Concentration Camps: Is the US still the "savior" or will they happen here? Fascism on the rise in health and everything else.

Recently, in Trieste, I visited the San Saba concentration camp, also known as the Rice Mill because that’s what it had been. On the scale of concentration and extermination camps of the Third Reich, it was small. “Only” 3000-5000 people, mostly Jews, were incinerated here, although others were shipped off to Auschwitz to experience a similar fate. It was my first visit to a concentration camp, and I do not know that I will ever go to Auschwitz, or Treblinka, or Sorbibor, or Belsen, but it was very disturbing. However, at one point the guide noted that it had been liberated by the Americans on May 1, 1945.* My eyes, already full of tears of sadness, teared up yet again but this time with pride. It was the same pride I have felt ever since I was a little kid, born only a few years later, every time I hear about my country, the US, standing strong against Nazism and Fascism, and liberating the camps.

But today it was a bittersweet feeling, because in just the last two weeks my country has been rapidly moving toward fascism. The separation of powers, the core structure of our Constitution has been ignored by the current President. I used to call him the Trumpenik, because it sounds very like the Yiddish word “trombenik”, defined by Wiktionary as 1. a lazy person or ne'er-do-well, or 2. a boastful loudmouth, both of which were good descriptions of him. But now he has decided to become Il Duce, another comparison that is very scary here in Italy.  And he, who was at least elected President if not dictator, hasn’t even been doing all this work himself. He has let Elon (who he sometimes calls Leon) Musk do it. Musk, not elected to anything, not appointed to anything with the advice and consent of the Senate, has taken control of the government’s two most critical functions, the funding of it and the information it possesses on all of us, including Social Security and Medicare. Medicaid has already suffered serious threats to its continued ability to help provide healthcare to poor people. As a federal/state partnership, the federal government pays from about 60-80% of the cost, higher in the poorer states – which are often also the most Republican states. The National Institutes of Health (NIH) funds health and medical research; the largest amounts are spent on cancer research, though many other conditions that affect many Americans – heart disease, stroke, Alzheimer’s disease and many others – as well as basic science research that sets the stage for discoveries on diseases we recognize. In addition to the direct funding of the research, the institutions grantees work at also get indirect funds to “keep the lights” on and to provide many of the resources that allow research to go on. The Musk lackeys see this as pork, or worse, things that “enable a leftist agenda” by, I assume, funding universities. The issue of NIH direct and indirect funding is well described by Dr. Jeff Burns, a neurologist and researcher at the University of Kansas Medical Center, in a Facebook post that unfortunately doesn’t have an out-of-FB link**.

Medicare and Social Security are the most popular programs in the country, put in place by Democratic administrations (as have virtually all programs that actually benefit a significant percent of the American people), and its recipients, mostly seniors, aren’t going to be happy to have those programs cut. It is not clear if anyone in the administration cares. Musk has his own ideas of what programs are worthwhile and what are not (often colored by his personal history and interest) and wasn’t elected to any position and is unlikely to be. Decimating the National Labor Relations Board (NLRB), which will be devastating to working people in the US, serves the interests of folks who run major corporations like himself and Jeff Bezos of Amazon. It has also been suggested that his animosity to the US Agency for International Development (USAID) may in part be a result of its support for the majority population of South Africa, from which country’s minority white former rulers Musk comes. And their investigation of his company Starlink’s contracts with Ukraine. And Trump himself is unlikely to run for election again – he got this job and will stay out of jail and make a lot of money and get his revenge on his perceived enemies. And maybe cancel future elections. But going after senior and rural people and programs that benefit red-state residents is not going to increase his popularity.

I care a lot about healthcare and the healthcare system as well as health research, but the moves toward fascism go much farther. Every agency, especially those tasked with enforcing the law and pursuing criminals (like say, felon Trump) has had its professional staff replaced with loyalists and ideologues, especially both the Department of Justice (including the FBI) and the Department of Defense. There are some glimmers of light, particularly from the federal courts, in decisions such as ‘Judge halts Access to Treasury Payment Systems by Elon Musk’s Team’, and indeed the NY Times suggests that the federal judiciary may be the last obstacle to him. But the top decision maker in the federal judiciary is the Supreme Court, to which Trump appointed three justices and has been very friendly to him. And it will be a long time before a lot of those cases get through the courts. And someone has to enforce it. And who thinks that Musk and his Gen-Z minions who have gotten access to and control of federal databases and funds will all of a sudden, even if these cases are successful, rewrite the codes to be the way they were and not leave themselves backdoors to get in? You can’t un-ring a bell.

Enough of this by me. There is plenty of detail being provided by many other sources, and almost all of it is depressing. Let us get back to my feeling of pride in the US and its fight against Nazis and Fascists, of being, on the world stage, the good guys. Of course, it was not always true that we were – plenty of countries were invaded by the US or had their governments overturned by CIA-supported coups, etc., and even in WWII there were the Allies, including the Soviet Union which lost 20,000,000 people! And there were pro-Nazis and fascists in the US, always. Even US concentration camps (if not death camps) were started by FDR, for Japanese-Americans.

But the idea that an opponent of democracy and freedom, a person who wants to be Mussolini, or Hitler, or Stalin, or Putin, or even Viktor Orban, is the President and has moved so quickly to dismantle our Constitution and has had no significant opposition? That makes me sad, and I wonder when we will re-create camps like the one I visited in Trieste, or worse?

 

*Actually, Trieste was first freed on May 1 by Yugoslav partisans. New Zealanders came May 2, and other allies (US and UK) a couple of days later.

**Jeff Burns’ FB post:

Why Cutting Indirect Rates Means Cutting Medical Research

Medical centers aren’t just buildings—they are the foundation that makes research possible. They provide specialized lab spaces, maintain infrastructure, ensure compliance with safety regulations, and handle the complex financial and regulatory requirements that keep research running. None of this is cheap, and none of it is optional.

The NIH is one of the most powerful vehicles for turning ideas into reality—funding research that directly improves lives. Securing an NIH grant is an ultra-competitive process and a gold standard for top notch research. When researchers like me win a grant, the funding covers the research itself (“direct costs”), but the university also receives “indirect costs” to support everything that makes the research possible: the facilities, oversight, administration, and ecosystem that allow scientists to do their work. Without that support, it becomes harder to do the work that advances medicine. And, NIH funding isn’t just about research—it’s an investment in people and communities, with significant downstream effects on the economy.

Cutting indirect rates doesn’t just trim a budget line—it makes research harder to conduct, slowing scientific discovery and the development of treatments that help people. For my own work in Alzheimer’s disease, this means fewer studies, fewer discoveries, and fewer opportunities to change lives. I work alongside hundreds of clinicians, scientists, students, and staff who have dedicated their careers to tackling this disease. But dramatically and suddenly cutting indirect support shakes the very foundation that allows us to take on these big scientific challenges.

This isn’t about cutting waste—it’s a massive, across-the-board budget cut to science. And the hardest hit won’t be the elite universities with massive endowments; it will be the institutions where every NIH dollar is critical. Less investment means less medical research—period. Cutting indirect rates isn’t just bad policy—it threatens innovation, economic growth, and the future of medical discovery.

The US health and social service system is evil

I have often written about how our health system is “deeply flawed”, but I realize that there are many ways in which this is a grand understatement. I initially intended to call this piece “health insurance companies are evil”, but realized that this singled out but one player. I mean, insurance companies are at least as evil as other parts of the health and social services sector, but naming only one part both does a disservice to that part, which is acting rationally in relationship to the other aspects of the system, and tends to forgive the others.

The thing wrong with our health system is that it is a mess; there are dozens or hundreds of ways to have health insurance coverage, or not, and each costs a different amount and covers different conditions, for different percentages, with different amounts of coinsurance and co-payment and deductibles. A single-payer health system, where everyone is covered with the same benefits for the same care (all that is needed, none that is not) and payments tiered to income, is the only rational and effective way to make sure that we have the possibility of quality health care. There can be no quality without equity. While I will not spend more time here making this case, because I and others have previously done so extensively, I will refer to it.

What is evil is how the system affects our actual people. However, people are not really ever seriously considered in “health reform” (or social service “reform”). Yes, people’s suffering sometimes gets mentioned by political candidates, who note that some people are paying too much or are not getting care. Indeed, this has been a big theme of Republican candidates who are critical of Obamacare, but whose only plans are ones which will make it a lot worse for most people. Actually making the system work for people is never really on the table, because when the political negotiations begin, the big players (insurance companies, providers, drug companies, device manufacturers, etc.) enter the picture.

Let’s get right down to it: people in the US, even those who are citizens, just do not get the coverage and services to which they are fully entitled, not to mention the coverage and services that they actually need. You have to sign up for Medicare, pay for Part B (which is what covers everything except inpatient hospitalization, including doctors’ fees), choose and pay for a Part D plan. If you are lucky enough to be able to afford one, you have to look through a maze of possible Medicare supplement plans and hope you chose correctly, given the multiple variables of your health status, the benefits profile, where you live, your actuarial as well as self-perceived probability of getting ill, and what you can afford. Even Social Security, a benefit that you have paid into for your entire working life, requires you to sign up and show you are eligible. This is nonsense; there is no reason it should be this way. We start with a non-system that does not cover everyone, provides inadequate coverage for those who do have it, and makes it difficult to sign up, presenting numerous obstacles which allow people to fall through the cracks.

Actually, this is more than nonsense; to the extent that people pay the price of inability to navigate the system with their health, it is evil. It would work, and be much simpler, if everyone, when they retire, got Medicare. And if Medicare covered everything for everyone wherever they live. Why not just make sure everyone gets Social Security? Why make it the responsibility of the person to demonstrate that they not only are truly eligible but that they can get through a jungle of options, often confusingly computer based, when they are getting to the end of their careers? Of course, if we had a single payer system, everyone would be in and there would be no change when you retired or became 65; you’d already be in a system in which everything you need and nothing you don’t need is fully covered.

Actually, in a good system you’d be better than “fully covered”. You’d be covered appropriately; you would, whoever you are, get the care that you need, but you would not be eligible for coverage for things that you don’t. We would have a health system that provided necessary, appropriate, and proven diagnosis and treatment for people, rather than emphasizing the provision of services which were most profitable to the providers. Insurers would not do their best to risk-select, would not be able to charge more for some people than others (and they can under Obamacare; they have to cover you even with a pre-existing condition, but can charge more), and would not even have to be for-profit. I favor a single-payer health care system such as Canada’s, a (fully-funded) Medicare for all, as does Sen. Sanders. But there are other reasonable alternatives; Switzerland, for example, has, instead of a single payer, multiple insurance companies. But these companies have to cover everyone, provide the same benefits, charge the same price, and be non-profit.

Critics of Sen. Sanders often say that a Medicare-for-All system would bankrupt us. This is also nonsense.  It presumes the built-in profit for insurance companies. It presumes that we would continue to pay the most of the most complex and high-tech procedures, and let providers (via the complex system of the RUC --  Changes in the RUC: None…How come we let a bunch of self-interested doctors decide what they get paid?, July 21, 2013, which essentially sets the Medicare rates on which all other payments are based) set the rates for their own procedures. The evidence is in every other wealthy country, all of which spend much, much less on health care and have much, much better outcomes. They also provide much better social services, not only for the needy and the poor, but for everyone. Retirees get their pensions. And they keep their health care.

The system works in these other countries; that is, if your interest is in ensuring that everyone gets the health care they need, the pension benefits to which they are entitled. If your interest is in maximizing the income of (some) providers and the profit for insurance and drug companies, then they don’t work as well. So I guess our system is not necessarily evil, it depends upon your values.

But, then, I would argue that the values on which the system is de facto based, though, are evil ones.