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Declining states and societies have a bad tendency to seize upon romantic ideas of restoration and revivalism, and pick a charismatic leader who will carry us back to greatness on his/her own shoulders. That often works out to be perilous. We have apparently aimed for a Ronald Reagan, and have caught a retread Silvio Berlusconi. All Americans should read up on the charismatic former Prime Minister of Italy – the beginning of his arc in politics is disturbingly like that of Trump’s.
The Washington Post offered:

Like Trump, Berlusconi relied on the fact that Italy’s liberal mainstream would treat him as a joke, using his ugly gaffes as an effective, disruptive campaign strategy to distract both from his lack of well-thought-out policy ideas, as well as his dangerous ignorance on foreign policy. That seems to be Trump’s plan, too. They both turned the jokes on the political elite by stirring up the electorate’s disdain for their critics.

Trump, like Berlusconi, is a master of metatruth – “Who can you believe?” In a corporate society, you believe the trustworthy voice, not yourself. It’s important in Corporate/Retail to stymie your individual bullshit detector. (LINK)  The proles get it exactly – you pick the Great Papa to lead us, because we can’t tell Shinola from anything else.

The press complained about the Teflon presidency of Reagan. Reagan was to some degree a master of this – then later, a victim of his own dementia. He played the character, and then I fear, the became the character while still in office.

Trump is hardly the bumbler and buffoon that he portrays on Twitter. If he were, he’d be living in a modest condo in Queens, and waiting by the mailbox for invitations to parties. But I don’t think he’s as smart as he thinks he is. (note)

I am alarmed that during the debates, neither candidate (nor the august press corps) brought up the fact that deficit lending to the United States has stopped earlier in the year, and that the rest of the world is liquidating its Treasuries.  The beginning of the slide coincided with Trump’s discussion about defaulting on Treasuries in May. (reference)

Remember, over the last dozen years, we need to sell $10 Billion worth of Treasuries a week to keep the American government solvent.  That has stopped.  China and Japan (!), and soon the rest of the world, have been peeling off Treasuries like a bad sunburn.  We the People only caught wind of dumping seven months later, when the Fed decided to raise interest rates, to sell the next release of Treasuries.  You must put things on sale when nobody’s buying. (link)  There is every indication that this trend will snowball, and the Treasury market will crater.  We don’t know what the resulting interest rate could be, but it’s likely to be a doozy.  The Fed doesn’t “plan” the interest rate – ultimately, the sovereign bond market drives the Fed’s decisions.  And the bond market thinks that the US has just turned stinky, and yank out your money while you can.

The lending markets will vacuum up cash for lending like nobody’s business.  Cash will be hard to get.  It will be increasingly hard to borrow, but more tempting to lend.  It’s a good time to get out of debt, I figure.  The Austrians would cause this a coming-due of malinvestment from overly abundant money on the market.  But if the US costs on the Federal Debt increase, that’s more money that goes out to the lenders every year.  No room for infrastructure incentives, no money for military expansion.  Or SCHIP, or Medicare, or Medicaid.  But we won’t see much lending cash coming from home or abroad until the interest rate matches the real one, not the phony one published by the Fed.  The real one’s about 4%-8% annually, but the Fed “massages” the real numbers to get a nicer result (link courtesy of ShadowStats.com.)  The latest change in the Fed rate racked up $50 Billion per year more that we must pay in interest on the debt.

That would increase Federal income taxes by 10% or so, just to keep up.  But a bump of 3% in the Treasury yields gives an annual payoff of an extra $600B per year on interest payments, on top of the $587 Billion shortfall we have every year or so.  Individual taxpayers would have to double payments to the IRS, to swallow all that debt service.  And Don’s poking our former #1 lender in the eye.  (The Chinese have dumped enough paper on the market since May to drop from #1 the #2 holder of US debt, first time since 2010.)

What we should worry about is how the cratering of the money market will affect medicine? It will just accelerate the transition into Newt Gingrich’s Magic Box Medicine. He’s become a fan of technology revolutionizing medicine. What he doesn’t know, is that technology revolutionizing medicine, is what medicine DOES on its own, without regulation. Things like iBreastExam, a piezoelectric gizmo that can pick up breast cancer (at what stage? With what sensitivity?) are being touted by the corporate set, and the political leaders swoon.

Pretty soon, there’s going to be a Medex SPOT cabin in the drugstores (and the airport lounges, and Qwick-E-Marts, etc.) that “is connected by satellite to a hospital Medical Call Center and provides the most comprehensive virtual medical examination facility possible in a cabin which is soundproofed, employs constant automatic sanitization of both the air, cabin surfaces and medical instruments handled by patients.”

One glorious power of futurism is the provision of perfection, just by assertion of perfection. What about the troublesome aspects involved in the intimate handling of hairless biped animals such as H. sapiens? Unlike their silicon masters, these bipeds can be nasty and imperfect. “Outside the cabin is a large washable sticky mat which removes 98% – 100% of surface foot and wheel borne contamination. (minimum 3 steps) so that patients entering the cabin on foot or in a wheelchair do not soil the floor. A cabin ceiling mounted camera and another camera under the patient seat takes photographs of the floor before and after the patient enters and after the patient leaves the cabin. Proprietary software determines if the floor is soiled after the patient leaves the cabin and can deduct a cleaning deposit from the patient’s SMART card and automatically take the cabin out of service and send a text message to the person responsible for cleaning the cabin.” See, humans are useful for something! And cynical readers could imagine the skin-color of the Call Center Janitor, or national origin or some similar thing. But since this is all in the future, we can assure that Citizens Only, or Whites Only, can be a job requirement for janitorial services – it’s in the future, by gum! Just say so, and we’ll make it so! (But of course the cleanup crew will be women – don’t expect everything to change in the future!)

We doctor proles will be doing three-minute examinations by Skype, linked into EMR 2.0 to check on these modern, up to the minute patient encounters. [The concern about drunks urinating in them can be alleviated by requiring a card before entry, and charging a cleaning fee to the errant toileters.]
One thing will not change in the next Administration – the corporate, Government and innovative tech people – the ones who brought us the EMR revolution – will be making the long-term plans for medicine.

They will definitely need a Magic Chair to do Paps and pelvics, as well as breast exams. The machine can set up a Twitter from the pathology lab with messages like “High Grade Dysplasia” and a WebMD link to the explanation. And, “In the event of an emergency the medical professional can press a button on the terminal which will open the cabin door, dial 911 with a prerecorded voice message with the location of the MEDEX SPOT cabin.”
Of course, the medical professional team will be divided into a mid-level who will spend whatever time is needed with a patient, and a MD/DO to do a sixty-second review of the presentation and prescribe the antibiotics and Percocet and such. The MD can see perhaps 60-90 patients per hour, and at $4.00 per exam, that’s – WOW! A lot of money. And once we get centralized Federal licensure for doctors, tied to their board certification status, we can elect to work for the uniformed Public Health Service. Or be classified as subsidiary doctors in the private sector. Or take up lawn care. Remember “Medical Care Is a National Security Issue!™”

If we are a profession that cares for humans, and arises by self-determination from the individual’s and community’s understanding of illness and death, and a need to mitigate the effects of these upon individual humans, then we professionals need to warn about things that are destructive to a humane society. And this sort of business, MedCubicles, is the Mark of the Technology Beast. But the Trump Corporateers will not be bothered. They see the landscape of medicine identically to the Obamacare visionaries. It is only a squabble about “private enterprise” and “government-regulated” and “federally provided.”

This is the future of medicine, and of education (ref. Betsy DeVos) and the making of a whole interlinked world for the happy proles in “a triumphant embodiment of the principles of planning, an ordered universe in the midst of the larger world of planless incoherence.” I foresee a centralized curriculum, and the end of the plethora of private schools for the near-rich, the 1%ers who cannot afford to send their children to the superior boarding schools of Europe. Charter schools, school choice vouchers and centralized curricula will bring these rogue private schools into the American educational system. Let the private schools keep their high prices, their legacy students, their school colors and fight song! Just bring them under corporate homogeneity, so they teach identical lessons in identical ways to interchangeable students.

The combination of vision, and assurance of future success, has a happiness not seen since the days of Trotsky and Lenin. Don, butt-dial Putin and ask him about these visionaries, T&L Inc.  Surely, we will get it right this time! And by then, the old cynics can be brushed aside into retirement, and the young cynics “readjusted” to soften their recalcitrance.

What is the future of medicine in the Trump Administration? Steady as she goes, captain!