U. S. Health Care

According to the Peterson Center on Healthcare, between 2010 and 2019, health spending across the 37 nations that make up the Organisation for Economic Co-operation and Development (OECD) averaged about 8.7 percent of gross domestic product (GDP) annually. But healthcare spending in the United States rose from 16.3 percent to 17.0 percent of GDP during that same time period.

The Peterson Center reports that “In 2019, the United States spent about $11,100 per person on healthcare—the highest healthcare cost per capita across the OECD. For comparison, Switzerland was the second highest-spending country with about $7,700 in healthcare expenses per capita, while the average for wealthy OECD countries, excluding the United States, was only $5,500 per person.”

The U.S. spends about $940 per person on healthcare administrative costs—four times the average of other wealthy countries and significantly more than we spend on preventive or long-term healthcare.

Despite significantly higher healthcare spending, the U.S. actually performs worse than other OECD countries in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes.

Why do we pay more and get less in healthcare? Because in the U.S., healthcare is a for-profit business. Doctors are in business to make money rather than being professionals dedicated to the care of others. In most OECD countries, medicine is a government-provided service. In both Canada and the U.K., for example, the public health service, a government agency, provides healthcare for all citizens. It is paid for by taxes.

The U.S. compromise is health insurance, often provided by employers. That still leaves many Americans uninsured. Obamacare, that is, the Affordable Care Act (ACA), was an attempt to reduce the number not covered. But even with the ACA, some 27.5 million Americans (9.1 percent) are without health insurance.

It’s long since time that Americans changed the way we do healthcare and made it a government function. We are hesitant because of our traditional distrust of government. We fear “socialized medicine.” Our working model stresses rugged individualism rather than brotherly assistance. It’s time we grew up and joined the other nations in the world in caring for our citizens.

Gun Ownership-Gun Deaths Ratio

When I read of the number of Americans killed by firearms every year and the number of weapons we own, I’m repeatedly shocked. More than 15,000 people died by gunfire in the U.S. in 2019. That was up from almost 11,000 in 2018.

And our rate of gun ownership is the highest in the world. Forty percent of Americans say they own a gun. Americans own some 390 million firearms. That means that most gun owners have multiple guns—we have more guns than we have people. In the U.S., our firearm ownership rate is 120.5 per 100 people.

The ratio between gun ownership and gun deaths is relatively constant worldwide: the more guns, the more deaths. Our gun death rate  in 2017, the most recent year for which I can find statistics, was 12.2 per 100,000 people with an ownership rate of 120.5 per 100 people. Compare us with our neighbor to the north. Canada has 34.7 guns per 100 people and an annual gun death rate of 2 per 100,000 people.

Americans are forever telling me that guns are at the heart of American culture. Ever since our pioneer days when guns were a necessity, guns have been an intrinsic element of our daily life.

There’s no question that they’re right. My answer: is it better to nourish our culture or to change it and prevent an annual death rate now approaching 20,000?

Alarmed About Trump—Again

For several days running, even when directly questioned by reporters, President Trump has declined to commit to a peaceful transfer of power if he loses the November election. He avers that voting-by-mail is fraudulent based on no evidence whatsoever. He himself has voted by mail. Make no mistake: He is threatening to refuse to cede the White House if he is voted out of office.

Rejection of the will of the American people as expressed in an election is the act of a dictator. As Trump has made clear repeatedly, he admires the dictators and looks down on democratically elected leaders. He believes that as president he is all-powerful. Over and over again, he has taken actions forbidden to the president and has refused to comply with legal orders from other branches of government including subpoenas. His Republican supporters, who still control the Senate, refuse to take him to task. They are complicit in the attack on American democracy. If the November election goes as I expect, the Republican party as we know it may cease to exist.

What I would love to see happen is for Trump to lose the election by a landslide, refuse to leave the White House, be arrested and tried for treason, and convicted. It seems to me that, even if that doesn’t happen, he has committed so many crimes he’ll surely be arraigned after he quits the White House—whether voluntarily or by force. And the evidence for conviction on multiple fronts is overwhelming.

Meanwhile, we Americans need to heed the warning: we have a president who is, in effect, threatening to seize dictatorial power. As Representative Adam Schiff warned, “This is how democracy dies.” We need to be prepared for the worst.

Solitude (2)

These days I prefer to be alone because I am grieving. My partner of many years died in March. Nothing can replace her. Mourning is not something I share.

A reader might ask why I am so careful to avoid contagion during the pandemic. It’s because I’m an older man with a history of lung cancer. That makes me a prime target for covid-19 that would likely prove fatal. For me, avoiding others is avoiding death.

So my weeks alone turn into months and maybe into a year. I mostly don’t mind, but sometimes I wonder if so much time alone might make me into one of those old people who’s alone so much he becomes erratic. My cure is to be disciplined—eat, dress, clean normally every day.

We’ll see if it works.


I’m now in my sixth month of isolation. The coronavirus pandemic has required me to spend all my time alone. The only breaks have been for groceries, and then I war a mask and stay at least six feet away from all others.

This morning, the outside temperature is in the fifties, but it has been down in the forties some mornings. That means it’s time to bring in my potted plants from my deck and arrange them next to the sunny window on the eastern side of the piano room. The change in weather reminds me that my seclusion began last winter, before I put the plants out when it got warmer in the spring.

How long will the pandemic last? Since the U.S. under President Trump still is doing nothing to combat the covid-19, I presume I’ll still be sequestered six months from now. More than a year in isolation.

I’m fortunate that I’m a loner by habit. I normally spend little time with others. I’m a writer, a profession that requires many hours working alone. My diversions are weight lifting, reading, playing the piano, a little gardening, and working on my house—all activities I do by myself.

But under normal conditions, I have a heavy schedule of readings and presentations to assembled groups of readers. Barely a week passes that I’m not out appearing in public. All that is, of course, on hold. And so far, I’ve only managed to arrange one remote reading. More will come.

More tomorrow.

Covid-19 Deaths in The U.S.

The U.S. continues to be hurt far more by the coronavirus pandemic than any other nation. We have now reached 200,000 deaths, the highest by far of any country in the world. We have just 4 percent of the global population but roughly 21 percent of both deaths and overall cases.

But six months into the pandemic, President Trump has still done nothing at all to combat the virus’s spread. With no evidence whatever, he claims that we have started to improve. He says we have done an amazing job in fighting the spread of the virus. He maintains that young people are “virtually immune” and repeats the claim that the virus “affects virtually nobody.” Meanwhile, more than 800 Americans are dying of the virus each day.

I trust that Trump’s performance on this issue alone will be enough to see him defeated in November’s election. His record on the virus is but one small part of his overall colossal failure as president. As a friend of mine recently observed, if we fail to remove Trump from office in the election, we deserve what we will get.

Yard Sign

My neighbor, who lives across the cul-de-sac from me, has posted a large sign in his yard. It reads:




The first and third lines are bright red letters on a white background. The middle line is white letters against blue. So he has the three patriotic colors—red, white, and blue—prominently displayed. The message is loud and clear.

When I congratulated my neighbor on the sign, he told me that four years ago he put out a similar sign supporting the election of Hillary Clinton. It was stolen within a few days. He’s waiting to see how long this one lasts.

It’s still there this morning. Four days now. There’s hope.

Do What You Have to Do (2)

The hardest part came at the very end, in April 1975, after the withdrawal of American military forces, when it was incumbent upon me to get my 43 subordinates and their families safely out of the country before the North Vietnamese attacked Saigon. To do that, I had to stay in place until the attack was underway. I had to lie, cheat, and steal to get my people on flights because the U.S. ambassador, Graham Martin, forbade me to evacuate them. A representative of the government of Hungary, a communist nation allied to North Vietnam, had assured him that the North Vietnamese had no intention of attacking Saigon. Signals intelligence—my job and the job of all my guys—made it blatantly clear that the North Vietnamese were about to launch a blitzkrieg against the city. The ambassador believed the communist representative instead of acting on the validated intelligence I was giving him.

The result was the worst days of my life. At the very end, I and two communicators who had agreed to stay with me to the end were isolated at our office during the final assault against the city. The enemy used rockets and artillery against us as they prepared to seize Saigon. The building we were in was hit repeatedly. The building next to us was destroyed, and two Marines at our gate were killed. On the afternoon of 29 April, my two communicators were finally extracted safely. I escaped that night under fire.

I’m justifiably proud of my service to my country and especially of my willingness to stay to the end during the fall of Saigon to assure that none of my guys or their wives and children were killed. I understand from President Trump’s perspective, that makes me a close kin to those who died in war—suckers and losers.

Maybe so. I did what I had to do, whatever it took.

Do What You Have to Do

Today I want to return to an idea I have explored several times over the years in this blog, the sense of devotion that a service member or government representative must have in a crisis: the willingness to do what is required no matter the personal cost, even it means giving up one’s life.

“Do what you have to do, whatever it takes.” Those words were my guiding principle during my thirteen years on and off in Vietnam supporting both army and Marine units in combat. It was an honor to be on the battlefield with the troops, undercover as one of them, but it also meant that I had to be willing to give up my life if that’s what it took.

The same words are the motto of characters in my 2017 novel Last of the Annamese, set during the fall of Saigon. There’s nothing elegant or poetic about the phrase. It’s down and dirty. It smells of blood and human sweat.

I was in Vietnam more time than I was in the states between 1962 and 1975, and I was put to the test multiple times. My job was providing signals intelligence support to U.S. combat forces. That meant telling the Americans, based on intercepted radio communications, what North Vietnamese forces were aligned against them, what their strength was, where they were, and what their plans were.

More tomorrow.

Global Warming and Gun Violence During Pandemic

The coronavirus pandemic has done little to slow down two curses bedeviling the U.S. caused by our own doing: global warming and gun violence.

Evidence suggests that human actions that gave rise to global warming, burning of fossil fuels and destruction of forests, have declined during 2020. But the heating of the environment was already moving so quickly that 2020 is on track to be one of the hottest years ever. We have had record high daily temperatures in a number of places in the world. The highest was in mid-August in Death Valley—130 degrees. That may be the highest temperature ever recorded. The previous record, 134 degrees in Death Valley on 10 July 1913, is now considered of doubtful accuracy. The world, in short, is getting hotter by the year.

And our gun violence hasn’t slowed because people are sickened and dying as a result of the spread of the coronavirus. Thus far this year, the U.S. has suffered over 30,000 deaths by guns. We have more guns in the U.S. than we have people. And as is clear from world-wide statistics, the more guns a nation has, the higher its death toll from gunfire. We suffered 4.43 deaths per 100,000 people in 2017 (the most recent year for which I can find statistics)—a far greater death toll than in other western democracies.

What does it take for us to learn from our own mistakes? As a nation we failed miserably to confront the covid-19 pandemic, resulting in tens of thousands of deaths we could have prevented. We continue to burn fossil fuels at record rates, assuring global warming will increase. We refuse to control the number of firearms in the hands of citizens, guaranteeing thousands of gun deaths.

U.S. exceptionalism has changed its meaning. It now refers to our unique national failures to meet challenges. If we are fortunate enough to have a new president and a new Congress in 2021, we must push for restoration of our ability to take on challenges and win.