Ethics in medicine

I read something the other day on Medscape that gave me pause and made me reconsider several things about my career as a nurse. After reading the article and reflecting some on it, I came to the conclusion that there’s a bit of an ethical crisis happening in medicine right now.

The article itself was about birth control and teen pregnancy. You can read the article here, and I will of course be pulling out bits and pieces for our discussion. The central premise of the article is this:

“The real goal is to empower women, not to reduce pregnancy,” said Neha Bhardwaj, MD, from the Mount Sinai Health System in New York City. “If someone wants to have children in their teens, you can’t tell them not to, she told Medscape Medical News. “We really have to reframe the conversation,” Dr Bhardwaj stressed in her presentation on contraception and coercion. “You can’t think of teen pregnancy as a disease.”

I can certainly get behind empowering women. And teen pregnancy is not a disease, that I can agree on. But then the article goes on to state:

“Teen pregnancies may contribute to high dropout rates, incarceration rates, and social costs,” but you still have to look at contraception through the lens of choice, she said.

And this is where I started thinking: does choice really trump dropout rates, incarceration rates, and social costs? I think one could make an argument that it doesn’t. But that’s the lens that’s been thrust upon the bulk of medicine: patient autonomy is everything. To the point that really nothing else matters. And to a certain degree patient autonomy certainly is important and does need to be respected. But what kind of position does that put the clinician in? What kind of position does that put society in?

The author admits, readily, that teen pregnancy leads to higher high school drop out rates. And incarceration rates. And that there are substantial societal costs. But there are medical considerations, too. Teen pregnancy is more likely to result in premature birth and low birth weight, which come with a unique set of medical risks and challenges for the baby. Doesn’t that deserve consideration? Is there no argument for waiting to have a child until you’re physically, emotionally, socially, and economically able to? If the argument is that we should empower women, isn’t it imperative that we help women make the best choice, not just the choice they have in a given moment? I am not the same person I was when I was 17. My ideas and values and goals changed significantly.

Now, that isn’t to say you shouldn’t provide pregnant teens with the best possible prenatal care. That isn’t to say you shouldn’t respect a patient’s choices or beliefs. But at some point you have to weigh belief and choice with potential harm. If you don’t, that leaves clinicians in an ethically unsavory position. I’ll give you an example.

In my job I give a lot of vaccines. I encounter a lot of parents who either outright refuse certain vaccines or what to make up their own schedule. Here, I’m hit with two ethical situations that I’m not comfortable with. The first is that the parents are not the patient, the child is. Yes, I realize that an infant or young child doesn’t have decision making capacity, but that means they’re completely at the mercy or their parents’ ignorance and fears. It also reinforces this notion that children are property that parents own. But that’s another blog post.

But, since I have to respect patient choice and autonomy, I have to comply with the parent’s wishes, which brings to situation number two: I have to release a child into the world unprotected against wholly preventable diseases. It’s one thing for parents to have their own set of beliefs, but this push for autonomy over everything else means that suddenly I’m complicit in what’s essentially medical neglect; I’m aiding and abetting parents in the harming of their children by being forced to respect ignorance and misinformation. I don’t like that.

There’s a similar movement with regard to culture in medicine. We’re taught to try and deliver care within the context of the patient’s cultural beliefs. Well, what if their cultural beliefs about health don’t overlap with modern medicine? Letting people wander around thinking that their diabetes was caused by ‘the evil eye’ instead of insulin resistance caused by diet and obesity seems like a bad idea. Isn’t it unethical to let people go through life refusing evidence-based treatments due to some misguided attempt to respect a culture that doesn’t understand or value evidence-based science? Doesn’t that just propagate pseudoscience? Just look at this slide:

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“Science is not the highest value to which all other orders of value should be subordinate.” I’m sorry but yes, science should sometimes overrule values. Sometimes the objective really is better than the subjective. The subjective does not need to be protected if it means objective harm is caused simply to maintain some kind of equivalency.  To use a non-medical example here, think of climate change. I don’t care if you think God won’t flood the world again because he promised Noah that he wouldn’t, because that belief doesn’t mesh with objective observations of reality, and thinking that can lead to catastrophic harm for millions of people. Is respecting subjective values really worth losing lives?

In some respect, I see this as an extension of the overly-PC culture we live in. Except that unlike an issue of free speech, where nobody is physically hurt by banning a Halloween costume or renaming a sports team, people really are physically harmed when we compromise care so as not to offend people.

In the end, this really boils down to two classic ethical dilemmas:

  1. Individual rights vs the collective good,
  2. Do your individual rights trump someone else’s individual rights?

I’m personally of the school of thought that in the first scenario, the collective good always outweighs the rights of the individual. The second situation is more tricky. In a situation where there are two parties, how do you decide if one person’s rights are more important than another’s? Think of the medical care of children: is the parent’s right to believe what they want and determine their child’s healthcare equal to or greater than the child’s right to health? Courts would say no, as they’ve ruled in the past that the right of a child to health is greater than a parent’s right to religious or philosophical beliefs.

Yet somehow the conversation in medicine (and science in general) seems to be taking the opposite approach frequently. I’m not arguing that we should be allowed to refuse care to someone simply for believing something different than us or because we don’t agree with them. Not in the slightest, as that comes with it’s own ethical consequences. But there does seem to be an ethical disconnect here. I don’t really know what the solution to that disconnect is, but I think it’s a conversation that medicine needs to have instead of being swept up in identity politics.

Why the GOP can walk all over its voters–and get away with it

The GOP finally got their bill to repeal and replace the ACA out the house. It’ll now go to the senate, where it’s pretty much doomed. If it doesn’t collapse altogether, it’ll be sent back as a much different bill. Regardless, pundits and experts are predicting that the AHCA has shown the republican hand, namely that they care more about tax cuts for the rich and not at all about your health.

That’s certainly true.

The bill sees hundreds of millions of dollars cut from medicaid and a corresponding tax break for the wealthy. It also allows insurers to drop you if you become ill or have a pre-existing condition. It’ll raise premiums for the elderly. It’s just an awful, awful bill. Which is why pundits are predicting a major backlash against the party come 2018.

I don’t think we’re going to see that.

Ultimately, a few red districts in blue states may flip, but it won’t be enough to shift the balance of power. Because I don’t think that this will perturb republican voters. History has shown, time after time, that they’ll vote against their own self-interest and I don’t think that this moment in history is an exception. Many of the deep red states have had republican governors, legislatures, and courts for 30+ years. And yet things keep getting worse for those states. If republican voters were ever going to finally wake up to the fact that they’re voting against their own interests, it would have happened by now. In fact, it’s probably never going to happen.

Here, take a look at this:

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Every single one of those states is solid red, and every single one voted for Trump. And every single one of those voters with a pre-existing condition will see their insurance either disappear or skyrocket in price. But I’m willing to wager that come 2018 they’ll still vote for the very same congressman who voted to strip them of healthcare. Why? Because many republicans are single issue voters. And what is that issue, you ask?

Abortion.

As long the GOP continues to be the party that opposes abortion and wants to overturn Row v. Wade they can pretty much do whatever they want to voters and still get re-elected.

59% of republican voters think abortion should always be illegal. Even among moderate or ‘liberal’ republicans, 41% think it should always be illegal. And that number has shifted up from where it stood in 1995; 20 years go, republicans were split almost evenly, 49%/48%. In the last two decades, republican voters have only become more conservative on this issue. In 2015, 21 percent of Americans said they would only vote for a candidate who shared their abortion views, up from 13 percent in 2008.

Particularly ironic, given that the AHCA isn’t friendly to pregnant women or babies and children. But I digress.

Economically, many conservatives align with progressive values. 52% of republicans with family incomes <$30,000 say the government has a responsibility to provide healthcare coverage for everyone, up from 31% just last year. And in a recent Gallup poll, 45% of republicans said they think the wealthy don’t pay their fair share in taxes. They hate those free trade deals that sent their jobs overseas–something Bernie Sanders talked about extensively during the election.  In other words, conservative voters know that they’re getting screwed over economically. As time goes on, they seem to be getting more progressive economically.

And yet…when it’s time to step into that voting booth, they always pull the red lever. And what does it get them? Healthcare? Gone. Overtime pay? Gone.  Clean water and air? Gone, too. Taxes? More income redistributed from the middle and lower classes to the donor class.

But hey, abortion, right?

Why do people believe conspiracy theories?

Consider this a companion piece to my last bit on flat earth ‘theories’ (and I use that term very loosely). The idea of a flat earth relies exclusively upon belief in conspiracy, that NASA and countless scientists are not only wrong, but they’re actively lying to you. You’ll see stuff like this all over Facebook, Instagram, etc:

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Of course the interesting thing about memes like these is that there’s never a reason given for why NASA and the media would perpetrate such a massive hoax. We can assume that anyone who develops and perpetuates a conspiracy is doing it for some reason. Perhaps unsurprisingly, there is rarely a motivation provided for these conspiracies. We’ll see why that’s not problematic for the believer in a moment.

Of course, the flat earth isn’t the only conspiracy out there. Climate change, vaccines, 9/11, cures for cancer or AIDS, weather control–take your pick. There are people out there who believe it and who disseminate that belief online via social media. The weather control one was a particularly new one for me, but I’ve seen it making the rounds lately:

Haap Patent Weather Modification Chemtails EMF

Well, at least here we have a motivation: military power. However, why would a secret government organization file a public patent for a top-secret weapon? That doesn’t make much sense, does it?

Whenever I look at these kinds of conspiracies, I’m struck by one common thread: they contradict themselves at an incredibly basic level. They set up these shadowy corporations or institutions as entities that are simultaneously both immensely powerful and yet completely incompetent. Take the HAARP example. Here we have a secretive government organization that has all this power and money and knowledge–they can even control the weather!–yet they’re so stupid that they file public patents, let photos of their devices leak onto the internet, etc.

None of that matters to the conspiracy theorist, because these conspiracy theories aren’t meant to appeal to a sense of reason or logic. That’s why they never provide evidence and they rarely provide a motivation. None of that matters, because conspiracy theories are designed to do one thing:

Mollify a perceived lack of control in the believer.  

But don’t take my word for it. There’s been research into why people believe conspiracy theories. This article from Psychology Today has some real gems in it for explaining the conspiracy theory phenomenon:

“Melley proposes that conspiracy thinking arises from a combination of two factors, when someone: 1) holds strong individualist values and 2) lacks a sense of control. The first attribute refers to people who care deeply about an individual’s right to make their own choices and direct their own lives without interference or obligations to a larger system (like the government). But combine this with a sense of powerlessness in one’s own life, and you get what Melley calls agency panic, “intense anxiety about an apparent loss of autonomy” to outside forces or regulators.”

To me, this makes perfect sense. When someone who values their independence see a lack of control or an erosion of that independence in their own life, they manufacture a scapegoat in these conspiracy theories. Research by psychologist Jean Twenge provides some empirical data for this:

“Twenge’s research examines how Americans’ personality traits have been changing over the past several decades, from the 1960s through the end of the century, looking at the personality scores for each year. For example, she finds that trait anxiety (or neuroticism) has been rising dramatically in both children and adults over this period. […] In another study, she shows that people have come to hold an increasingly stronger external “locus of control”; this refers to the feeling that external forces are determining what happens to you, as opposed to an internal locus of control, the feeling that you dictate your own outcomes. […] Individualistic values have also been getting stronger in our culture, with greater importance attached to personal freedoms and self-reliance. […] The rise in anxiety, individualism, and external locus of control may therefore underlie the rise in conspiracy thinking. This is somewhat troubling because these personality trends show no sign of leveling off. In fact, given the current pace of globalization and the “Americanization” of other countries, it seems likely that these personality traits (and conspiracy thinking) will be increasing elsewhere too.

That seems like a succinct and accurate representation of the people who I know that believe in conspiracies. In my last post, I featured a screenshot of a conversation on Instagram. Let’s take a look at it again:

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The bit about density is still circled, but this time let’s examine some of the other comments on the thread, starting with the one from mitch_and_tammy: “Who gives a fuck if the earth is flat or round. Either way, I’m still a middle class slave!” This comment doesn’t really tell us if this person believes that the earth is flat. But it does show a predisposition toward not questioning the conspiracy because of a perceived lack of power and control.

Then there’s the comment from bitabites: “I KNOW it looks flat I know about operation paperclip. I know not to trust anyone so I know not to believe anything…” I’m not quite sure what operation paperclip has to do with the flat earth. Nevertheless, let’s examine the other language. This person exhibits a high degree of individualistic values, with much emphasis on “I,” on what the individual “knows.” There’s a strong distrust of that external locus of control– nobody is to be trusted and nothing is to believed.

These two individuals, particularly the second one, exhibit the kind of anxiety and paranoia that psychologists commonly ascribe to conspiracy theorists. Their belief in a flat earth, therefore, are unsurprising.

It’s also unsurprising, therefore, that scientifically trained or inclined people seem less likely to believe in conspiracies. Science relies almost exclusively upon external loci of control–we need other scientists to independently confirm or refute our findings. And because science is a genuinely collaborative effort, there’s less emphasis on “I” and more emphasis on “we.” Science isn’t about the individual, it’s about the scientific community as a whole. Science as a collective body also tends to work toward the same goal, with mutual cooperation and respect. In short, science empowers people, groups of people, whole scientific communities.

So, what do we do to combat this? Well, from the research that’s been done the first and most obvious thing is to make individuals feel more empowered. We can do that on a political, social, and economic level. We can correct the massive income and wealth inequality that exists in this country for starters. We can stop moneyed interests and corporate lobbyists from influencing our political system. Those are probably the biggest causes of anxiety we currently face.

But we also have to do a better job educating people. Basic scientific understanding is floundering in this country. People don’t know how science works, and more importantly don’t know how to critically evaluate evidence or anything they read and see. Sadly, science has become one of those external loci of control, the “other” that’s trying to suppress you. Of course that’s farthest from the truth, but it’s the outcome of a society that doesn’t understand science and feels large amounts of anxiety and paranoia–we have a tendency to fear what we do not understand.

We in the scientific community need to do a better job of engaging with these conspiracy theories and their believers. If people feel a lack of control in their lives, what they really need is power. And I would argue that science is the ultimate provider of knowledge.

How to end the flat earth argument

Apparently people still think that the earth is flat despite an overwhelming amount of evidence to the contrary. This stuff is all over social media, and it infuriates me to no end because we’ve known that the earth was a sphere for thousands of years, and if ancient man could figure that shit out then I would expect that someone who has access to satellite photography would also be able to figure it out. But alas, people are ignorant as fuck and thus we have the flat earth theory. Everyone’s favorite astrophysicist, Neil deGrasse Tyson, recently had to respond to an NBA star commenting that the earth is flat.

I had an exchange with someone on Instagram earlier today. Someone I follow posted something showing how the earth was curved, not flat. Well, cue the “woke” enlightened folk. So I asked how a flat planet could form in the presence of gravity. Well, apparently gravity is also a conspiracy. Here’s the response I got:

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See, guys, there’s no such thing as gravity because density! Duh. And no, I’m not blurring anyone’s name out on here because if you’re stupid enough to think the earth is flat and gravity isn’t real you deserve to be called out. And yes, I also realize that you all have my Instagram handle now.

But here’s why I asked about gravity.

I wanted to think of a proof or a thought experiment I could give a flat earther to get them to realize that they’re wrong. And I think I came up with one. And it all hinges on gravity. In order for a flat planet to form, gravity either 1) needs to not exist, or 2) not behave according to our current models. My response to good ol’ Jonathan there was this:

“There’s a very easy way to prove whether or not gravity is real. Pick an object, any old object will do. Next, find a place you can drop it from–a second story window, a tree, a rooftop–it doesn’t matter. Now, if you know the mass of the object and the height from which you’re dropping it from, then it’s a matter of simple math. Calculate the time it would take the object to reach the ground 1) by using the standard model of gravity and the equation time = √(2d/g) and 2) by substituting the value of g for literally anything else–like the formula for density. Then drop the object and compare the times to those given by your two equations.”

That’s really something any middle school student should be able to do. The response I got?

…total crickets. Nobody had a response. None of the flat earth geniuses, to nobody’s surprise, derived a new form of math to describe acceleration and motion that didn’t use gravity.

Because you can believe that the government lies to us about the shape of the earth and the ISS and moon landing are faked by NASA, but there’s one thing that doesn’t lie–GODDAMN MATH.

But just the fact that this needs to be explained to people is incredibly disheartening. It speaks to a broken education system. It speaks to a culture steeped in paranoia. It speaks to a political system wherein people are encouraged to openly deny evidence. People are so quick to latch onto conspiracy, but they can’t see that the way to to truly keep someone ignorant is to make them question observable, measurable, testable, repeatable evidence. THAT’S how you keep someone in ignorance. And the fact that this is happening speaks volumes about our social and political state.

So if you ever run into a flat earther, give them this proof and see what happens. My guess it that cognitive dissonance will be so great that their head will explode.

Democratizing the workplace

I came across this article from the BBC the other day and it absolutely fascinated me. The article focuses on a Swedish software firm , Crisp, and their rather innovative approach to how their business is structured.

Crisp doesn’t have a CEO.

Yassal Sundman, a developer at the firm, explains: “We said, ‘what if we had nobody as our next CEO – what would that look like?’ And then we went through an exercise and listed down the things that the CEO does.” The staff decided that many of the chief executive’s responsibilities overlapped with those of the board, while other roles could be shared among other employees. “When we looked at it we had nothing left in the CEO column, and we said, ‘all right, why don’t we try it out?'” says Ms Sundman.

This is something that I have long suspected about the business world–that in many cases, the boss is completely superfluous. More on that in a bit. So what does a workplace without a designated leader look like?

Crisp holds four-day meetings for all staff two to three times a year. They are used to making decisions on issues that affect everyone, such as an office move, but workers are encouraged to make decisions themselves at other times. It also still has a board – a legal requirement – and this can be used as a last resort to resolve issues if something is not working.

Imagine that, the people who are actually doing the work are making the decisions! Together!

Henrik Kniberg, an organisational coach at the firm, argues that not having to ask a boss for decisions on projects or budgets means the firm can respond faster. “If you want to get something done, you stand up and start driving that,” he says. Yet Mr Kniberg stresses that not having to ask permission does not remove the need for staff to discuss issues or bounce ideas off each other. Because they are all in charge, workers are more motivated, he argues. Crisp regularly measures staff satisfaction, and the average is about 4.1 out of five.

Who would have guessed that giving the worker bees more freedom and self-determination would lead to a happier and more agile workforce? Truly shocking.

What I like about this article is that, for me at least, it dispels some long held myths that people have about business that they apply to their politics. There’s this idea that business is always better at everything than government. I’ve said for years that this patently false for a variety of reasons, but I think this article really drive home on central point:

Businesses can be just as bloated, top-heavy, and overly-administrative as the worst government you can think of. The equivalent of bureaucracy is alive and well in the private sector, and it’s just as detrimental.

I’m not sure how many presidents, vice presidents, junior vice presidents, CFOs and CEOs a company needs, but I’m willing to bet that, as this article from the BBC suggests, the answer is probably “None of them.”

The average CEO in 2014 made $22.6 million dollars per year. That’s a pretty tidy sum for a position, that, if Crisp’s example is any indication of, is essentially worthless. What’s more, that year CEO salaries increased almost 9%–way ahead of the 2.4% that the rest of the economy grew. And a 2000 study found that performance is a weak indicator of CEO compensation. The best predictor of CEO salary was the size of the company–no matter how terrible of a job they did. I’m sure everyone remembers all of those Wall St. folks that gave themselves huge bonuses after they collapsed the economy? The numbers are all here for you to take a look at.

And then there’s the lovely ‘golden parachute’ that we all hear about so much, which sounds like something Donald Trump would pay Russian hookers for, but is really just a giant check they give the top brass upon retirement. Here’s a list of the top 20 golden parachutes according to Bloomberg. I’ll recreate the top five for you here:

  1. Steve Wynn (Wynn Resorts): $358,134,747
  2. David Simon (Simon Property Group): $302,425,834
  3. John Hammergren (McKesson): $198,150,788
  4. David Zaslav (Discovery Communications): $161,119,864
  5. Brent Saunders (Allergan): $140,672,343

Man, what a great deal: getting paid tens of millions of dollars a year no matter how poorly you perform…and then they give you HUNDREDS OF MILLIONS when you retire!

What a fucking joke.

How many billions of dollars are wasted every year on executives that don’t do shit? Billions that could be reinvested in the company or the employees. While everyone else’s hours and benefits are slashed because of taxes or Obamacare or whatever bullshit line they throw out, the CEO gets to retire with hundreds of millions of dollars in his pocket. Notice how it’s never the top earners that are asked to tighten their belts during the lean times?

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But why is it this bad? How do these salaries get set? Well, in many companies, executive compensation is set by the board of directors. And who’s on the board? You guessed it–all of the executives. Executive salaries are out of control and keep going up despite poor job performance because they’re the ones giving themselves the raises and the golden parachutes. Pretty convenient, huh? This article in Forbes covers some of the insane catch-22s that allow this kind of unfettered greed and inefficiency to continue.

And then people wonder why a candidate like Bernie Sanders is so popular with people. Because people are tired of being bullshitted by business leaders and conservative politicians about how dire everything is while they keep making more and more money. They tell us all that they’ll need to get rid of social security and medicare while lowering the tax rates on the guy who just made $358,134,747 simply for retiring.

Because for all the ways they paint the private sector as noble, something for government to aspire to, the same bullshit happens there, too. The same bloating, the same excess, the same waste, the same frivolity. The same lack of accountability for the people at the top. Human greed and ignorance permeates all aspects of society, something that is often lost on conservatives. 

But it doesn’t have to be that way. Companies like Crisp are showing that. They’re just starting to show that there’s a different way to do things. You can essentially democratize the workplace–give the employees the reigns. Give the employees more of a stake in things. Give the employees the freedom they don’t get with a top-down organizational structure.

Because the same is is true in the workplace as it is in politics: the people have the power. Unions used to be how workers flexed that muscle. And then the bullshit started. “Well, you know, those unions, they just ensure that bad workers can’t be fired.” You hear this bullshit all the time, like with teachers. The teachers union just protects bad teachers!

An argument that seems especially ironic given that of the top 25 paid CEOs in ANY GIVEN YEAR from 1993-2012, one quarter of them worked for firms that took federal bailout money. In other words, these incompetent assholes fucked up, then used your tax money to stay in business and continue to give themselves a massive raise and an even more massive golden parachute. But hey, it’s the unions that are greedy, right?

It’s all bullshit, folks. Did you know that there are countries that don’t have a minimum wage? Doesn’t the sounds like a conservative republican’s idea of paradise!? Well, not so fast. Places like Iceland and Sweden have no minimum wage because workers have the right to collectively bargain. A lot of those evil socialist countries follow that model.

Oh, I get it: when the CEO gets to determine their own outrageous salary, it’s capitalism and moxie, but when the workers try to have a say in how much they’re paid it’s evil socialism. Again, how convenient.

So the next time someone tries to tell you that the government is wasteful and stupid, count for them the many ways the the private sector is also full of corrupt hypocrites.

 

What happened to those bootstraps?

Does anyone else find it supremely ironic that republican and conservative voters elected Donald Trump on the promise that his government would bring jobs back? Because I certainly find this sentiment to be the epitome of hypocrisy.

For decades now, all we’ve heard from the GOP and other conservatives is that the government is horrible and meddlesome, and everything would be better if there was less government interference and everyone took more personal responsibility for their lives.

Conservatives 2008/2012: “The government just makes things worse. Get rid of the government and everything will be fine–it’s not the function of government to create jobs, you libtards.”

Conservatives 2016: “PLEASE BRING BACK MY JOB, GOVERNMENT!”

It’s galling to me that the party of moxie and rugged individualism is now the party that applauds a government that directly gets involved in business and trade negotiations–the very things conservatives were crying the government should stay out of for the past 30 years.

How many times have we seen conservative politicians and voters say the following about welfare or the minimum wage: “We don’t believe in handouts. If you want to make more money, improve your situation, work harder, etc. Pull yourself up by your bootstraps like a real American.”

Well apparently conservatives in 2016 have thrown out their old bootstraps.

This article on CNN interviews people in a Kentucky town, “the poorest city in America,” that overwhelmingly voted for Donald Trump. Here are some snippets:

Beattyville residents want jobs, especially ones that pay more than the minimum wage of $7.25 an hour. They think if anyone can bring jobs back, it’s Trump.

Yeah, of course. The guy whose Trump brand suits and ties are made in Chinese factories is going to bring your job back. The same guy who immediately nominated the CEO of a fast food company who hates the minimum wage, Andy Puzder, as labor secretary.

Here’s what one of the men Kentucky elected to the senate, Mitch McConnell, had to say about the minimum wage: He cited a Congressional Budget Office study that he claimed said raising the minimum wage to $10.10 an hour would “destroy half a million to 1 million jobs. […] That’s not the way to grow our economy,” he added.

And here’s what Kentucky’s other senator, Rand Paul, had to say about raising the minimum wage: ‘The minimum wage is a temporary’ thing, Paul said. ‘It’s a chance to get started. I see my son come home with his tips. And he’s got cash in his hand and he’s proud of himself. I don’t want him to stop there. But he’s working and he’s understanding the value of work. We shouldn’t disparage that.’”

Good luck getting jobs that pay beyond the minimum wage, Beattyville. You elected people who propose the very opposite of that, who think, in Paul’s case, that trying to raise a family on a minimum wage job is great because it’ll build your character and teach you the value of hard work!

“If you got a job here in Beattyville, you’re lucky,” says Amber Hayes, a bubbly 25-year-old mom of two, who also voted for Trump. She works at the county courthouse, but is paid by the Kentucky Transitional Assistance Program (K-TAP), a form of welfare.
The vast majority of Beattyville residents get some form of government aid — 57% of households receive food stamps and 58% get disability payments from Social Security.

But I thought that welfare was just for the takers? Isn’t that what all the conservative politicians campaign on? Haven’t we all heard some iteration of that from conservative friends and relatives? Isn’t that what Mitt Romney said just 4 years ago, that 47% of the country votes to just get free stuff?

Here’s what Kentucky’s own Mitch McConnell said about food stamps as recently as last September: Asked about the improving economy, McConnell scoffed: Business leaders tell him they have “a hard time finding people to do the work because they’re doing too good with food stamps, Social Security and all the rest.”

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Residents of Beatyville would apparently beg to differ with Mr. McConnell.

From the outside, it’s easy to wonder why people in Beattyville don’t just move somewhere else. But out of all the people CNNMoney met in Beattyville, only one wanted to leave. The rest are drawn to the beauty of the place and the friendly community. “I’m country to the core,” laughs Puckett. He husband of 39 years nods beside her. Judge executive Mays puts it this way: “We’re perceived as a hillbilly, backwoods, all this and that. But we’re a good people.”

Again, whatever happened to those bootstraps, hmm? That’s what Paul Ryan or Rand Paul would tell you to do–work to improve your own situation and don’t depend on the government to save you. If you lose your job, find another, even if it means moving. Retrain yourself. Oh, you can’t pay for that? Well, you just need more gumption and definitely less of that darned government in your life, always making things worse.

Look, I have lots of sympathy for the people of Beatyville. They’re certainly in a bad place. Yet at the same time, they and the rest of their state have repeatedly voted for people who have told them that the government will make their life worse. That getting rid of food stamps will create an incentive for people to get a real job. That social security and medicaid should be cut or outright privatized. That the problem with America in general is too much reliance on the government.

In the end, Beatyville and other red cities in red states that are suffering are the victims of their own voting. It’s particularly tragic that they now expect the same government that believes that the government shouldn’t be engaged in safety net programs or other forms of public assistance to save them. If the democrats were smart, they’d get out grassroots campaigns to go to towns like Beatyville and help explain this to residents.

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I guess we’ll see what happens in 2018.

The protest condundrum

Well, over a million people marched in protest of President Donald Trump yesterday. And while I definitely agree with the protesters and their messages, I couldn’t help but think of one thing as I watched the coverage on the news:

Where the hell was all of this during the election?

If all of those protesters has poured as much energy and organization into the election, I would bet that we wouldn’t be talking about president Donald Trump right now. So while I think the protests were totally awesome on one level, on another level it seems like it’s too late. Trump has already been sworn in and he’s sitting in the oval office right now.

Trump, Pence, and the republicans in congress probably don’t give a rat’s ass about the protests because they already won and protests aren’t going to change that.

But that kind of activity probably could have changed the outcome of the election. Of that I have very little doubt. This past election suffered from pretty low voter turnout. People just weren’t excited about Donald and Hillary, so they stayed home.

voter-turnout-graph

But imagine if all of these people who protested had mobilized in a similar way before the election. Imagine if they worked that hard to drum up more excitement for voting. The outcome probably would have been different. Imagine if they’d all worked that hard to ensure that he didn’t get elected in the first place. These protests should have started the moment Trump won his party’s nomination, not after he took office.

There’s always 2020.