Saturday, January 14, 2017

100 Days, Opiods, Rep. Lewis and Sen. Rubio. Senseless, Dope Epidemic, An Impediment, An Immature Grandstander.

Yesterday Trump made an interesting comment when challenged  about the testimony of several of his appointees whose views differed from his own.

The media focused on the prospect of conflict and Trump replied he was not seeking yes men and was delighted they  spoke their mind.

Time will tell whether he meant it but it was a refreshing response to more "gotchas" from the mass media who have lost all respect and whose standings are below that of Congress.

Several memos ago I raised issues questioning why the first 100 days was such a big deal and then I talked about the opioid epidemic.  The WSJ had articles today about these matters. (See 1, 1a and 1b below.)

Most Nations that fall do so from without and most societies that fail do so from within.  America faces many challenges: economic and military, Because of our decline in education, our inability and/or lack of desire to control our borders, the spreading opiod epidemic, civil dissension and threat of terrorism the cost upon our government mounts.  As our debt grows the ability to address pressing issues also becomes a mounting concern..

Stop and think how much radical Islamic terrorism costs us just in protecting domestic transportation (particularly air travel) alone.  Add to this burden the assumption of illegal immigration costs for education, health care and crime and then figure in the cost of narcotics and it should begin to dawn on you why we cannot spend what may be required to rebuild our military and take care of our own legal citizen's health needs.  I have yet to mention rebuilding rotting infrastructure.

If we do not begin to rationalize the costs and construct solutions the internal pressures on our society will simply deteriorate our way of living and this is a simple fact.

Making America Great Again, in my humble opinion, is not within range until we first apply a tourniquet to the bleeding that is sapping our strength, diminishing  growth of our GDP and leading to unemployment.

These are the realities we face as a society and unless the politicians decide saving America is more important than saving their perks, jobs and opposing the opposition just for the sake of being obstructionists the ship of state will take on more water.

This is why the hour, in my opinion, is late and why Trump was elected to drain the swamp and put the train back on the tracks. This is also why I believe the anti-Trumpers need to start acting like adults and climb aboard. That does not mean they have to remain silent , that does not mean they cannot propose better ideas, if they truly have any, but it does mean Representatives like Maxine Waters and John Lewis and others of their ilk need to rethink their divisive messages. They  need to stop throwing IED's in Trump's path and give him a chance.  If they cannot bring themselves to co-operate then hopefully the voters will decide what to do about them when they come up for reelection and put an end to their cackling.

While I am on my platform, I want to be balanced and call Sen. Rubio for trying to be an irritant. Demanding that the incoming Administration brand Putin a "war criminal" is immature grandstanding.  We all know Putin is a thug but as long as he remains the one leading Russia and we have to deal with Russia what is to be gained?

If Rubio believes his being the sand in Trump's gears is going to advance his career and he will get credit for pointing out the obvious he needs to stand in the corner and write on a black board "grow up" a thousand or more times.

What possible purpose will it serve for Tillerson to sit across from the man he needs to negotiate with after calling him a war criminal?

Shrink your ego Rubio!

The Legend of the President’s First Hundred Days

Franklin D. Roosevelt invented the idea of an activist sprint from the start of a presidency, and many of his successors have followed his example. Will Donald Trump make his own early splash?


What will Donald Trump’s first hundred days bring: surprises, achievements, catastrophes? A slow, steady warm-up?

History can’t predict the mix, only offer a range of possibilities for the 45th president. For Mr. Trump, the range is wider than usual because he comes into office untethered by a record and uninformed by experience.
The initial “hundred days” as a distinct period in a presidency was first used to describe the special session of Congress called by Franklin D. Roosevelt in March 1933. It set the template for the opening act of an activist administration: a president and his allies (really subordinates) in Congress passing a bold program to address a crisis. The president, if not the program, is then enshrined in myth.
Roosevelt’s crisis was the Great Depression, which had festering for 3½ years. Unemployment was over 20%, and the banking system had collapsed. In his inaugural address, Roosevelt said, “This nation asks for action, and action now.”
Between March 9 and June 17, Roosevelt signed into law a heterogeneous package of initiatives. The Agriculture Department would pay farmers not to plant crops. The Civilian Conservation Corps would pay people to plant trees. The Federal Emergency Relief Administration was designed to oversee welfare programs, the Tennessee Valley Authority to build dams and supply electricity in a backward part of the country. The National Industrial Recovery Act gave the president sweeping power to regulate the economy.
These measures were delivered by a Congress with Democratic super majorities in both the Senate and the House. There were ideological super majorities too, since conservative Southern Democrats prone to balk at radical reform were offset by progressive western Republicans raring to go.
A crucial feature of Roosevelt’s program was the aura of myth he spun around it. The presidency, he had told a reporter during the campaign, “is more than an engineering job…. It is pre-eminently a place of moral leadership.” Roosevelt’s rhetoric fulfilled this mandate. It was simultaneously patrician and populist, devout without being sectarian, urgent without ever committing him to too many details.
His looks and his voice did the rest. His sunrise smile shone through photographs and newsreels, and he addressed the country in 15- to 30-minute radio broadcasts, the fireside chats. Speechwriter Sam Rosenman described the tone of Roosevelt’s chats as “an informal conversation with one or two of his friends.” Roosevelt delivered three of them during the spring and summer of 1933, telling Americans “what has been done in the last few days, why it was done, and what the next steps are going to be.” In his third chat on July 24 he christened the legislative spurt that had just ended “the crowding events of the hundred days.”
Over the years, Roosevelt’s mythmaking would be reinforced by admiring bards and court historians, from Archibald MacLeish to Arthur Schlesinger Jr. But his main mythmaker was himself.
A few unfortunate presidents have been so bombarded by disaster that they hardly had time for thought or planning, much less slipping into the job. Seven states seceded between Abraham Lincoln’s election and his inauguration; four more bolted during his hundred days. One grim morning in April 1861, as he desperately awaited the arrival of loyal troops in an undefended capital city ringed by secessionists, he complained, “I don’t believe there is any North.”The sprint from the starting line is not the only model for beginning an administration. Most presidents before FDR spent their first hundred days feeling their way into the job—none more consequentially than George Washington in 1789. Washington could consult the new Constitution for the legal specifications of his new office. But a constitution is not a flesh-and-blood example. Should a president shake hands at receptions? Should he seek the Senate’s advice on treaties by going to the Senate himself and asking for it? No one knew. Washington had to answer such questions day by day himself.
But FDR’s example inspired his successors, chiefly Democrats hoping to join him in the liberal pantheon (and in the winners’ circle of re-election landslides)Bill Clinton in 1993 faced no true crisis. His predecessor, George H.W. Bush, had presided over a recession that was already beginning to lift by the time of Mr. Clinton’s inauguration. 
But Mr. Clinton had ambitions and sizable Democratic majorities in Congress. He tapped into myth by taking a bus to his inauguration from Monticello (the bus had been his signature campaign vehicle, and Jefferson was his middle name). Fellow baby boomers in the press hailed him as a generational transformer.
Five days into his term, he made his bid for greatness by announcing a task force on comprehensive health-care reform, to be chaired by Ira Magaziner and Hillary Clinton. “I am certain,” Mr. Clinton said, “that in coming months the American people will learn—as the people of Arkansas did—just what a great first lady they have.”

Barack Obama signing two executive orders on Jan. 26, 2009.
Barack Obama signing two executive orders on Jan. 26, 2009. PHOTO: LARRY DOWNING/REUTERS

Barack Obama in 2009 faced real hard times—a crisis of the financial system. Congress 
and his predecessor, George W. Bush, fearing a second Depression, had already passed a 
$700 billion bank and credit bailout the year before. Mr. Obama, enjoying Democratic 
congressional majorities as large as Mr. Clinton’s, saw and raised with a $787 billion 
stimulus bill in February. In April and May (to stretch the hundred days a bit), Chrysler 
and General Motors filed for bankruptcy, setting up the auto bailout of July.

Unlike FDR and Mr. Clinton, Mr. Obama also made dramatic foreign policy moves. “I 
am not opposed to all wars,” he had declared as early as 2002, only “to dumb wars,” by 
which he meant the war in Iraq. He began withdrawing American troops in February and 
announced that he would not stop. “Let me say this as plainly as I can: By August 31, 
2010, our combat mission in Iraq will end.”

Republican presidents have tended to eschew the dramatics of the first hundred days, 
sliding calmly into office. George H.W. Bush in 1989 was encouraged to go slow by 
temperament, politics and timing. During his campaign, he had promised a “kinder, 
gentler nation.” Democratic majorities in both houses of Congress imposed caution, if 
not kindness, upon him.

And global upheavals beyond his control forced him into a spectator’s role. During his 
first hundred days, Poland’s Communist government legalized Solidarity, and Chinese 
students began protesting in Tiananmen Square. China’s liberation movement would be
drowned in blood, but Eastern Europe’s would topple a half-dozen Soviet satrapies and 
the Berlin Wall before 1989 was over.

George W. Bush, though a brasher man than his father, also came into office in 2001 
speaking softly. Minute Republican majorities in Congress—a Senate dependent on Vice 
President Dick Cheney’s tiebreaker and a 10-vote margin in the House—restrained him. 
The signature proposals of his first hundred days—the Office of Faith-Based and 
Community Initiatives and the No Child Left Behind Act—were small-bore welfare 
programs wrapped in social-conservative rhetoric.
Ronald Reagan used his hundred days to focus on the economy.
Ronald Reagan used his hundred days to focus on the economy. PHOTO: NEWSWIRE/GETTY IMAGES

Among recent Republicans, only Ronald Reagan in 1981, perhaps reflecting his youthful 
admiration for Franklin Roosevelt, adopted the Democrat’s model. Reagan faced a 
double crisis: stagflation at home and communism on the march abroad, from 
Afghanistan to Africa. He used his hundred days to focus on the economy, proposing to
cut tax rates and the rate of growth of the budget.

Although Reagan enjoyed a partisan majority only in the Senate, he worked with 
conservative House Democrats. His budget and tax packages would not pass until the 
summer, but his advocacy during the hundred days was vital to their success.

What Reagan excelled at, more than any other president since Roosevelt, was making his 
own myth. If Roosevelt was the patrician reformer, Reagan was the small-town optimist. 
A veteran of radio, Hollywood and what he called the mashed-potato circuit, he knew
 how to project his personality via the camera and the mic. As a speech maker, he was a
 master of quiet beginnings, holding himself back to draw his listeners and viewers in.

The first hundred days do not necessarily forecast the rest of a presidency. Roosevelt 
found the Depression hard to subdue. Reagan’s budget and tax cuts were followed by a 
recession. Mr. Clinton’s health-care task force ground to failure by the summer of 1994. 
George W. Bush’s compassion agenda was shoved aside by 9/11.He was helped by a near
-death experience. John Hinckley’s assassination attempt outside the Washington Hilton 
Hotel on March 30, 1981, was a command performance that no screenwriter would have 
dared to invent. Rushed to George Washington University Hospital, Reagan insisted on 
walking into the emergency room by himself even though he had a bullet in his chest. 
Inside, he cracked jokes. “I hope you are all Republicans,” he told the surgical team 
before they operated on him. “Today, Mr. President,” the lead doctor, a Democrat, 
assured him, “we are all Republicans.” Woody Allen famously said that 80% of celebrity 
is showing up. One hundred percent of leadership is showing up, and saying or doing 
the right thing.

Skillful presidents recover from such reverses. Roosevelt became a heroic wartime 
leader in his third term. Reagan’s recession gave way to a roaring recovery. Others 
muddle along.
President-elect Donald Trump speaking at a news conference at Trump Tower on Jan. 11, 2017.
President-elect Donald Trump speaking at a news conference at Trump Tower on Jan. 11, 2017. 

What does this mean for Donald Trump’s first days in power? He faces a number of 
crises, more inchoate than Reagan’s or Obama’s, but nagging. The economy has 
recovered slowly since 2008, and Americans are not happy with it. Bad actors roam the 
world, from lunatics (North Korea) to old rivals (Russia, China) to rampaging jihadists.

Trump has solid Republican majorities on Capitol Hill—52-48 in the Senate, 241-194 in 
the House. But will all Republicans always be in his corner? The Freedom Caucus in the 
House, which claims to represent the spirit of the Tea Party, has some 30 members.
“Freedom” is a word Mr. Trump seldom uses and hardly seems to know. Yet these 
congressmen represent districts that were solid for Mr. Trump in the fall. Will they 
follow their principles or their leader?

The great question mark is Mr. Trump’s program. His only policy preference of long 
standing is to be tough on trade; he was saying so in the 1980s, when the free-trade peril 
was Japan, not China. Curbing immigration was such a central issue in his campaign that
he could not backtrack on it without shame. Every other position he has taken or pledge
he has made is written on air, unsupported by a record of advocacy or evidence of thought.

Mr. Trump’s greatest strength, and potential weakness, is his skill as a myth maker. The 
cartoonist Scott Adams, who predicted in 2015 that Mr. Trump would win the presidency
in a landslide, speaks of his power to persuade by insistently repeating large and simple
ideas. In his late 60s, Mr. Trump mastered a social medium, Twitter, that is dominated by
 younger people—not in the spirit of moms posting adorable GIFs of their kids but with 
the uninhibited brio of gamer guys or high-school mean girls.

Can he keep it up? As an old man, John Adams wrote that George Washington had 
possessed “the gift of silence. This I esteem as one of the most precious talents.” The gift 
of silence allows a leader to conceal his purposes and forces opponents to reveal theirs. It
gives the public a chance to catch its breath. Mr. Trump may come to regret that he never
acquired it.Mr. Trump is a master of the effects of words, of how they amuse and wound;
of the meaning, not so much. Since there is always another tweet coming, who cares 
what the last one said? That works for an entertainer, or even for a politician whose only 
concern is hogging the limelight—but not for a politician who wants to leave a legacy.

My instinct about Mr. Trump’s instincts is that he will want bold strokes soon. Start 
building a fence, if not a wall. Talk up infrastructure, even if no plans are in place yet. 
Nominate a surprising Supreme Court justice (Ted Cruz?). Make splashy, friendly trips 
to Israel, to Britain (in need of friends post-Brexit) and, if not to Russia, to some in-
between rendezvous with Vladimir Putin, for a possible deal: You take Ukraine, the West
keeps the Baltics, and together we’ll bomb Islamic State.

Mr. Trump’s first hundred days are harder to predict than any other president’s because 
he is unprecedented. Every previous president had held a position of public responsibility
, either as a politician or a general. Donald Trump, uniquely, has no experience of 
leadership, and we have no experience of him leading. He doesn’t yet know what he is 
doing, and we have no way of knowing what he might do.

Cheer up—after the first hundred days, there are only 1,361 left.Mr. Brookhiser is a 
senior editor of National Review and the author of “Founders’ Son: A Life of Abraham 


Push to Protect Addiction 

Treatment Under Health Law Is 


Lobbying effort aimed at Republican legislators in states hit hard 

by the opioid crisis


Advocates for substance-abuse treatment are hoping to protect the insurance coverage
 provided by the Affordable Care Act by lobbying Republican legislators in states hit hard by the opioid-addiction crisis.The advocacy groups aim to “start educating legislators” on how a repeal
of the ACA, without a replacement plan to preserve coverage, would undermine efforts 
to address a public-health crisis that has become a major political issue, according to 
Gary Mendell, founder of Shatterproof, a New York-based nonprofit that lobbies for 
legislation to fight addiction.

Shatterproof, which plans to spend $300,000 on the campaign, is working alongside the 
National Council for Behavioral Health, a Washington, D.C., organization that represents 
the interests of 2,800 providers of mental health and addiction treatment.

Widespread abuse of powerful opioids, such as heroin, fentanyl and prescription 
painkillers, has pushed overdose death rates in the U.S. to all-time highs, hitting many 
states in Appalachia and the Northeast particularly hard.

The ACA increased access to substance-abuse treatment in several ways, including by 
giving states federal funds to expand health-care coverage under Medicaid, the insurance
 program for low-income Americans. Even before the ACA, Medicaid was the largest
source of funding in the U.S. for mental-health care, including substance-abuse treatment, according to the Robert Wood Johnson Foundation.
The ACA also helped other Americans buy insurance through government-run exchanges and required that these insurance plans cover certain “essential health benefits,” including substance-abuse 
The lobbying effort plans to focus on Republican legislators in eight states identified by 
researchers at Harvard Medical School and New York University as having experienced 
high opioid-addiction rates and wide expansion of insurance coverage under the ACA: 
West Virginia, Maine, Pennsylvania, Tennessee, Ohio, Nevada, Alaska and Arizona.

Those states are likely to get hit hard if the ACA is repealed without a comparable 
replacement plan, Mr. Mendell said.
The researchers published data this week estimating that 2.8 million Americans with 
substance-abuse disorders would lose some or all of their insurance if the ACA is 
repealed. They said about 220,000 of these are addicted to opioids.
The researchers estimated a repeal would withdraw at least $5.5 billion annually from 
treatment of mental-health conditions, including substance abuse. A group of 
Democratic senators issued a press release promoting the research and warning that an 
ACA repeal would “pull the rug out from under” efforts to combat opioid addiction.
In an email this week, the National Council for Behavioral Health asked the treatment 
providers it represents to write their members of Congress to oppose an ACA repeal. The
email included a letter template asking legislators to “protect our nation’s most 
vulnerable patient population and preserve their access to treatment.”
Linda Rosenberg, CEO of the council, said the group also will target Republican senators
 who have been outspoken about the need to address the opioid crisis, including Rob 
Portman of Ohio and Roy Blunt of Missouri.
“The skyrocketing costs of Obamacare are hurting families and small businesses all 
across Ohio,” Mr. Portman’s spokesman said in an email Thursday. “Senator Portman is 
committed to ensuring there is a smooth transition for all Ohioans to a better health-care 
system that also addresses key concerns about opioid addiction, mental health care, and 
other important issues.”
Mr. Blunt said in an email statement: “The Affordable Care Act did not live up to its 
promises, including the promise of affordable coverage. As chairman of the 
Appropriations Subcommittee that funds opioid treatment and prevention programs, I 
fought to successfully increase funding to combat the opioid epidemic.”
He added, “I will continue to work on a replacement plan that prioritizes access to 
treatment and prevention programs.”
Write to Jeanne Whalen at

1b)How to Treat an Opioid Epidemic

Addiction isn’t an illness like any other. Patients need not just the 

right medicines but therapy, support and, in some cases, tough 


Politicians and health agencies are deeply concerned. They 
overwhelmingly call for a “public-health approach” to the epidemic, 
emphasizing treatment with anti-addiction medications. As the U.S. 
surgeon general recently implored, it’s time for us to view addiction “not 
as a moral failing but as a chronic illness.”
As a psychiatrist who has treated people addicted to heroin for more than 
25 years, I endorse treatment over punishment. But the medicalized 
rhetoric of the public-health establishment—namely, that addiction is a 
brain disease in which neural circuits are “hijacked” by drugs—
oversimplifies the problem.
Consider an addict’s typical course of treatment under this approach. A 
young woman—let’s call her Kristy—is found curled up on the floor of a 
supermarket restroom, passed out with a needle still in her arm. Emergency
 personnel rush to the scene and quickly administer Narcan, a nasal spray 
containing a fast-acting opiate antidote called naloxone. A few minutes 
later, Kristy sits up, coughs and looks around hazily.
A drug user takes a needle before injecting himself with heroin on March 23, 2016, in New London, Conn.
A drug user takes a needle before injecting himself with heroin on March 23, 2016, 
When taken to the emergency room after being revived, Kristy may simply 
bolt before any referral to treatment can be made. The siren call of the next 
fix is strong.
Let’s hope, instead, that Kristy, frightened by her near-death experience, 
does want treatment. The emergency-room clinician would refer her to a 
local physician or an outpatient clinic, where she is likely to be offered a 
popular anti-addiction medication called buprenorphine, or “bupe.”
As an opioid drug itself, bupe is a pharmacological replacement therapy, 
like methadone, the classic anti-addiction opioid medication. It prevents 
withdrawal symptoms and suppresses drug craving, and usually comes as 
a filmstrip that dissolves under the tongue.
Bupe has some clear advantages over methadone. Its chemical properties 
make it less risky if taken in excess. And unlike methadone, which must be 
dispensed in clinics tightly regulated by the DEA, bupe can be prescribed 
by any qualified physician, who can refill a month’s worth of the drug from
 his or her office.
Another challenge to recovery is dropout. Despite the heartache that addicts
 cause themselves and others, ambivalence surrounding quitting is great, 
and premature termination of treatment is common. Attrition rates of 40%
 to 60% within a few months of admission are typical in treatment programs. Less time in treatment means that addicts have less time to learn recovery strategies, like identifying the specific circumstances in which they are most vulnerable to craving the drug.Some patients do very well with bupe, but there are problems. Too many patients continue to use illicit opioids while using the drug. Federal guidelines recommend that those taking bupe receive routine urine toxicology screening (for illicit drugs) and behavioral counseling, but overseeing such a program is a lot to ask of busy primary care doctors, who are the usual prescribers.
Rushed treatment in the office of a primary-care doctor also means less attention to fixing the often broken lives of addicts. Healing family rifts, reintegrating into the workforce, creating healthy social networks, finding new modes of fulfillment—all are imperative, but they 
take time and focused therapeutic care.
The unstructured setting of a doctor’s office can lead to the abuse of bupe 
itself. Sometimes patients cut off pieces of their bupe strips and sell them 
to other addicts, who use the drug to detox themselves or to get through 
times when heroin isn’t available or is too costly. Bupe is now the third 
most diverted prescription opioid after those containing oxycodone (e.g., 
Percocet) and hydrocodone (e.g., Vicodin).
My own work in treating addiction takes place in a traditional methadone 
clinic. Our nurses watch patients swallow the cherry-flavored liquid daily 
for at least the first few months. If a patient starts using heroin again, we 
can provide more frequent counseling, do more regular toxicology 
screening and suspend any take-home doses of methadone to spur better 
self-control. This careful monitoring is why there is a very low rate of 
diversion of methadone from clinics.
A similar system could be developed for the early stages of treatment with 
bupe. Patients would only be referred to local physicians once they are 
stabilized, a process taking anywhere from a few weeks to a year. 
Community doctors, who are now often reluctant to accept addiction cases, 
would be more amenable to treating patients who are securely into their

Many families see such legal action as the only way to interrupt the self-
destructive cycle in which their loved ones are caught. Users sometimes 
want it, too. “If I don’t do this, I’m going to lose my freedom eventually a
nyway,” a 33-year old heroin user told NPR as he prepared to ask a judge 
in Springfield, Mass., to commit him to care.I speak from long experience 
when I say that few heavy users can simply take a medication and embark 
on a path to recovery. It often requires a healthy dose of benign paternalism
 and, in some cases, involuntary care through civil commitment.
Drug courts are a way to leverage supervision from the criminal-justice 
system. If participants fail drug tests or violate other rules of the program, 
the judge tries to sway behavior by imposing consequences ranging from 
community service to more intrusive supervision to “flash incarceration” 
(jail stays of a few days).
Many drug courts expunge the records of those who complete treatment, 
and other variants of criminal-justice supervision can shape behavior using 
such carrots and sticks alone. The addition of bupe or an opioid blocker 
(naltrexone) can be offered as an adjunct to these programs.
With public attention and resources now closely trained on the opioid 
epidemic, there is a real opportunity for enlightened systems of care. Never
before in the history of addiction management have there been so many 
different therapeutic elements to apply in combination to promote recovery. But we can’t afford to focus on just one set of these tools under the false idea that addiction is a disease 
like any other.

No comments: