*It’s an old number but interesting; in 2016, about 700,000 foreigners who came to the USA and came by air or sea, i.e. were logged into the system, did not leave when they were supposed to.

 

*Perhaps surprisingly, 60% of Republicans and 83% of Democrats support increasing skilled immigration.

Since 2007, family based admissions have been about 800,000 per year; employment-based admissions have been around 150,000.

 

*Work visa renewals now can be done within the USA. ICE has extended work permit expiration dates; there is a backlog here of 1.5 million. It can take a year to get an initial work permit. In 2021, a House bill was passed that would have provided a path to citizenship for one million farmworkers here illegally. The annual 85,000 H-1B visa slots are typically oversubscribed by almost 10:1.

 

*Biden extended Temporary Protected Status through work-related 18-month visas for immigrants from El Salvador, Nicaragua, Honduras, and Nepal. Expiration dates vary; the underlying timelines go back to natural disasters: a 1998 earthquake for the former, a 1998 hurricane for the middle two, and a 2015 earthquake for the latter. The majority of the 400,000 people here under TPS have been in the USA for twenty years.

 

*Place-based visas are part of the immigration system in Australia and Canada. Maybe the USA should consider them: in the latest census, 80% of its counties (a total of 149 million people) lost residents in the 25-47 age group.

 

*Innumerable non-profit organizations are providing pro bono legal help and other assistance to migrants who have been transported to cities far away from the border. It is a thankless task driven by humane considerations; there is neither cohesion of service delivery nor any clarity of future planning.

 

*There are about 700,000 DACA recipients. An estimated 200,000 are teachers and frontliners. The DACA program began in 2012, under an executive order. The Supreme Court decision against DACA was on technical grounds; renewals are happening.

 

*There has been bipartisan support (and close votes in Congress) for a path to legalization for DACA recipients (example: Under the Dream and Promise Act, dreamers could remain for at least 10 years and become permanent residents if they did two years in college or the military or held a steady job), yet nothing happens as the issue is used as an overall immigration bargaining chip by both sides of the aisle. Note that work authorization for the parents of DACA recipients would be an important plus.

 

Political/Economic: Economics

 

*The USA reportedly has 9.6 million job openings, a number far greater than those seeking work; acceleration of temporary work visas would make sense. An estimated 75% of undocumented individuals in the USA are employed, the total number equating to 5% of all those working. (Immigrants represent 25% of the 4.3 million direct care workers in the USA.)

 

*Florida law SB 1718 invalidates out-of-state driver’s licenses given to illegal immigrants, requires hospitals to quantify uncompensated healthcare, and mandates employers with at least 25 employees to use E-Verify to confirm the legal status of hires. There are an estimated 770,000 undocumented immigrants in his state, many of whom work for entrepreneurial businesses: construction, hospitality, agriculture. Reportedly half of its crop farm workers lack status. The question is whether Florida’s on-going economic growth pattern will be stalled. There is initial evidence that this is the case; when an undocumented individual has the capability to choose where to work or live, Florida loses.

 

*While H-1B visas for skilled workers and H-2B visas for unskilled workers are capped, there is no cap on H-2A guest workers. The employer must attest he cannot find local workers for the job. In 2022, there were 300,000 H-2A visas issued, quadruple the rate a decade earlier.

 

*Cross border trade between the USA and Mexico is $1.8 billion per day; 1000 trucks/day cross at Brownsville, Texas; 200,000 cars and trucks daily cross the whole border.

 

*There is a $1 billion pledge by private companies (Nestle, Target et al) to support communities in Central America by assisting farmers, creating textile jobs, and investing in telecom.

 

*The EB-5 green card investment requirement for projects in designated job creation areas has been lifted to $900,000 from $500,000. Elsewhere, the requirement is $1.8 million, up from $1 million.

 

*According to FWD.us, TPS holders contribute $22 billion annually to the US economy.

 

Political/Economic: Legal

 

*California is arguing that the hiring of undocumented individuals, while federally prohibited, is not illegal at the state level.

 

*Noncitizens who entered unlawfully cannot obtain permanent residency even if they have stayed under Temporary Protected Status.

 

*Immigration and Customs Enforcement (ICE) taps a CLEAR data base from utility companies, compiled by Thomson Reuters and Equifax. This is probably not legal in the view of many immigrant advocates.

 

*ICE cannot make arrests in schools, hospitals, churches, daycare centers, or foster care facilities.

 

*A growing number of states have extended driving license privileges to undocumented individuals.

 

*Foreign students who overstay their visas by more than 180 days are barred from re-entry for three years. If unlawfully present for over a year, they are barred for ten years.

 

International: Canada

 

*Canada had been admitting 250,000 immigrants annually on a population base of 32 million, twice the proportion of the USA, Sweden, or Germany. Over half have college degrees. Only 6% of its foreign-born population is undocumented, compared with 30% in USA.

 

*Now, Canada is stepping up its immigration/permanent resident goals, to 1.45 million over a three-year period. In 2022, it took in 437,000 immigrants. Like the USA, Canada has an aging native born population and a large number of vacant jobs.

 

*Canada is openly going after American H-1B visa holders as it seeks to take advantage of layoffs in the tech industry.

 

*Eligibility for immigrants favors higher education and skilled work resumes. Its point system leads to a foreign-born population that is the best educated within the OECD. If accepted to the country, an immigrant is automatically on the path to citizenship.

 

*Seasonal workers (some with specific employer restrictions) who come for eight-month jobs often do so annually for 10-15 years.

 

*There are an increased number of border crossers into Canada, especially on the northern border of the USA. Asylum seekers in Canada can apply for work permits.

 

*Canada is not completely welcoming. It now bars foreigners for two years from buying residential properties in certain cities.

 

International: Other countries

 

*Latin America represents 8% of the world’s population and 1/3 of its homicides.

 

*In Honduras and El Salvador, remittances from those in the USA represent 20% of GDP. In Honduras,

2/3 of its nine million people are considered poor; 25% of families receive remittances. Total remittances from the USA to all countries are $80 billion, one-third of which go to those living in Mexico.

 

*Venezuela is hemorrhaging people, over seven million in total. Colombia has received 2.5 million and the USA, 95,000 (150,000 have been stopped).  Some 400,000 migrants (compared with an average of 10,000 per year in 2010-2020) have traversed the 70-mile Darien jungle between Colombia and Panama, 2,800 miles from the USA.  Indigenous populations in that area now experience contaminated water, garbage everywhere, and not infrequently, dead bodies.

 

*Special programs (up to 30,000 people per month) for Venezuela, Cuba, and Nicaragua allow an immigrant to come to the USA on a two-year work permit if they have a private sponsor. The program has reduced illegal crossings from the latter two, but has had little impact on the former.  About one-third of households in Venezuela relay on remittances to survive.

 

*Developed countries are bidding for foreign workers; the world would be richer if poor people migrated to the former locations. At the same time, different developed nations are implementing tough anti-migrant measures. Political pressure is on mainstream parties from the growing influence of those to their right. Part of the political perception is a widespread fear that the type of immigrant coming to, e.g., a country in Europe, is not the skilled, at least semi-educated profile that is desired. Businesses may like lower wage entrants but the populace in general does not, and neither regards current policies as being structural resolutions.

 

*Germany is shortening the time needed for immigrants to get credentials as its 84 million population base is aging and not growing.

 

*In 2022, five million more people moved from less affluent to more affluent countries than vice-versa. This is 80% more than the pre-pandemic level. The United Kingdom’s net gain was 600,000, a record.

 

*The European Union has sent considerable funds to Tunisia, the purpose being to assist that country in handling immigrants from and passing through Tunisia.

 

Closing Comment

 

The USA is the only country in the world destined to be comprised of multiple minorities. Kudos!

 

At the same time, net immigration is providing all the population growth in the USA. Thus, agreement on immigrant policies is mandatory to (a) avoid a continuation of the current chaos at the border and in the system overall and to (b) establish something resembling stability in the specific approaches being implemented by the multiple government agencies involved with immigration.

 

Bringing DACA recipients into the fold would be a good step one. Providing temporary work visas for as many entrants as feasible would be a helpful step two. Adding resources to the asylum judge system is a necessary step three.   

 

Politically, there must be a two-party explicit recognition that a defensible border Is a necessary component of any immigration policy package. Both must sign off as well on a legitimate border being meaningless without other measures to make the immigrant a welcome addition to this country.

 

 

For a quarter-century, I have been baffled by the quixotic communication pattern of people in all walks of life, representatives of every income and ethnic and religious category. What is with them, not having the time or courtesy for a simple e-mail requiring at most sixty seconds to answer a question? And what is there to make of a student who is simultaneously requesting grant support and not responding expeditiously to a request from the checkwriter?

Split families, sexual identity questions, mental and physical health problems, job frustrations, romantic entanglements, fatigue from working two jobs, documentation issues, irritating professors, dishonest friends, pressure from being an only  child, pressure from being the younger sibling of a successful older brother or sister who are perpetually put forth as role models, transitional difficulties in going from a small town to urban America, cultural adjustments of all kinds, a realization that everything prior to a first real career job is in some sense encapsulated in a bubble – I get it, lots going on — but no time for providing a minute’s worth of information that completes the decision-making loop?!

It is not as if the desire for communication is rooted in a quest for a specific positive outcome; it is simply a desire to know, “what is happening, what is going on with respect to what you indicated about your path (which included financial support, either in fact or projected from the fellow, me, who needs the communication).  Note that whenever a young person has asked what I expect from them, my answer has always been, “be the best you can be for yourself.”

Disingenuous communication is definitely not a goal, nor is a collection of words which drain the energy of the recipient, annoyed that the information feedback loop remains frustratingly incomplete.

Non-communication situations come in multiple varieties, but what do I make of Kalvin, seemingly (hopefully) a true outlier.

It seemed to be going okay from the initial interaction through the first three years of college, then radio silence. No response to any type of communication short of carrier pigeons. A policeman friend did a wellness check. Yes, Kalvin was alive.

Not long thereafter, we re-connected. In short order, we had set up a time for a one-hour phone call every other Tuesday.  All good, or so it seemed for several months through graduation.

And then, without a hint of negativity about our conversations, nor with a heads-up regarding a need for substantive change, radio silence returned.

This time, my attempts at finding out the “why” behind Kalvin’s action were supplemented with indirection. Besides every conventional attempt to connect, I mailed books (ones I had read and believed would be of interest to Kalvin) to his home and I even placed a book in his mailbox. When I saw on LinkedIn that he had landed a position with a non-profit agency in New York City, I commented that it was great to see he had found meaningful work, his longstanding goal.

 I know people are videos, not snapshots, but I had interacted with Kalvin for five years. What happened?

 Yes, juggling all the oranges of life (or are they more like bowling balls on occasion) is a challenge for any young person. But wait, that is true regardless of age. Help!

 (Explanatory suggestions/guesses as to what might have happened are hereby solicited.)

 

 

Having fun at a dental office: meet Dr. Zoltek and her exemplary staff

Whoa – do not misinterpret – this is not fun derived from mindless run-throughs of Tik-Tok clips or Instagram inanities. To the contrary, this is extremely high quality dentistry delivered in an atmosphere of camaraderie that in my experience is unique in a dental practice.

An émigré from Poland, Dr. Z graduated first in her class at UMDNJ. She is a solo practitioner  — if that is stereotypically construed as a high and mighty dentist barking out orders to assistants and dental hygienists, you again would be totally wrong. I have never seen such pleasant and productive interaction among staff and patients – there are more pleases and thank yous and smiles here than anywhere seen elsewhere in a normal day’s interaction in our unhappy society.

At the desk, Sheila greets you by name and you feel like you have entered into a positive environment; there is no portal, nothing technological to get in the way of you and the human providers of the service.

Rachel or Victoria takes you to the room where it will all happen, chats pleasantly (nothing forced), interestingly and intelligently with you and gets your ready for whatever procedure Dr. Z. is to perform.

Dr. Z. enters the operatory, hair sometimes askew — representing freedom in my view. Perhaps her agreement with my characterization reflected the fact that it took her ten years and an untold amount of paperwork to become a citizen. She is smiling and ready to go on a process, e.g. a filling or a crown or whatever is needed, any of which will involve multiple instruments and much back-and-forth with her highly capable assistant.

(OK, I admit it –there is part of your brain that does not let you forget that you are about to experience a bit of discomfort, more than a bit if you allow yourself to think excessively about that drill entering your stretched out mouth.)

Dr. Z. believes that the mouth is the gateway to multiple diseases. Before having surgery of any kind, she strongly recommends seeing Debbie, the office’s excellent dental hygienist, for a cleaning.

While your mouth is stretched open, you may hear Dr. Z. express her disdain for much of the medical establishment. If you agree, a thumbs up is in order and vice versa; your ability to be articulate nuance is rather hampered by everything that is going on in your mouth.  The same messaging system is used to answer the question of whether pain is being inflicted, any pain from the procedure that is, not the agony which is relevant to any analysis of our screwed-up healthcare system.

As Dr. Z. examines her handiwork, at times it brings forth the image of a sculptor (and not an inexpensive one). You often hear her exclaim, “that’s beautiful” or “perfect.” For sure there is ego involved in such admiration, but her appraisal is not done in an egotistical manner.

On my most recent visit, a person departing the office said to Dr. Z., “I will follow you to the end of the earth.” Presumably he was not a stalker but a highly satisfied patient. Not a bad recommendation, easy to put in a radio spot, on a billboard, or bumper sticker or website.  Well-deserved for sure!

Please note: this write-up was done by a human; there is nothing artificial about the intelligence expressed!

 

 

 

This is an essay about what you cannot buy at a store or anyplace else. Faith Hurtado (14) and Bob Howitt (considerably older) wrote alternating sentences about the capitalized words.

 RESPECT can’t be bought but is earned and not always deserved.

Nobody can buy PASSION because it is something that is within a person.

ANIMALS, although they are adorable, most are meant to be free running in the sun. Happy in the wild.

People may define individual EQUALITY differently. All agree it is impossible to purchase at a store

HUMANS can’t buy humans. They aren’t tools, toys, or objects. Especially not in a store. That’s cruel.

The DEAD cannot be purchased or disturbed except if they have designated organs to be donated.

LOVE can’t be bought. Sometimes, we have to accept it. Sometimes we lack it. Sometimes we lose it. Sometimes we demand it. Can’t be bought.

MONEY can be bought but first you need money that you earned and did not buy.

STABLE MENTAL HEALTH, though at this point, it seems no one has it. You can’t buy it.

HAPPINESS is defined by each individual for themselves. It cannot be bought, even though people sometimes think so.

OPINIONS can’t be bought. Especially because they come in all varieties. Some that should not be respected, some that could change the world.

CURIOSITY is a great characteristic, of limitless value and not available for purchase on Amazon or at the mall.

JUSTICE is something you fight for. Unfortunately we can’t buy it because there’s too much we need to fight for.

VALUES like honesty or thoughtfulness or reliability come without a price tag. No store can sell them to you.

 

 

 

 

“Let’s have lunch at Brewpub.”

When a woman who loves you makes a restaurant suggestion, you oblige without hesitation. It does not matter whether you have driven three miles or three hundred to reconnect after a lengthy period of being out of touch.

So we got in my car and drove the five minutes to the Brewpub. I’m not sure which was a stronger prop for her, my arm or the serious walking stick that had become her companion. We each had a beer (of the root variety); she had a Vermont Panini and I had a Cobb salad.

Our conversation was wide-ranging, beginning with a rundown on what family members were doing and continuing to a variety of issues, each lightly touched upon. The comments noted below, not individually ascribed, are representative of our topical interaction. If students of all ages had similar curiosity and interest in the other person in a conversation, it would be a step forward.

*The Supreme Court should have limited terms for the justices, maybe 20 years. Clarence Thomas is the most despicable man around, and his wife is worse. This animosity stems from the Anita Hill testimony.

*To succeed on Wall Street, one must work hard, read a lot, be curious, have a bit of luck, and regard the job as fun.

*Regarding immigration, people living on the border have a different perspective than those elsewhere in their comfortable surroundings.

*Biden is okay, especially considering his opponent. It is sad that neither party has identified a strong alternative candidate.

*Books being read included “War Diary,” “Paved Paradise,” “Lessons in Chemistry” and many others courtesy of Alexa.

*Tennis, her favorite sport of prior years, is on display at Wimbledon, a wonderful tournament.

Our extended conversation culminated with truly personal memories as she referred to her late husband (he passed in 2015; an exemplary teacher, his name was on a school scholarship for deserving students) and the many enjoyable trips they had taken together. She reminded me of my “walkabout” in my prior marriage and I remarked how fortunate it was that my ex-wife and I are friends.

It is July 17; 2023. HAPPY 97^TH BIRTHDAY, AUNT MURIEL!!! LOVE, BOB

 

Portals and Moral Injury

It was inevitable.

When my local physical therapy company was sold to MegaTherapy, Inc., the first order of business was a requirement that I fill out a patient portal. So now I will vent.

Could somebody demonstrate how the corporatization of healthcare, here represented by information portals, has contributed to patients being healthier? The incessant drive for efficiency, as measured by units of service, adjusted for value as determined by MegaInsurance, Inc., has depersonalized the relationship of healthcare provider to patient.

My primary doctor is in a small practice.  Any errors regarding the portal are of no consequence to either her or her office as administrative and financial functions have long since been outsourced – for efficiency of course. It took me a year and a direct conversation with a corporate computer geek to get information deleted which indicated I was seeing a pediatrician!

Speaking of my primary, I am unsure: can her input on my meds be overruled by MegaPharmacy? When I go to pick up my drugs, can MegaPharmacy both inform me that the manufacturer of X is shutting down the product line and render an opinion that Y is basically the same drug – without any discussion with the doctor?

Patient portals plus outsourcing of everything possible combine to sever the desired holistic relationship  among the healthcare provider, their office, and the client/patient. Instead of being concerned about the effectiveness of healthcare, the system is fixated on efficiency, the latter a term highly correlated with immediate bottom line enhancement. If you go through all the layers of healthcare, an observer might conclude that It is beneficial to the “medical-industrial” complex for people to remain sick.

**

I am always challenged to convince my perpetually skeptical daughters that the old man actually is not alone in his critique of healthcare, even if portals are not exactly the focus of any debate.

Consider the following points and ask yourself: do they make you more or less comfortable as a patient?

From a lengthy article in the New York Times Magazine of June 18, 2023:

• 70% of doctors are salaried employees of large hospital systems or corporations
• 30% of the staff in emergency rooms are employees of private equity firms
• Emphasis on speed, efficiency, and relative value units (RVU) encourages more tests and procedures while discouraging listening and talking time with the patient.

“Doctors must operate with a clear sense that they are serving the patients in front of them, not the government, data-collection systems, insurance companies, or hospital directors.” The overall result when they cannot do so is called “moral injury” (a term coined by psychiatrist Jonathan Shay), afflicting healthcare personnel who are unable to provide what they believe is medically appropriate service.

To be fair, there were two positives cited in the article: modest growth in the number of doctors who are providing direct service and a lawsuit in California against a private equity provider of healthcare, which seemed to be in direct violation of a state statute.

**

More ammunition for those who wonder about healthcare delivery comes from a Wall Street Journal article of December 30, 2021: “The Doctor’s Office becomes an Assembly Line.”

According to the author, Devorah Goldman, in 2018, 46% of doctors owned their practices, down from 75% in 1983. For the first time, less than half of doctors work in private practice.  Kathleen Blake, AMA vice-president of healthcare quality was quoted as saying that “hospital acquisitions of private practices doubled from 2012 to 2018, the result being modestly worse patient experiences and no significant changes in readmission or mortality rates.”

**

Healthcare ownership trends are particularly untimely because demographic change will bring more minorities into the ranks of doctors and physician assistants in particular. Minority patients will seek them out and want to interact longer than the standard insurance time allotments. Research on socioeconomic determinants of illness adds to the logic of medical personnel needing more time with patients, not less.

**

As one critic put it, “doctors no longer see patients, they see pathologies.”

In time, perhaps there will be an informational implant on our arm and a bar code on our behinds — they will provide patient information to the anonymous medical staffer who will then click on the correct box under robotic procedures –simultaneously sending the billing code to MegaInsurance. Before you get to your car, your portal will have pinged you with the cost of the procedure. Payment due in thirty days.

Very efficient!

**

Did I mention that my password at MegaTherapy is “Iloatheportals.”

**

Yes, I am ignoring the impact of AI/ChatGPT. Maybe on another day, I will tackle the complexities it brings to healthcare. Or not.

**

Not to be negative, but according to the World Health Organization, the United States is less safe than Russia in terms of its maternal-mortality death rate: 21.1 per 100,000 live births versus 13.7 in Russia.

 

serious, trivial, comical, sarcastic … and in no order whatsoever!       

*President Biden can shrug off kids being slaughtered, saying “I can’t do anything about it.” Meantime he is attempting to cancel student debt by using his executive authority.

*Is it fair that snow should be white, completely absent of diversity?

*Will the United States Constitution be declared null and void, given the profiles of its writers?

*Why should a King beat a Queen in cards?

*No replays of controversial decisions in any sport should last more than two minutes. If no change is agreed upon within 120-seconds, the original decision stands.

*If Trump goes to jail for paying a porn star, will Hunter Biden be his roommate for his legal infractions.

*NILs bring honesty to the corrupt business of college athletics.

*Baseball rule changes have made it almost impossible to read a novel between pitches.

*Advertising is now sometimes seen between foul shots in basketball, serves in tennis, and VAR decisions in futbol … and everywhere else.

*Gambling is omnipresent; what are the odds that I will finish this bit of inspiration and post it.

*Ya gotta love it. The “New York Times Sunday Magazine” brings tears to your eyes with its article on yet another social ill, with the extended essay interrupted by ads for multimillion dollar condos.

*Why is an athlete incurring a debilitating injury treated as a hero while a company employing hundreds of people is frequently regarded as an exploiter of people and the environment … and a tax cheat.

*If referring to a person with excess poundage as being f… is no longer permissible, can we mention rates of diabetes or heart disease.

*Many years back, I proposed a series of rules for soccer in order to increase its appeal to points happy, immediate gratification Americans. Suffice it to say, nothing happened. And yet the American soccer league, MLS, has grown in popularity, not because of open immigration but because millennials have adopted it as a nice social experience, more wine than beer in nature. Fearing that this current love affair may not age well, I hereby propose changes exclusively geared to points. (Please don’t throw things – even Pique wants some alterations in his lifelong sport.)

Run-of-play goals:   2 points; 3 points if the shot is taken from beyond the 18-yard box. Like the NBA. Penalty kicks: 1 point. More than half the time, penalties do not reflect clear-cut referee/VAR decisions.

*The Premier League, among others, has a system called “Relegation.” It basically says to a bunch of poor teams, get away from us, become better, and maybe you will have a chance next year to play at our level. Typically, the managers, aka coaches, are fired. Wouldn’t this be a good system for all major sports, both the relegation and the automatic firing. Think of the reduction in sports talk radio nonsense as the talking heads no longer would need to speculate about both the team and the manager.

*How does it happen: Democrats, supposedly home to all minorities, continue to receive large funding from teachers unions which act against the educational interests of minority children.

*Is hypocrisy better than no values at all!

*I forget, what is the latest scientific finding – is coffee now okay and wine not, are both okay if accompanied by incredibly dark chocolate?

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